VBAC

Dr. Hartung takes Higher Risk Pregnancies to Woodwinds Hospital
Dear Birthing Community of the Twin Cities Greater Metropolitan Area and Chicago and wherever Women have traveled from to give birth with Dr. Dennis Hartung at Hudson Hospital of Hudson, WI.

Several of you have asked me to let you know what Denny has to say about this. He’s emailed Emme and she’s shared that message. Today Denny and I were able to talk on the phone and he’s asked me to share these primary points:

There were no bad outcomes.

There has been no sanction of practice.

Hudson Hospital participated in a policy review on nursing care and some physician practice policies. The good birth outcomes supported by Dr. Denny, his nurses and colleagues were not included in the decision made following a recommendation Hudson Hospital instituting strict policies. Water births for instance will have many more restrictions. VBAC women will have continuous monitoring with OR staff in house.

 

Newborns will be given all tests and procedures.

The reason breech vaginal birth is suspended is because not all the physicians in Denny’s group agree to his attending VBB. The review board recommended to stop breech birthing until all the physicians agree to reinstitute VBB. The strategic public letter sent out by Hudson on the 7th of

March also mentions refusal of homebirth transports.

Denny informs them that refusing a patient at the door is illegal. But even if a homebirth family comes in, I noted, and as the letter describes, the new Hudson policy is to refuse patient informed consent and informed refusal. The letter implied physicians want to do everything they can for the mother and babies, regardless of family choice, this is implied in the letter.

Denny is concerned about patients’ rights to choose between interventions and procedures that have conflicting data and, thus, no assured result. So that if a woman declines an antibiotic for GBS or a cesarean for breech she should have that right since the data isn’t weighed in the favor of the intervention.

He’s not sure the administration understands the implications of instituting strict and restrictive policies at Hudson. 1/2 of Denny’s patients come from the Twin Cities. The other OBs, John Sousa and Alissa Lynch (sp) receive an overflow of his patients, and the Pediatricians receive a higher income simply because some of the group income is shared among them. Everyone there has benefited from the family-friendly care that has been given at Hudson Hospital. Dr. Hartung’s presence has benefited Hudson Hospital greatly.

Denny will hope to care for women having Breech, VBAC and/or Twins at Woodwinds now. (If I may, this seems to be an inconvenience for him, but a benefit for us in the Twin Cities!)

Denny also asked, with deep sincerity, please don’t make your social network initiative about him, he said this is about women’s right to informed care and how policies not based on evidence based care or the parent’s choices disrespect women and families. 

Robbi Hegelberg asked in the letter to area homebirth midwives and birth centers for questions to be directed to her at 715-531-6012. I suppose they will also see it after they project their 2013 income and then find that without Denny’s right to practice evidence based care that their patient numbers will drop dramatically. (That’s a little personal note!)

Dennis Hartung will continue to work at Hudson Hospital while increasing his presence at Woodwinds Hospital in Woodbury to meet the needs of his patients living in the Twin Cities area.

 

Dr. Hartung welcomes families to his care in Woodwinds, and Jeanette Schwartz, Lead Nurse at Woodwinds is happy to welcome him to come there more frequently. Laura France is the Director of Obstetrics. At Woodwinds, each Doctor makes their own practice decisions, as he understands it at this time. FYI, Denny doesn’t practice  at Regions or Joe’s.

Please don’t say things that might give Hudson any reason to sanction Denny Hartung for libel. (I know you won’t.) That’s important because it could very well come back on him, and this insight is not coming from me. I know you will be fair without name calling or blaming. Robbi and the other board members need to hear why we won’t be referring hospital birthing parents to Hudson any longer, that refusing informed consent and informed refusal is in violation of a woman’s right as a patient and as a human being, and I could go on, but I’m staying diplomatic here. Volumes of mail, calls, emails, and social network posts will make a difference. For those of you inclined, please say prayers, send victorious thoughts and/or light candles for Dennis Hartung. Denny very much appreciates this support from the community and in return he, too, is devoted to all of us, serving the birthing community with all his heart.

