Vaginal Birth with Low Lying PlacentaThread
May 08, 2010 12:07 PM
I have a low lying placenta at my 36 week U/S (1.1 cm from
May 09, 2010 10:32 PM
You can refuse any intervention, but the question is "Would it be wise to do so?" I certainly am not qualified to tell you that, and based on what you write, the conversation with your care provider that would allow you to answer this question hasn't happened. Your ob appears to be telling you what he plans to do, and you are to like it or lump it. He has not explained all your options to you--including doing nothing--along with the potential benefits and harms of each. In particular, you have not been told the risks of cesarean surgery.
The Childbirth Connection website has a great webpage on informed consent and refusal, but I think your first task is to determine whether you can trust your care provider's judgement, because his failure to provide the information to make an informed decision is already a red flag. The touchstone for this is to ask his cesarean rate. If it is more than 15%, the rate established by the World Health Organization and numerous studies as the reasonable maximum, you will know that you can't. If he hedges, for ex., "I only do them when they are necessary," or won't tell you or says he doesn't know, consider that another red flag. Should either of these be the case, I strongly advise consulting with an ob willing to assist you in arriving at an informed choice and whose judgment you can trust. That, by the way, almost certainly won't be another ob in the same office. One practice partner is unlikely to openly disagree with another. If there is a birth network, an International Cesarean Awareness Network chapter, or a birth resource center, they are likely to know who the progressive obs are. The local doulas are also likely to know as well. Failing that, you might call your local hospital(s) and ask the L&D nurse manager which of the obs is the most encouraging of natural childbirth. You can also see if any of the local obs has been reviewed on the Birth Survey. Hopefully, your insurance will cover seeking a second opinion, but even if it will not, this will be money well spent.
P.S. FYI: I'm working on the induction chapter for the new edition of Obstetric Myths Vs. Research Realities, and I can tell you that in women with prior vaginal birth, inducing labor with a ripe cervix does not increase risk of cesarean. Inducing with a cervix that isn't ready for labor does, although the difference is much smaller--a few more women per 100--than in first-time moms. Also, if you decide to go the induction route, don't induce before 39 completed weeks (the week that ends with your due date) to minimize the chance of the baby having respiratory difficulties, and refuse Cytotec, A.K.A. misoprostol.
All Times America/New_York
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