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.


  1. I saw, in one of your previous blog entries, that you wrote to a hospital in Germany to ask for an elective C-section there.

    Here in Norway, some people travel to the United Kingdom (and use a PRIVATE hospital!) to get their C-sections if they do not receive a favourable response here in Norway. (We have private clinics which do treatment including some operations here in Norway, but not delivery of babies.)

    Often these women want C-sections because of breech, and often for other reasons such as a bad previous experience with childbirth.

    For an elective C-section which involves travelling, the journey has to be made well in advance (as the people from the German hospital mentioned). If it's too close to the end of the pregnancy, there's a risk that the airplane flight will start the contractions.

    If I were opting for a C-section abroad, I would also want to check the need for extra travel insurance. (In case anything goes wrong with the C-section or any other elective operation for that matter, I don't think standard travel insurance will cover the added medical expenses abroad plus the costly home transport of sick patients.)

    Also, check regarding any problems there could be with the baby's citizenship/ birth certificate. A few people here in Norway have run into red tape when a baby has unexpectedly arrived in another European country. I don't know how it is for Canadians giving birth in the UK.

    I've also heard that some Norwegians get their elective C-sections in France, although I know very little about it. Could be an option if there's not a language barrier.

    Wishing you (and others) the best of luck!

  2. Realistically I think the US is probably the best option for a Canadian to secure an elective surgical birth in a private hospital. Some women in Canada do manage to secure elective Csections in a public Canadian hospital but there seems to be a fair bit of uncertainty with that plan.

    The logistics are a bit daunting....which is unfortunate because it seems the more straight forward of the available modes of delivery.

    I find it disturbing that women in first world countries are being forced to give birth in other countries because of the lack of recognition of a woman's right to choose how she gives birth.

  3. Gah. It should've been a BIG WARNING sign that your OB wouldn't give you a date or time, and was just going to "add you to the slate". The more I read about your story, the more frustrated I get. That's not how surgery rolls in this province. ORs are packed and it's such a competitive environment to get into the OR (or so my OB tells me)... Nobody with any sense adds their patient for a planned surgery to the slate on the day-of! I'm so sorry. It is becoming abundantly clear it was your provider who was not committed.

    Just to contrast, so you know what to look for, my OB booked my planned c-section for first thing in the morning (6am arrival time!) so we would be "first on the table" that day. She booked it when I was 23 weeks pregnant. She did this so I could not be bumped (and even then I was terrified of being bumped). And when she had me in for another minor procedure (she did day-of) she had to fight all the other specialists for the time to do my procedure, and I gather this was quite a battle from what she told me!

    So, to add to your #3, I would say, make sure you are first in line on your planned day. My OB was quite concerned about us being bumped out of the OR by an emergency.

    And (for #2) you'll probably need a psychiatrist for DX. Tokophobia, anxiety, PTSD. I doubt you will have a hard time finding a psychiatrist to help you with this, as you are manifesting at least some PTSD and anxiety. And start therapy now, so you have that to show that you've been "working on your issues" but they are unremitting... I was so tokophobic that I could not even discuss vaginal delivery without having a panic attack and birth videos made me cry. Hysterically. I kind of laugh at the diagnosis of tokophobia, because I just don't think it's unreasonable to feel that way. To me it seems unreasonable to be a-ok with a baby coming out of you like that. It seems insane to me.

    It is unfortunate that we can't just ask for what we want. I was just trying to describe to a newly arrived immigrant that you can't just get a c-section with ease. She was planning a c-section for her birth, as that is what is done amongst the middle/upper classes in her country and she just assumed she'd be able to ask for one and get one! I told her she might consider just going home for the birth, since her family is still in her country of origin... boy, is she in for a surprise. "What," she says, "Are wrong with c-sections?!" I tried to explain how women here want to give birth without an epidural and vaginally, and she was aghast! "WHY?! THAT'S HORRIBLE!" Just shows how different things are in other places in the world.

    I want you to know that I am really hopeful that you can have a c-setion with your next pregnancy if that is what you ultimately decide, and that I am rooting for you. I think you should be able to get this in the public health system.

    Many good wishes to you. And Merry Christmas.
    -The Pragmatist.

  4. I had no idea before this experience that a patients informed request would be brushed aside so cavalierly. I mistakenly believed in the charter of rights and freedoms, in patient autonomy and in the patient-physician relationship. I trusted the system and my doctor.

    Therapy starts Saturday. I will not make the same mistakes again....and I will seek to clearly communicate how wrong what happened last time really is.