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Totally confused about whether to do HBAC or VBAC in hospital with questionably supportive OB

post #1 of 14
Thread Starter 
A little background first: I had a c/s in Feb 2008 for "failure to progress" but also my daughter was 9lbs. 9oz. and posterior. Suffice to say I labored naturally on my own to 7cm then got terrified of transitional labor and opted for the epi. This slowed down my contractions and being on my back started the major back labor pain from hell! After 7 hours of that and no progress I opted for the surgery but I was also very unsupported and uneducated too.

Fast forward to now: 34 weeks pregnant, I had to switch OBs once already because I live in a rural town and my rural doctor won't do VBACs. The local hospital 15 min. away has a ban in place but won't refuse to do them as long as you arrive more than 4cm dilated and sign a waiver. I decided I'd rather go to the self-proclaimed pro-vbac hospital which is 50 min. away from me and I established care with an OB there who came highly recommended by three friends (one who labored and delivered without drugs and no interventions, one who labored with an epi and no other interventions and one who had 2 c/s, first for FTP and second was scheduled). So there are a variety of experiences at this hospital and with this one doc but everyone says they love her. She agreed to a vbac and said she would try anything I want. Trial of labor no matter how big we think the baby is etc.

Well, today I went for my 34 week appointment and she had just finished a surgery beforehand. She measured me and said I am measuring normal, 34 weeks fundal height. In the next breath she tells me this is going to be a big baby anyway and that she will need to do an ultrasound closer to my due date probably 38 weeks and that we would "go from there". She got all serious and said, "A 10lber is a definite no". I was floored and angry that she would reverse what she had previously told me. Now, maybe I haven't shown her that I am uber committed to having a VBAC and that I want my TOL regardless of what the u/s might say. In the beginning, when I first met her that was not my state of mind. I told her if we thought I was going to have an even larger baby I may want to schedule a RCS. But, that's not the case and I'm not as big and haven't gained as much weight this time as the first time. I also just plain feel better with this pregnancy, have more support, a doula etc.

But, I'm so worried about delivering with this OB and at this huge impersonal hospital that I'm starting to think about a home birth though that scares me too. My doula is also a midwife so that's how I would feel comfortable at home. My only concern really is rupturing outside of a hospital and then being 15 min. away from only a basic rural hospital at that. Ugh! Please help me figure out what to do. Any advice appreciated.
post #2 of 14
Would it be possible to have a "home" birth at a location closer to the good hospital? A friend's house or hotel or something like that, with the homebirth midwife in attendance?
post #3 of 14
Thread Starter 
Ruthla: I thought of that too but no. I don't have any friends or family in that area, closer to the big hospital.

It's funny too because I have heard of two or three VBAC stories up here that were home births but have heard of no successful VBACs at the hospital. Not that they don't happen at the hospital but that I live so far away I don't have many friends who choose to go down there for care and it is quite telling of how supportive the culture is in my tiny town of HBACs and home births in general. So there's that.
post #4 of 14
Would you consider a "hotel birth?" At one of those places designed for longer term (weekly or monthly) stays that has a kitchenette, or a private short term rental (VRBO.com, short term sublet etc.)? We are RVers and that's probably how we're going to do ours (provided I can get pregnant one of these days, sigh) since our 5th wheel can't accommodate a birthing pool. We're planning using a homebirth midwife and finding some sort of short term rental near the most baby friendly hospital.
post #5 of 14
I don't know about this one way or the other, but does a larger baby increase your risk of rupture even a tiny bit? Is that your OB's concern, or is it that she thinks a larger baby will be another FTP?

Have you had positive interactions with her and do you like her otherwise? What did she say when you said you really wanted to VBAC?
post #6 of 14
Quote:
Originally Posted by tangledblue View Post
I don't know about this one way or the other, but does a larger baby increase your risk of rupture even a tiny bit? Is that your OB's concern, or is it that she thinks a larger baby will be another FTP?

Have you had positive interactions with her and do you like her otherwise? What did she say when you said you really wanted to VBAC?
According to the NIH conference, a 'macrosomic' baby (either 8lb11oz+ or 9lb15oz+) does lower your chances for a VBAC ending in a vaginal birth. BUT that's NOT a factor in 'allowing' a mom to a trial of labor due to the fact that baby size is ONLY determined accurately AFTER birth. So basically what the OB thinks is stupid. IMO.
post #7 of 14
Thread Starter 
Austinmom: I'm not exactly sure what she was trying to say. She literally just said, " A 10lb baby is a proven No." I'm guessing that she meant it would seriously put into doubt my ability to vbac successfully, which I understand I guess. It was probably a factor in my first birth too, though being posterior and having to be in bed on my back didn't help either.

I'm going back in a week and half for my GBS test and I'm bringing DH with me so we can lay it all out there for her about our vbac wishes. I think I was too equivocal in the beginning with her and haven't really taken a firm stand on what I want (partly because I'm still figuring it all out!). If she seems open to everything we want I'll feel a lot better. If not, I guess I will be trying it at home with a midwife and transferring if I need to.

