Thursday, November 03, 2011

And now I totally have "The Ides of March are come" stuck in my head. Whatever, Caesar.

So, I got all weepy waiting to see if there was a baby in my uterus, and if it had a heartbeat, but I'd never, ever been made to cry , like, really cry, at a prenatal appointment. Until yesterday.

When I saw my OB - the one who complimented my hair - for the first time this pregnancy, he said that we would just schedule me for a repeat Cesarean at 39 weeks. They cut on the same scar. Easy.

And I was thinking, Yeah, easy for you. Not your abdominal muscles. In fact, you don't even have a vagina. What am I doing?

But I said, "Uh...that's the next thing on my list to ask you. What's your approach to VBAC?"

For those of you who haven't jumped through the Cesarean hoops (Hahaha - it's not really a hoop, just a small incision in your abdomen and uterus. A small incision through major muscles.), VBAC stands for Vaginal Birth After Cesarean. Those in the club pronounce it Veeback.

On a sidebar: in the fertility/birth world, I believe there are more acronyms than in the military. I don't know if you read Julia, but if you've ever struggled with fertility, or even if you haven't, you might love her. I think I've read her entire archives, would stalk her if she lived in DC, and love this post about dippos.


My OB, who I actually really like, gave me a verbal pat on the head and said, sure, sure, we could think about it and discuss it later in the pregnancy. Although very candidly, he strongly favors repeat C-section.

At which point I promptly started shopping for another practice. I might wind up with another C-section, but I don't want it to be automatic.

So I was very excited when I got into this highly regarded midwife practice, which is part of one of DC's major hospitals. You deliver in the hospital. But they are midwives, really focus on nutrition and exercise, and will work very hard for you to have natural childbirth.

This approach appeals to me. And the midwife I got to see is THE recommended person in DC for natural birth and VBAC.

(And I am deliberately not using names. They have an extraordinary reputation, and it's a a well-respected practice. They just take a harder line than I am equipped for. So if you're in the DC area, and this rings a bell, please don't guess.)


As soon as we began talking about my prior birth experience, the conversation became, well, kind of hostile.

WHY did I have a C-section?

Well, I was induced at 41 weeks...and I never dilated...and...

WHY was I induced?

Well, my OB was in favor of it, and it was August, and I was huge, and it was so hot, and I just couldn't handle being pregnant anymore.

Long story short, I found myself defending the choice I made to be induced at 41 weeks. The choice that was highly supported by my OB. Who would've made me induce at 42 weeks in any case.

I wound up bursting into tears, explaining how my dad had killed himself two months prior, and we had moved into this row house with a 4th floor kitchenette, and I was just so big and everything was so HARD.

What I didn't say was: first we moved out of Nick's place, and then there was my dad's suicide attempt, and then my dad's suicide, and then we moved again into this asshole of a house where everything was broken and dark and creaky and creepy and there was no normal kitchen and I had to lumber up to the 4th floor. And sometimes I would just waddle over to the liquor store and buy 10 pounds of ice because they don't sell it in smaller bags and waddle home in the hot fucking hot August sun with the goddamn ice melting down my leg.

And then I would haul both of us - the ice and me - up to the 4th floor and drink iced drinks and refuse to come down. And my husband worked ALL THE TIME and my mom was in her own crisis and FUCK YOU LIFE WAS REALLY REALLY HARD IT'S NOT LIKE I WAS SMOKING CRACK AND HAVING SEX WITH STRANGERS.

But I didn't say all of that. I just cried. And she asked me if I was under the care of a therapist.

I'm not currently.

She suggested that it would be helpful.

I said I'd had a lot. I'm on a break.

Her response then was as follows: I need to understand that with their practice, there is no induction because you're tired of being pregnant. I will probably go past 40 weeks. Given my profile, I will probably go to 42 weeks, because in their practice, you wait for the baby to come. And I could be in labor for five days.

If this is what I want, they will support me in this. It's a lot of risk for them, and so you have to sign a risk statement. Which makes sense to me. It's a litigious world, and their liability is high.

Also, I need to understand that the risk of stillbirth increases every week after 37 weeks. Every week after 37, the chance of your baby dying goes up. Am I prepared to take these risks? I need to really think about this.

