Birth Plans/switching doctors/various

[squibbylicious]

So I'm 23 weeks, I live in Canada and in my area there are only 2 midwives who take VBAC clients, one is going on vacation and the other was already booked for my EDD. So it left me with no option but OB. My OB after reviewing my surgical report is Ok with my going for VBAC. BUT at the practice she is in, I will always have an appointment with her, but they do the hospital rounds on rotation.. so odds are she WON'T be the one with me for delivery. I have no idea what any of the other doctors opinion's are on VBACs.

So... is a VBAC birth plan really any different from a regular birth plan? Is there anything in particular I should emphasize (I do want to have a natural birth)?

Should I switch doctors to guarantee I get someone I know for labor?

I am very afraid of being pressured into another section if I go overdue, especially since I think my EDD is wrong anyways (my cycles were long - 42 days, and I don't have an exact last period date - and the only calculator they have used is a second trimester ultrasound which put me at 14w5d), and maybe I should just say screw it and "hide" and go into a different hospital whenever I do go into labor? I don't know. After my terrible experience with my c-section I am so terrified of being forced down that route again.

[MNHall]

For starters I would definately address the due date thing with your provider! A 42 day cycle could very well put you a couple of weeks off! Which would really effect when you go into labor and if they'll allow you to continue on without a scheduled c/s!

As for the rest, hire a doula!!!! In the situation of getting the birth you want, having a doula next to you, to give you confidence, to remind you what you want, to help you stay strong when a doctor is suggesting you do x, y, and z. My doula told me she would not talk to the doctor in my place, but after the doctor suggested something (like lets say artificial rupture of the membrane), we'd talk about it, she'd help me decide (even though we both knew I didn't want that) and then we'd tell the doctor. Having a doula REALLY helped me stay strong in the areas where I felt the strongest.

As for the birth plan, I can't really think of anything different that you'd write about a VBAC, it's still a vaginal birth, natural is still natural....and so on. So, just write out your wishes, I think!

Do you have other options for doctors? Maybe you could look around and see if there are providers that are VBAC friendly and will be more than likely the one that would deliver you. It's certainly worth checking and not too late at all!!!

good luck!

[shenanegans]

where are you in Canada? I am in Montreal and I know was up against a very similar situation. I just hired a private homebirth midwife last month because I didn't feel comfortable giving birth in the hospital and not knowing if my Dr. would be there or not. ( I also couldn't get in the birthcenter because most of the midwives are on vacation) I think if you do stick with the hospital, a doula make a world of difference.

[squibbylicious]

It's impossible for me to get a midwife at this point. I live in Edmonton, midwives only recently began being covered by Alberta Health Care and so they are in very high demand right now. Only 2 in my area accept VBACers and have already passed by me. It's either a UBAC or a hospital.

I am looking into a doula.

I have recently decided that since my current OB delivers out of one hospital, and that I more likely will not even have her at the delivery (since all the doctors in the practice rotate on-call duty) I am going to labor at home for as long as I can stand and travel to a slightly more accomodating hospital.

[Meg08]

I'd check out the SOGC guidelines for VBAC, as well as look into individual hospital policies/preferences for what procedures they like you to follow and how sticky they are with them (if you can find that out). Specifically continuous fetal monitoring, and how they feel about epidural, IV, induction, augmentation and postdates.

http://www.sogc.org/guidelines/publi...bruary2005.pdf

You might want to find out if they have an anesthesiologist in the hospital 24/7. If they do, there should be less pressure to induce or augment.

I would definitely get that EDD addressed, and not by a second trimester ultrasound (although, if you don't know your LMP or cycle length, that could be difficult).

I'm of the opinion that if you don't go to the hospital until labour is well established, you have a better chance. [I had trouble typing that as they wheeled me into the OR fully dialated and trying not to push (DD was breech).]

Also - I would educate yourself about uterine rupture. I had some experiences in hospital with nurses blowing certain things out of proportion. If I hadn't been as well read as I was, I would have been scared to death. As it was, the panic just got ignored.

Congratulations on the pregnancy! Hope it all goes well.

ETA: Yes, you should have a birth plan.

[AustinMom]

The Due date thing is tricky, as second trimester scans can be off by weeks, ours with both our babies measured 9 days earlier than the due date of a first trimester and the DD of knowing the conception date, so I don't trust them too much. I'd tell your OB about this and get them on the same page as you. Ask them for documentation on accuracy of Due dates, how often a post date baby is really post mature (the real scare), how beneficial is induction. If you ask them, then they are more likely to believe the data they find for themselves. If they can't find any, tell them you will do some looking around with credible organizations, ACOG, SOCG, NIH, WHO, BJOG, etc, not just mommy-bloggers, they never take us as seriously

YES ON THE DOULA!!!! Any and every woman should have one especially in a hospital birth, especially in a VBAC and especially with a hospital birth VBAC.

As far as other OBs go, set up times to interview them and sit down and meet them. They should do this, it may just take you taking the initiative.

[ajmommy]

I'm with you on the midwife problem around here, there is too much demand and not enough midwives!! (I'm in Spruce Grove) Which hospital are you looking to deliver at that is more accomodating?

[shenanegans]

I am going to attend a march next week on international midwives day, it is trying to bring more attention to the problem of the huge waiting lists for the birth centers and midwives. Midwife care has been legalized in Quebec and covered by the health care for more than 10 years and it is still like this. I am from N.S. where midwives were just legalized this spring. I can't even imagine how difficult it is to get a spot there. Its a sad situation because there are so many women who would love access to a midwife for their births but it is so difficult. I had to hire a private midwife and pay for her services, which is no easy task to cough up 2000$. But I am too scared to try a vbac in the hospital.

[fireweed]

Hi! I'm in Edmonton too!
Have you checked out Dr. Marlene Lidkea? She's a GP, not an OB, and she delivers babies out of the Sturgeon in St Albert. She used to do home births, but i don't think she does any more. She is very VBAC friendly and will support a natural birth. I heard her speak last week at an ICAN event, and was very impressed.
Speaking of ICAN, you should also look into the local chapter(the Edmonton VBAC support Association). They have information sessions, and support groups i believe and also a yahoo group.

HTH. Good luck!!

[ShwarmaQueen]

Originally Posted by MNHall

For starters I would definately address the due date thing with your provider! A 42 day cycle could very well put you a couple of weeks off! Which would really effect when you go into labor and if they'll allow you to continue on without a scheduled c/s!

Totally!

I have a 42 day cycle also, and a 10-11 day LP, which means I ovulate approx 2 weeks later than the 'normal' cycle (I charted). When I went for an u/s at 20 wks DS was measuring 2-3 wks ahead of MY calculated due date, and if I didn't know better and had an OB, it would have been changed for sure. Plus, with being a VBAC, I would be forced into another unneccesarean. Consequently, I started having pre-labor contx on MY due date and had DS 3 days later.

I'd look for the most VBAC friendly doc around, ask ICAN members, etc. IF it doesn't feel right now, it will most certainly get worse the more pregnant you become. That seems to be the common thread among us VBACers!

[mandib50]

only 2 midwives in edmonton do VBAC's?! or is that just in your particular area of edmonton? there is a new midwife, she does have a restricted license but maybe she isn't booked yet. you might want to call the VBAC support group or ASAC for OB/doctor recommendations.

[jess152]

We had a VBAC-friendly MW come from Montana for a homebirth. She has gone to Fort McMurray in the past, as well as all over the rest of the province. PM me if you want more info.