VBAC and 42 weeks? - Page 2

[catemom]

Oh, I forgot to mention, when DS was born via c/s at almost 43 wks. gestation, his apgar scores were almost perfect!

[PassionateWriter]

Originally Posted by crunchybelle

Maybe you should try asking your cnm for cold hard facts on why she thinks it it so dangerous. I have never heard of VBAC and postdates together being more "high risk". And since you are having a hard time finding any info on it at all, it sounds like they don't have anything to base it on.

as a vba2cs, i think i have tried to research all there is out there and i have never seen any research on post dates w/ vbacs...i dont think it exists..and if it doesnt exist, its not fair for them to pull the card.

[kdtmom2be]

Originally Posted by meatloafkend

I know, however, that many doctors don't want VBAC moms to go overdue because they don't want the baby to get too big and put additional strain on the scar.

I don't have much to add except this peice of anecdotal information:
A friend of a friend gave birth at 41w+5 a few weeks ago and the doctor mentioned that babies lose weight in the days/weeks past 40weeks because thier fat stores start to deplete a bit. Maybe the doc was talking out his behind, but thought I'd throw that out there. Not something I've looked into myself!

[JBaxter]

Next time Fudge your LMP a few days to give yourself some extra time

[Otterella]

I have to wonder if the "decreasing success rate" of VBAC after 40 weeks has more to do with unsupportive care providers than it does with the mother's body.

[aylaanne]

Originally Posted by JBaxter

Next time Fudge your LMP a few days to give yourself some extra time

I've thought about it, but I'm worried that might be shooting myself in the foot. If it really is riskier to stay pregnant for that long, I don't want my stubbornness to put me or my baby at risk, kwim? OTOH, I also don't want to then go early (though highly unlikely, still possible) and have my baby gone over with a fine-tooth comb because they think she's more premature than she is. I also don't like to lie, and prefer to keep everything as above-board as possible. Part of my meetings with my MWs (both hospital and home birth) will be to figure out how much fudging can be covered with a wink-wink-nudge-nudge, and how much would seriously ruin their trust in me.

And they need to trust me. I believe in being equal partners with my birth attendants, and that means that I need to trust them and they need to trust me. If I'm just going to do what I want and to hell with them, I might as well UC, and I'm not comfortable with that at this point. So it's important that the trust stay intact.

[cathicog]

Originally Posted by aylaanne

However, my CNM and her "governing" OB are not going to be interested in my anecdotal stories, they will want research, or they're not going to listen to me. So I'm looking for published, peer-reviewed studies that clearly outline the risk/benefit scenario.
The OB office I work through operates on the midwifery model, and they are more open to letting me do what I feel is the right thing in general. I want to have another appointment with my CNM to talk about some possible future scenarios (like, if I do go to the hospital, how I will be outright noncompliant with their clear-liquids only in labor policy), but I need some ammo first.

Given the kind of CNM she seems to be, I highly doubt you will have a VBAC under thier care, no matter how many studies you show them. Have a homebirth. It is the only way you will probably ever be able to have a "normal" labor and birth, and to give birth when you are ready, not when a professional tells you to be... i am glad the OBs office seems more relaxed, but they arent the ones who issue the paychecks, or cover insurance, I would bet...I have a feeling it is probably the hospital they are associated with who Really Calls the Shots....

[PassionateWriter]

i guess im not getting this.

its almost as if the dr's dont have to "prove" what they are saying. if THEY say it, its golden and should be listened to. the patients are the ones who have to scramble and find the research proving what they are saying is not accurate.

so...if we cant prove them wrong, we have to accept what they say?

thats just not the way i accept my health care professionals providing care for me and my children. If they want to suggest something, or have a concern, they need to be able to back up what they are saying.

