I'm getting a VBA2C!

[Charlize]

I am currently 14 weeks pregnant with our fourth child, due in July 2011. My current OB will only do a VBAC after 1 c/s. However, something in me kept telling me to check around a bit more for other OB's. I called another OB's office today and talked to the nurse. She said I was a perfect candidate and the OB would be more than willing to do a VBA2C since I did have a natural birth with our first DD.

While I'm incredibly happy, I'm also anxious about what awaits me in six months. What should I really expect?

[soccerchic21]

I can't answer your question but I just wanted to say that is great news!

[TiffanyToo]

I would verify those statements with L & D nurses.

They have a much better idea of what happens, when a VBAC mom comes into the hospital than a OB nurse who works in an office.

I would ask about your doctors VBAC successes, failures and what his protocols, requirements,and sranding orders are for a VBAC. 

What the hospitals rules are for VBAC.

[Charlize]

Originally Posted by TiffanyToo 

I would verify those statements with L & D nurses.

They have a much better idea of what happens, when a VBAC mom comes into the hospital than a OB nurse who works in an office.

I would ask about your doctors VBAC successes, failures and what his protocols, requirements,and sranding orders are for a VBAC. 

What the hospitals rules are for VBAC.

The L&D nurses are hush hush about VBACs at this hospital and do not really support them as they are "dangerous." As far as I know, the nurse in the OB's office ran this by him and he was perfectly okay with the situation and is extremely supportive of VBACs or VBA2C so long as the mother goes into labor on her own. If labor hasn't started by 39.5 weeks, usually a c-section is scheduled.

I had an unexpected appointment with my current OB this morning and she now wants to research the topic more and see if she can do a VBA2C. She was under the impression the hospital here only allowed it if you had one prior c-section. She has done them when she was in a larger metro area and had great success. She also recommended having a doula attend as the nursing staff isn't all too supportive of VBACs.
 

[sommer64]

Congratulations!  How exciting! Kudos to you for following your intuition!

The American College of Obstetricians and Gynecologists published a new position paper on VBAC in November, 2010.  The new guidelines are much, much more liberal. This is based on both new evidence supporting the safety of VBAC and new evidence documenting the dangers associated with c-section.  This is really, really positive news for VBAC moms, and for VBA2C moms, too!  The new guidelines support VBAC, VBAC with twins, VBAC with unknown incision type, and VBAC when emergency surgery is not immediately available.

Is it OK if I offer some suggestions?

1) Do everything in your power to optimize your pregnancy.  Particularly, pay attention to your nutrition, and more than anything else, it is important that you exercise regularly.  You don't have to exercise hard! A twenty minute walk 5-7 days a week will dramatically enhance your VBA2C!!!  

2) Think about your last birth.  What happened?  What did you like?  What would you do differently if you had it to do over?  What was helpful to you? Do you have any unresolved feelings about the c-section? Do you feel you understand the reasons for the c-section? Find someone to talk to about this. Maybe an experienced doula or a midwife. Or a therapist, or anyone you trust.

3) Get a copy of your medical records from your provider. Many c-sections are performed for reasons that do not tend to reappear in subsequent pregnancies.  If your c-section falls into that catagory, that would be good to know.  For example, baby's position, prolonged rupture of membranes, fetal distress, etc.

4) Many of my VBAC clients feel some anxiety in labor until they get past the point where the c-section was recommended from the last labor..... (did that make sense?).  So, I recommend that you maybe visualize yourself getting past that point in labor.  Guided visualizations and hypnotherapy would be really helpful for that.

Best of luck to you!  I am totally confident that this baby will come out vaginally!

warmly, 

Sommer

Licensed homebirth Midwife

[sommer64]

Just saw your most recent post.  The requirement for spontaneous labor before 39.5 weeks concerns me. Most healthy pregnancies go past 40 weeks, and the research (at least what I have personally read) doesn't support the early cut-off. Your current OB sounds promising, as she is recommending a doula.......

sommer

[courtenay_e]

I read it as "they would SCHEDULE a cesarean if she had not gone into labor..."  You can schedule the cesarean for 42 weeks, or 43. 

[TiffanyToo]

OB nurses are IMO part of the marketing department and can and will often say what they think is going to keep your business.

Ask for references from other women who have successfully VBAC'ed with this OB.

Talk to Doulas, midwives and lactation consultants about how this OB is and when he typically shows up during the birth process.

As for the hospital L&D nurses they are the front line in a hospital birth they manage labor not the OB. The OB has protocals and orders that the nurses follow. Do not be afraid to ask your questions, ask for referals to VBAC friendly labor nurses. If that is not to be had is this really where you want to birth?   If the vibe is on that L&D floor is "VBAC is scary" your arrival in labor probably won't change that cultures thinking. Instead you become a threat to that cultural norm.

