Episode 236 Carlise's VBAC + Signing an AMA52m | May 24, 2023
When the empowering VBAC experience she envisioned took a hostile and combative turn, Carlise knew she needed to change birth locations immediately. Though signing an AMA was not something she thought she would ever have to do, Carlise found the strength to fight for the birth she deserved. Her thorough research and supportive husband and doula gave her the confidence to not tolerate a doctor’s inappropriate behavior.
Meagan shares the pros and cons regarding AMA forms to help you feel educated if you find yourself in a situation similar to Carlise. While it was extremely difficult, leaving that first hospital during labor was ultimately what allowed Carlise to have her beautiful, unmedicated VBAC!
Meagan: Hello, hello. You are listening to The VBAC Link and we have another story for you today. We have our friend Carlise and she is from all over the place but she is in Texas currently. This is where you had your VBAC. In Texas?
Carlise: Yeah, so both of my pregnancies have been here in El Paso, Texas.
Meagan: Perfect. She had a VBAC in Texas and she had a wild journey kind of similar to a month or two ago, I want to say maybe it was Morgan where she had to sign an AMA and leave while in active labor. We are going to talk a little bit about AMAs today as well in addition to her VBAC because it’s something that we don’t talk about a ton. If you don’t know what AMA is, it’s against medical advice. That is a form that we would have to sign to pretty much say that we are leaving against medical advice but sometimes we are put in situations– and I’ll share a story that I’ve been to as a doula– where we feel that we have to sign these AMAs.
Review of the Week
In this situation, you signed the AMA and went on to another hospital and had a VBAC and a different experience. So we’ll talk a little bit about AMAs but first, we have a Review of the Week as always. Just a reminder, if you haven’t left a review, we would love your review. You can leave it on Apple Podcasts or on Google. You can just search for The VBAC Link on Google. You can email us at firstname.lastname@example.org or wherever you listen to your podcasts. We love your reviews.
This is from runnervt. It says, “This podcast helped me get my VBAC.” It says, “I started listening to The VBAC Link to process my Cesarean due to breech presentation. It helped so much to hear women put into words all that I had thought and felt. Then I listened to it in preparation for my VBAC. Today, 8/7/22 and there were times I thought that my VBAC was slipping away but I was able to be prepared and get a little lucky and pushed out my 9-pound baby in 48 minutes with no tearing!” It says, “Thank you so much. Talk about the feeling of being superhuman. Thank you so much, Julie and Meagan.”
I love that, superhuman. You are all superhumans. Birth is just so wild. Wouldn’t you agree, Carlise? It is such a crazy experience but it is so amazing. It is so beautiful. It is crazy to think about how different births can be.
Carlise: 100%. It’s crazy.
Meagan: Between one baby to another or say you have five babies and you’re like, “Yeah, this has been the same.” I have a friend who has had her 5th baby. She was like, “Okay. I have had easy peasy births” and all of these things, and her 5th baby was a Cesarean. She was like, “That came out of left field.” It was a whole crazy thing. She was really sick and baby was really tangled in her cord. But yeah. It’s wild. It’s wild to think just how the unexpected can happen so I think it’s so important to listen to stories just like the one that we are going to be sharing today and all of the stories on the podcast so you can get a better grasp and understanding of childbirth, how it looks, the interventions, and all of the things that can happen in childbirth.
Sometimes it’s really hard to listen to those Cesarean stories for sure because you’re not wanting another Cesarean or if you’re a first-time mom listening to the podcast which we do have first-time parents listening to the podcast, it’s hard to want to listen to those because it’s not what you’re preparing for or it’s not what you think would ever happen but like 90% of us on this podcast, we didn’t think a Cesarean would happen either so it’s so, so, so important for us to learn all of the ways birth can come at us.
We are going to get to your story but I would love to know if you have anything that you would like to add in the beginning of advice to the parents listening.
Carlise: I think just doing as much research as you can possibly do and know that you may have some pushback in getting your VBAC or the birth that you want in general. But be confident in that research and also share that with your spouse or your support. Let them know, “Hey, this can happen or these are choices that we might have to make,” so that everybody’s educated and everybody goes in the room knowing what can happen because anything can prep for all of it but you’ve got it and it’ll be fine.
Meagan: Yeah. Yep. I love it.
