Giving birth at Royal Columbian? Here’s what you should know

Will and I after Wesley's birth in 2007. Photo: Lorenn Klassen

Will and I after Wesley’s birth in 2007. Photo: Lorenn Klassen

Of the five friends I have who delivered their babies at Royal Columbian Hospital, four of us had 30+ hour labours ending in emergency Cesarean sections. I have wondered how it could be that four out of five young, healthy women could all have so much trouble delivering our babies naturally that we would need our babies cut out of our bodies.

In the time following my own C-section I assumed it must be simply selection bias – we five weren’t necessarily representative of the general birthing population at Royal Columbian. Yet when I came across the Fraser Institute’s hospital report card, it resurrected the concern that too many births are ending with C-sections at RCH. According to previously private data the Fraser Institute unearthed through a Freedom of Information request, more than a third of mothers birthing at Royal Columbian delivered by Cesarean in 2007 and more than 80% of women who have had C-sections repeated the surgery to have their next babies. You can see that between 2001 and 2007 the rate of Cesareans at Royal Columbian has gone up to 32% from a low of 28%, and the VBAC rate (vaginal birth after Cesarean) has gone down from a high of 23% to only 18% .

This isn’t a problem only at RCH. About 30% of all births in B.C. were by C-section in 2007, and the VBAC rate  was just 16.4%.

Baby Nora, after my 'triumphant VBAC' in 2009. Photo: Lorenn Klassen.

Baby Nora, after my ‘triumphant VBAC’ in 2009. Photo: Lorenn Klassen.

The World Health Organization says the C-section rate for any country need not be higher than 15%.  Given that we have a publicly funded (and struggling) health system, the fact that we are seeing more than twice the recommended Cesarean rate is cause for economic as well as health concern. Among the long list of reasons to be concerned about the increase in C-sections on childbirth.org is this little factoid: “A cesarean costs nearly twice as much as a vaginal birth ($7,186 average vs. $4,334 average in 1989 in the US). It has been estimated that in Quebec, Canada, if the current rate of cesareans (18.8%) were reduced to that of Finland (11.9%), costs incurred by the provincial health care system could be reduced approximately $19 million per year.” Yowza.

In my first interview with the OB/GYN while I was pregnant, I asked all the questions recommended by my library of books: what is the C-section rate, what were their opinions on a variety of interventions, and other questions designed to get a sense of their level of support for a ‘natural’ birth. I had signed on with a team of six doctors, at my family doc’s behest, and each time I met a new one, I asked the same questions. Everyone responded that they would only use interventions and offer pain relief if ‘necessary.’ As I later discovered, ‘necessary’ is a matter of opinion.

Like many young women, I had assumed with my first pregnancy that I was at low risk for major complications. I had an easy pregnancy. I was only 25 and generally healthy. I had endured jokes about having “childbearing hips” more times than I could count. So I skipped the chapter on Cesareans in What to Expect When You’re Expecting. I spent the part of my birth preparation class that covered C-sections fantasizing about the relatively effortless and even pleasurable home births I had read about on the Internet. Labour was hard and long, but I had read almost every book for new mothers in the New Westminster Public Library (and a few more I ordered from Amazon), so I was expecting that. As my labour lengthened, I heard the empty ward begin to fill with other mothers’ cries followed by their babies’. My doctor kept going home. I laboured with little guidance from the nurses, grateful for my husband’s stalwart support.

My son was born after about 30 hours of labour followed by what I have learned is a textbook cascade of intervention: gas for the pain, doctor breaking the water to try to hurry the birth, followed by an epidural, hours of fruitless pushing and then an emergency C-section when we discovered the baby was poorly positioned. It’s possible that the outcome could have been the same had I been encouraged to labour in my own time with more support from my care provider. The experience of the birth of my daughter makes me wonder, however.

Those who follow me on Facebook or Twitter know that my second baby’s birth was ‘a triumphant VBAC’ (as my midwife Tracy Simpson described it on the Mama Love Midwifery Facebook page). It was a very short labour, also at Royal Columbian, and ended in the natural, medication-free birth I had so wanted with my first.

