5 1/2 days left. . .

[sap2010]

I have been lurking around and am getting to the point where I need someone to talk to. . . so here goes my first post!
In 2007 I was 15 days overdue with my first child, trying for an all-natural MW clinic birth. State law where we lived required a Biophysical Profile at that point post term, so I went to the hospital and they said I had low amniotic fluid and that I was to march upstairs to be induced. Instead, I marched into the parking lot and called my MW who asked me to come her her clinic. There, a non-stress test showed no problems with baby, and I was doing fine physically (emotionally not so much by this point), so she stripped my membranes and we waited a while. I had my first few contrac's (had none before that, not even BH with this baby) and then when nothing really developed, she by law had to send me over to the hospital. They started pit about 8pm that night and I lasted all of about 8 hours with those strong pitocin contrac's and finally begged for an epidural so I could sleep. (My MW recommended it too, b/c of how tired I was.) (My, how far I had come, from a drug-free, peaceful MW birth to being in the hospital, hooked up to all kinds of things, now with pit and an epidural!) I labored with the epidural all night, and by 10am the next day I was only at 8cm and stalled. (Thank you, all you chemical and emotional stressors!). Around 11am my fever spiked quite high and my baby's heart rate went to almost 200 and stayed there, and the OB on call recommended a c/sec. I looked at my exhausted midwife, and she soberly nodded her head and said she thought it was time to "call it." So... my first child was born.
Now I am expecting my second, and have had a picture perfect pregnancy (much like my first). We have been committed to trying for a VBAC, but there are a few things about our current (different) state's law that surprised me. First of all, MW's may not deliver VBACs here. Additionally, no one is allowed to induce in any way with VBAC's b/c of the increased risk of rupture that is supposed to go along with the strong contrac's of induction. Also, my OB told me she does not want me to "go late" because of how much the womb environment degraded post term with my first baby. So. . . they have scheduled a c/sec for Aug 10 (my EDD).
I am so incredibly stressed out with the pressure of having to go into labor before Aug 10! I actually AM having lots of lovely BH contrac's (much different from my first birth experience), some of them quite strong. My husband and I are "enjoying" each other as much as possible to try to encourage things to get started. . . I'm taking 1,000 mg EPO every evening and inserting the same amount vaginally on the nights we aren't having sex. Nipple stimulation seems to do nothing for me. I am going to my chiro as much as I can afford (1-2x/week).
Any advice on what else to do? Maybe a VBAC isn't in the cards for me, but I am loathe to give up on it yet!! What about castor oil? Is it going to make the "dangerously strong" contrac's that aren't safe for a BAC? Is it going to make me so miserable that I will hate life???
I appreciate any thoughts/advice!!

[thorn]

I'm sure there is no state law against inducing a VBAC (in fact even ACOG does not say that induction is contraindicated in a vbac) and just because they scheduled a c-section for your due date does NOT mean that you have to do it. Tell them to cancel it, or just don't show up. There is no medical reason you would need to have an ERCS on your due date.

Do you have a doula? Have you contacted the Seattle ICAN chapter?

[buckeyedoc]

I have never heard of state laws regarding VBAC inductions, just quirky and non evidence-based hospital and OB policies based on their CYA liability insurers or the fact that C-sections are more convenient for them. Are you sure they are giving you the correct information? Where do you live? Do you have a local ICAN group? I am suspicious that your provider just doesn't want to bother with a TOL/VBAC. I had one of those, and they gave me a 41 week deadline or RCS, so I switched providers to one who does a gazillion VBACs and recommends them. Otherwise, my plan had been to decline the RCS at 41 weeks. After all, they would not have been able to force me into one. It would have been stressful but not the first time I went against their nonsensical advice on something.

