Tips/advice on laboring at home - how long for VBAC?

[mbh]

Greetings! I'm expecting my 2nd child and really hoping for a VBAC this time (had a c-section with my 1st --- was induced at 37 wks due to high BP, and then ended up having an emergency c-section).

I have been told that I'm a good candidate for a VBAC (so far, so good) and the hospital is VBAC-friendly. However, I have also been told they'll be more likely to "go in" quickly if labor doesn't progress... and general advice has been to labor as much as possible at home.

Since I didn't get to go into labor naturally with my 1st baby, I am looking for tips on laboring at home and how to know when best to go in (aside from the obvious signals). I have often heard 4cm dilated as a good time --- but am a bit confused on how to estimate that?

Any tips/advice welcome! thanks!

[dogretro]

I had a scheduled breech c/s w/ dd, so I'm planning on doing the same thing: laboring at home. Mostly b/c I will feel more comfortable here, not just to avoid another c/s (although v v important to me). I am interested to hear what other people have to say on their experiences, too. 4cm, for me, is going to be way too early b/c that is the standard time for being admitted during birth. I have read articles in Mothering and birth stories on here where moms had much success deciding to leave during transition. Many also say it was crazy and uncomfortable. But that, thus far, is my plan.

[sparkysgirl]

you could hire a monitrice, either a mw or mw apprentice sometimes will do this. They will labor with you at home, check dialation, heart tones, blood pressure, ect. this way you know when the best time to go in is, and if by accident (or on purpose) you happen to go fast, then you have someone experienced there to catch!

another thought is to learn to check your own cervix and or learn about other signs of dialation and progress.

I would say stay at home longer than 4 cm, maybe more like 6. This way you are in a really good labor pattern and less chance that the hospital enviornment will slow your labor. Sometimes just being around strangers or a strange enviornment can effect things.

[kathan12904]

I'd stay at home much longer then 4cm. 4cm is the barest minimum of dialation that most hospitals will admit a woman who is in early labor and it means you will spend a lot of time laboring there. I'd second the advice about getting someone with the equipment and knowhow, likely a good doula can do this, to give you a better idea of how far into labor you are and/or check on the baby if you're concerned about that. The only real concern of checking on the baby during early-mid labor is to make sure the cord hasn't come out of the cervix ahead of the baby, but if your water hasn't broken or it breaks on its own without a big splash, this is not really a concern. Hire a doula, she will help you deal with these concerns and be worth every penny.

[catspage]

I waited for contractions to be 3 minutes apart and lasting a minute or more (this was around 1pm for me). I did follow this advice, but also waited until I could no longer walk or talk through the contractions (about 6pm, got to hospital about 7pm). When I got to the hospital I was only 2 cm dilated!!! I couldn't believe it because I was in so much pain. I progressed to 4 cm before the doctor got to check on me and was, therefore, admitted (9:30pm). I then stalled at 7cm for hours.

I was lucky to have wonderful nurses who believed in my VBAC because my DD wasn't born until 11am the next day. The doctor on the new shift wanted to section me right away, but the nurses talked him out of it.

Long story short, no matter what advice we give you, your body is going to progress at its own rate. You could have the baby before ever making it to the hospital, or you could have a long drawn-out labor. Having someone at your home who could check on you to see how you are progressing is good advice. Good luck!

[Right of Passage]

Stay home as long as possible! For my VBAC I went in during transition, I think hiring a doula will be your best bet at being successful. She will know when you're in transition, or if you're close so that you can get to the hospital in time.

[Bluegoat]

4cm is too early.

How far is it to your hospital? I am 5 min from mine, so I plan to go around transition, but if it were longer, I might try to time it earlier, because the car in transition stinks.

Typically, active labour has contractions 3 to 5 min apart and lasting 60 seconds, while transition has them 2-3 min apart and 60 - 90 seconds.

There are other signs too, like flushing of the face, sweating, hands shaking.

[maotmsmi]

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Edited by maotmsmi - 5/21/11 at 12:54pm

[Kwgrlup]

I hired a monitrice who acted as a MW while I was at home, and then a doula once we went to the hospital. I was only at the hospital for about 3.5 hours of my 20 hour labor. We went when I was in transition, about 6-7. When I got to the hospital I went back to a 5, but was at an 8 within 30 minutes. I would stay home for as long as you can. I also agree 4 cm is to early for a VBAC.

