VBA2C - Due a few days ago - help needed ASAP

[cinderella08]

Hi fellow VBAC mama's!

I'm a doula and currently have a client who is 40+3.  She had a cesarean after a failed induction with baby #1, and a RCS with baby #2 after not finding a supportive provider.  She wants a VBA2C desperately.... 

Her provider has been fairly supportive up until this point, but today baby got a 8/8 on the BPP and looks great but her fluid is slightly decreased - 6.5 and they want it at a 10-20. Her BP was slightly elevated at 130/88, but she is massively stressed over this situation and is sure the BP elevation is due to that.  No swelling, protein in urine, ect...  She even lost 2lbs.  Baby's HR was perfect, practicing breathing, ect..  Everything else is 100% fine.

The OB's have changed their story and are no longer supporting her choice to VBAC. She's scheduled for a cesarean Wednesday.  She refuses to go.  She wants to change providers.  Even to a provider who will do a low, slow, gentle induction at this point would be preferable to the cesarean.  However, none of the OB's at her current practice are willing to do a gentle induction since she's a VBA2C and they say the risk is too high (even though mom is 100% fine with that risk).  Her cervix isn't favorable - only 50% effaced and a finger tip dilated - but she still greatly prefers induction if her fluid continues to drop compared to a RCS. 

She's at a loss as to what to do.  Her OB did nothing but try to scare the life out of her today by telling her her baby would die with low fluid due to cord compression.  He must have said "dead baby" 25 times.  She sobbed in my arms after he left the room. 

I've dealt plenty with VBAC mom's and am a VBAC mama myself, but have never seen such bullying like I saw today.  This poor woman.  What else can I say or do?  Can this mama say anything?  Can she possibly demand an induction?  She's considering just now showing up for her scheduled c-section, but she's scared. 

I guess I just needed to vent and looking for support for myself so I can support this mama....  Any thoughts would be appreciated! 

*** UPDATE ***

She did it.  My amazing mama reached down and pulled her baby up and out - successful VBA2C. It's a boy, and her biggest yet at 8lb 3oz. After 5 days of intense prodromal labor, and 16 hours of 'real' labor - she did it! And I am so proud of her! The look on her face was simply amazing.  We *KNEW* she could do this!

Also - for anyone who asked about HIPPA/confidentiality and me giving details about her case - there should be no worries.  I had complete permission from this mama to ask fellow doulas, midwives, and other knowledgeable people about her situation.  She knew I was posting here in the VBAC forum, and was 100% fine with that.  So there should be no worries!  I don't want anyone thinking that I - or any doula - posts case specific info all over the net unless I have explicit permission!

Edited by cinderella08 - 7/18/11 at 9:40pm

[SAMarshall]

I'm no expert, but I'm going for a VBA2C also. If it were me, and since it is a bit late to switch providers, I would not show up for the c-section. It is still within her rights to refuse any treatments her OB "suggests." I would say, make sure she is well-informed about what is considered "low" AFI, and also about elevated blood pressure. I'm pretty sure fluid levels tend to decrease in later pregnancy, and that is perfectly normal. I went past 41 weeks with both of my pregnancies, and I would not be induced in any way. So, for me personally, I would refuse the c-section, suggest NST's however often the OB wants, and simply state that I will wait for my baby to choose his/her own birthday. There is no reason to induce or schedule a c-section if the baby is doing fine. She can try to increase her amniotic fluid by resting and drinking plenty of water. Then they can repeat the AFI scan in a couple of days. Those are my thoughts, just coming from my research and experience. I hope everything goes well with her birth!

[Monkey Keeper]

I agree with SAMarshall--I'd schedule another AFI/BPP and hyper-hydrate in the meantime. Also, under what conditions was her BP taken? Did they take it later in the appointment to double check? Can she check it periodically at home?   

I don't *think* that 6.5 is terribly low (though I am not well versed--I'm a polyhydro kinda gal), and it DOES change. Especially if it was as hot was it was here today!

Is there any way your provider would take her since you had a successful induction?

[elisheva]

ITA with Pink...if she is overweight, are they using the appropriate size bp cuff? Are they taking the reading by hand or with an automated machine. My readings are much higher with the machine.

[cinderella08]

According to AAFP, "normal" fluid levels in women of 40-42 weeks gestation is 5-25, so she's within normal range.  It is in the 100's here, scorching hot!  She's hydrated, hydrated, hydrated all day today.

She's monitored BP at home and it's been 100% fine.  They used the correct BP cuff and she isn't overweight.  She was just very stressed out and nervous and I'm sure that is why her BP was slightly elevated.

She's been having very irregular contractions since about 8am.  She goes in for another BPP today to check AFI.  She'll also have her cervix checked and if she's open enough, her OB will do a membrane strip.  Hopefully with the irregular contrax she's already having that may push her into full labor.

