how did/will you choose betw natural or medical birth and caregiver?

[kali]

Let me preface this post by saying I am not militant about either medical or natural birth. A home birth isn't really my style, but I don't want a scheduled c-section either. I want to try for a VBAC, but I want to deliver in a well-equipped, highly-ranked hospital. I generally believe the more natural the better, but do believe medical interventions are often warranted, and and will almost certainly ask for an epidural at some point.

When DS was born, I fully planned to have an epidural. After an uneventful pregnancy, I never anticipated a c-section, but ended up having to have one. DS never dropped, my epidural kept wearing off (each one faster than the last), and after nearly 24 hours of slow progress and pain I wasn't prepared for, I had a c-section. DS was whisked off to the NICU, I was too exhausted and nauseous to even protest, and we didn't even see each other for 5 hours!

Now that I've done some research, I realize that I probably asked for the epidural too early and should have tried to walk around, squat, use a birthing ball, etc for a while. Letting them use pitocin and cervidil when I was already in early labor was probably unnecessary and maybe even made things worse. The section wasn't the end of the world for me, but we definitely missed out on the early bonding and it probably contributed to our problems establishing nursing.

But I don't know who to ask about these things, or where to learn more. I try to make decisions based on data and was (perhaps naively) shocked to realize that the decisions OBs and hospitals make about births are not always based on solid evidence and optimizing expected health outcomes for mother/baby. On the other hand, it seems like the pro-natural camp is totally against any interventions. The books out there seem to fall in one of these two camps. I feel like my OB would probably reassure me that the c-section was unavoidable and a VBAC unlikely to succeed, but a midwife would probably counsel me against an epidural.

Where can I find balanced, unbiased data and advice?

[mg1278]

I don't know where to look for information, but wanted to say that a good midwife shouldn't outright counsel against an epidural. They should support you if you want/need one, but advise that you not get it too early (like you said).

[kedss]

I would have a conversation with your OB and see what vibes you get, if you aren't satisfied, then interview other folks. Find someone you are comfortable with abd listens to your concerns. Good luck!

[SnuggleBuggles]

\ Informed consent is my biggie. I don't think that I feel as strongly medicated/ unmedicated as I do knowing your choices. When you sign in at the hospital you are acknowledging that you are giving your informed consent to things. That means you are told the risks, benefits and *options* (as well as their risks and benefits). How often does that happen vs moms feeling like there is only one choice or bad things will happen?? So, I opted to find care providers that had that same viewpoint so I could trust that if a need to intervene arose that I really respected their expertise on it. I went to an OB/ CNM practice with ds1 and if some of the OBs had been on call during ds1's birth I frankly wouldn't have trusted them and if I had I would very likely have ended up with a pitocin at a minimal and odds are good, a c-section. Labor was slow and my water broke at the onset. Luckily the CNM was there and she was patient and supportive so long as baby and I were handling things well.

I agree with pp's, you need to talk to different care providers. I wouldn't tar any person based on their title. Some OBs are very open to truly supporting VBACs. Check out ICAN's forums for lists of VBAC friendly care providers in your area. And, it is a mistake to say that midwives, especially ones that practice at hospitals, would discourage an epidural. Now, they might because you are a VBAC patient (sometimes they recommend not being numb so you can feel if there is anything unusual going on) but for the most part midwives tend to be pro-informed consent and leave choices on pain meds up to the mom.

Have you read Marsden Wagner's "Creating your Birth Plan"? It's like Henci Goer's "The Thinking Woman's Guide to a Better Birth" but a little less hostile towards the hospital birth and traditional OB (Goer's book is still a worthwhile read but take it with a grain of salt). It really lays out the risks and benefits of things. It's a great resource if you want to research more about interventions with science behind them (the author was the WHO's head of maternal health, iirc). This website is wonderful, imo, for solid, neutral birth information especially regarding VBACs and c-sections; I'd highly recommend reading it:
http://www.childbirthconnection.org/

Finally, I really like this website. It's mainstream but very factual( that probably doesn't sound right but I don't know how else to say it...basically it's another pro-informed consent thing that is supportive of all so long as you know that things have risks and benefits):
http://www.americanpregnancy.org/

Beth

[KLD313]

My midwife encouraged me to get an epidural because of the situation I was in. I ended up having to be constantly monitored and couldn't walk around to ease the pain, I was given pitocin and my contractions were very strong and erratic. I think midwives treat the whole patient and she knew that was best for me.