With the newest ACOG and NIH conference guidelines about VBACs, I just don't see how your provider can justify forcing you into a 40 week deadline and not offering the option of a conservative labor induction. It doesn't go along with expert recommendations on VBAC. Why not have NSTs/BPPs after 40 weeks and see how your placenta and baby are doing? No need to induce or section if everything is great. I have gone "late" in both previous pregnancies, and my OB doesn't care until 42 weeks. If I reach 42 weeks, we may try to induce with a Foley catheter and possibly low dose pitocin. It does increase uterine rupture rate, but from about 0.5% to 1.5%, so not that dramatically when done under close monitoring. Only prostaglandin induction is really contraindicated in VBACs.

I am due on the same day as you are. I really hope you get your VBAC and not a "bait and switch" now at the end of your pregnancy. I am frustrated for you.

BTW, I have known of other moms who tried castor oil for VBACs. I don't believe it is contraindicated (anymoreso than it is in any delivery). You can also try membrane stripping, nipple stimulation, etc. However, if you are a long gestator, waiting might be the only option for a vaginal birth.

[justKate]

Your first child's birth sounds a lot like mine. There's nothing worse than hearing your midwife tell you its time.

I don't think I would be opposed to castor oil, but if that doesn't get things started, maybe you could "forget" about your scheduled section? Could you talk to your provider about a conservative induction?

Above all, try to relax and talk that baby into the world!

[sap2010]

Originally Posted by thorn

I'm sure there is no state law against inducing a VBAC (in fact even ACOG does not say that induction is contraindicated in a vbac) and just because they scheduled a c-section for your due date does NOT mean that you have to do it.

Yikes! How did I fall into the trap of being such a sheep?! I have a phone call into my OB right now and am waiting on a call back to nail down exactly what she is saying about the induction not being "allowed." THANK YOU SO MUCH for responding to my post!

I actually live in the boonies north of Seattle a good bit, but still in the states. . . am wishing so much that i'd written earlier on here. . .

[sap2010]

Originally Posted by thorn

Do you have a doula?

I looked into it, but DH doesn't understand the need (He was INCREDIBLE as a birth coach himself, in all truth!) or the expense. I think I'd like to have one, but the two I talked with weren't available and b/c of DH's resistance I gave it up about 3 months ago.

[MyFillingQuiver]

I was "induced" at 41+ weeks in WA state (Spokane) at a hospital with the only VBAC friendly practice around. The other OB's at the hospital (in case they had to care for me) were getting antsy since I was going "post date". The OB broke my water, and a few hours later I had my 3rd vaginal birth and my first VBA2C.

Best wishes!

[sap2010]

So. . . my OB's nurse told me today that it is the doc's personal policy not to induce VBACs with pit. The state regs she was talking about were no Cytotec/Cervidil with VBAC.
So, she said she still feels strongly based on my first birth's post-term difficulties that she does not want me to go late, but if I have dilated to at least 3 cm by my next appt (this Friday - in 2 days; I was 1 cm and barely beginning to efface 8 days ago but have had lots of BH since then and feel that the baby has possibly engaged; not sure b/c my first never did!) then she is willing to break my BOW and see if we can get labor going. Not sure how I feel about all this. . . it's a lot to process.

Interestingly, the OB nurse also told me, "You know, with a VBAC, the doctor basically has to be there for the whole thing." Which made me blink a few times. So does that mean she doesn't want to do it? Am I supposed to feel sorry for her because the state regs say that? She has never complained to me about this, but rather has seemed very pro-VBAC and encouraged me to do "go for it" since we would like to have several more children, if possible. Also, I am GBS+, so how can she just break my BOW and let me go home to see what happens? Something doesn't add up. I'm so nervous about how this is all going to work out.

Well, thank you all for your comments/advice!

[sap2010]

Originally Posted by MyFillingQuiver

I was "induced" at 41+ weeks in WA state (Spokane) at a hospital with the only VBAC friendly practice around. The other OB's at the hospital (in case they had to care for me) were getting antsy since I was going "post date". The OB broke my water, and a few hours later I had my 3rd vaginal birth and my first VBA2C.

Best wishes!

Congratulations!!!!!

