Friday, December 30, 2011

Ending the Loneliness of CDMR

There's a group of women, in Canada and in the US, who are poorly understood, often marginalized, and sometimes maligned. All they really want is the right to choose what happens with their own bodies. Most of them are highly educated and well informed. Most of them would fight for another woman's right to informed choice, even if that choice is different from her own. They understand that there is no one 'right' way to birth a child, and that birth, like most other life decisions is very contextual.

Yet, these women are labelled 'Too Posh to Push'. These women, if they are open about their choice, must continually defend it to others. Some achieve their plans. Others do not. For those who do not achieve their plan - it is a lonely place. There is no 'denied elective cesarean awareness network'. There are reams of classes, books and resources for those planning a vaginal birth, a home birth, and a 'natural' birth and plenty of support and sympathy for those who planned but did not achieve that vaginal birth plan. The same cannot be said for those who reject the notion that a vaginal delivery, or at the very least, a trial of labour, is the price of admission to motherhood. The resources are sparse in comparison.

There are a few bright lights, and they are making progress. Pauline Hull of the UK is an amazing resource. Her website and blog are both worthwhile reads. Ms. hull has been instrumental in the recent revisions to the NICE guidelines which give women the right to choose a cesarean delivery. Ms. Eckler is a Canadian journalist who has written about her choice. Dr. Magnus Murphy has co-written a book with Ms. Hull. The birth trauma organizations in both Canada and the UK are also supportive of the cause.

There is as of yet no, 'Cesarean by Choice Awareness Network of North America'....perhaps that is what really needs to change. We need a community and a voice of our own, and moreover, we need to be heard.

So as of today, I, Mrs. W, am venturing on a new project, "The Cesarean by Choice Awareness Network of North America"....details to follow, hopefully soon.

Wednesday, December 28, 2011

10 day (and counting) headache

My head hurts. More specifically the area immediately above my right eye (and sometimes behind my eye) hurts. Tylenol seems to assist, and yet the ache persists. The doctor evaluated my headache on day 3 - working diagnosis, Migraine, with instructions to go to the ER if it gets worse. I am now on day 10. It does not seem to be impacted by sound or light. It has given me a few hours of reprieve, only to return. It seems somewhat sinusy....

I am not a person who typically gets headaches. Never have I had one that has been so persistent, and so localized. I am not impressed...

Monday, December 26, 2011

What went wrong last time?

Last time, I, from my first prenatal appointment on, indicated that I wanted to deliver by prelabour elective c-section. Prospectively, I could not have known what would happen. It is not my fault, nor is it my daughter's. In hindsight there are things I might have done differently, but it is only with the help of hindsight that I know that these are important things...things that might have made a difference for me in my case.

#1. I would have/should have insisted on using my Expected Due Date (EDD). My expected due date was July 13, 2010. I had been keeping track of my cycles and had used ovulation prediction strips the month I got pregnant. My cycle is short, I knew when I ovulated. My doctor decided to base my EDD on my last menstrual period, and set the due date at July 17, 2010. I chose the date for the csection as soon as I could (July 9,2010). If my due date had been used, perhaps I could have chosen a date as soon as July 6, 2010.

#2. I would have asked for a referral or referred myself to a psychologist. This is not because I believe I was mentally unhealthy during my pregnancy, but rather, that perhaps having a psychologist give a prognosis on the impact a vaginal delivery would have on me, might have made the c-section more likely to happen. One of my reasons for wanting it was control, to eliminate uncertainty....there is some research that indicates that this may predispose a woman to problems if things do not unfold as planned.

#3. I would have insisted on a specific date/time, a 'hard appointment' for surgery. When My ObGyn said I would be an 'add to slate', the implications of that to me were unknown. I just thought it meant that I would know the day of delivery but not necessarily the time of delivery. I had no idea that it meant that my chosen method of delivery would be unlikely to materialize. My doctor certainly didn't tell me that it made the csection less likely to happen.

#4. If I could not have #3, I would have chosen a hospital with DOBA so that in the event that I went into labour while waiting, there would be a good chance an anesthesiologist would be available and that I'd still be able to get a urgent c-section and effective pain relief. I had the mistaken belief that a major tertiary hospital in BC would have the resources needed when needed. This may or may not have been the case.

#5. I would have done more research before deciding on a maternity care provider(s). My Dr.'s had excellent ratings and I was given no reason to think that they would not be supportive of my request. However, given it all to do again, I would have chosen different doctors...

