What do they consider a trial of labor??

[its_our_family]

I was speaking with my new ob and we were talking about what would warrant a repeat c/b. She talked some about the normal stuff and nothing was really out of the ordinary.

She said that if I was in labor for 8 hours and progression had stopped they would most like "encourage" a repeat. I'm fine with that. I'm thinking that if it is going to be a labor like ds was I'll know before 8 hours. (Then I talked to the ob I don't like and she said that she would only give me an hour...bleck! I DO NOT LIKE THAT LADY!!)

Anyway, I really like the first ob and we talked more and she was talking about how the safest thing is for me to go into labor on my own and have a baby (I liked hearing that and not...a repeat is safest...which is what #2 told me ) Then she mentioned that the 3rd safest (2nd safest was a scheduled repeat) was a repeat after a trial of labor. I'm assuming that meant in case I stalled out.

My question... What is a trial of labor? Is that if I'm in early labor for 8 hours and nothing happens? Active labor? How strong do contractions have to be to be considered real labor?

I know they say if they are regular and gain intensity and duration. I hate that way of "categorizing". Why? Because I will have 5 or 6 hours of that very thing and then it just stops. So, what is that considered??

You know....I'm just ready to have this baby so its all over with!

[Lucky Charm]

You know....I'm just ready to have this baby so its all over with!

I know you are. I am sure you are so "over it".

It seems that a "trial of labor" means different things to each doctor in the practice you are with. good grief, they cant even come up with a consensus? Megan, my hope for you (after reading many of your threads about your hopes and desires for this birth) is that you labor at home for most of it and arrive at the hospital in transition. You get there, they ask your name, and you start pushing. the baby's born, all is well and you can go home as soon as you want.

I started my labor and delivery rotation last month, and i took care of a woman who had a trial of labor. It went well, she progressed and had a vaginal birth. They closely monitored her contraction intensity, making sure that not only were they strong enough to actually do something, but not so strong and close together that she was hyperstimulated. The baby did well, and so did she.

Why did you have a section with your first baby? just curious.

I'm keeping my fingers crossed for you!

Lisa

[Defenestrator]

Re: What do they consider a trial of labor??

Originally posted by its_our_family
My question... What is a trial of labor? Is that if I'm in early labor for 8 hours and nothing happens? Active labor? How strong do contractions have to be to be considered real labor?

In the best case scenario, the doctors wouldn't be watching the early labor because you would be at home. Once your contractions get close together and build in strength and intensity to the point where you feel like you are in active labor and you go to the hospital, hopefully you will have had some cervical change. If not, I would highly recommend checking yourself out again, unless the hospital is really, really far from home. Once you do get admitted to the hospital, you will be expected to make progress at a relatively steady pace, probably 1 cm every hour or two. If that process slows down, you may find that doc #2 would start pushing for a section. The important thing to keep on the tip of your tongue is "Is my baby in immediate danger?" and if the question is no, and you feel up to continuing, ask for a specific amount of time before a recheck, like, say, 2 hours. Then do your best to get up, get mobile, change position, listen to your body, etc. to see if you can move the baby down.

From the docs point of view, they want to limit the amount of time spent attempting a vbac because they don't want a super-exhausted mom who has to have a c-section anyway. There is a lot of evidence arguing against augmenting vbacs with drugs to increase the strength of contractions, so they feel like one of their favorite tools has been taken away. In their minds, if a mom's labor slows down or progression stalls during a vbac, nothing will get it started again anyway, so why keep her up 12 more hours? What they don't take into account is the fact that many labors have natural lulls as babies shift into new positions, bodies readjust, etc. and that things like changing mom's position can have a major impact on the strength of contractions and the way the baby moves down.

I have attended quite a few vbacs, but only at two separate hospitals (and a bunch of homebirths, but that is different), so my experience reflects the habits of those hospitals, but I have to say that a lack of strength of contractions in early labor is treated like no big deal and moms are often sent home to finish their early laboring, while a lack of strength later on is seen as a tired mom who just isn't going to make it. The two vbacs that I have attended which led to repeat sections had moms who were just cooking along very nicely until they got epidurals, then the contraction strength just fizzled out. In one case the mom had an intense, short labor and made it to 10cm but had no strength for pushing (and was also being rushed because of an epidural fever that was diagnosed as an infection), in the other case the mom had a very, very long labor and made it to 5cm and then got the epidural and fizzled out.

Good luck.

[Missgrl]

Unforunately, it seems like a trial of labor is just that! A group of strangers that ultimately decides your outcome.:

[its_our_family]

Thanks ladies!!!

I had the section with my first for ftp...but really it was a failed induction according to my ex-mws. Pitocin 14 hours with no progress. I was at 3cm and 90% when I got there and ti never changed. Never had an epidural so I can't balme that. it jsut didn't work. I was sensitive to the pitocin and as soon as they would shut it off my contrax would even out to the "right kind of contraction" but my ob refused to turn it off (after fighting with the nurse IN my room) He had broken my water earlier. So, I had the section because they said I was bordering on uterine rupture because of the length of my contrax...last one was 90 minutes with no real break.

Hpefully I'll jsut be home and my water will break and things will just go along liek they should so it won't be an issue! I'm trying to get my ducks in a row before the show starts!

[pamamidwife]

Megan, I know you're not totally attached to a VBAC birth, but I'm hoping that you realize that you have the right to have the birth that you want. I hear alot of self-doubt in your words lately and even some fear and concern. I am hoping that your care providers are really supportive and that you realize how powerful you are - and how safe VBAC birth is if it's not interfered with.

You are in my thoughts lately.

[pamamidwife]

Originally posted by Missgrl
Unforunately, it seems like a trial of labor is just that! A group of strangers that ultimately decides your outcome.:

This is the perfect description....sadly. :

[its_our_family]

I know i can do it... Actually my mw weren't really all that supportive. Not that they weren't supportive but they weren't real gung ho or even that positive about anything. The only person who has goten me excited about it is my doula...BUT she broke her foot and is now not inolved and now I don't have a doula. There is one ob in the practice that I know for a fact is very supportive. One that is 3/4 supportive and 1 that is not supportive that i can tell.

I know I can do this I jsut feel like I'm behind in trying to figure out what all this "stuff" they throw around really means. I have not been motivated until jsut recently about finding out what is going on.

Thanks for your support ladies!