Am I good candiate for VBAC?

[Thenu]

I had gestational diabetes with DS (almost 3 yr old now) starting from 3 months of pregnancy. I controlled diabetes with diet till 5 months and had to start insulin after that. My OBGYN advised me to get induced at 38 weeks as that is the norm for people with GD (according to her). Being a first time mom and not knowing my options I agreed for that and they induced me with pitocin. I was not able to tolerate the pain and asked for epidural when I was 3 -4 cm (which I regret till this minute). Within an hour DS's heartrate was dropping and Dr came and checked me - I was 10 cm dialated. I had a very quick progression - went from 3 to 10 cm within an hour.

Dr asked me to try pushing and I had no feeling at all because of the epidural I had before one hour. Then Dr said we need to do emergency c-section for fetal distress. I have a phobia for blood and knife and asked her to avoid csection as much as possible. At the moment I agreed for the Csection as baby's health came as the first priority. DS was born weighing 5 pounds and 9 ozs with cord around his neck and body. He wasnt turning pink after he came out and they had to rush him to the NICU. He was in NICU for 3 days and was given bottle over there. Then he absolutely refused to nurse with all my attempts - had so many visits from LC, tried everything I could SNS, finger feeding etc etc. Finally I started exclusively pumping for him and I could do it only for 6 months.

I had severe postpartem depression may be because of the csection I had and also I started feeling DS was rejecting me as he cried everytime I tried to nurse him. One good thing was I healed great from the c section. I was up and moving within hours of the csection , stopped pain mediacations after 10 days and recovered great with no problems.

Now I am 27 weeks pregnant - diabetes started from day one of pregnancy. Under severe diet control and managing diabetes with insulin. I am seeing the same OBGYN and she insists on 38 weeks scheduled csection this time as well. DH feels that is the safe choice for us because of the high risk pregnancy but my mind is inclined towards a VBAC. I am not sure if I should try for VBAC despite the medical conditions. I do not want to cause any risk to the baby because of my choice or to risk my life as I want to be there for my DS and the baby.

Please give me your frank opinion of what do you think I should do at this situation ? Do you think I am a right candidate for VBAC or should I bite the bullet and go for another csection ? I do not even care about my pain or recovery - all I want is to have a successful breastfeeding this time.

(ETD) My doctor gives prematured placenta and fetal mortality as a reason for csection rather than the size of the baby

update at 36 weeks ( post #18)

[tessie]

As far as I know it's usual to offer induction at 38/39 weeks for mums with GD as the risks of stillbirth increase earlier than for non GD mums. So I think your OB was probably right on that point. Unfortunately, as you discovered, early induction increases the risk of complications.

If you need to have the baby at 38/39 weeks you will need to go into labour early. And as you can't be induced (increased risk of rupture etc in vbac mums) the chances are you will end up needing a c/s. I know this isn't want you want to hear and I'm sorry. However, I do know women who have had very positive planned sections - I think the planned bit makes a huge difference to the experience. You can choose how you want things to go - for example no screen so you can see the baby being born, skin to skin contact, immediate breastfeeding etc.

[liberal_chick]

Forgive me as I am woefully uneducated on GD. If the GD is well controlled, is there any reason you couldn't just go into labor? I always thought that the main reason "they" like to deliver GD babies early is b/c they have a tendency to be on the big side, but that certainly doesn't sound like the case for your first child.

If it is an issue of stillbirth increase, how much does it increase? I know that stillbirth rates go up after the 41st week (generally), but it is from like .1 to .2 or something of that nature, which are odds I feel good with (even though the odds technically double). So if the increase is something like that, you just have to weigh if that increase is worth the risk to you. Your doc could always do BPPs every other day or so to guage fetal well being.

And now I'll wait to be educated.

[Right of Passage]

I don't know much about GD, so sorry you've had to deal with that both pregnancies! I think aside from the GD you seems like a fine canidate for a VBAC. You progressed very quickly at 38 weeks with a less than 6lb baby. You also have the "comfort" of knowing your c-section was for fetal distress and not CPD or FTP with I think feel harder to work past.

I would seriously consider talking to other providers, contacting your local ICAN, and going with your instincts.

[tessie]

Do they allow induction for vbac mums in the US? It doesn't happen in the UK. I ask because induction will probably be necessary to achieve a vaginal birth at 38/39 weeks.

Yiu might be interested in the UK's NICE guidelines for treating GD for another perspective. 'NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.'

[cairomama]

You can induce a VBAC. Balloon cathetar is one method that is safe. Some will induce with pitocin but it needs to monitored very carefully.

