Conference moira::parenting_v3

    
    I have chosen to have a repeat c-section, too. I am due in 4 weeks.
    My doctor prefers to do the c-section when the baby is ready, ie.
    not scheduled. (In a way, I wish I could get this kid out of my body
    sooner!). I believe that if they schdeule your section, you'll
    still have 2 weeks leave before (the schduled date will be your due
    date). 
    
    I had 24 hours of labor the first time (almost 3 hrs of pushing), 
    so I expect this second section to recover faster. All the women I 
    talked to who had repeat c-section without any labor think recovery was
    fast. They also think the second time was more pleasant, they knew
    what to expect and thus they were more calm.
    
    
    Eva.
    

>    sooner!). I believe that if they schdeule your section, you'll
>    still have 2 weeks leave before (the schduled date will be your due
>    date). 


You better check on this... when I got the scoop last year, the Digital nurse
definitely said that for a SCHEDULED c-sec you get 8 weeks after, none
before.  I remember because I thought it would be awful to work one day and
be in surgery the next.


Marty


    

My disability literature states:

NORMAL DELIVERY

o	Up to two weeks before your delivery date.
o	Up to six weeks after delivery.

	(If you decide to work until the day you deliver, your
	disability recovery time does not change, and would still
	be up to six weeks after delivery)

CAESAREAN DELIVERY

o	Up to eight weeks after delivery for planned Caesarean
o	Up to two weeks before delivery and eight weeks after delivery
	for unplanned Caesarean

   How do you determine two weeks before something that is unplanned???
   
   My wife's previous O/G said, that most O/G's prefer to Do a C/Sect for
   repeats if the first was a C/Section. He didn't give a reason.
   
   One of the girls I used to work with, Had a C/Section for her first, and
   then went for a Natural Childbirth for #2. Later, she cursed everyone under
   the sun, for not warning her about how much harder it was...
   
   q
   

re .4:

>   How do you determine two weeks before something that is unplanned???

If you're planning a normal delivery, you get two weeks off before hand.
If you then go into labor on the expected due date, but end up having a 
C-section for some reason, then you've had two weeks leave before an
unplanned C-section.

That does leave the interesting question, though, of what the possible
rationale can be for having different leave policies before a planned
normal delivery and a planned C-section.  Any ideas?

    Maybe they figure that if you're having a planned C-section, that it by
    definition, will occur before your due date.  So maybe they think
    you're not "disabled enough" to be entitled to the 2 prior weeks of
    leave.  Personally, I think it's kind of fishy.  IMO, this policy
    should be changed.  

	Bear in mind that the policy is just a guideline.  Two weeks is not 
the outside limit, it's just how much you'll get without having to justify 
by anything more than "It's time to go!" 

	I went out 3 1/2 weeks before my due date and I was 9 days late, so I
was out over 4 weeks before my unplanned c-section. My doctor wrote a note about 
2 sentences long that got clipped to my STD form and that was it.

	Similarly, if you are having a planned c-section and your condition
is such that you should not be working, talk to your doctor and have him/her
write a note and take you out.  If the leave is medically sanctioned, Health
Services will not question it.

Tracey  

    Something to also keep in mind is that it is not a maternity leave, but
    STD and like any operation you are not given two weeks before.  For
    instance, if someone was having their gall bladder out, they would not
    be given two weeks before scheduled surgery.  That's why, (in my
    opinion) Digitals "maternity leave" stinks!!
    
    I was planned that I would have a c-section if the baby was over 8 lbs
    , but my doctor put on the report that we were going to try VBAC.  
    Therefore, I was given two weeks before (although I went three weeks
    early).  In your case (which was similar to mine) it sounds like your
    doctor can do that.  My first baby was very big and that was one of the
    reason for the c-section.  Naturally, the doctor thought the chances of
    the second child being large was good, but not guaranteed.  So, I was 
    schedule for an ultrasound about a month before my due date and at that
    time he would schedule the section, depending on the size.  Keep in mind
    that the ultrasound is 20% off either way.  Mine was really off!  The 
    ultrasound said he was about 8.5 lbs at 34 weeks.  I had him at 37 weeks
    and he was 7.9lbs.
    
    As far as surgery;  yes they do cut over the original incision.
    As far as recovery;  I found my incision to heal a lot slower and
    "messier".  Also, I was chasing around a 2 year old which makes it
    tough to "stay off your feet as much as possible"!!!
    