[thorn]

Originally Posted by sap2010

So. . . my OB's nurse told me today that it is the doc's personal policy not to induce VBACs with pit. The state regs she was talking about were no Cytotec/Cervidil with VBAC.
So, she said she still feels strongly based on my first birth's post-term difficulties that she does not want me to go late, but if I have dilated to at least 3 cm by my next appt (this Friday - in 2 days; I was 1 cm and barely beginning to efface 8 days ago but have had lots of BH since then and feel that the baby has possibly engaged; not sure b/c my first never did!) then she is willing to break my BOW and see if we can get labor going. Not sure how I feel about all this. . . it's a lot to process.

yikes! so now you only have until friday and not your due date? sheesh.

You can tell them that unless non-stress tests indicate there is a problem with the baby, you don't consent to induction or cesarean. But that doesn't mean they won't "find" a reason the NST is non-reassuring.

What post-term difficulties did you have with your first? The only difficulty I saw was that you ended up with a failed induction! And there's no reason to think you will go 15 days over again (you might, but there's no reason to think you will or reason to assume that something is wrong if you don't go into labor by 40 weeks either!)

[sap2010]

Originally Posted by thorn

yikes! so now you only have until friday and not your due date? sheesh.

You can tell them that unless non-stress tests indicate there is a problem with the baby, you don't consent to induction or cesarean. But that doesn't mean they won't "find" a reason the NST is non-reassuring.

What post-term difficulties did you have with your first? The only difficulty I saw was that you ended up with a failed induction! And there's no reason to think you will go 15 days over again (you might, but there's no reason to think you will or reason to assume that something is wrong if you don't go into labor by 40 weeks either!)

Well, I don't think she will insist on breaking my water on Friday if I'm not comfortable, but it might be my only chance at laboring instead of a c/sec. . . so I'm not so disappointed. Last Tuesday (7-27) they said this baby is measuring almost 9 lbs already, so if that's accurate she is pretty big. My first was 9 lbs 1 oz.
As for difficulties with my first, the placenta was really degraded and the fluid was very low by the time he was born. He had to have lots of antibiotics because they felt the womb was infected, but couldn't pinpoint the exact bacteria. My body would not dilate past 8 cm, even though I was definitely 42+ weeks and he wasn't small.
What do you think? I am trying to remember that she has a lot more experience than I do at this and that to this point I have felt that she was very open and honest and friendly towards the VBAC. I'm trying to remember that the nurse I talked to today (who actually talked about babies she'd seen die during VBACs, etc. ) could have been projecting some of her own feelings (probably was). And I'm trying to trust my instincts, but honestly I'm so confused about what is best and I have no real certainty about what that is!

[thorn]

I have the PDF of the most recent ACOG practice bulletin on VBAC, if you PM me your email address I will send it to you. It addresses postdates and inductions

[thorn]

Originally Posted by sap2010

Last Tuesday (7-27) they said this baby is measuring almost 9 lbs already, so if that's accurate she is pretty big. My first was 9 lbs 1 oz.

First of all, it's probably NOT accurate. Second of all, 9lbs is a good sized baby, but so what? Lots of women have bigger babies than that.

He had to have lots of antibiotics because they felt the womb was infected, but couldn't pinpoint the exact bacteria.

You didn't mention, but was your water broken, and for how long? Did they think the womb was infected because of your fever? Because epidurals cause fevers, it's a well known risk of them.

My body would not dilate past 8 cm, even though I was definitely 42+ weeks and he wasn't small.

Do you know what position he was in? Was he posterior?

the nurse I talked to today (who actually talked about babies she'd seen die during VBACs, etc. ) could have been projecting some of her own feelings

Really? how many babies has she seen die during VBACs? See, this is the kind of scare tactic I hate. The odds of a baby dying during a vbac are very low. Which isn't to say it never happens, unfortunately babies die in all kinds of births, but if she has seen multiple babies die in vbac attempts I'd want to know what they were doing wrong! The NIH consensus on vbac earlier this year that reviewed tons of studies said that the risk of uterine rupture after one c/s was between .3 and .6%, and that catastrophic rupture (ie fetal demise) only happened in a small percentage of uterine ruptures.

