Dr (Name has been removed to protect the not-so-innocent),
I've waited a long time to write this letter. Two years, in fact. At first, I waited until the rush of postpartum hormones had subsided, to make sure I wouldn't be unduly influenced. Then I waited, hoping time and counseling for post traumatic stress would render this letter unnecessary.
Two years ago, word on the street was, you were the best provider for TOLAC on the east side. I visited four other offices before deciding my sources were right. I knew that you and I hadn't clicked on a personal level, but that was OK with me, as long as I got my VBAC.
When I presented to the hospital with epigastric pain the day before Thanksgiving, I expected a gallbladder ultrasound and some IV fluids. What I got was a cesarean. Not a medically indicated cesarean, not a voluntary repeat cesarean. A cesarean consented to under duress. A cesarean based on a lie.
It's taken me two years of heavy research and a bio-ethics class to more fully understand what took place that day.
When you came by the hospital to see me the first time that day, you asked if I were ready for my c-section. I said no. We ran blood work. I spent the entire day in a bed doing nothing. The tests came back normal, but you said my pain was probably due to my liver going into failure. I couldn't believe normal blood work could indicate liver failure, so I asked for, and was refused (according to you, by three different doctors) a GI consult, you said that you'd consulted with a perinatologist and he'd recommended a section as safest for both me and the baby. Even though both mine and the baby's vitals had been within the range of normal for nearly the entire visit. (episodes of pain excepted when I did exhibit elevated BP readings but the baby's tracings were normal the entire stay). I did not, at any point during this visit, see or speak with another provider.
When you came back to talk with me that evening, the pain had mostly subsided. It was at this point that you again recommended a repeat cesarean. I asked if my husband and I could think about it over night, since there didn't appear to be any immediate danger. This is the good part. You told me, "If you leave, it will be AMA. Against medical advice, and your insurance company won't pay for anything we've done here today." That verbatim quote is seared into my memory because it was the pivotal statement you made that sent me down the road of a repeat cesarean instead of the VBAC I desperately wanted. It was also a lie. I have no idea if you really believed your statement to be true or if you knew The Hubs and I could never have afforded all those tests and continuous monitoring without insurance. What I do know, now, is that in addition to being completely false, this statement constitutes legal coercion. I did sign the consent form for the surgery, but not willingly. I signed it, because you made it clear signing was my only option.
I knew a second cesarean greatly reduced my chances of a future vaginal birth. You brought that little nugget of knowledge to crystal clear point in the operating room when I asked you to stitch my uterus on two levels, to increase the chance of VBA2C. You said, "not with me, you won't". But that was something I'd already decided.
And then you proceeded to mock me as I lay naked, numb and very cognitively aware on the operating table. With my guts on my chest and your hands in my abdomen, you derided my request and my choices, making perfectly clear your dislike for me as a person and my desire for vaginal delivery; a birth that science has repeatedly shown is safer for both mother and child.
The question I have is this: Was your Thanksgiving meal really so important that you risked my life, my future birthing opportunities and my child? Two years later, do you even remember that day? Because I do. I am fighting an internal battle to be happy it's my daughter's birthday when all I really want to do is curl up and cry because every time you touched me, every incision, every tug, every stitch-- constitutes battery when performed without consent. Dr. Name has been removed. I did not consent.
I hope in future you will treat all your patients, even the one's you don't like, with the respect and regard they deserve. Keep beneficence and non maleficence first in your mind, not a turkey dinner.