standard VBAC protocol... opinions? - Mothering Forums

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#1 of 22 Old 12-31-2009, 02:40 PM - Thread Starter
 
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while learning more about the H1N1 protocol at my hospital, I was able to talk to an L&D nurse about standard protocols that they do for all VBAC women.
  • continuous fetal monitoring after 4 centimeters dilation, "because the only way I will know if your uterus ruptures is if the baby's heart rate drops."
  • NPO, just in case...
  • mandatory IV lock, just in case

Other than that, I am allowed to move around unless I get an epidural, they have monitors that allow free movement, I can get into the tub or on the ball or whatever I want.

personally, I think that all these requirements are reasonable... I question their reasoning on the fetal monitoring and wonder if that will set me up for another cesarean... but the nurse said that out of the last 10 VBAC she has seen 7 were successful.

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#2 of 22 Old 12-31-2009, 05:41 PM
 
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Sounds reasonable to me - or at least, standard. I made my peace w/ continuous monitoring and had a great unmedicated VBAC 18 months ago. What is NPO?

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#3 of 22 Old 12-31-2009, 06:17 PM
 
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Sounds reasonable to me - or at least, standard. I made my peace w/ continuous monitoring and had a great unmedicated VBAC 18 months ago. What is NPO?
NPO = nothing by mouth (or, for most of my hospital clients, it means nothing by mouth when there's a nurse in the room )

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#4 of 22 Old 12-31-2009, 06:29 PM
 
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Sounds like a cool hospital! 70% successful VBAC rate is great!(for a hospital that is... ) I thought it was pretty reasonable too. Can you get some referrals, some people who have VBAC'd there? Maybe find out if she was telling the truth? (sorry for the cynicism, just know of too many people who tote the party line, to cover their behinds...) One question- if you have continuous monitoring, how are you able to move around? Generally the staff gets upset cuz movement makes the printout wonky...
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#5 of 22 Old 12-31-2009, 07:53 PM
 
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if you must be in a hospital I could live with those rules (except they are STUPID and unfounded)
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#6 of 22 Old 12-31-2009, 08:51 PM
 
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I had an unmedicated hospital VBAC with heplock and monitoring. Freedom of movement is key. I did Hypnobabies and never heard the monitors I just stated on my hands and knees (where my body demanded that I be) and had a quick and easy VBAC.
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#7 of 22 Old 12-31-2009, 09:15 PM - Thread Starter
 
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Originally Posted by cathicog View Post
Sounds like a cool hospital! 70% successful VBAC rate is great!(for a hospital that is... ) I thought it was pretty reasonable too. Can you get some referrals, some people who have VBAC'd there? Maybe find out if she was telling the truth? (sorry for the cynicism, just know of too many people who tote the party line, to cover their behinds...) One question- if you have continuous monitoring, how are you able to move around? Generally the staff gets upset cuz movement makes the printout wonky...
The actual cesarean rate of the hospital is 33%, shameful... She couldn't give me the VBAC statistic for her hospital, but the 7 out of 10 number she gave me was her own personal experience. I doubt that the actual success rate of VBAC is that high.

I do know people who have birthed their and had wonderful experiences, but I don't know anyone who has had a VBAC there. I am cynical as well... I was baited and switched into a cesarean last time.

according to the nurse, the monitor is telemetry based and also waterproof... I told her I wasn't comfortable with internal monitor...

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#8 of 22 Old 12-31-2009, 09:19 PM - Thread Starter
 
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Quote:
Originally Posted by DoulaVallere View Post
NPO = nothing by mouth (or, for most of my hospital clients, it means nothing by mouth when there's a nurse in the room )

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#9 of 22 Old 01-01-2010, 11:20 AM
 
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Yeah, in theory those all sound as reasonable as you will get from a hospital setting. However, I wonder if the "standards" change as nurses and docs change, yanno?

Is it possible for you call up L&D or tour the unit and get a different nurse's perspective? I hate to sound totally cynical -- well, I guess I really don't hate it -- but I've heard SOOO many people get the bait and switch that I wouldn't believe one person's version of the truth when it comes to hospital VBAC's.

