I Wrote a letter to the hospital administration

[nrsenadenos]

I agree with Jennifer.

Also, my concern with sending a letter this early on - will it "red flag" your file as a problem patient and/or put them on high alert to find a reason to report you to CPS or do one of the nastier scenarios?

[B's Mommy]

I'm sending it early on because I want to have good report with the doctor I choose - I am trying to avoid getting settled with a doctor only to have to switch a month or two before delivery. The better I know my doctor, and my doctor knows me, the better my birth will go.

I'll take out the AMA part, because you are right, I'm asking for an exception, so technically that wouldn't be AMA.

Sorry, but other than a couple errors I caught after posting this, I just don't see "several run on sentences and grammar errors". If there are so many, could you please point them out to me so I can fix them before sending my letter?

I revised a few things, so here is the updated letter. Oh, and I do have them addressed personally as printed - this was just my default. I have one to the CEO, and one to the Board of Directors.


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. As I understand it, TCMH does not allow VBAC births per hospital policy, but I am requesting an exception to that policy. 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. 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.

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. 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. 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. 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. 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. 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.

[z2akids]

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 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.

[HeatherlovesCDs]

I agree with Jennifer. I admire her willingness to be completely honest since I only mentioned one small thing even though I agree with her entire post.

I totally agree with finding an OB first. In fact, I would suggest finding one and then trying to get him/her to agree to writing a small letter stating that you are in fact a good candidate in their medical opinion and then attaching that to the letter you send.

The "all things considered" comment also had me wondering what you didn't like. I imagine you simply mean, in a hospital, but whoever else reads this isn't going to assume that.

Your quote should look be something like I have below. (ETA - Well, that's annoying. I took the time to try and figure out how to make it look indented, but when I posted it doesn't. So, the entire quote should be indented.)

I have reviewed all the medical literature. The ACOG’s revised guidelines 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,"

Based on my research, I have decided (I'd say "I believe") a VBAC is a safer choice for me than scheduling a repeat c-section.

You need to include more info about the specifics risks and such. The CEO is not going to know them. You need to lay it out.

I echo Jennifer also that I'm not trying to criticize at all. We just want you to have the best chance possible. I really hope that you are able to get the birth that you want at the hospital you want.

Good luck!!

[B's Mommy]

All things considered meaning I did NOT go in there looking for a c-section. Considering the c-section caused me great depression, anxiety, and a complete overall distaste and regret about my most of my birthing experience, I thought "all things considered" was the more mild form of, "Other than choosing the wrong OB, who sabatoged my birth plans, lied to my family to manipulate me, and ultimately destroyed my chances at a natural birth (from the part where she broke my waters without permission to the part where she convinced me to get stadol which completely made me unable to make my own decisions), it was a good experience." I'm not going to get into details in the letter because I don't want this letter spanning 3 pages - the longer it is, the lesser chance the CEO will even read it.

As much that is wrong with it, I don't even think I'm going to bother sending it. After the day I've had, it would be easier to just sign up for the stupid c-section and pray I don't die during surgery. I could go into details about everything you picked apart, but why bother? I DO have an OB who is in support of this, but he can get into trouble for not immediately referring me to another hospital knowing I plan on trying to VBAC, so he wants to see what they say about the letter before he gets involved with the hospital admin. He's almost gotten in trouble before because a patient blew off her scheduled c-section and came in in labour and refused to get cut - they thought he knew and approved of what she was going to do because of his very pro-VBAC stance.

But at this point why even freaking bother. It's nothing to do with you, and I know you weren't critizing so don't take it personally. I am just so incredibly ticked off that I even have to do this....that I have to FIGHT so hard already for a normal freaking birth. What the heck does it matter. If I die or can't have children ever again because of a screwed up c-section, oh well...I probably deserve it anyway.

[z2akids]

I understand that my post was frustrating. I simply want you to present the best possible case to the hospital administration if you really want them to change their mind. I spent 14 years of my adult life working in corporate litigation dealing with CEOs, CFOs and risk management types on a daily basis. Their job is to protect the hospital, not ensure that one patient gets what they want.

I am sorry you had a tough day, and I'm sure that my post didn't make your day easier. But, if you want to change hospital policy, you need to be prepared for a fight. If you are ready to give up just because I made suggestions that your letter needs to be much stronger, then you aren't ready for the fight ahead of you. I do think it's a bit dramatic to suggest that you should just give up and pray that they don't kill you.

You're right that I don't know your history. Neither does the CEO. The point is that he doesn't care about your previous experience. I know we want to think that our story matters. But, in his line of work, it doesn't. The numbers are what matter - risk versus benefit. It was your doctor, not his hospital that caused problems from your last post. So I would play up what great customer service the hospital provided and completely leave out any issues you had that were related to your doctor.

I read some of your recent worries with this pregnancy and I am glad to read that you've been able to get switch from your previous OB to a more VBAC friendly doc. It can be difficult to switch doctors so quickly early in your pregnancy and hopefully being able to do that over a couple of days will mean that other decisions will go easily as well.

[nrsenadenos]

Originally Posted by B's Mommy He's almost gotten in trouble before because a patient blew off her scheduled c-section and came in in labour and refused to get cut - they thought he knew and approved of what she was going to do because of his very pro-VBAC stance.

Would it be easier for you to just do the above scenario?

[borncrunchy]

I love it, although I would change one thing.... "i understand the risks of a uterine rupture during a TOLAC are between 0.5% and 0.9% if I am not induced." i would write "I understand the risks of a uterine rupture during a TOLAC are between 0.5% and 0.9% if I am not given any labor inducing medications or prostaglandins including cytotec, cervidil or pitocin, and that labor is allowed to progress naturally in its own time.".

I would also include some information about how the risk of uterine rupture in a mother who is not induced or augmented in any way is very similar to the risk of uterine rupture in women without uterine scarring who ARE induced or augmented.

Good luck!

[247mom]

You sound really disappointed in feeling forced to have a c/s at your local hospital. This may be totally not what you want to do, but I looked into the home birth laws for Missouri, and Licensed Midwives (CPMs) legally practice in your state, from what I quickly saw, it appears VBACS are allowed in the home setting in your state, would you consider looking into having a home birth? I have known many women who have avoided repeat c/s and many of the risks of VBACs (esp. those connected with induction) by having home births. It is a personal decision that must be carefully weighed, but I just thought I would make the suggestion.
This may be a good place to try to locate a qualified midwife, skilled in attending VBACs http://www.friendsofmomidwives.org/
Either way, I hope you can come up with something that works for you, sorry this is so distressing to you, I know I would feel the same way if I felt forced to do something I didn't feel was safe
Please KUP on what you decide and how everything goes!!

[umphreysmommy]

Originally Posted by 247mom You sound really disappointed in feeling forced to have a c/s at your local hospital. This may be totally not what you want to do, but I looked into the home birth laws for Missouri, and Licensed Midwives (CPMs) legally practice in your state, from what I quickly saw, it appears VBACS are allowed in the home setting in your state, would you consider looking into having a home birth? I have known many women who have avoided repeat c/s and many of the risks of VBACs (esp. those connected with induction) by having home births. It is a personal decision that must be carefully weighed, but I just thought I would make the suggestion. This may be a good place to try to locate a qualified midwife, skilled in attending VBACs http://www.friendsofmomidwives.org/ Either way, I hope you can come up with something that works for you, sorry this is so distressing to you, I know I would feel the same way if I felt forced to do something I didn't feel was safe Please KUP on what you decide and how everything goes!!

I just had a HBAC because even though there is no bans at my local hospital I just knew my chances of success and avoiding interventions was best at home.