Midwives are really out of the question in my situation because of my history of hypertension in late pregnancy. They won’t take me. Even if I did miraculously find one, my husband would say no. He is done with v-bacs.

I started off with a midwife with my first, but had a doctor picked out just in case. When my blood pressure went too high, I had to go to the hospital. I labored for over 40 hours and it ended up in an emergency C-section after the babies heart rate dropped dangerously low and would not recover between contractions. I had done my research on supportive doctors and I had a solid level of trust with this doctor. She knew I absolutely did not want a C-section and my resolve not to have one was well known. After the baby’s heart rate did not recover and continued to drop, the look in her eyes when she asked me to please consent to a C-section was one of almost desperation and fear. She was a mother of 4 herself, and it was a mother to mother moment. I know I made the right decision there.

On my second pregnancy I went past 40 weeks so they induced me. Failure to progress is what they told me. I was scared and decided to follow the advice of my doctor. To this day I wonder if it was the right decision. I tend to think it wasn’t.  If I hadn’t had a previous C-section, I would have told her to leave me alone until 43 weeks.
The third was a planned V-bac. I labored for 30 hours, failed to progress only to find out that the cord was wrapped around her neck. If I went much longer, she would have died.

This is a very difficult subject for me. Somehow I feel like less of a mother for not being able to birth naturally EVER. Without medical intervention I don’t think I would have had live babies, and with the first I probably would have died. There is a lot of pressure and it’s all on me to do all of my own research, to find the best doctors, to make wise and informed decisions. Sure, husband is supportive but really and truly, the burden falls on me. I’ve tried the best I can. And here I am now, still trying the best I can, but still feel so much guilt. Bah!

I have had 5 c-sections.  I understand the guilt of not being able to have babies naturally.  My prayers are with you.  Have you already signed the tubal ligation paper?  If no, please don't.  If yes, is there anything you can do to change it?  I think they brought in the specialists more due to preeclampsia.  If you would like to talk more please, DM me.  May God bless you and keep you.

Is there any possibility of relocating for about 4-6 weeks to a city with a specialist hospital for the birth?  I’m sure it’s expensive in terms of money, but if there’s a medical need?  I know someone who has high risk pregnancies and could not deliver at her usual hospital because they closed the maternity department after most of the staff refused to get the C-sickness 💉.
They left the older teens at home and farmed the younger out to relatives and took a a room at a residence hotel in a city 250 miles away.  

On the bright side, he's only around once per month. Talk to your regular OB. It sounds like she's supportive and might be able to shield you from having to see this specialist even if he ultimately does the c-section. Don't sign the paperwork. I agree with others here that there's no such thing as an emergency tubal. It's convenient for him, nothing more. And, not agreeing to that certainly doesn't keep him from doing a c-section. Don't listen to any "because you have Medicaid" nonsense. (As if normal insurance providers are super accommodating and easy to work with?!? Ha!!)

I so wish I could transport my OB up to you. He's super nice, agreeable even when he doesn't agree with me, and a great surgeon too. He last did my 5th c-section. He of course asked all the questions about future birth control and gave all the warnings as he should, but once he'd said his bit, he didn't pressure me into anything. When all was said and done, his last comment to me before leaving the operating room was something like, "I stitched you up extra well in case you need to use this again."  Oh, and yes I had Medicaid and never heard the phrase "because you have Medicaid..." from him.