Hospital Policy to Induce

[KempsMama]

I had my appt. today and confirmed that it's hospital policy to induce all VBACs. I'm devasted. I have no other options at this point, this is the only hospital within an hour of us that will even entertain the idea of a VBAC, and homebirth is out of the question for several reasons.

I don't know what to do. Part of me wants to just sign up for the repeat cection, because I feel with an induction I am doomed to fail. (DS1 was a cection after induction for "size" and 12 hours of labor with no progress. I was far less informed then and had a poor support system. I feel like my mistakes two years ago are going to haunt me the rest of my child bearing life, and I feel so depressed and sad all over again.)

I know the best thing is to do the best I can within the bounds of their policies, fighting what I can (like constant fetal monitoring so I can move around). But I'm at a loss as to what else I can do to increase my 50% chance of a successful vaginal birth. I plan on starting RRL tea soon. Should I entertain natural methods of induction the days before my hospital induction? Should I ask for a certain method?

I guess I'm looking for a shoulder to cry on, and some advice on how to make the best of this.

[HappyMommy2]

You can fight the policy. Just because it is "policy" doesn't make it right for you. You and DH just keep saying No.

It is hard to fight in labor though. That is why I ended up with an HBAC.

[philomom]

Can you just not show up to the scheduled induction? Or would your doctor drop you?

[_ktg_]

Ok so I'm confused ...

you had an appointment with your doctor/HCP and they said its the hospital's policy to induce VBACs? Or did you have an appointment/tour of the hospital? Did they describe the induction which would be used as pit is a contender in uping the % risk of UR.

This feels & smells fishy to me, as the doctor would have to set up the order for an induction to get admitted to the L&D unit and 2nd just because its a policy does not mean you have to consent to the procedure.

ETA: If the doctor drops you, they must refer you (especially if you are 34+ weeks) to another care even if that's just the hospital ER - you still have the right to go to the hospital when you are in labor. Personally at this point - I'd take that vs. what I would have to be dealing with an induction (with pit)

[KempsMama]

I'm not 100% sure he would drop me, but it seems likely, and all the research I've done indicates he is the best choice for VBAC at this hospital, so I don't really want to risk it. I am going to push for not being induced until 40+, instead of the usual 38/39 weeks. That will be a big enough fight, as my first was 9 lbs, and this little guy is growing at an even faster rate by all indications. I'm not going to allow an u/s to estimate size, because I trust my body not to grow a baby I can't birth, and I have a feeling I could be "risked" out of a VBAC entirely if a u/s estimated another "big" baby.

DH doesn't really understand my devastation. And my Step Dad (a surgeon) and Mother are angry at me for wanting to attempt a VBAC. So my support system really isn't that great. I can't afford a doula, and none of my IRL friends share my views on birth.

If only I'd known then what I know now, I wouldn't be in this spot. How do you deal with the regrets of getting cut in the first place, and the feeling that you have let all your future children down by failing the first???

[seashells]

I would honestly not patronize a hospital that has a policy to induce VBACs. Induction is contraindicated. To do something medically contraindicated... well, I just don't know what to say. Practicing evidence-based medicine clearly isn't their protocol.

I completely understand not everyone can do this but I would seriously plan an out-of-state birth if I needed to. But, yes, I know easier said than done. Do you have family or friends living in an area with more birth-friendly options?

ETA: Sorry I was posting when you were posting, so didn't see your latest post. I'll leave it up rather than deleting it, though.

[KempsMama]

Originally Posted by _ktg_

Ok so I'm confused ...

you had an appointment with your doctor/HCP and they said its the hospital's policy to induce VBACs? Or did you have an appointment/tour of the hospital? Did they describe the induction which would be used as pit is a contender in uping the % risk of UR.

This feels & smells fishy to me, as the doctor would have to set up the order for an induction to get admitted to the L&D unit and 2nd just because its a policy does not mean you have to consent to the procedure.

ETA: If the doctor drops you, they must refer you (especially if you are 34+ weeks) to another care even if that's just the hospital ER - you still have the right to go to the hospital when you are in labor. Personally at this point - I'd take that vs. what I would have to be dealing with an induction (with pit)

This was more of a casual convo with the OB education nurse, but this is the third time I've been told that this is hospital policy. I'm aware of the increased risk with pit, and she made it sound like once my body takes over the stop the pit. The reason for induction is so they can have the surgical team on standby-typical over-reaction to the ACOG recommendations regarding VBACs, from what I've read.

Where I live people just do what the doc says, no questions asked. They go to the ER for every single ailment or injury. They take antibiotics for colds. It's sickening. I've been lectured so many times by friends and family for this choice, as they are all convince both me and baby will die.