(I didn't know about this. Nobody told me about this, as Jordan was happily cooking away, week after post-37 weeks week.)

Also, she said, having IVF increases your likelihood of a C-section. So there's also that.


Plus, being older, you could just take longer to dilate. And clearly that's an issue, since I didn't before.

I see.

"So," I said, "you think I'm a bad candidate for VBAC?" (At that point, it seemed silly to even ask the question.)

"Not at all. I think you're a good candidate. You just have to really think about all these things and be prepared to deal with the risks. And your husband has to be on board."

I am dramatically condensing the conversation. We talked for at least 45 minutes, I think. I'd say I was on the defensive for 43.5 of those minutes.

So finally, finally when she said it was time to get on the table to listen to the heartbeat, I was so relieved. And then it took her a while to find the heartbeat. And I almost started to cry again.

She then found it, and said it sounded good. She added, "You have a lot of anxiety, don't you?"

I nodded. But I really wanted to say, "I was fine when I walked in. The only way you could possibly have made me more anxious would be to set my hair on fire."


  1. Jesus Christ, they sound the *least* compassionate practice ever. I know people need to know the facts and all but, geez.

    I'm not sure I believe that 37 week stat she threw out there.

  2. I think they are pretty hard core, but I also think they are probably harsher in the beginning to weed people out. If this approach isn't for you, you know it fast.

    I did a little googling, and it is in fact true. I have to look into it more. It freaks me the hell out.

  3. Use your intuition Lisa. It's there for a reason. Listen for it. And I hate it when people bully. There is no reason for it, even litigation. You were treated poorly in both instances. Credentials are no ticket to condescend. Breath, and know that we who walked with you in those very very dark days understand those tears. Every drop. You'll figure this out.

  4. You know, I think I understand where they are coming from in their approach. I don't think I like it, but I think I understand it.


    I think there is a difference between being firm and detailed and structured and making people understand the road ahead... and making people feel like crap about previous decisions.

    I like what Lynn said--use your intuition. If it's fear that's driving you, listen to that fear. But also keep in mind, no matter what this particular practice has as credentials that these are people you have to TRUST completely for the next LOTS of weeks. If you start off feeling this way with them, how long will it take until you feel comfortable (and not judged or anxious about your choices)--and how will that affect your pregnancy?

    (and thus concludes my ass-vice for the day)

  5. I'm with Lynn. I'd keep looking. You were treated badly at both places, but you were bullied at the midwife practice.

    Yes, they are trying to weed people out. But, do you want that kind of stress from now until you deliver? Isn't that judgment as bad as the other sort of judgment? Has the woman never met an emotional pregnant woman before? And BTW, don't we ALL need therapy? And from your description they don't sound terribly compassionate (and that's what I would want a midwife for. compassion and understanding. Doesn't sound like she has either)

    I know that you've probably already thought about all of this. Just remember, all you REALLY want is a healthy baby. Doesn't matter how little miss comes into the world, as long as she is healthy and strong when she gets here.

  6. Ugh I jsut lost my whole comment- and ot was a novel. Bullet points
    -They do sound pretty hardcore, but VBAC is a hard core thing
    -you can totally do it if you want to
    -it is OK iof you don't want to also. Nothing "wrong" with how you delivered Jordan, and don't let anyone tell you different
    -I think Natural Birth (hate that term) peple are so used to being defensive about their choices that sometimes it seeps through and makes them a little offensive
    -I think you are right about her seeing if you were one to be weeded out, it is a lot of work.
    -and finally, if you do decide to work with her, I think a frank talk about your mental health and therapy and the phrase NONE OF YOUR BUSINESS is in order.

    oh, and if you are interested in talking to a friend who ahd a great VBAC experience let me know and I'll hook you up with her contact info.

    Jeez, my bullet points turned into a novel too.

  7. I was induced with my twins because my oldest was born 10 days late, a natural birth that spanned three days and culminated with her aspirating meconium, suffering an 8-minute seizure, being intubated and knocked out cold for three days, then spending 10 days in a Level 1 NICU.

    My doctor didn't want to take the chance that the twins (then Tobias) would suffer the same meconium repeat.

    So, would THAT have been a good enough reason for your midwife?

