At 41wk3d (Thursday, July 10) we went in for a non-stress test at the doctor’s office. My blood pressure is high and there is protein in my urine, (baby was testing absolutely fine). We are sent to the hospital for an induction (not in my Birth Wishes either but excited that I would get to meet my little one soon). I was 1cm, 60% effaced and baby was high at -3 station.

That evening they put me on Cervidil and started Pitocin on Friday morning. [My blood pressure had already lowered by later that evening.] By Friday evening there was no change in my cervix and the baby was still very high. I was disappointed that nothing had happened but thought definitely by tomorrow there would be a change. I kept thinking that people say “don’t plan your birth because you can never plan what’s going to happen.” I remember thinking and saying to my husband that “I know you can never know what labor will be like, and I know it won’t always be like this, but I didn’t expect it to be boring.”

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Before the second day got started a nurse said that the OB wanted to come in before the midwife. I was instantly worried and told my husband to be ready to call our Doula, Jessica, and her apprentice, Kristen. I was worried because I didn’t want to be told that I needed a C-section when we had only tried one day of induction and we were both reading perfectly healthy. [My blood pressure already returned to normal and the baby was showing NO signs of distress.] I was also worried because during my pregnancy I didn’t see any of the OB/GYNs in the practice because I was planning a natural birth and I thought Midwives were the best way to achieve that.

The OB came in, checked me [still no change] and immediately started talking to me about a C-section and how the labor wasn’t progressing and I was way overdue. I expected this, but what he said next I never could have anticipated. He started telling me that the chances of having a natural labor were pretty much 0ut and that the longer I waited the more likely I was to end up with a “dead baby.” I was blindsided. He proceeded to tell me that I could leave the hospital and return home, but that I “would return a few days later with a dead baby.” He used the words “dead baby” so many times it was nauseating. I was terrified but I knew that the baby was healthy, just late. I told the OB that I wanted to continue with the Pitocin. He didn’t seem happy but left. As soon as he left the room I told my husband to call the Jessica and Kristen. I was terrified but I would be damned if I let that man scare me into major abdominal surgery for absolutely no reason.

He came in a few hours later to check me and when I told him I didn’t want HIM to check me but the Midwife. He seemed to take it personally and continued his “You’re just going to end up with a dead baby” rant. He also said that I wasn’t dilated enough to try and break my water and labor wasn’t progressing so a C-section was really our only option. Oh and we could still go home but we would return with a “dead baby” but that “Hey, I told you so.” We told him we wanted to think about it. He left the room and came back in a few minutes later. When we told him we still hadn’t made a decision (my sister had just come to visit and we had talked to her rather than discussing our new “options”) and were trying to find out more information he started questioning us and asking us what our “other resources” were (my husband is a professor with access to medical journals but he didn’t know that). At one point he looked at my 6-month pregnant doula, Jessica and asked, “Are you the Doula?” She said “Yes” and he asked “How long have you been doing it?” She said “A while” and he replied “Have you ever seen a cesarean performed on a dead baby?” That was the last straw. I was already crying because of other things he had said. We told him we still weren’t ready to make a decision and he tapped my leg and told me to go home and that it was our decision because he didn’t get “paid by the hour.”

We immediately started sobbing. It was probably the hardest day of my life and my husband’s so far. To be clear the baby was still not showing any signs of distress. We were scared and angry. When the midwife came back in we told her we didn’t want to see him anymore and that he was not welcome in our room.

It was difficult, but we decided to stop the Pitocin and waited until a new OB and Midwife came in the next morning at 7am. The new OB/GYN and Midwife were a complete 180 compared to the monster we saw the night before. I think they also thought/knew that a natural delivery wasn’t likely but they were willing to let me try by breaking my water as a last ditch effort to get the baby here. It started to work but by the time I was 5-6 cm later that afternoon I couldn’t handle the pain. Although I hadn’t felt much of the contractions the past two days, I believe my uterus was exhausted and I opted for the epidural, hoping it would relax me and take me the rest of the way. By 2:00 Monday morning I had stalled at 7.5cm/80%/-3 Station.