The midwife made all the difference. At least twice in my four hours labouring at the hospital, the OB on staff said he wanted to prep the OR for a repeat Caesarean. At one point the baby actually went back up the birth canal before the water broke, causing an increased risk of the umbilical cord wrapping around her neck. The OB wanted to send me for the C-section then, but the midwife recommended a controlled breaking of the waters, in which the OB carefully punctures the water sac and guides the baby down to ensure the cord doesn’t wrap around her neck. Then, towards the end, my baby’s heart rate dropped and although the OB would have recommended emergency surgery, my midwife wanted to give me the chance to push her out. With her support, I did, and my baby was born healthy and beautiful. I felt great. Tracey gave instructions at the hospital that I could leave after the required six hours of monitoring, as soon as I felt ready to go. Will and I brought baby Nora home in time for lunch!

In the end, neither birth was intervention-free. The difference was in how ‘necessary’ was defined, and how each care provider judged what level of intervention was required. With my first birth, I felt like everyone was just waiting to see how long it would take for me to give in. That’s probably not what they intended, but it is how I felt. The second time around I got scared, and my resolve began to waver. Instead of asking if I wanted drugs or taking my fear as a sign that I couldn’t do it, my midwife urged me to be strong and fight for the birth I wanted.

So, having now experienced both a Cesarean and a vaginal birth, an OB and a midwife, I have a few pieces of advice for expecting moms in New West:

  • Seek out a midwife for the best chance at a low-intervention birth. Most doctors pop in and out for periodic checks until you’re ready to push or something goes wrong. Midwives will stay with you throughout your labour, lending support as necessary. Start looking as soon as you know you’re pregnant. Midwives are in such demand now that it can be difficult to find one who is accepting patients.
  • If you’ve had a previous C-section, try a VBAC. The success rate is about 75%, so there are good odds that you will succeed. While the C-section itself is less painful than pushing out a baby, when the anesthetic wears off, the recovery is weeks-long instead of days. The postpartum experience is so different … I felt battered the first time, but euphoric after the VBAC. Also, with every repeat C-section, your risk of major complications with future pregnancies increases (important if you think you may want more kids).
  • Throw out the birth plan. A piece of paper won’t matter during labour. You’ll have more success by putting your effort into choosing a care provider and support people who you can be sure will lend you the strength to have the best birth possible.
  • Question your doctor. Don’t just ask if something is really necessary. Ask what will happen if it doesn’t get done, if you can try something less invasive or if you can delay just a little longer. Sometimes babies just  need a little more time and we all should be a little more patient.
  • If you do have a C-section, you are not alone. Once you start talking about it, you’ll probably discover a shocking number of others who have too. It’s also very common for women who have C-sections to feel sad or angry about the birth experience. It’s totally normal.
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29 thoughts on “Giving birth at Royal Columbian? Here’s what you should know”

  1. My first labour and birth were at Royal Columbian, and my second was not. Which, I think, tells you what you need to know about my experience there. Although, in fairness, that had little to do with the birth and more to do with our experience in the Special Care Nursery.

    My real point is that I completely agree with you about midwives. Both of my births were midwife-assisted, and I have not had a C-section. However, my first birth occurred unexpectedly at 34 weeks, so I was high-risk. I really believe that having a midwife present made all the difference in how that birth progressed. She absolutely intervened and advocated for me throughout the 9 hours I was there before my daughter arrived, and I was able to deliver almost exactly as I'd planned in spite of being preterm.

    I would also like to add that many mothers find doulas to be very helpful. They are not medically-trained, and do not replace either a doctor or midwife. However, the support they provide in labour has been proven to be highly effective in reducing the rate of interventions, pain medication and C-section. My friends who used them rave about how great they are.

  2. My labour was at a different hospital, in a different city and with different results- but I see the same themes running through what you are saying. I have also come to the same conclusion; when/if we have a second child getting a midwife will be first on my list.

