By Jill Arnold
This article is part of A Woman's Guide to VBAC: Navigating the NIH Consensus Recommendations, a collection of resources that address the most common and pressing questions women may have about their birth choices. View all sections in the guide, including a link to the authors, on the index page.
Talking to your care provider about VBAC can be a sensitive issue. Members of the American Congress of Obstetricians and Gynecologists have confirmed that concern over liability is a main reason they do not offer trial of labor to their patients. Some evidence even shows that younger obstetric providers are less willing and interested in allowing their patients to labor.
In addition, care providers, even those who are supportive of VBAC, can feel torn between their unease about what they can and/or want to discuss with their patients and their ethical obligation to deal honestly and openly with patients at all times. Women report feeling strongly influenced by their care providers' recommendations, even though recommendations are likely to be influenced by the care provider's fear of being sued (defensive medicine), rather than what is in the best interest of the woman or her baby.
In the United States, many women's choices for care provider and birth setting are limited by finances and/or insurance and Medicaid requirements. Regardless of insurance status, all patients have the right to make informed decisions about their care.
From choosing a care provider to talking about specifics of labor, asking questions is the best way to learn about your care provider and develop a relationship with them (or find someone better). Typical prenatal visits with a doctor are shorter than 10 minutes, so make a list of any questions before your appointment and write down notes on what you will research later. Please do not worry about your questions seeming annoying or time-consuming: you have a right to ask these questions in order to help you make informed decisions about your and your baby's care. If your care provider shows a pattern of not wanting to answer questions, you have the right to switch to one that listens to your concerns.
If you are seeking midwifery care, especially in an out-of-hospital setting, your prenatal visits are likely to be significantly longer and more focused around your specific concerns and questions. Prenatal visits in a birth center practice are typically at least 30 minutes long and with a home birth midwife are typically one hour long, providing ample time to ask questions about risks and benefits, back-up plans, under what conditions you might be risked out of their care, etc. Depending on the midwife's arrangements for collaboration with and referral to obstetricians, you may or may not have an opportunity to ask questions ahead of time of the doctors who might assume your care in labor.
Perhaps you've found a care provider who says they attend VBAC, but you recognize a large disparity between what they say and what you read in the NIH VBAC Conference Panel Statement. You can ask them about the gap between evidence and their practice or philosophy to try to clear up any misunderstandings. If their reasons are not satisfactory, it might be a sign to move on. There is no obligation to that care provider to stay in their care. If you feel it would be in your best interest to search for another care provider at any point in your pregnancy, it is up to you to be proactive. If this feels overwhelming, enlist the support of a partner, family member or friend to help make calls, set up appointments and get details squared away with your insurance company.
It’s Your Decision
When you find a care provider who is committed to supporting your decision for your birth, it is still important to discuss the spectrum of risks and benefits of trial of labor and elective repeat cesarean delivery. You are free to change your mind at any point during your pregnancy. Reading, talking and asking questions will help you weigh whether or not elective repeat cesarean delivery is a reasonable option for you.
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