Disappointing 12 week apt

[musikmama]

Had the VBAC "counseling" when I went in for my 12 week appointment this past Wednesday. I asked her what the VBAC success rate was for all of the physicians in the office (there are 6 docs in the practice, I think, and you get whom ever is on call) and she said 60-80%......obviously the national statistic and not answering my question. And went on to say that it depends on the individual situation and no the doctor on call. Really? I'm a teacher, and that's like saying my students' learning is only my responsibility.  She then told me that at 39 weeks, they automatically schedule for a c-section.  She won't induce, and she won't allow a VBAC past 41 weeks because of the uterine scar.  I get why no inductions, my research says that is true.  But she personally doesn't go beyond 41 weeks--she gave me nothing to back that up. I'm wondering if anyone can help me in that way, because what she "feels comfortable doing" is no necessarily supported by research.  Was seriously disappointed and POd when I left her office. The one I met with was the same who delivered my son by C-section. She also told me my chances are 60%, because my first pregnancy/birth was a c/s and I hadn't had a previous vaginal birth. Looking for ACOG or other studies that disagree with some of the things she's told me. Thanks!

[TrumpetMom]

My gut reaction is find another provider if you want a VBAC. I can't see and know of no reason why there should be a 41 week deadline for a VBAC. What if your dates are off and at "41" weeks, you're actually 40? And scheduling a c/s at 39 weeks- what's that about? Sounds more like a scare tactic to me.

At any rate, keep this in mind: no one can force you to consent to surgery. Period. They can give you a hard time, but even if they schedule a c/s, they can't force you to show up for it.

There are lots of websites where you can get info on VBACs, including articles and studies. Start with ICAN (International Cesarean Awareness Network). You can Google ICAN and it'll come up. Also Google VBAC and see what you get. VBAC.com is one site I'm aware of, that has a lot of information, mostly articles.

Good luck and I hope you get your VBAC!

[LisaSedai]

You are right that alot depends on what provider you end up with and that is what really sucks about going to a practice with several doctors, Have you talked with the office staff or the nurses at the hospital your doctor uses? They might be able to give you a more useful / truthful idea of the VBAC success rate. Also, if you have a local ICAN chapter they can give you information about the providers in your area.

About the c/s scheduling- it's common in many OB practices to do this. From your post it sounds like she wants you to schedule when you are 39 weeks for a c/s at 41 weeks? Most OB's don't want anyone (not just VBAC) going past 41 weeks because the risk for stillbirth increases slightly. Some OB's will reluctantly let you go later if you do fetal stress tests/ biophysical profiles/kick counts and it shows the baby is doing ok. You might ask her about that. I have heard of people who schedule C/S who just don't show up for it (have a family emergency and have to reschedule it) Did your previous pregnancy go over 41 weeks?

http://www.midwiferytoday.com/articles/timely.asp

Postdates, by itself, is not associated with poor pregnancy outcome. Extreme postdates or postdates in conjunction with poor fetal growth or developmental abnormalities does show an increased risk of stillbirth. But if growth restriction and birth defects are removed, there is no statistical increase in risk until a pregnancy reaches 42 weeks and no significant risk until past 43 weeks. The primary "evidence" of a sharp rise in stillbirth after 40 weeks—often misquoted as "double at 42 weeks and triple at 43 weeks"—seems to come from one study based on data collected in 1958.(1)

You might ask her if she is willing to do non-drug induction, such as the foley cath in the cervix or rupture of membranes. There are OB's who will induce/augment VBACs with low dose Pitocin IV.

ACOG Practice Bulletin No 54 from 2004
(There is a new bulletin out but you have to pay to read it.)
http://www.acog.org/acog_districts/dist9/pb054.pdf

Gestation Beyond 40 Weeks
Awaiting spontaneous labor beyond 40 weeks of gestation decreases the likelihood of successful VBAC, but the risk of uterine rupture does not increase (32,330. In one study of more than 1,200 women attempting a trial of labor after 40 weeks of gestation, only labor induction was associated with increased risk of uterine
rupture (33).