    My major issue with the care I received was, quite frankly, the amount of care I received. At the Foothills Hospital in Calgary, of my 12 hour labour, at least 4 hours was spent in the waiting room and less then one hour each was spent in the triage room and my labour room. Prior to going to the hospital I didn’t even know there was a ‘waiting room’; they must have missed that chapter in my pre-natal class. Given the amount of monitoring I had, we were very lucky that nothing went wrong. What I really needed was someone to be providing care for me through the whole labour.

    To me it is all symptoms of the same problem- the hospitals are over crowded, the doctors (and nurses) are over worked and the nurses are being leaned on for parts of post-natal care that they really are not trained for. (I won’t go into the care I received post-delivery, suffice to say I wish I had had a midwife for that care too.) Was every person who provided my care in labour and deliver and post-natal care kind, caring and trying to to their best? Yes. Were they equipped with time and training to do their best? No.

    I think it is this lack of time and people in our hospitals that have caused the c-section rate to be so high. It is more expensive, yes, but sometimes easier then really supporting a women through her labour. Midwife’s seem to be the best solution right now, but I think ultimately was need to start really talking as a country about the quality of health care we want to provide in our hospitals.

  3. Thanks for such a honest, open piece, Briana. I think I’m one of those four moms you talk about, as I too had a C-section at RCH. I had a midwife, but after 12 days overdue, an induction, a lengthy labour, and the entire cascade of intervention over the course of two days, even the midwife recommended the C-section because Kale was, as one nurse so nicely put it, “a star gazer” and was in the wrong position. But I never felt that it wasn’t my decision.

    I absolutely agree with you about midwives; Linda Peters was my midwife. She is one of the very few New Westminster midwives, along with Tracey. I recommend her n(and other midwives) for her guidance and support, not just during labour, but through the whole pregnancy and even afterward for 6 weeks.

  4. Briana this is great – we need a chorus of voices like yours, women demanding that their wishes be heard, and that concepts like “Risk” and “necessity” be appropriately understood.
    I hope you are okay that I sent the link to all of my co-workers!

    The only other suggestion I would make is for you to describe your decision-making process on how you arrived at a midwife the second time. As I recall, it wasn’t the first option and you did a lot of research and consideration to get to that point, with no small amount of opposition from medical people around you. Not to belabour the point – just to say for moms out there that you aren’t necessarily “born” a midwife patient, sometimes you evaluate your options and decide it’s the right choice for you. Also in your case you had difficulty finding a midwife, esp. in new west. Do you have any thoughts for New Westie moms who want to find a midwife? (other than to check the BC Association of Midwives website.)

  5. Great posting, Briana!

    I do know that the cecarian rate in Australia is also quite high. Women there are encouraged to book the babies birthday to fit their schedules and that of their doctors. I was also prepped for a cesarean for my first birth. Thankfully things progress too far for that. The crazy thing is nurses in Australia are trained in a speciality of midwifery, yet cesarean rates continue to be high.

    I do think it has something to do with timing,hospital efficiency, and the fear of liability. If only they were afraid of the liability for performing unnecessary surgeries!

    I hope your post encourages women to seek out the help of a midwife and to speak up for themselves with their doctors!

  6. Thanks everyone!

    Jocelyn: I had always wanted a midwife, but honestly I was too lazy to do the legwork required to get one the first time around. When my family doc recommended the OB team at RCH I trusted that it would be fine to take the easy way and sign on with them. Stupid me. The second time around I wanted a VBAC and I didn't trust that I would have a good chance with an OB, so I prioritized finding a midwife. My family doc didn't think I'd be allowed to go with a midwife for a VBAC, and referred me to an OB to confirm that it was safe. Luckily the OB had worked a lot with midwives and he reassured me that it was safe, and even said that given my preferences it was probably a better choice than an OB! As for how I found the midwife … well we can't all have sisters-in-law with connections to maternity care providers! I used you and Google, and discovered that it's a lot harder to get in to a midwife than I thought. I was lucky to find an opening with Mama Love Midwifery (I just squeaked in).

