Is it possible to have a hospital vbac?

[richella]

I live in a rural area about 20 mi from a hospital. The one midwife I know of who will come out here for home delivery has been called before a review board for doing a tolac, I don't know if they even let her keep her license. My friend who had a first birth at home never could find a local ob to back her up, she just lied to the midwife and said she had someone.

I don't feel particularly drawn to do the second one at home. I'd be happy if I could just go to the same hospital where I had dd, but bring a doula. I'd even take the same ob if I had to have a c/x again, I think his surgical skills were excellent. But I think there's no chance he would take me as a vbac patient. What options do we actually have? All you vbac-ers, did you do it at home?

Where do I start?

[logan&jordansmommy]

Hi,
I do think it is possible to vbac at a hospital if you choose wisely and do your research. Now, I haven't had a vbac...yet! But I can't do a hb because mw's aren't able to legally do them here. But I have been in contact with a quite a few women that have had them at the particular hospital I am going to.
I would really think about whether you want to have your same dr to do your vbac. I know some that go that route but I wouldn't. My last ob was a great surgeon too but that is definitely not what I am looking for! So, I would start by researching the hospitals in your area. See if the do vbac's and see what they vbac and c/s rates are. Do you have any mw's that deliver in hospitals? You can look there because *sometimes* they are more willing to do a vbac (it is so sad that they have to be willing but that is how it is these days it seems). Also, if a doc or mw says they do vbacs, I would make sure they don't put many restrictions on vbac's. For instance, I have heard of ob's that say they do them but they make you schedule a c/s at 39 weeks just in case. Well, that is just setting you up for failure. Or they require internal monitoring which requires breaking your water which puts you on a clock, kwim? Just things like that. So I would start by calling around and see what answers you get. And yes, I would definitely hire a doula.

What I am doing is hiring a doula who is also a mw. She is going to be with me at home while I labor. That way she can check fetal heart tones, vaginal exams (if I choose that) and I plan to leave for the hospital at 7-8 cms. That way I can spend the least amt of time at the hospital as possible.

Good luck!

[AngelaB]

Where are you in Kansas? I had my last ds(my 2nd vbac)at the Birth and Womens center in Topeka. It was a beautiful experience! We did drive almost 2 hours to get there and we stayed in a hotel for a while too.

They have had people from all over the state come to birth there. Good Luck!
Angela

[~Megan~]

I'm sure its possible but after having a homebirth I'd never ever have a baby in a hospital unless my child or I was in imenent danger. Its just not something I'd choose.
Homebirths are safer. Homebirths are better in myriad ways. More comfort and control and letting things happen naturally are what you need for a good birth especially a VBAC.

[spu]

we're planning a hospital vbac. #1 and 2 were twins, and at the time, I had a great perinatologist who did an induction, followed by a c. This time around with #3, he wanted to schedule a c from the get-go, which destroyed me. I drilled him to pieces, and at 18w, switched from his high-tech hospital to a much smaller midwife hospital (with ob's on staff for an emergency c). They are so incredibly vbac supportive and I'm thrilled that I switched. Both hospitals are at least an hour away, and more if it's rush-hour (gotta love living in the suburbs of Boston!) We also hired a doula who is a bradley teacher, so we're hoping to avoid drugs that could lead us down the road to another c. Do your research, ask loads of q's, and make sure you're comfortable and feel supportive. If your hospital staff has doubts, or treats it as a "trial" of labor, they may not be fully committed. Ask to see their stats on vbacs and repeat c's too.

good luck!

[mary3mama]

I had a hospital VBAC 3 years ago, but that was before the tide really started turning about VBACs in general. The hospital I delivered at was/is not known for listening to mama's needs, per se, but my OB knew I wanted to VBAC and did everything she could to make it happen -- including going against some hospital protocol for me.

I really have no idea if I'd be 'allowed' to VBAC in a hospital now.

I'm planning a homebirth for this baby.

[oregonbound]

I had a VBAC in a hospital 2 years ago and I had an OB who was incredibly supportive. He actually told me at my first appointment that he thought that VBAC was the safer option. If you've already found a doula, you might want to start by asking her if she knows whether there is a doctor or hospital that will be supportive. Otherwise, you could try your local MDC board or just call the various OBs and hospitals in town and ask them. Good luck!

