UGH! "Must have an ultrasound"

[feminist~mama]

My midwife just called and said that the two OBs at the practice have talked and decided that I must have an ultrasound to estimate fetal weight if I want to proceed with a VBAC. I'm 40 weeks tomorrow and worried that the ultrasound will say that the babe is really large and then the OBs will withdraw support.

Ugh! I feel backed into a corner- I don't know of any studies linking fetal macrosomia with uterine rupture, so it seems like a stupid and arbitrary thing to worry about. Of course there's a risk of shoulder dystocia, but that can happen even with an average size babe. My DD was 10 81/2, but she was also 43 weeks!

It's all worse because I work with them I think. Or maybe it's better. I don't know. I think I'm just rambling because I expected that they would "offer" an ultrasound at 38 weeks or so, which my midwife did and I said "no thank you" and I thought that would be the end of it. I didn't see this coming and so I feel thrown for a loop...

[elyag]

I have no advice for you but I wanted to offer my support. I hope you get your VBAC!

[RedOakMomma]

ddcc

Best of luck. I was also at 40 weeks, with twins (so docs had an excuse to be intervention/c-section-happy), and was "asked" to have an ultrasound.

I went for it, and it seemed to help. It reassured my OB that a vaginal birth would be okay. Even then, the weight estimate on baby b was well over a pound off. Baby A was off by close to a pound...and this was with estimates done on fancy schmancy instruments by a perinatologist.

I'd go for the ultrasound. It will probably show that everything is okay (weight, fluid levels, etc.)...and after that I'd not budge on attempting your VBAC. Hopefully the OBs are just looking for reassurance, and to know you're doing okay.

[mataji4]

Don't do it! Ultrasound weight "estimating" is really inaccurate at this point. You can technically refuse anything and still show up to have your baby. They can't refuse you care, even if it feels like it.

[mwright]

Ugh! This is when they start to hound you with this "intervention" stuff. Unless you have a true medical reason to have an ultrasound, DECLINE it. My midwife has many story's of her VBAC's being much bigger than the C-section baby. A big baby is no reason to induce or c-section you. Even ACOG says that. I'm 41 weeks today, measuring at 42 and there is no worry what so ever. Follow your gut, mama. No one can force you to do anything you don't want to do. Your body, your baby, your birth!

[Carliegirl]

Wow. This is so hard. I could totally see refusing it because it gives them less ammunition to work with...on the other hand....as soon as you refuse you're the "difficult" patient who refuses what the doctors recommend. Grrr....was totally there with my first birth and it got super adversarial. On the other hand if you have an ultrasound and they say "baby is large" then they'll tell you no vbac and if you refuse to section they'll drop your care. OR else...you'll be the evil patient that they try to punish. So frustrating. I wish I had words of clarity and help, Mama. I don't know what to tell you. I'll be thinking of you as you weight the choices and try to figure out what to do.

[emnic77]

Originally Posted by Carliegirl

Wow. This is so hard. I could totally see refusing it because it gives them less ammunition to work with...on the other hand....as soon as you refuse you're the "difficult" patient who refuses what the doctors recommend. Grrr....was totally there with my first birth and it got super adversarial. On the other hand if you have an ultrasound and they say "baby is large" then they'll tell you no vbac and if you refuse to section they'll drop your care. OR else...you'll be the evil patient that they try to punish. So frustrating. I wish I had words of clarity and help, Mama. I don't know what to tell you. I'll be thinking of you as you weight the choices and try to figure out what to do.

This.
That's a tough spot, I'm sorry.

[DeChRi]

Boy that is tough. My OB fully admits that sonos at this stage are totally not accurate. We laughed at the report she got from my u/s Friday as they said she was 6lb2oz and I have big babies that always get stamped little by late sonos. She said she had just delivered an 11lb-er that was sono est of 7lb.

Not sure if it helps, but my 3 late term u/s by 3 different techs have all measured them very small.

I go to a place that is happy to drop you if should you decline stuff, so I negotiated a lot.

Wish you luck in whatever choice you make.

[khaoskat]

I am due and hoping for a VBAC as well, on Thursday.

I think the OB's are being unfriendly to you. I am not having an US, and right now, the one OB (the more unfriendly one) thinks I am going to have about a 9 lb baby vs the 7 lb one I had. I reminded him that the 7 lb baby I had was also a single umbilical artery, and that all three of my living children were born over 9 lbs (DS1 - 9 lbs 2 oz; DS2 - 10 lbs; DD2 9 lbs 3 oz). Of those, only DD2 came by c/s, and it had nothing to do with her weight, but rather with the fact that she turned transverse while attempting to push her out (had just started pushing), stuck her arm out, and then wedged her shoulder in.

I would remind the OB's that you have vaginally birthed a baby over 10 lbs with no problems. That even though the baby is estimated to be LGA, that at this point in time, those USs tend to be very off and that the US results will not dissuade you from attempting a VBAC. That you will not consent to an automatic c/s, and at this point in time in your pregnancy you know your rights and that they are required to provide services to you for the next 30 days and refer you to an OB who can meet your medical needs. Same thing if you are using a CNM. At this point in time, it is considered patient abandonment.

Basically, don't let them bully you.

Heck, right now, even with an estimate by hands/tape measure of a 9 lber, being 40 weeks Thursday...I don't even go back in for another whole week, I will be 1 day shy of 41 weeks. They didn't even considering sending me down for an NST or US or BPP or AFI in the interim.

[Starfish11]

really frustrating and difficult position to be in, mama What did you decide?