Kandace in Lakeville

Vaginal Birth after Caesarean – The Key is Finding the Right Doctor and Hospital

The article below states that: “Most doctors or hospitals don’t have access to 24/7 hospital coverage by physician services in obstetrics, gynecology, anesthesia, neonatology with a neonatal intensive care unit, operating room availability for emergent Caesarean deliveries, massive blood banking and expert nursing.”

When I delievered my baby as a VBAC, at the age of 41, I did so in a small hospital in a small town, about 20 miles from the closest NICU. My doctor told me that their hospital had recently become approved for VBACs. My understanding of his explanation was that certain measures had to be taken in order to be allowed to perform VBACs. For instance, an anesthesiologist needed to be present in the hospital at all times in case of an emergency C-section. Hudson Hospital, where I delivered, did not have a neonatal intensive care unit (NICU). I was told that if a baby were to need immediate care it would be transferred to a hospital with these facilities.

A friend of mine gave birth to her second and third child vaginally in a birthing center in Wisconsin, attended by midwives, after having had her first child via Cesarean. Although I did not see the birthing center myself, I was told it was across the street from a hospital in the case of a need for emergent care.

She ended up giving birth the first time by Cesarean due to a diagnosis of “failure to progress.” She told me that she believes had she been in a hospital that her second two babies would also have been delivered by Cesarean. She believes that the midwives were more tolerant of a longer labor and helped while she progressed through the early stages of labor.

Here is the article to which I was referring:

Vaginal birth after c-section is option for women, not for some doctors, hospitals.

ScienceDaily (May 11, 2012) — Melissa Lunsford wants a vaginal delivery for her fourth child. Following a series of Caesarean and vaginal deliveries for her other children, she couldn’t find a doctor or a hospital willing to give her the vaginal birth option for her current pregnancy.

Unfortunately, too many women like Lunsford face the same challenge, says an advocate of vaginal births after Caesarean (VBAC) from Ben Taub General Hospital, one of the top VBAC-delivery hospitals in Texas.

“For some clinicians and hospitals, the prospect of offering a trial of labor after a Caesarean delivery is too risky. While risks exist, the possibility of delivering vaginally is still a viable option for many women,” says Dr. Christina Marie Davidson, chief, Obstetrics and Gynecology Services, Ben Taub General Hospital, and assistant professor, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Baylor College of Medicine.

Finding a physician and hospital that offers VBAC procedures can be difficult. Most doctors or hospitals don’t have access to 24/7 hospital coverage by physician services in obstetrics, gynecology, anesthesia, neonatology with a neonatal intensive care unit, operating room availability for emergent Caesarean deliveries, massive blood banking and expert nursing. At the Harris County Hospital District, the health system that operates Ben Taub General Hospital and Lyndon B. Johnson General Hospital, the Women and Infant Services has all medical coverage needed to make VBACs a viable option for women even after more than one Caesarean delivery.

In fact, Ben Taub and LBJ hospitals share the state’s highest VBAC rates of all hospitals, respectively 27.86 percent and 29.58 percent, according to a 2009 report by the Texas State Department of Health Services. The rates of Ben Taub and LBJ hospitals are routinely three times higher than the national VBAC rate of 8 percent.

“We believe women should have that choice. We can’t guarantee that they’ll have a VBAC delivery every time, but we can certainly plan for it,” Davidson says.

Factors associated with an increased likelihood for a successful VBAC include:

• Not facing a similar condition for the previous Caesarean

• Successful vaginal delivery or VBAC in past

• Previous Caesarean not for cervix complications or infant not descending through birth canal

• Labor starts on its own

• Younger than 35 years of age

After being repeatedly told of the inherent risks and dangers, Lunsford sought answers and comfort on the Internet. Her research of successful testimonials gave her hope. She next began an arduous search for a VBAC-friendly doctor.

“Everyone I talked to, including my friends, basically told me it was silly to think of delivering vaginally again after a Caesarean. But, it is important to me and something I knew I wanted,” she says.

After contacting 10 doctors to deliver her baby, Lunsford finally found Davidson, who not only had the expertise, but who’s also an impassioned supporter of VBACs.

“Women who choose to have a vaginal birth after Caesarean should have that option and not be discouraged because of a lack of knowledge or resources,” Davidson adds.

For Lunsford, the chance to deliver her son as naturally as possible is worth the effort.

“It is important to me and important to my entire healthcare team,” she says.

