Wednesday, November 30, 2011

Evaluating Potential Exit Strategies

I need an exit strategy for baby #2 before it comes onto the cervical horizon. I need to KNOW that the care I need will be there when I need it. It's not good enough to have a c-section date at Victoria General Hospital, knowing what I now know about how those are treated at Victoria General Hospital. I could not access the care I needed, when I needed it, last time and I have no reason to believe it would be any different this time. Further, I think Mr. W needs to know that there's an exit strategy before he'll even really risk putting baby #2 on the cervical horizon.

So what are my options:

Option 1: Plan to Deliver at Victoria General Hospital

The only pro I can think of is that it's local. It has a NICU and is a level of 3 hospital. It does not have dedicated obstetric anesthesiology (DOBA). Access to epidurals is questionable, as is access to maternal request c-sections, particularly those without 'medical indication'. The thing is, if I didn't want medical intervention or the insurance that it would be there when I needed it - I would likely plan a home birth. Given my history with this particular facility, I really don't think its a realistic option. At least not one that gives me any piece of mind...

Option 2: Plan to deliver at an Alternate BC Facility

The only hospital that has dedicated obstetric anesthesiology in British Columbia is BC Children's and Women's hospital in Vancouver. I'd be fine planning a delivery there. The problem is that because I'm not likely to be a high-risk pregnancy, and do not live in Vancouver - I do not meet their eligibility requirements for delivering there. I suppose I could find a friend to let me use their address to pretend to be a Vancouverite - but I don't know if I can bring myself to such dishonesty - I shouldn't have to lie to access services. Delivering there is hypothetically feasible, but I find it a huge drawback that I would effectively have to lie to do so.

Option 3: Birth Within Canada but Outside of British Columbia

According to the Health Insurance BC(a.k.a. Medical Services Plan or MSP) it will pay for unexpected medical services anywhere in the world, provided that they are medically required, rendered by a licensed physician and normally insured by MSP. Reimbursement is in Canadian funds and does not exceed the amount payable had the same service been provided in BC. I also note that the maximum that BC will pay per day for in-patient hosptial care is $75. I don't think an elective c-section at term would be considered an "unexpected" medical service - the expected nature of it is exactly what I find appealing (among many other things). Further, given the obscenely low rates of reimbursement of in-patient hospital care (note, I don't think BC incurs such a low expence if care is provided IN BC) - it looks like it might be an expensive option even if it were covered. There would also be travel costs incurred. It is also obvious that the person providing my prenatal care will not be the same person who delivers the baby.

I have enquired to Health Insurance BC about the coverage available for an out-of-province birth.

Option 4: Birth Outside-of-BC and Outside-of-Canada

This option has high travel costs and suffers some of the difficulties with #2, except medical expenses are likely to be even higher. Further, it would bestow upon baby #2 second class Canadian citizenship, which means that my grandchild could risk statelessness if baby #2 also has his or her child outside of Canada in a jurisdiction that does not grant citizenship on the basis of country of birth. If I do birth baby #2 in a country that does grant citizenship on the basis of place of birth, that baby gets the advantage of additional citizenship. It is also obvious that the person providing my prenatal care will not be the same person who delivers the baby.

I have enquired to Health Insurance BC about the coverage available for an out-of-country birth.

That pretty much sums up my options. There is no private option in BC or in Canada for that matter when it comes to giving birth. I cannot pay to guarantee access to an elective c-section at term, or even guaranteed access to an epidural.


  1. What about getting yourself DX'd with PTSD from a psychiatrist? It was my experience that when my psychiatrist backed my planned c-section, it became medically-indicated. I was told that even in the case of a transfer I would have been treated as if I was delivering breech and there would be no attempt at vaginal delivery.

    Given your experience, I am not entirely how true that would've been had I landed at Victoria General, aye, but a DX of PTSD would give you some serious bargaining power now, and I don't think it would be unwarranted, given what you've been through. Once you've got a psychiatrist on board, other specialists are pretty unwilling to contradict his or her advice. To do so leaves them open for accusations of malpractice. I know my OB didn't want to do anything without consult with psych. She is very cautious. My primary DX is CPTSD.

    I know this is not ideal. Ideally, you should be able to simply request a planned c-section and that be that. But if you could find a pdoc who made a good case that your mental health would be significantly compromised prenatally and after the birth, I think you would find an OB more amenable. I know that a few of my friends who have traumatic first deliveries and PTSD have been offered c-section as an option for number two (one of whom took them up on the offer). It's worth exploring, anyway.
    -The Pragmatist.

  2. Hi! Im wondering what you ended up doing?
    Im currently 23 weeks pregnant and am 100% certain I want a C-Section.
    I had a hell of a time, but I finally found a doctor who will grant me one,
    but it has to be at Surrey Memorial Hospital; and I've heard horror stories from him.

    Since I do live in the Lower Mainland, I was thinking of trying to get into BC W& Children.
    I heard they are fabulous and I am a big advocate for skin to skin after cesarian, and I dont
    want to be seperated from baby if at all possible. Seems to me that the doctors at BCW&C are
    advocates for you and your rights....Im just scared that they will dismiss me as Im young and likely "capable of natural birth" in their eyes.

    any insight into what you did, how your experience was, and any other advice would be great. My email is

    Thanks :)