#6. There's a good chance I would have gone elsewheres to have baby number 1.

Hindsight is great, it doesn't change the past but it improves the chance that I won't be forced to repeat it.

Thursday, December 22, 2011

Context Matters

If I take my experience out of context, it is not a bad experience. In fact it is an experience that many women strive for - an epidural free labour that is 5 hours start to finish, in a clean hospital, that results in a vaginal delivery with a few second degree tears and, ultimately, a healthy baby.

Millions of women the world over would trade their experience for mine, in a heart beat.

I've heard this before. It doesn't help.

Others may say, but its one day of your life. One day. Having a baby is like having a wedding - does it really matter if it doesn't go 'as expected'?, it's the marriage that matters, the years and months after the baby is born that matters.

I've heard this before. It also doesn't help.

Birth is a natural process, its best for mother and baby. Consider it a blessing that you didn't get the c-section, really, what happend was a "blessing in disguise", you should be thankful you didn't have to recuperate from surgery. Ask most women who have had a c-section and a vaginal birth, and most women will say they preferred their vaginal births.

I've also heard this before and, it is no solace.

These platitudes don't help because context matters.

I had a reasonable expectation that I was going to give birth by way of c-section. I had carefully weighed the pros and cons of my two delivery methods (c-section and vaginal) and I had made my choice. I clearly communicated that choice to my doctor, and I was led to believe that my doctor supported my choice. I had every reason to believe that I would avoid a vaginal delivery. If my doctor had told me otherwise, I could and would have made other plans. I spent 9 months defending my choice.

Then the day for surgery came...and I was led to believe that it was bad luck. There were more urgent cases, and that is why I got bumped. I was led to believe that there were pediatric appendectomies and quite simply that there were not the resources to provide me with my c-section when I went into labour. A vaginal delivery when you've prepared yourself for a c-section is terrifying in and of itself and knowing that things in birth sometimes go sideways, beleiving that there are not the resources there, should it actually go sideways is even more terrifying.

In the months that followed, I tried to cope with my experience. At first writing about it would cause me to be overwhelmed with the emotions. (I am now on most days able to write about it, as long as I don't think too much about it when I write). I asked for advice about how to get over a 'negative birth experience', I talked with other moms, I tried to bury it...but like a zombie it refused to die.

Then I read of other women, having their care delayed or denied at Victoria General Hospital - in February and again in August. And I questioned how unlucky I really was. The external review was done. I was convinced I was a victim of the dispute between the anesthesiologists/VIHA/BCMA/Ministry of Health feud. A casualty of a level 3 hospital not having dedicated obstetric anesthesiology (DOBA). I decided I needed to speak up about my own experience. I decided that I needed to work to change the system.

I started to blog again.

I wrote a letter to the editor of the Times Colonist.

I researched the potential to bring legal action, on a class basis, to bear on the issue. However, came to the conclusion that I could not be a representative plaintiff as by way of employment and marriage I was in a conflict of interest. For what its worth - there may be something to that aspect still.

I wrote the Patient Care Quality Office.

And then I found out, that my experience was entirely unneccessary. I could have had my treatment of choice - if only my doctor/hospital had facilitated it. If only I mattered enough to them, I would have got the care that I had sought. Apparently, I didn't matter enough. I was truly violated, not by some strange twist of fate, but either by negligence or intent. If this situation is not cruel and unusual, I don't know what is.

I know, that as a result, I need therapy. There's only so much that a person can be expected to handle on an emotional level - despite my better efforts.

There is still much work to be done to 'fix it'...if that is even possible.

Tuesday, December 20, 2011

Post-Partum Psychological Dystocia

During vaginal birth, occasionally the baby gets stuck and can't get out without some assistance. A change in position. The use of forceps or a vacuum. A broken clavicle. A change in delivery method. If the dystocia is managed appropriately, the baby and mother emerge relatively unscathed. If not, there are injuries that range from from mild to traumatic and debilitating.

I am happy that I have a healthy, thriving daughter. There was a time, from September 2010 to February 2011 when I was doing "okay" just not thinking about the experience - just basking in the new mommy joy...being thankful for every milestone reached, thankful to have a happy baby, thankful that life in general was good. I am very thankful (by whatever small miracle) that I do not associate my daughter's birth, with my daughter. It sounds absurd, but my daughter is seperate from the process which brought her into the world - she is not her birth, she is not responsible in any way for what happend.

