VBAC consultation

[pearl2]

I am planning a HBAC in anywhere from 3-8 weeks (I am 35 weeks and some change now). My midwife sets you up with an OB for a VBAC consultation at week 36. I prefer not to have this appointment, but it is really important to her that I have this consultation, I suppose to have an official report somewhere as a backup OB. I understand that. 

I really don't have any questions for the OB (well, maybe one). If I did go in for non-emergent transfer OR and emergency transfer, I would not even be using this same hospital system, so it's super highly unlikely I will ever see the OB again, and he/she will not be around in the case of a transfer. 

The only question I have involves my long 42-hour labor. I guess I am curious about if this labor is also extremely long, does the length of labor put extra stress on the uterus, thereby thinning it out around the scar more? I am not even sure if that question makes sense. Wouldn't that question also involve other factors like strength and frequency of contractions, dilation, effacement, etc.? 

The reason my labor was so long last time is baby was stuck at a -1 position/station from the first check 10 hours after my water broke until 42 hours later when she was still at -1, yet I was a 9+ and 100% effaced. In between that time, we did everything we knew how to encourage her to descend: spinning babies positions/pink pelvis things, birth ball, hot showers, other interesting moves, yoga moves, climbing stairs, lunges, deep squats, walking, nipple stimulation, hands and knees, birth sling, black and blue cohosh, (here start the medical interventions) IV due to possible dehydration since I was barfing the whole time, nubain (given to help me sleep at hour 17 after water broke), transfer for epidural/pit to a hospital after 34 hours after my water broke, hanging out at a 5cm for almost 12 hours and still -1 station, then eventual C-section after hour 42 and the above stats mentioned. When they sectioned, they found her arm/hand had gotten up near her face and was wedged in there very well. They are guessing when my water broke she moved quickly into that position and just stayed there--it broke very forcefully. I really am not sure what else I could have done to get her dislodged. I started WAY low on the totem pole of interventions and carefully weighed each one before moving onto the next. 

My baby's heartrate never dipped or deceled. She was fine the whole time. I felt like I had done everything I could literally and c-section was the best option in this case. 

I have done a lot of work and do not have any fears left unaddressed that I know of. I've really tried to search for them to root them out and I'm in a great headspace as is. 

I guess my question to you is what exactly would they go over, just statistics and risks and whatnot? It is going to be awkward for me as it is since I am not planning a hospital VBAC and I don't really have many questions for them. 

[labortrials]

So this appt would be with your midwife's back-up OB?  Maybe ask her WHY she feels she needs you to do the appointment.  I assume you (or your insurance company) will be charged for this extra appointment.  Anyway, I'm just wondering who this serves?  Is it something that her back-up requires as part of his/her willingness to serve as back-up?  Is there some concern your midwife has regarding your pregnancy?

I don't think some care providers like long VBAC labors, but you might want to check with your midwife on her experience with long labors.  OTOH, all labors are different, so you might not even experience that this time around.  Ask your midwife how she handles long labors and make sure she caries pitocin in case your uterus needs help contracting down after birth.

Just try to stay active, healthy, and hydrated.  Bump up your iron stores.  And know that it's normal for a uterus to thin in late pregnancy and during labor.

[pearl2]

She uses this one hospital about an hour away (same one I had DD in) as backup, but doesn't "require" you to use them for all transfers. They are arguably the most NCB-friendly in the area. Yes, I'd have to pay the copay, but I will be out either $20 or $40, and we're paying for her services in straight up cash until we can file to see what we get back after the birth. I am guessing it's for legal purposes, as in, yes, I have had a medical consultation appointment with a full out OB in a practice making me officially aware of benefits and risks of VBAC.

She does carry pitocin and has attended all sorts of births (I think over 900) and has a great team with her (a CPM from England and another lady who I gave permission to attend). My CNM is legal to attend in my state, so maybe it is some type of requirement since she is independent that I have this consultation with an established physician. I know she said she prefers her clients to have some type of backup/shadow care. So far, I've had a great pregnancy, so I am going to call her tomorrow and try to phrase my questions as to the backup/shadow care consultation thing.