VBAC Hopeful -- how long to stay at home before heading to hospital?

[AlaaJ]

My sister had a c section 3.5 years ago. Baby’s head was asynclitic but they didn’t realize that until 24 hours into the labor and until she was 10 cm dilated and pushing for two hours. She was then rushed off for an emergency section.

Her due date for Baby 2 is any day now and she really wants to try for a VBAC. She lives in a country where they strongly believe that “once a section always a section.” Her plan is to stay home and labor as long as possible and then head off to the hospital (she has found a doctor there sympathetic to my sister’s wishes but she has a long list of conditions that we believe will inevitably result in a section).

What do you all think of such a plan? Ok? Bad idea? Please do advise, as she doesn’t have much time left and she really wants to avoid an unnecessary surgery! Thanks so much.

[soccerchic21]

I had a VBAC in January. I was advised to come in before I couldn't walk or talk during a contraction. However, I was also GBS+ so they wanted to make sure I got the full antibiotic dose. It is hard to say from one person to the next. This labor was fairly fast for me (under 7 hours of active labor). 

I would think she should probably stay home until her contractions get too hard to handle. As in she really needs to focus very hard. Also I recommend using labor techniques to get her baby in the most optimal position. I leaned over a birthing ball a lot and my daughter was in a great position for birthing. 

[LisaSedai]

I was told to come when contractions were 6 min apart.

My plan was to labor in a hotel room close to the hospital and not go till I absolutely had to but I had premature rupture of membranes and was GBS+ so I went in mainly for the antibiotics. I had a very VBAC supportive OB though. If he had been a run of the mill OB I probably would have gotten a repeat section.

I don't think she's crazy for wanting to labor at home for as long as possible. If it were me though I would want to be within 10 minutes or so of the hospital, just in case and so to avoid a long car ride while in hard labor.

Has she checked out the ICAN website?

ELV and good luck to her!

[jenniro]

I think it sounds like a great plan.  I would even recommend she stay home until she feels the urge to push, assuming she is minutes from the hospital.  I tried to have a VBAC in a hospital that "allowed" VBACs, but had a long list of requirements, and ended up with a c-section.  I went to the hospital too early and when my labor wasn't moving as fast as they wanted, the pressure to intervene began.  I was in labor so I wasn't able to fight like I normally could.  I gave in after 12 hours of fighting and being stalled at 4 cm.  Is is any wonder my labor stopped in a hostile environment?  I wish I has showed up pushing.  If I had been at home when my early labor stopped, I could have just taken a nap, and waited for it to start again. 

[Izzy's Mom]

Extremely good idea! The longer you labor at home, the better chance you avoid the rules and requirements of the hospital. Once at the hospital things can spiral quickly because they want you on a monitor and you end up in bed. When to leave depends on proximity to hospital, but possibly she can even go to the hospital once things are REALLY moving (contrax very close together, and long and hard) but not actually physically go in. Walk around nearby or something?

Best wishes for a VBAC for her!

[mrsberman]

Maybe you can share the list of conditions with every one. Others might have some tips to help her say no while she's in labor.

I personally plan to stay at home as long as possible, but I do have an hour drive to the hospital. Also, my hospital and MW (plus her OB) are very VBAC supportive. They only require a hep lock and continuous wireless monitoring.

[AlaaJ]

Thanks, guys, for the replies & encouragement.

MrsBerman, I don't remember all of the conditions, but they include: NO eating and drinking at all due to possible need of general anaesthesia, required IV (w/ glucose, due to not being able to eat/drink), *must* come in if water breaks, and no pitocin or labor augmentation whatsoever (if labor stalls, plan B is automatically another section). That's what I remember for now.

BTW, I started another thread asking about the option of augmenting stalled labor with nipple stimulation via breastfeeding. Does anyone know how safe that would be? I heard that this might overstimulate a uterus? (Not something we want with a VBAC.) If it is ok, when should she start? During labor? On her due date? Never, unless labor stalls?

