Prenatal VBAC Questions

[Bazile]

In February of 2011 I had a csection for failure to progress after a failed induction. DD was posterior and had her head cocked to one side which is why we think I stalled at 3 cm and quit having contraction while getting Pitocin. Regardless of the reason for the surgery, unless Ina May Gaskin herself would reccommend a RCS I have no intention of being cut open again.

About 2 weeks ago I discovered I was pregnant with number two, and I'm due according to LMP on June 29 though I think early July is probably more accurate since I have a decent idea of when we conceived. I have my first prenatal on the sixth with the OB who removed DD. His practice claims to be VBAC friendly, and at my postnatal appointment he told me there was no reasons I couldn't VBAC in the future and gave me a copy of the NIH study to read. He also admitted that they don't so a lot of VBACs, and I have no idea how things will play out when I show up wanting to give birth this time. If things don't look so good for my chances using his practice I'm wiling to switch doctors and there's a decent chance DH may get orders while I'm pregnant, but I want to go ahead and at least start with people I'm familiar with. So my question is, what kinds of questions would y'all suggest asking at a first prenatal? Thanks!

**I know the go to answer on MDC is to skip the OBs all together and just use a midwife, but that's not really an option for us. We live in Alabama where midwife attended homebirths are illegal, and there's only one (huge) OB practice that has a few midwives on staff. I doubt I'd be deemed low-risk enough to be allowed to see them. We're in the Montgomery area, so almost 200 miles to TN and just over 4 hours to the Farm. Neither is all that practical while in Labor. There is a home birth midwife locally who has attended a friend's VBACs, but I'm not personally comfortable working with someone who is breaking the law even if the law is wrong. Plus military insurance means we have nothing out of pocket for a hospital birth, but Tricare would never pay for someone without a valid license in the state which DH would never agree to. And if a transfer became necessary, I have no clue how that would work. If DH gets orders forcing us to move before the baby's born, my first goal is finding a midwife and a birth center if possible.

[womenswisdom]

1. When would you recommend a repeat cesarean?
2. Is there a certain week you would not be comfortable with me going past in my pregnancy?
3. Would you induce a vbac mother? How?
4. What are the monitoring requirements for vbacs during labor?
5. What kinds of things might risk me out of a vbac attempt? (big baby, low fluid, postdates?)

Honestly, I would contact your local ICAN group and get a recommendation. If you were induced due without medical necessity (for example, for being 41 weeks), you can expect the same type of approach to labor this time. You are already aware they don't do many vbacs. It's generally not a good idea to return to a care provider who did unnecessary surgery (if you do feel it was unnecessary, which it seems you do) on you the first time and expect it to go differently the second time. It's very easy to say, from a prenatal standpoint, that you would not accept a repeat cesarean, but there really are valid reasons for cesareans and it's possible you might actually need one next pregnancy. If that is the case, you want to be able to trust your care provider if they tell you that it really is needed for your baby's or your health. It doesn't sound like you have that kind of relationship with this care provider, so I would start looking for someone you can trust.

[Bazile]

Thanks for the suggestions! I had thought of some things, but you suggested things that I hadn't even really thought of like what might risk me out of a TOL. I'm a little overwhelmed since despite us being careless as far as birth control goes, I didn't really expect to get pregnant.

I do trust my OB. If I didn't I wouldn't be willing to go back. It's a small (3 OB/GYNs) practice where you see the same provider every visit. He never had any problems answering my questions, and I really didn't have any issues until I got to the hospital where the issues were hospital staff. While I would prefer a midwife, and ideally a birth center, that's unlikely to happen unless DH gets out-of-state orders. I was induced with DD mainly because I was past 41 weeks, and she was born at 41 weeks, 5 days. At the time that DD was removed (I probably should quit using that word,but 20 months later I still don't believe I gave birth and don't really have a better way to describe her birth), I think the surgery was necessary. I also think that if we had paid more attention to positioning or if I'd of had more (it was just me and DH there plus the nurses who would randomly stick their heads in the door to tell me to be still or to lie back) support that the surgery could have been prevented. I also have questions that are related to DD's birth specifically which he's one of the only people who can answer. If things have changed and/or they're not supportive of me specifically giving birth this time, I do have a recommendation of a different OB, though I haven't checked to see if he takes our insurance. Knowing the Base doesn't have a hospital and thus no maternity services past pregnancy tests, I would find it odd if he would choose to shut out a decent sized segment of the local pregnant population. If that doesn't work out, I can ask at ICAN since I go to meetings when I can. But the closest chapter to here is in Birmingham about an hour and a half away, and so their suggestions for providers will be in the Birmingham and not the Montgomery area. I'd rather not have to go that far while in labor, but if need be we might could manage in a worst case scenario since at least it's closer than Tennessee.
My appointments today, so hopefully everything will be great!
 

[fayebond]

Ditto everything womenswisdom said.  I would say, educate your self.  ALOT.  And ideally, both you and DH be prepared to fight for what you want, with a specific plan and detailed, agreed to reactions for common questions by the nurses, etc.  I wanted to go back to my original provider for this VBAC baby too, but DH made the salient point that if it was the ancilary staff that messed us up last time, how can we know that they won't mess stuff up again?  And if someone says, the baby is in trouble, you need to be able to believe them: I couldn't trust that same group of staffers again, if they came to me in labor and gave every good reason in the world I still couldn't believe them because last time they were wrong.  I would evaluate the possibility that the nurses will be the same or worse at their jobs (in every sense of the word) when you go in to this same group in labor.  Could you believe them? again?