There is no completely reliable way to predict whether a trial of labor will be successful in an individual patient. (49-52)

Should women with a previous cesarean delivery undergo induction or augmentation of labor?

Spontaneous labor is more likely to result in a successful VBAC rather than labor induction or augmentation (52, 61, 62). A meta-analysis of studies published before 1989 found no relationship between the use of oxytocin and rupture of the uterine scar (83). In contrast, several more recent large studies have shown an increased risk (37, 61, 62, 84). In one large retrospective study of more than 20,000 women, uterine rupture was nearly 5 times more common among women undergoing labor induction with oxytocin compared with those who had an elective repeat cesarean delivery (37). However, uterine rupture occurred in less than 1% of women in both groups. Furthermore, among the women attempting VBAC, the rate of uterine rupture was not different between those who received oxytocin and those who labored spontaneously.

 

 Most of the time VBAC success is dependent on who the provider is - I mean midwife VBAC rates are 80%-90% because they aren't in a rush to load you with interventions and they don't put you on a time clock to deliver before it's time for their shift to end. With some doctors the only way you'll VBAC is if you come in 10 cm and ready to push.

Good luck!

[musikmama]

Thanks for the replies!  I think she did mean scheduling me for a 40 or 41 week c/s when I'm at 39 weeks.  My first c/s was due to persistent OP--so it was a valid reason.  My husband was very supportive, but we went in not having a plan in how I was going to handle pain, so I think I went in too early and got an IV to start.....I didn't get an epidural until 9 cm after that wore off, and I'm positive looking back, that I was in transition during it.  I went into labor on my own, 5 days before my EDD.    I'm not as worried about going past 41 weeks for that reason, but more so for the onslaught of interventions that already seem to be hitting me!  This time, I really do plan on waiting as long as possible to go to the hospital.  If she thinks I'm walking in the door at 40 weeks for a scheduled c/s she's an idiot. I just won't go. :)   

There are 2 hospitals in our metro area--the c/s rate is higher with a low VBAC rate at one of the hospitals, even though they have a large number of midwives employed--they aren't allowed to do VBACs. DUH!!!!  That irks me.  There are limited options for who will deliver at each hospital, as well as what my insurance will cover.  There's an in-hospital OB, then a  group of all women OBs where I currently go, and another  OB practice that has a building next to the hospital that is separate that DOES have 2 midwives, but again, not sure about insurance, and I almost am positive that my BF went there. She had 4 c/s.      There's a University hospital about an hour and 20 minutes drive from where we live, that have a higher rate of VBACs than at the hospital where I plan to give birth, but their c/s rate is higher than mine as well.  I wish there was a birth center around, but searching the internet-I found there are NONE in my entire state!

My husband was super awesome when I explained what I was told, and we talked about what we wanted to happen this time around. We both would have done things a bit differently the first time.  I know that he'll make sure I stick to my decisions and not let someone coerce us into something we don't want to do or think isn't necessary.

[justKate]

Honestly, what you were told about scheduling a section doesn't really bother me.  I was told the same thing--that they won't "let me" go beyond 41 weeks.  Well my official EDD is 3 days after MY EDD (I was charting) and DD was right on time, so if I get to 41+3...well that's not that different from 42, so I might not be feeling well that day.  Or whatever.

Did you go into labor on your own with your DS?  It does suck when you feel like you've chosen the best of a few not-so-great options.

BTW, the April 2012 due date club is here:  http://www.mothering.com/community/f/16999/april-2012  I can't remember if i've seen you there yet or not. 

[musikmama]

Labor with my DS was spontaneous, and came 5 days before his EDD. He was born 24 hours later. I'm not super worried about going beyond 41 weeks because my first one was really on time, but its still a concern because I don't want it to happen! I will have to do some checking about MY EDD, because with DS, and this pregnancy, I got pregnant immediately after stopping BC after my LMP. We're very fertile, apparently. LMAO!!! I kept track of mucus changes, but didn't do any temping.