"Overdue" hbac, feeling the heat...

[marrymeflyfree]

Hi all!

I'm 41+1 with my third baby, planning to vbac at home, but I'm really starting to feel the pressure and am unsure of what to do.  I have been receiving care from both a homebirth DEM as well as a hospital-based group CNM practice.  Of the group of CNMs, only one is aware of (and supportive of) my homebirth plans.

The problem is that I've had two very long pregnancies, and this one appears to be following the same track.  The first was 20 days past her due date, born normally.  The second was 22 days 'late', born via cesarean.  She was asynclitic, and my labor completely stalled after transferring from home to the hospital.  So here I am on baby #3, my last, feeling very down about my chances of a triumphant hbac.  I had an appointment with the CNM group yesterday, and am still only 1cm, ~50%.  The CNM that was there was not the one who knows of my plans.  She seemed rushed and said that I'm not even inducible, that by their policy it would be straight to the OR in a week if there's still no change, then she set me up with a "vbac consult" with the OB tomorrow.  My response was that this is normal for me, that we're both healthy, that I've had two perfectly healthy 'post dates' babies.  She just smiled and nodded and repeated hospital policy, of course.

Well, for some reason I thought this pregnancy would end differently.  I thought that by the third, maybe things would move a little more quickly.  I know things can still change on a dime, but so far the pattern is repeating.  41 weeks with hardly any dilation and far, far too few contractions.  Of course I've tried all the usual things; lots of sex, EPO, lots of strong RRL tea, nipple stimulation, birth ball, walking, walking, walking, blah blah blah.  I used castor oil successfully with my first, and tried it 3(!) times with my third - all three times it was as though I'd not even taken it.  I barely had any gas.  With the second, I tried the cohoshes many times, both the homeopathic preparation and, later, the tinctures, to no avail.  I was still nursing #1 at the time and labor started when my water finally gave way during a bf'ing session.  I thought maybe #2's poor position contributed to the late onset of labor, and I've had excellent chiropractic care throughout this pregnancy.  I think it's still posterior, so I'm doing lots of hands and knees, etc.  I've had two acupuncture sessions and can occasionally bring about a contraction with some of the acupressure points, but very inconsistently.

Blah, blah, blah.  Frankly, I'm tired of trying stuff, and starting to feel foolish about thinking I can have any influence at all.  I'm very confident about my dates this time...there was some question and wiggle room with the dates of the other two pregnancies, so I was hoping this time would be different - but....*sigh*. I will not schedule an induction or repeat c-section based on an arbitrary calendar date alone.  Baby and I are both the picture of health and that would be absurd at this point in my opinion.  But jeez...I'm nearing the end of my emotional rope here, not to mention that my husband (who travels a lot with his job) must go back to work soon and I have two young children and no other family nearby.  I feel like I am between many rocks and hard places here, and am unsure of what to do.

[RubThyNeighbor]

Both of  my kids were born at 42 weeks so I know what you feel.

Ended up having my 2nd (and the home vbac) at exactly 42 week 0 days. It was a Sunday or else my midwife wanted me to have a hospital birth at 42 weeks. She was okay with waiting until Monday to transfer care so it worked out that I got the birth at home. I did go for NST twice and all was okay.

At 41w5d I drank a pretty yummy castor oil drink ... after doing a whole bunch of other remedies. It sent me into a nice, slow paced but long labor. It was really nice to do it that way. If you want the recipe it is made with apricot nectar, lemon verbena eo, castor oil, almmond butter, topped with sparkling wine . It actually tasted great. I started my active labor 4 hours after I drank it.

Stick with your guns to do it at home if you are sure everything is okay.

[CordeliaLynn]

I don't have any advice.  I just wanted to wish you the best of luck!!  Update us when you can!  You can do it!!  :)

[roadfamily6now]

Ultimately it's YOU that has the final say. If you don't want to have an induction or c-section just say no. I know that's easier said then done, especially when being hounded by your care provider and the family and friends that are supposed to be supporting you!

My dear friend just had her baby 2 weeks ago. She went 42w6d and was a VBA2C. She was not a planned homebirth though but still managed to find a care provider that supported her. He also took into account that she normally goes well beyond 40 weeks so this pregnancy was not unusual for her.