Skin-to-Skin Contact Following a Cesarean: Fight for It – It’s Your Right

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This piece is about the importance of mothers staying with their babies after birth and of experiencing immediate skin-to-skin contact, even if a C-section is warranted. In my case, I was holding out for a vaginal birth but ended up with a c-section. This is the story about how I was able to get skin-to-skin contact following a C-section despite my first doctor telling me that it would not be possible.

As I’ve mentioned in a previous post on the birth of my child, the first OB that I sought care under was mandating that I have a cesarean at 36 weeks, mostly due to CYA policies. Not knowing any better I originally went along with her decision.

However, one day I was talking over my situation with a well-published neuroscientist who had recently had a child of his own. He was appalled that my doctor would recommend a c-section at 36 weeks. He suggested that I start researching my options immediately. His opposition to the C-section was not just medically-based. He felt that C-sections could have negative side effects on a mother’s emotional well being and he was worried about the lack of skin-to-skin contact. He stated that skin-to-skin contact (which might not be available with a cesarean) following the birth of the child was a crucial element in mother-child bonding, to nursing, and important for the health and well being of the child.

What is Skin-to-Skin Contact?
When a baby is born vaginally, he or she is ideally taken from the birth canal and placed on the mother’s belly immediately following the delivery. The babe is covered with a blanket to keep her warm. Babies lay on their mothers and begin to regulate their body’s temperatures in synch with their mother. They exhibit pre-feeding behavior and start to learn to latch on and nurse. In some research studies, scientists have filmed the babies as they literally army-crawl up their mother’s chest to reach the breast where they can start breastfeeding! It may take an hour but they make it and with any luck they latch on and start to nurse. This is skin-to-skin contact at its best. The mother and baby are united skin-to-skin immediately following birth.

Of course, there may be times when the mother is what they call “medically unavailable.” In these cases, skin-to-skin contact with Dad or another caregiver has been proven to be equally as beneficial to baby.

Why is skin-to-skin contact so good for your baby?

  1. The sooner the baby starts nursing, the more likely it is that the baby will successfully nurse and will latch on well. With skin-to-skin contact it is also more likely that the baby will nurse exclusively for a longer period of time. During the first few minutes of life the baby is not eating per se but is practicing the act of nursing and demonstrating pre-feeding behaviors. These behaviors are crucial to long term successful breastfeeding.
  2. Skin-to-skin contact with the mother (or even a father or substitute caregiver) helps the baby to regulate its temperature more quickly and without the use of a warmer. Many babies are put into a warmer directly following birth. Research shows that skin-to-skin contact is more effective in regulating the temperature of the new born than swaddling or being put in warmer. Research also shows that when a baby’s temperature drops, the mother’s temperature rises to compensate for the loss of body heat in the baby. The mother’s body is designed to regulate her baby’s temperature. She literally becomes her baby’s thermostat.
  3. With skin-to-skin contact babies breathing rates and heart rates are more stable and the baby’s blood sugar is higher.
  4. Babies who have skin-to-skin contact cry less than babies who are placed beside the mother/father in a bassinet. This is true even for babies that receive skin-to-skin contact from their fathers when the mother is medically unavailable. The infants become calmer faster and reach a drowsy state faster than babies who are put in a warming cot next to the parent’s bed. If you are medically unavailable ask the doctors and nurses to allow you or your husband or partner or family member to provide skin-to-skin contact or create a lang in advance so that your birth partner or doula can make this happen. This is better than no skin-to-skin contact and can have beneficial effects on the well-being of the infant.
  5. Babies born prematurely recover more quickly when they have skin-to-skin contact. Skin-to-skin contact is being promoted more and more in NICU’s (neonatal intensive care units) to help babies who are born prematurely to thrive. Skin-to-skin contact can reduce the infant’s need for hospital-supplied oxygen.
  6. Can you still have skin-to-skin contact if you are having a C-section?
    When I found out how important skin-to-skin contact was for the baby, I immediately wanted this for my child and me despite the fact that I was scheduling a c-section. I approached my OB about it which led to many conversations, discussions and tears. I brought in research articles supporting my desire and outlining the importance of skin-to-skin contact. The OB responded “Don’t worry. There’s plenty of time for bonding later.”

