GD & FTP, now trying for VBAC...questions & ramblings...

[ellairiesmom]

So...with DD#1, I ended up with GD, which wasn't a shocker. I have PCOS & went off my Metformin around 10 weeks. This time around, I am staying on my Metformin, my daily sugars & A1C #s are great, my weight gain is in check, OB is letting me skip the GTT & is on board with my VBAC plans.

I had to do a 38 week & 39 week U/S last time because I ended up on insulin the last month & they showed the baby being between 9 & 10lbs so the decision was made to induce at 40 weeks. Started Pit at 8am but by 4pm was still only 5cms. Couldn't take the Pit labor & got the Epi. She let me go till 10pm with no progress (still 5cms) & then suggested the Csec. At that point, I agreed. DD ended up being exactly 9 1/2 lbs & very broad shouldered/bellied (typical GD baby) so in my case, the U/S was accurate.

This time around we are doing a Bradley class. We deliver at a tiny hospital where my Mom is one of the head L&D nurses, so while we get special treatment & could probably be the only ones there when we go in, DH is still shy & I need him to be more of a strong coach this time. (not dissing him-we were both less prepared last time)

What is the difference in approach from a medical standpoint if your previous section was failure to progress vs something like breech? What about success stats? Are your chances lower if you were a FTP? Any correlations? My OB has been honest & said that she has no problem with my doing what I want but that she does start to get anxious when I get to 41 weeks because of rupture-which we have discussed & she knows I know the true low risk of it. She admits to the low risk... but says she doesn't like to play just by stats when it comes to human life...she also says she cares about me & knows my family well & isn't looking at me like a normal VBAC.

I am of course going to do everything I can to go into labor early/on time...but I am 27 weeks & starting to feel a little anxious about the "what ifs?"

I had a great birth experience last time-despite the fork in the road of a section. It wasn't as bad as I would have imagined it to be for me. But I would prefer a VBAC of course. I am in NJ so a home birth isn't an option & I love my Mom's hospital-we really have no rules or restrictions there & it is very relaxed. I have known everyone there for 15 years. From that aspect, I feel like I have the best of situations...I guess I just wonder what FTP might mean for me this time around...

Also-from what I have read, it seems like my FTP could also have been a result of the pit/epi combo?

Thx Mamas.

[mamatolevi]

I had a BS induction ("pre-preeclampsia") for my first at 40w. no GD, but he was a nice 9.5#. typical size for my family. the dr cranked the pit (I believe he deliberate set me up for a c/s by attempting to pit to distress) and broke my water at 1cm. It was a horrifying labor. I had the epidural by 3cm and when I finally was at 10cm I felt pressured to push despite having no urge to do so. I pushed for 3-4 hours. baby got to crowning and stuck for quite a while. I was labeled FTP/CPD. dr did not want to do forceps or vacume b/c he felt c/s was better. (yeah, for his wallet!) By then i was so exhausted and the epidural was clearly failing that I just said "get him out." With my water broken, I believe he just couldn't move into a better position to come out vaginally and being stuck to the bed b/c of the epidural added to the problem. (replacement epidural failed on the table)

my vba2c was induced at 41w5d. 10.5# with a 37cm head. pt was started around 9 a.m and she was pushed 5:00 p.m. in less than 20 minutes after starting pushing. I had a responsible and honest dr that time. Wish I'd had him for baby #2; I could have avoided the second cut.

When it comes to a scarred uterus, rupture can occur at any time durring the pregnancy. what week a mother is at has nothing to do with it as far I as anything I've read - though i am certainly not the research guru some folks here are. I'd ask for clarification and STUDIES from her to support her standpoint.

education is your friend here. Take a peek at the cochrane database and visit ICAN.

I'd also recommend you have a doula.

[ellairiesmom]

Thx for your response & for sharing.

Gosh, yikes! I am not concerned about my OB doing anything for her wallet or anything like that. I do recognize that in going with a member of the medical community, I am also going to deal with policies relating to protecting themselves from lawsuits though. But I am happy with her care & I think she does believe in me.

I actually know of 2 women who ruptured during labor which stinks because the %/risk is so low, yet I know 2 it happened to. Grrrrrr.

I have thought about hiring a doula but DH has been unemployed for 9 mos now & we had home improvements that had to be done for safety reasons so the Bradley class might end up being all we can afford.

I am just starting to really read here, ICAN & some other VBAC sites. It is so much information & often spread out in many directions so I am trying my best to take it all in.

Thx again.

[Buzzer Beater]

Stephanie,

I am new to this forum, but have been reading here for a long time.

It sounds to me like your ftp certainly was because of pit/epi... it happens to so many mamas. I don't know anything about GD or PCOS, or even midwives since I didn't have one. But in your post you said your OB doesn't see you as a "normal" VBAC. What does she mean by that? You're not having complications this pg, so what else would you be but a normal vbac? Not sure what that is, but, you're healthy now, and positive... right? My husband and I are also reading Bradley, as well as Marsden Walker and Jennifer Block.They have been so helpful to me to understand my c/s. You have time to stay healthy and "normal" and prepare yourself with knowledge...
Sara

[MsBlack]

Buzzer--

The way I read 'not a normal vbac patient' was about the OB feeling more attached to Steph as a person, less 'clinically objective in the usual way'. Thus, perhaps a bit more worried than usual about outcomes.

Stephanie--did I get that about right....or do you need to clarify for both of us?