My best advice is to just let your care provider know that you will be waiting for baby to arrive. It's fine to make some concessions like NST's weekly after 41 weeks or other non-invasive methods for monitoring baby and you to help make your care providers more comfortable with the situation.  (it also eases mom's mind too)  You WILL go into labor when it's time. 

[VBACmama4]

Your gestation period is just longer than some women, that's all. If you're both healthy, there is no reason to rush the baby out, not even if your doctor/midwife believes you must conform to "policy" in order to have a healthy child. Your body doesn't care about their policy. And ultimately it's not even your body that triggers labor, it's a protein secreted by the fetus's lungs signalling that they are mature enough to survive outside the womb. Once your baby's lungs are developed, that protein irritates the uterus and causes the onset of contractions. If baby isn't ready, they are just not ready, and no amount of tinkering with herbs and drugs is going to make your body do it's naturally scheduled thing. 

I agree with the above suggestion to continue to allow monitoring - non-stress testing, biophysical profiles - just to put your mind at ease and give you another chance to say no, thank you, to the induction attempts. You're the "patient", you're the consumer, they are service providers. You have the right to tell them how you are GOING to handle your birth. It's up to you how much control you let them have (even though controlling birth is probably one of the most arrogant concepts in modern medicine). 

I know it can be nerve racking, take it from a 3 time VBAC whose children don't like to be born til after 41 weeks. All of them were late, my most recent was born on May 7, 2012 and had a due date of April 18th (that's 42+5 and man was I getting some serious pressure). It can be really hard to plan for a birth based on the due date and have to change plans when baby doesn't seem cooperative, but in the end, it's so much better for you and your baby to let labor happen on it's own. I've never known anyone who had to walk in their child's high school graduation because the baby never came out :). 

[bfw0729]

I hope all is well with you. I had a hbac almost four years ago. It's amazing that docs and some midwives have this 42 week cutoff point. It's so frustrating as well as controlling on their part! I really hope you have a peaceful birth. Some of these birth professionals make it very difficult for women to focus on what's important, such as gestating in peace, rather than some arbitrary deadline.

[marrymeflyfree]

Thanks for the encouragement, really very helpful!  And I apologize for not updating sooner.  I had hoped that ignoring everything for a few days would just relax the baby right out of me, but....nope!  I initially cancelled that appointment with the ob, but was pushed to reschedule it by one of the more conventional CNMs in the hospital group.  I decided to just get it over with, and honestly I feel better with it behind me.  He was just patronizing enough to piss me off more than anything, and a lot of the down and discouraged feelings I'd had melted away!  I went in there thinking I would be encouraged to try an AROM induction in a few days when I hit 42.  I wasn't exactly prepared for what I did hear, which was that I should walk across the street right then and there and check myself in for a repeat C.  I laughed, honestly thinking it was a bad joke, then told him he'd be cutting a perfectly healthy baby out of a perfectly healthy woman without any clinical indication.  He interrupted and talked over me, played a few dead baby and 'i know you want to be a good mother' cards, and of course put the 'against medical advice' stuff out there.  I thanked him for his time and left.  That they call these appointments 'vbac consults' really makes me laugh.  Heh.  I'm to see the hospital CNM office tomorrow, and it could go a few different ways depending on which mw is in the office - but I'm outside their scope now, so I'm sure there will be something related to that.  

The whole thing isn't stressing me out as much as it had been, though it does make me angry that the only 'mainstream' option given to me was a repeat c-section despite the baby and I passing every test and measure of health with flying colors at every step of the way - and we weren't even at the magical 42 weeks.  I chose to receive co-care from a very vbac-friendly practice at a hospital with one of the lowest c-section rates in my area, and yet I'd still have been pushed into unnecessary surgery if not for being an educated patient, if not for planning to homebirth anyway.  I can't wait to get on the other side of this birth so that I can revisit this anger properly.  

Luckily I have a great and supportive and encouraging homebirth midwife to counter all of that and provide some balance.  The baby needs to get down and put some pressure on my cervix, but otherwise is in a great position.  I think if I could get some contractions going, we'd be in great shape.  That castor oil recipe actually sounds good, RubThyNeighbor!  I used it with my first two babies (successfully with the oldest!), but I'm a little hesitant to try it as a vbac!  But I am feeling optimistic for the first time in days, so hopefully soonsoonsoon...

Thanks again!

