VBAC consult part 1 is today.. « Back to Group Discussions

[WindyCityMom]

I have my extra long midwife appointment today.  It's for my VBAC consult- basically to prepare me for the second part which is a meeting with the OBs at 30wks where they'll try to scare me into a corner and not consent to a VBAC.  Or VTOL (vaginal trial of labor) as they say.

I'm really nervous.  The midwife I was supposed to be with is the one who was there when I was sectioned.  We don't click.  I got a phone call to confirm the appointment and it said it was with a different midwife- one I never really saw through my last pregnancy- I don't really have a "feel" for her so I have NO idea what to anticipate!  

I'm also really nervous because I gained a ton of weight between my last visit (4 weeks ago) and now.  And they were on my about my weight then.  I have no idea where the weight is coming from!  I've been working, and am on my feet running around for a good 8-10 sometimes more hours per day... maybe I've built up leg muscle  My diet isn't unhealthy either.  

[Carlin]

Hope all goes well!

[amysue]

I hope it goes well, too!

[ilovejeff]

How'd it go?

[WindyCityMom]

Blergh.

So the midwife I saw wasn't terrible, thankfully.  I wouldn't say she was great, but I woudln't mind her attending my birth.  She rolled her eyes at the comments the other midwife made the last visit about my weight.. apparently I've gained less than I did last pregnancy, so she feels that's fine.  She told me to get some sun for my Vitamin D.  I actually kinda like her...

The VBAC stuff..

We went through the consent form line by line.  I'm really, really not happy with it.  It doesn't seem very VBAC friendly at all.  There was the usual risk stuff, which I get and am okay with.  I have come to peace with the fact that death is always going to be a part of birth and the chance of maternal and/or fetal death with uterine rupture is extremely small.

What I don't like?
-My labor needs to begin spontaneously between 37 and 40 weeks of pregnancy.  She said they will let me go to 41 weeks.  They don't induce or augment VBACs, which I'm 100% okay with.  But that means c-section if I pass 41 weeks. I'm not content with that.  She said I can come in and get my membranes stripped every single day during my 40th week if I want to.. but I'm still not content with them signing me up for a c-section on the day I hit 41 weeks.  No.  I went to 42 weeks with my DD1..

-Continuous external fetal monitoring without telemetry is mandatory for VBACs.  I can only be unplugged to go to the bathroom.  I can birth standing up next to the bed, or sit on a birth ball next to the bed, but that's just about all they'll let me do.  I'm not okay with that either.

-Also, any little thing risks me out of VBAC.  I think GBS is one of them.  If I'm GBS+  again I'm firing my midwives the day before my section date.

I'll be laboring at home as long as possible.  I'm actually okay with it if I don't even go into the hospital.  My husband agrees.  Really, really sucks...

[crystal_buffaloe]

First, I have seen your belly pics! You are teeny! Tiny! Who in their right mind is concerned about weight gain if you're active and have a healthy diet? Smaller mamas need to gain more weight!

Both of the things you bolded would REALLY concern me.

I'm hoping that you can negotiate some during part 2 of the consult, but maybe that's wishful thinking. Is there any way DH can hold the monitor to you as you stand? Maybe you can spend A LOT of time in the bathroom. Or maybe you'll show up pushing and it won't be an issue.

Unless there is clear and pressing danger, there's no way I'm being sectioned without going into labor before 42 weeks. I've already had a shitty hospital induction, and I'm also okay with no induction for VBACS, but there's no way I'm just signing up before 42+1 (I know that everyone's comfort level is different, and I have a good friend who had a successful VBAC after a cytotec !!!! AND pitocin induction).

Let us know how things go with the second half.

[Monkey Keeper]

Originally Posted by WindyCityMom 

-My labor needs to begin spontaneously between 37 and 40 weeks of pregnancy.  She said they will let me go to 41 weeks.  They don't induce or augment VBACs, which I'm 100% okay with.  But that means c-section if I pass 41 weeks. I'm not content with that.  She said I can come in and get my membranes stripped every single day during my 40th week if I want to.. but I'm still not content with them signing me up for a c-section on the day I hit 41 weeks.  No.  I went to 42 weeks with my DD1..