Meagan: Okay. Well, we are going to get into this story but first, I just want to quickly introduce you a little bit more. We talked about how you are in Texas but you are from a small town in Missouri where you met your husband right after high school which is so awesome. You have been married for six years. You’ve lived in Alabama, Germany, and now Texas. You are a stay-at-home-mama providing stability for your girls. You have the two girls. What are their ages?
Carlise: My oldest daughter is two and we just had Amelia last month so they are almost exactly two years apart.
Meagan: Two years apart. That is so awesome. Your husband is an Active Duty Pilot?
Carlise: Yes. He flies Apaches.
Meagan: Yes. That’s so awesome. That’s really, really cool. I am so grateful to you for being with us today and I would love to turn the time over to you to share your VBAC story.
Carlise: All right. My first pregnancy was super uncomplicated. There weren’t any issues throughout the entire time. We actually got pregnant in Germany and then when we were PCSing or moving back to the States, I was 17 weeks. We didn’t have any issues. Then we got to about 34 weeks and baby was breech. They were like, “No, no. It’s good. It’s good. Baby can flip, whatever.”
I’m over here planning my vaginal birth, no problem. I have all this research done and then 35 weeks, still breech. 36 weeks, yep. Still breech. They gave me all of the things. ECV, moxibustion, Spinning Babies, and chiropractic care, but it was right in the middle of COVID so I couldn’t do chiropractic care. I couldn’t do acupuncture. I tried all of the things but she just wanted to be like a little taco. She was my little frank breech baby.
We scheduled a C-section for 40 weeks. She wanted to come at 38+4 so we had gone in because I had a very, very slow leak. It was slow enough to where I was like, “Okay. Is this my water? Is it not my water?” Yeah. Sure enough.
So when we got in, we had to wait a few hours because I had eaten that morning. We had a pretty uncomplicated C-section. The spinal took multiple different tries so that was horrible. The drain was at my collarbone so I didn’t get skin-to-skin after. All of the medication just made me super foggy and I straight up don’t remember the first two hours of my daughter’s life. I don’t remember latching her for the first time. It’s still really rough because that’s not the experience I wanted at all.
Carlise: So when I got pregnant again 14 months later, honestly I walked into it a little naive because when I had done my research for my first pregnancy, I knew I wanted that vaginal birth. I had seen information on VBAC a lot actually when I was doing some of my research. I just kept seeing that it was a good thing. It was recommended by ACOG or whatever so I just thought that that was normal.
Meagan: You didn’t even question it. You’re like, “Okay, great.”
Carlise: I didn’t even think about it. When I was trying to make my appointment on post because we have Tricare Prime and you have to be seen on post. They were like, “Yeah, no. We can’t get you in until you’re 17 weeks pregnant.” I was like, “No. That’s not going to work.” They pushed me into the network off post and that’s actually kind of what I wanted but little did I know, the military hospital is the most VBAC friendly. I didn’t know that at the time.
I had chosen an OB that everybody was like, “He’s great. He’s so good.” I was like, “Awesome.” At my first appointment with him, he sounded so supportive. He was like, “Yeah. You sound like a really good candidate.” He looked at my OP report. I was feeling really good about it.
Then every consecutive appointment with him, I think I had three legit appointments, he just kept saying, “C-section this. C-section that. Whenever you want to schedule a C-section–” and I’m like, “Yeah. I have a sneaking suspicion that this is going to be a bait and switch here.”
Meagan: Which is a terrible feeling. It’s not a fun feeling when you’re like, “Why is everything switching?”
Carlise: Especially when he sounded so supportive, it was so disappointing, and then having to switch at 20 weeks, you’re like, “Okay, great.” Then, the anatomy scan that he did was literally less than five minutes. We both know that is not an anatomy scan. He pointed out major features. He didn’t look at the spine. He didn’t look at the heart. He didn’t look at any of these things. I was just feeling so uncomfortable with my care so I was like, “Yeah, no. I think I’m going to be done.”
I was interviewing doulas and my doula had asked where this doctor delivered. I told her. The two hospitals that he delivers at have the highest rate of C-sections in the area as well as really, really bad reputations for episiotomies. Hearing her stories from being a doula at those hospitals was not great. I was like, “Okay, yeah. No, I’m going to switch now.”