And yet I'm stuck - I don't cope well whenever I reflect on what did happen. Sometimes when I read a news story about a mom denied pain relief in labour or having a c-section delayed or unable to access timely care, I find myself back there. In the delivery room. Terrified. Sometimes, ff the conversation turns to birth, and other moms are reflecting on their experiences - I am back there. In the delivery room. Terrified. Sometimes (often) when I turn my mind to the next baby, who is wanted but not yet conceived. I am back there. In the delivery room. Terrified.

Sometimes I'm just angry...and at others sad - in no small part because I know that it didn't have to happen.

It's been 17 months - the passage of time has done little to resolve the outstanding issues, and given what I know now - time alone is not the cure.

Friday, December 16, 2011

The PCQO Responds

A few months ago I wrote to the Patient Care Quality Office, wanting more information on my particular case. I believed that I didn't get my c-section because there were more urgent cases and I was bumped, and because when I went into labour there was no anaesthesiologist or OR available.

Today I received their response. I don't know what I was expecting.

I still believe that the lack of Dedicated Obstetric Anesthesiology in level 3 hospitals in this province is a problem. But it, according to VIHA's, Patient Care Quality Office, wasn't my problem between July 9 and 11th.

According to the PCQO:
-During the period of July 9 to July 11 there were times that the OR was not being used, and that my physician could have called in the back up anaesthetist.
-Throughout the period of July 9 to July 11, the back up anaesthetist was not called in for any cases during that time period.
-At the time my contractions started, the OR was not occupied and their was full surgical staffing available, however the OR did not receive a call from either my physician or the LDR to proceed with my c-section.

Let me make this clear, at the time it was confirmed I was in labour, my physician informed me that no anesthesiologist was available as the OR was occupied with 'pediatric appendectomies'.

In many ways this makes what happend in my case even more disgusting.

Wednesday, December 14, 2011

The BC Maternity Care Rant

I'm a bit livid right now. I'm livid with the anesthesiologists. I'm livid with the BC Medical Association. I'm livid with the BC Ministry of Health. The situation right now is an all out cluster f**k - the game playing has reached an obscene level, and in the middle of it are the patients. The mothers and the babies.

Yesterday the BC Government, announced funding for dedicated obstetric anesthesiology at Surrey Memorial, Royal Columbian and Victoria General Hospital. But don't break out the cigars just yet...this is not the birth of DOBA, at least not yet - I'm not sure if this will be yet another miscarriage or actually result in DOBA being a resource for pregnant mothers to rely on that will actually result in women having access to timely care (epidurals and c-sections) during labour and delivery.

So what is the cause of my cynicism? DOBA in BC has a long history - a history of being 'supported', but not actually realized. There has been a series of miscarriages. You see, the announcement yesterday is about 3 years too late. Why? Because, the government actually did try to get DOBA at these hospitals in 2009. What happend? Well not a single anesthesiologist applied to the positions. So as much as DOBA was then recognized to be a good thing that should be at all level 3 hospitals in BC, it did not come to be.

As a result - when I had my baby in July 2010, DOBA was not there. When Mrs. Frith had her baby in December 2010, DOBA was not there. When the baby in August was stillborn and sparked an external review, DOBA was not there.

So now, given the outright hostility between the BCMA, the Ministry of Health and the Anesthesiologists - I am in no way certain that DOBA will be in place anytime soon. I'll believe it when I see it, and in the interim - what about all the women who have been harmed between the time the government first realized that DOBA should be in all tertiary hospitals in BC and the time it actually becomes a reality?

There needs to be some accountability for the harm that has been caused - and right now there isn't...there needs to be some recognition of the pain and suffering that didn't need to happen, shouldn't have happend. If you've been harmed by the lack of DOBA in level 3 hospitals in BC, speak up - your voice deserves to be heard above the petty bickering!

Tuesday, December 13, 2011

The 2011/12 Labour Games in BC - Featuring Anesthesiologists

This issue seems to be moving so fast today as to make my head spin. I came across the following headline this afternoon:
B.C. Government's $2.5-million Surprise Announcement Called Game-Playing

The government apparently has tried to end the bitter dispute with anesthesiologists by offering $2.5 million for dedicated obstetric services at Victoria General Hospital, Royal Columbian Hospital and Surrey Memorial Hospital.

Unfortunately, it appears that the government decided that the deal hashed out with the BCMA did not need the involvement of the anesthesiologists. As a result, the anesthesiologists were not even aware of the pending announcement.

