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Old 04-21-2012, 09:28 PM   #13
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Re: I Wrote a letter to the hospital administration

I'm not going to correct it for you, but I've bolded and commented on the sentences that I would edit. I tend to get comma happy at times too.

Originally Posted by B's Mommy View Post
To whom it concerns:

I am currently pregnant, and I’ve begun to seek prenatal care for my upcoming birth in late November or early December. I had my first daughter at Texas County Memorial hospital by cesarean section in February of 2011. All things considered, my time at TCMH was pleasant, and I was made to feel very comfortable during and after labor. Why all things considered? Was it a good experience or did the good just barely outweigh the bad? As I understand it, TCMH does not allow VBAC births per hospital policy, but I am requesting an exception to that policy. Break this up. After reviewing all the medical literature, including the ACOG’s revised guidelines that state,

“Women and their physicians may still make a plan for a TOLAC (trial of labor after cesarean) in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk,”

I have decided that a VBAC is a safer choice for me than scheduling a repeat c-section.
You need to indent your quote at the very least. This sentence was very difficult to read and I would rearrange so you don't have a lengthy quote smack in the middle. I understand the risks of a uterine rupture during a TOLAC are between 0.5% and 0.9% if I am not induced, which is only slightly higher than women who have never had a cesarean. I also understand the risks associated with a failed TOLAC and the risks associated with an elective c-section. You need to lay these out for him. Breezing over the risks may leave him wondering whether you left them out because they don't support your position. Acknowledging the risks shows that you are aware and rationally weighing them.

The ACOG also states that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will. As well as that, if a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center. You're telling them that if they aren't comfortable with a VBAC, all they have to do is refer you elsewhere. I am asking for the hospital’s blessing to allow me to seek a physician with TCMH who is comfortable with allowing me to VBAC, and to be allowed the right of a TOLAC at TCMH. Too many acronyms. I am a good candidate for a TOLAC, and I will discuss the matter extensively with my physician, who will be able to review my medical records. The CEO is going to wonder what makes you think that you're a good candidate since you haven't sought medical care as yet. In the event my situation changes and I am no longer a good candidate for a TOLAC, I will change my plans accordingly.

I am willing to sign a Consent for VBAC form and can even provide one if preferred. I am also willing to sign the required forms to legally relinquish the hospital from any legal or financial responsibilities should something go wrong during my TOLAC.

Should I be denied the privilege of VBACing at TCMH, I will be forced to travel over 65 miles for all my prenatal care and while in labor for the right to give birth vaginally, and this is obviously not ideal. Too many concepts in one sentence. Break it up. I do not feel that it is right for me to lose my rights to a normal birth at a hospital that I felt so comfortable and well taken care of in because of one previous cesarean, when I am fully informed of the risks and especially with the ACOG’s revised guidelines. Again, far too much going on in this sentence. In addition, in your opening sentence you said that you were well taken care of "all things considered." That quote sounds like you are qualifying your care. TCMH gave me an experience that I know can’t be replicated at a larger hospital like those in Springfield. It was a great experience and the whole time I felt like I was receiving personalized, superior care as if I were the only patient in the entire hospital. I felt completely comfortable in TCMH, whereas normally I feel very uncomfortable and rushed in a hospital setting. I don’t want to miss out on this for my next and subsequent children.

Thank you for considering my request, and I look forward to hearing from you and birthing in your hospital this fall. You can contact me at xxx-xxx-xxxx to discuss this matter further.
Cut out the long sentences with multiple commas and keep it simple. I had to go back and reread several sentences to make sure that I understood what you were trying to say. The CEO won't take that time. You are asking him to do something that his risk management team deems to be risk prone. Ultimately, you need to send the letter that is right for you. I am not trying to burst your bubble. You may be able to get an exception. However, he is not going to give you premission to try for a VBAC when you do not have a doctor telling him that you are a good candidate for a VBAC. There is little to no upside to him giving permission and tons of potential liability. I understand that you don't want to start care with one provider and potentially have to switch. But, the CEO's legal team is unlikely to allow him to put anything about an exception in writing for you at this stage.

What I would do is ask around to find a doctor who is VBAC friendly and who also had privileges at that hospital. Get the go ahead from the doctor and then contact the hospital.

I am aware that my view is likely to be unpopular. I tried to look critically at the letter and provide you with my best to help you.

Last edited by z2akids; 04-21-2012 at 09:32 PM.
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