In Honor of Cesarean Awareness Month: a continuation of a Tale of Two OC Hospitals.
I had 2 first time moms in one of my Hypnobabies Classes. Their births were similar in many ways – but had different outcomes. In a large part due to the choice of their care providers and birth locations.
Mom 1 – Addison was birthing at hospital A, my favorite hospital (lowest cesarean rate, high VBAC rate, low episiotomy rate, no inductions before 40 week rule) with a care provider who has low intervention rates. This mom was tiny and I was glad she was with this care provider. Many others would have tried to scare her into a cesarean.
Mom 2 – Cara was birthing at hospital B, (higher cesarean rate, low VBAC rate, elective cesareans “encouraged” by many OBs) She had a care provider I didn’t know. But Cara was nervous about the care provider and asked my opinion a few times about changing. I encouraged her to interview other care providers and gave her some options of those who are supportive of NCB. But in the end she chose to stay with him.
If you were to guess right now, which one ended up with a cesarean, you would probably be right. I asked these moms if they were willing for me to share their birth experiences so that other moms can learn how choosing your care provider and your birth location can have a big effect on if you end up with a cesarean or not.
Here are their experiences. Tomorrow I will compare the two and look at what may have made the biggest differences.
Mom 1 – Addison
Early in her pregnancy she asked about their induction policies and about her cesarean rate.
The OB told her that they “only induce when it is medically necessary.” She also said, “We only do cesareans when mom or baby are at risk. C-sections are harder for baby and mom to recover from. This makes it harder for me, because I am worried about mom and baby!”
This helped Addison feel confident that her care provider was the right one for her.
39.5 weeks: Addison’s birthing time starts on it’s own.
Saturday night 8 PM her pressure waves (pw) were 5 min apart she went to the hospital. She got sent home because she was 1cm.
Sunday morning at 9AM, her pw were 3 min apart lasting up to 90 seconds, she went to the hospital again, but was sent home again because she was still 1cm.
3:30 Sunday afternoon she went back to the hospital – She was 3cm! Yay! She gets checked in and settled in her room.
The nurse did say, “If you want an epidural let us know.”
It was not mentioned again until Addison brought it up.
5 PM Sunday Addison gets an epidural so she could get some much needed rest. (She was still 3cm)
Midnight (7 hours later), she is still 3cm. Her care provider brings up trying pitocin. Addison asks to wait another hour to see what happens and says, if there is still no progress, then I am willing to try it. The care provider was fine with that.
An hour later, still no progress. So they start the pitocin at 1ml. The baby heart rate drops so they stop the pitocin. This little bit was enough to get things started and she starts to progress.
In all this time a cesarean was never mentioned.
5 AM Addison started to push.
Her baby girl was born vaginally at 6:10 Monday morning.
Mom 2 – Cara
EDD from known date of conception is Dec. 1st. When change to new OB midway through pregnancy he changed due date to Nov 27th based on 18 week ultrasound. Mom still considers Dec 1st as EDD
Monday, Nov 30th Cara has an appointment.
Her OB does a vaginal exam and finds she is 0 cm 0 effaced. OB says we need to do cesarean. This baby is not coming out on own.
She says “I’m not even due yet.”
OB’s response is “I know you think your EDD is Dec 1st, but in the chart it is written down as 11/27.” Her OB did mention induction, but because her Bishops score was so low it was unlikely to work and she would end up with a cesarean anyway.
Cara had been concerned about the baby’s activity level, so she schedules a cesarean for Thursday and her OB sends her to hospital for monitoring. The baby is doing great, so Cara calls to cancel the cesarean.
That evening she loses her mucus plug. While out to dinner with her DH her pressure waves (pw) start and they get more intense as the night progresses.
2AM Tuesday morning they head to the hospital, because the pw are 5 min apart.
She gets to the hospital and she is 2.5 cm dilated. They admit her to the hospital. Cara’s nurse is excited and says she has a good chance for a vaginal delivery.
Once she is checked into her room, her pw space out and don’t have a normal pattern.
6AM pitocin started to help get pw regulated.
Nurse comes in soon after the pitocin gets started and announces, “The best anesthesiologist is about to go off shift. Do you want an epidural?”
Cara was managing her pw ok, but she was nervous that with the pitocin they were going to get harder to handle and who wouldn’t want the “best anesthesiologist”? Cara says yes to the epidural.
7 AM epidural is placed and she is 3.5cm dilated.
With the epidural Cara found that she couldn’t really rest. She felt shaky, her legs felt tingly and time seemed to pass so slowly. She felt disconnected from her body and wasn’t sure it was doing anything.
(At some point maybe around 9AM, I called. Cara had called the day before when her OB said she needed a cesarean. I had left a message the day before reassuring her that her body knew how to birth a baby, but didn’t hear back, so I called again. I was thrilled to hear her birthing time had started on its own. I was a little nervous, because of her OBs comments the day before. I thought, “If she hasn’t had this baby by 5, he is going to want to do a cesarean.”)
1PM she is 100% effaced and baby has dropped more into her pelvis. But she hasn’t dilated any more. The pitocin was upped to the max, and they had to turn it down a bit because she was having too many pressure waves.
The nurse told her “If you haven’t progressed anymore in an hour we will do a cesarean.”
2PM she is checked again, “no progress” had been made. Cara had mentally prepared herself for this reality and because she isn’t really comfortable, even with the epidural and she is ready to meet her baby, she is ok with moving forward with the cesarean.
2:30PM her baby boy is born via cesarean! Cara said the best part is that the anesthesiologist really encouraged her to watch while they took the baby out. She wasn’t sure about that, she was scared to see herself cut open. But he reassured she would see the baby, not herself. So she did watch and thought it was awesome. That experience of seeing her baby come out helped it to be a positive birth experience. She felt connected to him and the birth experience.