If it were not for a VBAC friendly L&D nurse I would have had a repeat c-section. She helped me and worked with me not against me as the OB did.

VBAC wishes!

[soccerchic21]

I just had a VBAC and where I delivered will let you go to 42 weeks. They wanted me to schedule at my 35 week appt but I never did. Not to have the cesarean at 35 weeks but to just schedule a 42 week cesarean. I just didn't answer the phone when the scheduler called. 

I agree with a PP on making sure you have a very healthy pregnancy. This time I ate very well and exercised and instead of gaining 50 to 70 lbs as before I only gained 30 (I lost 23 after baby was born). 

With my cesarean (second baby) he was in a horrible position. So this pregnancy I focussed on optimal positioning of my baby from about 20 weeks on. Tailor sitting, pelvic tilts, etc. During labor I also focussed on positions that would help to get her down the birth canal. She was 3 pounds smaller than my son so that could have helped but I think the positive thinking also was effective. 

It really does help to deliver in a place where everyone is pro VBAC. The nurses where I delivered were incredibly supportive and did everything to help me have a VBAC. The last thing you want is a discouraging nurse. 

[Charlize]

Well, I have a not so good update.

I spoke with my current OB more in depth. She wanted to go to the OB I was transferring to so she could figure out how he was doing VBA2Cs, etc. Once she and I spoke to him, he backed out of the VBA2C stating it was "too dangerous after two consecutive cuts on the uterus." He point blank asked me "Why would you want to chance your baby and your life for a VBAC?" They also said they feel the hospital they practice at can't adequately handle a VBA2C. They said a surgical team, etc. is supposed to be there stat, but it doesn't always happen.

I have also talked to the main L & D nurse. She is very pro VBAC. She told me to fight for it, and if I can't get it here, go else where. She was stunned the OBs here have backed out on me. She even suggested going to Vanderbilt and Erlanger since they have NICU facilities on site and have a full surgical staff in waiting at all times. I'm also considering The Farm, but I'm not sure if my insurance would cover them at all. And I'm not sure how I feel about a home birth at this point. (I applaud the mama's who have went through a home birth, it's just not for me right now.)

Since I'm still on bedrest due to SCH (even though it is resolved), progesterone problems and unexplained bleeding, I can't exercise. But I am taking active measures in watching what I eat. So far at 15 weeks, and even with being on Prometrium and progesterone shots, I haven't gained a single pound and the baby is growing great. I only gained seven pounds with my last daughter and I truly think it helped me during that pregnancy. I also think that's why once I started contracting it seemed easier than with my first baby that I gained more weight with.

[ashleypLC]

What was the reason for the 2 c-sections?  I had a successful VBA2C in Nov 2007 and my OB said the chance of uterine rupture was only ~1.2%.  If there are no hospital policies against it then it is up to your OB.  Are these two the only ones in the area?  Did you contact your local ICAN chapter?  Any well equipped hospital can get you from labor room to baby out via c-section in less than 30 minutes so I'm not sure why your OB feels the hospital is not capable enough to handle you.  If that's the case they shouldn't be delivering babies at all.  Any reason you can't labor at home with a certified midwife and transfer close to delivery? 

I totally agree with Sommer on ways to prepare for the labor!  Especially the visualization.  Believe it or not I read everything negative I could get my hands on until 30 weeks then I mentally pushed it out of my head and moved forward with only positive thoughts, stories, etc.  Lots of walking, good nutrition, and good positioning.  I only visualized pushing the baby out of my vagina!  I actually didn't even think about what happens after that so when my midwife was busy down there while I was enjoying my baby I asked "what are you doing down there?"  To which she replied, "delivering the placenta!"  Comical!  Anyway, please feel free to PM me any questions you have.

Best of luck!

[Charlize]

Originally Posted by ashleypLC 

What was the reason for the 2 c-sections?  I had a successful VBA2C in Nov 2007 and my OB said the chance of uterine rupture was only ~1.2%.  If there are no hospital policies against it then it is up to your OB.  Are these two the only ones in the area?  Did you contact your local ICAN chapter?  Any well equipped hospital can get you from labor room to baby out via c-section in less than 30 minutes so I'm not sure why your OB feels the hospital is not capable enough to handle you.  If that's the case they shouldn't be delivering babies at all.  Any reason you can't labor at home with a certified midwife and transfer close to delivery? 

I totally agree with Sommer on ways to prepare for the labor!  Especially the visualization.  Believe it or not I read everything negative I could get my hands on until 30 weeks then I mentally pushed it out of my head and moved forward with only positive thoughts, stories, etc.  Lots of walking, good nutrition, and good positioning.  I only visualized pushing the baby out of my vagina!  I actually didn't even think about what happens after that so when my midwife was busy down there while I was enjoying my baby I asked "what are you doing down there?"  To which she replied, "delivering the placenta!"  Comical!  Anyway, please feel free to PM me any questions you have.