[_ktg_]

Originally Posted by KempsMama

I'm not 100% sure he would drop me, but it seems likely, and all the research I've done indicates he is the best choice for VBAC at this hospital, so I don't really want to risk it. I am going to push for not being induced until 40+, instead of the usual 38/39 weeks. That will be a big enough fight, as my first was 9 lbs, and this little guy is growing at an even faster rate by all indications. I'm not going to allow an u/s to estimate size, because I trust my body not to grow a baby I can't birth, and I have a feeling I could be "risked" out of a VBAC entirely if a u/s estimated another "big" baby.

DH doesn't really understand my devastation. And my Step Dad (a surgeon) and Mother are angry at me for wanting to attempt a VBAC. So my support system really isn't that great. I can't afford a doula, and none of my IRL friends share my views on birth.

If only I'd known then what I know now, I wouldn't be in this spot. How do you deal with the regrets of getting cut in the first place, and the feeling that you have let all your future children down by failing the first???

Heathyr - s you have not failed any of your children! We've all been there and done it. For me - it was twice! It sounds like you are starting to put together a plan of what you will allow in your healthcare and not. I agree with declining the U/S at 39 weeks - many folks don't hold stock in them.

Just saw your response - and ok more s and more planning for you!! If its induction you must have - then foley baby, foley! NO PIT! Do you have a copy of ACOG's standards? I don't think anywhere they suggest to induce labor via PIT for a VBAC to ensure a surgical team is available- that's just crazy medicine??!@!#@

Time to fight and draw your lines - you can do this!!!! Remember every procedure has options - make your doctors tell you what your options are, the risks of each option and how urgently you need to act on it.

[Llyra]

This is so confusing to me, because when I was trying for my VBAC (which I didn't wind up having, but for good, solid reasons that I'm at peace with), the one thing I heard from absolutely everybody-- my midwives, the OBs, the hospital, etc.-- was that they absolutely would NOT induce a VBAC. If induction became necessary, they would do the c-section, because they considered induction contraindicated in the case of a VBAC.

[zapzipzee]

Prayer. Lots and lots of prayer. God will keep you and your baby safe, and you will have the birth he designed for you to have.

That said, you are the one forking over the big bucks (or have already in insurance premiums), and it is your body and your child. Unless you are incoherent and incapable of making informed decisions, they cannot FORCE you to do anything. You are the boss. It sounds like you have informed yourself and already made your decisions. Stick to them. They cant go get you out of your house, haul you against your will to the hospital and pump drugs into your body. If it sounds like your doctor is going to drop you if you dont show up for your induction, I would just call ahead and say you have a family matter to deal with and will have to reschedule... You'd still be telling the truth...the family matter is that you're NOT going for an induction. Sounds like a pretty serious family matter to me. Good Luck. I'll keep you in my prayers.

[MNHall]

Wow girl, that's NUTS. That a hospital would routinely induce a VBAC? WHAT??? I'm sure you are just as shocked as me, but what are they thinking?? I know, I don't need to tell you or any others on this board...but that's just nuts!

At this point, I'd have some conversations with your OB. It sounds as though your OB is VBAC friendly, and you said your best choice. So, if that's the case, it sounds like/or hopefully is the case, that this OB has a success rate with VBACs. So, i'd talk about your concerns, what S/HE routinely does..as far as foley, pit, and so on. And talk about how long you would be "allowed" to wait for the induction.

If the OB says 39 weeks, negotiate for 40 (that's what I did with my last OB for my scheduled c/s on the books, just in case...she said 40 weeks, I said 42, we negotiated to 41)....when 40 weeks comes up, call in sick and say you don't feel comfortable having a baby today because of this "cold" you're having and give yourself a few more days.

At this point, I think the big conversation about what will happen should occur with your OB...the one that will be making the "final" decision....as in the final decision before YOUR decision that is. But, I feel like hospital policy only occurs once your in the door. OB policy is more of what will get you in the door. So, if your OB will allow you to 40/41 weeks, then the hospital won't have anything to do with it until you get there!

On a side note, have you found any support groups in your area, what about visiting the tribal pages here? To try to find some local support, some people that are more like minded....because I know when going for my first VBAC, positive and encouraging people surrounding me was a big deal. As for doula...are there any around that work with people who cannot afford a doula?

Wishing you the best and I pray that this VBAC doctor proves himself to really be the best!

