Grainne’s Adventures in Healthcare: Part II

c-sectionBy: Grainne Rhuad

In 2006, then President Bush made the heartfelt statement “Too many OB/GYN’s aren’t able to practice their love towards their patients.”  Boy, he wasn’t kidding.

I am sitting in the stirrups in an OB/GYN’s office for the first time in almost 15 years.  Not to worry, I haven’t been missing my screenings.  It’s just that for some time now I have opted to see a Nurse-Midwife for this type of care.  However now that my time childbearing (with the grace of G-d) is over I wanted to see someone closer to home for convenience.  My Midwife was about a half hour drive away.  I had chosen her both because of her excellent care and because the hospital she was affiliated with was a better facility for childbirth.

However now that I only need an annual exam, I decided to go with one of the local OB’s.  I am a little nervous.  The last OB I had seen was incredibly creepy.  He often made comments to me while examining my breasts that my shirt was silky and pretty….weird conversation for a man who should know better, seeing women’s private parts all day.  One may wonder why I didn’t just choose a female OB.  The reason is I have found women who I have run across in that field of medicine are nine times out of ten brusk, rough and not filled with warmth.  I can’t say why that is, but it has been my experience and I just don’t need a rough person messing around with my nether-regions.

So here I am today meeting my doctor for the first time.  He was a referral from my primary care Doctor whose wife had seen him and told me he was incredibly nice.  Which he was.  He looks like a jolly Tweedle Dee.  Round and genial.  He has good conversation skills and is not creepy at all.

As he takes my history and begins the exam he notes my c-section scar and asks when I had it.  I told him in 1992 (by said creepy doctor) He tells me “Oh that guy…he’s not around anymore.” This fills my heart with gladness.  “But it looks like he did good work.  Which pregnancy did you begin having C-sections in?”  To which I answer my second.  “So did they do the rest using the same incision?”

“No.” I answer the rest I had naturally.

To which he answers “Oh, well if you get pregnant again, that won’t be happening.”

It seems that the hospital in my area has commandeered women’s choice in what type of birth they have.

He goes on to inform me that the hospital will not perform Vaginal Births after a Cesarean (VBAC) any more due to liability.  This really isn’t about liability.  Most women are perfectly capable of delivering a healthy baby vaginally after a cesarean.  I myself delivered four.  However the new policy does not even take into account the successful VBACs someone like myself has had.

The real reason for this policy is money.  A cesarean costs more; there are more people involved, more drugs and a longer post-birth hospital stay.  The hospital is making money off this policy which is in effect taking away a woman’s right to chose how and where she can give birth.  In many areas of the country it is illegal to have a home birth, although it is not currently actively enforced, many pediatricians will not take onto their case load children born at home due to liability.

This is how our hospital’s plan is mapped out.  A woman can have a VBAC only if there is an OB-GYN on the premises.  This Doctor cannot just be a doctor delivering another baby; it has to be an on-call Doctor.  In our area there are 8 OB-GYNs who all live within 20 minutes of the hospital and have privileges.  However it is not enough for them to be on-call, they must be on rotation and physically at the hospital. Because all of our doctors are older, experienced and have good practices, none of them, understandably want to spend the night at the hospital.  It is unnecessary given that an average birth takes eight hours; there is plenty of time to have an on-call doctor come from home.  However, the hospital maintains that there are “serious” cases that move quickly and women can deliver in 15 minutes.  Well, yes, that can happen, but if it did, it would not be enough time to prep for a c-section anyway.

One of the dirty little secrets they don’t tell you is that anesthesiologists are not required to be on-premise.  So if a c-section is required a woman still has to wait for an anesthesiologist…unless it’s been pre-scheduled.

Pre-scheduling is another big piece of this.  Doctors, anesthesiologist and Hospitals love to have things run according to a schedule and an emergency birth just doesn’t fit with that.   Scheduled c-sections are so much more convenient for them.  Never mind how it affects the mother and child.

A woman experiencing a c-section will be in post-op an average of an hour.  If a mother has been completely put under as was my own case in an emergency, the post op could be longer.  During that time the hospital has the baby and depending on your own complacency and/or lack of education, the father may not even be able to be with the baby.

Stays in the hospital after a c-section are generally about 7 days.  This opposed to 24 hours with a vaginal birth.  This is because you have had major surgery.  Muscles are cut and a patient needs to be monitored for any post-op problems like accidental injury to organs, allergic reactions, post natal stress to mother and child.

For myself, in 1992, I was discouraged from nursing during this stay, nurses would fail to wake me when they took my child for “testing” and would feed her without my permission.  This caused undue distress to both me and made it that much harder for bonding to occur.  After the first day I had to put in writing that my child could not be taken without me be woken up and asked.  Also I was sleep deprived as the hospital rule was I could not sleep with my child in my bed.  As I always slept with all my babies, and I wasn’t willing to bend on this issue, I spent a lot of time awake, or half awake, sleeping only when someone I trusted could sit with me.

The biggest disappointment to me is that women are buying into this “convenience.”  Take for example a culture of women who have large families like those belonging to The Church of Jesus Christ of Latter Day Saints.  These women and families believe and teach that it is their duty and calling to have as large of a family as they can sustain, both emotionally and financially.  It is not about birth control as it is with the Catholic Church.  Rather they believe in having big families because raising righteous people is important to them.

Utah has one of the highest medical intervention rates in childbirth in the nation.  So, in a state where most of the people feel that families are important, the women have been sold on the modern idea that birth is the least important part.  They are ready to pony up for drugs to take away the birthing experience entirely, which makes one wonder if they really understand sacrifice and family at all.

But I’m not here to pick on The Church of Jesus Christ of Latter Day Saints.  Their birthing stats just make them an excellent study in women’s ideas about birth.  Women it seems have bought the convinience line too.  They want to have their children as easily as possible which any experienced mother, doula, midwife will tell you takes away from what the body does naturally and robs the mother and child of natural hormones that make for a healthier mom and baby.

Back to my doctor.  I ask him how it can be that after 4 successful VBACs I wouldn’t be “allowed” to have the birthing experience I decide.  He shrugs his round shoulders and tells me  he agrees but there is no fight left in him…Besides he says, you don’t need to worry about it, you are done having children right.

I can tell this rule is not one he is favorable to but like so many of us, there is no fight left in him.  However, what concerns me is when we give up fighting for what we believe our children and the next generations watch that and make decisions about what should be important to them.  We need to make sure we protect our reproductive rights, I tell him.

He doesn’t answer, which says a lot.