[AustinMom]

They can't drop your care. That's illegal.
http://www.ican-online.org/vbac/your...-banned-vbac-q

Yes, like everyone said, fetal size is not accurate here, and ACOG says that u/s is not accurate and should not be used to measure baby size. They also say that if macrosomia is suspected, induction and or cesarean are not viable options, and should not be done. If you want your OBs to know this, I'd ask them, "do you mind getting me some info on what ACOG says is best in these situations, and what their recommendations are?" Of course, have the info fo yourself, and then when they find out what they are doing is not recommended, they you may be better off than telling them "you're wrong". It's a way of 'tricking' them into thinking they are all knowing, but you are really just getting your way.

If you are worried about being 'punished', which is a concern I would have, I'd hire a Doula ASAP! She can help you advocate for yourself during your VBAC. You can refuse any procedure you want, including a u/s, induction, and cesarean. It's your choice.

Here are some links on that stuff
http://www.aafp.org/afp/2001/0115/p302.html
http://www.drplace.com/ACOG_Issues_G...s.16.27195.htm

This one is my favorite
http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract
Basically, with a VBAC mom, with suspected fetal macrosomia, there is no difference in a non VBAC mom. "The medical literature does not support elective cesarean section for suspected fetal macrosomia in nondiabetic women, and based on our experience, there appears to be no reason for treating previous-cesarean mothers differently."

Happy Birthing! If you want the u/s, get it. If you don't, don't get it. If you see it's pointless, don't get it. If you see it's pointless and know that certain outcomes (fetal guesstimated size) will cause your birthing team to be less than supportive, definitely don't do it. It's your choice.

[Carliegirl]

Originally Posted by AustinMom

They can't drop your care. That's illegal.
http://www.ican-online.org/vbac/your...-banned-vbac-q

Yes, like everyone said, fetal size is not accurate here, and ACOG says that u/s is not accurate and should not be used to measure baby size. They also say that if macrosomia is suspected, induction and or cesarean are not viable options, and should not be done. If you want your OBs to know this, I'd ask them, "do you mind getting me some info on what ACOG says is best in these situations, and what their recommendations are?" Of course, have the info fo yourself, and then when they find out what they are doing is not recommended, they you may be better off than telling them "you're wrong". It's a way of 'tricking' them into thinking they are all knowing, but you are really just getting your way.

If you are worried about being 'punished', which is a concern I would have, I'd hire a Doula ASAP! She can help you advocate for yourself during your VBAC. You can refuse any procedure you want, including a u/s, induction, and cesarean. It's your choice.

Here are some links on that stuff
http://www.aafp.org/afp/2001/0115/p302.html
http://www.drplace.com/ACOG_Issues_G...s.16.27195.htm

This one is my favorite
http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract
Basically, with a VBAC mom, with suspected fetal macrosomia, there is no difference in a non VBAC mom. "The medical literature does not support elective cesarean section for suspected fetal macrosomia in nondiabetic women, and based on our experience, there appears to be no reason for treating previous-cesarean mothers differently."

Happy Birthing! If you want the u/s, get it. If you don't, don't get it. If you see it's pointless, don't get it. If you see it's pointless and know that certain outcomes (fetal guesstimated size) will cause your birthing team to be less than supportive, definitely don't do it. It's your choice.

Geez! You're so informed and gutsy! I wish she could hire you for her doula! Heck, I wish I could have four years ago!

[tippy]

Originally Posted by AustinMom

They can't drop your care. That's illegal.
http://www.ican-online.org/vbac/your...-banned-vbac-q

Yes, like everyone said, fetal size is not accurate here, and ACOG says that u/s is not accurate and should not be used to measure baby size. They also say that if macrosomia is suspected, induction and or cesarean are not viable options, and should not be done. If you want your OBs to know this, I'd ask them, "do you mind getting me some info on what ACOG says is best in these situations, and what their recommendations are?" Of course, have the info fo yourself, and then when they find out what they are doing is not recommended, they you may be better off than telling them "you're wrong". It's a way of 'tricking' them into thinking they are all knowing, but you are really just getting your way.

If you are worried about being 'punished', which is a concern I would have, I'd hire a Doula ASAP! She can help you advocate for yourself during your VBAC. You can refuse any procedure you want, including a u/s, induction, and cesarean. It's your choice.

Here are some links on that stuff
http://www.aafp.org/afp/2001/0115/p302.html
http://www.drplace.com/ACOG_Issues_G...s.16.27195.htm

This one is my favorite
http://www.ncbi.nlm.nih.gov/pubmed/2...?dopt=Abstract
Basically, with a VBAC mom, with suspected fetal macrosomia, there is no difference in a non VBAC mom. "The medical literature does not support elective cesarean section for suspected fetal macrosomia in nondiabetic women, and based on our experience, there appears to be no reason for treating previous-cesarean mothers differently."

Happy Birthing! If you want the u/s, get it. If you don't, don't get it. If you see it's pointless, don't get it. If you see it's pointless and know that certain outcomes (fetal guesstimated size) will cause your birthing team to be less than supportive, definitely don't do it. It's your choice.

great advice!

[feminist~mama]

Update!

After thinking about it and talking to my partner and my doula, I decided to go ahead and have the ultrasound. They estimated fetal weight at 9 lbs, so that was great! I don't have an AFI number yet- the tech wouldn't tell me, so I'll have to wait until my midwife calls this afternoon.

Thanks so much for all the advise and commiseration ladies!

ETA: AFI was 16.8- so just perfect! Yay!