I talked to her about where she recommended and she’s like, “Honestly, on post. If you can get back on post, that’s going to be the most recommended but if you can’t,” which I wasn’t able to, the university hospital was going to be the second best place to get the VBAC. I switched my care. My pregnancy was super uncomplicated again. At the university, I never saw the same doctor which I really didn’t want but I was just like, “Whatever. I’m going to do this whether or not I have a supportive provider, so it’s good. You’re just here to give me prenatal care.”
They were definitely more tolerant than fully supportive. They kept saying at every single appointment, “You’re going to get an epidural, right? You’re going to get an epidural.” I was like, “No.” They’re like, “Okay, well it’s just in case.” I hear that a lot. But no, I’m planning on going unmedicated. They just kind of left it.
Then we got to about 38 weeks and my doula had called me. She’s like, “Hey, I just had a horrible experience at UMC. The nurses were really pushing back at everything that this first-time mom had wanted.” They didn’t treat her well and it just sounded super, super iffy. She’s like, “We can obviously still go. I just want you to be prepared that it might be something that we could encounter.” The whole time, I was like, “I just want to go to the military hospital.” I had my daughter there. I was really comfortable with the staff. I really liked their care. So I was like, “You know what? We’re just going to go to the military hospital in labor.” She was like, “Okay, cool. Sounds good.”
So that’s what we ended up trying. One day before 40 weeks, I went into labor super early in the morning. It was 1:30 in the morning. They were very odd contractions. It was like a rollercoaster for 24 hours. They started at ten minutes apart and then six but they would bounce around. They weren’t consistent at all. That just happened forever. I was just like, “I just want to be done.”
Meagan: You’re like, “I’m tired.”
Carlise: I was so tired. I was trying all of the things like the Miles circuit and curb walking, playing with my daughter, and trying to rest. Nothing was working. My doula was like, “Do you think it’s a mental block? Do you think there’s something?” I was like, “No, I feel good. The TENS unit is amazing.” I baked a cake while I was in labor. I was just like, “I don’t understand.” She’s like, “You’ve got this. It’s fine. It’s going to progress. Just try to rest as much as you can.”
Then it was at 40 weeks at 1:30 in the morning that we started progressing a lot quicker. I was at 6 centimeters and I was like, “Yeah, I’m going to call the doula.” My husband ended up calling and while he was on the phone with her, they were just getting really, really intense. He was like, “Yeah. I think we’re ready for you to come.”
She started making her way. It was about a 45-minute drive. At about halfway for her, she calls and she’s like, “You know, Carli sounded like she was ready to go. Is she progressing?” Doug was like, “Yeah. It’s getting serious.”
She’s like, “Okay. Let’s just meet at the military hospital. Let’s meet there. I’ll meet you at the parking lot.” We go ahead and make our way over there. It’s about a 15-minute drive so it’s not too bad.
She gets there at the exact same time that we do. The doula had also let the hospital know that we were on our way. They were already expecting us. When we got to the L&D, the nurses took me back. They did all of the normal blood pressure. They hooked me up to the monitors. They asked me why I had decided to go to the military hospital in labor. I gave them my whole explanation and they were like, “Yeah. Okay, sounds good.” They were super nice and very supportive. I had also taken all of my labs with me, the GBS strep results, and all of the things as well as printed out my post-OP report for them to have as quick and easy access.
Meagan: Which as a side note is always good to have even if you’re not planning on going to another hospital because you never know if a precipitous labor happens or anything but it’s really nice and usually providers enjoy having that. It brings comfort.
Carlise: Yes so that’s why we brought it. They also had seen that I had been in triage two weeks before because my daughter wasn’t moving as much. I decided to go there so that way they could check the baby and also have me in the system already. I had talked to a doctor as well about coming there in labor. They asked me all of the things like if I knew the risks and benefits of VBAC, just took some medical history, and were very supportive. They were like, “Yeah, absolutely. We don’t mind you coming here in labor at all.”
I felt so confident. I felt so confident going in. The nurses had been like, “Okay, cool. Sounds good. Are you wanting an epidural? Are you wanting an IV?” I was like, “No. I don’t want an epidural. I just want a heplock. I’ve been able to keep down fluids and everything so I’m not having any issues with that. I just want a heplock.” They were like, “Cool.” So very supportive and nice nurses.