    Kathleen: Recent research suggests that midwife-assisted home birth is as safe as hospital birth for low-risk moms. If I wasn't now considered higher risk due to the first Cesarean, I'd go that route. I am now convinced that many complications are due to hospital process disrupting a mother's concentration, making her less relaxed. Nora was coming faster than we thought, and probably would have been born at home by accident if the midwife had been any later. When she went back up the birth canal, I think it was because we raced to the hospital and I was told not to push even though I felt the urge. I think we would have avoided that complication if we had just continued at home, and thus we would have avoided the other stuff too. In Wesley's case, had I laboured at home, perhaps he might have righted himself before the water broke naturally. If not, if it would have been a C-section anyway, we would have had time to go to the hospital to get it done.

    Buffy: it is definitely a fear of liability that fuels the rise in C-section rates. C sections are major surgery and as such there is a lot of post-op risk associated with it. But surgeons feel more comfortable with surgical risks than the random risks of natural childbirth. There's also the fact that OBs are trained as surgeons. Natural childbirth is not really their area of expertise.

  7. This is a really great post. Congratulations on your triumphant VBAC!

    Both of my kids were born at BC Women's – the first because we lived in Vancouver when I started my prenatal care and the second because the first had been. Comparing my experience to friends & acquaintances, I firmly believe that the key to a satisfying experience – whatever that means to you – is support. What your midwife did for you during labour with Nora was perfect – she knew what you wanted and she supported your choices and advocated for you.

    Because I never have a family doctor I sought maternity care with both of my pregnancies. The first time I lucked out with the South Community Birthing Program, http://www.scbp.ca which is a fantastic mixed practice of midwives and doctors. It provides prenatal care in the form of a group prenatal class at the same time as the check-up; it provides support in the form of a group dynamic (you're placed in a prenatal group with 10 other women who are due around the same time as you), plus a free doula, it was absolutely the best way to have a first baby. It's only available to women in Vancouver but it is a model that I would so so so love to see done everywhere, all the time. My son ended up being delivered by a midwife – she was on call that day – and she fought her ass off for me every step of the way. She forced the OB to let me get out of bed and walk around instead of lying there with monitors on. She slowed everybody down, made them wait a few minutes to see what would happen instead of pushing the next intervention. I did end up delivering vaginally, with an epidural. It was the best possible outcome and I didn't feel short changed in any way.

    Of course, when I told my second maternity doctor this story, about having been induced because of low amniotic fluid, he told me that there's research suggesting many low amniotic fluid situations are not as bad as they're made out to be; if it's a hot day and the mum isn't drinking enough water, her fluid level will go down. He said had *he* been my doctor that he would have had me drink a litre of water and come back for another ultrasound, instead of admitting me and inducing me right away. So even at BC Women's, there's haste and unnecessary intervention; for many of the reasons your other commenters have outlined.

  8. Yes, I completely agree. We had Linda as our midwife. I still remember her commenting that "I've never seen that doctor return a syringe that he'd prepared before" after I pointed out to him that my wife had said that she didn't want those meds.

    There are a lot of competing considerations for doctors, but ultimately they became doctors to practice medicine, and surgery is often regarded as the highest form of medicine.

  9. Thank you all for sharing your experiences. I too am a c-section-survivor, as I like to put it, since my 2nd c-section nearly killed me. But I think it is important for every mother out there considering a midwife to ask that midwife the same questions that you would ask an obgyn, e.g. about c-section rate, etc. I had a midwife for both of my pregnancies and they both ended in c-sections, so to assume that having a midwife means you won’t end up on the operating table is unrealistic, particularly if you deliver at RCH like I did. Your chances of a vaginal birth are higher, but it’s far from a guarantee.

    I didn’t labour at all with my first child, who was cut from me because he was breech. With my second child, I went into a fast, awesome labour and my baby was descending well (even though he was breech too) and they still sectioned me. Both the obgyn and my midwife told me afterwards that I could have delivered him naturally (WHICH IS WHAT I WANTED AND THEY KNEW THAT). My midwife went so far as to say that I would likely not have had any problems and that if I decided to have a 3rd baby, she would definitely support me in having a vbac — not what I wanted to hear after just starting to recover from my botched c-section 2 weeks earlier.