It was time for the C-section. I tried to fight it but the Midwife was very calm and explained to me that it was time. She wasn’t angry or condescending. Nevertheless, I started to cry. I tried to ask for more time—2 hours, 1 hour, 30 minutes. My husband was very supportive and told that I had fought very hard and that it was okay to get the c-section. It made me feel better and I knew he was right. I said “okay” and they started getting everything ready. I held Jessica’s hand very tightly. The operating room felt surreal. There were people everywhere and I felt so drugged up and was shaking uncontrollably (from the epidural). But then I felt some tugging and heard her cry. I remember feeling happy and sad at the same time. They took her to clean her and I couldn’t see her for a few minutes. I didn’t know how to feel. Then they brought her to my cheek and I touched her hair and said “hey sweetie.”

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She was born on July 14th at 3:55am, 8 lbs. 8 oz., 21 inches and was still PERFECTLY healthy. She latched and breastfed immediately (20 minutes later in recovery). I know that in the end, I tried my all at a 3 1/2 day induction. I don’t regret anything, even the C-section, even though it wasn’t in my plan. My daughter is beautiful and healthy and we can’t be more grateful.

Postpartum depression is real. It is more than the proverbial baby blues for many women. This is a story for those who may benefit from the sharing from this mom. My comments are in italics.
My husband and I tried to conceive for over a year and were having trouble getting pregnant. I had extensive lab work and thorough check-ups done to try and figure out what was going on. I tried everything from acupuncture, chiropractic care, fertility supplements and herbs and finally out of the blue, I finally ended up getting pregnant. I was beyond excited but nervous about keeping this baby safe and healthy for 9 whole months.
My estimated due date was March 27, 2013 and I had a 3 page birth plan along with my hospital bag packed and ready about 2 months before I was due. I was beyond ready. My birth plan included delayed cord clamping, saving my placenta for encapsulation and to be able to have the baby the entire time for skin-to-skin and nursing and not allowing them out of my sight without my husband or myself present. (We encourage moms to have a very short birth plan- and a separate baby list. Keeping it simple helps it to be read. The things she was asking for were basic things that many hospitals offer to most every birthing mom.) I wanted a home water birth but I have a history of miscarriages (previous marriage), low progesterone levels, and worst of all, a blood clotting disorder. I did not want to take any chances since I was about 45 minutes from my hospital. I planned on having a natural labor and delivery. I requested a birthing bar for the end of my bed, to be able to labor in the bath tub as long as possible and for them to respect my wishes.
I had a doula that I hired from the beginning and she was also my chiropractor. I had issues with my doula throughout my entire pregnancy because I felt like she wasn’t doing what I expected someone in her role to do. I wanted a doula so that she could support me and be my voice for whenever I was in discomfort and would not be able to speak for myself. (The role of the doula is never to speak for the woman- as that is as disempowering as not listening to the mom- but instead to help her find her words and confidence to share those words.) I needed someone to support me and my birth plan as much as possible. (I think it may be difficult for someone to be a working professional doula and also have another full time professional job that may be a huge distraction. Some can manage it if their work is flexible, but with demanding jobs it may be more difficult. If during your pregnancy you feel the doula is not a good fit- change!)
I tried to stay as healthy as possible throughout my pregnancy and gained a healthy amount of weight. I took a hypnobirthing class. Overall, despite my blood condition, I pretty much had a text book pregnancy. I was so excited to be a first-time mommy. (Even though hypnobirthing offers many good concepts for a natural birth, having more tools may prove to be beneficial for a mom who does not find it to be the only effective tool in her labor.)
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It was now Sunday, April 7, 2013 and I woke up feeling different. It was now 12 days after my EDD. I was happy to be pregnant and enjoyed it the entire 9.5 months but I was tired, so huge, and ready to meet this baby. I started labor slowly and manageable that morning and all throughout the day. I kept in touch with my doula but she seemed preoccupied with other things. It was not almost midnight and I was starting to feel more uncomfortable. I knew we still had to drive to the hospital and it wasn’t necessarily around the corner. I sent my doula a text and asked her for advice. She said it was up to me but I could go ahead and head to the hospital if I wanted. She said to only call her if I got admitted. When we got to the hospital, I was checked and was at 4 cm. They went ahead and admitted me and things went fairly slowly. (ACOG in an attempt to lower the cesarean rate came out with a statement that we need to consider cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor. So they encourage women to realize early labor can take a long time. We find that if the baby is not optimally positioned- it may take even longer.)