They were like, “Okay. We’re going to get your support.” They went and got my doula and my husband and then they did a cervical check. At this point, my contractions were three minutes apart and very consistent. When they checked me, I was at 4 centimeters, 90% effaced, and -1 station. Baby was still up there a little bit. They also noticed some decels on the monitor. I was on my back and I was so incredibly uncomfortable. My daughter did not want me on my back. Every time I was on my back, it was awful.
We had asked the nurses if that was a possibility and they were like, “Yes, but you bought your ticket for admission because of those decels.” We’re like, “Okay, no problem.” We were expecting to get admitted anyways. So then the nurses were like, “Okay, we’re going to get the doctor but I want you to know that he’s very military.” My husband, my doula, and I are looking at each other and we’re like, “Hmm. That’s a weird way to describe a doctor. Okay.”
We were just expecting very blunt and very upfront. While we were waiting, I was just so uncomfortable so I got up beside the bed by the nurses’ station and was just rocking. I was having a really hard time with my contractions at this point. My doula came up behind me and gave me hip compressions.
Then the doctor comes in. He doesn’t introduce himself. He’s not like, “Hi, how are you guys doing?” Literally nothing. He goes over to the doula and just goes, “And who are you?” The doula introduces herself and he’s just going on and on about how she’s in the way. He’s yelling at her like, “You’re in my way. You can’t be in my way. You can’t be in front of medical equipment.” She’s just helping me with a contraction so he’s not even recognizing or caring at all that I’m having contractions and that I’m in pain and she’s trying to help me. He’s just more concerned that she’s in the way.
So then she moves beside the bed and he looks at her and goes, “After the exam, we’re going to have a chat.” We’re like, “What is with this dude? Why is he being so aggressive?” So then the first thing that he says to me again just in a very disrespectful tone is, “Why are you here?” I’m like, “What a weird question to ask someone in labor.” I was like, “I’m in labor.” He goes, “No. Why are you at this facility when none of your prenatal care has been here at all?”
The nurse was trying to tell him because again, I’m having contractions pretty often but no. He wanted all of the answers from me. He was just being so aggressive and I told him the whole explanation that I had already told the nurses. I also mentioned, “You’re being really, really combative. You’re making me uncomfortable.” He’s like, “You know, I’m not trying to. That’s not my intention, but you need to understand the position that you’re putting me and this hospital in by changing your care at 40 weeks.”
I was like, “Okay. I’m sorry, but I’m already here.” He just goes on for 30 minutes about how we’re putting him in a precarious position and we need to understand this. We need to understand that. We don’t have your records. I was like, “Dude, I brought you all of my labs. I brought you my post-op. What else do you want? What else do you need?”
Again, he just keeps going on and on. Eventually, my husband was just like, “Okay, man. What do you need from us? Do I need to go to the other hospital and get your records? Can you request the records or can we just move on because we are getting nowhere?” The doctor was just like, “You need to understand.” I was just like, “Dude, we get it. We understand.”
After that, he was like, “Okay, well I need to see if you are intact” which is a very weird way to say that he needs to check my waters. For some reason, I just had the fog. I knew that it was a swab. My doula was like, “It’s okay. It’s just a swab. They’re just going to swab you to see if your water broke. It’s not a big deal.” The nurses are like, “We’re pretty sure that her water hasn’t broken yet.” He’s like, “No. I need to check myself.”
So they’re prepping the swab and then my doula hears him ask the nurse for lubricant. I could have sworn that he said something about a speculum but I’m not sure about that. My doula was like, “Hey, Carli. Do you consent to a cervical exam?” I was like, “Wait, no. No, no. I do not consent. I just had one not even ten minutes ago. So, no.”
So then the doctor starts yelling at the doula again and saying, “Stop. You don’t give medical advice.” Then I’m having a contraction and he’s accusing her of making medical decisions, of moving me before the doctor came in the room, but he didn’t like that I was beside the bed standing up. He thought that she did that. So then after the contraction, I was like, “Dude, no. She’s only acting on my behalf when I have asked her to do something. You really need to back off. No. I do not consent to a cervical exam.”
So then he explains why he wants to do a medical exam.
Meagan: Again, you had just had one not long ago.
Carlise: Right, exactly.
