Episode 354 Meagan & Julie + Hospital Policies Surrounding VBAC

“Hospital Policy means the principles, rules, and guidelines adopted by the Hospital, which may be amended, changed, or superseded from time to time.”Julie and Meagan break down hospital policies today, especially common ones you’ll hear when it comes to VBAC. They chat all about VBAC agreement forms and policies surrounding continuous fetal monitoring, induction, and epidurals. Women of Strength, hospital policies are not law. They vary drastically from hospital to hospital. Some are evidence-based. Some are convenience-based. Do your research now to make sure you are not surprised by policies you are not comfortable with during labor!Defining Hospital PolicyBirth Rights ArticleNeeded WebsiteHow to VBAC: The Ultimate Prep Course for ParentsFull Transcript under Episode Details Meagan: Welcome, everybody. We are going to be talking about policies today. What do they mean? Why are they created? And when do we have the right to say no or do we have the right to say no?And I have Julie discussing this with me today. Hey. Julie: You know I’m a policy fighter. Meagan: Yes, we do. We do. The longer I have gone– in the beginning, I was not a policy fighter. I really wasn’t. I was a go-with-the-flow, sure, okay, let’s do it, you know best. That’s really how I was. Julie: A lot of people are. Meagan: That’s true. I think a lot of the time, it’s because we don’t know what our options are. We just don’t know, so I’m really excited to get into this with you today. I always love it because we kind of get into this spicy mood sometimes when we have topics like this that we are very passionate about. We are going to be talking about policies today. I do have a Review of the Week, and this is actually a very recent review which is so fun. We just posted on our social media for Google reviews. We were specifically looking for Google reviews and podcast reviews. These are so, so important for us but also for other people to find this platform. We want people to hear these stories. We want people to feel inspired and get educated and know their rights. Your reviews truly do matter, so if you have not yet, please, please, please do so. You can leave a review on your podcast platform, or you can go over to Google and just type in “The VBAC Link”, and then you can type in a review there. This reviewer is by Savannah, and she says, “I started listening to The VBAC Link Podcast around 16 weeks pregnant and continued throughout y pregnancy. It was so good and encouraging for me as a mama who was preparing for my VBAC. It helped me gain confidence, helped me know what to look for, and what to watch out for in my providers. Hearing others’ stories was so encouraging and helped me gain so much knowledge. I had my hospital VBAC unmedicated with my 8-pound, 15-ounce baby.” You guys, 8-pound, 15-ounce baby is a perfect-sized baby let me just say. “And I know that the knowledge I gained from this podcast played a huge role in being able to advocate for myself to get my birth outcome.” Huge congrats, Savannah, on your beautiful VBAC for your perfect-sized baby. I say that because you guys, let’s get rid of the “big baby” term. Let’s just title these babies as perfect-sized because an 8-pound, 15-ounce baby for some providers may be categorized as larger or maybe even macrosomic. it’s really important to know that your baby is the perfect size and your pelvis is amazing. You can do it just like our reviewer, Savannah. Julie: Your pelvis is amazing. Meagan: Seriously. All right, you cutie. Look at you. Did you just get a haircut, by the way?Julie: I did, yesterday. It’s a little short. We did some color. It’s a little smidgey shorter, but then I think I wanted it to still go in a low ponytail for births. That was my goal. Meagan: I’m totally digging it. Julie: Thank you.Meagan: I should be having fresh hair, but my cute hair lady bailed on me the morning of my hair appointment. Julie: Oh no! Meagan: Sometimes we have matching nails, but we would have had matching nails. We don’t have them today. You guys, we just miss each other. I miss you. Julie: Yeah. We need to go to lunch again. Meagan: We do. Yes. We love shopping, you guys. Let’s talk about hospital policies. Julie: Let’s do it. Meagan: We know that so many people go into– not even just birth, but really a lot of things in the medical world. They just go to a doctor’s office visit or go to a small procedure, or whatever it may be, and these places have policies. I want to talk about what it means. What does a hospital policy mean? What is the definition? The definition, according to lawinsider.com, says, “Hospital policy means the principals, rules, and guidelines adopted by a hospital which may be amended, changed, or superseded from time to time.” Julie: Oh, I love that addition. Amended, changed, or superseded. Meagan: Yep. Julie: Yeah. Meagan: Yeah. It can. Julie: And it does. Meagan: And it does. It does. Julie: It does. Meagan: You guys, let’s just start off right now with the fact of a hospital policy– or a policy, okay? A policy in general is not law. It is not law. If you decide to decline a hospital policy– Julie: It is well within your rights. Meagan: Well within your rights. You could get some kickback. You could probably expect it. Julie: You probably will. Meagan: But, that’s okay. That’s okay. My biggest advice is if you are receiving or