    Honestly, I support and applaud your interest in a VBAC. All of my births were vaginal, including the twins, and despite the prolonged, grueling labors, the rebound from the birth was lightning fast. Like up out of the bed and in the shower within hours (even with the twins). I understand absolutely why you'd prefer that over a C-section.

    But, this woman sounded so cold, so judgmental and that just doesn't sound helpful looking ahead to the emotional and scary throes of labor.

    Hopefully, the rest of the practice is different?!

  8. Lynn - Thank you for such lovely support. It is true that I need to listen to my intuition. Every time I don't, I regret it. And thank you for walking with me then and now. Hugs to you, lady.

    Ginger - I think that's very true. A friend pointed out that she could've said well, you are where you are, and given that, here's what we're looking at. Because you can't change prior decisions. And you make such a good point - I have so many weeks ahead (and even more if I go past 40) and the idea of being that kind of anxious in the next appointment really doesn't appeal to me. I know they're very good at what they do, and clinically I can trust them, but I don't know that I'm emotionally strong enough for this.

    cla517 - You are so right. I have plenty of stress in my life. Nick said he supported my decision with this because I wanted to have a better experience...which, so far, it is definitely not.

    Maiden Metallurgist - It drives me CRAZY when that happens. To the point where I typically copy my comments before I hit Post because when I type a long one and it is lost I get so incredibly annoyed.
    Thank you so much for this. I think you are completely right. I think they have to spend a lot of time defending their approach. And I think the hostility is probably towards the typical medical approach, and not me specifically...but that's how it felt, and it was emotionally exhausting. Maybe I am not hard core enough for VBAC. But I would love to hear your friend's experience. That would be wonderful.

    Dana - I have this feeling that that would have been a good enough reason. But she and I are very different people, so who the fuck knows. That's a terrible story, though, and I'm so glad that things turned out just fine. Wow.

    I don't know if at the age of 42, I am OK with the risk of going past 40 weeks, past 41, 42 weeks. I just don't know.

  9. Ugh .... I'm at 39 weeks TODAY and waiting to attempt my VBAC whenever my body decides it's ready. My doc is very pro-VBAC, but she's also unwilling to attempt any induction methods, so if I go to 42 weeks (dear god no!!!!) or if my blood pressure starts to creep up (which was the reason I was induced last time), I'm heading straight in for another c-section. At 39 weeks, that doesn't sound so bad, but I have to keep on reminding myself of the benefits of vaginal delivery. One thing that's been helpful so far is that I've hired a doula. She talks me down whenever I start to go crazy. It's her job to support me, and she's been an invaluable resource.

  10. I know you will end up in the practice that feels best for you, but may I suggest that you hire a doula? I can't remember if we talked about this before or not. I am trained, but never practiced, or I would offer my services. And here is a book with positive, natural childbirth stories that I loved:
    I suggest surrounding yourself in as many positive stories as possible and not dwelling on negative. I had a friend who wore a pin that said, "No negative birth stories please, my baby is listening."

  11. I second the comments which say to follow your intuition. I'm sorry the appointment left you in tears, it's an emotionally charged situation of course.

  12. Ugh so sorry to hear the midwife wasn't what you expected - although I believe in general they are better than doctors, they can be assholes just like anyone else.

    I think bottom line you have to find someone you feel comfortable with - relaxed mama = (hopefully!) easier birth.

    I also have a friend who had a good VBAC experience, here's a link to her blog:

  13. Lisa - there is no right or wrong here - the choice is a very personal one - BUT - it's really about delivering a healthy baby - not about how you would like to deliver. Both my children were C-sections - My first born was a horrible 72 hour labor that eventually ended in a C-section because the baby was in distress - Looking back I wish they had done the section hours before BUT they wanted to give me every chance. With my second child I told the Dr. either a scheduled C-section or an abortion I will NOT go through that again. Fast forward 10 years and I have two wonderful kids who I adore. The birth experience is the least of it. I knew what to expect with the 2nd C-section and that made it so much easier.
    Just a little positive PR for the politically incorrect side - Blessings and good wishes to you - whatever you decide.

