At 38 weeks, Debbie Fields was told by her OB/GYN that he would no longer support her plan for VBAC and gave her the ultimatum to schedule a cesarean or find a new doctor. In this interview, Debbie and her husband Ken each share their perspectives on what happened and how their journey to VBAC affected their lives physically, emotionally and spiritually.
ICAN Blog: I understand you were dropped from care by your original care provider. Tell us about that. What happened?
Debbie: We were dropped about a week and a half before my due date, which was Dec. 20. I had broached the subject of a VBAC with him during the fall. He said he was willing to let me try laboring, provided that I went into labor spontaneously, that I made continuous progress, and that he saw no signs of distress in me or the baby, and he went over the risks, such as uterine rupture. I said my husband and I were aware of the risks, and considered them a low enough chance to be acceptable. The doctor said that about a week before my due date, he would “check” me for progress and “schedule” me if necessary. I took this to mean that he would see whether I had started dilating and effacing at all, and if not, he would schedule an induction at the hospital after the due date. I wasn’t aware then that women with prior c-sections are not usually induced. At the Dec. 3 visit, I signed a waiver form at his request, indicating we had been informed of risks and stating our willingness to accept responsibility for them. At that same visit, the doctor called to my attention an appointment his office scheduled for me, on Dec. 14 at 7:30 AM, to have a c-section at Anne Arundel Medical Center. I asked to cancel it, saying we wanted to wait through our due date. He said the hospital follows a rather strict protocol for patients with gestational diabetes, and said I should talk things over with my husband. We both remained firm in our desire, so the next day I returned to the doctor’s office to request that the c-section be canceled. My doctor was not there, and his partner told the staff they could not cancel it without first getting his permission, so I requested that he call us as soon as he could. We did not hear from him that week; I went to my regular visit on Dec. 10 intending to talk to him. He explained he’d tried to reach us by phone and found the number disconnected. I assume he was dialing a wrong number. When I reiterated our desire to wait through the due date, he said that he and his partner couldn’t support this. He repeated that the hospital follows strict protocols, and said it would be impossible to reschedule a c-section so close to the original appointment date. I wanted to ask him about an induction if we passed our due date with no labor, but at that point he checked me and discovered no progress toward dilation or effacement. He then said, “You can cancel the c-section, but you’ll have to find a new doctor.” I left the office in tears. I had an appointment immediately thereafter at the maternal-fetal specialist who was following me for the diabetes, and the nurses there told me that inductions are not usually given to ladies who have had a c-section. They spoke with the specialist about my circumstances, and he stated that their office was willing to follow me through my due date and up to two weeks beyond, given that ultrasounds showed our baby was average sized and that my blood sugars were well controlled.
Ken: We had discussed early in the pregnancy the desire to have a VBAC. We were more knowledgeable about labor and delivery now although we still had a lot to learn. For our first child we only saw a film and read a little about it, because the person who was to teach us, decided to cancel our training. This time we wanted a decent opportunity to try a VBAC because there were a few more things we had learned and this time we might be able to avoid the difficulties recovering from a c-section. The c-section came after a day of labor. The medication made breastfeeding difficult and the incision got infected. Furthermore, the difficulties of recovering from major surgery don’t end for months. If this could be avoided, we wanted to try.
My wife told me that the OB/GYN said he would go along with our desire to try a VBAC. We trusted him because we shared certain moral and religious views. After one of the later appointments, my wife shared with me that someone at the office had mentioned that we were going to be getting a c-section. She responded that we were going to try a VBAC. We thought this was a simple mix-up since the OB/GYN had said he would go along with the VBAC. After an appointment about a week-and-a-half before the due date, my wife called me at work. She was distraught about the visit because she was told that a c-section was scheduled for about a week before the due date. The doctor had also noted that the hospital would not reschedule and if we did not conform, we would need to find another doctor.
Blog: How did you initially respond to this situation?
Debbie: We wrote the doctor a letter expressing our dismay at his stance, summarizing our recall of events, and stating that we believed he may have illegally abandoned me as his patient, since I was within 30 days of my due date.