Meagan: A little backstory, guys. I was reading this story on social media and I remember when I was reading this, I was like, “Why? Why? Why?” Every time, in my head, I’m like, “Why do we need to do this? Why do we need to do this? They just did this.” I was putting myself in your situation.
Carlise: It was so aggravating. The fact that he was prepping the cervical check without talking to me first. The doula had to mention it. You’re like, “Okay, that’s a super big red flag. Thank you for letting me know,” because if she wasn’t there, my husband would have no idea. So he explains why he wants to do a cervical check again and I’m like, “No. I don’t want a cervical check.”
So then he goes and sits down, stops prepping any exam at all, and he’s like, “I’m a really good doctor but I need to be able to do my job.” I’m like, “Dude. I already said that you could do the swab to check my water. I’m not refusing your care. I just don’t want a cervical exam.”
He’s like, “No. You’re refusing my care. I have to do both in order to–”
Meagan: Make an assessment.
Carlise: Make a decision. I was like, “Okay. I’m really uncomfortable with your insistence here. I want a new doctor. You’re not listening to me. You don’t seem to care that I’m having contractions every three minutes. I want a new doctor.” He goes, “There isn’t one.” I’m like, “What?” He’s like, “Yeah. I’m it.” So then the doula was like, “Okay. There has to be somebody on call. Can you go ahead and call them in?” So then he says, “Stop” again to her and says, “I do not engage with you.”
I was like, “Okay. I’m going to repeat the question. Can you call the person who’s on call please?” He was like, “No, there isn’t anybody on call. It’s just me. The next provider doesn’t get in until 8:00 AM.” At this point, it’s around 4:00ish. I was like, “Okay. Can I just labor with the nurses? Because you’re not touching me.”
Meagan: And the nurses were being so great.
Carlise: They kept trying to interject and answer questions for me but he wanted the answers from me. At that point, I was like, “Okay, dude. Just get out. Everybody needs to leave. I need to talk to my doula and my husband.”
They go ahead and leave. I’m like, “Okay. I don’t know what to do.” I’m freaking out. My doula was like, “It’s okay. You’re fine. We can stay here and deal with this dude. We can go ahead and just leave and go home. Your contractions are probably going to slow down since we’re dealing with this or we can go straight to the other hospital.” I was like, “Okay. Let’s definitely just leave. I’m done.”
We told him that we were leaving and he just seemed shocked.
Meagan: I’m sure.
Carlise: Just completely shocked. I was just like, “No. We’re leaving.” So then they were like, “You have to sign out AMA then.” I was like, “Cool. I’ll go ahead and do that. You’re not touching me.” We went ahead and signed the paper. As we were walking out, I’m having to stop every minute. The doula is like, “Okay. Yeah. We’ve got to go straight to the hospital.”
We ended up, and in mind fog, I was like, “I forgot my birth plan so we’re going to run home real fast. I’m going to get my birth plan.” That turned into an F-1 pitstop because I’m over here with really, really low sounding and having a rough time. Doug, my husband, is also freaking out. He’s like, “We’re going to have a car baby.”
Meagan: Oh yeah, I’m sure.
Carlise: He’s just panicking. So he’s speeding on the way to the other hospital. We get there and I had never gone through that entrance before. I had always gone in a different one on the back because my prenatal care was with Texas Tech and UMC, they’re right next to each other. So I always went into a different entrance.
So the entrance that we went into, I had no idea where to go. I’m over here. I swear I’m about to push and we don’t know where to go. This super nice lady who was coming into work was like, “Do you guys need a wheelchair?” Doug was going to say no! I’m like, “Yes. Yes, I do.”
So she gets a wheelchair. She brings us up to triage. As soon as we get up there and there was a trash can right next to the elevator. I’m just throwing up right next to the elevator. They’re trying to get Doug to fill out paperwork and have me sign things. I’m just kind of dying. Then I needed to go to the bathroom. I didn’t need to push. I just needed to go to the bathroom.
I go in there and my water breaks. My plug comes out. So then I’m just gripping the walls. I’m just blinded here by my contractions. So they get me into a triage bed and they’re like, “Oh yeah. Yep. Mhmm. She is ready to go. She is fully dilated. Baby is definitely ready.” The doula is over here like, “Okay, yeah. We need to switch her bed too.” So they switched me into a labor and delivery room. She’s calling all of the shots here because the lights were so bright. I’m over here like, “Oh man.” So she’s like, “Okay, those lights need to be dimmed. We need to take this gown off of her.”
