“The perfect patient”
(My take as a birth worker on what I think people mean when they call expectant women the “perfect patient”)
A perfect patient is a casual, non-medical description given to a low-risk pregnant woman, who is in ideal health, who is estimated to have a relatively easy and quick delivery (could be either vaginal or c-section— just uneventful).
I was called this title once in my life, 8 years ago.
I was labeled the perfect patient.
I was a quick in-and-out in time for dinner with your family kind of OB patient.
If you have been following me for a while now, you can probably guess that I am unimpressed by care providers who excel and are given 5 star ratings in situations when they are working with the patients they consider their perfect patients.
When life is easy, everyone is happy.
If every single pregnant patient was easy, we could argue that more people would have babies because less people would be traumatized by birth and we more eager to get pregnant again, and we could argue that if every single pregnant patient was easy, the world would be a more peaceful, agreeable place.
But this is not the case.
A majority of the families I work with would not fall under the above description “the perfect patient”
Many of the families I work with hire me to use their pictures and videos to heal from the birth traumas of their past births. Those are my perfect people. Many of my families need me to be part of their birth team because they feel like they need to process their birth once their baby is born and they feel like they could not do that without a visual story and that’s why they need me. Those are my perfect people.
Many of the families I work with hire me to help them heal, or to celebrate their baby’s first breath, or to remember the extraordinary team they made together with their partner or their spouse bringing their baby earth side.
I don’t seek out “perfect people” with quick and easy deliveries to photograph beautiful deliveries in the shortest amount of time so I can earn money to put food on my table.
And while yes, I am a birth worker by career, so I do need to put food on my table and pay for preschool and a mortgage…. however,
My perfect people are those who hire me because they say that they need me.
My perfect people are not always easy and quick, but they do always need me.
And so when I attend births, I tend to pay more attention to the people on my client’s birth teams (their care provider, their birth teams) who continue to stay respectful, patient, and compassionate to my client when things are not easy.
After mothering two infants who both ended up in the emergency room sick and our pediatrician was their guardian angel who I feel to this day saved their lives, those experiences taught me to pay attention to those care providers in all aspects of life, particularly in birth, who become guardian angels to my clients when the situation becomes seemingly impossible or difficult.
Pictured above is a two time c-section mama birthing her third child through VBA2C (vaginal birth after two c-sections).
After two C-sections typically would call for a repeat third c-section.
Is not only possible but yes, also a safe method of delivery when families choose care providers who deliver VBAC and VBA2C patients frequently enough to ensure this method of delivery is safe.
I more often hear from women that they had no idea that having a baby vaginally after one or two c-sections was even a possibility, and a safe possibility, because no one mentioned “VBAC” to them.
And to me, this speaks volumes.
Certainly, I understand not every patient is a safe candidate for a TOLAC (trial of labor after a c-section/VBAC (vaginal birth after a c-section), and I understand that there are many people who are informed about TOLAC, VBAC and VBA2C and decide to schedule a repeat c-section, however, there are very high numbers of repeat c-section deliveries who were never given enough information to make an informed decision after their second or third birth. Many families are only given the news that their second or third baby will also be born by repeat c-section.
The Real Definition of The Perfect Patient
The Real Definition of The Perfect Patient
As birth workers
(as OBGYNS, midwives, LD nurses, doulas, birth photographers)
the perfect patient to us should be
the patient who walks into our space and says:
I need you
That is it.
We were called to serve in a humble role as birth workers, to help people not only to bring their baby into this world safely physically, but also safely emotionally and safely psychologically into this world. That is our responsibility.
Further Discussion into VBAC, TOLAC, VBA2C and sourced information below
“Why is someone risking her life and her baby’s life with a vaginal delivery” is a common question I would hear. Continue reading and you will be surprised to hear that the American College of Obstetrics and Gynecology recommends a vaginal delivery after two c-sections as a safe option.
“ACOG recommends VBA2C (vaginal birth after two c-sections) as a safe option. Speaking of ACOG... Since 2010 , their stance on VBA2C is that it is “...reasonable to consider women with two previous low-transverse cesarean deliveries to be candidates for TOLAC (trial of labor after a c-section) and to counsel them based on the combination of other factors that affect their probability of achieving a successful VBAC.” (ncbi.nlm.nih.gov hyperlink source) More importantly to note is that there is no mention of a requirement to have had a prior vaginal delivery to be considered. If you are going for VBA2C, this bulletin is very important to have in your back pocket as you work with your provider to determine your care. (thevbaclink.com hyperlink source)
Please also reference this Frequently Asked Questions from ACOG on VBAC and TOLAC (click link)
Uterine Rupture and VBAC
Choosing a repeat cesarean does NOT eliminate your chance of rupture. We often only talk about uterine rupture during TOLAC (Trial of Labor After Cesarean, aka attempting VBAC), and by choosing elective repeat cesarean, you can eliminate any chance of uterine rupture. Although focus is usually on uterine rupture during labor, it is possible for uterine ruptures to occur before labor begins. These types of uterine rupture are usually more devastating, and can cause serious health complications or worse in mother and baby. It is NOT true that deciding against a VBAC means that you won't have any risk of uterine rupture. In fact, occasional studies have even found a higher rate of rupture in the elective repeat cesarean groups! So keep in mind that it is the PREVIOUS CESAREAN that puts you at risk for uterine rupture. (thevbaclink.com hyperlink source)