Ken: What should we do now? Should we conform and give up our goal? If we leave the practice, who should we turn to in this critical time? Who would even take us?
Was this really wise advice? My mother had been told to not breastfeed because it wasn’t “sterile”. My mother-in-law had been told to smoke during pregnancy in order to avoid excess weight gain. These views are seen as barbaric today, yet that was the advice one generation ago. This made us skeptical of some of the doctor’s advice. After all, what will the next generation see as “barbaric” in our generation? We believe the Bible is true and it seems like God has made vaginal birth as normally being the healthiest way to give birth. As we have discovered, God knew what He was doing when He equipped women with the ability to breastfeed. Why should He be questioned regarding vaginal birth?
We also began to realize that because we had been seeing a specialist, who upon hearing our plight, decided to continue to see us up to two weeks after the due date. How much were we really losing in losing the OB/GYN?
Blog: How did you find another provider and birth place?
Debbie: At the time, I thought we might have to try to stay at home long enough to get well established in labor, and then just show up at an area ER, in order to avoid an unnecessary c-section. A nurse at one hospital whose labor and delivery area I toured that week happened to mention to another patient that doing so could still result in unnecessary tests and hassles, since the hospital would have no record of prior prenatal care. Since I have multiple “risk factors” (gestational diabetes, overweight, age 40, history of miscarriages, prior c-section, and a genetic condition called MTHFR that can cause blood clotting), I decided that it would be best to try to find another provider, even though I was within a week of the due date. To complicate matters, our insurance would be changing January 1, and the weather forecast around our due date included over a foot of snow. While searching online, I discovered the Baltimore chapter of ICAN, and I emailed the chapter leader, Barbara Stratton. It was so encouraging when she emailed me back within 20 minutes, with very helpful information comparing c-section rates of area hospitals, along with other tips. We were able to find a participating midwife at Maryland General Hospital in Baltimore, who actually had a new patient appointment the next day and who was willing to see me. Maryland General has the lowest c-section rate in all of Maryland and D.C., so we were very excited to have a chance to go there.
Ken: We initially thought that we should find a hospital; after all, they would not turn us away at the emergency room. We decided to avoid our initial choice of hospital, because the OB/GYN may have poisoned them toward us. We visited a hospital that had just begun a labor and delivery section. They told us we needed to get our records, because any emergency room we go to will repeat all the tests and may go straight to a c-section out of fear of the unknown. Immediately we pursued getting the records which we were fortunate enough to do in short order. I was also being given advice by my supervisor that we had made the right decision in leaving. He and his wife had been lured into a c-section on their first pregnancy because they were having twins. His wife was pregnant again and they were persuaded to avoid a c-section if at all possible by the film, “The Business of Being Born”.
During this time, my wife had contacted ICAN and we were given some good information regarding our decision and which Maryland hospitals might be the most agreeable to our desires. We decided to pursue the one with the lowest rate of c-sections. My wife visited with their head midwife and she was so impressed with our story that we were the topic of one of the meetings she had with the other midwives. She accepted us but still had to get records from California regarding the incision during the c-section. This led us to believe that the OB/GYN was never intending to support a VBAC. The staff at the hospital was very supportive (the food was even inexpensive!).
Blog: Tell us about your birth. How did it go?
