Attempting vbac and have a lot of anxiety

[lillymonster]

I am 34 weeks. I was going with a hospital based midwife group. The interventions were getting to be a lot, and then they suddenly started getting nasty when I said I wanted to refuse ultrasounds etc. Unfortunately I went to l&D for limited baby movement and they found out I was contracting (and didn't know it) so they gave me water, then an IV, then turbutiline (sp?) After the first shot I refused any more because 1) I felt like crap and 2) it stopped the "contractions" (I had no idea I was having them, even when I saw it on the monitor) and 3) no cervical change. I was there a long time, wasn't allowed to eat, strapped to monitors, and I realized I didn't want to be there, that it was wrong. The same anxiety I had right before I went in for my induction for DD....this is wrong (for me - bad feeling type thing - not wrong in general)

So, I got a lot of pressure from the midwife on call to finish the shots. Uterine rupture was possible from early labor, I was told, but I still refused. Then I go into the office on Friday and told that I needed to get ultrasounds because I am almost 40, vbac, and there is a 5% chance of stillborn because of low amniotic fluid so I need to do 2 more ultrasounds (I just had one that was fine at 32 weeks) to check. I did some research online, and found while low amniotic fluid is debated, the risk of stillborn because I am a VBAC AND almost 40 is higher. Mostly because I am vbac then my age. Otherwise I have no risks - no GD, no -pre-e, underweight when I got pregnant and have gained only 25 pounds so far, nothing wrong with the baby, no previous health issues, no pre-term labor with the first. They will schedule a c-section at 40 weeks, don't know if it means I just schedule it, or it has to be for week 40, but I don't want another c-section.

So in my area, I can submit to getting test after test and possibly get ruled out of a vbac because of low fluid (I was told if it was low, and the iv didn't work, I would get a c-section) be hooked to monitors that may possibly show something that is not serious (like contractions I can't feel) while I am in labor and get a rcs OR I can have a homebirth. There is no middle ground in my area, well the only place that would probably be okay can't take me because they are booked for my due date/month.

So I am having a lot of anxiety. Would being in a hospital lower my chances of a stillborn? I probably would have never worried about it had the midwife not said anything.  Can i make it to the hospital in time if I have a rupture? I am about 25 minutes from the closest hospital, 50 minutes from the hospital that would let me vbac.

I have attended ICAN meetings, and talked with a homebirth midwife and doula, and posted a lot, but I still have anxiety. Is this normal? I just don't think I can stand being hooked up to an iv, and monitors and being stuck in bed. And after my L&D trip, with an iv for 2 hours, I have a bruise on my entire forearm. I can't imagine what will happen having an iv for longer!

[courtenay_e]

You can only feel comfortable where you feel comfortable.  You are not at higher risk for stillbirth at home, esp if you are getting regular care.  But if you want a  non-interventive vaginal birth, I'm thinking it really does sound like you're looking at a home birth.   (((HUGS))).  You could have a death in the family, though, and go on a "roadtrip" to a nearby town for the funeral until you go into labor.  That may get them off your back.  That doesn't mean that once you get to the hospital in labor, though, that you'll actually get your VBAC either.  Of course, neither does a homebirth gaurantee a vaginal birth, but in that climate, it does sound as if you are more likely to get the vaginal birth at home than in the hospital.  Good luck with your choice...but I'd make it one way or another soon, so that you can settle with it, and be comfortable where you are.

[keeptryst]

These articles by midwife Gloria Lemay might give you some reassurance and clarity:

http://www.glorialemay.com/blog/?p=60

and

 http://www.glorialemay.com/blog/?p=107

Good luck, keep the faith.

[kltroy]

This is a really frustrating situation for you.  It sounds like the group you are with are pretty conservative.  The low fluid thing is complex because fluid is an indication of how much blood the baby is getting (amniotic fluid = pee, which is directly related to the amt of blood baby gets).  But the measurement is imprecise, because they have to find "pockets" with some volume and that aren't obstructed.  I actually ran into this at the tail end of my last pregnancy too (at 41 weeks, also a VBAC).  I can't tell you what to do, but I can offer you a few thoughts and lines of questions that you might try and explore:

On the fluid issue:

- what are the risks to the baby if the fluid is X?  what is the cutoff for "normal" levels?  How much below normal is my level?  How likely is it that I could go home, drink a lot, come back tomorrow and my fluid levels would be normal/closer to normal?  Can we try that?   

You need to ask yourself, obviously, whether ignorance is bliss in this case.  If you think it is, then refuse the testing.  But if it will give you peace of mind to know, and/or you don't care to fight with your MWs about it, then go ahead and get monitored.  If you do, make sure you (1) drink LOTS for the 24 hours prior to the test, and (2) eat something sugary about 1-2 hours before the test so that baby is awake and moving around lots.

If you get to a point where you do agree that baby is better out than in, you will have to decide whether an induction is better than a repeat c-section.  This will depend on how ready to be in labor your body is.  Either way, you should discuss whether scheduling a c/s for 40 weeks is reasonable.  I would argue that being past 40 weeks does not put your baby at risk (assuming there are no other indications to get the baby out).  The good news is that you can just call and cancel the day before or the day of.  You can suggest that you schedule for later if your MW insists, or at least schedule for 40+6 days, and if it's a weekend, then you might as well move it to the following Monday.