[Beccasteve03]

Hang in there momma!  My HBAC baby didn't come until 41w 2d.  My midwives weren't worried, but I did feel pressure (not from them though!) to get that baby out!  I really wanted that vbac and felt like being "over due" was just one more thing hanging over my head....  Good luck!  I hope baby comes soon!

[marrymeflyfree]

I'm having a lot of trouble finding my optimism....42+3 and no sign of anything laborish.  Both my homebirth midwife and the hospital midwife I last saw said that the baby is still too high to really consider rupturing membranes.  We have another appointment today, maybe something will be different, but I would be surprised if there is any change.  Everything feels exactly the same...almost twilight zone-like, as though time has skipped ahead but this pregnancy is still in the 2nd trimester.  I really don't feel term or post-term in the least!  People keep asking how I feel, and I think to myself that I feel too good!  But I am running out of options, and honestly my courage to continue is starting to wane as well.  

[activemomma]

I just wanted to tell you that I found reading this very encouraging (I'm already feeling the heat at 39 +5 on my second VBAC) and working to keep calm during the remainder. I hope that you find a good calm space again. I just took some rescue remedy and took a nap and I'm feeling much calmer.

Wishing you the best!

[bfw0729]

I hope you are doing well. Please update when you can.

[fruitfulmomma]

I am a little late to this thread and hope your are holding your little one right now but wanted to chime in on the dates issue...no c-sections here but several "late" babies, including a couple of 44+ weekers. I have really long cycles and lmp dating does not take that into account so I seriously doubt my girls were anywhere near that far along, last one only looked about 39 at birth, which makes sense since my cycles were running about 8 weeks and ovulation is generally supposed to occur about 14 days before your next period. My cycles were so erratic after my miscarriage that I did not have a clue when my lmp was when I got a positive with this one, so we are basing edd on early ultrasound which is supposed to be prety accurate but still up to a week off. So we will see how close she actually is. 

Anyway just some thoughts for you or anyone else reading this to consider talking with your care provider about if you have the same issues. 

And of course just like babies grow at different rates on the outside, they do the same on the inside as well. 

[janarae18]

ah Mama I hope you are doing well... my first labor I went 42 + 5 and yes i was with cnm's and I refused to be induced and they were NOT happy with me at all lol... but baby comes when they want......... I ended up with  a section anyway but I am hoping for an hbac as well ... please hang in there!
 

[marrymeflyfree]

I've tried a few times to write a reply, but just couldn't get through it.  It pains me to report that I ended up having another c-section.  I'm still thoroughly in the middle of processing it and have been sobbing buckets every time I think about it, which is only about every third second of the day.  This is a bit long, but maybe someone else can learn from my mistakes.

It was the culmination of a lot of factors.  One, heavy pressure from the hospital, the OB, and even the hospital-based midwives (the one truly supportive midwife in the group was out of the office for the last weeks of my pregnancy with a family emergency...as guilty as I feel for thinking it, I do wonder if this changed my course...).  By coincidence, the hospital was in the process of tightening up their policies for birthing women right around the end of my pregnancy, and a post-dates vbac was definitely more than they wanted to deal with.  There was also some disagreement about my due date.  The early ultrasound I'd had put me 6 days ahead of my dates.  I *KNOW* my date was correct.  The CNM group agreed to use my date, but the OB absolutely refused.  So as far as the hospital was concerned, I was well beyond 43 weeks at this point and well out of their happy place.  Also, my husband travels for work and the day was quickly coming when he would have little choice but to go back.  He had taken 5 weeks of vacation to be home for the birth and beyond (it's laughable now, but I really didn't think I'd go as long this time for a few reasons), but that had run out...he was by this point out on a sick call under less than great circumstances.  All of that was bringing up huge anxiety for me because it's exactly what happened with my previous birth: I ended up finally going into labor the day before he was to leave for 6 weeks.  That birth turned out to be a cesarean...I had a 17mo at home and no family nearby and a recovery and...it was a scramble to get help here, steal a few extra days off for him, and hubby literally left to race to the airport within seconds of dropping me off at home.  That aspect of that birth was like the traumatic icing on the crappy cake, and we were looking at the very real possibility of repeating that.  And most importantly, the fear was really taking over.  The night before that last prenatal appt had been really rough for me.  I was tired, getting scared, anxious.  I'd lost my zen place.  I knew that I probably should cancel the appointment and call my homebirth midwife, but I felt an obligation to go, to do their tests and document that all was still well as of this moment as far as anyone could see.  I wanted to be just compliant enough to keep them on my side in the event that I really did need them, I guess.  In the end, my compliance, my desire to appear responsible, hurt me.

