UPDATE! I feel like my pro-VBAC OB is turning against me

[satchie]

Hi everyone,

This is my first post in this forum, but I wish I had come here for support long ago. I am getting close to my due date and I feel like my birth plan is slipping through my fingers. :(

I am currently 37wks with my second child. My son was born by CS four years ago at 37 weeks when my doctor was concerned about HELPP syndrome and potential pre-eclampsia. I had rapidly climbing blood pressure and I felt awful. DS happened to be in footling breech presentation and we hadn't had time to do a version yet, so CS it was. So be it. I was disappointed, but came out of it with a healthy boy at 6 lb 7 oz.

This time, I said from the beginning I wanted to do a VBAC and both doctors in the practice were very supportive, especially since the only reason for doing the CS was that DS was breech.

But as the pregnancy has gone on, it seems like the doctors keep "mentioning" the possibility of C-sections. I started noticing it especially from one doctor (there are two in the practice) at about 32 weeks or so. He kept asking me at every visit, "So how are we delivering this baby?" and I had to remind him yet again of my wishes. It was very subtle at first, so I didn't think too much of it.

Well here I am at 37.5 weeks and the last 5 weeks or so it's like they are LOOKING for things to go wrong! I mentioned I had a rash on my belly and they sent me to get my liver enzymes checked. I am "measuring large" so they wanted me to go for an ultrasound. The ultrasound then found that I have excess amniotic fluid and estimated that the baby was almost 8 pounds, which I KNOW this OB is going to make a big deal out of, since he said a "10-lb baby" would be one of the reasons he'd want to do another CS. (By the way, I called today and learned that the amniotic fluid index was 25, which according to what I've read online is the upper limit of normal.) 

My sister, who is due a week before me, is planning a home birth with a midwife and while I thought at first that was not for me, I am starting to get envious and angry at myself for not exploring the option sooner. This pregnancy has really been quite comfortable for me, compared to the last one (I am no longer at a stressful job) but it feels like it's been one doctor's appointment or blood test after another to rule out different complications. No wonder healthcare is so expensive in this country! I'm afraid to open my mouth lest they send me for some new test.

I'm going to see the other OB (the one who doesn't seem as CS-happy) next week and see what he says about the U/S and in the meantime I've been trying to eat a high-protein, high-fiber diet in case the "excess" amniotic fluid and "large" baby size is related to borderline GD issues. Any homeopathic remedies or stories of similar experiences would be gratefully appreciated!!

Sorry for the rant! Has anyone had this experience before? Were you able to work with your doctor, or is a sympathetic midwife the only way to get a VBAC in this country (U.S.)?

Thanks for listening,

Sarah

[jenniro]

Maybe your next appt will be better, but I think you should listen to your intuition.  Put your OB on the spot, ask him/her exactly what you need to make sure they support you.   You should be able to trust your provider.  If it doesn't feel like it's going to work out, it is never too late to switch providers.  I know of women switching providers at 39-40 weeks b/c their docs were pulling bait and switches, one switched providers and gave birth the next day!

[Monkey Keeper]

I had some similar concerns show up at the end of my VBAC pregnancy.  My OB expressed her 'concern' about them and very frankly told me that as OBs, they are trained to anticipate the worst possible outcome so that's why she was mentioning things. My AFI was 31, and baby measured mid-9s at 41w. I looked her in the eye, said, "Neither of those concern me.  I know I can birth a big baby, and I know the fluid measurement is a guess at best." She smiled and said, "Okay, then we wait." She did offer a foley induction since I was closing in on 42w, but I declined and she was fine with that.  The little bit of pressure to have the baby sucked, but she admitted that it was an "occupational hazard". She swept my membranes that day, I did a little bit more to encourage labor, and I had my VBAC 2 days later. 

FWIW, she NEVER recommended an RCS. It was a dirty word in the room for us, and she even cried with me when DS turned breech at 34w. Even at the end, she was favoring an induced TOL versus an ERC. We had an excellent relationship, and I think she was as excited as I was when I turned up at the hospital in labor! 

I agree with jenniro's advice to put your OBs on the spot and demand a commitment to the birth that you want. If you can't get that then try to find another option.  It definitely isn't too late.  

[TiffanyToo]

I would encourage you to talk to your sisters midwife, explore that as an option for you and your family.

I would ask your OBs for references from other VBAC moms just to get a feel for how real they are about VBAC.

[maotmsmi]

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Edited by maotmsmi - 5/21/11 at 9:39am

[satchie]

Hi all,

Thank you all for your thoughtful replies! I took your advice and talked to the less-interventative, more pro-VBAC doctor last week and he basically said he had no problem letting me go to 40+ weeks, he's not concerned about the size of the baby, and the amnio fluid is just borderline high.

BUT, I hit a snag this week when the baby suddenly turned from head-down (though not engaged) to face-up transverse and has stayed that way for 3 days now. I am 39 weeks on Monday and I feel like time is running out for her to turn!  On the plus side, with the extra amnio fluid I think it does give her more room to flip flop around, so maybe there's hope??? 

