rmc28: (uterus)
[personal profile] rmc28
... and a flaming temper does wonders for cycling up Castle Hill - I overtook at least five people rather than my usual puttering quietly at the back of the queue.  But anyway, what I need to do is separate out facts and emotions after today's appointment with an obstetrician at the Rosie.  

Facts:

When I arrived the reception desk seemed not to have my appointment listed, but told me to wait while they sorted it out.  After a bit I was taken for the standard blood pressure and urine tests, and about 45 minutes after my appointment time I was called in to see an obstetrician.

He told me:
  • Because I dilated fully last time there is no reason I cannot aim for a VBAC (vaginal birth after c-section) this time
  • He does not recommend a home birth for a VBAC, and it is against NICE advice and policy at the Rosie.   It remains my choice, but to insist on a home birth would be against medical advice, and therefore I would have to accept responsibility for the risk to myself and the fetus if I did so.
  • This is because they need to do "constant monitoring" of the fetus while I am in "active labour".
  • This is because there is a 1 in 200 chance of my c-section scar rupturing, which could lead to the death of myself and/or the fetus if not detected and responded to immediately.
  • The "30 minutes to prep an operating theatre" stat which I was given in NCT antenatal classes last time is accurate for "emergency" i.e. unplanned c-sections, but not for "crash" i.e. actual emergency c-sections, for which "you would be in theatre before you realised".
  • My impression that my pregnancy is low-risk is wrong: the combination of my BMI and the prior c-section means that I am categorised as a high-risk pregnancy.
  • However, his advice against a home birth is based entirely on the c-section scar and not my weight/BMI.
  • My impression that a VBAC is as low-risk as a first-time pregnancy is wrong.  It is much higher risk (though he did not put numbers to this).
His response to my attempts to express concern about medicalisation of pregnancy, intervention cascade and the raised likelihood of c-section in hospital versus home birth was "you seem to have some very strange ideas about the delivery unit".  He suggested a compromise of delivering in the Midwife-Led Birth Unit for a less medicalised experience, with the delivery unit "aware" and therefore able to intervene in a hurry if required.

He will refer me to the VBAC clinic in the Rosie, which I did not know existed, and will book me for another appointment at about 24 weeks which will give me time to consider the advice given today, and hopefully to have attended the VBAC clinic appointment.

I reiterated that my starting point was to prefer a home birth but that I would consider the medical advice given and discuss it with my husband.


Emotions/reactions:

I left feeling very angry and disappointed:
  • annoyed with myself for failing to communicate the medicalisation/intervention cascade concerns very well
  • annoyed by the apparent dismissal of those concerns
  • annoyed with being classified as high-risk based on my weight rather than e.g. my blood pressure or my activity level
  • annoyed by the implication I only consider myself responsible for the risks to self and fetus when going against medical advice, rather than being responsible throughout for weighing the advice given and making an informed choice
  • wondering if I should just say stuff it and let them cut me open again anyway rather than have this fight
  • feeling stupid for wondering the above because it was no fun at all healing up for 3 months last time
  • determined to check the NICE advice and the latest information on VBAC & homebirth risks
On the other hand, he has written brief factual notes in my record, with no "beware of the hostile angry hippy", and he may well have squeezed me in at no notice because of the apparent cockup with the appointment. 

Date: 2012-01-23 20:36 (UTC)
naath: (Default)
From: [personal profile] naath
RAGE!

(unfortunately I lack useful facts+figures)

Date: 2012-01-23 21:38 (UTC)
hilarita: trefoil carving (Default)
From: [personal profile] hilarita
The 1 in 200 chance of c-section scar rupturing does not sound very nice to me. However, I think he sounded quite rude for not considering your views about the medicalisation of birth. It would be good if you could get figures (from the VBAC clinic?) about the risks of VBAC birth vs the risks of 1st time pregnancy, really.

But yes, you have responsibility for the risks etc. *anyway* - even if you're following medical advice you haven't actually handed over agency to the doctors anyway. What a silly thing to imply.

Date: 2012-01-23 22:41 (UTC)
From: [personal profile] techiebabe
Hi,

I can completely understand why you're flaming! And I would certainly be cross at being judged on BMI rather than other figures such as blood pressure.

I wonder if there are any other things you can do to reassure yourself and the people who will be caring for you (medically I mean). I can't quite remember why you needed a C section last time, I remember it as being a combination of large baby plus baby in wrong position - are there scans or tests you can do in the run up to labour or at the start of labour, to identify whether this is an issue? I presume by the delivery date you will have an idea of the baby's size, is there anything that a visiting midwife or a quick out-patients check could do at the start of labour to see if you have a good chance of giving birth safely and naturally? Could you plan to do this, and know that you can then go home and stick to your birth plan in the confidence that you have information to back this up?