[pinuchkin]

I had a very managed labor with my first culminating at a C/S at less than 4cm after 12+ hrs at the hospital, so like you I had no idea of what full/active labor might be. I had a pretty good idea that I would have NO idea of anything outside myself (or inside as the case was) during labor, so we hired a doula who was in midwifery training to free my husband up from fretting so he could just be with me. It was a great decision, and a great investment. I labored near the hospital (at a hotel - great everlasting hot water), until my doula said I "sounded pushy" and I was 7+ when we got in. I actually would have felt okay staying away even a while longer, but it worked out okay in the end. However, once real/full active labor set in, I wouldn't have had any idea what stage I was in without help, and if my husband was the judge, he would have dragged me in once I started sounding like an insane cow.

[bonichka]

This is a big question for me too. I also had my C/S after being "stuck" at 7 for several hours. My midwife wants me to come in "once labor is active" or about 4 cm. I definitely felt that would be too early.

I just had another conversation with her about this yesterday. And we kind of came to -- if you're going to wait until transition, you almost may as well homebirth. Which I did consider. I love these midwives, by the way -- a different group from my first birth, found after much research.

I don't necessarily want to stay home till I'm past 7 (my doula will check me as long as no ROM), but I don't know where my head will be as I trudge through where I made it through before.

I'm doing Hypnobabies, which is definitely helping. But does anyone have any other tips on getting past the "stuck point" from a previous birth?

Bonnie

[onyxravnos]

nak but wanted to mention you can always go in, get checked and if you decide your not 'far enough along' you can always leave and come back later...

i planed a UBAC but had i intended to go to the hospital i would of wanted to go about 6pm (ds 2 born at 8:45) contractions were on top of each other (1 - 3 min apart) and i was okay in-between but only slightly able to deal with anything during.

a doula may be able to help you... 1. to generally help you labor, 2 to help you recognize when to go to the hospital, and 3 to help you once your there.

[cathicog]

Most of the time, if the mom is stuck at 7 cm, sometimes everyone needs to back off and let her sleep! There may be an emotional thing holding it up, or did anyone check to see if baby is posterior? sometimes a posterior baby just needs time to turn himself around. I hate it when women are pressured into continued performance, at a centimeter an hour(hospital standard) and sometimes a labor just doesn't work that way, for whatever reason. Staying home until just before transition sounds like a marvy idea.But with 3rd and subsequent babies, sometimes baby gets born before you can get out of the house... In that case, I would try to have someone knowledgeable nearby to keep an eye on mom and baby postpartum, and just stay home. (for my third child, that person was myself!)...

[AustinMom]

I cannot stress enough that you need to atleast have a Doula. I plan on having a HBAC because I know the hospitals here are not pro-VBAC enough for me to trust them. This is what I would do, and did.

1. Look up the hospitals statistics on how often a VBAC happens. Then look at what your caregiver's stats are. Some say they are pro-VBAC, but if they have a VBAC success rate of less than 60-70%, find a different caregiver.

2. Hire a caregiver who understands your wishes. Our midwife has a CS for her 1st because he was asynclitic (the same reason we did) and then a HBAC with her second. She will be able to really identify with what we go through.

3. Hire a Doula. We plan on hiring the Doula here who does all the ICAN group meetings locally. The other one we are going to interview teaches the Doula certifications workshops locally.

There is a lot of emotional barriers in birth, even more so in a VBAC, and you really need someone who is experienced in recognizing these barriers and helping you through them.

If you do decide to go to the hospital, it is likely that you will have a typical first time mom pushing stage (2 hrs or so), so you COULD wait till you feel an urge to push to leave. If that is too late for you, then I would wait till you KNOW you are in transition, and for this you pretty much need either a midwife assistant or montrice, or VERY experienced Doula.

Good Luck!

[pinuchkin]

Bonichka, I empathize very much. Having never made it past 4cm for my c/s, that was a huge mental sticking point for me. The one thing I did (among many) that made the biggest mental/emotional difference for me was making a set of Sculpey beads - big red O's, with little white/yellow dots around the periphery: one with 1 dot, one with 2 dots etc. etc. Those beads went with the beads I got from my best friends & treasured relatives @ my mamablessing/shower onto a necklace that I grabbed/wore in labor, and a good part of that time I was holding onto the four and moaning "OPEN". Hypnobabies does tons of visualization, and that was my primary one - slipping right past 4cm so quickly that I wouldn't even know the difference. The other thing that meant a lot to me was NOT being checked until it seemed that I really needed to be. If you're with your healthcare provider (esp. if a hospital), you're probably getting frequent checks. I figured it was better not to know, and to assume that I was doing just fine on my own schedule.

I lived 1-1/2 hrs from my midwifery office with a bad-traffic interstate, so I labored at a hotel that was only a few minutes away, and that was the best of both world in some ways.