-Continuous external fetal monitoring without telemetry is mandatory for VBACs.  I can only be unplugged to go to the bathroom.  I can birth standing up next to the bed, or sit on a birth ball next to the bed, but that's just about all they'll let me do.  I'm not okay with that either.

-Also, any little thing risks me out of VBAC.  I think GBS is one of them.  If I'm GBS+  again I'm firing my midwives the day before my section date.

WHOA. All of these are so not even supported by ACOG. What a bunch of idiots. I cannot believe the pomp and circumstance around this whole thing! My hospital was piloting a VBAC consent form with my last which my OB gave to/reviewed with me. It was kind of similar. And my OB thought it was ridiculous (there were none of the restrictions, but a lot of scare-tactic language). She even said a bunch of OBs were trying to get the hospital to revise it and she wanted one that was the same for RCS .

Anyway...   #1 and #3 are just ludicrous, especially #3. There absolutely is NO MEDICAL REASON for it. Are they going to section every. single. mama who is GBS+??? *sigh*  That said, you will have SOME movement with regular EFM. You may even be able to at least walk around the room. Not ideal, but not as bad as you are envisioning. 

I am so angry on your behalf. SO angry.  Remember that since you have had one successful vaginal birth, you already have an OVER 75% CHANCE of VBAC success. I

[dmpkmom]

sorry to ask what others already know but is this for  a birth at a birth center or in a hospital w/ MWs? I guess regardless...I don't even think most OBs supportive of VBACs would have that stringent of "rules". I went to 42 weeks exactly w/ my last and my HBMW did had a "rule' that after 42 weeks she couldn't let me deliever at home..that I understand. I even understand if it were set at 41 weeks (w/ a bit of "IF every other day NSTs comes out okay...mom's BP is okay, no protein in urine...then there's some wiggle room). But seriously..if you don't spontaneously start labor before 41 weeks, they'll cut!  Really??? There are other means/non drug means to get labor going, like a foley balloon, nipple stim, etc. You aren't really post date until AFTER 42 weeks, not b/w 40 and 42 from my understanding.

If it is a free standing birth center and you risk out are there hospital options?

[Yeeska]

Pardon my language but why the hell would GBS affect VBAC?

I would say to just handle challenges as they come. You're likely to go into labor earlier than you did with your first, especially with good emotional preparation, chiropractic care, good fetal positioning, etc. Perhaps things could be interpreted to inducing at the end of your 41st week? In a lot of ways the midwives have to appease "their" doctors, so find the coolest one and get her to help you work the system, as necessary.

You may be surprised how few of those things become obstacles. If you get the list and PM it to me, I can give you tips for avoiding, handling, and working the system surrounding them.

[ilovejeff]

Remember that they can't force you to do anything you don't consent to...so your plan of laboring at home as long as possible sounds great, and when/if you go in to the hospital, tell them that you DO NOT CONSENT to EFM, etc. And it might be a good idea to take the ACOG guidelines with you to your next consult, since they are more in ine with your ideas than the OB's.

[WindyCityMom]

This is a hospital based group of midwives that are supposedly fabulous for non-vbac births. All of their "rules" are put into place by the OBs that they are under. 

The funny thing is the consent form they gave me cites ACOG!

RE the GBS+ stuff, it's apparently just for VBACS.. all of my third trimester labs and glucose test need to come back "perfect" in order for them to go through with a VBAC.  

My next consult is at 30some weeks with the OBGYNs in the office, supposedly they want to make sure my labs are "perfect" before they even bother with sending me to the consult.  

This is all stressing me out so much.. I can't stand it.  I lost a huge chunk of my mucus plug last night and I'm trying to take it easy today.  I wish there were better options in my area... but being a VBAC mom on medicaid.. those options are slim.

[Yeeska]

Well, there are ways to be sure to beat the GBS test...

And, of course, eating plenty of protein before the GD test pretty much assures passing it.

[MissE]

Originally Posted by Yeeska 

Well, there are ways to be sure to beat the GBS test...

And, of course, eating plenty of protein before the GD test pretty much assures passing it.

Would you mind sharing? Does it involve eating bunches of garlic again? I would be interested to know how to beat the GBS test. I was positive with DS and negative with DD, hoping to be negative agian.