ETA: Sadly a 33% section rate sounds almost heavenly compared to where I'm at -- county wide we are at about 50%! And it's a heavily populated county, we're talking Miami, FL, a major metropolitan area.

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#10 of 22 Old 01-01-2010, 12:06 PM
 
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  • continuous fetal monitoring after 4 centimeters dilation, "because the only way I will know if your uterus ruptures is if the baby's heart rate drops."
  • NPO, just in case...
  • mandatory IV lock, just in case


Seems pretty standard.
Of my 7 VBAC's only two have had truly continuous monitoring and those were the two I had epidurals. The unmedicated ones I had intermittent or pseudo-continuous monitoring. Definition of pseudo-continuous monitoring? Belts on but little to no reading because I refused to get in a position where they would work well and just did my own thing.The nurses would chase the baby with the monitor between contractions sometimes. Included an induced VBAC for pre-e while I was on mag. The only non-negotiable, IME, is fetal heart tones after every push.
I've always been allowed ice chips and sometimes clear fluids except during part of that PE labor. They kept me totally NPO until I was 4-5 and they were reasonably sure it would be a vaginal birth.
I've had an IV or heplock with every single baby except one who came faster then they could get it in. IV's do not bother me at.all. (had so many in my life it is a total non-issue) So it is a 'battle' I let them think they 'won'.

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#11 of 22 Old 01-01-2010, 01:10 PM
 
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The problem from my experience with those telemetry units and monitoring in general, is they only really work well while you are laying in bed on your back and not moving. Every time I would move, the monitor would move and loose the HB. If I wandered to far from the nurses station with the telemetry unit, it would loose the HB and then would be chased around by a nurse trying to get me back to my room and in bed, so she could do the monitoring.
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#12 of 22 Old 01-01-2010, 03:20 PM
 
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Another thing to keep in mind is that some hospitals only have a few telemetry units on hand. So if a few other mothers are using them at the same time you're out of luck.

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#13 of 22 Old 01-01-2010, 04:48 PM
 
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Oh one thought about telemetry units: sometimes you'll get there and ask for one and the nurse will tell you that they don't have one or it's broken. ASK ANOTHER NURSE. Lots of them are too lazy to go get it and/or do not know how to use it. If there is one in the hospital, you may need to ask around. I would speak to your Dr./MW and have them order it in your chart as part of your birth plan.

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#14 of 22 Old 01-01-2010, 10:27 PM
 
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That sounds similar to what I had. My hospital had telemetry monitoring which I had no problems with. When I went on the hospital tour, I asked about it and the nurse had no idea. I panicked and called my midwife. She assured me that they had telemetry units in every single room. And they did! (At my birth, I figured out the nurse that took us on the tour was a LC which is probably why she didn't know more about the L&D amenities). The monitoring was no problem for me. They gave me a tube top and stuck the monitors in there. I moved as much as I wanted and used the showers, tub, etc. The pressure of the plastic units on my abdoment could get mildly annoying but it wasn't awful.

I had a saline lock (same thing as a hep-lock but they usually use saline not heparin now). The nurse stuck it on the back of my thumb which SUCKED big time b/c it hurt every time I applied pressure to my hand (though it did take my mind off the contractions at times). I'd ask them to put the saline lock on the back of your hand where you won't be applying pressure.

NPO is silly. You need to keep up your strength and if you get dehydrated, that the perfect excuse to open up the IV line and give you fluids. I ate (lightly) and drank. Thats easy enough to get around though - just eat/drink when no one else is in the room.

I should mention that the telemetry units have rechargable batteries which don't last forever. I labored so long at the hospital that they lost their charge. It probably took a good 15-16 hours though. I was pushing at that point so it didn't matter that they had to hook up the wires.

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#15 of 22 Old 01-03-2010, 09:28 PM
 
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Sounds standard...I VBACed under those conditions. I wouldn't assume that it's just a tactic to "bait-and-switch" every time the moniter loses the HB...it happens all the time and they're used to re-adjusting like a thousand times. Granted it will depend on who's watching your readings, but it's unlikely that even a really trigger happy nurse will be able to get you into surgery without double checking the readings first or calling in a doc who will do it. Do you have a midwife or doula or pro-VBAC doctor who will be there with you? Sometimes the general nurses just need to be told to calm down.