  14. Hey Lisa,

    I am sorry you had such a crappy experience. I agree with previous posters about doing what you want to do and trusting your intuition. In saying that, I just went through a repeat C-section 10 weeks ago. I can say it was a lot better than the first go round. For me, the risks of a VBAC were just too high and my husband was REALLY uncomfortable with it and he has NEVER discouraged my choices in the past - so that spoke to me as well.

    If you decide to go through with the VBAC, you may want to find some one who does not increase your anxiety level, geez, pregnancy it hard enough.

    If you want to hear about my repeat c-section experience, feel free to email me.

    I am confident that you will make the decision that is right for you and your family. I am so happy for you that you are in a place to have to make this decision!!

  15. Oh jesus, what a bitch. I can understand that she's auto-defensive, but really. As cla517 said, hasn't she figured out that strong emotions are normal with pregnancy? Amazing.

    With my first, I was induced at 41 weeks because of my advanced maternal age, and because of the g.d. gestational diabetes and concerns of a too-large baby. Then enjoyed three days of labor and an emergency c section. For #2 I tried for the VBAC, but fully expected to go overdue again. My water broke at 40.5 weeks, which was a total shock, and we ended up doing another emergency c section the next day. Oy. But my point is, my doctor was okay with the VBAC attempt because we did it in the hospital, for in case anything went wrong. Condescending attitude aside, if you really like the first doctor, just tell him you're going for VBAC in the hospital. He didn't sound adamantly against it.

    No one ever told me about the danger-after-37-weeks statistics, though. So this all might be moot if you want to finish up earlier... another thing maybe worth remembering: tons of stuff could happen to make these decisions unneeded. Like, I had a placenta previa that would have made a c section mandatory if it hadn't resolved on its own.

    And hooray for Nick being the amazing supportive husband he is. I know having Moses along on my appointments helped me to be less intimidated by the doctors, and more able to voice my concerns. You're a big girl and all, and so am I, but it really made a difference. Double team the doctor!

  16. Adding my two cents... I was bullied into a c-section with my first and really wanted a vbac with my second, but I looked around and found a midwife that made me feel comfortable. The health system is different in Italy than in the US, but you need to be comfortable with the person that's treating you. I honestly think that's more important than their reputation or the facility or anything else because you literally have to put your life and your baby's life in this person's hands. I think you should keep looking just so you have something else to compare this practice to. As everyone else said, your intuition is the most important thing, you don't want to have someone who's going to bully you or make you anxious or make you cry when you're in labor.
    You can only control so much about how you give birth, but you can control who the people in the room are to a certain extent, and you deserve to be surrounded by competence, caring and love that day, cause that's what helps you make it through it.
    All that said, and premising that I'm very happy i had a successful vbac cause really wanted to have that experience, postpartum pain-wise I would say they're pretty much equal. I actually had so many stitches from the vbac that possibly the cesarean was less painful... just a thought.
    I hope that you find the right solution for you and your family and that you have the best birthing experience ever! (basically fast, no tearing and little pain!) hugs.

  17. The strangest part of this experience is that making you feel safe and comfortable is one of the most important things for a Vbac. Read some ina may gaskin, her books really helped me for my second labour and delivery.

  18. I see childbirth choices like I see abortion: It's your choice and it's not my business to tell you what to do. Jeez, it's not like you agreed to a scheduled c-section at 38 weeks so that your OB could make his golf trip to Pebble Beach or something. I'm a big ol' hippie and even I understand that there's a time and a place for pitocin and an incision. Maybe that MW really was following a wedding-out process, but still - shit happens. C-sections happen. And you're not a villain from "The Business of Being Born" if you've had one. GAWD.

    Ugh. I wish I could you my OB as a baby gift. I've cried when I've seen her but only because I trust her and feel like I can show vulnerability around her.

  19. Clarification on my first sentence of the comment above: If I'm going in to see a pro-woman MW, I'd expect the same level of respect about my previous birth choices as I'd expect about my previous pregnancy choices. Meaning, "my uterus's history is not open for commentary or criticism".

  20. Go with your gut and with the person who makes you feel comfortable. I wish I could put the OB I had with Josie in a box and mail her to you, because she was so awesome, gave me straight info and then was cool with whatever I decided.

    For what it's worth (i.e., nothing), I'm kind of in Politically Incorrect Anonymous's camp.

