VBAC2C in Portland, OR

[luckyjenw]

Hello,

I'm 26 weeks pregnant with my 3rd child. My first two were c-sections with no trial of labor. The first c-section was because I had a high fever and the midwife wasn't comfortable with me or the baby going through labor "cooking," so off to surgery we went. I had my second c-section 14 months later because I was told that it was "too risky" to have a VBAC so close to my first c-section. Here I am 6 years later and I want my natural VBAC (dammit! ) My OB is willing to let me try a VBAC2C if I go into labor on my own, but she wants that to happen around 38 weeks. Yeah, right! I'm consulting with a midwife practice as well, but only 4 of the 9 midwives are on board with taking me on, and they require an OB or Peri back-up. I'm feeling :. My DH isn't comfortable using a direct entry midwife and really prefers a hospital birth.

My question is twofold: 1. Have you had a successful VBAC2C in the hospital? With midwife? With OB?

2. Anyone have experience with VBAC2C in Portland, OR. I'm looking for supportive practitioners.

Thanks so much for your help!
Jen

[courtenay_e]

jen, I'm going to move this to the Oregon tribal area, where you are likely to get more locally knowlegeable people to respond. Good luck! (and WELCOME TO MDC!!!)

[mamatolevi]

I'm not in Portland. I had a successful induced vba2c in Atlanta in 2007 with an OB who is very NB and vba#c supportive. It can be done.

Have you checked with your local ICAN chapter? What about doulas? They should know who is doing what and how folks are being treated by different facilities and providers.

I'm in Seattle and am finding the birth options on the west coast surprisingly limited for my repeat VBA2C. (somehow I expected the PNW to be a little more forward thinking when it comes to birth than GA) I'm currently with a practice whose policy is that they do not turn anyone one. however, I'm hearing so much in the birth community about how conservative they are that I don't trust that come 38w they'll find a reason to start pressuring me.

I am switching to UW. I feel like I'll have better options (MWs and OBs) at the univ hospital as they are not allowed to turn anyone away. I'm also hearing that they are very respectful of HB VBAC transfers. So far my discussions with the nurses and MWs there have been encouraging.

An acquaintance in Nashville, TN is having a similar experience with a univ hosp near her being more open minded about, or at least respectful of, her wishes to at least try to have a vba6c. She's been in correspondence with the head ob there and while he said he rec's a c/s, that there would not be eye rolling or bullying at the facility if she were to go for a TOL.

[ancoda]

I only had 1 c-section and I know that it is easier to find VBAC providers after 1 then it is to find VBAC providers after 2.
I had my 2 VBACs with Andaluz. If you haven't yet you can check them out here. I really liked them.

I have also heard lots of positive things about ALMA midwifery

I actually have not heard all that positive things about most of the hospital midwives around here. So hopefully someone else can come on here and tell you about them.

[luckyjenw]

Here's what I've found so far in my VBAC2c adventure...my OB (the one who did the 2nd c-s) at Kaiser Perm. is supportive of my attempting a VBAC2c but basically said, "Sure! If you go into labor at 38 weeks and you're dilating on your own, etc. I'd be happy to let you have a trial of labor." The midwife I met with at OHSU was initially very encouraging but called me a week after our appointment to let me know that 50% of the midwife practice was on board but the other half was not comfortable supporting me. Therefore they'd need to get a peri. and a staff OB on board as well. I'm waiting to hear back...

I've got a call into an independent midwife practice (A Gental Beginning--in N. PDX) to see what they have to say. I wish I was braver and could do a homebirth or birthing center, but I'm just worried about what would happen if I was one of the very, very few who ran into a serious complication.

Thanks for your input, ladies!

[luckyjenw]

p.s. I'm going to go look on ICAN for resourses. Thank you!

[UberMama]

I was told at Kaiser in Clackamas that I would be allowed to VBA2C by TWO different OB's and a variety of NP's.

Finally at around 34 weeks, I went in for another appt and another OB had no idea why anyone told me I'd be allowed to VBA2C. She said unless baby was crowning when I arrived, they'd c/s me.

Sure enough, I went into labor at 38 weeks on the dot and had a c/s that night. (I would have pushed to VBA2C but I was tied down by a surrogacy contract, so unless I wanted a potential legal battle, I had to do the c/s.. sigh..)

[Belle]

Originally Posted by luckyjenw

Here's what I've found so far in my VBAC2c adventure...my OB (the one who did the 2nd c-s) at Kaiser Perm. is supportive of my attempting a VBAC2c but basically said, "Sure! If you go into labor at 38 weeks and you're dilating on your own, etc. I'd be happy to let you have a trial of labor." The midwife I met with at OHSU was initially very encouraging but called me a week after our appointment to let me know that 50% of the midwife practice was on board but the other half was not comfortable supporting me. Therefore they'd need to get a peri. and a staff OB on board as well. I'm waiting to hear back...

I've got a call into an independent midwife practice (A Gental Beginning--in N. PDX) to see what they have to say. I wish I was braver and could do a homebirth or birthing center, but I'm just worried about what would happen if I was one of the very, very few who ran into a serious complication.

Thanks for your input, ladies!

Catherine and Nora (A Gentle Beginning) are homebirth CNMs. I wasn't aware that they still did hospital births.

I'm pretty sure that my midwives would do a VBA2C but you would need to talk to them about it. Again, they're homebirth midwives, but very experienced.

[fayebond]

I'm only on VBA1C, but the hospital midwives are not 100% behind me either.  So far I have interviewed several different OB/midwife people at four hospitals in the Portland area...