    My own family doctor also told me that I should have just pushed my baby out and ignored the obgyn and midwife, but I really felt like I had absolutely no choice but to consent since my midwife did not seem like she was going to fight for my vbac after all. SHe was prepping me mentally for a c-section from my first call to her telling her I was in labour.

    I’ve gotten over the angst of that experience; life gets busy and you just do. But it makes me so angry to hear about other women who end up going through what I did. It is just so wrong and doesn’t seem to be getting better fast enough.

  10. I don't know what to say.

    You are a victim of our p3 medical system.

    The system is taxpayer funded (Public), requiring equipment from private companies (Profit) and the Doctors make kickbacks using it on the (People).

    Your probably a victim of the drug companies too. I wonder how much Pregnant Mare Urine you've ingested. Or what anti-biotic cultures you've been needlessly exposed too.

    Getting cut in a hospital is getting more and more risky.

    People are ignorant to the dangers we are facing by our foolish prescription happy doctors. Practically everyone carries MRSA now, VRSA is right around the corner. Then what Doc ?

    N.W.

  11. Wow – just stumbled on this when looking for more info on the maternity ward at RCH and got scared – until I scrolled down to see that the second one went better with Tracy by your side. This will be my first, but I hope with Tracy by my side it will be okay.

    1. Jessica: Good luck! You're in good hands with Tracy. I am very grateful to her for helping me have such a great second birth experience.

  12. Linda Peters delivered all three of my living children…and was involved in my other pregnancies. She is fabulous! She supported me during an 'easy' first pregnancy but difficult labour which probably would have been a Csection if with an OB. After difficulties, she worked closely with an OB and perinatologist, during subsequent pregnancies. THe post partum support she provides is the best. She is a wonderful, talented midwife with a heart that matches.

  13. I delivered my first child there and I have nothing but good things to say.. Except to that one horrible nurse.

    My daughter almost died in labour and they still let me have her with out a C-Section. I don't agree that they always seem to take the easy way out at RCH. You wanna hear horror stories, start talking about giving birth at SMH.

  14. Not even close, 2 weeks and 2 days of labour, then 6 1/2 of active, with absolutely no break between contractions. The reason my daughter almost didn't make it is because 4 years earlier I was in the pre-stages of cervical cancer and the Dr did Chryotherapy _ freezing of the cervix and when he pulled the freezing tube out he broke it along my canal. This caused major scarring which made intercourse almost completely unbearable. My family Dr said the only thing that would fix it was if I could have a child vaginally. It fixed the problem but almost killed my child. I am now pregnant again and I am scared that I am going to have to have a C-Section, my family Dr is opting for one however my obg says I should be fine to have a child naturally as my daughter fixed the issue. HOwever I may have to have an emergency one. I am a single parent and I do not want to have to take care of 2 children while recovering from a major surgery.

    I still say RCH is one of the best that I know of – as long as no one gets the horrible mean nurse…….

    1. Oh my, that is quite a lot to deal with! It sounds like RCH is a good choice for you. As I understand it, they are very skilled with high risk births. My concern is more about jumping too quickly to intervene when the risk is low and more time or less invasive techniques might work better.

      Second labours are often MUCH faster than first labours. I wish you all the best, and hope that your baby is born more quickly and with less trouble than your last! Do you have friends or family to help you once the new baby arrives? The C-section recovery can be difficult (especially if your first is small enough to need lifting … you're not supposed to lift anything heavier than your newborn for the first few weeks). Even if it's a vaginal birth it would be best to have some help in the first days following the baby's arrival.

  15. I have a very supportive family and these two children will be 7 1/2 years apart. My daughter keeps telling me it is her baby…. lol.

  16. Are you kidding me ?! I had singletons, 4 sets of twins, triplets, which included breeches, transverses, as well as Vertex (head down/face down-propers birth position.) and NOT Once, did I get taken to " the club house " ….. (ie: OR for C-Section .) They treat me like a Queen over there.& I / we prefer it to Scared Memorial.