(Forgive me if I'm barking up the wrong tree. It's just that I would try to answer medics' concerns by making plans to reassure and work with them, while still getting my own way as long as it looked sensible / safe.)

I hope you are less seething now, and find a constructive way forward.

Do you mind if I ask a friend if she has any information about natural home births following a previous c-section? She runs antenatal classes and has had two home births, and I think if any of my friends would know, she would. I wouldn't tell her why I was asking (and I don't think she knows you).

Date: 2012-01-25 15:52 (UTC)
From: [personal profile] techiebabe
I asked my friend Jennie, who said "I don't know of any specifically but there's a home birth Yahoo group they could join at homebirthUK@yahoogroups.com - can ask for advice on there plus there is a member called VBAC Information who I'm guessing would be useful (her sig tells me she has had 9 children, including three home VBACs)." I don't know if that's any help?

It sounds like your reading was useful, sorry if my suggestion was misguided. Yes, I'd be cross if people just looked at BMI and not levels of fitness or the reason why you haven't chosen to go on a diet of a specific type, etc. I seem to remember there are good health related reasons why you don't get on with a "diet".

I hope you find an obstetrician who will listen to you more openly or at least come to understand your perspective.

Date: 2012-01-23 23:34 (UTC)
From: (Anonymous)
Given my recent experiences of the Rosie, you'd be more likely to get active midwife care and attention (and hence someone noticing the scar had ruptured) with a home birth than with a Rosie birth :-/

It sounds like you did and said all you could in the circs, I'm sorry he was so dismissive. Hopefully the VBAC clinic will be more helpful.

[geekette8 / Vicky]

Date: 2012-01-24 00:22 (UTC)
ailbhe: (Default)
From: [personal profile] ailbhe
I'm afraid I used my mental ill health as a counter-risk, which made things easier for me. Also, private midwife. I couldn't fight.

Date: 2012-01-25 00:17 (UTC)
ailbhe: (Default)
From: [personal profile] ailbhe
Oh yes, it was - is - real, but it's not available to everyone! And I wouldn't want it to be.

If anyone suggests induction after a c-section, run away and then write LOTS OF LETTERS complaining. It's really, really not safe. At all. No. Never. RUN.

Glad you found good info.

Date: 2012-01-24 01:59 (UTC)
miss_s_b: (Default)
From: [personal profile] miss_s_b
Oooooo I would be cross too. Patronising git.

I wonder if this would be an issue for me with my ovary-removal-scar, which is apparently very similar to a c-section scar, were I to choose to have more spawn...

Date: 2012-01-28 21:43 (UTC)
miss_s_b: (Default)
From: [personal profile] miss_s_b
Poo :(

Date: 2012-01-24 09:27 (UTC)
bens_dad: (Default)
From: [personal profile] bens_dad
He will refer me to the VBAC clinic in the Rosie, which I did not know existed

Sorry. Last time you discussed this delivery I didn't point out that the Rosie had a "Consultant Midwife" who specialized in VBAC, because I got the impression that you were aware of this.

We saw the Consultant Midwife and thought her very helpful and supportive (although after offering to come to our appointment with the head obstetrician and fight our corner, she didn't/couldn't turn up. We assumed that like us after finding more facts her position had changed).
I'm afraid I don't remember her name so can't help you determine whether she is still there.

Date: 2012-01-24 23:30 (UTC)
twigletzone: Red and white striped socks clothes-pegged to the guy rope of a tent. (Default)
From: [personal profile] twigletzone
wondering if I should just say stuff it and let them cut me open again anyway rather than have this fight

No honey, you bloody should not. It's your body and your baby, and mother nature has been doing this shit far longer than any doctor's had the gadgets and acronyms to help him get too big for his boots. What does he think's going to happen, you won't go into labour at all unless the hospital gives you permission?

I hear you 200% about the doctors with their heads up their backsides thing too. You already know I'm in the middle of a long and agonising NHS process - well it's plagued by doctors even more idiotically self-important than this one. I've taken to writing Letters of Middle-Class Outrage, which insanely enough appear to be having some effect - largely because it's far easier for me to think and put things across well in writing than it is on the spur of the moment in speech. Maybe it would work for you as well.

Date: 2012-01-26 10:59 (UTC)
From: (Anonymous)
Only just saw this - hope you're feeling better about your so-called 'risks'.

He's one of those doctors....who refuse to believe that you're making actually risk-averse choice. Hope you can find someone reasonable to talk to in VBAC clinic...

And independent midwives cost about 4-5K in London (depending on service level)...and some like to remind you that you can pay off in small monthly increments over 2 years without interest.

Date: 2012-01-26 11:00 (UTC)
From: (Anonymous)
(sorry, that was trinity_gal)

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