Consequently the move is seen as game-playing by the anesthesiologists.

I think there's merit to the game-playing accusation. The issue has been ongoing for years (since 2009/10 at least) and it does appear that this latest pronouncement is in response to pending job action. I also think the anesthesiologists have a right to be unhappy with the negotiating environment. The fact that what is ostensibly a union could negotiate the terms and conditions of employment without input from the individuals it claims to represent - is a bit disturbing. It is more disturbing when that same group has been begging for its own voice for years.

Unfortunately, I think this means that I'll have to hold off on the celebratory champagne - as I've got a gut feeling that as a result of the game playing by the BCMA and the government that it might be a while before DOBA becomes a reality. I feel the announcement, particularly the timing of it and the way the deal was reached, might well inflame the situation further. This is no olive branch.

The real losers of all this game playing of course, are the women, particularly those who want and need medical services (c-sections and epidurals) during labour and delivery and have those services delayed or denied as a result.

I hope I'm wrong, the women and patients of BC deserve better - they should not have to pay the very painful price in this dispute.

News on the Anesthesia Front in BC

This morning I woke up to the following headline:

Job action by B.C. anesthesiologists could delay, cancel medical procedures

It appears that the issues between the province, the BCMA and the anesthesiologists are no closer to being resolved. I wish I could say that I was somehow surprised by the headline, but I am not. Further, it makes me even more hesitant to plan a birth in BC - if I was not so keen on the idea before given past experience, I am really not so keen on it now.

What is really disturbing about the proposed job action, is that patients are the ones who will ultimately pay the price. People generally do not undergo surgery because its a fun thing to do, rather they do so because the benefits in the long-term outweigh the pain of recovery and the risks associated with the surgery. Waiting to be 'fixed' isn't fun, often its a time of anxiety, disability, pain and suffering. Having your surgery further delayed or even cancelled because of a labour dispute isn't fair -- and can leave patients feeling like the system lets them down.

Further, in a health care system such as Canada's, there is no outside option - you can get 'medically neccessary' services but you must get them through the public system. Some people might be 'lucky' enough to have the resources to arrange for their surgeries either in another province or out of country - but doing so is an adminstrative and logistical nightmare that can be quite costly.

This does not bode well for expectant mothers in BC who might need anesthesia services that could be considered 'optional'.

Friday, December 9, 2011

A Retrospective Reason for Wanting an Elective C-section

It has dawned on me that another reason for wanting a c-section with #1, would be to actually have a respected choice with #2. In Canada, and in British Columbia particularly, women who want to have vaginal births after c-sections (VBAC) are actually encouraged to do so. This is despite the relative risks of repeat c-sections compared to VBACs. It actually is a preformance indicator of the health care system, and those in the ministry of health (whoever they are who decide these things) actually want to see the number of women who attempt VBACs in BC increase. It's a bit mind-boggling (to me) in a province where only 1 hospital in BC currently has DOBA - but at any rate it is what it is.

I have a friend who is currently pregnant, and if she decided to go for a VBAC she would be free to do so. She is currently planning a RCS (repeat c-section) - but without a doubt, knows that the final decision of c-section or VBAC is hers and hers alone to make. I am somewhat envious of her freedom to choose at this point in time.

So I can add to the reasons for wanting an elective c-section: The Right to Choose Mode of Birth with subsequent births (all be it that vaginal births subsequent to a c-section do have higher risks).

Is DOBA in BC around the corner?

Last week, the anesthesiologists were given a 'final offer' in a pay dispute that has been ongoing for years. The dispute has impacted on the quality of care that mothers at Victoria General Hospital have been able to access during labour and delivery.

This week the anesthesiologists have offered $3 million of their own funding to help recruit staff to help high-risk pregnant mothers and their babies.

Unfortunately, unless offers become deals, the situation at Victoria General Hospital (and other level 3 hospitals in BC that do not have DOBA) is unlikely to change. So far the track record for resolving the problem is less than inspiring. Unless the offer made on December 1 is competitive with what is available in other provinces, I don't think its very likely that the anesthesiologists will accept it. Further, unless the BCMA and the Ministry of Health are willing to work with the anesthesiologists on their offer of $3 million to recruit maternity staff - it is unlikely to have any impact in practice.

I am watching this situation unfold, and am truly hoping for the best as patient care needs to be the priority in this province - too many moms and babies have already paid a rather dear price while the BCMA, BCAS, and Ministry of Health have squabbled.

