Hypothetical WWYD?

[MunchiesMom]

I'm not PG yet but have been educating myself on VBACs and why my first birth resulted in a c-section. I'm struggling with which birthing option would be best... for a successful VBAC, health/safety, and family friendly for my son. I would like to have a game plan before I get PG.

We only have a few MWs in my city and the ones who have hospital rights don't take VBACs. Only one MW will HBAC, and she has the least desirable reputation. So here are the options as I see them. Which one do you think is best? Or am I forgetting an option?Homebirth MW won't HBAC but says she acts as my doula and labor at home with me then we'd show up at a hospital in town pushing. Or a traveling MW.
Edited by MunchiesMom - 3/24/11 at 12:30pm

[justKate]

Option one.  Or option four, depending on how far out of state is.

You should make it a poll!

[TiffanyToo]

option 5 hire a traveling midwife. 

[MunchiesMom]

Hum.. I don't think I can add a poll now that I've already posted.

How do traveling MW work? Who does your checkups and where do they stay?
Edited by MunchiesMom - 1/25/11 at 4:00pm

[TiffanyToo]

Here is a link.

http://birthpartners.com/midwives-willing-to-travel.aspx 

My understanding is you do much of your own prenatals. Ask that question of the midwives you decide to email.

Good Luck and VBAC wishes!

[neveraim]

Originally Posted by MunchiesMom 

I'm not PG yet but have been educating myself on VBACs and why my first birth resulted in a c-section. I'm struggling with which birthing option would be best... for a successful VBAC, health/safety, and family friendly for my son. I would like to have a game plan before I get PG.

We only have a few MWs in my city and the ones who have hospital rights don't take VBACs. Only one MW will HBAC, and she has the least desirable reputation. So here are the options as I see them. Which one do you think is best? Or am I forgetting an option?

1. The amazing homebirth MD who does my female care won't HBAC. But apparently she thinks it's too risky and her two previous HBACs resulted in a transfer. She wants me to drive 2 hours to a VBAC-friendly hospital where some MWs have rights (not her).

I say go for it...IF you know the MW has a fantastic VBAC success rate and will accomodate your wishes in labor.  There is nothing that will give you a better chance than a truly supportive provider.  If you just *think* you'll do better with these midwives you might want to explore another option.  People drive from hours to get to my OB because he has a proven track record (92% VBAC success rate) and is just the most fantastic human being you ever met.  He's worth the drive.

2. The next best homebirth MW also won't HBAC but says she acts as my doula and labor at home with me. Then we'd show up at a hospital in town pushing. However this MD doesn't support full-term breastfeeding and flat out told me she wouldn't want me to nurse while PG. I hope to tandem...

This is not the worst option ever, but you are leaving it to chance that you'll be stuck with some a**hole OB...even if you are at 10 and pushing they still may 'find' a reason to wheel you to the OR. 

3. The not-so-popular MW. I've been told NY healthcare professionals that she adhered to the lowest possible standard and others say she has a poor bedside manner.

I dealt with bad midwives for my second attempt at VBAC.  I ended up with a third c/section.  go with your gut feeling.

4. Traveling MW.

could be a great choice!  But you still need to decide what your back up plan will be...if you need a non-emergent transfer, (long labor, etc.) you might want to consider option one...meet with the midwives and discuss your plans, etc.  I don't know how this works either. 

You know, all of it depends on your previous reason for c/section too.  Where do YOU feel like you need to be???

Good luck!
 

[MunchiesMom]

Thanks for the info and the input. I appreciate the encouragment to follow my gut. And if I'm listening, I think that tells me options #2 and #3 are at the bottom of my list!

I adore MW #1 but hate the idea of driving two hours to birth... What if it stalls out my labor? What if we have to drive over night (which scares me) or on a snowy, icey interstate (which really scares me, I have driving fears apparently)? I don't want to be two hours away from DS. Nor do I want to drive with a newborn. Plus, it's not like MW #1 would be a part of the birth... she'd share prenatal care with the MWs at the VBAC-friendly hospital two hour away. So I probably wouldn't see her much on the birth day.

[MunchiesMom]

Thanks for the earlier replies...pretty split, like I am!

Does anyone have research about when during labor the risk of UR is the highest? Is it more likely during contractions or the actual pushing?

[neveraim]

I believe it's very late in labor...transition/pushing when your uterus is working hardest.  The VBAC doc around here does not like you to be at the hospital unless you are well into labor...the later the better.  He attends all types of VBACs...after multiple c/sections, special scars, etc.  If he was concerned about UR during labor, I would think he would want women to come a little earlier...He pretty much tried to talk me into leaving (a VBA3C) when I was 3 cm and contractions were about 2-3 mins apart and 60+ seconds long.  (I'm glad I stayed because I was pushing a few hours later)

Of course, It CAN happen at any time and to anyone (even women who've never had a c/section) but most likely, yes, when pressure on the uterus is greatest. 

 

Originally Posted by MunchiesMom 

Thanks for the earlier replies...pretty split, like I am!

Does anyone have research about when during labor the risk of UR is the highest? Is it more likely during contractions or the actual pushing?

[MunchiesMom]

NeverAim - Congrats on your VBA3C!! I enjoyed reading your blogg. Your ob sounds like a Godsend. I wish we had a hidden gem like that where I live!

[AlexisT]

I would probably go with #1. I definitely wouldn't want a MW I didn't trust and who had a poor reputation, so #3 is out. #2 sounds dodgy - a not really supportive doc and taking your chances. Thing about a traveling midwife--would you get to meet her first? At least with a MW 2hrs away you could meet them beforehand, maybe early on so you could be sure it was right and have time to change your mind.

[neveraim]

Thankyou...he is wonderful, I love him!!!

 

Originally Posted by MunchiesMom 

NeverAim - Congrats on your VBA3C!! I enjoyed reading your blogg. Your ob sounds like a Godsend. I wish we had a hidden gem like that where I live!