Monday, September 27, 2010

Obstetricians say the darnedest things...

Woke up yesterday feeling dizzy and things went downhill from there, so shortly before ten last night found Erik & I in labor and delivery at University Hospital, with me hooked up to monitors.

Now, Baby-O and I are just fine.  It turns out I was just massively dehydrated, probably as a result of the stomach virus that made its way through the household last week.  I have a Texas Tea Bucket--an insulated, quart mug from Bill Miller's--that stays by my hand and I thought I was doing a good job of keeping myself filled, but apparently not.  Two bags of fluid later and they let us go home.

But there were a few scary moments there at the beginning, because when they first hooked me up to the monitors the baby's heart rate was sky-high.  I'm talking 220+, whereas normal is 140 to maybe 160.  And so that led to an interesting little conversation with the obstetrician on duty.

He said to me "I don't like doing c-sections unless I absolutely have to."

"Well, that's good, because I don't like having them unless I absolutely have to.  That's why I had two c-sections and then a VBAC."

"Where did you do that?"

"The c-sections were at Portsmouth Naval Hospital and then the VBAC was at Kapi'olani Women's Medical Center."  (Note that probably neither of these is the perfect name for the hospital in question; I'm good not to call my husband by my youngest daughter's name.)

"And they let you?"

"I didn't ask.  I just did it."

It might be worth noting that Erik's head slowly came up from his book about the time the doctor uttered the word "let."  The conversation continued for a bit after that, but it never got productive.  The doctor--who was a very nice man, by the way--just could not grasp the fact that I hadn't asked for permission to give birth the normal way.  And seemed to think that, somehow, I was going to ask permission this time around.

Apparently, researching an issue and advocating for your own health is not a very common thing.  The American College of Obstetricians and Gynecologists, not exactly a group of Earth-mama hippies, considers women with two previous c-sections "appropriate candidates for a trial of labor after c-section".  Hell, there is good indication that even moms with three previous c-sections can safely and successfully have VBACs.  Risk of uterine rupture is minute, running less than half a percent(That article mentions only the risk after one c-section, but the ACOG guidelines and the link mentioned in the other study both indicate that the risk after multiple c-sections is comparable.)  Additionally, the risk of maternal death is lower for a VBAC than an ERCS, although the chances in either case are minute (0.02% for VBAC vs. 0.04% for ERCS).  Also, if you look at the success rate of VBAC (75%) versus the national c-section rate (around 30%), it becomes plain that your chances of a successful VBAC are at least as good as of any other woman who wants a vaginal birth.

Given all of this, why on Earth would I ask permission to NOT have major abdominal surgery performed on me?  On what planet would that make sense?  It's not a matter of me being "allowed" to have a vaginal birth with a head-down, healthy baby.  It's a matter of me allowing a doctor to usurp my rights as a human being and bully me into an unnecessary medical procedure.

And anyone who knows me knows how likely that is.


Craig S. Miller said...

Kudos for the research and not backing down. Working in a hospital, I see many doctors make the jump from scared little lemming to demigod based on social merit rather than the acquisition of medical knowledge. Sometimes an informed patient can intimidate them. If you sense that, I.M.O. its time to seek a new provider.

Charlene said...

Sometimes you just have to educate the doc. I figure it's my body and I get to choose what if anything to do.

suz said...

Yes, but for HIM, a c-section is less risky - ask his lawyer! Find a new doc ASAP.

Sabra said...

No fears, Suz, this was just the OB on call. ;-)

TOTWTYTR said...

Ditto to what Craig said. I applaud you being not a passive "patient", but an informed consumer of medical services. All too many people just do as the doctor tells them because they trust that the doctor knows best. Mostly they do, but all too often it's a resident making the decision, not the attending physician.