    1. Hi Indi,

      Wow, how many babies did you have?! I don't know when you had your babies, but doctor bias for or against C-section and other interventions waxes and wanes according to US trends in litigation (which affects Canadian doctors' perceptions of risk) and other factors. It also makes a huge difference whether you ended up with a C-section with your first. If you did, the likelihood of you having a second surgery is 80% at RCH.

      The individual in charge of delivering the baby makes a big difference too. There are some doctors, even some OB/GYNs who limit intervention as much as possible. I've only had two kids, so I don't know what other hospitals are like. I can speak only to my own experience. Research (mentioned above) shows that I'm not the only one.

  17. I really enjoyed reading your article, Briana. I am currently 38 weeks pregnant with my 3rd child and will be delivering again at RCH for a 3rd time. I am also very fortunate to have Linda Peters as my Midwife again, as she was there for my first two children.

    I definitely have to agree with almost everyone here about how some OB/GYNs are very quick to suggest a C-section when it really isn't necessary. I had a relatively smooth labour with my first child back in 2005 (12 hours or so) but when it came to my second in 2007, I was in labour for about 28 hours. After 6 hours of pushing and "not-pushing," the OB/GYN on duty was ready to give me a C-section. Had it not been for Linda and her accurate instincts, I probably would've had an unnecessary C-section. Linda patiently waited for a more experienced OB/GYN to come on shift, who did a proper assessment of my condition, and was able to deliver my son by forceps without an episiotomy, I did have to get an epidural but I'd rather have that than a C-section.

    Linda is a wonderful Midwife (as I'm sure other midwives in New West are) and I couldn't have imagined having my babies without her. I know Midwife's are more in demand but it is amazing how many people out there are still very unaware of the benefits of having one. It seems there is a common misconception that midwives are associated with home-births only or that they are not experienced enough. It couldn't be further from the truth!! Not to mention the awesome post-partum care that you receive.

    Thanks again for the article. :o)

  18. I found your post when researching hospitals in my area. Thank you for sharing your birth story. I live in Burquitlam and I am only a few minute drive from RCH. I am currently pregnant with my second child and I hope to have a VBAC. I actually did have a midwife for my son's birth however she was not as involved as I thought a midwife would be. She kind of just sat in the corner and monitored my contractions and only came close to do the monitoring of my son between contractions. She would call out for me to relax when I started to panic during my irregular piggybacking contractions. I gave birth at St. Paul's. I did love the care I received there (the nurses were wonderful) and the C-section was an emergency. Reason being is that my son's heart stopped beating from time to time and it took awhile to start again. I think it was because the contractions were very intense (EFM after a epidural gave the results). The cord was wrapped around his neck as well. My family doc has stated that I can try for a VBAC however she isn't that keen on a midwife. I wonder if some docs just think that midwives are taking away some of their earnings??

    Thank you for recommending Tracy. I have given Tracy's clinic a call and I hope that she will be able to squeeze me in. I haven't heard back yet. Fingers crossed as she is just down the street from me. I will also give Linda Peters a call as well if it's a no go with Tracy as it sounds like other women have had great experiences with her as well. It's great to have a strong support in your midwife/doctor because I found when they told me that I would have to have a C-section with my son that I did little to stop it. I was so tired and just wanted to have my son out. But this second time, I want to be able to push the little one out for myself. And not have to itch all night after the birth because of coming off the drugs of the C-section plus the epidural made me shake uncontrollably. I was lucky to witness my sister-in-law's natural home birth and found it so encouraging for me to try it for myself.

    It is frustrating that when I mention to some friends that I want to have a VBAC they think I'm crazy to go through all the labour again when I can easily just have a C-section and bypass it all. However, I know that I am not crazy and reading about a successful VBAC experience like yours gives me a lot of hope. Thanks!

