Very supportive hospital vba2c-too good to be true?

[Cian'sMama]

Hi Mamas,

I am having a vba2c in October and have been speaking with hospitals and midwives. So far I had no midwives willing to attend me after contacting several in my area. We ended up speaking with the head of obstetrics at the major hospital in our area. She was incredibly supportive. She gave us the latest research and statistics and told us there is no reason why we should not have a TOL and that she believed we would have a successful vbac. I will have continual wireless monitoring if I labor there, but will have free movement and access to birthing ball and tub. My two previous pregnancies went to 41 w 10 days and 42w. When we discussed this she said they would recommend induction after 41 weeks. I was shocked and said I thought that induction made vbac much riskier. She explained that they only do it after 41 weeks and that of course this is only a suggestion. She emphatically explained that this is MY birth and all choices are up to my husband and I. She said we will not be pressured and assured us that no one there would be surprised to see a woman laboring after 2 previous cesareans. All of this left my husband and I a bit dumbfounded. We were expecting the exact opposite of what occurred.

I do not want to be negative or cynical but I want to be realistic and prepared. With my second child we were very naive about the support we would get with a hospital vbac; fromt the minute I showed up in labor I was treated like I was as fragile as glass. I was put into bed, monitored and had people hovering over me inducing fear into every minute of my labor. We were treated like we were doing something very dangerous and wrong. It was awful and eventually we succumbed to another cesarean. Looking back I realize that the decision was made out of completely unfounded fear. It was "what if.." and "nothing has gone wrong, yet. Lets get her out before something happens."

So, Is it possible that we will experience this kind of support at a major hospital? Does anyone have any experience like this? Should we be skeptical? Any insight is appreciated!

[MyFillingQuiver]

Not too good to be true...rare, but not too good to be true.

I had a great VBA2C last June at a smaller, but completely equipped/modern hospital.

The rooms are small, they have "family maternity care", meaning they love family members/support to be present. They do not have tubs because of space issues...they have 18 rooms. They do have ALL private rooms and bathrooms, which is HUGE for me..to me, birth/recovery is a very private and intimate time that should NEVER have to be shared with strangers!

They provide wireless fetal monitoring so that mama's can walk as much as they like, squat, do their birth ball, etc., if their Dr wants some monitoring at that time. You labor, deliver and recover all in the same room. The 24 hr room service for food had excellent quality and healthful choices.

Most importantly, it was me, my OB, my husband and 1 nurse in the room for delivery...no one else. No one took my baby out of the room EVER. Everything was done in the room. They weren't too overbearing with our no-vax choices.

Anyway, it was a great experience. Many ladies from the local ICAN group discuss having their babies there, while squatting, being on all fours, etc. The OB practice I went to is located within the hospital, and they have 24 hr anesthesia coverage for emergencies. They have 2 OB's who are the "Only game around" in having VBAC via hospital/OB.

This time around I'm planning a homebirth, but it was a REALLY hard decision since I loved the hospital birth! I'm thankful I didn't choose a homebirth because my last hospital experience was "so bad".

Best wishes to you!

[CherryBomb]

I had a great hospital vba2c with a wonderful OB and great nurses.

[kltroy]

One of our local teaching hospitals is the same way - very VBAC supportive, and happy to attend VBA2Cs. They're all very reasonable and evidence-based, which I appreciate. I had a really nice VBAC there 22 months ago.

[babycatcher12]

Where do you live? This sounds fantastic! Not too good to be true, but certainly rare. I would love to get a hold of their Policies and procedures (I'm a L&D nurse) and bring them to my hospital and get their docs to talk to our docs so we could start a paradigm shift!

[claddaghmom]

I think it's definitely possible. But what sticks out at me is the induction issue. I find it contradictory that she would talk about research, rates and support for a vba2c, but then say they routinely induce after 41 weeks.

[3tammuz]

I agree - definitely possible to have a supportive team at a hospital VBAC. I had that with my first VBAC and I am hoping to have that again now with my second. I think talking to people/hospital/staff ahead of time is great. GOOD LUCK.

[Cian'sMama]

Thank you all for your replies. Again, I am surprised! I have become skeptical of the mainstream birthing community and expected to hear replies saying that I should be very wary of such a supportive hospital. I am happy to see that vbac's are getting more support. The hospital I am referring to is Dartmouth-Hitchcock Medical Center in Lebanon, NH. I told the OB that we have been told many times that our best option was home birth and she said that this is the fault of hospitals for not being more supportive of the womans' preferred birthing choice.

About the induction, the OB said that of the very few vbamc they have attended, the rates of success go down significantly after 41 weeks. When I asked about the dangers of induction, she said they are significant and women need to decide what they are comfortable with. I will ask if they have had a ruptured uterus with induction drugs. I would never choose induction. It just appears to be too dangerous.

Thanks again for the insight.

[Mom2M]

I had a great one too! Wireless monitoring and free movement, went to 42 weeks!

