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Old 01-27-2010, 01:15 PM   #11
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Re: can't find VBAC waterbirth - :crying:

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Originally Posted by NavyMommy View Post
Did you ask them why you can't have a tub during a VBAC? My hospital only has 2 tubs, but I'm calling as soon as I think I'm in labor to see if I can get one of them. I'm a VBAC too, but it didn't seem like it was going to be a huge deal when I talked to the hospital and Drs.

Chances are most (if not all) of their patients have CFM and if they offer tubs they probably have wireless monitors for the mamas that get them. I would probably call and see what kind of monitoring they do while you're laboring in the tub (not mentioning you're a VBAC), and see if you can adapt that to your situation. If they say they have wireless waterproof monitors I would just ask why you couldn't use them as a VBAC.
One told me it was just "policy". The other said they don't have waterproof monitoring equipment and that is required for VBACs. Grr. It's a good idea to try asking about the monitoring without mentioning VBAC.

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Old 01-27-2010, 02:19 PM   #12
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Re: can't find VBAC waterbirth - :crying:

if uterine rupture is the your biggest fear about birthing at home, then here's an interesting read I like to share, and I'll quote the following part too:

" In your letter you state that uterine rupture occurs in about 2%
of VBACs. For lower transverse cesarean sections, all of the research we
were able to find points to a general risk of less than 1% for VBAC women,
and much lower when induction agents were not used. ACOG’s 2004 practice
bulletin lists rupture risk as less than 1%. Here are a couple of the
recent studies on VBACs and their uterine rupture rates: Landon, et al (2006) - .7% for single prior cesarean, .9% for multiple prior
cesareans.
Lydon-Rochelle (2001) – .52% (spontaneous labor) .77% (induced without
prostaglandins)
Regarding your statement that in cases of uterine rupture, “death of the
baby is almost certain and death of the mother is probable,” I was unable to
find any study confirming this. In a 2004 Landon study, of the 124 uterine
ruptures, there were 2 fetal deaths.[iv] In the Lydon-Rochelle study, there
were 5 fetal deaths out of 91 ruptures. Obviously any fetal death is a
tragedy, but fetal death from uterine rupture is rare, not “almost certain,”
and fetal death can be a consequence of repeat cesareans as well.
Another surprising statement in your letter about maternal risk is
“virtually 100% will lose their childbearing ability” if they don’t die. In
the Lydon-Rochelle study, 4 women needed hysterectomies out of 91 ruptures,
again the overall risk is low, not “virtually 100%.” The 2004 Landon study
also concluded that the risk of hysterectomy and maternal death was about
the same for both the trial of labor group and the elective repeat cesarean
group.
I am troubled that information on VBAC risks is not combined with
information on repeat cesarean risks. Only providing information on VBAC
risks does not allow prior cesarean women to weigh the risks and benefits of
each birth option. The Nisenblat study on multiple cesareans found a
hysterectomy rate of 1.1%, and an overall “major complication” rate of 4.3%
for second cesareans and 8.7% for a third or higher number of cesareans."


Honestly, even continuous monitoring can lead to many other interventions, c/s including. So to me, that's a bigger risk than the very low risk of uterine rupture
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Old 01-27-2010, 04:20 PM   #13
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Re: can't find VBAC waterbirth - :crying:

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Originally Posted by BaBaBabyMama View Post
My main concern is that if there was a uterine rupture or some other complication, I am pretty far from the hospital. I know it's rare, but it is serious when it happens and being fairly far that's what makes me uncomfortable. That's awesome that you were able to have 8 at home in water!!
I'm glad you have your main concern mapped out. Because once you identify that main concern, you can educate yourself completely about it. I hope where ever you land, you end up completely happy with your desicion. That you are not forced or pushed into something because you believe you don't have options. I hope you find some peace most of all.