She tells moms all the time now, to take that opportunity if they need a cesarean.
(Looking back Cara says she wishes she had waited longer to go to the hospital and also that she had waited to get an epidural.)
Can you see how hospital policies and staff attitudes can effect the outcome of a moms birth? What are your thoughts? I will share my insights tomorrow.
This is an interesting look at these two hospitals. I delivered at Hoag. I had a fantastic care provider, and nurses that were very supportive of natural birth (they just didn’t have a clue HOW to support me, but I think that can be true of nurses anywhere). Ultimately, because I had premature rupture of membranes and was given pitocin, I chose an epidural that I did not want. But even though my water had been broken for 24 hours+, no one ever mentioned a cesarean to me. I ended up having a great vaginal birth.
What I did want to mention about Hoag that I really appreciated is that they are the only hospital in Orange County (to my knowledge) that is certified Baby Friendly. This meant that they encouraged immediate skin to skin contact, immediate breastfeeding, and delayed eye ointment and vitamin k. My baby was never separated from me, and all necessary procedures were done in my room with me. For moms choosing a hospital, these things DEFINITELY matter – especially for getting breastfeeding started the way it should.
If I had to have a hospital birth again (which I wont 🙂 ) I would still deliver at Hoag, and would make sure I had an OB that was very supportive of natural birth.
The glaring difference I see is the doctor and hospital’s willingness or unwillingness to wait for dilation. Or rather, to trust in the mother’s body to do what it needed to do.
Addison was 3 cm for 7 hours and they could have decided at any point that it wasn’t fast enough for their satisfaction, but they didn’t. They waited and she progressed well. When her baby was in distress they identified the source of the problem and took care of it.
Even though Cara was also at about 3 cm for 7 hours, she did have progress (effacing and descent), and that should show that her body was doing what it was supposed to do. I also don’t see anywhere in Cara’s story that the baby was in distress. It sounded more like she was tired and the insistence of the staff eventually wore her out to the point that she agreed to the surgery. I also don’t understand why they turned her pitocin up so quickly to the point that it was maxed out within a few hours. They could have turned it up more slowly and allowed her body to work with it rather than trying to make the pitocin take over.
As a side note, I read something today about how synthetic oxytocin can actually cause a mother’s body to produce less natural oxytocin. Essentially, the presence of the synthetic can slow or stop the natural labor pattern.
There’s more to it than this, but those are my initial thoughts.
I think in Cara’s case the cesarean mentioning was coming from the OB. I only guess that because of how he wanted to do one before her birth even started. I think this is why choosing a care provider is as important as choosing a birth location!
When it comes to birth, it seems like so many doctors are just so impatient. Like so many things in our society, it seems like everything is such a rush. Why? Why do we need to put a time limit on a natural process? I know that sometimes there are legitimate medical reason for not letting things progress on their own, but it doesn’t really seem like that’s the case a lot of the time. I wish that more women could just experience a more accepting, more “go with the flow” type of environment!
I love reading this blog and learning more about birth. I recommend it to all my maternity clients I photograph and also list it on my Resources page! I used Hypnobabies with my birth and am so thankful I did that =) Trying to pass it forward!
Hi great blog. I’d like to share my experience. I live in Sinai, Egypt and planned for a homebirth with a very experienced Russian midwife. I have all the hypnobabies cd’s and hoped to birth using them. The local government hospital is 5 min. from my house. A few days after my due date I went into labor at home in the evening. By the next morning late my pressure waves were intense so I called the midwife. Midwife said I was 5 cm dilated and all ok. A bit later with very intense pw I started to bleed. Midwife said maybe it’s the placenta. I freaked out. We called an ambulance and went to the hospital. At the hospital dr.s said it was ‘excessive show’ and nothing to worry about. So I calmed down and went to a room. Dr’s wanted to start pitocin but I said no. They shouted at me and then made me sign forms releasing them from liability. They were very rude and violent in their language. Then one dr. said I was fully dilated but I felt no urge to push. Stayed with a female intern in my room trying to push baby into birth canal until she said that head was not leading the way. So went to the delivery room with the stirrups and all of it and one big dr. laid on my stomach to help push baby out. Her arm was coming first. She was born fine so problems at all. I could have walked out of the delivery room and was perfectly fine exc. for the episiotomy which is standard for most births in hospital here. My suggestion to any mom planning a homebirth with a midwife (or without one) is to have an obgyn whom you trust to be on call for ‘plan b.’ So if you have to transfer you won’t be shocked or traumatized by the birthing procedures at the hospital which were very different from what I practiced with hypnobabies. Ie. yank the placenta out right after birth, give you antibiotics without asking you. Luckily I had the dr.s give me the eyedrops for the baby and I threw them in the rubbish! I think many obs just don’t have any knowledge or experience with natural birth or the natural stages of birth so they just don’t know.
Thanks for sharing your experience and you make a great point that you should have a good OB back up when planning a homebirth.
Interesting difference between the two… I live in OC and am switching providers from one who delivers at Hoag to one who delivers at Saddleback. I was wondering if you can e-mail me the name of the provider in the first example? Sounds like the kind of person I would want on my side!
So please tell us, WHAT is the name of the truly vbac friendly hospital? I’m desperately searching for one right now and not having much luck.
I live in Long Beach and am willing to travel. My current OB delivers at two hospital in Torrance that “allow” vbacs, but you have to obey their 18 month rule between births….no exceptions. I’ll be 13 1/2 months….
Saddleback is I think more VBAC friendly.