Wednesday, December 7, 2011

The Justifications for a C-section This Time Around

My reasons for wanting a planned c-section at term with my first pregnancy were very rational. I was very well informed about my options, and had found an OB who I thought would respect my wishes. I was looking forward to meeting my baby in a calm environment and avoiding the physical changes that can be expected when a woman undergoes a normal vaginal delivery.

This next time around (which isn't even on the cervical horizon - so might not even happen), I cannot ignore that my body has been subjected to a normal vaginal delivery - no matter how unwanted it was. I cannot undo those physical changes, no matter how much I may want to. No more so than a woman who has undergone a c-section can undo the c-section. No obstetrician will ignore this fact either - and it's likely to make finding one to agree to my request for a planned cesarean harder than it was the first time.

In a second delivery, labour and delivery tends to be much faster (typically half as long as the first, which for me would be about 3 hours). Further the risk of emergency c-section is greatly reduced when the first pregnancy resulted in a spontaneous vaginal delivery. If I go into labour spontaneously (as I did last time), the risk of c-section is 2.3 percent, if I'm induced the risk is 7.5 percent (source: BC Perinatal Services Annual Report).

As such 2 of my reasons for electing c-section last time - avoiding a real and significant risk of emergency c-section and wanting to avoid the physical changes of a normal labour and delivery - aren't really valid this time around.

So what is there to gain by having a c-section this time around?

1. Avoidance of labour pain - given an expected labour that would be very short 2.5 to 3 hours, there's a good chance there might not be time for an epidural the second time around. Labour pain is hell on earth - before I suspected that it might be hell on earth, which is why I wanted to avoid it in the first place and now I know it is hell on earth.
2. Avoidance of further physical changes.
3. Avoidance of the experience of a second 'normal' birth.

And at what cost?
1. There's a good chance I won't find an obstetrician to agree to my request locally - as such I'm looking at travel expenses, and medical expenses. I should anticipate that acquiring a c-section this time around might be around $20,000.
2. Increased length of hospital stay and a longer recovery.
3. Increased risk of maternal morbidity and mortality.

From a physical standpoint - there's not a lot of justification in requesting a c-section this time around. Going through a c-section isn't going to reverse the physical changes that resulted from the first delivery and is unlikely to resolve any of the psychological issues. I know this.

And yet the idea of subjecting myself to another 'normal delivery' is deeply disturbing to me in part because I would be doing so because my right to choose was violated the first time I gave birth.

My situation logically sucks...

Tuesday, December 6, 2011

Medical Tourism: Elective C-Section Edition

So far my efforts looking into option #4 (arrange to have baby #2 outside of the province, and outside of the country) have not yielded a lot of success. I've contacted one Canadian based company that specializes in medical tourism in the US called Timely Medical Alternatives, and one German company called Erikson Medical.

Neither response was positive, but at least the response from Timely was polite and brief. "Thank-you for your inquiry. Unfortunately, we do not offer c-sections. I'm sorry that we cannot help you."

The German response...well I'm reminded of the Seinfield episode with the soup nazi - "No C-section for you!". I'll be honest it hasn't exactly provided the best start to my day.

The email from Erickson starts of nice enough:

Hello Mrs. W. - thank you for your request. we do not think that we can help you. In Germany c-sections are mainly favoured in cases of emergency.

Had the email ended there, it would have been negative but not insulting. Very much similar to the email from Timely. The email did not end there. Rather it continued...

Responsible doctors do not recommend planned c-sections. does this means that if I find a doctor that will respect my well-informed request for a c-section and my autonomy as a person, that that doctor is irresponsible? Of course the email does not end there either, it continues further:

A birth is a natural event and natural birth is the best way for the mother to bring her child to this world, and it is known that to go through birth is important for the further life of the child.

Hurricanes are natural events. Earthquakes are natural events. Forest fires are natural events. Heart attacks and kidney stones are again very natural events. Further, are all those babies - you know the roughly one in three who are born each year via c-section irreparably harmed as a result of their births?? I don't think so. What's important for the further life of the child is not the 'how' of its birth. Will the child have loving parents? A warm-dry place to sleep at night? Access to education? Good food to eat? Guidance and nurturing? Of course the email doesn't even stop there.