being told that this is a hospital policy, and you disagree with the policy, or maybe you agree with the policy for someone else, but for you, it’s not working, and you say no, and they say, “Well, –”Julie: “It’s hospital policy.” Meagan: “This policy is policy, and if you choose to break it, then you can sign an AMA.” Julie: You are so funny. “This policy is policy.” It’s like that though. Meagan: That’s literally what they say. Julie: They say, “It’s hospital policy.” And you say, “Well, I don’t agree with that policy.” “Well, it’s hospital policy.”Meagan: “Well, it’s policy.” Okay. Well, I’m telling you I don’t like your stupid policy. Julie: I don’t like your stupid policy. We are spicy, huh? Meagan: I mean it, though. I think I maybe shared this a little bit, but I had a client who had a home birth planned. She decided to go to the hospital because she had preeclampsia, and this nurse was not giving her her baby. She kept saying, “It’s policy. It’s policy. It’s policy.” I was like, “This mom’s word trumps your policy.” As a doula, I was getting into some rocky, choppy waters I was feeling. I could just feel the tension building. It did not feel comfortable at all. I looked at my client. Julie: You’re just like, “Give her her doggone baby.” Meagan: They could kick me out. They could. I need you to know that they really could kick me out. She was like, “That’s okay. I want my baby.” So I pushed. I pushed. I pushed and I pushed. We did get her her baby, but we had to fight. We really, really, really had to fight, and it sucks. It really, really sucks. So there is a website called pregnancyjusticeus.org. We’re going to have this. I have not actually gone through all of it. It is– how many pages is this, Julie? It is a lot of pages. It is 65 pages, you guys. It’s 65 pages of birthright information, going through a lot. Julie: It will be linked in the show notes. Meagan: Yes, it sure will. If you want to go through this, I highly encourage it. It is from Birth Rights and Birth Rights Bar Association, the National Advocates for Pregnant Women. Like I said, it’s 65 pages, but what they said in here I just think is so powerful. It says, “There is no point in pregnancy in which people lose their civil and human rights, and yet all over the world, people often experience mistreatment and violations of their rights during pregnancy and birth and postpartum.” We see these things. Julie: You need to make that a social media post. People need to know this. Meagan: Yes. Down here even further, it says, “We also know that doulas and other people providing support to pregnant and birthing people often bear witness to rights violation of clients of loved ones. In a recent survey, 65% of doulas and nurses indicated that they had witnessed providers occasionally or “often” engage in procedures explicitly against their patients’ wishes.” This is a serious issue. Julie: It is a serious issue. I feel like it’s really frustrating, especially as a birth photographer where my lines as a doula are very separate, but I always doula a little bit at every birth I go to. It’s not hands-on stuff always, but it’s hard when you see people getting taken advantage of and they don’t know they are being taken advantage of and they don’t know that they have options or choices and they don’t know that they can decline or request changes, and that’s probably the hardest part is that people just don’t know. I have a little tangent, but I’m in this Facebook support group for this medication that I’m on. It really amazes me continuously about how little people know about a medication that they are taking, a pretty serious medication that they are taking, and how little their doctors inform them of what the medication is and what some of the side effects and issues are, and what they can reasonably expect from it because some people have completely unreasonable expectations because they haven’t dug into it at all. The other day, somebody said something like, “I’ve been really, really tired and fatigued since I started this medication, but I called my doctor and she said that fatigue is not a common side effect with this medication,” and I’m like, “What?” It’s literally listed on the manufacturer’s website that it’s a side effect. It’s listed on the insert for the medication. It’s talked about all the time in this Facebook group, and it can be caused by a number of things that this medication affects. The fact that either her doctor didn’t know or just told her– anyway, it leads me. I promise there’s a point to this. It leads me to the fact that your doctor does not know everything about everything, especially a family doctor. This medication is prescribed by family doctors sometimes and endocrinologists. It is impossible for them to know everything about everything. Something like obstetrics and gynecology is more specialized so it is more focused. It is a more centralized area of study, but still, your doctor doesn’t know everything about everything. It is not uncommon for them to not keep up in advancements in medications and technology and practices as they evolve. It’s very, very common for the medical community to be 10-15 years behind the current research and evidence. It just is. Doctors and nurses and all of these things who have to have to have a certain number of contact numbers per year to keep up with training and education, but it is impossible for them to keep up with