She explained that the operating room was not designed for skin-to-skin contact; that there was a drape that came up to the mother’s neck which would prevent skin-to-skin contact; and that additional staff would be necessary to help me have skin-to-skin contact with my baby. She explained that there was a sterile field that could not be crossed and that having the baby on my chest could compromise the integrity of the sterile field. She also maintained that the possibility of skin-to-skin contact would depend on who would be available at the hospital on the day of my surgery and although she could try, no promises could be made.

This news led me to an all out search for a hospital that would allow skin-to-skin contact following a c-section.

Usual Practice
Until recently, usual practice involves separating the baby from the mother as soon as the baby is surgically removed from the mother. The mother is shown the baby over the drape, the baby is then weighed and treated and swaddled and placed under the warmer. That baby is taken to the mother’s room until the mother is finished being stitched up and returns to her room after a stay in the recovery room. The baby and mother are reunited in the mother’s room with the mother only have briefly viewed her baby.

Advocate for Yourself
After determining that skin-to-skin contact was a must-have for me in the case of a cesarean, I contacted three hospitals and asked them about their OR procedures with a c-section and whether I would be able to have the skin-to-skin contact I desired.

The doctors and nurses that I spoke with were all supportive of skin-to-skin contact. I recall one doctor saying that it would be against hospital policy but that rules were made to be broken. This same group of hospitals were changing their delivery practices and training their staff on the importance of in-room boarding (meaning the baby stays with the mother for as much time as possible rather than going to the nursery).

Be Persistent
I finally found an OB who was willing to honor my desire for skin-to-skin contact. The last thing he said to the accompanying nurse before I went into the operating room was “Make sure she gets her skin-to-skin contact.”

The idea of having my baby whisked away from me after the surgery that brought her into the world was devastating to me. I knew that this could not be right. I had carried this baby for nine months and they were going to show her to me over a drape and then take her away. How could this be healthy for the infant and the child?

Obviously, allowing skin-to-skin contact is not an insurmountable request. The obstetrician that I switched to at 28 weeks was Dr. Hartung of Hudson Hospital. He did not hesitate to honor my wishes. He ended up being my greatest advocate and allowing me to get my birthing desires met.

I want to thank Nurse Jessica and Dr. Hartung for providing me with the best birth possible with my cesarean and for helping me get the skin-to-skin contact with my baby that I so desired.

In the meantime, if you are planning a C-section, ask about the possibility of skin-to-skin contact. If the doctor refuses, stand your ground. If the doctor continues to resist, call other hospitals and find a doctor that will honor your wishes.

And, of course, remember that most births do not go as one plans. Even in cases where skin-to-skin contact doesn’t occur due to uncontrollable circumstances, the baby will still thrive and bond with his or her mother. And just because one doesn’t have skin-to-skin contact right away does not mean that breastfeeding isn’t possible. What in theory is the BEST for our baby doesn’t always match with the reality of mothering. We can only take what we know to be best and do with that what we can.

Things to Think About:

As a society, how can we advocate for change among OB’s such that they are open and willing to the idea and practive of skin-to-skin contact even in the case a planned or unplanned C-section?

How can mothers advocate for themselves with OB care such that they can get the type of birth experience that they desire?

How can we be proactive in attempting to create change at the hospital level?

What can we do in our own community to educate OB’s and hospitals about the importance keeping babies united with their mothers especially during the first few hours following birth?

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Vaginal Birth After Cesarean – Make an Informed Choice

When I was 28 weeks pregnant I ended up changing obstetricians.

A year before getting pregnant, I had surgery on my uterus. Basically, my situation as a pregnant woman was similar to that of a woman who had previously given birth via cesarean and was pregnant again.

When I went to the doctor I assumed I would be able to have a vaginal delivery because my surgical report stated that it was not contraindicated. In other words, the surgeon said there is no reason this woman can’t give birth vaginally. However, during the first ten minutes of my first OB visit the female doctor I had chosen informed me that a cesarean at 36 weeks was mandatory in order to reduce all risk of uterine rupture (which is reported as less than .01%).

Full term is 40 weeks.

The doula I later hired was appalled. She said, “That’s like planning to deliver a baby prematurely.”  

