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Feeling conflicted about VBAC - need advice! - Page 2

post #21 of 57
Just to reassure you, the rupture risk does not increase as the baby grows, or as you pass your due date. The chance of successful VBAC goes down slightly past the due date, but this data is also confounded by how many women have scheduled cesareans once that due date has come. It is no less safe to labor with a 41 week baby than a 38 week baby as far as risk of rupture goes. More labors start spontaneously after the due date than before, so putting an arbitrary date out there decreases the chance of success.

I attended a VBAC this morning. This mom actually didn't follow that most-babies-after-the-due-date rule, though. Her first baby was a cesarean for breech at 34 weeks when her water broke and she was in good, active labor on arrival to the hospital. This time, her baby was head down. Her water broke at 36 wks 6 days, at 1:40 this morning. She started having contractions at about 4 am, was complete a little before 7 am, and after pushing for a fair while, birthed her baby girl at 8:28 am.
post #22 of 57
Quote:
Originally Posted by daekini
OMG!

I still sort of feel like I'd wait up to 40 weeks. I don't want to be induced! I don't want any meds! But I also don't want to wait too long b/c I'm afraid of the rupture risk increasing as weeks pass by...
No VBAC woman should ever receive labor inducing drugs, like pitocin. The risk of ruputuring the uterus is too high when meds are involved, the meds put too much unnatural strain on the uterus.

As far as I know there is no great risk of a uterine rupture with post due babies than with any other time of delivery. The worry is that a post due baby will undergo stress and be in meconium or the placenta gets to old and quits providing for the baby -- seriously rare event.

Here is why a hospital VBAC was out for me --
- Required continuous EFM monitoring, not intermittent.
- When on the EFM you are not allowed to move b/c it moves the baby and throughs the EFM off the heartbeat area. (Was not allowed to move w first baby b/c water had ruptured and was on continuous EFM.)
- Unable to move, meant for me less ability to manage and work through my labor contractions. I was also on Pitocin which causes contractions to be one on top of the other with no breaks for breathing or preparing inbetween.
- Unable to manage contractions, makes you want pain meds.
- Pain meds knocked me out, except w the contractions hit, so really wasn't effective except to put me out for seconds inbetween contractions and then come to in sheer pain.
- IV pain meds obviously a mistake, I had an epidural. A VBAC having an epidural is a mistake b/c an epidural can slow down labor and then the hospital staff want to bring it back with labor inducing drugs. VBACs should not have labor inducing drugs, so they will then say c/s.

As for my first experience, not being able to move did not allow me to work my baby into position for birthing. I was not willing to risk being set up for failure, so I decided on a homebirth.

I really do believe a lot of hospitals routine procedures and protocols (which you doctor really has no control over), set VBACers up for failure. There are some woman who can birth without moving, I'm not one of them. I am a primal hip swaying mover in labor.

If you haven't read it read A Thinking Woman's Guide to a Better Birth by Henci Goer.
post #23 of 57
Alison,

Just thanking you for starting this thread. It has been very helpful to me as I find myself in a similiar situation. I think I am now reconvinced to get to work on trying for a VBAC.
post #24 of 57
Thread Starter 

That's wonderful to hear!!!! I didn't know you were expecting - congratulations!
Really, though -
Thanks to everyone who has offered up their experiences and knowledge. If anyone else has more to add... feel free to keep it coming.

I'm definitely going to try to labor for a VBAC. I'm really nervous/excited - I find it sort of sad that when I talk to the doula I feel very positive and excited, but every time I leave the OB office I feel like giving up because they just fill your head with risks. Not that they have even ONCE discussed ANY risks associated with a repeat c-section. In fact, I won't be able to have a doula assist with labor because the philosophies are in such conflict that there could be some problems with working with both an OB and doula in this case. It really sucks, and at this point in my pg I don't feel comfortable switching providers - everything else has been really great, my OB actually suggested VBAC from the start. The doula I've been talking to is offering pain coping/birthing classes to prep me and is offering her support in other ways.

This has been a real learning experience for me.
thanks again...
post #25 of 57
http://www.cochrane.org/cochrane/revabstr/AB003766.htm

This is the Cochrane database abstract on continuous labor support during labor. It is an analysis of several studies involving over 12000 women, that found that doula-type support improved outcomes for moms and babies. The Cochrane Database is a well-respected source of evidence based findings.
I'd be uncomfortable working with a doc not willing to acknowledge such evidence.
post #26 of 57
You are right Alison. My thanks should have been to all those who responded as well.

I have lots of reading to do and no doubt I will have some questions along the way but its nice to be headed down that road again. Hopefully I can get some time to call my doula tomorrow and chat with her too. It's nice that your doula is willing to work with you and around any conflicts which might arise between her and your docs! The more support the better.
post #27 of 57
Thread Starter 
Quote:
Originally Posted by doctorjen
http://www.cochrane.org/cochrane/revabstr/AB003766.htm
I'd be uncomfortable working with a doc not willing to acknowledge such evidence.
The truth is, I'm really not comfortable with the fact that she's not supportive of using a doula. Well, actually she doesn't have a problem with people using doulas and has worked with them in the past, just isn't sure about my situation. She wants to monitor things pretty closely and feels that the doula would be so limited that it wouldn't be "worth it" in her words. At this point I'm just going to set my teeth and refuse epidural etc and pray that I can do it with the support of dh. I have this feeling I'll be begging someone to call my doula, though.