everything. It is okay for you to have different opinions than your provider. It’s okay for you to want different things than is hospital policy, and it is perfectly reasonable for you to make those requests and for those requests to be honored. It is also okay for you to know more about a particular thing than your provider might. Meagan: Yep. Julie: Period, exclamation point, shazam. Meagan: Well, we’ve talked about this with other providers. We’ve heard other stories where people come in. They have stats that their providers haven’t even seen. They just get stuck in their own way and their policies, and there are other things going on outside, so they just point-blank say, “No, this is how it is,” and you might have more information. That doesn’t mean you are more educated or qualified or whatever to be a doctor. Julie: Yeah, exactly. Meagan: It doesn’t mean, “Oh, I might as well be a doctor because I know this information and you don’t,” but it means that you may have found information that your provider is not aware of. It is okay for you to bring that to their attention. In fact, do it. Congratulations for them to find out the information that they might not have known yet, so they can do better for the next patient. Julie: I want to say that there is an attitude with some medical care providers of, “Don’t confuse your Google search with my medical degree.” Meagan: Yes. Julie: Come on. I really have a big problem when people get like that because first of all, and I’ve said this before, and I will continue to say it again, we have at our fingertips access to the largest amount of information ever available in humankind ever at our desktops. We can sit down, and you can go and find information and studies related to anything ever. Yes, don’t go looking at Joe Blow down the street’s opinion about childbirth or whatever. Yes, that might be a credible source. It might not be, but you can literally find these same studies, the same research, and the same information that these providers have access to in their path to their medical degree. Is it extensive? No. Are you going to have the hands-on experience that they have doing these procedures and C-sections and things like that? No, you’re not, but you still have access to the same information that they have access to. I have a big problem when providers have this arrogant attitude that they know more. Yes, they do know more generally. They might not know more when it comes down to specific things that have been updated since they have gotten out of school. Meagan: Yeah. I feel like in a lot of ways, we hear these policies and these things come up, and you’re like, “But where?” Then they can’t show you the policy or stat. Julie: Yeah, then they’ll be like, “You’re 20x more likely to rupture.” You’re like, “Can you send me the research?” They’re like, “It’s the way we’ve always done it.” Meagan: I did a one-on-one consult, and a provider told someone that they had this astronomical amount of percentage of rupturing, and I was like, “Wait, what?” Julie: Seriously. Meagan: I was like, “Please challenge your provider and ask them for that.” She did, and they were unable to give her that. We can just hear things, and if we just take them, it can be scary, and it can impact decisions when maybe that’s not true. I also want to talk about policy for providers. Their policy should be that everyone should have informed consent. They have policies, too, that not only you have to follow or that they have to follow. It’s a whole thing. There are many policies. Your provider really has to explain the risks, benefits, and alternatives for any medical procedure, intervention, or anything coming your way, but we see it not happening most of the time. We just see people doing stuff because it’s within their normal routine but it’s breaking policy which is so frustrating to me. So you can break policy? I want intermittent monitoring. I don’t want consistent monitoring. I’m breaking a policy? Julie: So what?Meagan: So what? Julie: So what? Sorry. Meagan: Let’s talk a little bit more about VBAC and policies surrounding VBAC. We know that policies are just there. They’ve been created. During COVID, holy Hannah. We saw these policies change weekly, you guys. Julie: Daily. Meagan: Yeah, seriously. They went in and they were like, “This is our new policy. This is our new policy. This is our new policy,” and I was like, “What?” Julie: It was freaking whiplash.Meagan: Yes, it was horrible. It was horrible. But they can change a policy just like that. You can say no to a policy just like that. So, okay. Sorry. I digress. Let’s go back. Let’s talk about what policies often surround VBAC. I know a lot of the time, in hospitals all over, it’s a policy that midwives cannot treat VBAC. Or you can’t be induced because it’s a policy. You can’t induce VBAC. We talked about this before we started recording, and I said it just now. It has to be consistent monitoring. Julie: Yeah. Well, can I just do a little bit of a timeout and a rewind for half a second? Hospitals are businesses, okay? I just want to explain this to everybody. Hospitals are businesses. I think we know that. You don’t have to have that explained. Businesses, in order for them to run efficiently and smoothly, need to have policies, guidelines, best practices, standards of care, procedures, and things like that. It is a business. It is okay for them to set