Quote:
Originally Posted by mariola View Post
if uterine rupture is the your biggest fear about birthing at home, then here's an interesting read I like to share, and I'll quote the following part too:

" In your letter you state that uterine rupture occurs in about 2%
of VBACs. For lower transverse cesarean sections, all of the research we
were able to find points to a general risk of less than 1% for VBAC women,
and much lower when induction agents were not used. ACOG’s 2004 practice
bulletin lists rupture risk as less than 1%. Here are a couple of the
recent studies on VBACs and their uterine rupture rates: Landon, et al (2006) - .7% for single prior cesarean, .9% for multiple prior
cesareans.
Lydon-Rochelle (2001) – .52% (spontaneous labor) .77% (induced without
prostaglandins)
Regarding your statement that in cases of uterine rupture, “death of the
baby is almost certain and death of the mother is probable,” I was unable to
find any study confirming this. In a 2004 Landon study, of the 124 uterine
ruptures, there were 2 fetal deaths.[iv] In the Lydon-Rochelle study, there
were 5 fetal deaths out of 91 ruptures. Obviously any fetal death is a
tragedy, but fetal death from uterine rupture is rare, not “almost certain,”
and fetal death can be a consequence of repeat cesareans as well.
Another surprising statement in your letter about maternal risk is
“virtually 100% will lose their childbearing ability” if they don’t die. In
the Lydon-Rochelle study, 4 women needed hysterectomies out of 91 ruptures,
again the overall risk is low, not “virtually 100%.” The 2004 Landon study
also concluded that the risk of hysterectomy and maternal death was about
the same for both the trial of labor group and the elective repeat cesarean
group.
I am troubled that information on VBAC risks is not combined with
information on repeat cesarean risks. Only providing information on VBAC
risks does not allow prior cesarean women to weigh the risks and benefits of
each birth option. The Nisenblat study on multiple cesareans found a
hysterectomy rate of 1.1%, and an overall “major complication” rate of 4.3%
for second cesareans and 8.7% for a third or higher number of cesareans."


Honestly, even continuous monitoring can lead to many other interventions, c/s including. So to me, that's a bigger risk than the very low risk of uterine rupture
I'm glad someone else said this
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Old 01-27-2010, 04:49 PM   #14
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Re: can't find VBAC waterbirth - :crying:

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Originally Posted by BaBaBabyMama View Post
My main concern is that if there was a uterine rupture or some other complication, I am pretty far from the hospital. I know it's rare, but it is serious when it happens and being fairly far that's what makes me uncomfortable. That's awesome that you were able to have 8 at home in water!!
Ditto Mariola! I have always lived 40 minutes to an hour from the hospital in all 8 VBACs.
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Old 01-27-2010, 05:18 PM   #15
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Re: can't find VBAC waterbirth - :crying:

I am not concerned over UR at all, I'm just concerned about having an HBAC with a non-licensed midwife where I'd have no protection at all if something happened I know I probably SHOULDN'T be concerned, but I am I'm very excited about my VBAC with my midwife though, she even discussed with me how a repeat C/S is WAY more risky than a VBAC.
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Old 01-27-2010, 06:54 PM   #16
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Re: can't find VBAC waterbirth - :crying:

www.icanofbaltimore.org

They can help you. The deal is that none of the BCs in the area will let you labor there if you want a VBAC. Special Beginnings in Arnold is good (I am going there). There midwives will deliver out of AAMC. The only problem is that AAMC won't let you labor in water if you are doing a VBAC. I say that HB is the way to go if you absolutely want a waterbirth.
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Old 01-27-2010, 07:33 PM   #17
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Re: can't find VBAC waterbirth - :crying:

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I am not concerned over UR at all, I'm just concerned about having an HBAC with a non-licensed midwife where I'd have no protection at all if something happened I know I probably SHOULDN'T be concerned, but I am I'm very excited about my VBAC with my midwife though, she even discussed with me how a repeat C/S is WAY more risky than a VBAC.
Out of curiosity, what "protection" would you think you would have with a licensed midwife if "something happened"? Even if you were having your first baby, there is still a chance of "something" happening (you need to find out what those SOMETHINGs are that you are concerned about). I'm not sure what licensing for the midwife would do for you in that case.

And I happen to know at least one licensed mw in SC that does VBACs, but it certainly is under the table.
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Old 01-27-2010, 07:45 PM   #18
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Re: can't find VBAC waterbirth - :crying:

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Out of curiosity, what "protection" would you think you would have with a licensed midwife if "something happened"? Even if you were having your first baby, there is still a chance of "something" happening (you need to find out what those SOMETHINGs are that you are concerned about). I'm not sure what licensing for the midwife would do for you in that case.

And I happen to know at least one licensed mw in SC that does VBACs, but it certainly is under the table.
I contacted EVERY licensed midwife in SC (there's a list of them on the web - each one HAS to be listed on SC DHECs website if she is licensed) and got the EXACT same response from each - none of them do VBACs anymore at home. The birthing center doesn't even allow VBACs. They each gave me their own reasoning, but the ultimate consensus was it's not allowed.

