Seeking advice/advocacy/help with VBA4C or HBA4C

[SweetPea17]

Hello! I am new to this discussion board but have found most of the posts regarding VBAC very helpful. I haven't found anything pertaining to my specific situation, so here goes.

I have 4 beautiful children with my 5th on the way (34 weeks gestation). All my previous children were C-sections. The first one: an emer. c-section for "failure to progress" (more or less), subsequent children ERC's because hospitals had VBAC bans and I wasn't informed of any other options at the time. We are living in a different state now, and I am so happy to be seeing a midwife and staying out of the medical atmosphere. However, due to a recent change in ID law, my midwife cannot deliver my baby without consent from a doctor

I am left with a just a few choices: go with a midwife who is not licensed and do a homebirth; possibly birth in a neighboring state at a hotel with the same or a different licensed midwife (still looking into the laws about that); drive to SoCal where my mom lives and have a birth there (husband would not be able to attend bcuz of work); or have another c/s.

Does anyone have any encouragement, advice or ideas that would help me out? I would greatly appreciate it.

[kltroy]

With 4 previous c-sections you have some risks no matter how this birth goes down.  I'm sure you will find no data on this, since very few women attempt a VBA4C.  I'm guessing that the risk of UR is certainly greater than it is after 1 or 2 c/s (I find it impossible to believe it wouldn't be).  So the real question, given that you have no data to work with and given that a 5th c-section also has problems, is how do you get the birth you want in the safest way possible? 

Personally, given that I'm guessing the risk of UR is not negligible (let's say, for the sake of argument, that it's around 5%) I would not be comfortable having a home birth in this situation.  Your own comfort level may be different.  I would *definitely* not be comfortable having a home birth with a midwife who did not have a license and/or (ideally) admitting privilages at a local hospital in this situation.  The problem is that IF there is a problem or a potential problem, if your MW is unlicensed and/or will not be able to accompany you to the hospital or even acknowledge that she is your MW, she may be hesitant to have you transfer.  And this could increase the risk of a bad outcome. 

So this leaves you with a hospital birth.  Ideally, you would find yourself a doctor who truly believes that you have the right to *try* anything as long as you really truly fully understand the risks.  (yes, these people exist).  If it were me, I'd go into the hospital, go ahead and have the EFM (because this is the most reliable method to detect UR the soonest -- and we are working with the assumption that you are at elevated risk for UR relative to most VBACs), sit on the birth ball or in the tub (see about a telemetered system), and have your baby. 

How do you find this person?  I'd start by contacting your local ICAN chapter -- they generally know who is VBAC supportive within your community.  Another option would be to show up at a local VBAC-friendly hospital ER when you are in labor, let them know you're a VBAC if they ask, allow them to monitor you but otherwise leave you alone, and have your baby.

Best of luck!!

[Drummer's Wife]

But is a hospital birth really an option?  If the laws are such that MW's can't attend vbamc, then I would assume that there aren't any hospitals willing to agree to a VBA4C.  I really don't have any helpful advice, OP, but feel for you b/c I would also love to at least be able to attempt a vaginal birth after 4 c-sections, but am not sure I'll ever be able to find a provider. (not that I'm even pregnant, yet.)

Best of luck, and please keep us updated. 

[SweetPea17]

Kltroy, thanks for your reply.

You make some very good arguments about the unlicensed MW. However, if I stay with my current MW and we go out-of-state, will she still have privileges to accompany me, if it's needed? I know she will get in trouble if we stay in-state, so that is definitely out of the question. I don't know of any doctors around here would even let me try either.

I subscribe to ICAN, and have looked extensively at their listings and articles. Unfortunately, they don't have a local chapter where I live. I hope to start one in the near future, but that just leaves me to the regional coordinator, whom I've already emailed about my situation. I'm hoping she'll have some good advice and suggestions for me.

I will definitely keep y'all posted! Thanks!

[SweetPea17]

UPDATE!

Well, I found a different MW from out-of-state and we are going to get our HBA4C! She's experienced in HBACs, so I feel confident that we will tsf in time if it is necessary, which I'm hoping is not going to be the case, but you never know!

Anyway, thanks to all the moms for all the support and advice. I REALLY appreciate sooooo much!

Praying everything goes well!

[nirem]

I know this is old, but I was wondering how it went?

[Kwgrlup]

It looks like she was successful!  http://www.mothering.com/community/t/1318288/intro-to-me-and-my-desire-for-a-vba4c#post_16530583