parameters for which they want their providers and nurses and everybody who is at the hospital to operate under, right? It’s okay for them to have those things. It’s okay for them to set those because if you didn’t have those, the business would fall apart. Everybody would be doing whatever the heck they want. There would be a lot of disorder, right? Meagan: Yes. Julie: So policies and procedures and these best practices and things like that are created in order to keep things aligned and have a nice model of care so that they can be more cost-efficient so that the patients know what to expect so that the providers have a routine and things like that. Meagan: Yeah. Julie: There are reasons for these things. However, when we like to push back, when we are bothered, and the thing that really is frustrating about these policies is when they are put in place so rigidly that there’s no flexibility and that it takes away a patient’s autonomy, and that it removes individualized care from the birth experience. So this is why we want to talk about this. This is why we don’t think all policies are dumb. No, we don’t. We see the reason. We understand why they are in place. However, we want you to know that it is well within your rights as a human to decline and request changes for these policies, and to desire something different, and to have that desire respected. It’s hard when some providers and nurses get so stuck in the fact that, “This is policy,” that they take away your autonomy and your right to choose. That’s what we’re pushing back against, and that’s what we want you to know. These policies are not law. You have the right to want something different and to request something different, and to have that right respected. Okay.Meagan: Absolutely. Absolutely. I couldn’t agree more. I do think it can be really hard because they have these things to keep order and to keep things tidy.Julie: And with the intention to keep you safe. Meagan: Yes.Julie: But sometimes intentions don’t always translate well. But anyway. Meagan: Yeah. But really quickly before we get into what policies surrounding VBAC are, when we start questioning policy, there are things that can come into play where there are threats, there is coercion, there is gaslighting that starts happening because they are really panicked that you are questioning their policy. They feel very uncertain that you are questioning that. Julie: They may even feel unsafe, or they might never have had the policy challenged before so they don’t know what to do about it. Right?Meagan: Yeah. Yeah. Just know that if people are coming at you with, “Well, if you don’t do this, then this,” or whatever it may be, then it can get intense, but you can still say no. You can also ask for a copy of that policy. Again, even though that policy isn’t law, you can still ask for it. Julie: Ideally, you can do this before labor begins because it’s really hard to fight and bump up against these policies during labor. Meagan: Yeah. Julie: It’s going to be a lot harder. Meagan: Yeah. Yeah. Okay, so let’s go in. I talked a little bit about fetal monitoring. Julie: Induction. Meagan: Not being seen by certain people. No induction. Or the opposite. Julie: You have to be induced. Meagan: You have to be induced. Julie: By such and such a date. Meagan: Yes. It’s just so funny because it varies all over. Julie: It does vary all over. Meagan: Let’s talk about it. Okay, so fetal monitoring. Julie: Don’t forget epidural placement too. Meagan: Yes. Epidurals. Julie: We can talk about that. That’s my favorite one to argue against. Anyways. Okay.Meagan: There are so many. Okay, let’s talk about fetal monitoring. What is the policy typically behind continuous fetal monitoring?Julie: Yeah, so most hospitals– in fact, I’ve never met a hospital where this hasn’t been the hospital policy– is that continuous fetal monitoring is required for everybody, but especially for VBAC. They double down for VBAC because one of the first signs of uterine rupture, especially for someone who has an epidural, is irregular fetal heart tones. That can be one of the first signs of uterine rupture. Most hospitals are very, very adamant about having continuous fetal monitoring, especially for people who are undergoing a TOLAC which is a trial of labor after a Cesarean. It’s not a bad word. It’s just how it’s defined in the medical community before you have your VBAC.The reason they do that, like I just said— but honestly, if you don’t have an epidural and if you aren’t under any type of pain medication, the first sign of uterine rupture for you is going to be really intense pain. That’s going to be your first sign. Especially if you are going unmedicated, I think it’s perfectly reasonable to request intermittent monitoring. Do you want me to go into why they introduced fetal monitoring in the first place?Okay, in the early 1970s, we saw lots of rapid advancements in the medical field and technology related to the medical field. Things like continuous fetal monitoring got introduced. Antibiotics became more readily accessible. The procedures themselves, especially the C-section procedure, became perfected and easier to do with fewer complications and fever rates of infections. All sorts of things started happening at a really rapid pace in the early 1970s. One of the things that got introduced was continuous fetal monitoring. The intention behind the continuous