[Yeeska]

Well, you can insert garlic the night before (I'd tie a string around it for easy removal) or you can insert a tampon soaked in diluted tea tree oil.

http://www.gentlebirth.org/archives/gbsAlt.html

http://community.babycenter.com/post/a26004075/natural_prevention_for_gbs

[nukuspot]

Why would you want to "beat" the GBS test?  You need to know if you are a current carrier, whether or not you choose treatment so you can be vigilant for signs of GBS in the newborn, especially if you decline antibiotics in labor.  Doing the garlic thing will only temporarily wipe out flora in the vagina, it WILL return.  You really need to know your true status so you can make an informed decision.  I have no problems with anyone who would decline antibiotics in labor (I probably would if I am positive) but I would never try to give myself a false negative test.  That is scary to me that it is even recommended.  Best to know what you are dealing with and then you can be on guard.

[MissE]

I can see where the probiotics would work. I googled around a bit and there's many things you can do but I'm not sure if I would want to insert anything in my vagina overnight. I was GBS positive with DS and being on yet another IV didn't really bother me then, I didn't know any better. I was GBS negative (without any interventions...I was just negative) with DD and the newfound freedom was amazing, even though I was on constant fetal heart monitoring. I have an OB appointment tomorrow and will ask if there's any way to get off the hook with the ABX, even though I bet it's hospital policy to treat every positive women with mandatory IV ABX.

[Yeeska]

Originally Posted by nukuspot 

Why would you want to "beat" the GBS test?  You need to know if you are a current carrier, whether or not you choose treatment so you can be vigilant for signs of GBS in the newborn, especially if you decline antibiotics in labor.  Doing the garlic thing will only temporarily wipe out flora in the vagina, it WILL return.  You really need to know your true status so you can make an informed decision.  I have no problems with anyone who would decline antibiotics in labor (I probably would if I am positive) but I would never try to give myself a false negative test.  That is scary to me that it is even recommended.  Best to know what you are dealing with and then you can be on guard.

The thing is, a person could test negative and be positive by the time she went into labor (esp one who has tested both positive and negative in the past). The information from the test is an incomplete picture, at best. And, yes, if it's just about having antibiotics or not, it's best to make an informed decision. I'm not discouraging anyone who is allowed autonomous choices from having as much information as possible, especially from as minor a procedure as the GBS swab.

The problem for WindyCity (whom I addressed to begin with) is that they could rule her out for VBAC based on a positive GBS test. If the only reason not to have a VBAC is being GBS positive, then the risks of tricking a GBS test are much lower (IMO) than having an unnecessary c-section -for both baby and mom. Beyond this, a vaginal rinse can be done during labor to kill any GBS in the vagina at the time of birth, were there cause for concern about it.

Ultimately, a GBS infection in a baby is both rare and treatable and certainly of less concern than windycity's alternative.

Personally, I am not comfortable with the risks of antibiotics unless I feel very confident that they are needed (esp for a baby), so I will likely decline the test entirely and do a tea tree rinse as appropriate during labor. I am an experienced mother and babies with a GBS infection act clearly sick. Besides, I might test negative, be positive at the time of birth, go untreated due to the earlier test, and not even be watching for the right stuff because I think I'm negative. I'm NOT saying that any of this is what others should do, feel, or think. This is just my philosophy and I'm explaining it. I don't mind doing so about any choice, esp regarding birth and breastfeeding, since I work in the fields.

[nukuspot]

If a mother is positive for GBS at the time of delivery and is untreated the baby has a 1 in 200 chance of contracting GBS.  For some that seems like a rare complication, for others that might seem like the odds are too high.  I believe that parents need full informed choice.  To say GBS is "rare and treatable" is not full informed choice.  Like I said, for some the risk would make them call it rare, for others it would not be.  And treatable, yes it is, IF and when it is caught early and in time.  Some of the first signs of GBS in a newborn are lethargy, poor feeding, etc.  That can be confused with many other things.  If a mother calls a provider and says her baby is having issues, and they look in her chart and it shows that she was GBS negative (because she purposely skewed the test results) GBS will not be the first thing on their minds, and they might not think about it until other options have been tried and failed.  By then it is harder to treat...