1. Providence St. V.  The doctor from Columbia Women's Clinic said I could do a trial of labor (TOL) if everything looked good but VBAC is risky and she is worried about that.  Also, not all the doctros there allow VBAC, so it would depend partly on who I got during labor.  The midwife from Women's Health Care Associates said I'm a good candidate but they could not accept me officially until a consult with an OB at 6 months.  She said it is good that I want a TOL, and I would be a good candidate for group prenatal care that they offer.  Her assistant was nice but worried that I wanted to try something so risky as a VBAC.  And when asked, the nurses on the L&D floor said I might be allowed a VBAC if my OB would okay it, they didn't know anything else.

2. Tuality.  L&D nurses said if I could find a doctor who would allow a VBAC I would be able to TOL.  They don't have midwives and laughed at the idea of a birth plan.  

3. Legacy Meridian Park.  Made an appointment, they forgot I was coming.  I only briefly checked out Legacy Emmanuel, which I've heard really good things about, but they are pretty far away from us. When I called Emmanuel's midwife group, the first thing on the phone menu options was getting ahold of an on-call midwife if you are in labor.  So that's a good sign, but I have not followed up yet.

4. OHSU.   Would accept me for a VBAC but "don't get your hopes up" until the 6 month OB appointment, when they decide if I can stay in the midwife program or must transfer to the regular OB group.  Recommended group prenatal care to me, said I am a good candidate for that.  They require a placement ultrasound at 36 weeks, and if baby is breech or big, I would need to get 2 more ultrasounds and an MRI to be cleared for TOL.  They share a total of 7 labor rooms with the regular OBs, so I would have to call in before coming to learn if I could even come in at all that day or if I would need to google the nearest other hospital.   I have now been to three appointments, and at every one I arrived ten minutes early.  At every one I got called back over 30 minutes after the appointment was supposed to start.  That's called to the room, not actually seeing the nurse, mind you.  Once, we waited an hour and a half, and finally  I had to leave for another appointment before actually seeing anyone. They said they are just really busy right now.  I expect this means alot of people were recommended to them and we're all going to end up competeing to fit in that last trimester, let alone EDD.

I did have a consult with Andaluz Birth Center.  If nothing else it was a time to feel good about my chances for VBAC and learn about community resources (their one day prenatal class is only $35, a bit hippie for my taste but good information and far cheaper than anything). I will add, in favor a birth center, there are several located less than 5 minutes from major hospitals, and you can get AN HOUR of their time free.  Last baby I didn't get to see my OB for that long, not even in total.  

I also talked to three home birth midwives, not including the two I've spoken to at birth centers.  All were quite confident about VBAC, and said they usually see the same success rate for VBAC as for regular births (meaning CS happens at about the same, 3% rate, for everyone).  About 5% of their clients, they said, transfer to a hospital.  So about half the hospital group end up needing a CS, uterine scar or lack thereof.

That's my experience so far.

[sk8boarder15]

This is a good thread thank you faye beyond for all that great info. I'm moving to Portland soon and If I get pregnant will be looking to VBAC. 

[fayebond]

sk8boarder15,  There are ALOT of options in Oregon, you get so many many choices it can be hard to narrow it down.  Note that if this is your first VBAC after ANY number of CSs, and you want to give birth ata birth center, you must have at least 1 year between the first baby's birthday and the conception of the second baby.  Otherwise they can't legally take you,  That's the main legal rule I've come across, otherwise its just different hospital policies.  And MWs can't continue your care if you are over 42 wks 6 days overdue or if you go into labor 5 weeks early.  Which even if it weren't a law that part seems just plain sensible to me, but I digress... Its a great place to give birth because the laws are very lenient about the whole birth thing, and even the hospitals vary somewhat in their birth philoophies.  

Update on Tuality: they have great CS rates, but they also get alot of patients from a local Hispanic clinic, so its less thier policies than the cultural and financial situation of a subset of thier clients. IF you exclude the hispanic population, the rates are the same as St V. (which says SO many bad things to me I won't even start.   At least St. V has the excuse that their NICU unit is considered the best on the west coast and therefore they get alot of emergency/high risk mamas).  

Update on Andaluz: they offer HBAC services, which is what I'm going with.  I was so impressed by the midwives there, their attitude and clear knowledge base was really the key factor for me. The appointments are the same except they kinda expect me to lead it, which is uncomfortably new but aslo so cool (no one ever asked how I felt about things so much before!  It should be intutive, I mean, its my pregnancy, but I'm still getting used to not being told what to do and what we will talk about each time).    And they ASK about tests instead of assuming I must have them.  I chose two midwives, who each ahve one apprentice.  At the birth, one of the midwives will be there, and both apprentices (also, love that I will have actually MET my entire birth team beforehand, equally new to me and so very comforting).   The only downside is that, unlike an unlicensed midwife (which is also legal here!) , they would ahve to transfer my care at 42 weeks 6 days.   I was early last time and don't feel like that's a likely scenario for me to worry about, but I did find one of the ULMWs to call if that happens and I want a second opinion (after seeing an OB at St V who I found to be very VBAC friendly, of course.  :) Yes, I am a bit over planning).

[*Christa*]

ICAN of Portland Chapter Leader here, feel free to message me or contact me at [e-mail] about VBAC or VBAMC info.

[sk8boarder15]

Fayebond, is that 1 year after you gave birth, or one year after the 1st birthday? 

At this point I'm not pregnant, but we are flip flopping on if we want to adopt or get pregnant. My son will be 2 in one month, so its been nearly 2 years since my only C-Section.