    
    I am just curious... What if the C-section is scheduled within
    2 weeks of the due date? I would think the woman would be entitled
    to part of the leave. Say, if the section is scheduled on the 39th
    week, the woman should be given one week before the surgery, right?
    All women in the 39th week of pregnancy should be equally
    incapacitated regardless of the kind of delivery selected!
    Does anyone have any information on this?
    
    
    Eva.

    
    I have had 3 C-sections (and I think that's about it for me!), 2
    while I was here a Digital.  My last 2 were scheduled 1 week before
    the due date and there is absolutely no policy saying you can take
    a week off before since you're into your "two week due-date time".
    It's scheduled surgery and I worked the day before I went into the
    hospital.  Kind of too bad, because who is to say you won't go early
    and beat them to the operating table and, having at least one baby
    already at home, it'd be nice to have the time to get ready for the
    next.
    
    As for the surgery itself, I found that each one got easier to handle,
    both physically and mentally.  The recovery time was about the same,
    but on your second you KNOW what not to do and you know exactly how
    you're going to feel so you don't worry as much about the little
    aches and pains.
    
    P.S.  Yes, they cut on the same line, remove the previous scar tissue
    and make a single scar for you.  That is one thing, each time you have
    a C-section, it takes a little longer in the operating room because
    they have to remove old scar tissue.  
    
    	The ultimate prize is worth it though, scar and all!
    
    -dorothy

    
    re.10
    
    Digital policy - thanks for clarifying. 
    But, that is so unfair. It seems like an obvious "miscalculation"
    in the part of the policy makers. Even if the c-section is planned,
    soemone can go early. It will be more difficult for the colleagues
    to handle the "emergency" situation. 
    
    Eva.
     

	I'll repeat.  Even though there is no policy saying that you can go out 
before the surgery, if you are medically diasabled, you *can* go out early.

	Those two weeks before the EDC are NOT to help you get ready, they are
two weeks of *diability*.  If you need to go out, talk to your doctor.  He/she
can arrange for you to leave early.

Tracey
	

    
    Got to add my story because it's slightly different from the others.
    
    I also had a repeat, planned c-section for my second child.  The decision 
    was made early in the pregnancy because, with my first, I only dialated to
    7 cm. and got stuck there, and the odds are for the same thing happening
    again (according to my obgyn).
    
    Anyway, he likes to schedule repeats for 2 weeks ahead of due date. 
    Due his schedule, we had to schedule it for one week ahead.  Because I
    have really irregular cycles, we used the results of 2 ultrasounds and
    my best guess as to conception for the due date.  We ended up being off
    by 2 weeks because my 9 1/2 pound son was 3 weeks early (no wrinkles on 
    his feet seems to indicate this, according to the doctor).  They have
    to be real careful about going too early because of the lung
    development.  
    
    About disablily leave before the delivery:  my doctor put me out on 
    medical leave 4 weeks before delivery because of various medical
    problems I was having with the pregnancy. Both Health Serivces and
    my management went along with this because it was obvious I was a mess.
    
    My obgyn cut along the same incision line.  I have found that my scar
    now after 18 months is much smaller and healthier looking than my old
    scar after 2 years.  I guess it all depends on the surgeon (different
    ones for each c-section).
    
    Even with a 2 year old running around and a husband who had major
    neck surgery 1 week before I delivered (and so was incapacitaed
    himself), my recovery was much faster and better the second time.
    First, I didn't go through 36+ hours of labor before the surgery
    this time.  Check in 2 hours before surgery time, walk down to the
    operating room joking with the doctor and hop up on the table for my
    spinal.  An added benefit for me was my sister the maternity nurse.
    Because I knew what day I would deliver, she fixed her schedule to work
    that day.  She checked me in before hand and was the nursery nurse in
    the delivery room - the second person to hold her nephew.
    
    Oh yeah, second, I had lots of help at home.  Between my mother, my
    mother-in-law, and my sister-in-law, there was someone with us all
    the time for 2 weeks and during the day for another 2 weeks.  I knew
    before hand that my husband wouldn't be able to pick up anything more
    than 5 pounds for the first month so I arranged for lots of help.
    The first time, I wanted to be independant fast, or some such
    craziness, so I only had help for the first week and then I was on my
    own for the most part during the day.  I was alot more tired and worn
    out then.  The second time, I took it easier in the beginning and so
    got my energy and stamina back alot faster in the end.  
    I guess I learned my lesson the hard way.
    
