Are you referring to your care or the care of the baby? As an adult you have the right to determine your own care. Especially if this is a religious choice, I would be concerned about returning to a Doctor that has advised you that he will not respect your wishes. Have you checked out the services available to you there in Atlanta that offer bloodless options?

Atlanta Medical Center Bloodless

Yes, I am referring to my care. I am on medicaid, so my choices are limited. This is my third doctor I have seen because the first just wanted to schedule a C-section and the second told me that if it came down to it, he'd force blood on me. The doctor I am now seeing is a really good doctor and very reasonable. I feel that perhaps he might come around if I present viable options and show him that I have made a conscious, educated decision. Thanks for the link. I'm taking a look at it right now. It would be great if I could find a doctor who is educated about bloodless medicine.
As far as my question, is it possible for me to go with the doctor I have and if something goes wrong I can have the hospital take over to let him off the hook?

Nikki,
I am not really understanding the question. How will the hospital 'take over'? Do you mean you have a doctor who is a hospitalist who will take over and respect your wishes already lined up?

Keep trying to find a doctor who will respect your wishes if something goes wrong. You want the ones that will be ready to use alternatives like cell salvage, that will detect and correct any anemia you may have during the pregnancy and be aware of the medications that can be given to boost production of red cells after pregnancy if blood loss is expected. Any doctor can respect your wishes when things go fine. You want to be pro-active and make sure that you are taken care of. You need a doctor who will do all he can to ensure the best delivery possible, but also be prepared and armed for the worst scenario as well.

If this is an important matter to you, it would be well worth your time to contact the bloodless center that is in your town. The number on the website offers a phone consult. What have they told you about the OB doctors that work with them?

Although you are correct in stating that the risk of bleeding is higher for C-section than for vaginal delivery (true whether you are a VBAC or not), C-sections are done regularly with no blood whatsoever. Your main risk as a VBAC, as you already know, is uterine rupture along the previous uterine scar. At the hospital where I work, the success rate for VBAC is 91%, and the majority of failed VBACs are not uterine ruptures, but are the result of fetal intolerance of labor or failure to progress.

If rupture should occur, however, the chance of extensive bleeding is great, so you should at least have a Durable Power of Attorney in place that clearly states your determination not to have blood or blood products. It also clearly state any products or techniques you WILL accept, according to your conscience, such as clotting factors, cell salvage, or acute normovolemic hemodilution.

You would definitely benefit by trying to locate a doctor who will respect your wishes, whether that doctor practices at a bloodless medical center or not. Whoever you choose, you should discuss with him/her a specific bloodless course that he/she will follow should uterine rupture or postpartum hemorrhage occur. This should be reflected in orders that are placed in your chart and signed by the doctor ahead of surgery.

Have you contacted the Atlanta Medical Center to see if they take medicaid patients? Also, many doctors are not comfortable doing surgery without blood simply because they haven't been trained to do otherwise. Perhaps if you could have the doctor you seem to like so much make contact with one of the Center's surgeons, he could get some idea what kinds of options he really has to wotk with instead of just using blood.

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Jan Grossberg, RN, BSN
Editorial Team

Nikkij,
Are you one of Jehovah's Witnesses? If so, have you talked with the Atlanta Hospital Liaison Committee to get help finding a facility and a doctor to care for your needs?

In my effort to help you, either my last post was removed or it didn't go through. Atlanta Medical Center (404-265-6712) whether or not you are one of Jehovah's Witnesses, will help you. Call the number and ask for the coordinator of the transfusion free program.