Debbie: From the first appointment through the entire birth experience, we appreciated being given the chance to let things proceed normally, without excessive intervention. The snowstorm, and my due date, came and went without labor beginning, although we’d taken the precaution of staying in a hotel near the hospital that weekend. The evening of the 22nd, I began having contractions regularly. Overnight, they gradually strengthened and got closer, so in the morning I thought we should probably head to the hospital. When the midwife on duty checked, she found I was beginning to make some progress but wasn’t at the point of being admitted yet. Rather than send us home, she suggested we walk, and she demonstrated a position I could use during contractions both to minimize discomfort, and to help assure that the baby was positioned properly. Finally, I was admitted. I kept hearing echoes from our older child’s birth that made me fear I might end up with another c-section: I made slow initial progress with dilation, I felt overwhelmed with pain so I accepted medication, and in the end the baby seemed stuck behind a lip or ledge around my cervix. The radical difference was how the midwife and nurses would respond to these challenges. Instead of immediately turning to pitocin, they eventually offered to strip my membranes and break my water. Rather than make me bedfast with an early epidural, they suggested a lower dose of a temporary medication that would enable me to rest while making progress, and when I did finally have an epidural, it was just enough to be effective, not so much that my labor stalled. They were willing to wait to allow contractions and my pushing do their job to help the baby move further down. And most importantly, when the baby showed some signs of distress, the doctor was immediately brought in, but he monitored the situation and allowed the midwives to try changing my position instead of hauling us off to the operating room. Thankfully, everything went beautifully. I was very trepidatious going into this birth, thinking that I might not be successful with a VBAC. God used the hospital staff and my husband and sister-in-law to support me in every way
Ken: Around the due date, there was a blizzard, so we traveled to a hotel near the hotel just before the blizzard. The baby didn’t come so we returned home a couple days later after the blizzard had passed. A couple days after the due date, in the evening, my wife went into labor. At 3 a.m. we went to the hospital (as we entered Baltimore we saw the remnants of a terrible accident that appeared to have fatalities). They admitted us after a couple hours of walking there (at about 3cm). Since my wife had no rest that night, they gave her some Stadol to help her get some rest. After that wore off, she bravely faced the labor. Our sister-in-law (a.k.a. “Amazon woman” for her ability to avoid all medications during her 7 births mostly at home) later arrived and assisted me in coaching and massaging. Finally, at about mid-day she could take no more and asked (screamed) for an epidural (at about 6cm). After a couple more hours we got to 7 cm, and it appeared things were going to go into the evening, but progress came in spurts. The baby moved forward but seemed to get stuck. After some prayer and pushing, he moved past it. Soon he crowned and again seemed to be stuck with the added complication of a dropping heart rate. My sister-in-law and I had taken turns along with nurses in holding legs (an event that I likened to Aaron and Miriam holding up Moses’ arms in the battle against Amalek), but now the nurse took charge and turned my wife to the side which brought back the heart rate. The hospital OB/GYN and a midwife were in the room, but no one had brought up a c-section. My sister-in-law was even impressed. Finally, our baby was born and we were thrilled. Immediately, he was placed on his mother and a little later enjoyed his first feeding from her breasts.
We stayed for two days (went home Christmas day – what a wonderful gift we were given!) and the staff was wonderful. Since they had heard about us, I think every midwife whether they were appointed to look after us or not, popped in to meet us. The only male midwife (midperson?) on staff told us that they prided themselves on having such a low c-section rate and encouraged us to send to them others who shared our views.
Blog: What did you learn from your experience?
Debbie: For one thing, I couldn’t believe how much better I felt postpartum with a VBAC, even with a Grade 1 tear, than I’d felt after my c-section.
Ken: God answers prayers. God knows best. Find out about the rates of c-section of the OB/GYN and the hospital. Talk is cheap.
Blog: What advice do you have for other women and their partners who find themselves in this situation?
Ken: At work, I’ve already assisted one family to drop their OB/GYN and hospital and have armed another family to be ready in case they are pressured. I would also encourage them to trust in Christ, because the stresses of the situation may have overwhelmed us without the comfort of the Gospel. I teach a class on Song of Solomon and the wisdom of the book which has blessed our marriage makes a big difference in trying to handle these stresses together with my best friend, my wife, my lifetime companion.
Blog: Anything else you want to share?
Debbie: We were so humbled that the Maryland General staff, from medical providers to dietary aides, kept coming in and saying, “Hey, we heard about you! You have a lot of courage–congratulations!” We never set out to be rebels…we sure are glad for the way things turned out.
Ken: Some think we are mavericks or are leaders in a movement against the pressures of unnecessary c-sections. We don’t see ourselves that way. We just wanted what we thought was best. Other countries have lower mortality rates for mothers and children at the time of labor, yet they have lower rates of c-sections. We are doing nothing different than the rest of the world so how can we really be seen as doing something unusual or different?