Thursday, June 18, 2009

Finding the Right Practitioner

If you are hoping to attempt a VBAC it is crucial to find a caregiver who is supportive, encouraging, and trusting of VBAC's. They should also be knowledgeable and experienced in VBAC deliveries. It is important that your caregiver be comfortable and confident in order for you to feel safe and trusting in them and their judgement. Unfortunately it is becoming more difficult to find a caregiver who will offer the choice of a VBAC. I feel this is because of the fear of lawsuits and the high cost of insurance doctors and hospitals have to pay if they are doing VBAC's, not to mention the money they make by preforming surgery instead of allowing VBAC. I of course personally prefer midwives but there are good VBAC doctors out there as well. I suggest taking the time to interview a few different practitioners to compare their responses and attitudes to really have a better feeling as to which one is really going to help you the best to achieve the birth you desire.. Discuss with them your desire to have a VBAC, your goals and preferences and find out their philosophies, experience, success rates, and how they will work with you to have the birth you desire. If their responses don't satisfy you, or they don't seem like they would be supportive of your decision, if they have too many protocols to follow, etc..I would suggest finding someone who is a better fit. Also if you have different hospital choices or birth centers I encourage you to visit them and find a place you would be most comfortable in.

Sometimes doctors seem supportive but as time goes on they change their tune. I have heard many stories of this happening. Hopefully if you get that feeling you will be able to change and find someone who truly is supportive. I had a friend who did that in her last trimester and was so grateful she did. So how do you go about finding one who is truly pro-vbac? Here are some things to keep in mind when first meeting your caregiver:

  • They should believe that women should labor unless there is a medical reason not to, and talk about the benefits of labor for the mom and baby.
  • They should respect the woman's right to make the ultimate decisions about their birth.
  • They should view pregnancy and birth as a natural process, not treated or viewed as a medical condition.
  • They do not have policies that discourage VBAC such as having a "big baby", gestational diabetes, pregnancy going past 40 weeks.
  • They should have a high success VBAC rate of 70%.
  • They should show acceptance of your choice to have a doula present if that is what you want.
  • They should not routinely use interventions during labor.

To understand their views on the above subjects here are some good interview questions to ask:
I got most of these off of the ICAN website.
  1. What are your beliefs about birth and prenatal care in general?
  2. What are your beliefs about VBAC births and prenatal care?
  3. How do you feel about VBAC delivery? Do you support VBAC?
  4. Do you feel a VBAC is a safe option for women?
  5. Approximately how many VBACs have you attended?
  6. Of those patients in your practice who wanted a VBAC, how many were successful?
  7. What do you think my chances are of a VBAC success, given my childbirth history?
  8. What is your rate of cesarean sections and under what circumstances do you usually advise them?
  9. Are VBAC patients treated any differently than patients who have never had a c section?
  10. Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
  11. What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
  12. What book(s) would you recommend that I read?
  13. Are you familiar with ICAN?
  14. What prenatal tests/procedures do you usually require? Recommend?
  15. What do you think of Birth Plans/ Preferences?
  16. How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
  17. Do you have a vacation scheduled near my estimated due date?

Questions regarding Labor & Delivery

  1. What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
  2. Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
  3. How many people can I have with me during the labor and birth?
  4. How do you feel about doulas?
  5. What is your usual recommendation for IVs? Pitocin? Confinement to bed?
  6. What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
  7. How often do women in your care give birth un-medicated? How many with minimal medication? In what percentage of your patients do you induce labor?
  8. Approximately how many of your patients have un-medicated births?
  9. Do you do breech deliveries?
  10. What would you suggest if I had another breech baby? (Before labor? During?)
  11. At what point do you arrive at the hospital during labor/delivery?
  12. What labor positions do you recommend to your patients? Do you encourage movement during labor?
  13. How much fetal monitoring do you routinely use during labor? Intermittent?
  14. Do you allow light eating/ drinking during labor? Does the hospital?
  15. Are you OK with No IV – but a Hep Lock?

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