She didn't even want me to write a birth plan. She said it would be like guaranteeing I'd not get the birth I wanted - like carrying an umbrella and then it doesn't rain. I wouldn't use her again. I just don't feel comfortable switching right now when I'm so confident I can VBAC, and she supports it. Many of the other OBs around here wouldn't even consider it.

Do I make any sense at all?
post #28 of 57
I think it is a little strange that your doc doesn't want you to have a doula. Most practitioners jump with glee. they are such an asset to labor and the results of doula-attended births are great. It is scientifically proven that they help. As for me, I am definitely having a doula this time with my VBAC. I plan to stay home for a long time with the doula to avoid some of the EFM at the birthing center. Maybe you can talk to your doc again about the importance of a doula to you? Or, you could just hire her anyway?
post #29 of 57
Thread Starter 
I could hire her anyway - the doc didn't say NO, but she was very negative. I'm going to make a copy of that article and give it to her. Maybe that would make her more supportive of it.

The negativity is what keeps me from having the doula at my son's birth - I'm the peacemaking type, always in the middle of everything, and I'm afraid that I'd be very stressed by the conflict between the two. I know that the doula wouldn't be the problem - I'm pretty sure that the doc would be negative during the labor and I don't want to be in the middle of it. I guess I'm taking the easy way out at the moment, but it may not be so easy at the labor.... I'm feeling so confused! It's like I finally made the decision to VBAC, and now I have to deal with this.

My doula is so supportive. When I talked with her she said that she is just pleased that I still wanted to VBAC and she is going to help prepare me for that. To be honest I'm not sure that she wants to be in the middle of that confict, either.

I don't know what I'd do without the support of my loving dh. He's reading up a storm and asking me to find books so he'll know how to help me. After all the poor decisions I've made in my life I can't believe that I made such a perfect decision to spend my life with him.

Thanks so much for all of your support, too - And thank you Leah for reviving this thread!
ali
post #30 of 57
Thread Starter 
Quote:
Originally Posted by daekini
I don't know what I'd do without the support of my loving dh. He's reading up a storm and asking me to find books so he'll know how to help me.

BTW, anyone have any suggestions for dh to read???
we have "husband coached childbirth"...

Also, is there anything out there geared toward VBAC support for partners?
post #31 of 57
I'm planning a VBAC in Sept/Oct and my dh has read parts of "Natural Childbirth after Cesarean" which I found to be more helpful than VBAC companion, although that was good too. I mainly pointed out the questions about the previous birth experience because we really needed to talk that out, but it has good stats/stories too if he needs reassurance that it's safe.

BTW, I just hired a doula and wouldn't do it otherwise this time. It really seems strange that your OB doesn't want one...they are so common now and can take all sorts of roles, and mine has already been so helpful in terms of education. Good luck to you though, that's a tough spot.
post #32 of 57
Quote:
Originally Posted by daekini

Also, is there anything out there geared toward VBAC support for partners?
what a great question! My husband is eager to read up too. We have pulled out our old Bradley class book and the materials that came with it but if anyone has other suggestions, I am all ears!
post #33 of 57
While ideally it would be a great help to have a doula present, I do think there is a lot you can gain from her before the actual birth. It sounds like she is doing a great job at preparing you and your husband in every way she can now.

As for not having a birth plan, that would disorientate me a bit. We had a very detailed birth plan with ds and since we ended up with an emergency C-section much of it went out the window but surprisingly enough, there was stuff in there they were able to keep to and more importantly, I think it gave the staff a better idea of what type of birth we were hoping for - not that if we didn't get it we would be devestated or angry - but rather something to strive for, focus on. I intend to have one this time as well and it will most likely be just as detailed, if not more so, and will include a caveat about emergency situations should they arise (just as our first birth plan did). I don't see it as a invitation for disappointment or disaster at all but rather a comfort blanket of sorts.
post #34 of 57
Thread Starter 
I was really shocked when she essentially said she wouldn't read a birth plan if I wrote one. I felt like she was saying that my wishes were totally invalid, and something to be disregarded. I'm trying very hard to want to keep her as an OB. I have 10 weeks left and I'm not feeling up to switching right now. The devil you know.... is sometimes just a lot less scary than the devil you don't. Especially 'round here.
post #35 of 57
I agree with you that the no birth plan thing sends up red flags...

The fact that she wouldn't even read a list of your wishes for the ideal birth is unnerving. The things you put in a birth plan are not set in stone demands, they are ideals based on everything remaining within normal limits, you know?

I'd be running for the hills, honestly. If she won't listen to you before the birth, what on earth would make her listen DURING?