    Best of everything,
    
    Donna
     

    Thanks for all the replies/shared experiences. I have my next regular
    check-up in two weeks and plan on asking how my dr. will handle a
    planned c-section. I'll post what I hear for other noters' future
    reference.
    
    
    Sandy 

    
    I have decided to go for a scheduled c-section 2 days before my due
    date.  I have had the labor experience thank you, and after 19
    unproductive hours, ended up with a c-section with Hannah.  The
    c-section experience was so good (recovery was quicky and easy--no
    muss, no fuss), I've decided to electively repeat the experience!
    
    My OB will be on vacation in Thailand until April 25th.  He said he'd
    come in to the hospital at noon on the 26th, and do my c-section.  I
    kidded him about jet lag (much truth is said in jest!) and he said,
    "don't worry--I can do a section with my eyes closed...!"
    
    One of my closest friends (and neighbor) who is a nurse anestesist will
    be in the O.R. assisting.  My mother will come a few days before the
    birth to help out at home and stay for a couple of week after.  Then,
    my mother-in-law will come for a week as well.  I think I'll have
    plenty of help--both my mom and my mom-in-law are the helpful types.
    
    If I go into labor early, I will still have a c-section--only my OB
    won't perform it.  That's ok I guess, if it happens.
    
    The reason I'm writing this note--is because, according to my OB, very
    soon, insurance companies WILL NOT allow elective repeat c-sections. 
    He showed me an article in one of his professional journals (a rather
    large article) that stated that insurance companies are "putting the
    lid" on repeat c-sections starting within the next year.  
    
    My OB is of course, livid.  According to the article, all women are
    going to be expected to labor and until there is some absolute medical
    proof that a section is needed--no section.
    
    In my case, chances that I'll need a section anyway (even after trying
    labor) are fairly high---I have no desire to go through all the pain
    and frustration only to end up with a section anyway.  Of course, I
    definetly will be able to get my section, so I don't have to worry. 
    But if I were to have yet a 3rd child--I'd have a problem.
    
    So this is a note of warning to all of you out there who want, need, or
    desire a scheduled repeat c-section--you may not be able to get it.
    
    Personally, I think it's outrageous that insurance companies are
    getting involved in medical decisions that are between a woman (or
    person) and their physicians.  In the future, will they also deem
    epidurals during labor "unneccessary" to control spiraling costs?  Or
    medication, period?
    
    Sorry to ramble and I certainly don't mean to go down a rathole.  I
    just hate instrusions on my life....
    
    Bonnie
    
    

    While I'd certainly prefer to avoid 19 hours of pain, myself, in all
    fairness I can see why insurance companies are doing this.  It's
    already obvious that this is another means to curb insurance costs.
    I agree with it.
    
    Insurance companies need to, and do, get involved in medical issues
    which involve patient and doctor.  It's their business.  While not all
    insurance providers' employees have a medical background, a good deal
    of them do.  Also, I know that a large number of insurance companies
    pay big bucks to consultants to review costs and medical procedures.  I
    worked for a health care consulting firm and their biggest client was
    BC/BS, among others.  The consultants, in turn, consisted largely of
    doctors, nurses, medical sociologists, psychologists....  So, to say
    that they (insurance companies) shouldn't be involved isn't exacty
    realistic, nor is it completely fair.
    
    Everyone (including myself) is interested in cutting insurance costs
    and, hence, our costs.  Unfortunately, everything isn't always cut and
    dry.  While you and your doctor can anticipate your needing a c-section
    when the time comes, there's no way to prove (from what you're saying)
    that you will *definitely* need one.  It's unfortunate, but issues like
    this cannot be examined, generally, on an individual basis.  They've
    got to set some guidelines.  
    
    As you probably know, research is showing that there has been a gross
    amount of unnecessary c-sections done in the past and there is a move
    towards reducing that number.  You can find the same types of studies done
    for a wide variety of other medical issues, e.g. back pain treatment,
    hysterectomies, etc.  
    
    Personally, if my doctor were upset with this decision and I were in
    your situation with the 3rd child, I'd have my doctor give hard
    evidence to the insurer that this is not a maybe situation, but a
    known fact based on whatever past experience I've had.  
    
    In general, I have to agree with what the insurers' decision is. Nobody
    likes pain.  But, hey folks...I don't know about you, but my deductible
    just went up!  Medical insurance costs won't go down.  It sure would be
    nice if they stabilized for a while, though.
    