[MNHall]

I've had two friends that have chosen induction with a VBAC....for them they did weigh pros and cons and in both of their situations they did use it as a last resort....it was a very very very slow amount of pit (which I believe if induction is used, pit is the better of the choices, instead of progestiglans (???)...I'm not good with this type stuff). Anyway, for my friend with the successful induction, she was very well dilated and effaced, but no action and a small dose of pit got her started and they turned it off.

My old OB also told me that if I went into labor on my own, but let's say stalled around 6cm, that we could entertain the idea of pit...since I went into labor on my own. So, I've heard a lot of different things.

Anyway, we have main 3 hospitals around town that do deliveries, 2 would totally take a VBAC the other does take VBAC, but in the past they've been a lot more c/s friendly, but, they are really making strides to turn their additude around....and actually, that's where I had MY VBAC. In the case of this last hospital I mention though, they do allow VBACs, so really it comes down to the doctor delivering. The hospital's policies are fine...but if you have a doctor that is very VBAC friendly, it makes for a great delivery!

So, in your shoes, who would be delivering you...I'd want to talk to them and ask them questions about THEIR stats....like how many VBACs have they done? Their c/s rate. How many successful vs not successful VBACS. How many inductions? How many VBAC inductions. That kind of thing!

[tangledblue]

I've heard very good things about Dartmouth-Hitchcock from a friend of mine who gave birth there (not a c-sec or VBAC).

[thorn]

Originally Posted by kltroy

One of our local teaching hospitals is the same way - very VBAC supportive, and happy to attend VBA2Cs.

we have a similar hospital here

[schreiberwriter]

I would want to know that an OB with a similar attitude was on duty when I was in labor. As we know, doctors are people and have varying experience and comfort with medical situations like VBAC.

I was induced as a VBAC and it went well. The stat is 1% chance of rupture with VBAC, right? I think it goes up to 3 or 5% (can't remember). I figured that was better than 100% chance. That induction was a ton different and better than my first induction, which led to a c-section.

Of course, it's better to avoid induction.

Looking back at my two births, I wish I had hired a doula. I think doula support would have made a difference in both of my labors.

If you want to read my birth story, PM me and I'll send you the link to my blog.

[BarnMomma]

One red flag- with continuous monitoring you will not be able to use the tub. It seems a lot of hospitals put those tubs and showers in the room purely for show. Once you're strapped up with a monitor- you can't get wet! Just something to think about.

I would also do everything you can to avoid an induction. Look into Evening Primrose oilm homeopathy, acupuncture, etc.

[wills_mom]

Originally Posted by BarnMomma

One red flag- with continuous monitoring you will not be able to use the tub. It seems a lot of hospitals put those tubs and showers in the room purely for show. Once you're strapped up with a monitor- you can't get wet! Just something to think about.

I would also do everything you can to avoid an induction. Look into Evening Primrose oilm homeopathy, acupuncture, etc.

Some hospitals have wireless telemetry monitors that are waterproof and you can go in the bath with them. I wish all hospitals had the wireless telemetry. I know our hospital has a few sets, and they offer them to the moms doing natural childbirth first. Only one room has a bath though so you have to hope for an off night at the Maternity ward, lol.

To the OP: My OB and hospital has been very supportive regarding my VBA2C. She has, however, made it pretty clear that she would not allow an induction with pitocin. I agree with her though, more because I had pitocin with my first son (after already being at 10cm) and it was hell.

[kltroy]

I grew up in Hanover and my mom used to practice as a CNM at Dartmouth Hitchcock. It's a very good birth climate in general, with a large portion of the births being attended by midwives, so it doesn't surprise me that they're pretty evidence-based.

You'll find lots of info about the pros and cons of continuous monitoring; there are some legit medical reasons to do it with a VBAC (it is the earliest indicator of UR) and while it can be an annoyance, I didn't personally think it was that big a deal. You can have a telemetered unit if there's one availabe (and then you can get in the tub) or you can sit on a birth ball next to the bed. That's what I did for my VBAC and it was FINE. Anyway, ask lots of questions, and even if it comes down to 41 weeks and they would often induce, that doesn't mean YOU need to be induced. That's a discussion you should have with the OB as you get closer to your EDD. There will be risks and benefits to both waiting and inducing, and you may opt for repeated membrane sweeps after 38 weeks to hedge your bets. Anyway, lots of options, and I'm personally a big fan of this hospital in general.

[MommyDOK]

Originally Posted by Cian'sMama

. I will ask if they have had a ruptured uterus with induction drugs.

I would encourage you to do research rather than look at anecdotal experience. As you know, UR is a completely rare event. No ob has enough experience w/ UR to really have an opinion on them. It's like Ina May who won't take vbac w/ single layer bc she had a bad outcome w/ one. IT is devestating to see a ur, I"m sure, but I would hate to see a whole policy based on one experience. Macones did a study that showed vbac rates went DOWN w/ induction. So that is something to look into as well. IIRC, any mom has an 80% chance of vbac, goes down to 70% w/ augementation and 60% w/ induction.

I know it is reassuring to know they might not have had a bad outcome w/ their inductions (even w/ induction the rate isn't 10% or anything like that), but it is always good to look at literature. I know Mark Landon did two studies on vba2c.


Vbamc can happen very well at a hospital. We've had them locally. Keep us posted!