  19. Hi all;

    Im a 22 year old in New Westminster, who just found out Im 8 weeks pregnant. I do not have a family doctor or OB-GYN, and the only testing I've had so far is a blood requisition. I know I need to have my blood pressure checked, a Pap smear, pelvic exam etc etc.
    I'm writing here in hopes that someone can refer me to a great family doctor, and/or OB-GYN. From the walk-in clinic where I found out I was pregnant, I was sent to Royal Columbian Hospital. They do not seem to care that I haven't had any of the necessary tests, and said the soonest I can go in is Dec. 22. As all of you are well aware, a first time pregnancy is very scary, and you want to be getting all the scheduled tests, ultrasounds, and check marks. I am feeling lots of anxiety, and would just love a family doctor who cares about me and will take the time to assure me that my baby's and my heath is on par.
    Please feel free to email me at chanel-xo@live.ca

    Thank you :)

    1. Hi Chanel, I would recommend calling one of the local midwife offices. They can take care of all of the tests you need and they will provide much more support for you during pregnancy, labour and post-partum. I had an OBGYN with the first baby and a midwife with the second, and I found the second experience far more supportive and caring. My OBGYN didn't remain with me while I laboured, whereas my midwife did. Plus, the first few post-partum visits done by a midwife are in your own home, which is far nicer than having to go out to a doctor's office. You can find a midwife by searching http://www.bcmidwives.com/find-a-midwife. My New Westminster midwife was Tracey at http://mamalove.ca/. Good luck!

  20. Great article – it reminded me of the research I went through when we were expecting our first (and so far only) child. And the terror I felt watching "The Business of Being Born" and wondering if anywhere in Canada was "that bad."

    I have to say though, there is a part of your article that was glossed over, that I think a lot of women could benefit from: the importance of paying attention to and researching every possible outcome in pre-natal classes and independent research.

    I had a midwife-assisted (though ultimately OB delivered), doula-attended birth (vaginal w/epidural & forceps) at St. Paul's, and there were a number of occasions my husband and I needed to tell everyone to stop so we could think about what we were comfortable with having next in terms of progress, pain management and interventions. We were only able to do that because we attended a very comprehensive pre-natal class that went quite deep into the physiological process of giving birth, and over all the pros and cons of each intervention.

    The instructor also stressed that we could always ask for a moment to discuss next steps in labour before interventions were made (asking the medical staff if 5 minutes to make a decision would make a difference – usually no), and our attending midwife was also on board with this method.

    As frightening, stressful, and just plain distracting as it can be to think about scenarios like caesarians when we don't want it as an outcome, understanding them (and the road that may lead there) is the best thing we can do to take our health in our own hands to try to ensure the outcomes we hope for.

    In the end, the doctors and midwives are the medical professionals, and shouldn't totally defer to us, but neither should we feel we need to blindly defer to them – we should start treating birthing as more of a partnership, and do our part to be fully informed participants.
    My recent post Dog Days

  21. Jen: I, too, am wondering what class you attended? Who was it run by, or even who the instructor was?

    Any information would be helpful since not all prenatal classes are created equally, and the one you attended sounds particularly informative.

  22. Although this post was published quite a few years ago now, it still holds true.

    With my first I gave birth at women’s and ended up needing to be induced because my water had broken and I didn’t go into labor myself. I don’t have complaints about my birth- it was the hospital stay after that was a nightmare.

    In the two years since having my son, many of my friends have had babies with most delivering at royal Columbia. Out of the 7 babies born, 5 were via csection. 5!!

    When I got pregnant for the second time, women’s wasn’t an option. It was rch whether I like it or not. This time I decided I would go with a midwife as I so passionately do not want a csection yet didn’t want to fight it if it was actually necessary. I am very happy to read that your midwife was Tracey Simpson, as she is one of my midwives, along with Lindsay Barnes.

    I am now 26 weeks along and the pregnancy is going well. I didn’t really think the difference in care between an ob at the women’s clinic and these new west midwives would be that different, but it is drastically different in the best way. I feel like I know them very well and they know me. I trust them.

    So much so that I am attempting a home birth this time. I am honestly scared to walk into royal Columbia so i really hope the home birth will be successful but I know that if things aren’t working out, I have such wonderful midwives to be there for me.

    Thank you for your post.

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