After being in labor for several hours, I was beginning to feel more and more discomfort and decided that I was ready for the bathtub to help relieve some of my surges. They told us that the tub attached to my room was not working. They didn’t have a different room to offer us. They never brought in the birthing bar and when I asked my doula about it, she said she would check but I never got it. My doula never offered me her birthing ball. I was confined to the bed and my husband was trying to help me but we were both new at this and there was no one to help or listen. (It is a shame that this mom felt confined to the bed. Often without encouragement moms will stay in the bed although they should have freedom of movement per evidence based studies.) I was so upset that my wishes were being ignored. I was stuck at 9 cm. for many hours and in so much discomfort at this point. I could not get relief from anyone and I was not progressing. I refused anything that would force labor and wanted to wait as long as possible to see if things progressed on their own.
After about 17 hours in labor, I was approached about a C-section, again, and told them that I did not want one, again. (The average woman is in labor for more than 19.5 hours)  They told me that I was not making any progress on my own and it would become dangerous for myself and the baby. We looked to our doula for advice and she said it was up to us.(The role of the doula may have been confused at this point as we do not give medical advice or refute medical advice. Instead we help you formulate questions to help you gather more information. ) Once again, I had no support from her. I felt so alone. Nothing was going as planned. I had taken some castor oil a few days before to try and speed things along and they were concerned that with the baby being “overdue” and with me taking the castor oil, she might be swallowing her meconium. (We are never fans of castor oil but the studies are not conclusive on whether this indeed can cause the baby to pass stool due to taking it.) This scared us to the point that we knew we had to do whatever it took to get her out. The baby’s heart rate started dropping, as did mine and then they mentioned that they needed to perform an emergency C-section. At this point, I just wanted her to be safe. We started to prepare for the C-section and my husband and I were both so frightened. Within a few hours, they were performing the surgery. (I can only assume this was not an emergency but an unplanned cesarean since it was not done right away.g  And I am guessing the baby’s heart beat issue resolved as well. )
I remember being so drowsy and out of it and feeling such a sense of disappointment and sadness. She was born at 7:31pm on April 8, 2013 and they had someone ready to aspirate her lungs in case she had swallowed the meconium and fortunately, she was fine and didn’t need it. (There is always a team for cesarean babies as they are not squeezed on the way out and need some additional help with breathing often. The fact that this baby was so healthy was another indicator that she was not under distress in the last hours of her labor after all.) She was a healthy 7.10 pounds and 21 inches long. I was so excited to see her but was so exhausted since I was never allowed anything to eat or drink or even time to sleep. (Eating and drinking in labor is good practice as per evidential studies. And it sounds like an epidural to allow her to rest and wait out a few more hours could have resulted in a possible vaginal birth.)I was so drowsy that I could hardly stay awake to see her when she was born. When we were taken to our recovery room, I never really got a chance to bond with her. I never got the skin-to-skin (Family centered cesareans are now being offered in a few hospitals in the area- which allows the baby to be skin to skin and nursing while in the OR.)and to top it all off, I had to keep staying on top of ensuring that they saved my placenta. I reminded them many times and still, they managed to throw it away. They had apparently done 2 more C-sections after me and I asked them if they could dig it out. They knew they messed up so they had someone dig it out. I worried if I was getting mine or not but they were certain it was mine because I had some large fibroids during the pregnancy and this marked my placenta in a unique way.
When I got back to the room, I was expecting my doula to give my baby her first adjustment since she had been through so much trauma with the C-section. My doula had already left and I was so upset. (Rarely we leave before seeing the mom after a cesarean. Often we are allowed to meet her in the recovery area. Occasionally for reasons often that are outside of the control of the doula, the mom is separated in recovery for several hours. If it has been a really long labor, we may leave- but it would have to be an extended stay in the recovery area or another mom calling in labor to have us do so.)  Soon after that, my mother was kicked out of the room because at this point, she was considered a guest and it was after visiting hours. My mother went with us and she does not drive, we were not sure how she would get back to our house 45 minutes away. I was so stressed and knew that I would need her help but there was nothing I could do about that. At this point, I haven’t even had an opportunity to enjoy my new baby and I felt as though everything had gone wrong and was completely out of my control. There is nothing worse than feeling like you have no control over this new experience. (I can not even imagine a family member who had been invited to the birth would be asked to leave if the mom desired to have her stay to help. I am unsure of which hospital this was but this is a travesty for sure. I stayed the night with my daughter and her husband after the birth of her babies)
