I am planning on a hospital vbac in November. I have been feeling confident about my choice of doctor and hospital, especially since they're so near the house. My plan was to labor for quite a while at home, and then go into the hospital when I am definitely in active labor. The hospital is 10 minutes at the most from the house. But I'm reading about efm, and whether I should do intermittent (which is what I prefer) or continuous. I'm less sure now than when I began. I am concerned if I don't go in in early labor, I might miss signs of fetal distress, and hurt my baby. I want a natural birth/vbac, so obviously, it's probably best if I stay home as long as possible for that to happen. Can anyone share their stories/knowledge/resources/links??
Tell me what you know about uterine rupture...
I vote with the original plan. EFM, while the best known method for detecting fetal distress, is largely unreliable. We don't really know much about what it means, we have lots of theories that OBs act on, but no way of knowing whether that's useful or not. Just having continuous EFM ups your (non-VBAC) risk of C-Section by 30% (Obstetric Myths Vs. Research realities, by Henci Goer, is FULL of great-to-know factoids like that! But the last chapter is a bit hippie for my taste, and its $40 to buy even from amazon, so, consider borrowing that). Also, interpretations of EFM vary widely, and you can find experts who will argue for CS from almost any EFM reading, and experts who will argue its not necessary, so it depends on who is monitoring you at the time. Actually, that's probably my bigger reason for sugesting you go in late: if you happen to land there while the nurse on call is someone afraid to "Be responsible" for your VBAC, your odds of CBAC will be higher the longer you are in their care. And for all of how nice the nurses are in prenatal, you probably won't meet the actual L&D nurses at all until "yours" arrives at your bedside. If you could arrive pushing, that, IMO, would be ideal.
Have you found your local ICAN group? Talking to real people who have done both VBAC and CBAC was very helpful to me, and they have alot of resources like books to borrow, birth plan ideas, doula recommendations, etc. All of the VBAC mamas agreed that their hospital VBACs were successful only by chance: they got there too late for interference, or the doula could distract the nurses long enough for them to finish crowning, or the doctor on call was too busy to argue with them, etc.
You could be in labor for many many hours, but once you get to the hospital, you're on their time, not your baby's and not your body's.
I am a vbac hopeful due in November too, and my midwives don't want me at the hospital until I'm in active labor. Then I will go on continuous Efm, per their requirements. What does your care provider advise?
I've had two HBACs. During my 3rd pregnancy, I went to an OB for a GBS test and he took my pregnancy history and I was told that, had I been in the hospital, they would have sectioned me for "failure to progress" in my 2nd pregnancy. There were no problems during my labor, no fetal distress or anything of that nature. He would've sectioned me b/c it took 32 hours. So, yeah, stay home as long as you can.
Thanks, ladies! I needed a confidence boost, I think. I should add, I have been GBS positive for this and all my other previous pregnancies. I took abx early this pg because my urine tested +, should that factor in, too? Honestly, I don't know how willing I am to do a hibacleanse, garlic vaginally, etc. I do take probiotics, etc, but it hasn't seemed to help much in the past.
You should read up on GBS to decide, I think. For me, I would just go on as usual, especially since you are going to be in the hospital anyway. The main problem with GBS is if the newborn shows symptoms in the first few hours and if it goes untreated and if its actually the serious kind and if the antibiotics cause a problem after all those other ifs. Its not something I would worry abut or allow to influence my choices either before or during the hospital stay, just because its not that big of a deal in terms of general population risk. Some nurses would argue otherwise, my aunt is a nurse and argues that problems with the anitbiotics they offer you "in case" are just as bad as the actual GBS baby problems she has seen, so I'm with her. :)
Knowing your status would be important, but not a reason to go to the hospital early, IMO. The abx cross the placenta and go straight to the baby, so it's not like they need a lot of time to take effect. Just long enough to run the dose through your IV. Hth!!
Edited by Bmorefarmgirl - 8/13/12 at 9:04pm
Wait as long as you can before you go to the hospital. Unless your water is broken for an extended period of time your baby is not in danger due to vaginal strep. You can easily treat it at home, here's a link: http://thecontrarianmom.com/2010/09/10/group-b-strep-simple-treatments-for-group-b-strep/ .
As far as uterine rupture, EFM only detects the possibility of rupture if the baby's heart rate decelerates, which can happen for other reasons and often leads to misdiagnosed "baby in distress" diagnoses. Here's an article I found useful http://www.birthtruth.org/efm.html
I've had 3 VBAC's, with my last (5/7/12) I labored for almost 3 days at home and when I got to the hospital I labored for almost an hour, had to forcefully change positions regardless of the monitoring, and when I found a good position my baby crowned almost immediately and was born after 3 pushes. If there's no sign of distress, tell them you will consent to intermittent monitoring and trust your body - there are almost ALWAYS signs of rupture even without monitoring.
Not to be negative, but if your water does break a reason besides GBS to go the hospital early rather than later would be the position of the baby. If the baby is not head down and low you could be at risk of cord prolapse. So, before staying home make sure you know how high the baby is.
Have you hired a doula? Having a doula who has worked with VBAC's before and who is knowledgeable in Childbirth Education would be the best thing for you right now. You would have your own coach and birth professional in your corner educating you through this! Look on the many Doula Search Websites or go through www.CAPPA.net or www.DONA.org to find certified Doulas near you.
CAPPA is the Childbirth And Postpartum Professionals Association which trains and certifies all types of doulas and childbirth educators and lactation professionals- it is an International organization and is second in size only to DONA. Doulas Of North America - which trains and certifies only doulas. Of course there are many other smaller organizations out there that train and certify but they are too many to list. You can google FIND A DOULA and it will come up with a list of directories that you can use to also gather names.
You should always interview at least 3 if you can find that many so that you can make a good comparison of personality, training, experience, skill-set, services, and fees. You want to have a good match for you and your partner. Which means both of you should be at the interview. Interview questions to consider- http://www.babycenter.com/0_doula-interview-sheet-questions-to-ask-a-potential-birth-dou_1458427.bc or http://mammahery.blogspot.com/2009/10/questions-to-ask-when-interviewing.html or http://www.bellybelly.com.au/birth/hiring-a-birth-attendant-questions-to-ask
And there are many other sites out there on questions to ask! There is a Doula out there for everyone! Hopefully you can find yours!
P.S. And finding a Prepared Childbirth Class Series that is not being taught by the hospital, that lasts around 6-8 wks would be very beneficial as well! And Check out the facebook group http://www.facebook.com/groups/vbacfactscommunity/ They are a wonderful resource as well! The lady that runs it is "Jen VBACfacts Kamel" and you can "friend" her! She's great! Her site is http://vbacfacts.com/quick-facts/ PM or email me if you want anymore articles and stuff! (email@example.com) Good Luck!