BTW, my sister had her midwife-assisted home birth this weekend and it could not have gone better, she labored for only 3 hours. I am over the moon at the birth of my niece and SO pround of my awesome sis, but I can't help wishing our birth experiences weren't so completely opposite. I am definitely won over to the idea of using a midwife -- and isn't it International Midwife Day? Hooray for midwives everywhere!

[Monkey Keeper]

Originally Posted by satchie 

Hi all,

Thank you all for your thoughtful replies! I took your advice and talked to the less-interventative, more pro-VBAC doctor last week and he basically said he had no problem letting me go to 40+ weeks, he's not concerned about the size of the baby, and the amnio fluid is just borderline high.

BUT, I hit a snag this week when the baby suddenly turned from head-down (though not engaged) to face-up transverse and has stayed that way for 3 days now. I am 39 weeks on Monday and I feel like time is running out for her to turn!  On the plus side, with the extra amnio fluid I think it does give her more room to flip flop around, so maybe there's hope??? 

Wonderful news!!! No to request that OB to "special" you so that you don't end up with the other one ;)

Take a deep breath about baby's position.  My DS flipped to breech (half complete, other leg across my belly) and back TWICE after 33w, the 2nd time around the 39w mark!  It definitely was the fluid, because no one who palpated me questioned that he had plenty of room to turn. Are you seeing a chiropractor who is Webster certified?  If not, go pronto. I also had great luck with massage--not the spa kind, but medical massage.  Lots of doulas are LMTs and have great experience with pregnant bodies and baby positioning. If you can, try acupuncture and moxibustion. Plus there are lots of things you can do at home--check out spinningbabies.com.  Pelvic tilts are great, as are inversions.

You have time--and space!!

[satchie]

Originally Posted by PinkBunch 

Wonderful news!!! No to request that OB to "special" you so that you don't end up with the other one ;)

Take a deep breath about baby's position.  My DS flipped to breech (half complete, other leg across my belly) and back TWICE after 33w, the 2nd time around the 39w mark!  It definitely was the fluid, because no one who palpated me questioned that he had plenty of room to turn. Are you seeing a chiropractor who is Webster certified?  If not, go pronto. I also had great luck with massage--not the spa kind, but medical massage.  Lots of doulas are LMTs and have great experience with pregnant bodies and baby positioning. If you can, try acupuncture and moxibustion. Plus there are lots of things you can do at home--check out spinningbabies.com.  Pelvic tilts are great, as are inversions.

You have time--and space!!

Thanks so much for the encouragement. :)

I did start seeing a chiropractor last week and she definitely helped me get my hips re-aligned and now I realize that's when the baby went all the way head-down. Before that she was mostly head-down but still kind of diagonal. However, I only went on Monday this week and it was Tuesday morning that I woke up and felt that the baby had turned again. I could actually see her back, as the lower half of my belly was flat like a shelf -- it was kind of freaky! I will go back tomorrow and maybe she can help me get her positioned correctly again.

I did check out spinningbabies a few weeks back but if I remember the website said not to do inversions if there is a lot of amniotic fluid and the mother has given birth before. Maybe I misunderstood; I found the website to be a little confusing.

Sarah

[Monkey Keeper]

Sarah---get thee back to the chiropractor! It will help. I also would read up on belly binding to find out if that might help keep her in place (though I really think that the fluid is largely to blame ;) ). As for the inversions, I did not do the ones on an ironing board, just the hands-and-knees ones down the stairs. If you know baby isn't head down, either those or pelvic tilts will hopefully help get her up out of your pelvis and give her room to move. You also can try putting a bag of frozen veggies near baby's head to see if she will move away from it.  But moxabustion has, by far, the best rates of turning a non-vertex babe.

[satchie]

THANK YOU, THANK YOU, THANK YOU for the suggestions and encouragement. I really want other mamas to read this and be encoraged, because I was losing hope and guess what! Delivered an 8-lb whopper of a healthy baby girl this morning!

Thursday they checked the fluid and it was up to 28 so the perinatal doc marched in and basically lectured me for 5 minutes about doing a CS and why hadn't I already scheduled one for 39 weeks?! He was almost indignant about it. I was so angry I was shaking - he's not even my OB! I called my OB immediately after and he talked me down again and said "Come in tomorrow and we'll talk this out."

It turned out to be the more conservative doc in the practice in that morning but I just had a really honest heart to heart discussionn with him where he spelled out all the risks and I told him point blank I still considered it worth the risk compared to major surgery and he agreed to wait and see what would happen over the weekend before checking in on Monday. The last thing he said was, "so hopefully you'll be waking me up at 2am this weekend." (No pressure or anything!)

I went straight to my chiro for adjustment work and the whole time she kept repeating, it's going to work out, just visualize it and have faith. I also went home and did 3 inversions off the couch and 3 pelvic tilts and by night time I was sure she had turned down again. I took some primrse oil and enlisted Dh's help with a few hormones and what do you know but my water broke at exactly 2am. Ha! They aren't kidding when they say polyhydramniotic water breaks like Niagara Falls, btw!