[MacMacMoo]

As far as caregivers never really had an option. Being military you sort of get hte luck of the draw. However the hospital where SqueekMoo was born had a free class on all the various drugs they offereded fo releave pain during labor. They were very informative on the topic. We went in with a very open idea of what we wanted. We said that we'd prefer to try for a non medicated birth but reserve the right to change our minds, which we did once I had some off the charts contractions.

[daisymommy]

For me, I had an intervention-full birth, including epidural with DS#1, and hated every minute of it, including how I recovered after wards, how DS was drugged up after wards, failed to nurse, difficulty with bonding...just all around I felt like the only good thing I got out of it was a beautiful baby boy. But that wasn't enough for me. I felt that I deserved a good birth experience and a healthy baby. The two should not have to be mutually exclusive. I feel like so many woman feel like birth is just an awful horrible experience to slog through and try to discard all memory of when it's finally over, so that you can get to the good part, your baby. It shouldn't have to be that way. I realize for many people though, what is horrible for me, is not the same as for them, and vice-versa.

So, the next time I was determined to do things differently, and had DD in a birthing center with a midwife and nurse doula. Totally awesome experience, like night and day for me and DD!!!

That was so fabulous I went with a home birth for baby #3, and it was even better. I would do it again in a heart beat.

So my answer was, I tried it one way, didn't like it, read a ton of info, and tried the other way next time. Glad I did.

[Indianamom2]

Well, I don't know that I have a specific answer for your questions, but I'll share some thoughts.

I've had a completely unmedicated, easy quick labor/delivery (first child) and an induced-with-cervadil-only, long, mostly unmedicated, but ended with an epidural delivery.

I had two different Ob's over that time, both of whom I liked, but with somewhat different philosophies, I think. The first was much less likely to induce and worry about size. She wasn't anti-intervention, but she also wasn't an alarmist and encouraged being patient and as natural as possible. I would have stayed with her, but she moved across the country half-way through my second pregnancy so that wasn't an option! The second pregnancy, I ended up at an entirely different practice with rotating OB's (didn't care for that AT ALL) but likd the one that actually delivered me. That whole practice was more intervention-prone, IMO, but I still was determined to go as natural as possible, and having successfully done it once, I knew I could.

My second child was overdue (like the first) and because the OB's thought he was going to be large, they opted to induce, and I agreed because I was miserably hurting (It was a rough pregnancy). I would not agree to it again, I think. I ended up getting an epidural only after 16 of the 18 hours and I don't regret it a bit because I think it made a very tired me be able to actually enjoy the birth of our son. I was exhausted, whereas with DD, it was quick and easy enough (most of the labor at home) that the dynamic was very different.

All in all, I'd search for an OB who listens to you, who is patient and who you trust. You can't predict your labor or delivery, all you can do is know your options and what you think you will prefer and then you need to have a doctor that you trust so that if things don't go as planned, you know you are in good hands. It's really about all you do.

[RunnerDuck]

I'm planning a vbac and have found that while doctors are generally supportive of them - or claim to be - labor policies either in the doctor's practice or in the hospital are really less than vbac friendly. I am actually between doctors now at 26 weeks because the practice I was seeing, they insist on constant fetal monitoring if you are vbac... external, and then internal once your water breaks. They will not let you use the wireless set up which means in labor you are limited in your movements to how far the wires will reach - ie not far. SO no walking, no showers, etc while in labor. Yes they will let you vbac. No they will not make it pleasant for you. I know it's partly CYA - because IF something goes wrong they want to be able to say they aren't to blame. But the odds of this stalling labor and resulting in a c/s just don't seem worth it given the risk of rupture is SOOOO small.