Minta
Mom to 2 and 1 on the way

[roadfamily6now]

I dont know about KS but all 4 of my VBAC were in a hospital! I am now trying to fight to have a midwife assited homebirth, go figure!

[CEG]

It may be that you know your doc well and they would be supportive. But as a general piece of advice I have learned from my nursing clinicals- do not have an OB if you want a vaginal birth!!

From what I have seen (and admittedly this is just a couple of hospitals in one area) doctors believe you will need a c-section but will allow you to have a vaginal birth if nothing bad happens. Midwives believe you will have a vaginal birth and in the rare instance a c-section may be required. This difference in philosphy is huge. For instance today a primip who had been in active labor for about 9 hours was told she was "on the clock" because she had "only" made it to 7 cm. She later ended up with an "emergency" c-section for nonreassuring fetal heart tones, or in other words, time for the residents to go home and want credit for this birth.

Although your doctor may be the rare exception, what I have seen from the hospitals reaffirms my belief that medical education does not respect the birth process. I also get the feeling from most of the residents that they are really too young/immature to make those sorts of decisions. They are not looking at the big picture or the mom's perspective when they go to c without a real reason. The possibility of having a c-section is tossed around like it is a choice on the lunch menu. Everyday I am amazed all over again that luck allowed me have a midwife. I certainly woud have been sectioned by an OB for my labor.

[gypsycat]

I had a hospital vbac that went great. Even if my son did get his head stuck ,my ob was able to maunuver him out.
My o/b was vbac freindly and apparently there was no problem with the hospital policy on vbacs. Just be sure you check the hospital and your doctor out totally. Make sure you know what all their policies are ( ie. how long will they let you labor before policy says they have to interfere? How long will they let your pregnancy progress before interfering.)
Some doctors and hospitals have rule and others don't.

good luck on your vbac

[richella]

Thanks for all the responses. I'm pretty sure the FP MD and the OB I worked with before will say no to a vbac really fast. AngelaB, I'm in Chase County, about 20 mi west of Emporia. I know about the Birth and Womens Center and have heard good things about it, but I thought they didn't do vbacs. Will look into that. I know of a MW who does them, she's located in Topeka but her website says the Topeka facilities don't allow them, so her vbac patients go to KC. I'm kind of leaning that way, though it seems like a long distance, about 120 mi total. Course, my last labor was so long I could have driven there and back several times.

I'm curious about laboring in a hotel room. What did you do? I guess cause last time my water broke early, I had a lot of fluid and had to put a towel on the car seat just to get to the hospital, imagining that in a hotel room makes me laugh (and I shouldn't, we have a motel and that's one mess I don't want to have to clean up!)

[kathan12904]

My answer is no, its not possible to have a vbac in a hospital and those that do are the exception to the rule. Just b/c midwives are illegal doesn't mean you can't find one, I did and I'm right next door in midwife hating missouri. Also, if vbacs do happen in hospitals, they don't happen in ones that call them tolacs.

[richella]

MWs are legal over here, I think in the region I'm in there's just not that much demand. When I was in hospital birth class there were about a dozen couples and I and one other woman were the only 2 who weren't planning to have an epidural 4 mos before due date.

[AngelaB]

The birth and womens center DOES DO VBACS!!!! I highly recomend them. THey can do vbacs because Josie (the md) who is officially in charge cant be told by the free standing birth center organization how to run her practice. Its a little more complicated than that but you get the idea.

Anyways I had my 2nd vbac at the birth center in april. It was so nice and the hotel was just a hotel! I showered and tried to sleep and paced the floor. THere are some really nice parks in Topeka. Norla my mw sent us out to have a big breakfast so I would have energy for the day and we hung out in topeka trying to get labor going steady. I have tweaked my nipples all over that town!!!
One of the nurses, Lori, is a mdc member she could help tell you more about it if she comes by here. She was my nurse and she was perfect! She also took beautiful pictures.
~Angela~
I wanted to add that the birth center is across the street from the hospital and Josie would go with you as your care provider. You can also pay the nurse to come with you as well.

[maxmama]

Originally Posted by kathan12904

My answer is no, its not possible to have a vbac in a hospital and those that do are the exception to the rule. Just b/c midwives are illegal doesn't mean you can't find one, I did and I'm right next door in midwife hating missouri. Also, if vbacs do happen in hospitals, they don't happen in ones that call them tolacs.