I started trying to nurse the baby and I was persistent in trying to get her the colostrum the first few days. It was not going well and I could not get a good latch. She was constantly crying and hungry and I was not able to successfully nurse her. They had to express my milk and have me pump a little to feed her through a small tube. It would hurt me to nurse her by cradling her because of my surgery and the soreness from it. (The lack of support for moms needing help with breastfeeding is a hospital issue at most every hospital. I feel strongly that attending LLL meetings prior to having a baby and taking a great couples’ breastfeeding class helps!)
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I started feeling so inadequate as a new mother. I was not as happy as I expected to be at this point with a brand new baby. I hated feeling this way but I didn’t know how to make things better. My husband was there by my side the entire time but he couldn’t help me either. After about 4 days in the hospital, I was finally released and it was a tough transition at home. I could barely get around and nursing was still a struggle. I had to break down and get the baby formula to try and supplement and this was disappointing to me. No matter what I did, I could not seem to find my happiness. Here I was, a brand new mother, with a healthy baby girl and yet I was so depressed. (The way a mom feels about her baby is affected by her birth experience. Recovering from major surgery only adds more sadness to this situation. Having a postpartum doula could have been the best gift she could have gotten- someone to help her talk through her birth, help her get rest and help her with breastfeeding would not have been a luxury but a wonderful necessity at this point for sure.)
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I was crying everyday for most of the day and trying to hide it from my husband and my mother. I had so much love and support from them but I felt so incredibly alone. I even had moments where I would see my baby getting hurt, not by me but where she would fall or something like that and I felt horrible for thinking these thoughts and worst of all, I didn’t know where they were coming from. I had my placenta encapsulated after about a week after I got home and despite what others may believe, I truly feel that they are what saved me. It could be in my head but as soon as I started taking them, once she got them back to me, I started feeling better. (We hear the stories of how placenta encapsulation is so helpful in these situations!) I never felt that way again. Postpartum depression is a very real thing and although mine was very short, thank God, I felt the pain of it and hope that it never happens again. (These are all expected feelings directly related to PPD.)
I have since told people my story, in a much shorter version, and they seem to see it as though I’m complaining and being selfish. They tell me at least I have a baby and as long a she was healthy, I should have been happy but what they don’t realize is that when a baby is born, so is a mother. I may not have had the perfect labor and delivery that I wanted, but now that it is 15 months later, I can appreciate that I do have a happy and healthy baby and despite what I went through, it was all worth it in the end! (It makes me sad that the feelings that a mom struggles to share are diminished in this way and she is not being heard as she begins to process her pain.)
Thanks for listening,
Martha Kelly
I can only hope that Martha heals from this birth. I hope she seeks a childbirth class that offers a safe healing space for her to do so prior to her next labor. I hope she is able to find an experienced doula who will support her fully and that she finds a provider that offers patience in her having a gentle VBAC. I know that Martha has plans to do things very differently the next time. So often women feel like this will never happen to them.
Birth experiences affect so much about how a woman feels about herself, her baby and can impact so many areas for life. Please value the experience and help moms have the proper support in labor- the proper support after the birth and in the first month of motherhood. Stories like this need to be told so others can think about what they would want to have be different. Thanks so much Martha for sharing. The sad thing is pregnant couples do not know what they do not know. The preparation you think is enough, often is not providing you with what you may really need. Often times there are red flags along the way that your intuitive voice warns you about- listen to that voice.