  21. Here was an interesting article from a medical blog that explains why VBAC rates are so low from an ob's perspective:

    I cannot help you since I haven't researched VBACs, but I did switch ob's at 20 weeks (I stopped trusting my doctor after the practice made a mistake for a friend of mine, and erroneously told me my baby's heartbeat was low when it was completely normal because the baby was only 6 weeks old, and they were telling me he should have the heart rate of a normal 8 week old baby). Switching ob's was the right thing to do, since it relieved my stress, and the new ob did a wonderful job of delivering my son.

  22. diatribes and dish - My fingers are so very crossed for you that everything goes smoothly. I hope your blood pressure stays down and you have a VBAC, and I also hope you'll share your experience! All the best to you. Also, if I continue down the VBAC route, I will definitely hire a doula. It's one of the things I regret not doing before.

    Stacey - No, we hadn't talked about this. I wish I'd known you with my first pregnancy. That is really, really interesting. I will check out the book, regardless of the approach I decide to take.
    Thank you!

    HK - Yes, you are right, it is all emotionally fraught. Thank you for always being so supportive.

    Frugal Vegan Mom - You are right - I do believe in the midwife model, but anyone can behave like an asshole. Thanks for the blog link. And yes, definitely need someone who makes me feel comfortable.

    Anonymous - You bring up such a good point, and one I sometimes lose sight of. What I want most is a healthy baby, not a birth experience. I opted for C-section because they said I was going to wind up with one anyway, and I could do it while things were fine or wait for the baby to go into distress...which of course was the last thing I wanted, even behind surgery. Thank you for sharing your perspective.

  23. Yeah, another baby post! I was looking forward to reading the next one of these. Even though this story is full of negative stuff, still glad for the update.

    You know, I appreciate the fact that all the doctors and the midwives seem to need to (are often legally required to) talk about all these risks, but sometimes I wonder who it's really helping hearing about them?! (Especially in a tone like that...) I'm at 24 weeks at the moment (first time, whowzer), and I have somehow managed to immunize myself against these risk conversations in self defense. There are so many damn risks that I know if I spend time worrying about them I'm going to go FUCKING NUTS. So instead, positive thinking for me to keep hold of the sanity. And with you being in a situation that the medical world associates with tons of risks, well, sheesh, hope you can manage to stay focused on the positives and not let all the risk-mongering get you too down. Anyway, I hope you can find someone who makes you feel more comfortable. I know I hate it when medical folks get judgemental. Ech.

    I'd recommend those Ina May Gaskin books as well, as she is all about the positive side of pregnancy. (Semi side note: Sometimes I feel like she is so positive that it borderlines on just lying about how hard the birth experience can be, but a lot of people have told me that it totally helped them assuage the birth fears they were dealing with at the moment.)

  24. I really admire your seeking to do the best for your second child and yourself from the very beginning. I'm with the people who advise you to trust your intuition. Hopefully the midwife practice really is hard at the outset and then gets less judgmental/more supportive... I had to argue with the midwives practice that I went to during my labor about my not wanting to have an IV or multiple checks of my dilation progress. They gave me some scary scenarios about if I were to bleed out, etc. It ended up working well, because I had a feeling it'll be okay. I'm rooting for you on the VBAC!

  25. i dont like folks that take hard lines on just about any subject just about any time...(see i cant even take a hard line on hard liners)... but yeah... the world is a mysterious place and none of us know the answers or even the questions most of the time... every pregnancy is dif just like every baby...and as my granny used to say ...illegitimi non carborundum!! xoxo

  26. Oh wow. I kind of hate the woman you dealt with. I understand that it's their practice and they need to weed out people who don't/won't follow their guidelines but I don't think it's right that you had to defend your previous actions. You did what was right for YOU and for YOUR baby at the time. God. People can be assholes.
    You're a rockstar, lady. You'll figure out what's best for you and your family.

  27. Angel JAM - I am going to email you. I do want to hear about your experience. Nick has not expressed that level of concern, but if he did/does, I will certainly take it seriously. You and another friend both had scheduled C-sections and both had good experiences, and I'm so glad to know that.