    -d

    
    While I agree that medical costs need to be curbed, I question the
    wisdom of insurance companies getting "involved" in the doctor/patient
    relationship.  If an insurance company won't sanction a particular
    procedure or treatment (or length of stay in a hospital), many doctors
    are in effect, embellishing the situation in order to get insurance
    company approval.  For instance, my OB feels very strongly (it is his
    professional opinion) that if I have 2 c-sections he WILL NOT even
    attempt a VBAC should I decide to have a 3rd child.  If my insurance
    company INSISTS that I try to deliver naturally, my OB will come up
    with a medical reason as to why I need another c-section.  If
    physicians want to come up with sound medical reasons--most of the
    time, they can.
    
    As the wife of a physician, I can attest to the fact that having
    insurance companies "get involved" in the doctor/patient relationship
    does little to control costs.  The only costs it controls are those
    where the abuse is glaring.  My husband, when he was in training, used
    to "moonlight" as a "peer reviewer" for a medical consulting firm hired
    by BC/BS to question physicians on their decisions regarding certain
    procedures and hospital stays.  My husband would call the physician and
    say "this length of stay or this procedure does not concur with the
    recommended treatment/length of stay, etc.  Please GIVE ME A MEDICAL
    REASON WHY I should approve this."  The physician would usually explain
    the situation and together, they would usually come up with a good
    reason why the procedure/stay should be sanctioned.  Once the insurance
    companies have 2 physician signatures (the treating physician and the
    "peer reviewer,") they will not both to look into it further.
    
    Hence, if one has a good relationship with their physician, and if
    there is any question whatsoever (don't forget, the physician is being
    squeezed on both ends--to control costs by the insurance companies and
    to do everything possible for the patient in terms of tests, etc. to
    avoid malpractice suits...)then one can pretty much get what they and
    their physician feel is the best course of treatment...
    
    In my case, both my physician and I feel that a scheduled c-section is
    the way to go both now and in the future.  I will not have an insurance
    company tell me what they will and won't pay for--I pay my premiums and
    I expect a service.  And just like you, my premiums have also gone up.
    
    Again, I wonder where it will stop.  What if your insurance company
    says they won't pay for any epidurals or related medications during
    labor?  They have the right to do this.  Do you think they are
    justified?  In order to have an epidural, an anasteseologist must be
    present to administer it.  It involves all kinds of intervention
    (suddenly, you need to be monitored, etc.).  Epidurals contribute to
    increased costs during childbirth.  So do OBs for that matter.  Midwives
    can perform the same function as OBs in "normal deliveries."  Will your
    insurance company eventually tell you that you must see a midwife and
    only if you have complications will you see an OB?
    
    I don't mean to digress--just to point out some of the pitfalls of
    thinking that one birthing procedure is more costly or better than
    another.  As someone who is appalled at the infant mortality rate here
    in New England, I wonder if more c-sections were done in the
    inner-city, if the infant mortality rate would improve.  I believe both
    Beth Israel and the Brigham are currently looking at that issue as
    well.  
    
    Didn't mean to go down a rathole here.  Obviously this is a subject
    that peaks my interest and causes me great concern.
    
    Bonnie
    
     

	Acutally, I believe that the situation you describe (seeing a midwife is
"normal" and an OB is only called in for complications) is the norm in England.
Can anyone from over the pond confirm this?

Tracey

    
    Tracey,
    You're right!  Seeing a midwife for ALL prenatal visits and only seeing
    an OB during labor (if there are complications) is the norm in England. 
    A friend of a friend (who is a DEC employee) came back to the US to
    have her baby because she was very disatisfied with the quality of
    "care" she got over there.  She wanted to see an OB for her prenatal
    visits and was unable to.
    
    I'm not saying she was right or wrong in coming back to the US for the
    last part of her pregnancy--including delivery.  I am saying that a
    large part of controlling costs may involve US--THE PATIENTS.  We may
    have to change our level of expectations, period.  
    
    It is also true that in England, kidney transplants are NOT done in
    persons over the age of 55--for financial reasons (unless the person
    can pay for the entire cost of the procedure, including physician and
    hospital fees) in cash.  I have heard, but would like confirmed, that
    this is true of dialysis as well--meaning that anyone who gets kidney
    disease over the age of 55 is as good as dead.  Can anyone over there
    confirm/deny?
    