I hear women say, “I had an emergency cesarean.”  I have attended well over 500 births and I have to say there have only been three that were real emergencies. If you have time to discuss things with your care provider. Time to get your partner dressed for the birth, and time to have them pack up the room, time to make a phone call, etc… then it is not an emergency situation. Emergency cesareans happen quickly. The room fills up with staff- your bed is unhooked from the wall- they are shouting orders as they wheel you down to the OR… if your care provider is not there they will snag any doctor available… that is an emergency cesarean. If you don’t have an epidural then you are put under general anesthesia and your partner is not invited into the OR suite at all. So, unless that happened, note that you had an unplanned cesarean. And according to the statistics those will more likely occur between 8am and 5pm, next likely between 5pm and 11pm and rarely between 11pm and 7am… why? Because there is less “management” of your labor and your care provider is sleeping or may not even been at the hospital. Then you have to ask yourself was my unplanned cesarean really necessary at all?

After all as in Monty Python’s The Meaning of Life, you are probably not qualified to know how to birth!

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Recently a doctor wrote an article Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You to forewarn parents of the signs that your doctor really does not like to wait for natural birth to occur. His honesty is profound. I consider this a must read!

There are two hospitals in the metro area that offer a “Family Centered Cesarean.” One is done at AMC with Intown Midwifery and at Dekalb Medical with Brad Bootstaylor with patients of  See Baby Midwifery and with the doctors backing up Intown Midwifery. They do that type of cesarean for any non emergency- keep in mind you hear “emergency cesarean” used often for “non planned cesarean.” A true emergency is very different from a non planned surgical birth. So he provides it for any real non emergency situation and tries to offer it then if possible.  One other group provides a family centered surgical birth but only does so for planned cesareans. That is the physicians who back up the ARMC midwives in Athens.

This approach is shown to “enhancing bonding, initiating breastfeeding and reduces postpartum depression”- isn’t that what we all want?

Here are some video links to this new approach as well as the traditional approach.

A Local Atlanta Family Centered Cesarean   Family Centered Cesarean

This is a modified skin to skin after the birth cesarean- not really a full experience but better than most:

Modified skin to skin cesarean

A unique natural expulsion technique:

Natural Expulsion

Malpositioned baby was born via cesarean:

Malpositioned Cesarean

And for comparison sake- here is a “normal” cesarean:

“Normal” Cesarean

A local cesarean including some of the pre surgery prep:

Kennestone Cesarean Birth

You may be asking yourself, why is this not available elsewhere and why does ARMC require it to be a planned event. ARMC says it takes more staff when Dr Bootstaylor says that it does not take more staff when he does it. Elsewhere I think women are not demanding the opportunity for this type of experience. If you demand it, often the powers within the medical center will listen. Change comes from creating the voice within many. Ask your hospital why they can not follow suit and help women have a good birth experience no matter if it is vaginal or cesarean!

Today I had a postnatal meeting with a mom who had recently had a successful VBAC- vaginal birth after a previous cesarean. She reminded me that the phrase I used when helping her to decide whether or not to change practices late in her pregnancy was the question of whether the practice she was in was being only tolerant to her having an opportunity of a trial of labor or were they truly supportive of her VBAC. She said as time went on she realized that the enthusiasm they offered initially was short lived as each month passed. She would hear more doubt each appointment up to the appointment where the midwife she thought would be the most supportive came right out and told her she was very doubtful if the baby this mom was carrying would come out vaginally. That was the straw that sent her out of that practice and into the supportive arms on the midwives who supported her in a wonderful vaginal birth only a short while later.

It made me wonder… if we told our care providers what we wanted and they followed it up with a negative or even just a placating comment. why do we believe they will be supportive later? For every time an OB said, “yes, many first time moms think a natural birth would be good, until their first contraction!” I wish a woman would turn on a dime and say, “you do not sound like the doctor for me!”  I would love for a woman to state what her birth ideals are and then ask her provider how he or she plans to help them achieve it. Perhaps then they would reach for that business card of a great childbirth educator and say this class she offers will help you prepare. And then they reach for another list of doulas who they find work best with moms who want a natural birth. And perhaps they will even find a way to help make insurance companies see the benefits of paying for these services.  Perhaps the pediatricians would pass out LLL meeting schedules for their breastfeeding moms and the card of a good lactation educator or counselor. Am I dreaming?

The only way a woman is going to get the care she desires is to demand it! When my daughter and I drove five hours from the Atlanta metro area to seek the best breast reconstruction for her bilateral mastectomy, it spoke to why we felt the need to spend hundreds of thousands of dollars elsewhere. If enough women stand up and turn on a dime and refuse inadequate, substandard care for our labors and birth, when we flee to other facilities that offer more options like water births, if we do it in enough numbers, guess what? The dollar screams at the other care providers and locations for births. They may not listen immediately but we need to let them know they are loosing our dollars!

We have a voice. Join the facebook page facebook.com/GABirthActivists to hear more about how you can have your voice heard!