Contractions started shortly after at 7min apart and had progressed to 3min by the time we got to the hospital, and within 5 hours I was fully dilated and pushing, and she was born under 30 minutes later. The doc said, "Well, you proved us wrong! And if you want to do another VBAC there's not a damn thing we can say about it!"

Sorry for the long post but I just wanted to share my experience that inversions and chiro totally worked for me in case anyone is in the same predicament. And also to thank everyone for their support - I am afraid I may have given up if I hadn't posted here.

Proud mama to my little 8 lb chunker...
Sarah

[satchie]

Please excuse any typos, I am not good typing on my phone!

[cinderella08]

Yay, yay, yay!!!!!!!!  So proud of you for standing your ground!  Well done mama!

[Monkey Keeper]

Originally Posted by satchie 

THANK YOU, THANK YOU, THANK YOU for the suggestions and encouragement. I really want other mamas to read this and be encoraged, because I was losing hope and guess what! Delivered an 8-lb whopper of a healthy baby girl this morning!

Wooohoooooooooo!!!!!!!!!!!!  Congrats momma!  I'm so proud of you for standing up for yourself and so thrilled that you had an awesome birth.  Welcome to the world, little one!!

[LisaSedai]

Congrats on your VBAC! So glad you proved that OB WRONG. Happy birthday baby!

[CookAMH]

I'm so happy for you! Way to stand your ground and great job giving birth!

[lawmama1984]

Just saw this thread but wanted to share my congrats too! You did an awesome job...I am so happy for you!!!

[satchie]

Thanks so much everyone! I am thrilled with my girl and with how everything turned out. It went even better than I would have hoped. It's funny how I ended up with the doctor I was afraid I'd get, and yet the birth experience was wonderful, even peaceful. It was just my husband, me, my doctor and one nurse, and they let me decide when to start pushing. So I didn't feel rushed or like it wasn't in my control. And when she was born the nurse handed her right to me and then left us alone in the room with her. I barely remember seeing my son at birth and I didn't get to hold him until hours later, and I was too drugged up to properly enjoy it.

Two very interesting things I learned later. Apparently the nurses' station was buzzing that there was a successful VBAC. Two different nurses told me they hadn't seen one in a long time -- how depressing! But one of them (my favorite nurse from our stay, she was amazing!) said "Please go around telling people you had a successful VBAC. Maybe you'll start a trend!"

The other thing was that the doctor I was complaining about earlier who had lectured me for not having already scheduled a CS (I'll call him "Dr. No") actually complicated things even more than I knew at the time. After lecturing me, he faxed a recommendation to my OBs that I deliver by CS at 39 weeks. As my OB explained later, by doing that Dr. No introduced a legality issue. Now my OBs could be held accountable if they ignored that recommendation. He said, "He should know better than to put something like that in writing. But he's the youngest doctor in the practice."

I feel like I should call this Dr. No and give him a piece of my mind. Who is he to insert himself into the decision between me and my doctors? At the very least I can gloat over having breezed through labor despite all of his dire predictions. 

[satchie]

One more thing... I just called to make my post-partum followup appointment, and the receptionist who answered said "Good for you! I wanted to do a VBAC but I gave in at the end."

I had no idea it was so rare to have a VBAC around here! This is starting to make me angry. Especially how she said "gave in" like that. You know she was probably pressured from every angle to just go ahead and have the C-section already, even if it wasn't what she wanted.

I did hear that the new director of a nearby hospital (not the one I delivered in) wants to make VBAC more of the norm. I hope that campaign is successful. Every doctor I've talked to, when asked directly, says it's the safest and what is recommended, and yet none of them seem to want to actually do one!

[Monkey Keeper]

Originally Posted by satchie 
 Apparently the nurses' station was buzzing that there was a successful VBAC. 

While the hospital where I deliver does a lot of them, I had quite a few nurses/aides comment about it to me, particularly since my DS was well over 9lbs. I even got to encourage an aide who was pg to go for it! :D I kinda like being an ambassador.
 

[Lisa1970]

I had already had 2 vbacs when I got in to a supposedly proVBAC doctor who lied to me and claimed I had previa when I did not. I found out after the csect that he was lying. That was my 2nd csect. I switched to another OB for the next. Then at 36 weeks, her office suddenly decided no vbac and I had to have a csect immediately, or they would call CPS on me. That was my 3rd csect. Then I went on to have a vbac elsewhere. But then, with the next child, the doctor started ordering weekly sonograms and NSTs. She insisted the baby could die and she was so worried. Then she sprung on me that at the first sign of any labor, I have to be in the labor and delivery, on monitors, and not move until the baby is out and alive. Every time I spoke to her, she expressed worry that the baby will die. That became my 4th csect. 

If I could do it over, I would have left these doctors when they turned sour, even if it was in the 41st week.