fetal monitoring when it got introduced was to decrease the rates of cerebral palsy in infants. Cerebral palsy usually happens when during either pregnancy or labor, oxygen is deprived to the brain of the baby. It can cause a stroke and damage part of the white matter in the brain. The idea behind it was if you could catch the reduced flow of oxygen to the baby by monitoring its heart rate, you could intervene and do a C-section in time to get the baby out before cerebral palsy happens, essentially. The interesting thing about that is that after continuous fetal monitoring was introduced, there was no change in the rate of cerebral palsy. It stayed the same. It still is very similar. But what it did do is that it was one component that increased the rates of C-sections and other interventions. They are more likely to take a baby out due to nonreassuring fetal heart tones, and we’ve seen no improvement in maternal mortality and morbidity rates and infant mortality rates either with the introduction of all of these interventions. Meagan: Yeah. One of the reasons why they say that it’s mandatory for VBACs specifically is because fetal heart tones decelerating is one of the signs, one of many, that a uterine rupture may be taking place. Julie: Right, right. I said that. Meagan: Oh, you did. Julie: Yeah. Meagan: I was reading the link. I missed that. Julie: No, no. You’re fine. Say it again. It’s okay.Meagan: No, you’re fine. Okay. So with uterine rupture, fetal heart decels are not always a symptom of uterine rupture. What do you feel like it means? I feel like so many people feel more comfortable having their baby on the monitor so they can hear them. Julie: Oh, they do. You know what? The staff is more likely to do that too. This is really sad, but we have a labor and delivery culture that is very, very comfortable sitting at a desk down a hall watching a monitor to see how a patient is doing rather than remaining in the room and watching them. They rely more on what is going on on the contraction monitor and the heart rate monitor than they do the visible signs of the patient. It’s how they’ve been trained. It’s how they monitor dozens of people at once in a labor and delivery unit, and I feel like continuous fetal monitoring and the contraction monitor are other ways that de-individualizes care. I don’t know if that’s a word. It takes out the individuality. It takes out the rights to the human and it takes out really watching the person, and relies too much on the data. Data is good. I love data. Don’t get me wrong. I am a data junkie 110%, but data can only take you so far. I feel like that’s why people freak out about the continuous fetal monitor thing. “How are we supposed to know if you’re doing okay at the desk because we can’t see the chart on the screen if we’re not monitoring you continuously?” It puts more work on them, which is okay. I can’t imagine being a labor and delivery nurse because sometimes you have more than one patient that you’re monitoring and watching, and you’ve got lots of other things to do including charting and all of this stuff. Meagan: Yeah, this is one of those things that was created that even though the evidence didn’t prove that the reason why it was created worked out, it stayed because it brought ease to monitoring labor, and monitoring it not in the same room, and being able to have five other patients while seeing a chart. Okay, so fetal monitoring is one. Let’s talk about the induction or the non-induction that we’ve seen policies on both ways which also is so weird to me. I know it’s hospital to hospital, but why aren’t we going off of evidence?Julie: Dude, dude. Do you know what is so funny to me? I will also cry this out from the rooftops until I die, but if you really want to understand what maternal healthcare is like in the United States, you’ve got to talk to a doula or a birth photographer because we see not only hospital births and home births and birth center births, but we see all of the different hospitals and how they vary in hospital policy. It is so funny to me sometimes the conversations that I hear or have with labor and delivery nurses who insist one thing, then the next labor and delivery nurse in the next hospital insists on something completely different. “Oh, it’s not safe to go past 20 for Pitocin on VBAC,” then the next hospital will be like, “Yeah, it’s perfectly safe as long as you are monitored and the OB signs off on it.” It’s so up, down, and sideways based on whatever this specific hospital policy is. It’s not their fault which is why sometimes I like travel nurses in labor and delivery units because they go all around the country and have vastly different experiences with all the different hospitals. It’s fun to see the culture shift that can come in when that happens. Meagan: Yeah. Okay, so in some hospitals, it is policy that you have to go into labor spontaneously. Julie: Yeah. They will not induce for VBAC. Oh, but if you haven’t had your baby by 40 weeks, it’s hospital policy to do a C-section. Meagan: Yeah, they will not induce you, but then if you don’t go into labor by 40 weeks, they have to schedule a C-section. What’s the evidence there, and why is that even being a policy?A lot of providers after 40 weeks fear or they say that VBAC uterine rupture chances skyrocket after 40 weeks because, “Oh, that baby is getting bigger. They’re stretching that uterus out,” but