Your best shot at a vaginal birth is to go into labor on your own. If there is prudent reason to induce, a gentle pit induction is shown to be reasonable - but there is no reason you have to do that or c/s on your due date. There is a HUGE window between your due date and 42 weeks, it doesn't have to be one or the other, and the odds are that you will go into labor on your own before then.

[c'est moi]

i wouldn't let her break your bag of water. if nothing happens within X amount of hours, you're going to end up the c-section anyway. if baby's not ready to come out, breaking the waters might do nothing.

also, the status of your dilation says nothing. people can go from one number to the next in minutes, moments, or seconds. i have a friend who went from a 2-10 in 20 minutes. people have gone from nothing to a baby in the same day and some people walk around at a 3 or 4 for weeks at a time.

lastly, weight estimates are notoriously off in the end. you're always hearing about women induced because of baby's size who end up giving birth to 7 and 8 lb baby. i hear they can be as much as 1-2 pounds off in the end.

sorry, but nothing your OB seems to make much sense to me .

stick to your guns mama!!!

[sap2010]

Originally Posted by c'est moi

lastly, weight estimates are notoriously off in the end. you're always hearing about women induced because of baby's size who end up giving birth to 7 and 8 lb baby. i hear they can be as much as 1-2 pounds off in the end.

Originally Posted by thorn

First of all, it's probably NOT accurate. Second of all, 9lbs is a good sized baby, but so what? Lots of women have bigger babies than that.

I know this is true, for sure. They told me my first was 6.5 lbs the day of the BPP but he was actually quite a bit bigger.

Originally Posted by c'est moi

sorry, but nothing your OB seems to make much sense to me .

~sigh~

[GOPLawyer]

First off...(((hugs))). Being surrounded by such stress while pg really stinks.

Ok...here's what's going through my mind while going over your posts...

You didn't say but I'm assuming that you were 42+1 days? That only puts you at one day late. To me, that says your babies may just need to cook a bit longer which would make me nervous about forcing a birth at 40 weeks.

What womb degradation is she talking about...just low fluid levels? Was the fluid level really, dangerously low (did you see the actual ? Did your OB look at your records for the actual level?

Especially since you are GBS positive, why are you having cervical checks? They can't tell you if you are about to go into labor but they can introduce infection (I'm wondering if this is what happened w/ your first birth?). You could be closed up tight yet have your baby in your arms the same day.

You absolutely have every right to refuse an induction and/or c/s. They cannot force you to have one w/o a court order which is *really* rare. I had an OB try to force me into a scheduled c/s....I told them to cancel it as I wouldn't be there. You can do the same. There's no medical reason that you've stated that would call for a c/s.

And OMGosh....break your waters when you're GBS+....that's just asking for trouble. 1)That puts you on the clock...your OB knows this. At 24 hours (if not sooner), I guarantee your doc will call for a c/s. 2) This really ups your chances of getting an infection. Breaking your water...especially w/ GBS...should be an absolute last resort.

I'm sorry, Mama. I hope I'm not coming on too strong. I just see so many red flags with the situation the OB has created.

Never forget....the decision is YOURS. (((hugs)))

ETA: Sorry for the redundancy...I see some things have been addressed while I was typing. :-)

[GOPLawyer]

One last question.....

Imagine cancelling the c/s. How does that make you feel? What do your instincts say?

[sap2010]

Originally Posted by thorn

You didn't mention, but was your water broken, and for how long? Did they think the womb was infected because of your fever? Because epidurals cause fevers, it's a well known risk of them.

I went to my MW at 37 weeks with my first and complained of copious clear fluid that I couldn't explain, was wondering if it could be amniotic fluid. She looked under a microscope in their clinic and said it wasn't amnio but that I had a whopping yeast infec. (To my knowledge I had never had one before and had no symptoms other than the fluid!) So. . . when I had the BPP at 42 weeks and they said there was next to no fluid in the BOW, I wondered what had been going on. About 9 hours into induced labor my water broke on its own, but there was just a trickle of it. they said that my body was not making enough. . . but anyway, that was about 9 hours before the c/sec.