It was a Friday afternoon appointment.  There was a lot of pushing to go ahead with a repeat c, and to do it now.  I had planned to hold off on any decisions about anything until at least 43 weeks, which would have been the following Monday.  The midwife was not able to get me on the schedule for anything on Monday and was concerned about who would be on call, how I'd be treated, if I just came in to L&D.  I think it was true concern to a point, but manipulative also.  They refused to do anything induction-wise, and the baby was still too high to wisely consider AROM.  I was still barely 2cm, 50% effaced, and virtually no contractions to speak of...a couple of minor ones at night, but nothing significant no matter what I did.  Cohoshes, birth ball, nipple stim, orgasms, chiropractic, acupuncture, etc, etc...my poor hubby was starting to feel like little more than a prostaglandin factory.  I was afraid to use castor oil with the scar, but I wish I had.  Anyway, the point is that the fear had taken hold, hub would have no choice but to leave soon, and I was feeling beyond dejected about the seeming lack of any action in my uterus...and I broke down in the CNM's office and caved.  We walked over to the hospital, and the speed with which everything happened after that is just breathtaking to me.  I know I'm seeing things a bit dramatically, but jeez...it was like the vultures had been circling and dove in as soon as I acquiesced.  My appt with the midwife had started at 1:20 and we were there for a good while, and my son was out of me by 4:30.  I was in a fog, like a bad dream.  I fell into playing the 'good little patient' role and of course taking care of my son, but it all really hit me within a few hours of being home.  Like a ton of bricks.  I just kept thinking what the hell happened here?!  What was I thinking?!  How did I end up here?!  How did I let this happen?!  Over and over.  It still baffles me.  I was an excellent vbac candidate.  I had birthed vaginally before, and quite easily.  I was beyond healthy.  My baby was healthy.  There were no signs of distress in the least.  He was in a great position, not tangled up in his cord, not super huge by any stretch (just under 8lbs), blah blah blah.  And worst of all, I hadn't even planned to be in the stinking hospital to begin with.  They were supposed to be my backup, my 'lets be responsible hbac'ers and do co-care just in case'.  And despite a ton of knowledge and wisdom guiding me otherwise, despite it being completely antithetical to my personal philosophy, I let them and their fear-mongering into my head, and for that I am SO pissed off.  I am angry at the system for pushing me into that corner, and I am really angry with myself for allowing it.  When I broke down and agreed to the cesarean, I was honestly embarrassed to call my homebirth midwife.  I asked my husband to call her while they were prepping me.  When I think back over the last couple of weeks when things were getting really tense for me, I realize that the only time I truly felt good and confident and relaxed was on my way home from her house after an appointment.  I should have called her that day before agreeing to anything, should have called her that morning before the appointment when I knew I was feeling low.  

I'm usually not one to second guess myself, but I have a lot of 'should haves' and one enormous regret with my son's birth.  I still cannot believe that I did it, that I just handed over my autonomy and my son's right to a normal birth.  It just feels so hollow, so disappointing.  I don't feel at all like I've given birth, and honestly my bonding with him at this point is somewhat forced.  At least I had a good long labor and very long second stage before transferring with my first cesarean, so I still felt like I was part of the process and came out of the surgery feeling like my daughter and I went through it all together.  I had gone into labor spontaneously, so at least I'd given it a chance with that one.  But this time...is different, and I am so sad.  He is my last baby.  He was the bonus 'do over' baby, was to be the healing birth that I hear so much about.  But what happens when you don't get your healing birth?  When it is, by far, worse than the one you wanted closure from?  And when it was, more or less, your choice?