Anyway--as long as your blood sugar remains normal, then you really shouldn't be asked to worry about GD's impact on your baby or your own health. The problems associated with any form of diabetes during pregnancy are about poor blood sugar control and the effects of that on moms and babies.

FTP is a BS designation in my opinion. FTBP, maybe--the med ppl's 'failure to be patient'! What occurred for you is not at all uncommon in induced women. I mean, I understand under those circumstances, why you chose induction and it was perhaps best for you and baby at the time. But I would avoid it this time for sure! Induction is not safe for vbacs, for one thing. But it so often leads to that cascade of interventions and often to csec.

This time, use your Bradley stuff and stay home as long as possible. Maybe you could find a doula in training to help you...or maybe you have a friend who might make a good helper during labor to support you and your dh both. Your ability to eat and drink freely during labor, to move and position yourself freely, are so very key to labor's efficiency (for any woman). And that will only happen at home, because once you get to the hospital you will be on the monitor, confined to a great degree.

I'm not sure why the OB is more worried about 41wks and beyond. I agree w/the pp who said you should ask for studies to back up the idea that the longer the pregnancy, the greater the risk of rupture....I have never seen this tho maybe I just never found those particular studies. I think perhaps this is more about the OB wanting to reduce her own time of worrying about you, her own need to see this pregnancy done ASAP--because you are someone she cares about! And I get that, I really do relate....but HCPs can't impose their own comfort, feelings and needs, outside of evidence based practice, on those they love or on anyone.

What I have seen is that many vbac women have a lot of prodromal, on and off labor, in the days or even weeks leading up to active labor. This, to me, is a very effective way of leading into labor slowly, to give the scar plenty of time to adjust to the pressure and (normal!) stresses of labor, to stretch and work it gradually which IMO REDUCES the chance of rupture. JUST my opinion, tho--something I've seen several times in vbacs. In any event, this can mean a 41 or 42wks birth--with a baby who is healthy with a healthy mom.

The other thing that you have to remember is that csec carries it's own risks as well. Especially repeated csecs--the risks rise with each successive surgery. Your OB understandably believes more in the apparent control she can exert by doing a RCS rather than waiting it out with you....but she really does not control events, or your health, more with csec than with normal birth. You have to weigh this into your considerations.

So--get the info, weigh the advice, and at some point just let your heart guide you. You will know what to do....but you may need to set some boundaries with those who want to inspire your fear, in order to find that knowing.

[ellairiesmom]

Thx so much for the great advice.

And MS Black hit the nail on the head with her explanation of what I meant by not being a "normal" vbac to my OB. She is very personally invested in me as a patient because she works with my Mom at the L&D of a very small, quiet, intimate, small town hospital on a daily basis. She & I have a diff kind of relationship than I have had with any other HCP & she has been very open to my research & thoughts on the GD in this pregnancy.

I don't think her 41 week "mark" is about her wanting to be done worrying about me though-I think it's just typical med community mentality. But I don't think she is coming from some horrible "Dr" place. There are some midwives I have spoken with who have agreed with much of what she has said-there is a sense of caution these days because of lawsuits-especially in states like NJ.

I have been reading so much on the forum about vbacs & induction & the jury is definitely split on it. I keep coming back to this...if we try all our natural methods of induction & by 41/42 weeks...I got nothing...would it better to try & do a low pit induction vs a rcs?

I am getting ahead of myself of course-I am only 27 weeks & I don't want to stress about the what if's for 41/42 weeks...but I am kind of a planner & like to have things laid out.

My Mom & Sis in Law will be at our birth but I have been thinking about someone else who can be less "emotional". My best friend has had 2 homebirths & would be someone I could count on. Something to think about. Our Bradley instructor is a Doula but our hospital is an hour away-was thinking about asking her about being there while we labor at home?

[DocsNemesis]

I agree, she's probably more worried about the typical *baby will die if you go past 41/42 weeks* mentality in todays medical community than about your risk of rupture. Although, she did say that yes? So yeah, I'd be asking for a study or some sort of hard evidence that risk of rupture increases after 41 weeks. I have never heard of or seen such a study, so I doubt there is one.

Anyway, if its just an excuse and she has no proof, then your only real concern with being overdue is the other typical concerns. Meconium-which isn't generally a danger and which seems to occur much more often in moms who are being induced for being overdue than being overdue itself (I've seen moms go 43 weeks+ with no meconium a LOT), the placenta getting *too old* which I find is rather BS as well. I mean, since when is 42 weeks a magic number that means the placenta is going to die and some catastrophic event will occur? (Interestingly I was a 44w 1d baby and my moms OB noticed that her placenta had started to calcify and possibly separate and told her this was probably why she finally went in labor. So apparently her OB saw the placenta as being the cause for her to finally have me and didn't see that as a bad thing-he saw it as the body doing what it should). They also like to say that baby will get too big-you only have so much room in there! Babies don't tend to get too big for their mothers. It wouldn't make much sense. My own former OB said that in 15 years of practice, he had never had a case of too big baby. Only once had he seen someone unable to birth vaginally and it was due to a misshapen pelvis (due to rickets I believe). And the only time he'd been worried was with a teensy asian woman and her rather large samoan husband. The baby was only 6 pounds full term, lol. (also, anecdotally, I was only 8lbs 10oz, my 42 week babe was only 8lbs 6oz, and my early baby was almost 9 pounds! There is actually some speculation that baby's may actually lose a little weight going overdue.)