Advice for a successful hospital VBAC?

[pascal]

I'm planning to have a VBAC in a hospital (don't yet know where or with who. I'm moving from DE to South Atlanta and am also seeking advice on good OBs, Hospitals Doulas and Midwives in the area).

I've talked to my OB here and he recommended that I avoid induction (which I agree totally, I beleive its best to wait until they baby is ready to come out) and that if I forego the epidural I'll be able to push more effectively and if my uturus ruptures i'll feel it in time to do something about it (i guess perform an emergency cesarean).

My first labor/delivery: 26 hrs at home and in a birth center with Midwives, pushed for 5 hrs, too exhausted to push any more, transfered to hospital down the block, c-section (I was hi as a kite during thanks to those blessed drugs! after so much PAIN) gave birth to a 10 lb 11 oz 24 " boy.

I'm 4 mo pregnant with another boy, but I also weigh 20lbs less than last preg. I did not have Gest Diabetes. And I have a Hypothyroid which was detected by my OB after big boys birth and is currently being treated.

okay...
what can i do now and once i'm in L&D to increase my chances of a VBAC? Will I be able to assume several positions like I did in the BC? Or will I be strapped to monitors? Do I have a choice?

Thanks

[dotcommama]

You should ask your doc about what the hospital policy is as far as needing to be monitored, ability to assume any position needed, etc. . . each hospital and ob has different views about what is necessary. Definately discuss your options and preferences ahead of time.

As for good VBAC advice - I started a thread a while back called, "How to have a sucessful VBAC" and got lots of great ideas. Here is a link: http://mothering.com/discussions/showthread.php?s=&threadid=44088

[jayasun]

THere are so many facets to having a successful VBAC. And while what happens after you get to the hospital does matter very much, so do many things before you get to the hospital.

Do you have your records from your first birth? Was baby malpositioned? I would get familiar with Pauline Scott's Optimal Feotal Positioning. While many babies are born posterior, or even brow, or other slight variations of the "norm" certainly having your baby aligned as optimally as possible is to your advantage.

Yes, your baby was big, but I know there are babies born bigger than that vagninally everyday. I am not minimizing the amount of work it is, but your body is designed to birth the baby you grow, Even if it is near 11 pounds.

I would learn as much as I could about normal birth, and about interventions. I would get really educated on VBACs (glad you have 5 or 6 months left :-) ) I would learn about all the things that can decrease my chances for vaginal birth- CEFM, epidural, AROM, care providers, fear, emergency crew in the green room, no food during labor, etc. I would learn everything that can increase my odds of having a VBAC- doula, GOOD care provider that truly believes in birth as normal and trusts the wisdom of your body to birth.

If you need suggested reads, let me know.

Then, after I had learned the above, I would get serious about finding a care provider. THe care provider would be someone that stacked the odds in my favor for vaginal birth. I would find someone that was going to protect my body and wait for labor to begin, without inducing. It would be someone that trusted birth, and could keep their hands off me and out of me. And I would make sure that no fetal monitors were in the picture. I would want to be able to move around in what ever position I felt right in.

So, I would find a supportive care provider, and place of birth, and I would make sure I knew the hospital's VBAC policy and protocol. I would get a copy of it in writing. Many docs will tell you some of it, but not all, and finding out the rest of it at 40 weeks can really put a crimp in your plans. Once I knew I had the care provider and birth place I felt comfortable with, I would write and extensive birth plan, and get it signed by the midwife or doctor.

If at any time, I sensed they did not believe in my ability to birth vaginally, or that they were unsupportive in any way, I would run the other way.

That being said, I think it is really hard to find a doc that truly supports VBAC in this litigious climate, and with ACOGs new quidelines. THus why so many people are finding out it is better to just stay home. I'm just not sold on the idea that healthy birthing women need surgeons present at their births.

Blessings and best of luck,
Jaya

[stafl]

I disagree, but have not had my 2nd baby yet.
My OB is very supportive of VBAC. He said there is no medical reason why anyone should have a repeat c-section unless something major goes wrong. Not all doctors are created equal, you just have to find one that is right for you.
Hospital policy is a guideline, you don't have to follow it if you don't want to. You do have a choice. They will make you sign a waiver, but they can't force medical interventions upon you unless you and/or the baby is in serious danger. You have better chances of getting what you want if you seem to know what you are talking about, and have everything planned out well ahead of time. If you come across as a raving lunatic, they will treat you like one. Stay home as long as possible before showing up at the hospital.
Hire a doula, preferably one familiar with VBAC and the hospital where you choose to deliver.
Definitely write a birth plan, and go over it with doc and doula ahead of time. Have many copies of it to hand out to nurses, staff, etc when the time comes.
I am also going to write a back-up birth plan, just in case c/s is necessary again.

[jayasun]

Stacy- it sounds like you have a gem of an OB! I did not mean to imply that it is impossible to find an obstetrician that supports vaginal birth, just that it is becoming increasingly difficult. There are always those few and far in between, and you are fortunate to have found one!

Many blessings on your journey,
jaya

[Cathi]

Originally posted by stafl
but they can't force medical interventions upon you unless you and/or the baby is in serious danger.

Ah, but who's definition of "danger" do you have to go by? Sometimes the mere fact that you are being cared for by someone who is under another's authority (and insurance policies) can be enough to force you into a csection. A laboring woman can have the best laid out plan but when she's in labor she's extremely vulnerable. That makes her easy prey to someone else's agenda. :( It's sad, but true, and something us VBACers have to be very careful of.

Stafl, I actually agree with you on a certain level as I myself have found an OB willing to VBAC me and one who gives me free reign over my choices (so far). So I do think that midwifery isn't always the answer. It certainly isn't in my case.