The hospital here has the heplock as "optional" for a VBAC unless you have some other risk factor...I had a major PP Hemmorage last time (VBAC) so I now fit that description. The whirlpool and everything else are still a go though Even though we have the three same conditions, I know it's just policy.
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#16 of 22 Old 01-04-2010, 12:50 AM - Thread Starter
 
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Sounds standard...Do you have a midwife or doula or pro-VBAC doctor who will be there with you? Sometimes the general nurses just need to be told to calm down.


I have a Doula and also have found the most supportive OB who would take me on. She knows of our plans to VBAC and our wishes for as non-interventive birth as possible and seems to be ok with it. The only thing I guess I can do now is ride the waves...

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#17 of 22 Old 01-04-2010, 11:59 AM
 
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This is pretty standard (though I agree unnecessary). My OB's difference is that he encourages liquids during labor. We've even agreed that clear chicken soup counts--I feel like having some homemade soup from my mother during labor will be very relaxing for me.
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#18 of 22 Old 01-05-2010, 12:39 AM
 
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The NPO is ridiculous though, and could be harmful. Ask them what their medical reason is, there is no reason why it would get in the way of how surgery/anesthesia is done today. I had a long labor with my first, and was not "allowed" water or food. I had no energy...that certainly did not help me progress in labor, and I know it contributed to my csection. I woudn't run a marathon without grabbing water or some kind of energy food... why labor that way? If you don't want to make waves, just say it is your husband's food or water if asked, and eat it when no one else in the room. But do not deprive yourself of nourishment.

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#19 of 22 Old 01-05-2010, 02:19 AM
 
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My plan for a hospital with those mandates would be to:
1 - stay home as long as absolutely possible
2 - make gatorade ice cubes to bring along (maybe some honey sticks too?)
3 - request a waterproof monitor with telemetry if available (shower saved my life)



Quote:
Originally Posted by Riverbeauty View Post
while learning more about the H1N1 protocol at my hospital, I was able to talk to an L&D nurse about standard protocols that they do for all VBAC women.
  • continuous fetal monitoring after 4 centimeters dilation, "because the only way I will know if your uterus ruptures is if the baby's heart rate drops."
  • NPO, just in case...
  • mandatory IV lock, just in case

Other than that, I am allowed to move around unless I get an epidural, they have monitors that allow free movement, I can get into the tub or on the ball or whatever I want.

personally, I think that all these requirements are reasonable... I question their reasoning on the fetal monitoring and wonder if that will set me up for another cesarean... but the nurse said that out of the last 10 VBAC she has seen 7 were successful.

Dr-Mom and SAHD extraordinnaire. DD1 (5), DD2 (3), MMC 04/10.
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#20 of 22 Old 01-09-2010, 05:54 PM
 
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honestly, I wouldn't fight about the npo. It is standard and it is a rule by the anesthesiologists....fighting w/ a nurse won't do any good. My doctor told me I could eat even though the anesthesiologists would be mad.

The solution is to just eat when the nurse leaves the room.


ps-- what's w/ Miami's high cesarean rate?? Are there cultural factors contributing to the high cesarean rate??
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#21 of 22 Old 01-10-2010, 07:43 PM
 
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Supposedly, it's part cultural, part malpractice. Most OBs in S.Fla. don't carry malpractice insurance. They stand to lose all their assets in a lawsuit. So they section early, and they section a lot. There's a hospital in Kendall (IIRC) wiht a 70% rate.

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#22 of 22 Old 01-10-2010, 11:21 PM
 
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This sounds a lot like the VBAC rules my midwife explained to me. She didn't mention NPO, though; will have to ask her about that. (If that's the rule, then yeah, I'll just eat/drink when no one's in the room.)

The other rule I'm curious about is that you can labor in the birthing tub, but not actually deliver there. The concern, I guess, is that if you rupture, it takes more time to get you up and out of the tub and into the OR than if you were dry and on a bed or other non-watery surface. But is the risk of rupture while actively pushing that much higher than just during labor itself? I would think if that was such a concern, they wouldn't let you labor in the tub at all.

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