that’s really not necessarily the case. We’re seeing it happen more and more and more where people are then doubting their body’s ability to give birth or go into labor. They are so scared that their baby’s going to get so big that they’re going to cause uterine rupture if they go past 40 weeks. I mean, really. You guys, the amount of things that we see coming in The VBAC Link’s DM’s– I love that you guys write us. Please keep writing us, but it’s frustrating, not that you’re writing us, but that these providers are telling people these things. Then we have the opposite that we have to induce by 40 weeks. Julie: Can I read you this thing? There’s a post in The VBAC Link Community today. It was a VBAC agreement form. If you’re birthing at a hospital, you’re more than likely going to have to sign a piece of paper showing all of the risks of VBAC, but they don’t ever make you do that for a C-section. This hospital VBAC policy, hold on. I was reading it this morning. Listen to this. This is word for word from this VBAC agreement form from a hospital. “I am aware that the best chance for a successful VBAC is to go into spontaneous labor, and that the risk of Cesarean section is increased past my due date. In an effort to afford me the best chance of achieving VBAC, I agree to be induced the 39th week of pregnancy or sooner if medical issues are present if I am still pregnant.”In that same paragraph, they say that the best chance of a successful VBAC is going into spontaneous labor, but if you don’t go into labor by 39 weeks, we’re going to induce you. Meagan: It also says that after 40 weeks, Cesarean chances increase so we have to induce a whole week before. Julie: Yeah. Right? Meagan: I’m sorry. Julie: This is real life. How is this even a thing? Blah, blah, blah. That’s what I say. Screw your policy. How can you contradict yourself like that? It says, “The risk of a Cesarean section is increased past my due date, but it’s also increased if you induce me, so either way I have increased risk.” This is literally what they are telling you in this form that they make you sign. Meagan: You know, those forms are so important to pay attention to, you guys. As you are getting these forms, the VBAC consent forms, or VBAC agreement forms or whatever. They title them all differently. Julie: I’m just reading this hospital policy more. Sorry. “I am aware of the hospital policy requiring two IV access sites.” Meagan: Okay. Today, which you guys, was last– I’m trying to think. It was a month ago. Okay, a month ago– I recorded the episode today, but a month ago, when this is coming out. Go listen to Paige’s midwifery episode. She just was talking about that. That is a policy within the hospital that she helps people at. They have two hep locks. This was news to me as of today, and now you are seeing this in this policy. Why? Why? What is the evidence behind that? Why?Julie: This VBAC agreement form is every single thing that we are talking about. “I agree to have continuous fetal monitoring. I am aware of this policy by this obstetric group–.” I won’t say it because maybe we shouldn’t call them out. Maybe we should. “--to require epidural placement by the time of active labor. I am aware of the implication that certain complications of labor can be life-threatening to myself and my baby. These can only be addressed promptly at the hospital. To lessen the risk of delay during a complication, I agree (in bold)--”Meagan: Yes. All of the agrees are in bold.Julie: “--to come to the hospital immediately if I am in labor or if my water breaks.”Meagan: Ugh. Julie: “I have been adequately about the risks, benefits, and alternatives of VBAC, and have the opportunity to ask questions. I am aware that no one is able to guarantee a successful VBAC and that repeat C-section may be indicated if my baby is breech, I do not adequately dilate, I am able to push my baby out, my baby does not tolerate labor, there is a concern for uterine rupture, or if any unforeseen medical issue arises during my pregnancy which makes labor unsafe–” according to who?Anyways, “certain methods of induction of labor are not permitted to be used in patients with prior Cesarean sections. I understand that if I am induced, the only safe options include medical dilation with a balloon, Pitocin, and breaking my water.” That, I feel like, is accurate. Meagan: That is valid. That is valid. Okay.Julie: That’s the only one. Cool. Meagan: Cool. Out of ten. Julie: Are you reading this right now? Do you have it up?Meagan: Yes. I pulled it up. Let’s talk about epidural. You guys, this has 86 comments already. One of the commenters said, “You absolutely do not need to get an epidural, have continuous monitoring, or go into the hospital when labor begins. These are often things to avoid when trying for a VBAC.” Julie: Yes. Yes. Meagan: You absolutely can have these things. “You can have these things, but having an epidural before 6 centimeters can put you at a higher risk of Cesarean including continuous monitoring. Your rights override policies.” This is what she said. She said, “Are you in the States? Did you sign this?” Julie: But I love what Flor Cruz with Badass Mother Birth said. “This is atrocious. Run. I would rather give birth in the woods by myself than to agree with this monstrosity.” Meagan: Really, though. We have so many things coming at us. We’re so vulnerable when we are pregnant, and we want