Opinions, please, Hospital's "reason" for a No-VBAC POlICY - Page 2

[BoringTales]

Originally Posted by aylaanne

get a midwife and stay home.

Worst advice ever, ever, ever.

You're going to have a hard time finding a doctor to VBAC you AND induce you with Pit. That seriously ups your risk for rupture. If you generally don't go into labor naturally you may not be a 'good' candidate for VBAC.

Also, what if there was a true, true emergency, that actually would necessitate a c-section during your labor. At what point would you consent to a life-saving operation? If you bring in some form written up by a lawyer saying you DO NOT consent and you will bring legal action, your care may be compromised in the event of a true emergency.

I'd go to Duluth. I think being farther away is worth it, in the grand scheme of things.

[wombatclay]

What state are you in? Some states track medical data by hospital (including vbac and c/s rates by hospital) so you may be in luck. A local ICAN group may have the statistics on hand, but google can usually turn them up as well.

What can be really tricky is finding out exact numbers for an individual care provider. Our local hospital tracks how many vbac mamas/how many successful vbacs/provider data but they only release the success data to the public. The attempt vs success data and the success by provider information is kept confidential.

And although it may not be something you're dealing with here, a really really good VBAC success rate for a care provider should raise flags too. Sometimes a care provider really is just that good, but other times they're risking out mamas or transfering care for mamas who no longer "qualify" for VBAC. And sometimes a really non-VBAC friendly dr happens to be the one on call when a vbac mama comes in pushing and tah-dah! They have a successful VBAC on their record. It's always worth double checking and really getting into the nitty gritty. But it sounds like you're doing that already!

Induction- yup, generally a bad idea for a VBAC mama. My vbac OBs would consider a foley cath induction if there was medical need. But they didn't consider post dates or ROM or anything like that a "medical need" on it's own. Hopefully your care provider will be as hands off! The women in my family take a bit longer to "cook" a baby... there are a few studies out there that show that women in certain populations tend to gestate longer. It may be something to look into (how long your mother/female relatives stay pregnant), you might just be a "ten month mama". Especially since your babes all seem to a pretty consistant, "normal" size for a regular term infant.

Good luck and keep asking questions!

[OceansEve]

Originally Posted by BoringTales

Worst advice ever, ever, ever.

You're going to have a hard time finding a doctor to VBAC you AND induce you with Pit. That seriously ups your risk for rupture. If you generally don't go into labor naturally you may not be a 'good' candidate for VBAC.

Also, what if there was a true, true emergency, that actually would necessitate a c-section during your labor. At what point would you consent to a life-saving operation? If you bring in some form written up by a lawyer saying you DO NOT consent and you will bring legal action, your care may be compromised in the event of a true emergency.

I'd go to Duluth. I think being farther away is worth it, in the grand scheme of things.

Welcome to MDC. You really should check out the unassisted childbirth and homebirth forums, they are very enlightening.

[alegna]

Originally Posted by BoringTales

Worst advice ever, ever, ever.

why? Stats?

-Angela

[ShwarmaQueen]

Originally Posted by BoringTales

If you generally don't go into labor naturally you may not be a 'good' candidate for VBAC.

For some reason I thought that all pregnant women eventually go into labor naturally.

[thorn]

there are docs who will induce a vbac with gentle pit if everything is favorable and there is a medical reason for it. pit doesn't increase the risk of UR as much as cervadil or cytotec. foley cath induction is another good method though.

contact your local ICAN chapter (or the closest one to you if you don't have one in your city), they will have the lowdown on docs, hospitals, and midwives in your area.

[Smalls181]

I remember recently a mama on here who was looking into a VBAC, but her providers were trying to scare her by saying that if the baby got "too big" it could put too much strain on the scar tissue, upping her chances of UR. I don't recall that claim ever being substantiated, but I could be wrong. Just something you might want to investigate and have info on before getting to that point.

[funkymamajoy]

Originally Posted by 2boys3girls

HERE'S THE REASON THE DIRECTOR OF THE OB DEPT GAVE ME YESTERDAY WHEN I SPOKE TO HER: "WE DO NOT HAVE AN ANESTHESIOLOGIST (<sp?) OR A SURG. TEAM ON STAFF 24/7, SO WE CANNOT ALLOW VBACs"......

If they have an ER, then they have an anesthesiologist and a surgical team on staff.

And, how can they address any need for an emergency c-section (prolapsed cord, etc)?

[traceface]

Originally Posted by wombatclay

My local hospital does not have 24/7 ER coverage but they bring in a complete team when a vbac mama arrives. It's expensive for them and as they've recently changed financial management teams this service may not be maintained.