She can't see my provider as I saw a CNM and the CNM's at the practice are "allowed" to see VBA2C, only VBAC.  :(

The plan is to just cancel the cesarean for tomorrow and push the OB off until Friday (she'll be 41 friday).  If no baby by Friday, she wants to go in for another BPP and/or NST to check baby.  If baby is fine, she'll continue to wait. 

[SAMarshall]

That plan sounds like a good one to me. I would suggest she always have someone (either you or her partner/spouse?) with her for support so she won't feel bullied or pressured into something she doesn't want. I know going past 41 weeks is tough, but a lot of babies are meant to. And due dates are just estimates. Remind her of that! :o)

[akind1]

Amber, will the OB side do VBA2C? hope this is it for her!

[kltroy]

i dealt with this issue w/ my VBAC a few years ago.  Fluid levels below 5 would be a legit worry about blood flow with the placenta.  Above that and they shouldn't be bugging her.  For her NST retest today, make sure she drinks plenty for the 24 hours before, and eats a good meal about 30-45 minutes before she goes in. 

Ultimately, if the baby needs to come out b/c of a legit concern, she can opt for a gentle induction with pitocin.  This is a good option esp. if her cervix is already pretty soft/dilated.  Pit only inductions are associated with minimally increased risk - one that I would personally be comfortable with (around 1% UR rate). 

[LisaSedai]

Sending ELV and good wishes to the Mama. It is hard to hold your own against OB scare tactics that would sure make my blood pressure go up.

[greenhands]

http://www.glorialemay.com/blog/?p=60

Hugs to you both.  It takes a brave woman to be willing to go back in for another BPP/NST at 41 weeks after the complete and utter disrespect she was shown (not to mention lack of informed consent!).

[Mama Willow]

How about some natural induction methods?  My OB gave me a list.  EPO orally and vaginally, walking, fresh pineapple, eggplant parm.  And of course sex.  I'm not sure which of these helped me (if any) but had a successful VBAC 1 day before due date.  Good luck!

[ablepearl]

Have her soak.  In a pool or a tub with epsom salts to help increase hte fluid levels.

[christyk]

You mentioned looking for support, to support the woman.

I find myself thinking about my second child's birth and the wonderful doula I had then. I was trying for a vbac. I desperately wanted the vbac and my doula was wonderful at encouraging me, supporting me, giving me information. She did everything she could to help me have that vbac. But then when it became obvious that continuing on that path would put my child at risk, she helped me shift gears. When my OB was snarky, she agreed that yes, the OB had been snarky and mean, but she also pointed out that the OB looked scared. She helped me recognize that the OB was just... trying to make the best of a bad situation. She helped me trust the OB. Though she was incredibly tired (from a long, long day with me) she sat with me in the recovery room while I was on oxygen. Then I remember when I was holding my baby after the csection and she was getting ready to go... I offered to let her hold my baby and she said no. She said she would another day, but to let the baby snuggle with just me that day, and somehow, it helped to hear that. It might sound weird, but it was her way of affirming that despite the csection and everything, I could still have this special bonding time with my baby.

My doula helped assure me that I wasn't a failure, just because I couldn't have a vaginal birth. She helped make the csection special. She helped make sure I was breastfeeding fine. She listened to me when I was angry at the OB, but she also helped me make peace with the OB. I'm really greatful for that.

I'm new to mothering.com. Or rather I've been lurking for a while but too scared to post, but I wanted to post this, because I think... there's more than one way to support a mother in this situation.

Best of luck.

[hildare]

i don't know so much about the epsom salts.. my reasoning is thus:  magnesium is used to stop contractions in PTL.  i really have it in my head that ES can disrupt labor for some reason....

breast stimulation.  as much as possible.

[kltroy]

Well said.
 

Originally Posted by christyk 

You mentioned looking for support, to support the woman.

I find myself thinking about my second child's birth and the wonderful doula I had then. I was trying for a vbac. I desperately wanted the vbac and my doula was wonderful at encouraging me, supporting me, giving me information. She did everything she could to help me have that vbac. But then when it became obvious that continuing on that path would put my child at risk, she helped me shift gears. When my OB was snarky, she agreed that yes, the OB had been snarky and mean, but she also pointed out that the OB looked scared. She helped me recognize that the OB was just... trying to make the best of a bad situation. She helped me trust the OB. Though she was incredibly tired (from a long, long day with me) she sat with me in the recovery room while I was on oxygen. Then I remember when I was holding my baby after the csection and she was getting ready to go... I offered to let her hold my baby and she said no. She said she would another day, but to let the baby snuggle with just me that day, and somehow, it helped to hear that. It might sound weird, but it was her way of affirming that despite the csection and everything, I could still have this special bonding time with my baby.