[onelilguysmommy]

Originally Posted by kdtmom2be

I don't have much to add except this peice of anecdotal information:
A friend of a friend gave birth at 41w+5 a few weeks ago and the doctor mentioned that babies lose weight in the days/weeks past 40weeks because thier fat stores start to deplete a bit.

its because the placenta can potentially start to shut down in some women/pregnancies so the babe isnt getting as much nutrition, so they start to lose weight. same as anyone outside the womb. stop eating and your body will use up what youve already got, kwim? that happened to my oldest.

has absolutely nothing to do with a vbac, just going postdates.

[AlexisT]

Originally Posted by cathicog

Given the kind of CNM she seems to be, I highly doubt you will have a VBAC under thier care, no matter how many studies you show them. Have a homebirth. It is the only way you will probably ever be able to have a "normal" labor and birth, and to give birth when you are ready, not when a professional tells you to be... i am glad the OBs office seems more relaxed, but they arent the ones who issue the paychecks, or cover insurance, I would bet...I have a feeling it is probably the hospital they are associated with who Really Calls the Shots....

I think this is a huge leap, and based on the evidence given you can't say that. It may be nicer if your OB/MW does everything the way you want without a question, but having protocols doesn't automatically mean they're going to pull the bait and switch.

On the other side of the table, I know someone whose OB was really not very supportive of VBAC. She was in an MFM practice and switching wasn't really an option. The peri was very cool, the regular OB was not. Well, that unsupportive OB caught her baby... or, rather, pulled him out with forceps. (Yes, he was really stuck, and my friend was totally exhausted and just couldn't push any more.)

[maxmama]

Scarring of the uterus is not the issue. The issue is that most practices will not induce a VBAC, and most practices also strongly encourage delivery at or just after 42 weeks. So if you can't induce, but the baby needs to be delivered, guess how it will come out?

[aylaanne]

Originally Posted by cathicog

Given the kind of CNM she seems to be, I highly doubt you will have a VBAC under thier care, no matter how many studies you show them. Have a homebirth. It is the only way you will probably ever be able to have a "normal" labor and birth, and to give birth when you are ready, not when a professional tells you to be... i am glad the OBs office seems more relaxed, but they arent the ones who issue the paychecks, or cover insurance, I would bet...I have a feeling it is probably the hospital they are associated with who Really Calls the Shots....

Originally Posted by AlexisT

I think this is a huge leap, and based on the evidence given you can't say that. It may be nicer if your OB/MW does everything the way you want without a question, but having protocols doesn't automatically mean they're going to pull the bait and switch.

Alexis is right, and you did make a whole lot of judgement. My CNM is incredibly liberal, so for her to say something like "your risk of dying is higher the farther post-dates you go with a VBAC" is sobering for me. She's wholly supportive of my homebirth and my homebirth midwives and will be giving me prenatal care in tandem with them. The visit we had was not long enough for her to start pulling studies and statistics out, and I am planning on making that appointment with her in a few months. What I'm looking for, here, is to have my own set of research done, so I'm not just taking her word for it, I've seen some of the studies myself.

I would never want a provider who would make decisions based on anecdotal evidence. If I went in to see her and said, "I had 11 people on Mothering.com say they had a VBAC or knew someone who had a VBAC after 42 weeks and their babies were fine" and she was like, "Oh, well then we'll just let you go into labor whenever then, because obviously it's safe," that would be a huge red flag for me. Likewise, I am expecting her to back up her statement that post-dates is risky with research. I don't want her making any decisions about my care based on stories she's heard from other people. I want to know the facts.

Originally Posted by PassionateWriter

i guess im not getting this.

its almost as if the dr's dont have to "prove" what they are saying. if THEY say it, its golden and should be listened to. the patients are the ones who have to scramble and find the research proving what they are saying is not accurate.

so...if we cant prove them wrong, we have to accept what they say?

thats just not the way i accept my health care professionals providing care for me and my children. If they want to suggest something, or have a concern, they need to be able to back up what they are saying.