However, if your GD is well-controlled and baby is doing well, then why induce? I think you should find another provider who is supportive of VBAC.

Ask your local ICAN chapter or local doulas, natural childbirth educators or other VBAC moms for recommendations and get a 2nd opinion or 3rd opinion.

[kltroy]

Wow that sounds like a scary first birth! I'm so glad your baby ended up being ok. As for now, I guess I would probably take a wait and see approach. You've got GD but it's well controlled. If things still look good and your baby is estimated to be a reasonable size at 38 weeks and seems to be doing well, there's not reason to not let it cook another week. Same thing at 39 weeks - if it seems like everything is just ducky, there's no reason not to keep letting the baby cook. Obviously you're being monitored more closely b/c of your GD and possibly b/c of your history. In my mind, this should be reassuring to everyone that your baby is doing fine. If there comes a point where it is clear that your baby is better out than in, you can always schedule a c-section. And if that point never comes, shoot for a VBAC.

[AlexisT]

The problem with inducing a VBAC is that, IIRC, you need to be a little bit dilated for a Foley to work. If you're totally unready for labor, the only thing that works are prostaglandins, and that's ill-advised.

cairomama, if she's insulin dependent, she's risked out of most midwifery practices. And most OBs are going to be jumpy about a woman who's had GD so early in pregnancy and has been on insulin. This isn't a VBAC issue so much as a GD issue.

[MsBlack]

Seems to be the big thing for you is that your blood sugars have been well controlled this pregnancy; as I understand it, that is what makes the difference between high risk pregnancy and not-so-high-risk. RiskiER, perhaps, than a mama with no blood sugar issues--but not necessarily high risk. It is the uncontrollable blood sugar that pushes a woman into that category.

Have you looked into other providers? Maybe you can find one with a little less fear concerning your status, and more evidence-based habits.

Check out the International Cesarian Awareness Network

ican-online.org

From ICAN you can get the best information on vbac, and vbac-friendly providers/hospitals in your area.

[roadfamily6now]

You are received a lot of misinformation from many people and I am sorry about that.
You have needlessly been scared when instead you should have been informed!

The risks of complications from Gestational Diabetes increases when it is UNCONTROLLED! From the sound of your last pregnancy, you did a great job at controlling it and you should have been allowed to have a vaginal birth.

From the March of Dimes website:

If gestational diabetes is left untreated, the baby faces an increased risk of:

Being born too large (10 pounds or more)
Birth defects
Stillbirth
Newborn complications

I implore you to find a new care provider. One that will talk to you and answer your questions. You might be classified as "high risk" but you are not that high of a risk. You CAN have a VBAC!!

Keep your blood glucose levels under control and this will help to minimize any complications. Stay active and eat well. You know the drill.

You can have a Vaginal birth!! Please feel free to email me privately if you want to talk more about this.

[tessie]

Thinking about this, random people on the internet (definitely including me!) probably aren't the best people to offer medical advice. Seeking a second opinion would be a good idea. You might find that you are genuinely high risk but you'll be certain that the decisions you make are the right ones for the right reasons. I hope your pregnancy continues to go well and you have a good birth (whatever way) and that breastfeeding is successful.

[wbg]

I do not have any wise vbac words of wisdom, but I would recommend that you get a second and third and fourth opinion. I would see both another OB, and definitely a midwife. I would email practitioners across the country and then weigh up the information you get. I would look into a practice that has a high vbac success rate and that has experience with GD. Try posting in the finding your tribe area for healthcare provider recs. I wish you all the best for your pregnancy and birth.

[mauri456]

I think your body is absolutely capable of a VBAC. It sounds like you had an awesome first labor. (as far as dilation goes!!) But will you go into labor before 38 weeks? Possible.. but it probably not likely. That stress at the end to labor is going to be immense. If you want to VBAC you need to find a supportive provider. It also sounds like your doc was pretty jumpy to go back and do a c/s. It's hard to say w/o records, but your story makes me think that...

I'd definately get another opinion!!! It is true that a MW may risk you out due to the GD BUT maybe her back up doc is willing to work with you.

[DocsNemesis]

I just wanted to pop in and say, a folley catheter is ok even when completely closed. I was offered one at 33 weeks with my last one (I had HELLP), they do something to manually dilate it just a teensy bit and then insert the catheter. I was completely closed and thick, so I know its possible-though I was also told the chances of it going successfully with that kind of start is lower.

