New doula with ?? about an "unfavorable cervix"

[katy_bug]

Hi everyone - I have only one birth under my belt and another is due in 7 days.  She is going for a VBAC and her drs are not 100% supportive of VBACs in general but she doesn't have any choice due to her insurance coverage.

She had an appointment today and the doctor told her that she was not dilated and she had an unfavorable cervix.  He wants her to go ahead and think about scheduling a c-section.

From what I have read, an unfavorable cervix just means that she is not ready to go into labor yet and since she is only 39 weeks then she should just wait.  Do you have experience with this? What is the typical timetable for cervical ripening . . . I mean it seems reasonable that it could happen in the next week or two, right?

Thank you!

[DoulaAlicia]

Unfavorable cervix means her doctor is NOT supportive AT ALL!!  That's what it means....

Anyway - yes of course she could go into labor at any moment or weeks from now.  And her cervix doesn't speak English and won't tell us when...hehe.  Even an "unfavorable" cervix can go into labor soon.

MANY OB's don't believe that a VBAC should have a vaginal birth after 40 weeks pregnant for fear that they will have a rupture.  The risk of rupture is very slight but they use this approx. 1% risk number to scare women out of the vaginal birth.

As the doula it is your job to "inform" your client the best you can on things her doctor isn't telling her such as her true risks for complications if she waits to labor AND her true risks of surgery if she chooses to have the cesarean.  She needs to make the choice.  Unfortunately many women who choose OB's get scared to death by them and give in.  That is why the information you can provide is so important to her.

Also if she does go into labor and try for a vaginal birth then she will likely have to face a ton of interventions at this hospital which could make the likelyhood of her success less.  When I have a VBAC I generally talk with them beforehand and see if they are comfortable staying home as long as possible in labor and if they are we stay!  If they go too early they get stuck with IV's and monitors and get trapped in a triage room and more....and IMO it is even more important for a VBAC Mom to avoid all this than a first time Mom.  They can get dejavue if their first birth went south in a hospital - they can get scared and sometimes they can be pressured by staff to do things they originally wanted to avoid.

Well my muchkin doesn't want me to type anymore apparently because he is wailing...  have to go!  I wish your Momma all the best!

[mamagranola28]

I agree with what DoulaAlica said.  It's also worth mentioning that cervical checks during the last few weeks of pregnancy tell your client NOTHING.  You could mention to your client that the problem here is not her cervix but the intervention of the vaginal exam.  NO EXAM = NO HASSLE about her non changing cervix.  It just blows my mind that this Dr. is suggesting that just because her cervix hasn't ripened yet at 39 wks. means that it won't ever open!!!!  That is TOTALLY bull crap.  This DOCTOR is trying to manipulate your client into a c-sec she does not want and that is totally medically unnecessary.  You could also mention that keeping her legs together and refusing vaginal exams is totally within her rights and could help avoid this same problem at her 40 wk appointments and beyond.  She also does not need her cervix checked to: confirm she's in labor, to chart progress or the lack there of, to tell her it's "okay to push" etc.

Also induction for VBAC moms DOES increase the risk of rupture.  Post dates is NOT an automatically medically needed c-sec.  Help her understand how to keep herself healthy and stress free in these last weeks and encourage the baby to get into/stay in a good position for birth.  If she feels like time is running out and she needs to go into labor ASAP there are more natural ways of softening her cervix like:  EPO orally and next to the cervix, sex etc....

Leah

[chellebee]

It can happen in like, a day.  Or in weeks. Or in early labor!  I had a VBAC client go from not dilated to baby out in 8 hours, no problems.

[katy_bug]

Thanks for all the information.  I agree that her provider is very unfavorable . . . but its who we have to deal with.

I reassured her that she still had time for her cervix to ripen and not to worry as long as everyone is healthy.

One more question, is EPO safe for VBACs?  I have read contradicting information, some saying yes and others saying no b/c of the potential for a repeat c-section and risk of bleeding.  Of course non of this was from a scientific paper so I don't know.  May you have a paper you can direct me towards?

Thanks again!

[mommyminer]

I just read in Midwifery Today about foley inductions and VBACs (doesn't increase risk of rupture).  Also, www.inspiredbirthstories.com sells a homeopathic labor stimulation (I have no financial gain), but everyone else is right.  Sounds like your client is being set up for another c-section. 

I don't think EPO increases risk of rupture, but I know some people do.  I think the benefit in this case would outweigh the risk.

I would recommend she google search natural induction methods -- lots of sex and nipple stim will help.  Everything in the world won't change the OB's mind.  He'll look for any reason during labor to cut.... then what is a vulnerable laboring momma gonna do when she's told that she's risking her babies health?

She did have a choice.  She choose to use her insurance and go with this group.  We make choices at every step of the way.

[DoulaAlicia]

Originally Posted by mamagranola28 

It's also worth mentioning that cervical checks during the last few weeks of pregnancy tell your client NOTHING.  

Yeah - tell her that she can tell her OB to keep his fingers out of her hoohaa and tell him she's waiting till "x" week/days (if ever) before she is comfortable with a cesarean unless an obvious medical concern presents itself.  

I also agree that she did have choice....  I know it can be expensive paying out of pocket for a midwife..  in or out of hospital.  But if it might save you from emotional trauma and the physical harm of surgery and your baby from the consequences of such sometimes it is more worth it than you might believe.  I had a homebirth I totally couldn't afford with my fourth.  The midwife discounted some of the birth, and I still owe her several hundred in the next few months.  But I wanted an experience of peace for my last baby....  But the mama has to realize this for herself...

[katy_bug]

Originally Posted by DoulaAlicia 

 

I also agree that she did have choice....

She did have a choice.  She choose to use her insurance and go with this group.  We make choices at every step of the way.

Maybe she did have a choice, but as her doula it is not my place to judge her decisions.  I just have to help her where she is.

I appreciate the information.

[texmati]

Good for you for supporting a mama where she's at!

Originally Posted by katy_bug 

Maybe she did have a choice, but as her doula it is not my place to judge her decisions.  I just have to help her where she is.

I appreciate the information.