The false negative for GBS swabs at 36 weeks are 4%.  There is no false positive.  So yes, not 100% accurate, but it's the best we have to go by.  I will reiterate that it is vitally important for a mama and her provider to know if she is a GBS carrier at the time of birth.  This is regardless of if she chooses antibiotic treatment or not.

I am a midwife and I teach an alternative pharmacology course at the local midwifery school.  We talk a lot about alternative treatment for GBS.  I believe that there should be choice for a mama other than abx in labor as well.  There are many alternative protocols that can be used (not studied, but anecdotal).  Usually they start at 37 weeks and continue daily until labor.  They usually involve garlic and herbal suppositories (every day, not just one day to fool a test) and an oral tea blend.   IMO, a vaginal rinse at the time of labor will do little.  And also the risks of any vaginal douching during labor (Hibiclens, tea tree, whatever, are not recommended for GBS.  It can push the small amount bacteria that it doesn't kill further up towards the cervix (and baby).  Vaginal washes of any kind are especially contraindicated if the membranes have ruptured, which sometimes they do very early in labor.  Then what would you do?

Also, finally, let me say that I do NOT think that GBS positive status should in any way rule out VBAC.  That is ludicrous and I would personally fight tooth and nail for anyone that tried to argue it.  It is not a contraindication for normal vaginal delivery and VBAC mamas have no higher risk of transmission than any other vaginal birthing mama.

I wouldn't normally post but one of the few things that really irks me on MDC is the mention that the GBS swab is something that needs to be "beaten".  It's just a tool to help a mama and her provider make an informed decision.

[WindyCityMom]

In all honesty I do feel that I will be GBS+ again.  I do plan on "fooling" the test with a hibiclens protocol beforehand, as well as taking garlic and probiotics, cutting sugars, etc.  Once baby is born *I* will most certainly not rule out GBS if there happens to be something wrong with baby.  In a lot of places CPS/DCFS can be called for a mother refusing antibiotics on herself and her child.  Practices that allow a hibiclens protocol instead of abx are hard to find.  As a candida-prone person, I try to avoid abx whenever possible.  If I'm having to breastfeed a newborn, thrush can severely impact our breastfeeding relationship and that is something I definitely do not want to happen.  

[nukuspot]

I'm glad you feel confident enough to be alert for any GBS symptoms in a newborn.  If any mama is GBS positive and declines antibiotics it's really important.  You don't have to sell me on the reasons you don't want to do IV antibiotics, I really do understand.  I just couldn't understand why you would not want to know the information if you are positive.  But I guess if you just treat yourself as positive regardless of the test (which you are just doing for your doctors it seems and not for your own information) then it is your choice of course.  I obviously was not aware of the climate around GBS in Chicago...Here in the PNW we do have people that refuse the IV abx if they are GBS positive in labor.  And I have never, ever heard of any doctor ruling out VBAC just because of GBS status.  That is completely not evidence based and makes me so angry that they are holding that over your head.  It seems to me that if they are making up blatant excuses to try to risk you out of VBAC they have an ulterior motive.  I'd report them to ACOG (after the birth, obviously, no use making them angry if they are your only option).

By the way, you mention a Hibiclens protocol.  Most places do not use it simply because Hibiclens has been studied and shown ineffective for treating GBS.  Plus it is a caustic chemical, not one I'd like by my baby's head.  if you are serious about "fooling" the test, it seems that whatever you do to "fool" the test you should continue doing until labor.  If it works well enough to give you a false negative, then keeping yourself negative seems important, rather than letting the colonies grow back after the test is over.  But Hibiclens isn't safe long term.  Suppositories made from minced garlic and marshmallow root powder, rolled with a 1:1 ratio of water on a cookie sheet and let dry and stored in the refrigerator are safe to use daily.  You can also drink Goldenseal (we like to use Oregon Grape Root since Goldenseal is endangered) tea, starting at 37 weeks (since it might possible cause uterine irritability, one cup 3 times a day.  Plus probiotics.  Femdophilus is especially good since is targets the vagina.  Hope you find this info useful.  I wasn't meaning to be rude.  It just makes me really nervous when people talk about fooling the test...But obviously you are between a rock and a hard place.  I hate that they put you in this situation.  Best to you!