[luchadora13]

Originally Posted by KempsMama

DH doesn't really understand my devastation. And my Step Dad (a surgeon) and Mother are angry at me for wanting to attempt a VBAC. So my support system really isn't that great. I can't afford a doula, and none of my IRL friends share my views on birth.

If only I'd known then what I know now, I wouldn't be in this spot. How do you deal with the regrets of getting cut in the first place, and the feeling that you have let all your future children down by failing the first???

I also have a DH who doesn't understand why I want a VBAC so very much. My DH and family believe that my 1st c/s was necessary because my baby was simply too big! Almost everyone around me says I should simply do what the doctor tells me to do. There is not a doula who serves my area. If it weren't for these forums, I would be a mess!

So I am just sending you lots of {{{hugs}}} and prayers. I also am still dealing with the regrets of what lead to my first c/s. It's hard. But, sweet mama, just know that you did not fail your first child! It is the doctors and hospitals that have failed all of us!

[valkyrja]

i'm confused. the hospital policy where i am is NOT to induce VBAC (!)
i left my OB b/c he insisted on a repeat section if I don't go into labor before 39 weeks (how crazy not to let you go full term, when it's very common to go 40-42 weeks, also, they may be a few days or even a week off in estimating the due date). i'm now with a team of OBs that are VBAC friendly, my due date was May 1st but at my appointment this week, after seeing in u/s that there is plenty of amniotic fluid and the baby is doing great, they agreed with me to "change" the due date and add a week because their policy is to not let you go longer than 41 weeks...but because they gave me an extra week, they're agreeing to giving me 42 weeks to labor naturally. in worst case, ie. if i don't go into labor on my own, i've been discussing with them to induce with a slow pit drip, they're reluctant to try any type of induction, but i think i can get them to do this with me (hopefully don't have to do that)...from what i read, i think you should demand them to be very conservative about inducing VBAC. i really don't believe in inducing before your due date...doesn't make sense...with my first born, my water broke at 37 weeks and being strep B positive they wanted me in the hospital, where they were trying to soften my cervix with cervidil - that didn't work. my body just wasn't ready to labor. it was a disaster. i'm optimistic now that i'm reaching 40 weeks that this time my body is ready for labor because baby and I have had longer time and I'm just starting to efface (50% this week). my thoughts and prayers are with you and i wish you a wonderful, healing VBAC

[KempsMama]

Thank you all for the support. I was a mess about this a few hours ago, and am calmer now, silly pregnancy hormones. DH dragged me and DS1 out for a couple hours of fishing, and I had a wonderful time playing with my son, put things into perspective for me.

I know the induction is backwards. From what I gather, this hospital believes it can only support a VBACing mother if the entire surgical team is in the building the entire time the mother is in labor, therefore they induce to manage staffing. Totally backwards, and risky and so on. I am going to put together some research and write a letter to the hospital in an attempt to get them to look at the policy, but beyond that I do feel the best option for me and my family is to try and work with the hospital and this OB. I have several friends who have used him for multiple births, none of which were cut, despite all the common reasons to cut. He genuinely seems to do everything possible to avoid surgery.

My plan right now is to
A)Write a letter to the hospital. Who knows if this will have any result, but at least I can say I tried.
B) Do everything I can to prep myself for the best labor possible, including RRL and the like.
C) Delay induction as long as possible, without putting my relationship with my OB at risk, as I really do feel he is my best chance at getting the birth I want.
D) Research herbal induction methods, with the intention of using them under favorable circumstances to induce labor at home, and labor at home, as long as possible prior to a hospital induction. For example, if I can get my OB to agree to induce at 41 weeks, schedule induction for Wednesday, start natural induction methods at home on Sunday evening, in an effort to avoid a pit induced birth.
E)Develop a very detailed birth plan that includes the possibility of a repeat cection, and go over every detail with DH until I'm confident he will help me fight for what we want.
F) Continue to look for an additional birth supporter, through my church and other resources.

Thoughts?

[elisheva]

Will your OB attend your birth himself if you randomly go into labor or do you just get whoever is on call?

If I were in your situation as your described it, I'd let them schedule the induction as late as possible and then find a reason to not show up. I wouldn't show up for the rescheduled induction, either. When I went into labor, I'd wait as long as I could to go to the hospital and, ideally, show up pushing. For my last HBAC I actually toyed with the idea of writing "NO" on my hand so I could flash it to anyone I needed to as I get to a point where I'm fairly non-verbal near the end of labor.

IMNSHO, inducing a VBAC is ridiculous, dangerous, and unsupported by any evidence PLUS they are opening themselves to major lawsuits should things go awry.

[KempsMama]

Originally Posted by elisheva

Will your OB attend your birth himself if you randomly go into labor or do you just get whoever is on call?

