Wednesday, February 12, 2014

Like Watching a Movie When You've Already Read the Book

I am blogging about this with the permission of the mother involved.

There’s a caesarean by choice mom in Ontario (Alliston) who has contacted me – and unfortunately her story seems to be unfolding pretty much as my story unfolded with the birth of my daughter. Except, her OB told her at 33/34 weeks that she would not do a caesarean unless there was a medical indication for one, but if a medical indication presented itself that they would move to a caesarean as soon as possible. The doctor implied that the “Ministry of Health” would have a problem with her undertaking a maternal request caesarean (I call BS!). My doctor failed to refer me until 32 weeks, and I did not know if my request would be granted until I was 36 weeks.

The woman was upfront about what she wanted with her care provider from the start of her pregnancy (as was I). Had the doctor been upfront with the woman at that time, she could have moved on to an alternate provider that might have facilitated her request (as might I have). Instead, she was treated paternalistically (as was I) by a doctor who seemed sympathetic, who seemed to listen and to understand – but who ultimately frustrates what is desired by the patient by ensuring that what is wanted cannot be realized.

After being informed by her doctor that her care plan is unlikely to be realized – this woman has been left scrambling. She’s gone back to her family doctor hoping that if he advocated for her that her plan would be facilitated. No luck. She’s written a letter to her doctor that says she does not really consent to a vaginal birth and that she is worried about the potential harms of vaginal birth for both herself and her daughter. She’s pointed out the NICE guidelines on caesarean by choice (she’s Canadian so they don’t really apply). She tried to give her doctor Pauline McDonaugh-Hull and Magnus Murphy’s book “Choosing Cesarean: A Natural Birth Plan”. Her doctor declined reading it. She is currently left hoping something goes wrong so that she can have the caesarean she wants. Her OB wants to begin performing “stretch and sweep” procedures at her 37 week appointment next week.

I’m saddened that nobody has seen fit to refer this woman for a psychological assessment – as the idea of a vaginal delivery causes her a considerable amount of anxiety, they are declaring they won’t do the caesarean without a medical need – without recognizing that the mental health impact of an unwanted vaginal delivery IS a medical need. Rather than investigate that, they just out-rightly have denied this woman access to the care she needs and are doing so in a rather unethical way, by having delayed referral to the point where alternate care is not possible. The lack of understanding and compassion is appalling – as is the lack of recognition that a woman has a right to decide what to do with her own body and she should not be unreasonably prevented from doing so. This woman has not fallen through the cracks, so much as she has been shoved into a crevice.

So what would I do if I were faced with that situation?

I might start contacting lawyers and legal aid to figure out if there was some way to avoid having my rights violated. I might write a letter to the College of Physicians and Surgeons of Ontario calling out the behaviour of the physician. I might contact the media about my plight. I would contact Birth Trauma Canada for advice. I might contact the Office of the Ombudsman and file a complaint. I might contact patient rights organizations with my story. I might go to a different hospital with a reputation for being more “woman friendly” at 39 weeks and beg for a caesarean. I might hire a psychologist to try and advocate on my behalf – or maybe contact a perinatal social worker to see if she could help. I might ask the doctor to provide me with a medical reason not to perform the caesarean. I would go to another care provider – even if it meant the on-call OBGYN at the hospital and I would continue to make my wishes known in as clear of a way as possible.

And ultimately, if all that failed and I was still subjected to a vaginal delivery I did not want. I’d do what I’ve done – try to handle it as best I can, to try and cope with what has happened, to try and not let it impact my life more than it needs to because you can’t change the past – you can only do what you can to make the future a better place.

I’m really sorry that I cannot do more for this mother – it is like watching a movie when you’ve already read the book. Sometimes you can only hope for a different ending.

P.S. If anyone can help make a different ending happen - please drop me an email at - Thanks.


  1. I find it so unbelievable that the mental health of a woman is not considered when deciding on the medical necessity of a c-section. As this woman advocates for herself, I would tell her to take a page from the NCB playbook and tell her to refuse her consent to do any procedures designed to induce labor (stretch and sweep) unless her doctor can convince her the baby needs to come out (medically indicated).

  2. My goodness. A) terrific piece B) your advice is stellar, I can't think of anything else, other than spending a lot of money to approach a new doctor and pay for surgery upfront. I wish this lady the best and urge her to seek professional psych services ASAP to talk about her feelings surrounding her pregnancy and also her 'care'.

    1. This is Canada - there is no pay for access. If something is in the public system, there is no private parallel system alternative. You can pay out of pocket for a psychologist and get pretty quick access. Psychiatrists require a referral or access via emergent care. Referrals tend to take a while in Canada....

  3. This is one of the truest statements I have ever read in relation to the stories women have told me/ I've read over the past 10 years:

    "I’m really sorry that I cannot do more for this mother – it is like watching a movie when you’ve already read the book. Sometimes you can only hope for a different ending."

  4. Go over to Flint Michigan and look up Theodore Fellenbaum at genesys hospital, he will help her...

  5. Was there a different ending?

  6. See the subsequent post - the mother delivered vaginally after an induction, there was no adverse physical complications, the mother did have access to an epidural.

  7. Congratulations to the mother: I hope she finds peace with the method of birth and joy in her new baby. I have experienced that awkward desire for something that would justify a c-section without endangering the baby -- I have read "spinning babies" with the opposite intent, for example -- and have tried to walk that difficult line between advocating for myself and trying to retain some emotional reserve to that a vaginal delivery, if it did happen, did not overwhelm me. Personally, I found it possible to make peace with the idea of an unavoidable vaginal delivery (going into labor on the train, for example) but so, so hard to know that my wishes could be discarded by whoever happened to be on staff at the hospital. This Ontario mother is a brave woman and I wish her all the best.

  8. I think anyone who would WANT a c/s without medical necessity has to have some screws loose. I had an unwanted c/s with my first and an unassisted vbac with my 2nd. The vbac was easy as pie.

  9. Unassisted VBAC, but the woman who wants a patient choice CS has 'some screws loose'. I note that elective cesarean is the least risky mode of delivery for the baby (in terms of death or brain damage). Hindsight is always 20/20, and I imagine if you were the 1/200 who ruptured, or the 15-40 percent who needed an emergency CS, your point of view would be dramatically different. You got lucky, nothing more, nothing less. Patient choice cesarean moms prefer taking a known option rather than one filled with uncertainty, it is a rational choice and it deserves both support and respect.