It is a fairytale that a c-section is more easy for the woman. The abdomen has to be cut through which means a scar you have for the rest of your life and which can cause problems, and a long period of recovering after the c-section during which you have pains, are not able to carry, while you have to take care of then two children.

It's a fairytale that a vaginal birth is more easy for the woman, it's not - at least not for all women. It particularly isn't easy for the woman who has absolutely no desire to experience natural childbirth. Many women have life-long issues associated with their vaginal births - for which they would happily trade a c-section scar. I, for one, would happily trade the memory of natural childbirth and its sequalae for the memory of an elective c-section and the scar. I am aware of the additional recovery associated with c-sections and am more than prepared to make arrangements for the care of myself and my children during that time of recovery. Of course the email doesn't even end there:

I know what I am talking about, I myself have three children, one of them with an emergency c-section. That was the worst birth.

Thanks for relating to me your personal experience of an emergency c-section. An emergency c-section is NOTHING like an elective c-section. And then it continues:

Of cause there are pains during the birth, but isn`t it also interesting to experience, what a body is able to do?

I've experienced what a body is able to do - not that I wanted to, but I did. Thanks, but no thanks...continuing:

And if you decide yourself to take an epidural (I had this one time) you do not feel anything and still you have the softer choice of a natural birth for you and the child.

Epidural or not - I would still be aware of the large object passing through my vagina, when I do not want a large object passing through my vagina. Didn't like the first time, won't like it next time. And since when is a vaginal birth the 'softer' choice for the child - has she seen the shape of some kids after they go through a 'natural' birth? ...there is yet more:

Another point of not recommending the planned c-section in Europe is the risk of a long flight in the state of high pregnancy. Do you want to come months earlier or do you want to risk a birth "above the clouds" with none professial medical help at all? This obviously is much too dangerous.

I get the logistics of planning a foreign birth. It is perhaps the one aspect to it that is a big detraction. If it was an option (which it doesn't appear that it is) - I would work with it. If that meant going to Europe several weeks before the baby and staying for a few works after, then that is what would be done. Still there's more:

So go into yourself and consider again. Of course it is beautiful to have a second child. And the second birth usually is much easier and shorter of time than the first one. Talk to your doctors and mention your fears, there are possibilities to release pains. Maybe you have a midwife who you appreciate and who can be with you and accompany your birth. And then plan your natural birth which really can be an overwhelming experience!
I wish you the very best!

I spend a lot of time 'into myself' - my decision is not about pain and there is no way I'd consider a natural birth. So it's very obvious that: "Dieses Baby wird nicht in Deutschland geboren werden!"

Friday, December 2, 2011

Measuring Access Delayed and Denied

I have anecdotal evidence that timely access to medical care during labour and delivery is sometimes delayed and sometimes denied in BC. I have news articles about these cases and I have the conversations that I have had with other moms. I have some evidence that access to some services is significantly lower in BC than in other parts of the country (for example, the use of epidurals in BC is 30 percent compared to 60 percent in the rest of the country).

I know a problem exists, what I have no real way of knowing is how big of a problem exists. Statistics on how long a person waits for a requested service are not kept. Statistics on requests for services that ultimately didn't happen are not kept. Statistics on services that are bumped by more urgent cases are not kept. As such, I don't know how many other moms in BC are like me - I know that I'm not alone in my experience, but I don't know exactly how not alone I am.

I fear that I am less alone than I should be - I fear that cases like mine, that should be a very rare exception, actually aren't. I fear that quality care is missing for many women. If access delayed and denied was measured, it might be a first step to recognizing that a problem exists, the magnitude of it and moving towards changing it so that patients have a better experience of care.

Thursday, December 1, 2011

Update on the financial implications of Options 3 and 4....

If the baby were born out-of-province but within Canada the birth of the baby would be covered by BC Health Insurance.

If the baby is born out-of-country there would be no financial coverage of the birth.

Can I find a hospital/OBGYN within Canada in which I would be confident that outcome and plans would be reasonably aligned?


Option 5: Forego Baby #2

My options suck. In order for me to really be at peace with the idea of baby #2, I need to know that I could schedule a c-section at term and that it would actually happen. Given a history of 'successful' vaginal birth, I know that asking for and getting a planned c-section in Canada is likely to be even harder than it was last time. It didn't happen last time - and I did almost everything to see that it would happen. If it did, then asking for a repeat c-section would be a walk in the park.

So maybe baby #2 isn't such a good idea. Maybe I should just not go there, let the past be in the past and focus on an only child future.