Originally Posted by thorn

Do you know what position he was in? Was he posterior?

Not sure...

Originally Posted by thorn

Really? how many babies has she seen die during VBACs? See, this is the kind of scare tactic I hate. The odds of a baby dying during a vbac are very low. Which isn't to say it never happens, unfortunately babies die in all kinds of births, but if she has seen multiple babies die in vbac attempts I'd want to know what they were doing wrong! The NIH consensus on vbac earlier this year that reviewed tons of studies said that the risk of uterine rupture after one c/s was between .3 and .6%, and that catastrophic rupture (ie fetal demise) only happened in a small percentage of uterine ruptures.

I know - it was one of those things that hits you after you've hung up the phone and have time to process how horrible it was for someone to say that! She said she worked with a group of 8 OB's in Bellevue, WA before coming to my doctor's practice and that was "way back when VBAC's were more common." She said they did them all the time and didn't think anything of it until they lost a baby and it "affected the whole community," and then the doctors started being more careful, but they still lost a few until the regulations became tighter. . . I wanted to say something about the new ACOG report(s) but was not knowledgeable enough about them and didn't really want to engage her at that point.

Originally Posted by thorn

Your best shot at a vaginal birth is to go into labor on your own. If there is prudent reason to induce, a gentle pit induction is shown to be reasonable - but there is no reason you have to do that or c/s on your due date. There is a HUGE window between your due date and 42 weeks, it doesn't have to be one or the other, and the odds are that you will go into labor on your own before then.

My doctor won't be a part of any pit induction with a VBAC. It seems like the main reason for going on my due date is that it is a Tuesday and she only does c/secs on Tuesdays.
Another bit of info... my husband has to be out of town the Mon-Sat after my due date, so I feel stressed to just go along with my doc so I can "for sure" have the baby while he is here. I can't imagine doing this without him. He is trying to change the plans. . . But I know this is probably keeping me from being entirely objective!

[sap2010]

Originally Posted by GOPLawyer

You didn't say but I'm assuming that you were 42+1 days? That only puts you at one day late. To me, that says your babies may just need to cook a bit longer which would make me nervous about forcing a birth at 40 weeks.

Right, and even if they are accurate about her size, that doesn't necessarily mean she is mature, correct?

Originally Posted by GOPLawyer

Was the fluid level really, dangerously low (did you see the actual ? Did your OB look at your records for the actual level?]

I saw the actual fluid - was so surprised at how little it was. I remember it being HOT too, like microwaved hot water. . . Strange that I just remembered that. But OB has all records from first birth and gladly lets me look at them too. I don't remember any mention of it. It was at the hospital, but my MW was there. . . Don't have many happy feelings about how "together" she was the day of my induction.

Originally Posted by GOPLawyer

Especially since you are GBS positive, why are you having cervical checks? They can't tell you if you are about to go into labor but they can introduce infection (I'm wondering if this is what happened w/ your first birth?). You could be closed up tight yet have your baby in your arms the same day.

It was my first cervical check, and it was before the GBS+ test came back. . . I guess it was just routine and I went with it?

Originally Posted by GOPLawyer

And OMGosh....break your waters when you're GBS+....that's just asking for trouble. 1)That puts you on the clock...your OB knows this. At 24 hours (if not sooner), I guarantee your doc will call for a c/s. 2) This really ups your chances of getting an infection. Breaking your water...especially w/ GBS...should be an absolute last resort.

This bothered me too. . . but I am wondering if that was the nurse's idea or my doc's. It doesn't really sound like my doc. . . so I am just going to go to my appt Fri AM very cautiously. . . I wish I had time for a second opinion, but I have no idea who even to go to at this point!!

[thorn]

Do you have a copy of your surgical record? It would say the baby's position. A malpositioned baby can keep labor from starting, and could stall you out like that (especially with an epidural because you can no longer labor in some of the positions that would help the baby rotate)

check out www.spinningbabies.com for more info on that