VI- I prefer to go to Wholefoods as a last resort. Growing your own food, or shopping at local farmers market is ideal. If I really needed to go shopping for something, I try to get it at Trader Joes, and some things I need or will send a client to Wholefoods for, but only as a very last resort, for a whole myriad of reasons to long to go into here...
Overall I thought this was an excellent article, so all that I didn't comment on, I thought was wonderful, and I even learned some things. But I did feel the need to correct some facts. Thanks for taking the time to write such an informative article.
IIIV- ACOG does not require hospitals to to have an in-house OBGYN, operating room and anesthesia personnel ready. Not at all. Any hospitals' decision to refuse a woman a VBAC is made out of ignorance for ACOG guidelines. This is part of a press release issued by ACOG in July of 2010:
""Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."
Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.
The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. "
I commend Dr. Chandler on his courage to stand up and do something, locally about the VBAC issue. In absence of the ability or desire of a woman to have or risk an unnecessary repeat C-section in any hospital, the benefits of VBAC homebirth for the mother outweigh the risks associated with a cesarean (as Dr. Chandler points out), although the infant mortality is slightly lower overall when VBACs are attempted in hospital and thus the VBAC program in Natividad is an example for other hospitals to follow in reducing infant mortality. There are no actual barriers for CHOMP or SVMH to provide VBAC support, only perceived barriers. Actually, though many people don't realize it, any care provider or institution who tells a woman "once a cesarean, always a cesarean" is simply either lying or ignorant to both science and ACOG guidelines.
V- $500 is the minimum fee for doula care. I know of no well-experienced and/or trained local doula who only charges $500 for her doula services. The local going rate in Monterey County for a trained and experienced doula is about $700-$1600.
Overall I like the theme of this article. Here are a few fact corrections:
I - There are 4 Licensed Midwives in Monterey County(not 2), and one actively practicing CNM (plus at least 3 other CNM's living in Monterey County), some (and possibly all) of whom would be happy to gain privileges at Natividad. Actually it is legal for Licensed Midwives to have hospital privileges. There are several Licensed Midwives in Arcata who do have hospital privileges because an Obgyn was willing do the paperwork to incorporate those LM's into the hospital as Midwives in their own right. I can't speak for the other 3 LM's in Monterey County, or the other 4 CNM's, but I have tried to gain hospital privileges at Natividad and would be happy to receive them, but that takes an Obstetrician willing to spend the time to do the paperwork. Specifically LM's are at most within their legal ability to practice midwifery in California in hospitals, rather than out-of-hospitals as long as all the OBGYNs are refusing our requests to officially provide back-up for out-of-hospital birth.
II- Epidurals do not block pain. Actually they usually reduce the sensation below the waist. Sometimes they don't work at all, and there is pain anyway, If they do "work" and block the sensation, that means it's extremely difficult to get the mother in a position favorable for birth. It's not impossible, just takes more work. Sometimes Epidurals cause permanent paralysis, which in fact starts with a nerve shattering pain during the administration of the Epidural. That would be too traumatic for me to even watch, and I can't remember exactly but I'm probably the doula who stated that I would refer mothers to other doulas if they knew in advance that they wanted an Epidural. Of course if a mother planned not to have an epidural and decided in labor that she did need an Epidural, I have nothing but respect for her personal decisions, which are made based on new information(ie. the pain of a pitocin-induced labor).
III- The other local doulas do not necessarily feel the same as me and would be happy to take a client who is planning to have an Epidural, so it's not accurate to say that the doula crowd "doesn't have much patience for moms who choose pain medications." It wouldn't even be accurate to say that I as a doula don't have patience for a mom who chooses an Epidural. Patience is what I do have. Patience to sit with a woman for hours, or days and use my expertise to help her get through her labor and provide natural comforting techniques. If a woman wants an Epidural, and knows that in advance I don't think it's a lack of patience, but wisdom to refer her to a doula who could better assist her. And there are many local doulas who could and would locally.
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