Posted by My OB said WHAT?!?.
Nov
29
Posted by My OB said WHAT?!?.
“…You Can Still Have ‘Natural Birth’ If You Want.”
“But you can still have ‘natural birth’ if you want.” – OB to mother, after explaining how a mandatory IV, artificial rupture of membranes, internal monitoring and manual exploration of the uterus after birth are all required in order to VBAC.
There are 41 comments to this post.
Does “manual exploration” mean what I think it means?
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Details Reply:
November 29th, 2011 at 5:28 am (Quote)
Yes, it does and it is very dangerous. Doctors have been known to poke holes in uteri while exploring, not to mention the potential for infection.
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road2vba2c Reply:
November 29th, 2011 at 6:32 am (Quote)
…and then blame the hole on the VBAC…
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Jessica Reply:
November 29th, 2011 at 5:56 am (Quote)
Ok I know a baby comes out of there but Im wondering how a hand would get up there? And wouldn’t that hurt like hell? I think if someone did that to me theyd have a broken face from my foot!
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NMal Reply:
November 29th, 2011 at 8:42 am (Quote)
Me too! Now I feel really ignorant about anatomy. I thought I knew, more or less, what was where– but I can’t figure out how someone’s hand would get into one’s uterus. I guess the cervix would still be dilated… but omg! that’s disturbing.
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Details Reply:
November 29th, 2011 at 9:18 am (Quote)
I’m thinking the 4 inch dialated cervix is only a slight problem, but the vagina which has not only diameter, but also length would be the whooper of a problem. Imagine putting your hand in a mayo jar, Now imagine that the neck on the mayo jar is 3 inches long, kinda more like a vase.
And the reason he wants to check is so he doesn’t get a call 3 hours later saying, “She appears to be bleeding internally. You need to come back and do exploritory surgery and close up any openings in the old scar.” So to solve that problem he wants to feel his way around in every case rather than sit by her bedside and watch and wait and see what might be required case by case. Afterall you have to make it one size fits all even if the end result is poking a hole and introducing infection by having your hand in her uterus, your wrist at her cervix and however much arm it takes to get that far in. BTW this techinque was declared dangerous prior to 1994. No doctor should be doing it or even talking about it.
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Sheva Reply:
November 29th, 2011 at 9:42 am (Quote)
Yep. I have two friends who’ve had it done. It’s apparently hell. One agrees to it – her doc says it’s necessary. The other one yelled at her doc to take her hand out, but was ignored – and they kept me out of the room til the doc was done.
And, yep, the whole hand goes up in there.
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Kim Reply:
November 29th, 2011 at 3:04 pm (Quote)
Most painful thing I’ve ever experienced, hands down! And I’ve had 3 babies (1 unmedicated, 1 c-section and a VBAC with a 6 hour long transition stage). In my situation, the placenta came out in pieces and I was losing a lot of blood. Dr. had to reach up there and try to get the pieces that were still attached. All the while, telling the nurse to get some O+ for a transfusion and to prep the OR if he couldn’t get it out. Yeah, that was fun…
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road2vba2c had this to say,
Nov 29, 2011 @ 5:07 am (Quote)
That’s ridiculous…
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What I don’t get is: how in the world do people come to think that adding risk-carrying interventions that do nothing to address the actual risks of a VBAC make the whole process SAFER?
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Jenny Islander Reply:
November 29th, 2011 at 8:26 am (Quote)
Well, sure–it helps the OB feel safer because the OB has control. The mindset is that an OB is not caring for a patient: the OB is solving a problem. If the patient protests, the patient is getting in the way of solving the problem. With this mindset it is easy to dismiss the patient’s concerns for her own safety. Silly patient! The OB is in control so obviously the situation is safe.
Except for the part where the OB’s attempts to control the labor actually put the patient and the passenger in danger. But that’s unpossible!
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What emergency would be so immanent that you couldn’t have time to set an IV? Would that be because you wouldn’t be receiving the individual care as you would with a midwife, who would in all likelihood recognize there is a problem in enough time to deal with them (and transfer from a home birth)? Instead you want to add to the risk factors by introducing foreign objects into my uterus and child (and internal monitoring is NOT harmless, you should see the scar on my son’s head!) Run away, VBAC is best when left alone with educated professionals on your side.