[Thenu]

Thank you so much for the suggestions. I have joined my local ICAN yahoo group and will try to find more about VBAC supportive providers. When I talked about VBAC to my OB/GYN in the beginning of this pregnancy she said I may be good canditate but it is against her group's policy to do a VBAC so if I am interested she can refer me to another OB who can try VBAC. At that time we decided not to take any risk as I already had gestational diabetes and had to start insulin from the begining of this pregnancy.

I have my OB visit next week , I will try to talk to her more about this and go for a second opinion with the dr she suggested earlier. I will also educate myself more about VBAC before meeting her. This forum has great info about VBAC. I am also trying to make my mind ready to face a csection as well and concentrate more on what I want this time (like trying to nurse in the recovery room itself and not letting the hospital give bottles/pacifier to the baby etc) than worrying/fearing about it.

[MsBlack]

I really think it is a good thing to prepare for all the possibilities as you described. It really seems to help allay anxieties as labor approaches, to have some idea of how you want to handle various 'what ifs'. Partly that is simply because of the having-a-plan should something come up--but I think more importantly it is an act of empowerment to make those plans in the first place....and all acts of personal power will just tend to feed your sense of personal power

[folkgirl]

I am in basically the same boat with you, although my provider is VERY pro-VBAC (he did 80 for our ICAN group last year) and that's not the issue. I went into this pregnancy believing that controlled=controlled, even if it was controlled via medication. I am on metformin and have been on insulin ~22 weeks. The issue I'm having right now is that I am learning that if you are on insulin the risk of fetal demise may be appreciably riskier, although I don't have the exact numbers yet (working on that). Something about introducing insulin changes things, even in well-controlled mothers. That is disappointing news to me but I still have a ways to go in my pregnancy and a lot of things could happen.

My first piece of advice is to run far from the doctor who doesn't do VBACs. Be thankful that she is up front with you about it; that's better than nothing.

Second--research, research, research. KMom's info on GD with insulin is excellent and is where I am getting a lot of my info. I also have an ICAN friend who is research-savvy who is helping me. I want to know where I stand on this before I make any decisions, if I get to that point. For the record my OB is actually okay with going past 40 weeks but my peri is not. I'm not going to take either one of their words as gold. That's why I am going to research and be an active participant in this decision. Also--you will find from KMom's site that most experts agree that going to 40w is okay, it's going past there that's debatable. There's no reason to induce or have a c/s at 38 weeks unless there is an indication of a problem.

Third--in case you do have to make a decision about whether or not you need to be induced, make sure you have the facts on VBAC and induction. While an induction is at the bottom of the list of things that I want to happen, there's one thing below it and that's a c-section. So yes I would rather be induced than have a repeat c-section, although please God let me be favorable for an induction if it comes to that. I am comfortable with VBAC and induction (via Foley cath + pit or something similar) and comfortable with my provider's expertise in that area.

Good luck and keep us updated on how things are going!

[Thenu]

update at 36 weeks

Thank you for all the replies and they were very helpful. Just would like to give an update as I just hit 36 weeks today. My diabetes numbers are not good and a1c test came back with 6.7 (it should be less than 6). I am on 4 insulin shots everyday and struggling hard to control my diabetes.

As of now my c-section is scheduled for Feb 5th - I would be 38 weeks 2 days that time. I talked my doctor into doing a VBAC if I go into labour on my own before 38 weeks. I also asked about inducing with foley catheter balloon method. Since I am already 2 cm dilated (in today's internal exam) my doc feels my cervix would become more favorable at 38 weeks and there is no use in using foley induction that time. She said if I am so keen on inducing before going for the c-section then she can try low pitocin induction but that will be very risky and she gave me a form explaining all the risks asociated with VBAC and asked me to sign my consent.

DH and I had a good talk about my insulin dependent GD and finally decided if I go into labour on my own before the scheduled date then we would try for a VBAC but we dont feel comfortable with pitocin induced VBAC as they have to do internal monitoring . Also my doc was telling that might have to take epidural just in case if there is a rupture and an emergency situation arises. if I dont go into labour before feb 5th then we are okay with doing the repeat c-section.

I am 2 cm dilated at 36 weeks , is there any chance of me going into labour on my own before 38 weeks ? I am taking RRL tea(3 cups a day) and planning to take 1000 mg of EPO from tomo onwards. My doula suggested me to take Arnica 30X, Cimicifuga Racemosa and caulophyllum txalictroids (Homeopathic forms of blue and black cohosh). Also suggested me to listen to hypnobabies 'come out baby' mp3. Are these homeopathic medicines safe to take ? will it help natural induction ? Is there anything else I can do bring natural labour other than the one I mentioned above + nipple stimulation, sex, walking? Would appreciate any help ...