My doula helped assure me that I wasn't a failure, just because I couldn't have a vaginal birth. She helped make the csection special. She helped make sure I was breastfeeding fine. She listened to me when I was angry at the OB, but she also helped me make peace with the OB. I'm really greatful for that.

I'm new to mothering.com. Or rather I've been lurking for a while but too scared to post, but I wanted to post this, because I think... there's more than one way to support a mother in this situation.

Best of luck.

[ablepearl]

http://www.glorialemay.com/blog/?p=60

[Alenushka]

I am curious about HIPAA. Are doulas exempt from these regulations? It seems that OP posted tons of  personal clinical information. If I happened to live in the area and knew the client info posted here, I would recognize the woman.   I personally, would be uncomfortable if anyone, be it OB, doula or midwife, was posting this much of my clinical info on the Internet.

 Why not advise your clients to get second opinion form another OB?   Or a midwife?  They are the professional who provide obstetrical treatments. From what I understand, doula provide non medical support and really can't give medical advice.

I can see how upsetting it is to hear about possible  death but in order to  have an informed consent form the patient, the Doctor has to stay how the procedure is done, what are the risks and benefits of the procedure and what are the risks and benefits (if any) or not doing the procedure, and if the alternative treatment is available.  It can make any sort of procedure sounds scary as the doctor has to state any risk, not matter how small.

[motherhendoula]

Originally Posted by Alenushka 

I am curious about HIPAA. Are doulas exempt from these regulations? It seems that OP posted tons of  personal clinical information. If I happened to live in the area and knew the client info posted here, I would recognize the woman.   I personally, would be uncomfortable if anyone, be it OB, doula or midwife, was posting this much of my clinical info on the Internet.

 Why not advise your clients to get second opinion form another OB?   Or a midwife?  They are the professional who provide obstetrical treatments. From what I understand, doula provide non medical support and really can't give medical advice.

I can see how upsetting it is to hear about possible  death but in order to  have an informed consent form the patient, the Doctor has to stay how the procedure is done, what are the risks and benefits of the procedure and what are the risks and benefits (if any) or not doing the procedure, and if the alternative treatment is available.  It can make any sort of procedure sounds scary as the doctor has to state any risk, not matter how small.

LOL - you can recognize someone by their blood pressure??  wow - youre good! 

OP - its moms like this that make me so happy i work postpartum only!  You labor doulas have so much more to deal with!  All i can say is good luck and hope everything goes well for your client

[Alenushka]

There is reproductive history etc. Again, perhaps I am paranoid because at my job HIPAA is serious business.

Originally Posted by motherhendoula 

LOL - you can recognize someone by their blood pressure??  wow - youre good! 

OP - its moms like this that make me so happy i work postpartum only!  You labor doulas have so much more to deal with!  All i can say is good luck and hope everything goes well for your client

[pers]

Originally Posted by motherhendoula 

LOL - you can recognize someone by their blood pressure??  wow - youre good! 

OP - its moms like this that make me so happy i work postpartum only!  You labor doulas have so much more to deal with!  All i can say is good luck and hope everything goes well for your client

What if any of her friends or family members happen to be MDC members?

Because they probably know this information:  

Originally Posted by cinderella08 

Hi fellow VBAC mama's!

I'm a doula and currently have a client who is 40+3.  She had a cesarean after a failed induction with baby #1, and a RCS with baby #2 after not finding a supportive provider.  She wants a VBA2C desperately.... 

Her provider has been fairly supportive up until this point, but today baby got a 8/8 on the BPP and looks great but her fluid is slightly decreased - 6.5 and they want it at a 10-20. Her BP was slightly elevated at 130/88, but she is massively stressed over this situation and is sure the BP elevation is due to that.  No swelling, protein in urine, ect...  She even lost 2lbs.  Baby's HR was perfect, practicing breathing, ect..  Everything else is 100% fine.

The OB's have changed their story and are no longer supporting her choice to VBAC. She's scheduled for a cesarean Wednesday.

Which could apply to a lot of woman.  But, she may also have mentioned that she is using a doula named Amber or even mentioned the name of the OP's business to a friend or family member who is interested in using a doula in the future.  That information, the area she serves, her hometown, etc. are either in her sig or in the link from the sig.  So now if someone she knows who knows her very basic history happens upon this post it is entirely possible they would recognize her and now know all about how upset she is when she's really not ready to share, or even that she is thinking of just not showing up to her c-section (which would be an extremely bad idea, in my opinion). 

Or w hat if a concerned mother in law is worried about her health and concerned that she might be getting bad advice from her doula so goes searching to find out what she can about the doula's reputation.  MDC threads show up on Google. 

Both scenarios are extremely unlikely, but both are possible.  Stranger things have happened. 

Edited by pers - 7/13/11 at 10:07pm