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Melissa Reply:
November 29th, 2011 at 10:22 am (Quote)
When something catastrophic like a uterine rupture happens, blood gets shunted away from your arms (where an IV would be placed) to vital organs, collapsing veins and making it very difficult to start an IV in a hurry, which you need to administer fluids and general anesthesia. Ruptures usually aren’t slow either; they happen quick. True that their pretty unlikely even with a uterine scar and pitocin augmentation (which would only happen in a hospital) increase risk, but yes, there are situations for which you would want a saline lock in place before an emergency happened, even with one to one care.
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Jessica Reply:
November 29th, 2011 at 10:57 am (Quote)
I had a uterine rupture with my 2nd, before labor even started. I had no idea what was happening besides I was bleeding alot! Went in and they thought it was a placental abruption. They didnt have any trouble getting an IV in me, and from the time I started bleeding until I had her was almost 4 hours, they took their good old time monirtoring me before they did anything. And if they absolutly had to, couldnt they get a vein in a leg or neck or somewhere else?
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Robyn Reply:
November 29th, 2011 at 3:02 pm (Quote)
Actually, from the stories of women who have undergone repeat c/s after attempted VBAC because of uterine ruptures are pretty easy to spot long before they become catastrophic. There’s unusal pain that is completely different than the contractions themselves. There’s also the fact that labor will often stop. Not just stall, but completely stop.
I can understand how it may seem that it would come on quickly, though, in a woman who’s numb from her nipples down and you’ve got a doctor prescribing pitocin to bend the will of an uncooperative uterus.
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Melissa Reply:
November 29th, 2011 at 4:45 pm (Quote)
It depends. I’ve sudden ruptures in unmedicated women.
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Knitted in the Womb Reply:
November 29th, 2011 at 8:34 pm (Quote)
Melissa, based on research statistics you would need to attend 400 unmedicated VBAC’s (no induction, no augmentation) to see 2 ruptures.
In my area even VBAC’s are sometimes induced or augmented. And of course the majority are getting epidurals–perhaps up to 90%. So for you to see “ruptures” plural in unmedicated cases, I’d think you would have to attend at least 1000 VBAC’s–possibly as high as 4000–lets not even consider how many you’d have to attend to get “ruptures” plural that result in instant vein collapse and other “nasty, nasty things.”
Of course if you are seeing a lot of Cytotec inductions the numbers drop a bit…one rupture per 20 births…so you’d “only” need to attend 40 without epidurals to get 2 ruptures…but still…that would be 100-400 total VBACS just to get the unmedicated ones…and how many more to get the “nasty, nasty” ruptures…
I’m curious as to where you have been so blessed to work that you’ve seen so many VBAC’s?
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NavelgazingMidwife Reply:
December 1st, 2011 at 12:36 pm (Quote)
The only URs (in about 900 births/40+ VBACs) I’ve personally seen were 2 primips being induced with pitocin.
However, in my community alone, there have been just under a handful of URs in homebirthing women, one before labor even began and before 37 weeks.
I don’t think it would take that exhorbitant number of VBACs to see URs, especially not dehiscences. But, if the OB keeps his hands out of the uterus, the dehiscence will probably not be seen/felt.
Also, I’ve had to do 2 manual explorations of the uterus in 29 years of birth, one for a cord that fell off (no, NOT CCT, either) and the other for a hemorrhaging mama. It was rather easy to push the fist/hand into the vagina & then uterus… no resistance at all. Doing this right after the birth is *totally* different than doing it even an hour later. It isn’t pleasant for anyone, but a midwife/doc worth their salt explains while doing. I’ve seen manual explorations in the hospital and they’ve seemed *much* more painful than the two I did (according to the moms).
One last thing. A saline lock is a tiny, tiny bit of insurance should the small risk of the shit hitting the fan occur. Getting an IV started in a woman hemorrhaging 1) isn’t easy 2) is a waste of personnel when ALL hands should be helping the mom stop bleeding/get blood. I’ve witnessed one of the rarest of the rare obstetric complications… an amniotic fluid embolism… and I promise, trying to start an IV in a woman with DIC would have been beyond tragic. This is one “intervention” that I believe is worth its weight in gold.