Thanks for the help everyone!
post #8 of 14
A 'proven' no? What does that mean? It sounds kinda bolonga to me. It sounds like she is saying if you have a 10lb baby (which the only way of getting this thought would be to believe 100% in u/s sizing which is off by far more than 1lb with a 10lb baby) your body can't VBAC. That's really really really inaccurate.

I don't think size really has that much to do with it, especially if eat even moderately healthy (not pints of ice cream and dozens of cookies a day). This is a great article I hope you find good info in.

http://www.spinningbabies.com/baby-positions/cpd

This is another:
http://www.midwiferytoday.com/articles/pelvis.asp

This is a video montage of tons of moms who were told CPD and VBACed bigger babies, some are 9+lbs, 10+lbs, some 11lbs.
http://www.youtube.com/watch?v=roFVkDV45MM

Babies are squishy, and pelvis are stretchy. Posterior babies are more difficult as their head circumference doesn't match the pelvis opening as well as an anterior baby.
post #9 of 14
Quote:
Originally Posted by AustinMom View Post
Babies are squishy, and pelvis are stretchy. Posterior babies are more difficult as their head circumference doesn't match the pelvis opening as well as an anterior baby.
exactly! my 1st baby was 9lbs 2oz. he just never came down into the birth canal so of course when he was so big the OB said the c-section was necessary due to his size. : granted he also had a big head (15.5 in) but I'm pretty sure he was just in a funky position plus I was flat on my back with an epi.

when I hit 41wks with baby #2 my (new) OB sent me for a NST & BPP. the u/s tech measured him at 10lbs 6oz but blew it off because she said there was just no way and measurements are so inaccurate that far along. 3 days later he was born with no meds, no interventions (not even an IV), not even a tear. he was 10lbs 6oz. his head was also 15.5 in.

baby #3 was born at home. he was 9lbs 6oz.

I don't know if my sharing gives you any more confidence but I'm hoping so. if your OB won't budge then maybe consider finding another? good luck!
post #10 of 14
I think it is really good that you are going to talk to your OB about how you feel and what you want. I think that you being clear and straightforward will really help clarify the situation and you can make a decision after that.

I'm not sure I would switch to a home birth at this point. I think it might be confusing for your doula to become your midwife. And, having a home birth does involve a different kind of preparing for which there just might not be time. Do you know what your fears about home birth are?

All that said- I think that listening to your heart/intuition will guide you more than anything- especially if you've been working on tuning into yourself.
post #11 of 14
Since your doula can just switch to be your midwife why not just plan for a homebirth where you can relax and labor how you want without someone doubting you because your baby is "too big" or whatever and if you feel that you are tired or that the labor is not progressing the way you want then just transfer to the hospital. I recently had a hbac and I went into it with that plan and everything went fine beautiful healthy boy born on my bed. I am so frustrated that dr.s try to scare vbac mom's with the 0.5% chance of uterine rupture when there are definite risks with pitocin and epidurals which can also cause uterine rupture or FTP and you rarely hear of dr's yelling about those risks before they routinely hand them out.
post #12 of 14
Thread Starter 
Thanks for the support and input everyone. I have thought a ton about it and I'm just not ready to do a rural hbac. Thankfully after today's appointment and ultrasound showing a 6lb. 14oz. very normal-sized baby for 37 weeks, my doctor is finally seeming positive about my chances and I think this was what she needed to get on board. I, of course, know these ultrasounds can be way way off but it's also reassuring to me that I may not have to push out a sumo baby since I'm doing this completely naturally. I'm actually getting very excited now about my chances of a successful vbac with all the support I've gotten here, in my doula and DH. Thanks again and I hope to be posting a success story in just a few more weeks!
post #13 of 14
I'm glad you sound like you know you're plan/have decided. I just wanted to throw in my two-cents/reminder that no matter WHAT anyone says (b/c I know in the moment it can seem like it's not your decision.) It is ALWAYS your decision - and noone can FORCE a section on you - truly. So stick to your guns, do your best work and Congrats on having a doula who hopefully will be your "wall" and help out w/it all!!! GOOD WISHES for an easy, beautiful VBAC!!
post #14 of 14
6lb 14oz WHEW. I would really not do anymore U/S though if I were you just in case since OB thinks it's a good reason for a C/S. My C/S baby's U/S day before delivery said he was going to be over 9 lbs with a big head. He was only 7lbs 14oz. My VBAC girl (no medication hospital birth) was 9lbs 14oz. I didn't get any U/S with her after 32 weeks when she was a "normal" 3lbs 9oz.
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Mothering › Forums › Pregnancy and Birth › Birth and Beyond › VBAC › Totally confused about whether to do HBAC or VBAC in hospital with questionably supportive OB