She was taking off my TENS unit. They’re trying to put on monitors and I’m promptly trying to take them off so just being very unhelpful which I did not care about. So then they were trying to get the monitor on to check the baby. I was on my hands and knees which they did not want me on. I did not care. The doula is trying to help so she had reclined the bed so that I could lean over it so that way they could get the monitors on. That actually ended up working super, super well.
Then I was feeling the need to push. Then I was just really self-conscious because I was feeling like I needed to poop. I was just like, “Oh no. This is horrible.” She’s like, “No, that’s normal. It’s fine.” I was like, “No, I actually think I need to go.” So she’s like, “It’s fine. They’re going to catch it. Don’t even worry about it. Just focus on the baby right now. You’re okay.” She snapped me out of it. I was like, “Okay, we’ve got this.”
I was pushing and they were like, “No, no, no, no. The doctor’s not in. Don’t push. Don’t push yet.” I was like, “I’m not not pushing so y’all need to figure it out.” So then the doula’s over here like, “She’s crowning. Baby’s crowning right now.” Then they’re just rushing in and I could feel the ring of fire. I was like, “Okay. I need to pause for just a minute,” because I could feel if I kept going that I was going to tear up. I honestly loved that I could feel that versus having an epidural and not being able to feel that.
Within another couple of pushes, baby was out and I didn’t have any tearing. I didn’t have any issues at all whatsoever. I did not get the Pitocin for the delivery of the placenta and I didn’t have the IV. I didn’t have anything, just honestly the most natural birth except for the hospital situation.
Meagan: Yeah, yeah. But no interventions other than maybe a cervical exam here and there.
Carlise: Exactly. It went super well honestly overall and I was so proud of myself because I was just like, “I did that and I was able to advocate for myself.” My doula was amazing. My husband was very supportive even though he was freaking out.
Meagan: Oh I’m sure. Yeah.
Carlise: He told his dad. He’s like, “It was super, super intense. The last couple of pushes, she sounded like a banshee and then baby was out.” I was like, “Wow, babe. Thank you. Thanks. That’s super sweet of you.” The nurses afterward kept coming in and they were like, “Okay, we need to drain your IV and we need to check your stitches.” I’m over here like, “No guys, I don’t have any of that.” They’re like, “Wow, okay. You’re the easy patient.”
That birth, I was able to feel her before she came out. That was amazing. She got right on my chest. Delivering the placenta was super easy. I love that I can remember it and I’m proud of myself. The first thing that I said after birth was very colorful which definitely included, “F that doctor” which we then had to be like, “No, no. Not you, ma’am. Sorry.”
Meagan: Yeah, yeah. I can relate to that one because that’s what I said. I said, “Screw you,” and then I named the doctor. Take that.
Carlise: Mhmm. I was just amazed and then everybody that I tell when I’m like, “Yeah. I left the hospital at one-minute contractions,” and they’re like, “Oh, no.” I was like, “Yeah, no. I would rather have had a car baby legitimately–”
Meagan: –than to go there.
Carlise: Absolutely not. I was so disappointed and the fact is that’s what we encountered. We put in all of the complaints that we could possibly put in and I’m still waiting on the head of OB to contact me but the doula had a really, really good meeting actually with the head of OB, a lot of the staff, the provost marshall apparently was in there as well.
Meagan: Wow. How did she connect? How did she go about doing that?
Carlise: Apparently, with doulas, there is a different system for them. I’m not entirely sure but there are different routes that they can go because they are professional birth workers. She had contacted the head of OB and then the head of OB was like, “Okay, this is really serious.” So I think they just coordinated together. The end of that resulted in a giant meeting with all of the OBs to basically educate them on what to do when a doula comes in.
Meagan: Oh wow!
Carlise: And that doctor that we encountered has to go to those meetings. My doula’s teaching it. It’s a class. I was like, “Yeah man. You’re going to deal with that.”