    Also, Stuart Brook--how does the Canadian system handle
    C-sections---medications during birth, etc.  Some information as to how
    other countries handle this kind of stuff would be enlightening...
    
    Bonnie
    
    

    I'm no longer over the pond ... but am FROM over the pond ...
    
    It is very much true that a doctor is called in for complications ...
    and moreover, not necessarily an OB, unless the complications are such
    that a specialist is called for.
    
    Beware though in comparisons with UK medicine ... For the routine,
    delivery, and aftercare, generally care is very good in the UK, but
    for complications, some people do wonderfully well, and others do
    terribly.   It is a different kettle of fish altogether.
    
    From what I've seen and read, and the Canadian experience, half the
    battle has been malpractice protection.  Seemingly unnecessary C-sections,
    and numerous other medical procedures are performed, driving insurance
    costs through the roof ... not entirely becase the procedures are
    strictly unnecessary, but because the procedure is technically safer
    than some other procedure or none at all, thereby providing protection
    to the surgeon and physician.
    
    So, what it all boils down to in the end, is you either suffer the
    scrutiny of extreme justification by insurance companies, or you
    take more responsibilit for your own life and more acceptance that
    your Doctor, unless he is grossly malpracticing, is doing the best
    he can for you.  With malpractice insurance going through the roof,
    Doctors are charging more and more for their services and insurance
    companies are rebelling after people complain about insurance costs.
    
    While I agree with you Bonnie, that insurance companies are getting
    a little heavy handed in attempting to implement cost controls, on
    the other hand we all want to kep the cake and eat it too.  There's
    got to be a way out of this mess somewhere.
    
    Stuart
    

    
    Stuart,
    I absolutely agree with you--that "there has got to be a way out of
    this mess somewhere."  But each solution has grave consequences and
    I certainly wouldn't want to be one of the decision makers.  It all 
    seems like a "no win" situation to me.
    
    Every configuration I think of...from limiting malpractice awards to
    having insurance companies pay for hospitalizations and tests only 
    (ie: no doctor visits) has direct and in many case, dire impact on the
    people/families/lives it will affect.  
    
    There certainly is no easy answer.  But something that is very clear to
    me--if we start accepting that our insurance companies can and will
    make medical decisions that GO AGAINST our physicians ability to
    practice what they feel is "good" or "safe" medicine--we're all in
    trouble.  My big concern--and I see it more and more--is that insurance
    companies are dictating what is and is not acceptable in terms of
    illness, medications, and recovery.  
    
    Again, I am not exadurating when I say that in the future, insurance
    companies may refuse to pay for pain medication during
    childbirth--unless the medication is medically needed.  And I strongly
    doubt that epidurals "are needed" or "necessary"--they are just nice
    for those women that choose to have them--or that ask for them during
    labor.  Again, they do add additional costs to labor--and it can be
    argued that the cost is unneccesary.  Just like the additional cost of
    a repeat C-section (without laboring first) can be deemed unneccesary.
    
    My 2 cents,
    Bonnie
    
    
    visits)

    Bearing in mind that the Canadian health system is not quite the
    same in all provinces ..... in general terms it is much the same.
    
    We have a federally / provincially funded and administered health
    insurance scheme which pays the doctors a given, agreed upon fee
    for most what might be termed as basic health services, and includes
    annual checkups for adults, well baby checks.  Where a procedure is
    medically necessary, then, unless it is classed as experimental,
    like AZT treatment for AIDS was until just recently, then it is
    covered.  Plastic surgery is probably the one main area which has a
    grey area.  In hospital physiotherapy is covered.  Psychiatric
    services are covered ... psychologists are not except as a part of
    a hospital treatment program.  Ward rates for hospitalization are
    covered.  Prescription drugs are not, unless injected and supplied
    by a physician or provided while an in-patient of a hospital.  
    Most diagnostic testing is covered.  Eye examinations
    are covered, the cost of glasses or lenses is not.  Dental work is
    not covered except as the result of an accident, and then only in
    as much as to stabilize the situation in the mouth.  Hospital costs
    of dental work performed in a hospital is covered.  Chiropody and
    osteopathy are not covered.  Anaesthesia is covered.
    
    The coverages are provided are available out of province, but only up
    to the amount payable in your province of residence, unless the
    coverable treatment is not available in your province.  The amount
    paid to the Doctors for each service is agreed upon by the appropriate
    Physicians organisation in the province and the provincial government.
    
    Additional coverages are usually provided by private insurance, and
    for example, the Digital Canada plan includes ...
    