My take home lessons from all of this are many, but there are a couple of things that I feel are really worth mentioning in this cautionary tale.  I think that if this, this unnecessary repeat, can happen to me, it can easily happen to just about anyone.  I went into this armed with a huge amount of knowledge and motivation, with a great support team, and with every confidence that I could birth a baby.  I felt better in this pregnancy than I had with my other two and couldn't wait to labor again.  And somehow it all fell apart in the end, and now I really intimately understand why the repeat c-section statistic is so high.  The box in which birthing women must fit in hospital-based care is pretty tight already, and it shrinks considerably when you're attempting a vbac.  I realize that there is no safe place for me in conventional care.  Odds are very, very slim that I will have another baby, but I absolutely will not participate in conventional care if that should change.  I had only out-of-hospital midwifery care with my first two pregnancies and was pretty relaxed and confident right up until the end with both despite very long pregnancies.  I was supported, and my midwives' only concern, truly, was for our good health and well-being as a family.  Our care was individualized to our needs and our situation.  This time, it was painfully clear that decisions were being made about me based on the hospital's liability first.  Our specific circumstance and needs were ignored by the OB even when this was directly questioned.  Instead, we were reduced to statistics and probabilities and worst-case scenarios, and the end result was an unnecessary surgical birth.  It's case closed for them, but it will impact me for the rest of my life.  

[bfw0729]

As soon as I read your post, I needed to respond. I am truly so sorry for the things you experienced and needing to undergo another surgical birth. I recall describing my c-section as being the victim of a loose bullet. It can hit just about anyone. It takes a lot of time to heal and I hope you are able to quickly heal (both physically and emotionally) from this unexpected birth. I am saddened by this awful birth climate in which we all must labor and birth. If a woman doesn't fit an obstetrician's perfect mold/criteria, then resistance is met and nonsensical fear introduced. Please be gentle to yourself, your son is blessed to have a mother that cares so much about him. My son only recently learned (at the age of five) about how he and his twin sister were born into this world. He understands that his sister was born in the more "conventional" way and he needed to be taken out surgically. He understands that it wasn't ideal, but is happy that daddy and I tried our very best to have him come out like his sister, but it didn't work out that way. Just knowing that we cared enough about how he entered into this world puts a smile on his face. 

[janarae18]

*Hugs* Mama... you are strong to wait that long.  If it is any consolation to you please know that your story can help others (including myself) debating the whole cocare thing / hbac... Please take care of yourself and if you need get some counseling... It is so hard when you are beating yourself up. I beat myself up pretty bad for choosing my csection after a long hard labor post dates... so please don't be too hard on yourself... 

[fayebond]

*HUGS*

I beat myself up about how my CS went down too. Its some consolation that the hospital people have every advantage (they "deal" with this situation day in and day out and darn if they don't get good at winning). Wait and pray about the more children idea: a couple more smiling faces might be a blessing, you don't know.

*HUGS*

*EXTRA HUGS*

[fruitfulmomma]

[crystal_buffaloe]

I'm sorry that you had to go through this, mama.

I'm hoping that your healing goes well.

[VBACmama4]

I understand how victimized, weak and angry you probably feel. I remember those feelings well even though my CS was over 11 years ago. I managed to have VBAC's since then but I literally had to fight tooth and nail and still had to give in to procedures that were in no way necessary, nor a part of my birth plan, but were performed regardless for the sake of saving the worst case scenario. It's very sad that women are considered just a vessel in the eyes of a profession that can save lives but instead chooses to inflict unnecessary surgery on otherwise healthy mothers and babies to avoid lawsuits. I think the most important thing to remember is that this is not your fault. As someone said above, hospitals are trained to win at this, and they are good at it. You chose to follow suggestions from trained medical care providers in order to give your baby a safe birth, and that is not wrong. Your choice was absolutely valid because you were concerned, I know how that feels too, after my 42 week mark a larger and larger part of my brain kept telling me "You're going to hurt your baby if you wait any longer to give birth", "Just take the advice and have the CS, it's the safest way", "You're just being stubborn, if he's in danger it's all your fault".. if I hadn't waited to go to the hospital after 3 full days of labor, I would absolutely have ended up with a RCS. I called the hospital to tell them I was in labor on the second day and they told me to hurry in, but my husband and I agreed to wait a little longer - otherwise your story would be my story, and I'm positive of that. We're only so strong, especially where the safety of our children is concerned. 

When you start to feel guilty, remember, you made a decision to sacrifice yourself for your child's safety. In time I hope you can heal, and I know that's hard to even imagine, but it does ease. You may never be at peace with it but if anything you have been given a renewed spark that you'll carry into the next pregnancy if it happens, or to educate people around you who have experienced this. 

HUGS