Best of luck!

DD2 was delivered via c-section because she was breech. Right before the c-section, she turned. But, they already had my spinal block in and the OB suggested we go ahead with the c-section. DD3 was a repeat c-section. I went into labor with her two days before the scheduled c-section, so they did an "emergency c-section" due to that.

Were both of your c-sections back to back?

[ashleypLC]

Originally Posted by Charlize 

Originally Posted by ashleypLC 

What was the reason for the 2 c-sections?  I had a successful VBA2C in Nov 2007 and my OB said the chance of uterine rupture was only ~1.2%.  If there are no hospital policies against it then it is up to your OB.  Are these two the only ones in the area?  Did you contact your local ICAN chapter?  Any well equipped hospital can get you from labor room to baby out via c-section in less than 30 minutes so I'm not sure why your OB feels the hospital is not capable enough to handle you.  If that's the case they shouldn't be delivering babies at all.  Any reason you can't labor at home with a certified midwife and transfer close to delivery? 

I totally agree with Sommer on ways to prepare for the labor!  Especially the visualization.  Believe it or not I read everything negative I could get my hands on until 30 weeks then I mentally pushed it out of my head and moved forward with only positive thoughts, stories, etc.  Lots of walking, good nutrition, and good positioning.  I only visualized pushing the baby out of my vagina!  I actually didn't even think about what happens after that so when my midwife was busy down there while I was enjoying my baby I asked "what are you doing down there?"  To which she replied, "delivering the placenta!"  Comical!  Anyway, please feel free to PM me any questions you have.

Best of luck!

DD2 was delivered via c-section because she was breech. Right before the c-section, she turned. But, they already had my spinal block in and the OB suggested we go ahead with the c-section. DD3 was a repeat c-section. I went into labor with her two days before the scheduled c-section, so they did an "emergency c-section" due to that.

Were both of your c-sections back to back?

Yes, they were back to back.  My first born was 12/03 (24 hours of labor and 2 hours of pushing and many, many unnecessary interventions) and my second was 09/05 (repeat).

[Charlize]

Interesting.

Both of the OBs said my risk went from 1% after one cut, to 5% or more after the second cut.

I meet with my MFM doctor from Erlanger in about four weeks for the anatomy scan and plan on asking him how he feels about VBA2C or if he could suggest anyone that might be willing to do one. Once I have my anatomy scan done I feel I will know a lot more and might be able to persuade someone to assist me. I'm still waiting for my call to be returned by The Farm. Not sure how I'm feeling about basically a HBA2C, but we'll see. I would trust their opinion, though.

[womenswisdom]

Originally Posted by Charlize 

Both of the OBs said my risk went from 1% after one cut, to 5% or more after the second cut.

This is absolutely not accurate unless you've had some type of incision that is not a low transverse.  Also, repeat c-section at 39.5 weeks if no labor is not evidence-based AT ALL.
 

[TiffanyToo]

TN ICAN of Nashville   Contact: Jessica Caldwell eMail Address: [e-mail] Telephone: [phone] Website: icanofnashville.webs.com Or Contact: Lindsey Seger Telephone:

TN ICAN of Chattanooga Chattanooga Contact: Rebecca James eMail Address: [e-mail] Telephone: [phone] Website: Or Contact: Rachel Jimenez Telephone:

TN ICAN of Knoxville Knoxville Contact: Kimberly Sebeck eMail Address: [e-mail] Telephone: [phone] Website: www.facebook.com/group.php?gid=170751447099 Or Contact:     Telephone:

Here are the ICAN groups in TN call even if one or all are not local that would be your best resource for finding VBAC supportive medical professionals in your state. VBAC Wishes!

[Charlize]

Thanks for the links! None of them are close to me, but I wouldn't mind the travel.

[Charlize]

I have contacted ICAN of Chattanooga and Nashville both. Hoping to hear something back from them soon.

[jenniro]

Hope everything works out for you.  I fear I may have the same provider issues when I, hopefully, get preg this summer.  I will be doing a VBA2C.  I live in a rural area so I have very limited options.  Keep us updated. 

[LisaSedai]

I spoke with my current OB more in depth. She wanted to go to the OB I was transferring to so she could figure out how he was doing VBA2Cs, etc. Once she and I spoke to him, he backed out of the VBA2C stating it was "too dangerous after two consecutive cuts on the uterus." He point blank asked me "Why would you want to chance your baby and your life for a VBAC?

 

Am I reading this right? You found an OB that does VBA2C. Your current OB has a little chat with him. Suddenly he is anti-VBAC? I don't think he was VBAC friendly in the first place if he pulls out the "dead baby/dead mommy" card on you, so maybe it is lucky you found out prior to transferring to his care.

Hope your TN ICANer groups can provide some good info on providers for you ( I found my VBAC OB through ICAN) or that you can go to the Farm.

Good luck!!