    90% prescription drugs (those available only by prescription)
    100% Hospitalization charges upgrade from ward to semi-private
         or max semi-private for private upgrade.
    90% basic preventive and minor restorative dental procedures (to a
         max in the provincial dental fee guide)
    60% major restorative dental procedures (crowns etc ...)
    50% orthodontia (capped to about $1000 per person lifetime max)
    90% psychologists, chiropractic, physiotherapy where prescribed by
         a physician, and subject to annual maxima.
    And hospital and physicians costs out-of-province which exceed the
    amount payable by the provincial fees.
    $100 bi-ennially for prescription lenses.
    
    What this in practice means is that over 10 years and 3 kids, we have
    spent on medical, except cough syrups and that kind of thing about
    maybe 100 per year, dental about 300 per year, optical about 50 per
    year.  Uncovered medical (plasters, cough syrups, aspirin etc) maybe
    250-300.
    
    Until this year, this insurance cost us out of pocket about $25 per
    month ... and this year was implemented as an employer tax, unseen
    by the employees.
    
    
    That's the background and the kind of service which we get, which can
    really only be described as very good value for money!
    
    Now ... costs are skyrocketing here too ... for much the same reasons
    as in the US ... malpractice suits being the primary one.  Hospitals
    are closing beds to cut costs.  There are waiting lists for certain
    procedures, particularly if elective, and certain critial care
    treatments (depending on local circumstances).  The Ontario doctors
    went on strike a few years back in an effort to keep a rip-off
    procedure called extra-billing, which alllowed them to charge the
    patient more than the province would repay them.  They lost.
    
    Generally speaking though, if the Doctor deems a procedure necessary,
    then that is the end of it, although they will have to justify some
    costs to the province, and in the case of some procedures, the patient
    may be billed.  This is rare though.
    
    That's the Canadian view.  Anybody want to move north ?
    
    Stuart

    Putting on my English hat ...
    
    The one important thing to remember in England is that the family
    physician is your primary care physician ... most are trained in
    obstetrics ... and they are regularly handling pregnancies, so it
    is a little unfair to demand to see an OB, unless there is some
    particularly motivating reason to see a specialist.  The level of
    medical care in general in England will seem poor by comparison with
    North America, but it is effective and the system does work, albeit at
    times, badly.  To see a specialist, you must be referred, or covered
    by a private insurance scheme.  Unless you have compelling reasons too,
    you cannot change GPs.
    
    I believe the problem of dialysis does depend greatly on where you
    live and what the demand on local services is like.
    
    Putting my Canadian hat back on ...
    
    Here again, many family doctors are in fact general practioners with
    some specialty .. many are surgeons, many in obstetrics.  So, you
    may well be cared for by your GP here too ...  Although you can ask
    to see a specialist if you wish, and while many specialists take
    new patients by referral only, here the answer is easy if your Doctor
    won't give you that referral ... you see another Doctor.

    Back to the planed C-section...  I just went through this with my
    second child.  My first after a looong labor ended up with a c-section
    she was 9 lbs 1 oz.  My second followed shortly after the 1st and my
    doctor watched the weight of the baby to determine the need for a
    planed c-section.  I ended up having a successful V-BAC but If we would 
    have gone for a planed C. I would have had to get a second opinion.  If 
    the C section was really needed the insurance company would have paid it.
    That is how I understood the insurance company was going to "monitor"
    the need for a repeat c-section. 
    
    I hope you have a successful delivery however it happens! 
                                     
    Karen

Just found this topic and thought you may be interested in another part of the 
world.  My gynecologist followed both my pregnancies and did both deliveries.
The first was a caesarian, placenta gravis (over the cervix) and breech.  I 
lost a lot of blood and had a devil of a recovery since the baby was tiny
(less than 5 pounds due to the placement) and sick.

The second I had what was called a "normal" birth (the boys are 2 yrs, 3mnths
apart).  since the first was a caesarian, the doctor didn't want to give me
anything to hurry the delivery since he didn't want to strain the scar.  So
I did 24 hours with over an hour in the second stage.  He did have to widen
the cervix the last centimeter by hand and use suction but the baby was
healthy and normal.

Then, a year later I had the egg sized hemorhoids caused by pushing too hard
removed.

The insurance here has nothing to say in cases such as these.  What the doctor
says goes.  We discussed it together (the doctor and I), I accepted his
recommendation, and that was that.

ccb