    Laura - I do like the OB, but I am happy not to go back to the same hospital, and I don't like him enough. I mean, it might just be poor communication skills, and if he laid out the X reasons that he really felt that a C-section was the way to go, I'd have listened. But as he left it, I felt like it could be just for his convenience/malpractice liability/whatever

    And I actually just spoke with the midwife, who just called me to see how I was doing. We talked about the stats - she says they are not high, but there is a risk, however small.

    And it would've been helpful to have him there. I get flustered and then am not my best advocate.

    Moomser - it is terrible, just terrible, that you were bullied by your OB at all, and being shoved into a c-section is no small thing. I'm so glad you found a supportive midwife. You are so wise in pinpointing about the only thing you can control about the birth process. Hugs to you.

    Marissa - Yes. What you need most is to feel safe and comfortable. In fact, in life, those are huge driving forces for me. I am going to read her, for sure.

    Guacaholic - I like how you approach this. It is true - your prior choices with your body are your choices. They affect you in the here and now in some instances, but you shouldn't be beaten up for them. I really do like how you think!

    Wendy - I know you loved her. Your experience sounded wonderful. It's kind of funny to think about, actually. One day she'd be practicing in Denver and the next she'd find herself being shipped to DC. :)

    Jaclyn - Thank you for that. It was VERY interesting. I knew it was about liability...but didn't really understand the why of it. That laid it out nicely. I think I am going to go to one more appointment and then make a decision, which will put me at 19 weeks. I appreciate knowing that you switched mid-way through and it all worked out for the best.

    click clack gorilla - Congratulations! How wonderful! Yes, there is a lot of scary information out there and if you let yourself get caught up in all of it, you'd just have to curl up in fetal position yourself. I am prone to anxiety and I do fret about so many of these things. Also. I intend to read Ina May, but I did read a review that mentioned orgasmic birth, which does sound very much like science fiction to me. But I am interested - she sounds like such an interesting character.

    A.K. - Thank you. I just got a call from the midwife, and this is how it is looking - hard at the outset but actually very kind and supportive. The thing that's so hard about birth, at least in the US, is how much you have to advocate for yourself, when you're in this hugely vulnerable position. I'm so glad it all worked out fine for you!

    blonderthanyou - I tend to have pretty extreme feelings, but I don't necessarily foist hard line views on others (except maybe Nick :)). And thank you - you just gave me such a good laugh.

  28. Hillary - I love you, hunny bunny. I love how protective you are over people you care about. I can relate to this immensely. I have an update - something positive that just happened.

  29. I am so late on posting to this thread it almost makes me think it's stupid of me to do so.

    However, I can not in just not post. So here we go.

    1.) Your original OB was an idiot for not explaining his X reasons for you having another c-section.

    2.) The midwife was in my opinion based on your condensed version very callous as to why you had your previous c-section and also not really hip to the fact that because of the increase in stillbirth after 37 weeks your original OB might have been concerned and therefore opted for the c-section at 41 weeks.

    With all that being said, my one and only birth story is one of those that makes most women cringe. I started my labor on my due date (which apparently is rare as hell), and we continued to labor for FOUR days. I kid you not -- FOUR FREAKIN' DAYS OF TORTURE! By the end of day three, I wanted to kill everyone in the world, including myself just to make the pain stop, because our Midwife (yes, we went to the place to have a kid in Colorado)said we just had to wait it out and I should be tough. Did I mention already that I had been in labor with full on transitional contractions for three days already??

    Sometimes ... your body wants to give birth but it just can't. I got to seven centimeters and my body said quite literally ... freak you, no way am I stretching anymore.

    They cut my son out of me my husband said. It took several minutes of rocking my son gently from side to side while the table actually moved with them doing this for him to be brought into the world. His head had gotten stuck in my pelvic girdle -- he was born with a white ring around his head and a bruise on his cheek he was so smushed in there! My husband was horrified that labor could be so brutal.

    More than likely had I known that this was going to happen, I would have happily opted for a c-section in the first place. A doctor can't know how a labor is going to know. They can only speculate -- which of course scares the crap out of the parents most of the time.

    And it's just one of the reasons I don't think another is anywhere in our near or distant future.

    I applaud you for finding a better midwife/physician for you and what you need. And yeah, pushy-shovey medical people give me the creeps.


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