How can something be impossible and still the exception to the rule?

Also, our unit does call VBACs TOLACs, and we still have a 70-80% success rate. The assumption is that you will be able to vaginally birth your baby. TOLAC is used among staff (never in front of patients) to distinguish between women who have had a successful VBAC in the past and those who have not. We have a LOT of repeat VBACs.

You might want to consider that assumptions you have about hospitals and VBAC might not be completely grounded in reality, but in the experiences you personally have had. Before writing off hospital VBAC, you may also want to consider that there are hospitals where VBACs are considered an everyday event.

[richella]

I used the term TOLAC because that was what was used in the article I read about that particular MW. I don't even know if she uses the term, but her website has a whole section on VBAC without using the t word once.

I don't find it offensive, myself. Of all the possible options, vbac is by far my preference, but if everything were exactly like my last birth (of course it will all be totally different), I would take the c/s a lot earlier, and not wait till I was starving and exhausted.

AngelaB, I always think of Topeka as a big suburb w/ a ghost town instead of a city. I will feel more at home there thinking of you tweaking your nipples wherever I go. Did you go to that Indian restaurant downtown? I love it but I think I might be more likely to carb load at the Olive Garden, they have bigger chairs.

[MommyDOK]

Richella, I recommend you contact the Kansas City chapter of ICAN. The leader, Eva knows A LOT about vbac all across Kansas. You can find her at www.ican-online.org website.

I had a vbac at a hospital w/out a hitch. The only thing that could have gotten in my way was I had another posterior baby, and the pain really got to me, but I still pushed her out.
As a co-leader of ICAN (St. Louis), I've seen many, many moms have vbacs at the hospital and at home. What helped me was reading dozens of stories of vbacs, talking to other moms who had vbac'd and making sure my doctor agreed w/ me on all aspects of labor etc. I spent hours reading ACOG journal studies on vbac, ur etc.
I interviewed lots of doctors and was even considering going as far as Topeka to their birthing center. I finally found a doc in St. Louis that practiced evidence-based medicine so I didn't have to journey too far.

Let us know how your journey continues.....

[cloak]

I had a hospital VBAC. Went completely natural too. It's possible.

[Oana]

It is possible -- do get a doula if you can.

here is my story of a hospital VBAC, maybe it provides some hints. Labor at home as long as you can.

GL!
Oana

http://www.mothering.com/discussions...d.php?t=511800

[pampered_mom]

Originally Posted by maxmama

You might want to consider that assumptions you have about hospitals and VBAC might not be completely grounded in reality, but in the experiences you personally have had. Before writing off hospital VBAC, you may also want to consider that there are hospitals where VBACs are considered an everyday event.

I don't mean to pick on you, maxmama, I really don't....

Seriously, I realize that you have a fairly decent birth climate at your hospital, but that is very much the exception to the rule. Where I am located the hospitals are not at all like that - and that's EVERY SINGLE ONE OF THEM within at least a 50 minute radius. I'm glad that you have found a hospital like yours to work at, but even you have to admit that finding a hospital where VBACS are considered an everyday event is pretty darned near impossible in many places in the US.

That said...is it possible to have a hospital VBAC? Sure. Is it probable? No. Does that mean that if you are most comfortable birthing in a hospital that you should stop looking? No. It just means that you need to explore your options in your area and entertain the possibility of traveling to a different location (and staying with friends and family).

I hate that it has to be that way, but unfortunately, until some radical changes take place in our birth culture that's just the way that it is.

Your best bet is to do your research well. Head on over to ICAN (www.ican-online.org) and check out the information there. Consider signing up for their e-mail list. There is a wealth of information over there including women who can help you find the applicable studies. Certainly consider hiring a doula for your next birth.

And, most importantly, determine where you would feel most comfortable giving birth. For me that's at home, but for some women, like maxmama, that's in the hospital. Which is fine - I would never suggest she birth at home unless she indicated she were open to the possiblity. I'm also limited in that unless I go for a homebirth it's pretty much guaranteed I'd end up with a repeat c/s. As such, I'd never choose the hospital unless circumstances were more dire and even then I'd go in fighting.

When it all comes down to it, you need to determine what your ideal birth story would be for the next one and use that as your starting point.