Ob wants to wait until I am 30 weeks to discuss "VBAC restrictions"? Why? - Page 2

[colsxjack]

Our OB discussed VBAC at the first appointment at 12 weeks or so. He didn't even bat an eye when we asked to talk about it and was very supportive and matter of fact (We also have a midwife, but have to have high risk OB due to twin pregnancy VBAC).

Even with twins, our OB is very supportive of trying for VBAC. He doesn't see any reason as to why it would not be successful. He feels it somewhat depends on why our first failed to progress but also said there is no real way to know why she failed to progress. We feel it was because of induction causing her to change position during labour and then not be well situated to keep dialation progressing.

Our OB gave us very good stats on chance of rupture...0.5%, which included all types of rupture. Only 5% of those ruptures being significant. All this is even with twins.

What increases the risk dramatically is the use of cervidel during induction. And the use of pitocin in any med to high dose could increase risks.

We are feeling very good about the chance of VBAC and this doctors skill and willingness to do it.

[Alenushka]

You can't simply think in terms of raw numbers.  C-section rate of VBAC is neither low or high in itself.

What is the served population? Is the number of women with certain diseases and risk factor higher or lower than average?

Is that a university center that deals with more complex cases?

Is there higher incedence of multiples in the population?

IS this the only hospital in the are of Level 3 NICU?

[ananas]

I would refuse to wait until 30 weeks to discuss it. Tell her you would like it to discuss it ASAP, or will you have to find another care provider. I see no reason her to string you along until 30 weeks if she isn't as serious about your VBAC as you are.

[fayebond]

lots of good responses!

I won't repeat what everyone said, but basically, I'd look at another care provider.  Don't bother trying to argue or force her to commit to a position, if she's truly unwilling to talk about it that is enough of a red flag to find another CP.

colsxjack, I'm impressed there is an OB who is so cool with twin VBAC, that is a great sign for the medical community at large.  So exciting!

[DoulaGinny]

Originally Posted by VBACmama4 

The reason a doctor suggests 30 weeks is because that is the point when most doctors will refuse to accept a pregnant patient, so if you're 30 weeks along and your current doctor says, no VBAC, you'll be more likely to have to stick with that doctor because no one else will take over your prenatal care. It's a sneaky, horrible thing and SO many docs do it. There is NO reason why she can't explain risks, benefits, rates and outcomes with you right this second. 

That's it exactly!  Unfortunately, doctors think they can control their patients better that way by forcing your hand and cornering you.  But they do it in such a way that makes them look better than they are.  Go to www.vbacfacts.com and get all the info you can.  She has a wonderful site with tons of up to date info and advice!  And you can facebook her "Jen VBACfacts Kamel" and she has a group on facebook https://www.facebook.com/groups/vbacfactscommunity/    Get Penny Simkin's THE BIRTH PARTNER and Korte's THE VBAC COMPANION and Ina May Gaskin's INA MAY GASKIN'S COMPLETE GUIDE TO CHILDBIRTH at the very least. Those will give you a great foundation of pregnancy, labor, birth, and VBAC's.  Go on the Ican website also.

Find an experienced Doula who has worked with VBACs before who can educate and coach you through this.  And immediately force your doctor's hand on the info while searching for midwives and other doctors for backup.  You will have to do all this learning and doctor hunting as fast as you can before your window shuts and they refuse to take you for prenatal care.   Its going to come down to how committed you are to having this VBAC.  Unfortunately, women have to work very hard for them.  What they said about educating yourself on all the processes of birth is true.  That's another good reason to find a Doula who is also a Childbirth Educator if you can.  Then you get the best of both worlds.  Find an in-depth prepared childbirth class series that lasts 6-8 weeks-so you know it will cover everything well.  

Oh, and exercise exercise exercise!!!  All the VBAC midwives i have talked to, especially the ones who have had VBAC's themselves stress getting in the best shape of your life for this!  So, water aerobics would be a great addition to prenatal yoga.  And be diligent with those as well as your diet. so that GD doesn't creep up on you or they will probably not let you do a VBAC.  Ask Jen about diets and stuff you can do for that when you find her on FB.  She's great for resources!

PM/email me if you have any questions.  I have several articles from Jen and other great solid resources I can email you.  :)     ([e-mail])

Edited by DoulaGinny - 9/9/12 at 7:17am

[LisaSedai]

Being an obese diabetic doesn't mean you can't VBAC. It depends on your provider. You may have to be doing fetal non stress tests and biophysical profiles every one or two weeks after 36 weeks though.

I wouldn't stay with a provider who refused to discuss her VBAC "rules" until you are too far along to switch providers.

[SweetTooth]

Hi Ladies! Thank you so much for all your great responses & advice. Sorry I haven't had a chance to reply quickly enough - we were out of town for a wedding. But this Monday, I am definately going to set up an appointment with a different provider (the Midwives at UCLA). I'm thinking I won't get an appointment with them until sometime in October, so our plan is to have our final appontment with our current OB to get our bloodwork results, pay any unpaid bills and give them a request to release our medical records to us. I am pretty much planning to tell her that we want to switch providers since the practice philosophy with the UCLA midwives seems more in line with our's.

Since posting my original post I have been reading much more about birth and VBAC (got 4 books so far - The Birth Companion, The Thinking Women's Guide to a Better Birth, Ina May's Gaskin's Complete Guide to Childbirth and The VBAC Companion).

My hubby is not much of reader. I am thinking he'd be more responsive to a movie or something. I have started corresponding with a doula (who has had a VBAC herself), so hopefully she will have some DVD resourses we can borrow.

As for my excersize routine, besides my 30 min yoga video,  I've started doing 15 min of elliptical time every day and am planning to bump it up gradually. It's been record heat over here so walking outside seems so unappealing lately!

[fayebond]

I'm not a fan of the original, but the Busines of being born VBAC edition was pretty good as far asmoviesgo.  DH mostly was happy to learn any factoids I could pass on, so you reading might be enough, you never know.

[nearlyelated]

I'm seeing a midwife, but they recommend a consult with an OB at 30 weeks to discuss VBAC.  I'm not sure why that's the time line here but it sounded like standard practice.  

[SmtmsAlwys]

Originally Posted by SweetTooth 

Hi everyone!

I just saw my OB yesterday and although she seems very willing to answer questions, when I brought up my wanting a VBAC she said that it would be better to wait until I was further along, about 30  weeks, to discuss if I would be a good candidate for a VBAC. I guess I must have looked confused when she said that, because she went on to say that at around 30 weeks she'll have a better idea of how my pregnancy is progressing and be more able to discuss VBAC restrictions with me. It didn't seem like she wanted to pursue the topic further at that moment, so I just agreed to hold off with my questions...

My question is, what are the standard "VBAC restrictions"? And also, why the 30 week mark? What happens around that time of gestation that indicates whether or not one would be a "good" or "bad" candidate for a VBAC?

Any help/advice is much appreciated. Thanks!

Honestly? I think your doc is just waiting 'til you're too far in to switch when she tells you that she won't "allow" you to VBAC.

[SweetTooth]

we FINALLY got insurance and switched providers to Kaiser Permanente. the KP hospital we are planning to go to has an 11% c-section rate and is known to be vbac supportive. after speaking with some relatives and friends, we have a few good referrals lined up for CNMs and OBs that are supportive of natural births and vbacs. one of the OBs recommended to us is even trying to get birth tubs in the birthing rooms for the hopital closest to us. i'm feeling alot more reassured now in the decisions we are making... thanks again for all the thoughtful replies.

i just found out that Netfilx is showing More Business Business of Being Born. it wasn't on there a couple of months ago, so Yay for Netflix!