I NEED PRINT-OUTS OF ACOGs OFFICIAL STATEMENTS ON VBAC, VBA2C, & GOING PASSED 42wks. PLS READ!!!!!

[danalyn]

IN the interest of time, I will get right to the point of my post.  to quickly summarize, I am 41.4 days along with baby #7, first 4 births were PIT induced vag. births, #s 5 & 6 were c-section with the first being b/c of baby girl's 10cm ovarian cyst & my polyhydramnious & the 2nd cs b/c of 2 local hosp. VBAC bans.  Also, I've gone 14 days passed EDD twice. once with this OB.  20 yrs ago I broke both my pelvis and tailbone.  Quite possibly that is why I don't labor naturally.  ?  Anyway, this pregnancy has been dif. in that I've been having weekly adjustments since March w/ a chiro who has a strong interest in VBAC, I've recently had ONE session of acupuncture, it is confirmed that my baby HAS significantly dropped, I've been having some really NICE contractions, as well.  So, a VBAC ban went into effect at my hosp. about 8 yrs ago.  I've had the same OB for 5 babies now.  She has always been (supposedly) pro-VBAC. Well, yesterday I went to the hosp. for my 2nd NST.  Everything seems EXCELLENT.  My OB told me last week that she DOES NOT want me to go over 42 weeks.  She gave me some rather "frightening" info on the placenta no longer functioning and me giving birth to a "dead 10 lb baby".  (i have big babies).  Well, yesterday, she called my room at the hosp, informing me that she put me "on the schedule" for a CS for this morning, "in case" I wanted it.  I told her, "no, take me off".  She asked what my plan was.  I told her I'm planning to wait another week or so.  To that she replied, "I hope your baby doesn't die."    She also told me, that babies chances of survival decrease after 39 weeks.  OK, so I know she is just trying to "cover" herself here.   I also am aware she is using "fear tactics" IMO to do so.  It seems to me like she is making medical decisions with the hosptial's and her best interests in mind, NOT MINE or my BABY"s.  she is aware of the "progress" i've been making.  She is aware of my desire to VBAC. FTR, I could not find an OB or fam. practice doc who would take me after 2 CS.  I found ONE doc. who said she would only give me a couple hours to "remain at any given dialation w.o change" b/f calling for a CS.  that just scared me.  I'm thinking about calling her again, to see if she'll still take me, but I know it's late in the game.  so anyway, I NEED OPINIONS AND FACTS, ON ACOGS OFFICIAL "STATEMENTS" ON VBACs, VBA2CS, AD GOING POST DATE.  I'VE LOOKED AT THEIR WEBSITE, NOT SURE WHAT IF ANYTHING I SHOULD PRINT OFF.  ALSO, WHAT DO YOU TH INK OF WHAT SHE SAID.

OMGosh, THE hosp OR just called to ask if I'm coming in  for my CS this morning.  I told the woman what the OB said to me, she said "that is just wrong" and voluntarily gave me admin's phone numbers including CEO phone numbers to call.  yes, i know i should have done this weeks/mos ago.  

[khaoskat]

Ok, I will say I am not sure where to find them, but I will go immediately post on ICAN's yahoo group and see if someone can come give you the information.

You can also join the yahoogroup yourself, as there are many supportive ladies there.

As for your OB - I wont say anything, because what I have to say is not kind....

Let me give you my history..

DS1 - 42 weeks 5 days - Vaginal Birth after 23 hours of induced labor -- 9 lbs 2 oz 23 inches

DS2 - 42 weeks exactly -- 10 lbs 22 1/2 inches

DD 1- Not important for this discussion

DD2 - 40 weeks 6 days - C/S for turning transverse lay stuck arm out and wedged shoulder in during pushing phase -- 9 lbs 3 oz 22 inches

DS3 - VBAC - going by my dates - 42 weeks 1 day - going by OB 40 weeks 1 day - going by US 43 weeks 3-5 days.  11 lbs 1oz  21 1/2 inches

[ablepearl]

There was recently a discussion on the ICAN list about post dates and the placenta fears for post-dates.  Basically they said it is a non-factor.  You may just need to gestate longer.  If you were able to have a vaginal birth after induction I would say your injuries have no bearing on your ability to go into labor on your own.

The largest number of stillbirths happen at 38 weeks, even at 42 weeks there are less than at 38, although there are more at 42-43 weeks than at 39.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28178/

You can always type up a 'consent form' for the doctor to sign, something like this:

  It should state that:
 * she does not want a repeat cesarean section
 * she is aware of the potential risks of a repeat c-section, including placenta accreta, hemorrhage, increased risk of stillbirth, infection,  increased risk of maternal death, and four-fold increases in neonatal 
respiratory distress
 * she is not being offered a choice of how she will give birth
 * if she experiences any complications as a result of being forced to  have a c-section, she will be pursuing legal action against the provider who would not support her in a trial of labor."