Also, in the case of contractions, if there's no cervical change then you're not technically in labor, so they shouldn't treat you as though you are.  This is a situation where it would probably make sense to ask for a vag. exam if it happens again.  Heck - I had regular contractions for about a week that I didn't feel, and that resulted in no cervical change, before I had my daughter. 

At the end of the day you need to do what feels right to you.  You probably do have a risk threshold about the fluid thing, so it might be a good idea to read up on that and figure out what you would do in various situations.  For example, if the risk of stillbirth was 1%, would you keep carrying the pregnancy and wait for labor?  How about 2%?  5%  10%  Even if you don't know exactly where you would draw the line, it helps to think about this before you are confronted with the decision in the hospital.

[buckeyedoc]

FWIW, I briefly had low fluid at 40+4 (only detected because I had a u/s for having a tiny fundal measurement), but my OB sent me home to rest and drink a ton of fluids before a recheck in 24 hours. The recheck was totally normal, so we continued to wait, and I had a VBAC at 41+1. My OB was very pro-vaginal delivery and never treated me like a rupture waiting to happen.

This is what concerns me from your post: "Uterine rupture was possible from early labor, I was told, but I still refused." I mean, goodness, uterine rupture could happen during pregnancy before labor even starts, but come on! It's rare and hardly ever catastrophic even among women who fully labor and push, even among VBAmCs and even women given low dose pitocin. Why the huge scare tactic?

You have to decide what feels right for you. Of course, I had a little anxiety leading up to my VBAC, but not as much anxiety as if I were climbing back on the OR table for a RCS. Stillbirth is a slim possibility in any pregnancy, and sure, that is scary. I am 36 and a long-ish gestator, so for me, I was OK with agreeing to a conservative induction if I passed 42 weeks, since I know there is a little uptick in stillbirth and meconium aspiration risk after that point, or if I would have had something really concerning going on in my pregnancy. That was where my comfort level sat, so just do some soul-searching and find where yours is. I am sorry that your providers are not really VBAC-supportive.   

[A_Random_Phrase]

I guess I was lucky. The doctor said we could "try" for a vbac. I'd never heard of uterine rupture and the amniotic fluid was never checked. I was 36 1/2 years old with that baby and 38 1/2 years old with my last. Both were vbac. With my first vbac, before I went into labor, I could put my hand on my belly and feel contractions but didn't know they were there otherwise. I just figured they were braxton-hicks contractions.

I was in a hospital with my two vbacs because it is illegal in AZ for a midwife to attend a vbac home birth (and I had not yet heard of unassisted birth). In other words, I see no reason why you couldn't try for a homebirth as long as it isn't illegal in your area.

I'd certainly want to stay away from all of those interventions and scare tactics.

(I hope this post makes sense. I'm very tired and really should be sleeping.)

[labortrials]

I'm not sure I've seen a higher rate of stillbirth correlated to VBAC.  Do you have a link for this info?

I'll be 38 when I have my baby this summer.  I don't feel old in the slightest.  35 is a fairly arbitrary expiration date.  I also think that many low risk women are scared into thinking they are high risk when they're really NOT.  Don't give in to the pressure.  IMO, if this group (of course they are going to back eachother up in their findings!) isn't really supporting you the way you need, then you might want to go elsewhere.

Hugs!  It's tough dealing with this pressure when all you want is a healthy you and a healthy baby!!

[LisaSedai]

It sounds like maybe you are with a "medwife" group. I was 42 years old, diabetic type 2, and overweight when I got my VBAC. My OB didn't ask me to get an U/S ( I had had one at 32 weeks) - all he wanted was weekly then twice weekly fetal heartrate/movement tests. As long as they were ok he was fine with me going 42 weeks. Are they having you do kick counts? I decided not to do homebirth b/c I tested GBS+ and was worried about the baby's blood sugar being low after birth but there are people who labor/deliver with homebirth midwives in hotel rooms with a hospital nearby for just in case- maybe that would be a more comfortable option for you. Sorry they are giving you crap.

[lillymonster]

i wanted to update. On Monday I will be 36 weeks. Some of my anxiety has gone away. Basically at this point I am sticking with this group, but the good things is that after 30 days before my EDD, they can't "fire" me, so I can stick with them and refuse some treatment. I "forgot" to get my 36 week u/s (been busy with the holidays!) And then I have have to miss the 36 week appt anyway. From now on my DH has offered to go with me with all appt and push the no more u/s. He can't make the 36 wk one because of work (any other day that week would be fine) and they said they can't reschedule - again trying to give ME a hard time that I HAVE to come, so I am going to cancel it.

I won't see that annoying midwife for another 4 weeks, a few days before my EDD. I may be stuck with her for my birth, but I heard she is only on call 3 times a month anyway, and I am using a doula and hopefully after a 50 minute drive there, we will get there too late for any ivs and such.  The thing that is annoying is that they all don't seem to back each other up - they all have said something different, so it might be a crap shot if I get the one that is more medically inclined or not.  But anyway, I have decided overall to have a few back up plans and then not think about or worry about something that may not even happen.  Holidays are stressful enough sometimes, and then be a few weeks before having a baby! UGH! But I am trying to spend the next few weeks not worrying.

[jenniro]

Just wanted to drop some support for you!   I know how frustrating and hard it is to be doing something that is best for you and baby, but everybody treats you like you're not.