Meagan: That’s actually really cool to help that space be a little bit more collaborative because I feel like we are a little spoiled here in Utah. People are like, “How do the doctors treat you and handle things when you are in there?” Usually nine times out of ten, it’s very friendly and it’s not hostile like that but if it were, I think that we would probably want to be doing something like that as well and say, “Hey, we are all here for this patient. We are all one team here. We’re not here to be combative and create trauma emotionally.” That’s really cool. That’s really awesome. Good for your doula.
Carlise: Yeah. I was so proud of her, especially being yelled at by a doctor.
Meagan: Yeah. Yeah.
Carlise: She’s trying to advocate for me as much as she can but she also doesn’t want security called on her so she was having to find a balance between that.
Meagan: And she doesn’t want to make it any worse for you.
Carlise: Exactly. That was super, super odd. The fact that I meant to mention it in my story, but he had been quizzing me over VBAC facts, then he was telling me that I was wrong. I was just like, “What?” and just freaking out. She just helped me so much. I’m a huge advocate for doulas and having one and I 100% recommend anybody to have one for sure. My husband would have had just no idea exactly how to advocate for me in the way that my doula had. It was great.
Meagan: Yeah. Yeah. I feel like there are so many benefits of doulas but just like we were saying, she helped him too. She helped him through this process I’m sure to feel more comfortable and at ease with the things that were taking place. Even that alone whether you had a lot of help with counterpressure and stuff like that but being able to have a sounding board and someone there that you feel is on your team and it’s not you two against one person. I’m sure that brought so much comfort to him.
Carlise: 100%. The fact that the doula had also done some childbirth education with him so that he knew how baby comes out and the different stages as well.
Meagan: Yes and then when you have a provider questioning the facts around VBAC and you’re saying this and then they’re saying no or they’re shutting you down or they’re giving you false percentages which I know is a thing, that can be really, really scary if a partner is not educated or doesn’t know ahead of time. So that’s another really great pro of doulas is that they usually meet with you before, counsel, and go over all of those stats.
I remember the feeling. I literally was on the treadmill walking, trying to pass the time because I hate the treadmill, reading your story and I’m like, “Oh my gosh. This is just so intense. It’s so intense.”
Carlise: It was nuts. When I was trying to prep my husband for the VBAC, I’m pretty sure he just got really annoyed by me listening to this podcast all of the time. I’d be like, “Babe, you should have heard this from this mom.” He’s just like, “Ugh, I can’t wait until you’ve had the baby because I’m so done hearing about all of these VBACs all of the time and all of these stories.” But then honestly, it prepared him. I was like, “Babe, this can happen,” so when we were facing this doctor, he wasn’t second-guessing me at all.
When I told the doctor the different things that I knew about VBAC because he wanted to make sure that I knew, Doug was like, “No. She definitely knows the stuff. She could spout this off normally.” He was confident. That made me more confident and with my doula being there, it helped a lot.
Meagan: That makes me smile. I love it. Now you can be like, “Yeah, now I’m one of those people on the podcast.”
Carlise: Mhmm, yeah. He was like, “I get to hear this story for the 35th time.”
Meagan: I love it.
Carlise: I was like, “Last time, babe. Last time.”
Meagan: Last time. Maybe, maybe not. You’ll be sharing it for years. You’ll be sharing it for years.
Meagan: Well I want to talk a little bit about the AMA, the Against Medical Advice form. It is one that like I said, maybe I’m crazy. It might have been a year ago actually that we talked about. It’s not one that happens often or that people maybe even know exists. I just want to give a little side note. It’s not something I suggest always doing like, “I’m just going to sign this AMA.” Against Medical Advice forms are taken pretty seriously but when you are in a combative, hostile environment, an AMA may be something that can get you out of that experience.
I, as a doula, was at a birth where a mom chose to sign an AMA. From a doula’s standpoint, it was really interesting. I was like, “I would have totally done that too as a mom.” We were very much in labor. It was very clear that we were in labor but the toco, the monitor, wasn’t picking up the contractions.
This doctor comes in very rudely and says, “You’re not even contracting. I don’t even understand why you’re here.” She looks at me and her husband. She’s like, “I’m contracting, right?” We’re like, “Yeah, you’re contracting. You’re doing really great.” They’re like, “We’re probably just going to send you home anyways so we can just sit here and wait,” and just was very rude, questioning her, and pretty much saying that she was not even in labor and that she was over the top.
Carlise: Oh, lovely.