If I go into the hospital during his office hours, he will stay with me through delivery. If I go in on a weekend when he's not on call, I could end up with another OB.

[MyFillingQuiver]

I understand many of your sentiments Heathyr! I really do... it's additionally difficult when you don't have "real" understanding of your emotions from your spouse (and in their defense a lot of times they just "can't" get how important it is) and close family.

I was induced with my VBA2C for our last baby. My OB explained this to me as being a real possibility if I went to 41 + weeks. Being that the other OB's that practice at that hospital agreed to stay with me during my L&D if he were absent, even though they didn't fully support the notion of a VBA2C, I was really in a pickle. I didn't feel terrible about the induction, as I also had 2 vaginal births prior to the sections under my belt...so I see how that differs from what you are facing!

He just broke my water, and I used wireless telemetry to be monitored. I was a good candidate for AROM (whatever that is, LOL!) since I was slightly dilated, effacing and baby was WAY low. While I would have really preferred NO interference, it worked out well to get the result I wanted.

That's why the homebirth this time. Anyway, I get feeling "why do I even bother and lets just do the section", because that's EXACTLY what I did with my unecessary repeat section for our 4th child...totally just up against hospital policy, so I just scheduled it..what a mistake.

You are NOT a failure no MATTER WHAT HAPPENS. You are dealing with a system that is nearly impossible to deal with. You could potentially try to naturally induce, or miss your induction date, or succumb to the induction to play by their rules, but I implore you to NOT schedule the section, as you still have GREAT chances of success at your vbac..something you won't have with a scheduled repeat section.

I'm here for you...you know that. I'll pray about it, too. Please PM or email me anytime. I understand some of your emotions and struggles.

[kltroy]

I understand the "logic" of their induction policy... except for the fact that it's not logical. Say they induce you at 7 AM so they can have the surgical team around. What happens if the induction is slow and you haven't given birth by 5:00 and the team has been sitting around for 10 hours?

Anyway, I think writing a letter and having a real logic-based conversation with your OB is reasonable. Some points that I would bring up or ask about include:
- will this OB actuallY BE THERE for the labor/birth?
- what is the time "limit" for an induction and what methods do they use?
- if you go into labor would it not be reasonable to simply CALL THEM when you're in early labor so that everyone has time to get to the hospital to be "in house" by the time you get there?
- what if you go into labor at a "convenient" time? Say you naturally go into labor at 7 AM but things progress slowly and you're not ready to have the baby until 3:00 AM the next day (this happened to me with my VBAC) - what do they do in that situation with their surgical team??

I think a conversation like this - not confrontational, but genuinely having your OB explain the logic behind the policy - would help you BOTH gain a better understanding of where you are each coming from - and may faciliate you meeting in the middle somewhere.

[AustinMom]

First off, I want to validate how sad, ridiculous, outrageous, painful, exhausting it is for us VBAC moms to just get a better, safer birth for us and our babies! I feel ya. I am HBACing, and that's because of policies like this. We are going to have a Doula also. You mentioned that HBAC is out of the question, I understand that, and I feel even if it wasn't, it's your personal choice, but as far as a Doula, goes, NO WOMAN SHOULD LABOR WITHOUT ONE, especially in a hospital setting. Doulas are cheap if you can find one that is starting out, or just call around, tell them your sit, and maybe one will volunteer for you. It's worth the call, because you NEED that support, especially with a hospital induction of any kind. I'd Doula you, but I'm in Austin . Our DONA trainer her is from the twin cities area, and she was a Doula up there forever and a day, and I'm pretty sure she set up different programs for volunteer Doulas. Check into that, call MWs and ask them if they know of any.

Also, if you feel you can't refuse an induction, there ARE safe ways to go about it. First off, don't start with 2 milUnits, start with .5MU. It's half of what the FDA recommends as a starting point. Go up gradually, like another .5 MU every 20 min. Once labor gets steady, ease off of it, so your body takes over. Do a lot of research on what the FDA recommends, what the manufacturer recommends, and what is "protocol" in the hospital. A Doula will help you with all this too.

Remember four phrases "I do not consent to that" "We need time to think about that" "what happens if we do NOTHING" "We need time to pray". This will help YOU stay in control, and gather your thoughts and emotions throughout labor and before interventions take place. Just about every intervention has time for you to "pray" however you interpret that, I'd use that time to pray and think over my options privately.

[KempsMama]

Thank you all for your support.

I'm reeling right now from the results of my glucose test...both the one hour and three hour came back outside of acceptable levels. Off to re-do my meal planning.