VBAmC info from ICAN http://www.ican-online.org/vbac/vaginal-birth-after-multiple-cesareans

[ablepearl]

updated ACOG recs   http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm

[ablepearl]

Also, a GENTLE induction can be done, it isn't the best option, but it is an option.  Some doctors will say NO WAY, but if it is done properly it can be safe.  Read up on the symptoms of UR and be prepared incase it happens.  But the risk of rupture with induction is still less that 5%, so there is a 95% chance that there won't be a rupture.  I know many women would not want to go this route, but I would take a gentle induction at 42 weeks over a 100% chance of c-section.  FOley bulb, stripping of membranes or maybe, maybe rupture of membranes if I knew baby was in a good position.

Are you currently in teh hospital?  If so that is a bummer because sex could be a big help in getting you into labor.

[AFWife]

Originally Posted by ablepearl 

Are you currently in teh hospital?  If so that is a bummer because sex could be a big help in getting you into labor.

Personally, I wouldn't let that stop me if I really wanted to do it naturally...

[ablepearl]

Originally Posted by AFWife 

Personally, I wouldn't let that stop me if I really wanted to do it naturally...

I wouldn't either 

[AFWife]

Originally Posted by ablepearl 

I wouldn't either 

And sex is EXACTLY what "induced" me with my last birth...at 37 weeks. I'd had a few good, but random, ctx the previous day so we had sex to try to get things going...and had a baby 24 hours later.

[miriam]

danalyn, I hope you are OK.  Please post and let us know.  

[konayossie]

Originally Posted by ablepearl 

There was recently a discussion on the ICAN list about post dates and the placenta fears for post-dates.  Basically they said it is a non-factor.  You may just need to gestate longer.  If you were able to have a vaginal birth after induction I would say your injuries have no bearing on your ability to go into labor on your own.

The largest number of stillbirths happen at 38 weeks, even at 42 weeks there are less than at 38, although there are more at 42-43 weeks than at 39.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC28178/

I don't disagree with what the intent of what you're saying (that going to 42 weeks or even a bit past isn't the dire situation that this horribly insensitive OB seems to believe. However, I did want to point out that when people are reading this, they need to look not just at the # of stillbirths each week, but those numbers in relation to the # of overall births since there are fewer pregnancies each week, especially past 40 weeks, so a lower # of stillbirths doesn't necessarily tell you much about the percentage. Better to check over to the last column with the prospective risk for unexplained fetal death by week. Thanks for the link to this study--I hadn't seen this one!

[ablepearl]

At 38 weeks the risk was 1:529 births

At 39 1:617

40 weeks 1:680

41 weeks 1:606

42 weeks 1:565

 the risk then increased again to 1:465 births, which is approximately the same as the risk at 37 weeks of 1 out of 475 births.

So while there are less births at 42 weeks, there are not more deaths per hundreds of births at 40, 41 or even 42 weeks.  (this information was from the table in the linked study)

[konayossie]

Right, I guess I found this really interesting b/c the HCPs yelling about inductions aren't lying that one's risk of unexplained FD do go up (albeit very little and very slowly) from 40 weeks on--but they are also BEST at 40 weeks (so why the push to induce/RCS at 39 weeks?) So yes, more babies die at 38 weeks than at 39, 40, or 41, but the odds are slowly increasing from 40 weeks on.
 

Originally Posted by ablepearl 

At 38 weeks the risk was 1:529 births

At 39 1:617

40 weeks 1:680

41 weeks 1:606

42 weeks 1:565

 the risk then increased again to 1:465 births, which is approximately the same as the risk at 37 weeks of 1 out of 475 births.

So while there are less births at 42 weeks, there are not more deaths per hundreds of births at 40, 41 or even 42 weeks.  (this information was from the table in the linked study)

[ablepearl]

I suppose it is one of two things.  Either the doctors really don't know what the research says on stilllbirth after 40 weeks, which is very possible, or they do know and they are just misrepresenting the truth.  Yes, it is truw that the risk does increase, but it never get worse than the risk at 37 weeks.  So, while it is true that the risk increases, leaving out the part about it still being less likely at 42 weeks than 37 weeks really changes what they are saying.

I am putting my eggs in the doctocrs don't know the truth and trhey just repeat what they have heard others say.

[konayossie]

Yeah, DH and I were talking about this last night, trying to figure out how docs end up saying such awful (and ridiculous) things to women like in danalyn's case (I read him the OP). My guess is that they have just been taught generically that "the risk increases after 40 weeks" (without every looking at the studies themselves) and then I figure if they've ever had a case of unexplained late term FD in one of their patients, they become complete supporters of "get 'em out as soon as possible" to try to prevent a future death. A very human reaction, but not a very scientific or evidence-based one....
 

Originally Posted by ablepearl 

I suppose it is one of two things.  Either the doctors really don't know what the research says on stilllbirth after 40 weeks, which is very possible, or they do know and they are just misrepresenting the truth.  Yes, it is truw that the risk does increase, but it never get worse than the risk at 37 weeks.  So, while it is true that the risk increases, leaving out the part about it still being less likely at 42 weeks than 37 weeks really changes what they are saying.

I am putting my eggs in the doctocrs don't know the truth and trhey just repeat what they have heard others say.