Meagan: This one doctor that came in was like, “You are just highly sensitive and being overdramatic. Maybe you should learn how to cope better because you’re not even contracting yet,” and just talking down and being very rude. She’s vomiting. She’s shaking. She is clearly laboring. They leave and she turns to us and says, “What other hospital takes my insurance?” As a doula, I wasn’t expecting that but at the same time, I should have expected that because of how rude they were to her. I said, “Well, this hospital and this hospital.” She rips out her IV because they had given her an IV for fluids for vomiting. She ripped it off, was holding her arm, and was like, “Let’s go!”
Carlise: That’s intense.
Meagan: I was like, “What?!” She was literally holding her arm and she was like, “I am done.” Her husband was like, “Me too.” They were getting her dressed and as a doula, I’m like, “Okay. I go where you go.”
Carlise: Man, all right. We’re doing this now. Okay.
Meagan: She’s walking out and they’re like, “What are you doing? What are you doing?” They’re freaking out and she’s like, “I’m leaving. I am going somewhere else to have my baby. You said that you were going to send me home anyways so I am going home.” They were like, “We’ll have to have you sign an AMA.” She was like, “Where do I sign?” They were like, “Oh, but your insurance won’t cover this.”
Carlise: Mhmm, yeah. Okay.
Meagan: She was like, “I don’t care. I’m signing this AMA.” We went. We were 6.5-7 centimeters when we got to the hospital and had a baby a couple of hours later. Dad caught the baby. It was a beautiful, beautiful experience.
So AMA, what does that mean? It’s really leaving the hospital without the physician’s advice before they decide to discharge you. It says right here in a NCBI which we will make sure that this is in the show notes today if you want to read a little bit more. But it says, “Leaving a hospital against a physician’s advice may expose the patient to risk of an inadequately treated medical problem and result in the need for readmission.”
That is important to remember, that we as parents know that. We are signing this form and we are saying, “We assume the risk of us leaving because we are leaving against your advice,” but I also think it’s important for us to know and follow our mom's gut to be like, “I’m just going to have this baby and do this.”
Meagan: You have to think about it. If you are in an AMA situation, you want to really think about it. You want to weigh out the pros and cons and you want to be educated. If you’re listening to this podcast, you’re definitely starting your education because as you mentioned, you learn along all of these stories. But it’s a big thing. The article says, “The problem with AMA discharge is the prevalence of risk and costs. It can formulate recommendations of managing and preventing them on the basis of available evidence.” That’s so hard because they can say, “Well, this happened because you left,” or even the cost of insurance.
They can say, “Oh, well we won’t do this because you left against our advice.” So it’s important to definitely learn more about an AMA and why you would sign an AMA but know that an AMA exists because if you are in a hostile environment, it’s probably not a healthy one.
Carlise: Right and that was my thing too. I didn’t feel safe with this care provider and then being told, “No, there isn’t another provider,” I feel like there are going to be so many more interventions and so many things that are going to be done without my consenting because obviously, they already tried to do that once. I would rather sign an AMA and leave than to have you touch me and cause issues that shouldn’t have been caused at all.
Meagan: Yeah. Yeah, exactly. I think it’s important to know that it exists and then know the pros and cons. It’s just one of those other things. Know the pros and cons of signing an AMA or what that entails and then having that backup plan. But just know that it exists because for the client of mine, she was like, “I couldn’t have stayed there. I was feeling so anxious. I was feeling so triggered and traumatized by what they were doing and what they were saying to me.”
She said, “The second I walked into this new hospital, I just truly felt 100% at ease. 100% at ease.” So yeah. It’s so important to feel that comfort, know your options, and look at you. You did! You went and you had an unmedicated, no-intervention VBAC.
Carlise: Yeah. Honestly, it’s been amazing. The recovery has been fantastic and I am so proud of me and every mama who has had a VBAC and had to fight for it. That’s just awesome.
Meagan: You should be so proud of yourself. Congratulations. Thank you for coming on and sharing this story. I also want to end with a preface by saying that sharing this story is not to bash an OB or anything like that.
Meagan: It’s not anything like that because OBs are great. I’m sure he was caught off guard. He had his stuff but at the same time very much acted in a very unprofessional way.
Meagan: It’s important to know all sides of things.
Carlise: 100%. Absolutely.
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