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Monday, April 19, 2010

VBAC- Finding a Midwife

I have had several people over the past few months asking me about finding a care provider to support their decision to have a VBAC (Vaginal Birth After Caesarean).

Each pregnancy after the Caesarean birth of my eldest son, was a struggle to search for a midwife.   Why a midwife?  Because I KNEW without a shadow of a doubt that if I had chosen a Doctor in a hospital setting I would fail.  I knew that I wanted to labour and birth at home and that going with  a midwife was my only option.  And of course there is the fact that the model of midwifery care was so much more appealing to me:  Being with the same two care providers for the entire pregnancy, knowing that THEY would be there for the birth and that I wouldn't be subjected to the laws of chance with what doctor I would have when labour started.  Not to mention the fact that midwives have much lower statistics for Caesarean Sections and unnecessary medical interventions.

With each of my pregnancies I had to search for a midwifery group to take me on- and the searches became far more involved and difficult after each C/Section. What finally won out in each case was perseverance!   (That and the fact that many of my emails to Groups said things like "I'm having a home birth regardless of whether or not I can find a midwife!"...)

The following is a copy of the letter that I sent out to just about every Midwifery Group in SW Ontario.  Feel free to use it as a basis to write your own!!

Good morning,

I would like to introduce myself...and then beg for your help.

My name is Danielle Arnold, I am a breastfeeding and natural childbirth activist and co administrator of Natural Mothering. I'm also a mother of 4 and due mid February with baby #5.  My family and I have recently returned from Africa, from the Democratic Republic of the Congo.  Since arriving back in Canada in Sept. I have moved and settle my family in Brantford ON, and I am now trying to find a maternity care provider.

I realize that this is very short notice, but I am desperate to find a midwife or obstetrician to support my need to have a VBAC birth.

Let me give you a brief synopsis of my birthing history.

My eldest son, 1991- born at 38 weeks after my water was "accidentally" broken, failed induction followed by, of course, a caesarean section.

When I became pregnant with my eldest daughter in 2002 I knew I did not want to repeat my experience in a hospital birth. We found a midwife and had a  natural home birth.  10 hours of active labour and 35 minutes of pushing.

When I was pregnant with our youngest daughter (2005) we moved across the country  to Kamloops BC, and I made the shocking discovery that there were no midwives within a 3 hour drive of our city.  Back to the hospital, and another OB and another very negative experience. I ended up with a slow posterior labour. Tsking OB's telling me that I'm endangering my baby..... exhaustion and no support, I gave in and allowed them to do a C/S.  As far as C/S's go it was very easy and the recovery was quick and relatively painless.

Then came my pregnancy with my youngest son in 2007.  We had moved back to the Toronto area and I spent 4 months trying to find a midwife who would take me on for a home birth.  Finally I found a lovely midwife in east Toronto.  We found an OB to consult with at Toronto East General, and he agreed to my TOL.  By 41wk5days I'd been in and out of prodromal labour for over a week, at 3-4 cm and fully effaced.  When I called my midwife, while in early labour  she was uncomfortable with our home birth plan and advised  that we transport. The OB on duty (NOT our consulting OB), was a completely obnoxious man who screamed at me and my husband, told us that we were trying to kill our baby, alluding that we were horrible parents etc.....and yet again I ended up agreeing to another C/S- though this agreement was completely made under duress:  I was left feeling that I had no support and no say in the decision.

This is where the main difference comes from my previous C/S births.

First of all the spinal block  did not take on my upper right quadrant,  no one would listen to me when they started the surgery.... when I started screaming at them "I can feel that", the student anaesthesiologist (yes, it was a student who placed the spinal block....again, against my wishes) pumped me full of Ketamine- Instantly I was out of my mind.  I couldn't see or hear anything... but I could feel everything.  By the end of the surgery I had managed to get control of myself again and was at least verbal and aware.   They took us to the recovery room and left us there.  I managed to nurse my son with a lot of help from my husband, and when the nurse came in I asked for painkillers. (as the spinal block hadn't taken in the upper right abdominal area, neither did the painkillers)  She said that she would find a doctor to get the "OK", and that I would be moved to my room in the next 1/2 hour ........ 3 hours later I was still in the recovery room, hadn't seen a single medical staff member and still had no painkillers.  My husband finally stormed out to the nurses station and demanded that someone come look after me and get me moved to my room (the previous nurse had forgotten to tell anyone that I was there.)  2 days later I went home and 2 days after that I returned because I KNEW that something was wrong- that I wasn't getting better.  It turns out that the surgeon had stitched an abdominal nerve into my internal stitches.  Solution: NONE.  I was told that I just had to wait till the internals 8-10 weeks.  So I spent the next 8wk5 days hunched over , unable to walk straight, unable to carry my new born baby. Because of the huge amount of drugs for pain they had me on (they had to keep changing them because of the reactions I had- such as ulcers...), I have almost no memories of my son's first 9 weeks of life.

Needless to say I do NOT wish to have a repeat Caesarean Section.

As I said at the beginning of this long winded letter, I am a Natural Childbirth advocate.  I have done more research on the topics of VBAC births and C/S's, medical interventions and the statistics involved than most maternity care providers.  I am VERY well aware of the risks of uterine rupture  during a TOL VBA3C, probably more so than most medical professionals.  I am also VERY well aware of the risks of having a 4th C/S, to both my self and my baby. I am not an unreasonable woman, I am not someone looking for that miraculous all empowering feminine experience who wants to have a Home water unassisted lotus birth in the back yard in a teepee... so that I can say that I did.  What I am is a well researched, knowledgeable mother that wants what is best for myself and my baby.  Which is NOT a scheduled caesarean section.

I do not expect any midwives to agree to allowing me a TOL HBA3C... as much as I detest the necessity, I realize that Ontario midwives are bound by the rules of the Ontario Midwives Association and the "guidelines' of the hospitals that they have privileges in.  But I need someone to support me in my wishes to have a vaginal birth in a hospital.  I NEED someone to go to bat for me with the hospital administrators and obstetricians , to say "this woman knows her situation and knows the information and knows the statistics and knows the risks involved and wants to have a Vaginal birth."  Someone who will guide me in my quest to make this a reality.

Because the truth is this:  This is my body, this is my baby, this is my birth.  I am the only one that should have the ability to say how and where I will birth my child.  I should have the right to say "NO" to a scheduled caesarean section.  I am aware of the legalities and I know that a hospital can not force me into a medical procedure that I do not allow.  But I also know enough to know when a C/S is necessary and am willing to work within those parameters.

So please:  I need your help.  I do not care how far I have to travel to have my baby.  I just want to find someone who will support my informed decisions and will stand by me.

I am looking forward to speaking with you further, and hope to have the opportunity to convince you that I DO understand all that is involved in my decisions.

Danielle Arnold