a VBAC so badly. We have forms like this being given, or we have policies being thrown at us, and we say, “Just say no,” but when you’re in that moment, it’s really difficult. I think something that I want to say is, as you are learning these policies, as you’re learning more, figure out if you are someone who can stand up to these policies and say no, or figure out if there’s someone on your team who you need to have be there to help you find the strength to say no. Also, make sure that your family knows and your team knows what’s important to you when it comes to these policies. What triggers you? It is very difficult to say no or, “I am not going to do that,” or to not even say a word because they just strap the monitors on you, or call anesthesia because they just did a cervical exam, and the nurse logged that you’re 6 centimeters, so anesthesia is just coming down, but you might be doing really well and not want an epidural. Okay, I want to talk about epidurals. Julie: Let’s talk about epidurals. Jinx. Let’s do it. This is my favorite policy to tear apart and rip apart. Here’s the thing. The reason why they tell you they want an epidural placed, but you don’t have to have it turned on, just to have it placed just in case, is if a uterine rupture happens, you can dose up the epidural and go back to surgery, and they don’t have to put you under anesthesia. It sounds great, right? Cool, yeah. Let’s do that. That sounds great. I don’t want to go under general anesthesia if I have to have a C-section. Here’s the problem with that. First of all, going under general anesthesia does carry more risks than having surgery with a spinal or an epidural. It does. That’s just common knowledge. Nobody is going to argue that here. We get that. The problem is that in a true emergency, we’re talking about seconds matter. Minutes matter. If you have a catastrophic uterine rupture and baby has to be out now, baby has to be out in minutes or less. They are going to do a splash and dash. They are going to throw the antiseptic, the orange stuff– Meagan: Iodine? Julie: Iodine. They’re going to throw iodine on your belly, and they’re going to slice you open. Sorry, that was a very not-sensitive way to say that. They’re going to take the baby out as fast as possible once you’re in the OR. They have to knock you out under general anesthesia. There is not enough time to dose an epidural, especially if it’s not ever turned on. But even if it is turned on, it takes 20 minutes or more to get an epidural dose to surgical strength to where you will not feel the incision and the surgery that comes with a C-section. 15-20 minutes at minimum in order to get you dosed to surgical strength. If you have an epidural, and it is urgent where minutes matter, you will have to go under general anesthesia no matter what, period. If a C-section is needed, there is time to give you a spinal which takes effect in just a few minutes, 3-4 minutes. It takes some time to get the anesthesiologist in and the OR prepped and things like that, but usually and realistically, if it’s something that’s urgent but not emergent, you can get a baby out in 10-15 minutes without already having an epidural placed. Here’s the thing. Placing an epidural is preparing you for surgery, period. If there’s an emergency, you will have to be put under general anesthesia, period. If a C-section is needed, and minutes don’t matter, but we need to get this baby out soon, you can get a spinal, period. So, screw that epidural hospital policy. It’s literally for convenience so you already have an epidural placed so that they can take you back to do a C-section. Meagan: Yeah. But again, the epidural just doesn’t get in fast enough even if it’s placed or not. Julie: Exactly. Meagan: Ugh, I hate it. I hate when it’s like, “I don’t want an epidural, but I’m getting it just in case.” Okay, then going back to this policy that she was just reading, “will not labor at home. If my water breaks, I have to come right in.” You guys, if you want to labor at home, do your research. I understand. Always, always– I don’t even care if you are a VBAC or you’re planning an induction or what. Always learn the signs of uterine rupture, always. It’s so important to know. Even though it happens very little, it happens, and we need to know the signs. But, it’s okay to labor at home. Talk to your provider about that. If they are like, “The second you have a contraction, you have to come in,” that is a red flag. You guys, they also start monitoring and pushing induction even though your labor has been going. They induce your labor more. They get it going further. What if you’re having prodromal labor, and it’s just going, and then it stops for 5 hours? There are so many things. I’m no provider. I can’t say, “You must labor at home,” or “You should really labor at home,” but really look at these things and understand what could happen if you choose to go in the second your water breaks. Let me tell you what happened to me. My water broke. I went straight in. Within an hour, I hadn’t progressed too much, so they started Pitocin. They immediately started Pitocin. They kept cranking it up. My body was struggling. I was struggling. My baby had a couple of decels. They called it. It’s just really, really frustrating. I mean, you guys. We have so many comments in this here that I could just read all of them because they say a lot. They say a lot. This