I am expecting my CNM and her governing OBs to back up what they say. My research is to decide whether I'm going to listen to them, or whether I'm going to do what I want, anyways. How much risk is too much risk for me? How do I want to manage my pregnancy as I anticipate labor? What factors need to exist for me to agree to a RCS? These are decisions that I am responsible for, whether I have a home or a hospital birth, an attended or unassisted labor.

The beauty of having people who do birth for a living assist me with my pregnancy and labor is that I get their experience, education, and wisdom to assist me in making all those decisions. The difficulty is reminding all of them--CNM, HBMW, and OB--that the decisions, and their consequences, are MINE and mine alone.

[thepeach80]

Originally Posted by maxmama

Scarring of the uterus is not the issue. The issue is that most practices will not induce a VBAC, and most practices also strongly encourage delivery at or just after 42 weeks. So if you can't induce, but the baby needs to be delivered, guess how it will come out?

Maybe DRs here are more liberal, I don't know. I was induced at 39 wks w/ my last VBAC and will probably be induced again at 39 wks if baby is not here by then. We have a panel discussion after BOBB and the DR they had there also mentioned inducing a VBAC as long as the baby was already working on it. I was contracting on my own and at 4cm when I went in and Ilana was born 3.5hrs after I went in.

[AlexisT]

From the sound of it, you weren't induced--you started on your own. You were augmented, which some docs will do under controlled circumstances (pit raises the UR risk). What can't be done with a VBAC is the standard induction using prostaglandins (Cervidil and Cytotec) because it raises the UR risk by several times. I've heard of VBACs being induced using a Foley cath, which sounds like it wouldn't raise the risk of UR (no drugs involved) but you'd have to be close to going on your own for it to work.

Routine induction at 39 weeks is a bad idea in general, though. Why does your OB think it's a good idea for you to go early?

[maxmama]

Originally Posted by thepeach80

Maybe DRs here are more liberal, I don't know. I was induced at 39 wks w/ my last VBAC and will probably be induced again at 39 wks if baby is not here by then. We have a panel discussion after BOBB and the DR they had there also mentioned inducing a VBAC as long as the baby was already working on it. I was contracting on my own and at 4cm when I went in and Ilana was born 3.5hrs after I went in.

Liberal isn't the issue. Increased rate of UR with pitocin and prostins is. At 4cm, it's really an augmentation, not induction.

[thepeach80]

I was not in active labor though when I went in and might not have been for several days, so I do consider it an induction. Semantics I guess?

My DR gives everyone the option of going in at 39 wks if they want. I chose to go in. It's hard to coordinate care for my kids while I'm in the hospital having a baby and I had bad SPD and was ready to be out of pain. I will probably be induced again at 39 wks this time as well if baby is not here by then. Not my top reccomendation for anyone, but I would rather go in and be induced, or at least try, then go straight to another c/s on anyday.

[maxmama]

Originally Posted by thepeach80

I was not in active labor though when I went in and might not have been for several days, so I do consider it an induction. Semantics I guess?

My DR gives everyone the option of going in at 39 wks if they want. I chose to go in. It's hard to coordinate care for my kids while I'm in the hospital having a baby and I had bad SPD and was ready to be out of pain. I will probably be induced again at 39 wks this time as well if baby is not here by then. Not my top reccomendation for anyone, but I would rather go in and be induced, or at least try, then go straight to another c/s on anyday.

I'd be more concerned about your doc offering elective induction at 39 weeks, which is not condoned by ACOG or supported by th research, and is known to increase the risk of cesarean, iatrogenic prematurity and fetal distress.

At 4cm, you may not have been actively laboring, but that's what an augmentation is for!

[cathicog]

Originally Posted by AlexisT

I think this is a huge leap, and based on the evidence given you can't say that. It may be nicer if your OB/MW does everything the way you want without a question, but having protocols doesn't automatically mean they're going to pull the bait and switch.

You are probably right, and I guess I haven't seen too many flexible OBs. It is good you have someone who will work with you. They are rare. Enjoy your birth.