Same thing in my case, the anethesiologist popped his head in after I arrived in active labor and said, I'm here waiting just in case, I'm sure you won't need me though. (this was a pretty VBAC supportive hospital in Santa Cruz, CA) Not only does he need to be there, according to their policy, he needs to be there *just* for me. The theory is, even if an anethesiologist is on site, on duty, he could be busy with an emergency appendectomy or in the middle of an epidural, right at the moment that the VBAC mama needed him. So this doc was just being paid to doze in the Dr.'s lounge and wait for me to deliver. Not very cost-efficient, true, BUT...

it has to be 10 times more cost efficient than performing 30% more c-sections than neccessary! I pointed that out in a conversation about this once, and was told that, yes, that's true, except so few women want a VBAC while many are fine with/even want a c-section. So that cost is a given, while the VBAC mamas are fewer so it's just considered an added, avoidable expense for the hospital.

I think about this a lot, just the financial side and how health care dollars are being spent on so many c-sections. This stuff does come down to money, and that's fine, it's a reality. But strangely, in this case, even among those supposedly concerned about the $$ side, no one seems to realize how much *cheaper* (and healthier) VBACs are for the vast majority of women. (and of course just avoiding unneccessary c-secs in the 1st place)

[traceface]

Originally Posted by funkymamajoy

If they have an ER, then they have an anesthesiologist and a surgical team on staff.
?

are you sure? I think it depends on the hospital.

I am pretty sure that here, the anesthesiologist can be a 10-min drive away, so if someone presents in the ER needing immediate surgery, they call him and he's there by the time they have the patient ready for surgery.

My OB even told me once, in a true obstetric emergency they can start the c-section using local anethesia/drugs w/out the anesthesiologist present! hoping of course he arrives w/in minutes to take over, at least the baby gets out fast if he is struggling badly

[OceansEve]

At our hospital the ER is in another building

[ShwarmaQueen]

Originally Posted by traceface

My OB even told me once, in a true obstetric emergency they can start the c-section using local anethesia/drugs w/out the anesthesiologist present! hoping of course he arrives w/in minutes to take over, at least the baby gets out fast if he is struggling badly

I've heard of the same thing here. A mom had a c/s without major anesthesiology to save the baby's life.

[wombatclay]

The "what about in a true emergency?" question gets asked a lot in regards to 24/7 OR access and what it boils down to is that many smaller or rural hospitals just don't have that level of coverage. In the case of a true emergency where minutes make the difference, the chance is good they will lose the baby or the mom or both. They also don't have a level III NICU (though they did qualify for level II recently) so if babe is in distress they will keep mom but transport the babe to a hospital 1+ hour away. It's just one of the trade offs you make when you live in a remote/rural area. In the case of a car crash, boating accident, or other "big" trauma the person is life flighted to a larger medical center. During off hours it may take 20-30 minutes to assemble a surgical team if life flight isn't necessary. That may take to long for a best case outcome, but that's the best they can offer.

A speaker at my ICAN group mentioned that the drs writing the ACOG guidelines are all associated with large medical centers. They write the guidelines to reflect what they expect to have available... the problem being that there is a world of difference between the resources available at a major medical center with a roster of hundreds of providers in each specialty and what is available at a smaller hospital with only a half dozen people with the necessary credentials.

[AlexisT]

Originally Posted by Turquesa

The reason that VBAC's are considered "dangerous" and ACOG wants hospitals to have the anesthesiologist on hand is because of uterine rupture. But uterine rupture is caused almost invariably by artificial induction of a VBAC labor, something that is unique to OB's and hospitals. Rather than discourage such inductions, ACOG declared "Keep it up, boys. We'll just hire more specialists to stand by."

ACOG now discourages induction of VBAC using prostaglandins--it's in the 2004 practice bulletin.

Also, rupture is not almost invariably caused by induction. It ups it by a factor of several times, but the usual figure for a non-induced, single transverse incision is a 0.5% rupture rate. (I should add that I don't think that this, in and of itself, is sufficient not to VBAC; it's merely something the woman and provider need to keep in mind.)

The additional restrictions on VBACs are an interesting application of logic. It's true that a rupture is less likely to have a catastrophic outcome if mom can be rushed into surgery. The question is whether 24/7 coverage actually ensures that this will happen. Decision-to-incision time can vary quite a bit even at hospitals with 24/7 coverage. If they have the docs in the building but they take too long to get everything set up, it's no better than having to call the OB from his house 5 minutes from the hospital.