is fear-based care. I’m sorry that you’re having to go through this.” “This is the dumbest thing I’ve ever heard,” someone said. Julie: Seriously. Meagan: When it comes to hospital policy, it’s not a law. It’s really not a law. Stand up for yourself. Understand the policies surrounding VBAC. When you are looking for a provider, we cannot stress this enough. Ask them about their policies. If their policy is that you must get that just-in-case epidural, you have to have that baby by 40 weeks or we induce or we schedule a Cesarean, you have to come in the second a contraction starts, if your water breaks, you must come in. You have to come in. They’re making people sign these policies like they are the law. Julie: Yeah, like it’s a legal document like you can’t change your mind. That’s what it does. It makes people think they have to agree to things. “I signed the document, so here I go.” Meagan: Here I am. I have a written agreement, but they can change. What did it say? What did the very first definition say? It says, “It can be amended, changed, or superseded.” Supersede. Julie: Superseded. Yes. But here’s the thing, too. I’m kind of glad when hospitals do this because it shows you all of the red flags. It lines out the red flags, no questions, black and white, red flags laid out for you. Then you know either how to address them before labor, or how to hightail it out of there and find another practice because nothing is worse than getting blindsided during labor by a policy that you don’t agree with and having to advocate to change that during labor.I would encourage you if your provider doesn’t make you sign a wonky form, then before you even start care with them, find out what their hospital policies are about VBAC. Find out so that you can address them ahead of time. Have your provider sign off on changes to policy that you want, and put it in your medical records so that if you get a different provider on the day that you go into labor, that provider can access your records and see that it has been signed off, or approved, or whatever your changes are that they are going to make to the policy for you and your specific needs. It is okay to ask for that. It is okay to fight for that. It is necessary to fight for that sometimes. Obviously, it would be ideal for you to find a birth location whose policies align with the things that you want. Sometimes, somebody might want continuous fetal monitoring. Maybe it makes them feel better mentally. Maybe that’s just their preference, and that’s okay. It’s okay to want that, but it’s not okay to let a system dictate how you want to birth when you want something different. Meagan: Yes. Absolutely. It’s also not okay for you to feel cornered or like you’re bad, coerced, or you’re a bad mom because you’re making a decision that goes against a policy. I don’t like that. I do not like that. It’s not okay. I highly suggest going and checking out the show notes and reading more about your birth rights, what they mean, and all of it. In part of that little birth rights document pdf, the 65-page document, it talks about down in the first 4 or 5 pages– let’s see. It says, “I have the right to–”, and then it has a whole bunch of things. It says, “To say no and be heard. To have my basic needs be met. To labor in the way that works for me. To birth vaginally. To know all of my options. To change midwives, doctors, and nurses. To not be touched. To ask people to leave. To feed my baby human milk. To leave the hospital or the birth center.” You guys, you have rights. You have rights. You are amazing. Use your rights if you are in a corner that feels like they are being taken away or they’re gaslighting you, or coercing you, or whatever it may be. You have rights. Check this document out. I highly suggest it. Talk to your providers. Check out their policies. Dissect the policies. Dissect them. Really break it down. What does that mean? Why is this being put on as a policy?In one policy that Julie just read, it said that they will not induce, and that VBAC is not applicable to being induced with certain things other than x, y, and z. Okay, if you do the research and you learn about that, that is pretty dang valid. That is understandable. That policy has been put in place for your safety. Okay? But there are others that I would say no to. They may be thinking that it’s for your safety, but there is no evidence behind them. Dissect them. Learn them. Learn how to advocate for yourself. Get your team ready. Know it’s not a law, and love yourself because you deserve more. Okay. Anything else you’d like to add, Julie?Julie: No. I love that. Love yourself. Take ownership. Take ownership of your own birth experience. Don’t give it to somebody else. Stand up for yourself. Take ownership. I love what you just said. Love yourself. You deserve to have choices in how you are treated during your birth experience. Meagan: Yes, absolutely. Okay, thanks, everybody. ClosingWould you like to be a guest on the podcast? Tell us about your experience at thevbaclink.com/share. For more information on all things VBAC including online and in-person VBAC classes, The VBAC Link blog, and Meagan’s bio, head over to thevbaclink.com. Congratulations on starting your journey of learning and discovery with The VBAC Link.Support this podcast at — https://redcircle.com/the-vbac-link/donationsAdvertising Inquiries: https://redcircle.com/brands