Give Yourself Every Possible Chance To Have A Vaginal Delivery

"Once a cesarean, always a cesarean," doctors used to say. Today this rule no longer stands; VBAC -- vaginal birth after cesarean -- is often the childbirth method of choice the next time around. Diana Korte, author of The VBAC Companion: The expectant mother's guide to vaginal birth after cesarean offers these tips about how find the help you need to help you get the birth you want.
Diana Korte

Find a compatible caregiver
Look for the professionals who offer what you want, instead of trying to fit what you want into what they do. This is true whether you want a high-tech pregnancy and birth or whether you're looking for a midwife to assist you with unmedicated childbirth. As you interview possible doctors and midwives, eliminate the people who you know will not give you what you want. Remember, you're looking for cooperation and enthusiasm, not reluctance.

If some of the healthcare providers you interview tell you that your ideas are unsafe or unnecessary, isn't it better to determine their attitude early while you can still change doctors more easily? When calling hospitals, ask about everything on your birth plan list. Don't assume that if you're breastfeeding, they won't offer your baby formula in the nursery. Don't take for granted that if they have a Jacuzzi for laboring women to help relieve labor pain, it will be available to you. Ask first.

I started with a big upscale OB practice with seven OBs and, as I found out, seven different opinions on how to treat a VBAC. One doctor said external monitoring was fine; another wanted an internal pressure catheter, et cetera. At thirty-two weeks, I finally got the nerve to investigate the other OB practices available through our HMO. I actually interviewed the doctors about their VBAC procedures, quite a change from my "trust your doctor" mindset in my first pregnancy. I ended up switching to a "no-nonsense" HMO group -- no fancy examining rooms, no classical music piped into the waiting room. They all knew me as the lady who wants a natural childbirth. But they gave me respect and treated me as an educated adult who wanted to be an active participant in her birth experience. I spoke to all four OBs in the group about my birth plan, brought my doula with me to an appointment with the doctor I was least comfortable with, and took a proactive role in my pregnancy. - Alexandra G., Tennessee

What your insurance offers
HMOs, PPOs, point-of-service plans, and even the old-fashioned fee-for-service plans are all bought by an individual company for its employees from one of many giant insurance companies, each of which has accounts with hundreds, if not thousands, of businesses and corporations. Your employer might offer only one insurance plan, but some of you may be able to choose from all of the options outlined here. If your employer offers more than one insurance carrier, you might be able to switch plans only during one designated month in each year.

Unlike the insurance options I've discussed so far, an independent practice association, which is similar to an HMO in benefits, is a group of physicians who contract with several insurance companies -- not just one HMO -- to offer insurance benefits to you or your company.

The financial costs
A decade ago, cesareans added $1.5 billion to the total U.S. tab for childbirth. Today's total cesarean cost is unknown, but surely it's still more than a billion dollars.

If your insurance covers all costs for your birth, then perhaps the price of childbirth, whether VBAC or repeat cesarean, is not a pocketbook issue for you. More and more couples, however, are having to make larger co-payments for hospital charges, whether for extra days in the hospital or for medications. An epidural costs [approximately] $500 to $2,500, for example, depending on the hospital and the anesthesiologist. An extra day in the hospital in 1994 averaged $931, up from $245 in 1980. And at least some insurance plans, especially HMOs, encourage VBACs to the point that all cesareans have to be prepared by the insurance company. If the cesarean is not approved, the doctor does not get reimbursed for the cost difference between a vaginal and cesarean birth.

Interview questions
Ten Interview Questions for a Doctor or Certified Nurse-Midwife

  1. Approximately how many VBACs have you attended?
  2. Of those patients in your practice who wanted VBACS, how many were successful?
  3. What do you think my chances are of VBAC success, given my childbirth history?
  4. What is your cesarean rate?
  5. How do you usually manage a postdate pregnancy or a suspected CPD?
  6. What's a reasonable length of time for a VBAC labor if I'm healthy and my baby appears to be healthy?
  7. What percentage of your patients do you deliver yourself?
  8. How many people can I have with me during the labor and birth?
  9. What is your usual recommendation for IVs, Pitocin, prostaglandin gel, amniotorny, epidurals, confinement to bed, EFM (and so on)?
  10. How close together are your appointments?

Tags: vbac

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