As this was my first pregnancy I assumed the doctor was making a sound medical decision and that this was my only option. However, it was only after I began searching for hospitals that allow skin-to-skin contact following a cesarean (something my doctor would also not agree to) that I learned I had other options and that my first doctor was taking THE most conservative approach.

I was furious that it took me 28 weeks to learn that I had options.

During my interviews with other doctors, I learned that some doctors would not even think of performing a cesarean at 36 weeks. I learned that many women choose to have trials of labor, to attempt vaginal deliveries, and still others, after weighing the risks, to have cesareans, usually around 39 weeks. At no point during the many months I was treated by my original doctor was I informed of these options or given any autonomy in this decision.

Why didn’t my doctor explain my options to me? Why didn’t she explore what was medially possible rather than just taking the most conservative approach? Why wasn’t I involved in the process of making this decision?

This doctor’s fear-based approach to this health care decision was less than empowering.  She basically gave me the impression that I could die in my living room at the first onset of contractions if I chose not to deliver by cesarean at 36 weeks. I was panicked at the thought of making a decision contrary to her’s. She was seemingly prioritizing the hospital’s and the clinic’s liability over the health of the baby.

In addition, she was not open to other opinions. When I informed my doctor that I would be getting an opinion from a perinatologist (a doctor who specializes in high risk pregnancy), she stated, “I’m sure he will have the same opinion as I do.” When asked if a differing opinion would change her mind she stated that it would not.

Contrary to the information she gave me, I learned that from other doctors that a uterine rupture was a very unlikely event and that a later cesarean could easily be scheduled with little risk to me or the baby. There was a general consensus that attempting labor following uterine surgery involves risks and if I was motivated to take that risk then these other doctors would be willing to accompany me on that journey. At the same time, they would all be just as comfortable scheduling and performing a cesarean at 39 weeks or even later if that was what I wanted. It was a hard decision, but I felt better knowing that I had been given all the information in a non-biased way and that the decision was mine. From all of these providers I was left with the impression that we would be negotiating a treatment plan and that we would be working together as a team.

The medical treatment I received at the women-only clinic was not consistent with their motto. The website stated, “At [our clinic], we strive to help you be as informed as possible while you make your health care decisions.” I question the ethics of an approach that withholds information and options available to women. I would encourage all clinics to adopt such a motto and to take it to heart as all women deserve to make personal, informed choices about their healthcare.

I chose my original clinic because of its all-female staff and because I thought I would be treated from a woman-centered approach. However, my experience was quite the contrary. I did not experience my treatment as woman-centered, nor did I experience my treatment as being respectful of my rights and autonomy regarding choices around my healthcare. A health care clinic that prides itself on an all-female staff should provdie a practice that empowers women and values her right to free choice and information regarding her delivery options.

In sum, there are many women who would prefer to attempt labor following uterine surgery or a prior c-section. However, a woman must have all of the facts and options available to her so that she can make an informed choice.

Unfortunately, cesareans are on the rise because doctors shy away from VBACs (Vaginal Birth After Cesarean). If you are pregnant and have received an opinion from a doctor that recommends an early c-section or a repeat c-section, consider seeking a second opinion. The last four weeks of development for the infant are crucial in regards to its long terms health and well being. The lungs are still developing and there is evidence to suggest that babies born before 36 weeks are more likely to have asthma. Get all the information you can and make the best decision for you and your baby.

http://ican-online.org/

http://www.vbac.com/

At 42 weeks Dr. Hartung, of Hudson Hospital and Clinics, delivered my beautiful baby girl via cesarean due to medical issues unrelated to my prior surgery. She was a happy and healthy baby.

Dr. Hartung


Here I am with my baby’s doctor right after everything was over with. Dr. Hartung was amazing! (He practices at Hudson Hospital in Hudson, Wisconsin.) We live in the Twin Cities (Minneapolis) so we drove about 1/2 hour to each appointment with thim.

He was open to me making the birth experience whatever it was that I wanted it to be. Even though it ended up in a c-section, he encouraged me to try for a vaginal birth but left the decision up to me. After meeting with many people who were motivated only by risk management, it was refreshing to have a doctor that was motivated by birth being as natural an experience as possible while having respect for medical issues that could arise.