She did check out the ICAN website, no chapter where she is now (in the middle east).

Thanks for reading!

[TiffanyToo]

 I don't remember all of the conditions, but they include: NO eating and drinking at all due to possible need of general anaesthesia, required IV (w/ glucose, due to not being able to eat/drink), *must* come in if water breaks, and no pitocin or labor augmentation whatsoever (if labor stalls, plan B is automatically another section). That's what I remember for now.

This does not sound like a very supportive VBACing environment. I would make sure she knows what the progression of labor typically looks like. http://prenatalyogacenter.com/blog/understanding-the-signposts-of-labor/  use that as a way to determine what is going on and when to go to the hospital.

BTW, I started another thread asking about the option of augmenting stalled labor with nipple stimulation via breastfeeding. Does anyone know how safe that would be? I heard that this might overstimulate a uterus? (Not something we want with a VBAC.) If it is ok, when should she start? During labor? On her due date? Never, unless labor stalls?

I think anything like nipple stimulation/sex are good methods of encouraging labor and sustaining labor. I think you can over stimulate if you fail to moderate. Continuing to stimulate without regard to the messages the body is sending usually leads to intervention or other problems like over stimulation. Listening to the body's messages is a good way to avoid intervention as well as over stimualtion.

She did check out the ICAN website, no chapter where she is now (in the middle east).

ICAN has a number of papers written that have valuble information on labor and birth.

Thanks for reading!

[trekkingirl]

I stayed home as long as possible with both my VBAC's.First VBAC was 24hrs labor and second VBAC was 5hrs. I augmented labor with castor oil. Worked well for me both times, but doesn't always work for everybody. This does cause loose stools so I had to drink a lot of fluids. This go round I was only at the hospital for 45min and she was born. Although it is really hard to travel while in the transition stage of labor like I did.

With my first (the c-section) I had all you can eat chinese buffet about an hour before my emergency c-section. I think at least drinking fluids is a must while laboring for a VBAC. Good luck to your sister.

[soccerchic21]

 I don't remember all of the conditions, but they include: NO eating and drinking at all due to possible need of general anaesthesia, required IV (w/ glucose, due to not being able to eat/drink), *must* come in if water breaks, and no pitocin or labor augmentation whatsoever (if labor stalls, plan B is automatically another section). That's what I remember for now.

 

I agree with Tiffany that does not sound supportive. With my VBAC I was offered water constantly and food. I was asked if I had dinner which I had 5 hours previous and then asked if I was hungry. I declined because I knew I would just throw it all up and I told my midwife this. I was told to come in when my water broke only because I was GBS+. 

[mrsberman]

Those are some strict conditions. My hospital has the no food in case of general anesthesia rule also, but I won't be following it. The risk is so rare and I've read about people aspirating on stomach juices if there isn't food in their system. I'm one of those people who has crazy over active stomach acid/juice production when I'm hungry, so not eating would put me in the same situation as eating.

I agree with others that it doesn't sound like a VBAC friendly environment. To automatically c/s as a plan B instead of considering other options isn't good. There are lots of VBAC women on MDC that have used low doses of pitocin in their labors. I would consider it if my labor stalled as well as AROM. 

I'm not sure about the nipple stimulation thing. I hear the contractions can be intense but I've never heard of them overstimulating the uterus. I'm going to have to check out your other thread to see what others say.  I do know of someone who used her shower head on her nipples to help get things going, but she wasn't a VBAC.

[AlaaJ]

"Al hamdu lillah" -- all thanks & praise are due to God.

Natural VBAC accomplished!

She stayed home until 5 cm and continued laboring peacefully at hospital till delivery stage, about 10 hours later. Pushing was difficult and very painful from the brief details that I have gotten so far but all's well, thank God.

[Izzy's Mom]

Wonderful news!! Congrats to her!

[LisaSedai]

Wooo Hooo! Congrats mama and happy birthday baby!