As far as protection goes. I chatted with three un-licensed midwifes and none of them carried insurance. However, ALL of the licensed midwifes I talked with have insurance for, God forbid, situations where the mother or baby's health is in jeopardy and one/both don't make it. Protection for lawsuits, malpractice, ect... That's all I mean. Being able to hold accountable.

As far as "under the table" I just mentioned that because I actually had one lay midwife contact me and say she would "be at my birth" but she wouldn't want me mentioning it, couldn't put her as the attendant in any official records or documents, and she wanted to be paid cash. She was not licensed but completed all her training. She isn't licensed in SC JUST in order to do VBACs. I wasn't comfy at all after speaking with her...

And the SOMETHINGs I am concerned about could be anything. Baby born with breathing issues - severe enough that the midwifes limited supply wouldn't be able to assist, or a severe quick hemorrhage of the mother, or - as rare as I KNOW it is - a rupture.
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Old 01-27-2010, 07:46 PM   #19
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Re: can't find VBAC waterbirth - :crying:

I really, really, really wish it were different. I myself am in midwifery school currently and KNOW that rupture is such a TINY risk. WAY more minuscule than even the risk of a repeat C/S. I will never understand why they deemed it unsafe to have an HBAC.
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Old 01-27-2010, 08:01 PM   #20
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Re: can't find VBAC waterbirth - :crying:

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I contacted EVERY licensed midwife in SC (there's a list of them on the web - each one HAS to be listed on SC DHECs website if she is licensed) and got the EXACT same response from each - none of them do VBACs anymore at home. The birthing center doesn't even allow VBACs. They each gave me their own reasoning, but the ultimate consensus was it's not allowed.
Yes, I'm very familiar with SC law regarding this. I also personally know many of the SC midwives.

Quote:
As far as protection goes. I chatted with three un-licensed midwifes and none of them carried insurance. However, ALL of the licensed midwifes I talked with have insurance for, God forbid, situations where the mother or baby's health is in jeopardy and one/both don't make it. Protection for lawsuits, malpractice, ect... That's all I mean. Being able to hold accountable.
So, you want to be able to sue if something went wrong? Did you talk with Tavish? I didn't think she carried malpractice insurance. And malpractice insurance IN NO WAY holds the midwife "accountable" it just is supposed to make it so they don't lose their family home, etc., in case of a lawsuit. Accountability is provided through peer review, the state midwifery association, and the licensing board. In the state I am in, none of the midwives are licensed. However, we do have accountability. That is provided through our state midwifery association as well as the NARM board if a midwife is a CPM. So parents have an avenue for complaints and for the midwives to be censured if they are practicing in an unsafe manner.

Unless it was required by law, I would NOT carry malpractice insurance. It helps weed out those who would want to sue someone if something went wrong. People who think that if they sue, well, the midwife has insurance for that, so it won't hurt her are sadly, horribly mistaken. A lawsuit can RUIN a doctor or midwife. It can be the end of their career. THere are still HUGE fees in a lawsuit for the midwife to pay. She could end up losing her house anyway, even if she has "insurance".

Homebirth is about the PARENTS taking responsibility for their birth and the outcomes. It is about parents understanding that there is an irreducible risk in birth, and that they are comfortable taking that risk into their own hands. It is about understanding that just because something goes wrong, doesn't mean SOMEONE has to be to blame -- sometimes meconium happens. If you would want someone to be "accountable" if something went wrong, please don't have a homebirth, because in a homebirth, the buck stops with mom and dad. Not the midwife.

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And the SOMETHINGs I am concerned about could be anything. Baby born with breathing issues - severe enough that the midwifes limited supply wouldn't be able to assist, or a severe quick hemorrhage of the mother, or - as rare as I KNOW it is - a rupture.
SC midwives are CPMs, and are therefore required to be certified in Neonatal resuscitation and to have the equipment to use it. They also carry appropriate meds for hemorrhage. And yes, rupture can happen. So can cord prolapse, placental abruption, shoulder dystocia or a few other complications that are time emergent and life threatening and can happen no matter your location.

If you don't feel safe having a homebirth, you should not have one. But the studies do show that homebirths attended by a skilled midwife are just as safe as hospital births. What this means is, even if you have your baby in the hospital where they have "all the medical equipment", things can still go wrong that lead to permanent disability or death. And these things happen in the same percentages as they happen at home.
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