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Knitted in the Womb Reply:
December 1st, 2011 at 2:22 pm (Quote)
I stand by my numbers. The research consistently shows a 0.5% rupture rate for spontaneous VBAC…which works out to 1 rupture for every 200 VBACS.
Of course there are going to be some care providers who attend 50 spontaneous VBACs and get two ruptures, while some attend 350 VBAC’s before they get to 2 ruptures…that is how “averages” work out (just like I had 2 breeches in my first 10 clients for a 20% breech rate…even though the over all breech rate is supposedly 4%–by the time I’d gotten to 100 clients my breech rate was down to 6%).
And yes, there have been ruptures in home birth in my area…two of them that I know of in the past 5 years. Both in the same woman. VERY sad, my heart breaks for her.
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xanthina Reply:
November 29th, 2011 at 3:54 pm (Quote)
All else fails, there are these two huge arteries in your neck. I was taught that when “normal” fails, there are alternatives, and ones that can save your life. When my dad was in the ER, they got the NICU nurse to stick his IV, because he was so dehydrated.
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Melissa Reply:
November 29th, 2011 at 4:41 pm (Quote)
IVs don’t go in arteries, they go in veins. And I for one would way rather have a saline lock than a central line.
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xanthina Reply:
November 30th, 2011 at 1:17 am (Quote)
Thank you for the correction, I will admit to not knowing everything. 
The heplock/saline lock causes me to go completely stiff. IF I was in that situation, I’d rather need a line, than have a lock that will cause me to freeze.
But that is were the ability to decide what is right for me, and you for you, becomes so important.
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Allison had this to say,
Nov 29, 2011 @ 9:15 am (Quote)
Ok, I can kind of see a saline lock because, sometimes IVs can be tricky in a hurry, depending on the skill of the nurse, hydration of the patient etc. I know they are really annoying though. (Spoken as a nurse who does not work OB and is not great at IVs, who has had 2 homebirths)
But the rest of this crap varries from overkill to downright dangerous. Run. And I’ve never understood why AROM is desirable except under very specific circumstances.
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My point was that there was NOTHING AT ALL in any way at all, anyone could call ANYTHING in this type of birth, “NATURAL”!!
An IV is not natural. Nothing natural about having an internal fetal monitor on. I don’t naturally want to stay in bed when I’m in labor.
The OB has no idea of what a natural birth looks like. Unmedicated, yes. But what woman would want to go through THAT without medication?!
I shook his uterus-exploring hand goodbye and found a midwife.
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Rebecca Reply:
November 29th, 2011 at 11:53 am (Quote)
Hope you got the birth you wanted with a midwife.
I really wish doctors would quit confusing “vaginal” delivery with “natural” delivery. Yes, in both cases the baby comes out through the vagina, but the rest of the process can be different- and there are many shades in between.
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v had this to say,
Nov 29, 2011 @ 12:58 pm (Quote)
Wait..so you have to agree to a doc having their arm inside your vagina prior to labor in order to be “allowed” to labor? Someone would have to be deperate to agree to that. What a twisted way of thinking on the doc’s part!
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Knitted in the Womb Reply:
November 29th, 2011 at 8:39 pm (Quote)
At least these women are getting warned. With the more and more aggressive cord pulling to deliver the placenta that I’ve been seeing in the past few years, I’ve seen a drastic increase in manual exploration of the uterus to get clots out–this in women with no prior cesareans. As in I only saw it done ONCE in my first 7 years of being a doula, but I’ve seen it done at least 5 times in the last 3 years. Its awful.
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Yes I got the VBAC I wanted with a midwife and then 4 homebirths. Find out more at http://www.birthingtheeasyway.com.
I learned the hard way to birth the easy way!
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Well, I would agree that a VBAC should at least have a heplock in case of an emergency. That’s a pretty mild intervention for safety issues. The rest? Find another Dr.!
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BeckyJ Reply:
November 29th, 2011 at 7:33 am BeckyJ(Quote)
I tend to agree. If I had been at the hospital this time, I wouldn’t have refuse an IV line being placed, but it wouldn’t be used unless it was an emergency.
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