Waiting for VBAC at 41w 3d

[ms sig]

I'm surprised to be writing this, but I'm still waiting to go into labor. Tomorrow morning will be my 2nd non-stress test. I still feel the baby a-kicking and I'm still getting uncomfortable contractions, that don't seem to conform to any pattern.

I have a hospital birth planned with midwives there and they've been pretty open and non-pushy as far as my options. They'd like the baby to be out at 42 weeks though and then it's a matter of a repeat c-section or an induction with a catheter-like bulb to help ripening, then breaking the waters, and a low dose of pitocin. I'm not going to try to push it longer than 42 weeks, so I'm going to have to choose one of those options if nothing happens soon.

My doula is pushing for the induction, but frankly I'm not so sure. The success rate for that is about 55-60%, which isn't that encouraging. I mean, I'm really not looking forward to another c-section *on top* of a failed TOL. Considering that, I often feel like I rather just get have a planned cesarean birth. The baby is also oblique posterior now, which was also an issue with my first one.

I know I'm not so gung ho as some people about a VBAC -- I started out gung ho with this birth, but then had placenta previa and so they thought I'd need a C -- but then that resolved itself -- and then a breech baby to 36 weeks -- but then that resolved itself -- so I feel like I've been through the wringer, making peace with needing a C, and eventually kind of lost my drive to do VBAC.

I guess I'm looking for some advice of which way you're thinking I should go, and/or encouragement for a VBAC. Thanks.

[CookAMH]

Of course, only you can decide. I hope you get valuable input. The way I see those complications having passed is keeping that VBAC opportunity open.

FIRST of all, you still have time, a few days, and a lot can happen then. Also, if it comes to induction, their method of induction is what I would personally consent to before consenting to a rcs. I'm sorry babe is posterior . Can you spend some significant time on hands and knees to get baby to shift? Are you interested in posting a thread about ways to get baby to turn anterior? Maybe over in Birth and Beyond...

Remember that every birth is different from the last - it's so hard to not think that the same thing might happen again.

Do you wish to have more children? I personally feel a lot is riding on my upcoming, anticipated vbac because we want more kids after this, and it's harder to find a good mw/doc for VBA2C. Something to consider.

Also, try to not to make decisions based on what you are afraid of, of what might happen. It sounds like you have a supportive midwife (I haven't heard of any non-homebirth midwives allowing one to go past 42 weeks, so that sounds pretty typical, that is a policy for my mw too).

[ancoda]

I hope everything goes ok for you.
I second doing lots of being on hands and knees. If you have a yoga ball lay on it a lot and rock back and forth, that is how we got my last son to turn.

Not that it changes the situation that you are in, but my babies like to cook extra long. Both of my VCACs were past the 42 week mark. One was 42wk 5 days and the other was 42wk 6 days.

[Monkey Keeper]

Originally Posted by CookAMH

The way I see those complications having passed is keeping that VBAC opportunity open.

Me too!! My VBAC baby was breech at 34w and again at nearly 39w. I came to terms with possibly need another c/s, but I kept positive that he would turn, and I would get a chance to VBAC.

Are you trying anything to encourage labor? I started getting some pressure from my OB to induce when my first BPP showed elevated fluid levels AND a big baby. I declined, but I really pulled out the stops to get labor going: chiropractic, acupressure, massage, walking, and finally acupuncture. I did the first four on Monday, labor started early Tuesday morning, and I added acupuncture Tuesday afternoon which brought my ctx to 3 min apart.

You're so close! If still want to, YOU CAN DO IT!!

[kltroy]

Hope NST was fine and that you're ok or in labor already. ITA that at this point, you might as well try what you can to get labor going on its own. Accupuncture/pressure, sex, walking, spicy foods, nipple stimulation etc. are all good. Inductions work quite well -- even for VBAC -- IF your body is close to going into labor on its own. A VE should help to determine this. IMHO, if it's time to get the baby out (either b/c of bad NST or when it gets past 42 weeks) and your body is NOT close to being in labor, you need to determine your odds of success to help you make a decision. The VBAC calculator can help you with this:
http://www.bsc.gwu.edu/mfmu/vagbrth2.html

IMHO, if I were at less than about 40-50%, I'd consider a RCS. But we all have our own threshold for decision making. ACOG says that at around 60% success rate, the risks of attempting a VBAC are roughly comparable to the risks of RCS, since VBAC really only has a downside if it turns into an RCS anyway.

Best of luck!

[CookAMH]

Originally Posted by kltroy

IMHO, if I were at less than about 40-50%, I'd consider a RCS. But we all have our own threshold for decision making. ACOG says that at around 60% success rate, the risks of attempting a VBAC are roughly comparable to the risks of RCS, since VBAC really only has a downside if it turns into an RCS anyway.

I realize that calculator can be helpful for some, but nothing can be predicted, and the % given can just sit in the back of a person's mind during labor and deflate their hope or drive to have one when it gets tough. I strongly think being told that you have, say a 40% chance of a vbac can have a serious impact on the success of that vbac, regardless of the situation.

[cairomama]

Skip the calculator. You are not a number. My friend just had a VBAC of a 9 lbs baby with a 15 inch head through an anthropoid pelvis at 41 weeks 3 days gestation. She also had an invert t incision and an anterior placenta.

A more likely indicator of success is your provider's VBAC success rate. Some providers have success rate of 90% and loose selection criteria. Others have strict selection criteria an only a 40% success rate. I think that speaks volumes.

[CookAMH]

How are you doing?