Good luck to you! Remember that she's your employee!
post #36 of 57
Any way you can bring a doula and just say she is a "friend?" I think sometimes docs misunderstand the role of a doula and think they are going to be in a situation where the doula is recommending one thing and the doc another. In reality, though, a doula's job is to provide support for the laboring woman - and that's support that docs traditionally don't have the time or inclination to provide, and the nurses are often too busy to provide.
Even if your doc follows the ACOG guidelines and says in the hospital while you labor, she is unlikely to be in the room much - probably just every so often to check your progress and then catch the baby. This leaves likely hours of labor where your doula could be supporting you. And doulas generally don't have an agenda - they simply help you with your agenda.
It's a little puzzling to hear that you shouldn't be prepared (write a birth plan) or supported (hire a doula) but don't worry, you can do it! Makes you wonder what the real plan is.
When I was a resident physician, I once attended a birth where there was this woman who was so wonderful to the laboring woman who was a teenager. She helped her work through contractions, brought cool cloths for her head, helped her into good positions to push, told her she was doing wonderful, and basically supported her through a great natural birth. After the baby was out, I said to the teenager "Boy, you have the nicest sister!" And they both cracked up because the woman I assumed was a sister was a doula through a volunteer program to help young women. That was my introduction to doulas and I loved having them around after that. Unfortunately, doulas are non-exsistent where I currently practice.
As far as books - I'm quite fond of "The Birth Partner." It isn't about VBAC specifically, but it has wonderful tips for supporting a woman in labor.
post #37 of 57
I just thought I would let you know that at 28 weeks (ended up really being 30wks) my OB 'terminated' my care for reasons of non compliance. I was told I refused the GT test, but in reality they never would put any reason in writing and I have come to believe I asked too many questions and had asked about vbacing. (The GT test doesn't hold water for an excuse, I didn't have it with any of my pregnancies with this OB office...)
I hired a lay mw DEM and had a homebirth after 2 c/s. It took me a few weeks to find a DEM.
For me it was easy to say hb b/c I had wanted a hb w my 1st. It was also very plain to see from my prior experience in the hospital that vbacing w the restrictions put in place by hospitals in our area I would have a slim chance of success.
Please don't use being so far along in your pregnancy be an excuse not to seek what you want. If you really want to go for a vbac, be 100% committed to seeking out the care you need to ensure the best possible chance of success.
post #38 of 57
Thread Starter 
Thank you ladies so much for you support, encouraging words and knowledge. I'm thinking of visiting a different OB to see what another viewpoint might be.

I wish I had the ~oh i don't know what it would be called, guts?~ to hb, but it has taken a long time for me to even get to this point after such a majorly medically interventive pregnancy with my dd. I love reading the hb birth stories...
post #39 of 57
Alison, I just wanted to share that at 30 wks I switched to a CNM after my dr told me of the hospital's no vbac policy :. I have heard of women switching even later than that. I did have a hospital vbac but my birth plan was honored (my mw was so glad I wrote one). I had hired a doula b4 my switch and I kept her. She was wonderful. In fact she helped dh help me better.
I am so glad that my hand was forced [ to switch] in my situation. I don't want to even imagine what the birth would have been like with the dr. My vbac was awesome! (Here is the story: http://www.mastbrookfamily.com/Faithsbirthstory.doc) While I did have a few interventions, it was overall a wonderful, healing experience.

The fact that your dr is not interested in a birth plan or doula signals red flags for me as well. It certainly wouldn't hurt to visit another one, or even look for a midwife.

Best wishes to you!!!
post #40 of 57
Thread Starter 
Okay I just had a loonnnng talk w/ my own mother and she's helping me figure out what to do. She's very concerned about the situation I'm in w/ my OB.

I think the first thing I'm going to do is tell my OB how I feel - like I'm bobbing around untethered in turbulent seas. Like she wants total control and I have to just go along with it. I'm afraid she'll rush me into the OR for a surgical intervention when maybe it isn't necessary [yet]... and without a birth plan or doula to ground me I'll be forgetting my goals, forgetting the research, disoriented... and very complacent.

I believe in giving people a chance to explain themselves and remedy the situation. So I'm going to tell her these things and see if she'll stop talking over me and interrupting me long enough to hear what I'm saying. If we can't have a meeting of the minds, I'm going to find another provider.

This is such a weird place for me to be. I'm a pretty assertive person normally, I teach biological sciences at a university and I'm not stupid. But somehow this experience, combined with my previous birth experience, makes me feel a bit like a bovine being herded around... Maybe part of the problem is that I'm a control-oriented person and so is she. Maybe we're in the middle of a mental tug-of-war of some kind?

My next appt is in 2 weeks. I'm going to gather strength (drawing much of it from all of you!) and figure out what to say between now and then.

My Mom asked to be with us in the hospital during my labor because she doesn't want me to be "dumbed" into another c-section while I'm disoriented from labor and may not be thinking straight. She's a toughy, and won't be bullied. I have mixed feelings about this, but I'm leaning towards saying yes. She can learn some things from books between now and then and wants to provide supplemental labor support, co-partnering (but in a much smaller role) w/Mark. We're very close, but do have our differences...

anyway, sorry to ramble... that's what you get for making me think! :LOL
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