VBAC client told babe is too big (doulas?) - Mothering Forums

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Old 03-19-2010, 11:09 PM - Thread Starter
 
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I am a new doula (though I've taught childbirth ed for 3 years), and I have my first VBAC birth coming up around April 9. The mother's doctor did an u/s and told her that baby is measuring 7lb 7 and she should plan a cecarean if she doesn't go into labor soon. She wants to naturally induce labor, but I am concerned with the veracity of that judgement (I know that they can be wrong in guessing baby weight through u/s). Do you have any advice for me on this topic?

Mandi - Doula/Childbirth Educator, Loving my DH, DS, DD, DD, missing my three (last m/c 4/2010)
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Old 03-20-2010, 12:10 AM
 
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Yes, u/s is horrible for guessing weight, and even if the baby is big, that does not mean she can't have a successful vbac.

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Old 03-20-2010, 10:47 AM
 
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Will she listen to you at all? If you tell her that 7lbs is not too big, will she believe you or her doctor? Does she have GD? How big was her last baby?

You need to let her know that the doctor is blowing smoke up her butt. He doesn't want her to VBAC, and he's setting the stage to take that option away from her. It wasn't a VBAC, but my friend just had a waterbirth to a baby over 10lbs, and she's a size 0!! No tears, nothing. Size is not a problem!

If she's serious about getting a VBAC, I can't believe that she wont listen to you. If she's not that serious, and it's just something she going to try, then she'll probably listen to her doctor. Good luck!
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Old 03-20-2010, 04:04 PM
 
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How does the mother feel about what is happening with her? How open is she to changing care providers? In my experience when a care provider starts saying that a mother should schedule another cesarean (or a cesarean in general) that tends to give me the sense that they will find whatever reason they can once mom is in labor to perform a cesarean.

I currently have the most wonderful client ever who is also going for a vbac and at first her doctor kept saying she could vbac and as time went on things changed and so now the mom switched providers to one that I know has done vbacs with mothers and she is so much happier.

I have yet to see a successful vbac with a doctor that isn't supportive. Like I said if they are 100% on board they tend to come up with some reason for a cesarean later on.

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Old 03-21-2010, 03:27 PM
 
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I had a client successfully VBAC a 9.5 pound posterior baby, after a 26 hour labor. She had a very supportive and patient OB. I know many others would have sectioned her in a heartbeat. Size has very little to do with VBAC-ability, or birth-ability for that matter.
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Old 03-21-2010, 05:01 PM
 
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This late U/S is very unreliable at estimating & 7lbs 7oz is hardly a big baby even if she still has a couple weeks to go. I've attended VBAC babies well over 10lbs regularly, even had a couple in the 11-12lbs range. Those 2 were homebirths, but the mother should be made aware of what the body CAN & was made to do.

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Old 03-22-2010, 01:59 PM
 
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You could send her this link:
http://www.ican-online.org/

Also, baby weight is NOT an issue! Unless a woman has a pelvic deformity or has been in an accident and the bones in her pelvis are fused, her pelvic connective tissue will soften and open in response to the hormones of labor. If she stays in an upright position or on hands and knees she will allow space for her tailbone to move out of the way and her pelvis to open fully.

Also, baby's craniums are not fused and the bones of the skull are designed to overlap if needed to fit through the pelvic opening.

Finally, our bodies are 72% water--think of how malleable a water balloon is--babies "squish", so weight is really irrelevant--again except for VERY rare cases.

If anyone took the time to think about the physiology, they would NEVER worry about baby weight, IMO!

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Old 03-23-2010, 01:55 AM
 
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The previous posters have given a good run down on why the doctor's recommendation is not evidence based.

My advice to the new doula is to not get too attached to the outcome. It sounds like mom has chosen a caregiver that isn't supportive of vbac. She chose her caregiver. Educate, certainly, but it's not within the doula's scope of practice to convince women to listen to them, or to "save" women from their own poor choices.

Good luck! I hope it works out!

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Old 03-23-2010, 10:50 AM
 
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Quote:
Originally Posted by mamallama View Post

My advice to the new doula is to not get too attached to the outcome. It sounds like mom has chosen a caregiver that isn't supportive of vbac. She chose her caregiver. Educate, certainly, but it's not within the doula's scope of practice to convince women to listen to them, or to "save" women from their own poor choices.


I have a hard time with this sometimes. Sometimes I repeat the mantra "It's not MY birth; it is her birth, her choices. My job is to support her choices" in my head every now and then.

I try make sure they have access to the information available to make informed decisions, but sometimes a decision will be made that just seems... uninformed... but you have to roll with it anyway.
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Old 03-23-2010, 04:54 PM
 
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That's not a big baby. It's on the small to average size. Late term u/s are notoriously inaccurate for weight. The bigger questions are these:
Is she truly committed to a VBAC? if she is, she probably needs to change care providers, cuz this one put the bug in her ear about future surgery. If she wants a VBAC, she probably needs to run fast in the other direction, and find a hb midwife....
If she wants to stay with her current provider, I would help her understand that her best chances of a VBAC in hospital would be to stay home as loong as possible, even to the point of almost pushing(depending on the distance she has to go to the hospital)...and to read everything she can on ICAN and other VBAC websites to prepare for a vaginal birth. You might also show her some of the UC websites/info, JIC she has this baby much faster than the other one...and to help her know what normal labor looks like...Best of luck. She is going to need it. I am glad you are helping her!
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Old 03-23-2010, 05:29 PM
 
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Uh....yeah, unless something else is going on (which it doesn't seem) the Dr. is WAY off base. ACOG says to estimate baby weight, to use leopold's manuever (feeling outside the belly) as it is more accurate than u/s. U/S can be off by up to a lb.

Also, and mainly this is the REAL point, a "big" baby, macrosomic is either 8lb 15oz or 9lb something. NOT 7LBS!!!! I would advise your mom to be VERY cautious with this.

Also, ACOG says to do nothing different when true macrosmia is suspected, meaning, no iductions, and certainly no c/s, as it doesn't show "better" outcomes for mom or baby.
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Old 03-24-2010, 05:44 AM
 
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Let's say she has the MOST conservative doctor on the planet. Let's also say her previous c/section was for a baby that was 6 lb and they say it was due to CPD. Finally, let's pretend u;s IS accurate for estimating fetal weight (which even ACOG says it is not).

Ok, even with that worst case scenario, the recommendation is usually something like this in those conservative circles: you should offer c/section for macrosomia with suspected fetal weight 4000 gm or over, advise it at 4500gm, insist on it at 5000gm.

A 7 lb 7oz baby is none of the above.

she should:
-ask the doctor his VBAC success rate
-ask if he supports VBAC or just does them when he has to
-ask to see what the ACOG guidelines are and if she can get a copy

It will allow her to see if he really just prefers repeat c/s and also force HIM to read the guidelines and realize he is full of crap

This is all assuming she has no medical condition involved that we are not aware of that would warrant a repeat c/section (but still not based on size of baby).
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Old 03-24-2010, 05:14 PM
 
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Quote:
Originally Posted by momtofourinhawaii View Post

she should:

-ask to see what the ACOG guidelines are and if she can get a copy

It will allow her to see if he really just prefers repeat c/s and also force HIM to read the guidelines and realize he is full of crap
I LOVE THIS, I'm going to start advising moms to ask their Dr. for guidelines. This will hopefully open a lot of eyes. Thanks for posting this.
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