GA Cesarean Section Rates According to the CDC, the national rate for total C-sections in 2012 was 32.8%. There are no current hospital-level cesarean rates for Georgia available online to the public. The most recent rates published are from 2010 (Source: GAHospitalPriceCheck.org.) We checked with the GA Hospital Association, but only got numbers for the last quarter of 2013, so CBS46 surveyed local hospitals, and obtained updated rates for all of 2013.

Hospital Total Cesarean Rate (Jan. 2010-Dec. 2010) Updated Rate

Atlanta Medical Center 30.30% 25.5% (2013)

DeKalb Medical – N. Decatur 35.32% 36.0% (2013)

Emory Johns Creek 28.24% 30.9% (2013)

Emory Midtown Unknown 29% (2013)

Gwinnett Medical Center 32.46% 32% (2013)

North Fulton Regional 20.05% 19.5% (2013)

Northside Hospital 38.20% 40% (2013)

Northside – Cherokee 33.93% 33.5% (2013)

Northside – Forsyth 38.51% 35.5% (2013)

Piedmont Hospital 34.60% Did not provide

Piedmont Henry Hospital 30.64% 22.8% (2013)

Rockdale Medical Center 33.00% Refused our request

South Fulton Medical Center 24.76% (merged with AMC)

Southern Regional Med. Center 29.92% 28.2% (2013)

Wellstar Cobb Hospital 35.69% 35.86% (2013)

Wellstar Douglas Hospital 34.69% 33.84% (2013)

WellstarKennestone Hospital 35.01% 35.39% (2013)


http://www.cbs46.com/story/26028989/c-section-rates-high-at-most-atlanta-hospitals

Alden came into this world like thousands of babies do every day, but delivering him was a unique experience for me.  Here’s how I remember Alden’s birth day.

When I was 35 weeks pregnant and literally minutes after finishing my last project at work, I came down with a fever.  The fever continued, and I generally felt on the verge of getting the flu for a week.  At my 36 week OB appointment, the doctor told me to rest the next day in an effort to reduce swelling and beat the low grade fever.   (more…)

I would love your input on this article- post to the blog so others can see your ideas… but last night I had a client have a wonderful VBAC and it made me think about what helps make a VBAC happen… here are a few ideas to ponder:

Choosing the right care provider. I put this first because I think it is paramount! Ask your doctor or midwife a few questions- how often do their previous cesarean patients choose to go for a VBAC? How many are successful? Do they enjoy working with moms who choose VBAC? Often times a care provider may say they are supportive but their numbers will show a lot. Often times they change their tone as you become more pregnant. Or they support it only if you birth by your due date- going over your due date is not acceptable. Some will help you into labor if you desire with breaking your water or low dose of pitocin. Others will only schedule another cesarean if you do not birth by your due date. Make sure they are really on board. Make sure you are a good candidate for a VBAC in their view before you proceed.

Choose a doula. It may be helpful to choose one with experience with VBAC but supporting a woman is universal- but having a doula there to help encourage you- to help remind you of your ideals- to help you in determining what may be considered in labor- these help. The studies show a doula reduces the chance of the initial cesarean but I think having one for a VBAC is essential for most couples. They are there to support the partner as well as the mom. (more…)


…got an email today from a client saying she would not need the doula she hired after all. Seems her baby is breech and so her doctor has told her she needs to have a cesarean birth. Hmmm… her doctor made this decision when she is only 36 weeks pregnant. I do not know if he talked to her about her options… the various ways to get the baby to turn… the medical ways to get the baby to turn…the option of a vaginal birth with a skilled physician… I do not know if he told her about these things… All I know is as of tonight, she has somehow been convinced that a surgical birth- one which would more than likely determine all of her future births, was her only option… I find this sad. Gentle Birth Archives.

Sad because she put her trust in her doctor to guide her. His or her guidance should be information that then allows her patient to make a decision based on that information. I sent her information tonight in that email in case he or she did not. It makes me sad that she is four weeks from her due date- and actually six weeks from when the baby could come without being officially “late,” and her care provider has already determined that it is hopeless for her to consider a vaginal birth! And sad that the truth may be hard for her since she does not know me or trust me- and her medical care provider is the “good” guy here that she may trust more than the full truth. (more…)