I almost wonder if they make it unpleasant just so you will say whatever, section me.

I am hoping to find someone who will let me labor with intermittant monitoring.

Otherwise I will stay at home as long as possible, and walk around outside the hospital as long as possible, and then check in.

The birth center here in Pgh won't let you vbac - though the midwives there will follow you in the hospital. Home birth is really not for me but I do kick the idea around some... I am so skeeved out by this monitoring thing.

My son was a natural delivery - my girls were c/s because baby A was breech and I had pre-e - I do feel a c/s with them was best. I don't have any emotional trauma or whatever from having needed a c/s - I am not looking for a vbac to heal anything - but I don't want another c/s due to stupid policy. Medical need, I am fine with. But I feel like the vbac policies just set you up for vbac failure.

[AnnieW625]

I am very open minded when it comes to all things medical, which is pretty rare on this board.

We chose the hospital where we delivered DD1 at because it has one of the best NICUs on the west coast. I got doctor recommendations from friends. I was new to the area too so I wanted to deliver there vs. delivering at a Kaiser where I knew no one who had delivered there. With DD1 my 17 week ultrasound showed that I had a 1 in 5 chance of needing a c-section because I had placenta previa (low lying placenta) so I got used to that idea and had no problem w/a c-section had I ended up needing one. By 32 weeks DD2 had moved up far enough so I could have a vaginal delivery, but still I carried soo low with her that I wouldn't have pitched a fit had a dr. told me at the very end that a c-section would've been best.

With DD2 we delivered at a Kaiser hospital (we switched back to Kaiser when DD1 was 18 mos. old) and we chose the hospital closest to us had just been built. I was assigned a dr. by Kaiser, and I lucked out and got a really good doctor. Had I not been comfortable I would've switched by asking them to assign me to another doctor. It probably doesn't matter much to most people but the Octomom had her 8 babies at the older hospital with the same medical staff that I had access to at the new hospital and I figured that if those babies could be kept alive that the medical staff must be pretty good.

Pain med. wise I am scared of needles so I didn't want an epidural with DD1, however I got one at the tail end of my labor (just 2 hrs. before she was born) because I had strep B so I needed penecilin, my labor had stalled after my water had been broken so I needed pitocin, and my labor progressed from being completely stalled at 5/1/2 cm. to 10/1/2 cm. and ready to push 3 hrs. after starting pitocin. I got my epidural probably right around 8 cm. . I was still able to push and pushed with little issues for just over an hour.

With DD2 I was barely dialated after my water broke at home and the contractions weren't that close together. Once I was checked in I got an IV of nubane which was great because it allowed me to sleep through the contractions (it made them tolerable Braxton Hicks) so I got about 3/1/2 hrs. of sleep. By 7 am the dr. came in and thought I was still going to need an epidural so she put the order in for the cath, and the epidural. By 7:30 when the nurse came back in to check me I was progressing a lot, put the cath in, but said it was going to be close so she didn't know if I could get an epidural, but I still wasn't far enough to push. At 8 am the new nurse came in, checked me and said it was close to pushing time, I asked for more nubane as I knew that the epidural wasn't going to happen, and she said nope it's too close so I waited another 10 minutes for the contractions to get heavy again and I told her I wanted to start pushing. I pushed for 20 minutes. I didn't miss the epidural, but at least I had the nubane and don't regret asking for the pain medicine; because I would've been a wreck like I was with DD1 had I not had the option to get a little bit of sleep. With DD1 I had been up for 24 hrs. when they told me I was going to need the pitocin (and was told by the morning nurse they should've sent me home because I could've gone another 2 weeks at 5+ cm and never felt more tired). Honestly although there was pain from contractions and pushing I thought the most uncomfortable part of labor was the initial check of the cervix with the metal speculum.