[1littlebit]

Originally Posted by BoringTales

Worst advice ever, ever, ever.

You're going to have a hard time finding a doctor to VBAC you AND induce you with Pit. That seriously ups your risk for rupture. If you generally don't go into labor naturally you may not be a 'good' candidate for VBAC.

Also, what if there was a true, true emergency, that actually would necessitate a c-section during your labor. At what point would you consent to a life-saving operation? If you bring in some form written up by a lawyer saying you DO NOT consent and you will bring legal action, your care may be compromised in the event of a true emergency.

I'd go to Duluth. I think being farther away is worth it, in the grand scheme of things.

no the worst advice ever is the above post. first of all how many women are now or ever have been pregnant forever? seriously, i don't know of anyone who gave birth to a teenager. and going over 40 weeks doesn't mean you don't go into labor naturally... 40 wks is an average meaning some women go under some women go over. just because some doctors like to induce at 40 wks b/c they don't understand the definition of average does not mean a woman doesn't go into labor naturally. if she has never been able to go into labor before someone induced she has no reason to believe she doesn't go into labor.

secondly in a true true emergency she can transfer. she can also consent to a c section in a true emergency. if only doctors listened so well that they actually respected it when someone does not want to consent to something. good grief birth is natural the odds of needing medical intervention are slim. and uterine ruptures are more common with the use of pitocin so she may very well be better off with a midwife at home far away from intervention happy doctors and their slice and dice ways.

[3boys3girls]

OP here. You all sound so knowledgeable about this topic. I'm very happy to be reading all these responses. Just out of curiosity, are any of you OBs, MWs, or other med-PROFs? This is what I'm quickly coming to the realization of: I have had 5 very medical-ized births, though I've been very happy with ALL of them & I've been very happy with my current OB (except my first birth, but I was so young & "uneducated". God had us covered, is all I can say!) I think what I'm dealing with now is a lack of confidence in myself regarding my ability to "naturally" go into labor. I need to find that confidence! Please tell me if this is stupid and irrational..... what if I *DO* end up going into labor on my own, go to the hosp when I'm really-really progressed, and then refuse the CS.....? Me? Spontaneous labor? I guess stranger things have happened. Thoughts? I def. need to ask my doc how she'd handle that "hypothetical situation".....

[ShwarmaQueen]

Originally Posted by 2boys3girls

Please tell me if this is stupid and irrational..... what if I *DO* end up going into labor on my own, go to the hosp when I'm really-really progressed, and then refuse the CS.....? Me? Spontaneous labor? I guess stranger things have happened. Thoughts? I def. need to ask my doc how she'd handle that "hypothetical situation".....

Only irrational if you think you *won't* go into labor naturally. It might not be by 40wks or 42 wks (magical gestational ages that they are) and your doc may have issues with that. She might even act supportive now then turn at the end...just a ponder...

Oh, and I'm not a doc, a MW, or nurse...just a lay person who hopes to have a VBAC eventually.

[OceansEve]

Originally Posted by 2boys3girls

OP here. You all sound so knowledgeable about this topic. I'm very happy to be reading all these responses. Just out of curiosity, are any of you OBs, MWs, or other med-PROFs?

If that's the only people you want to hear from you will probably end up with another medicalized birth (with the exception of some MWs). But if that's what you want then thats fine. I think majority of what you will find here are people who have been through VBACs successful or not and all the information they gathered in their experiences.

And you are correct the fact that you don't think you are capable of going into labor on your own is a huge statement to the lack of faith in your body and what birth is.

[rainashine]

Originally Posted by AlexisT

Also, rupture is not almost invariably caused by induction. It ups it by a factor of several times, but the usual figure for a non-induced, single transverse incision is a 0.5% rupture rate. (I should add that I don't think that this, in and of itself, is sufficient not to VBAC; it's merely something the woman and provider need to keep in mind.)

I'm fairly certain this .5% rupture rate includes induction/augmented labors. It may exclude those induced using proglastines (sp?).

There was a small study done in the last couple years in Israel, most mothers recieving no pitocin and those that did get some it was less than 20(not sure what the normal unit is). Of the almost 900 vbacing women, there was only 1 rupture and that happened several hours after birth for a rate around .12%--much lower than the usual .5%. This is SMALL study but looks promising.

[thorn]

http://www.homebirth.org.uk/vbacinduction.htm

the studies they use in their chart were fairly large (over 2000 in 2 of the studies) and show a .45%-.7% rupture rate for spontaneous labor.