VBAC, did you head to hospital at early labor stage? - Mothering Forums

Forum Jump: 
 
Thread Tools
#1 of 16 Old 04-19-2012, 03:16 PM - Thread Starter
 
RachealDD's Avatar
 
Join Date: Apr 2012
Posts: 3
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

My dr is supportive for me having a VBAC, even doing natural.  My main concern is she wants me to have continuous EFM and therefore no showers and limited movement.  The dr. also wants me to come to the hospital as soon as I'm in early labor so that she can monitor the baby and watch for uterine rupture.  The hospital is 10 mins. away with average traffic and lights.  I'm afraid that once I get to the hospital and hooked up to the cont. EFM that I'll be limited in movement. 

With my DS I was induced the night before, the nurses had to keep coming in to adjust the CEFM because while I was trying to sleep any movement caused it to loose the signal.  l was offered a sleeping pill at the beginning of the night but didn't take it till early early morning thinking this would help.  I took the whole pill and I was so drowsy like I'd been up for 3 or more days.  I remember family coming in to visit to say hi, but it's so hazy.  I feel like I didn't really have a chance to try for a natural labor.  Apparently I asked for an epidural and then after some intense contractions DS's hr dropped and they prepped for c-section.  Until discussing the labor with DH I didn't remember asking for epidural and my DH said he asked me if I was sure. 

Being so close to the hospital is it really such a big deal to wait till active labor or at least a little while into labor before going to the hospital?

Thanks for any information.

RachealDD is offline  
Sponsored Links
Advertisement
 
#2 of 16 Old 04-19-2012, 05:36 PM
 
VBACmama4's Avatar
 
Join Date: Mar 2012
Location: Maryland
Posts: 89
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Hi Racheal, I'm a VBAC'er also and I have had OB's tell me I should get to the hospital earlier in labor because of the need for continuous fetal monitoring. Getting to the hospital early is really only necessary if your labor is progressing quickly, if you've got cause for concern such as a large amount of blood or discolored fluid discharge. Unless it's really medically necessary, like your doctor has specific cause to believe there is a complication, it is just as effective to ask for what hospitals sometimes refer to as a 20 minute strip. This is when they monitor for 20 minutes out of each hour, and after a few "strips" they will sometimes lay off even longer as long as there is no cause for concern.

 

Also, ACOG has changed it's views on constant fetal monitoring over the past 2 years. Initially they recommended constant monitoring and OB's and hospitals went overboard with it, making it a near requirement for a hospital birth. Some hospitals still have this policy, although some doctors don't follow it. In 2010 they re-issued their practice bulletin, updating the finding that intermittent fetal monitoring is just as effective, and can be done by both by EFM and fetal dopptone (the device they use in a doctors office to hear the heartbeat). There have also been several studies that site constant monitoring and epidural as being part of a group of interventions that can lead to higher rate of Cesarean, based on the fact that both essentially limit the ability of the mother to move during labor, making the pelvic bone much more inflexible and inhibiting the ability of the baby to move into position. I'm a prime example of that fact, since I was also induced in my first pregnancy and my body wasn't ready to have the baby, so the meds, epi and constant monitoring made it so impossible for my son to descend the birth canal that when he was born by Cesarean he actually had a small dent in his forehead. 

 

The thing to consider is this: if you have a rupture, or more likely a dehiscense since rupture is pretty rare, you will be able to tell. Dehiscense (a small window of opening usually in one end of your uterine scar that can leak fluid into the area between your uterus and your skin) comes with pain, sometimes bloody discharge, and often a bubble or bulge in the skin on the outside of the body. Rupture is much more painful, and often comes with pain in the diaphragm and shoulder, as well as a greater amount of bloody discharge and again, the skin near your scar can look bulged or discolored. Most ruptures happen fairly early in labor too. So, if you are laboring at home and notice any of these symptoms then I'd say get to the hospital asap. If not, you probably have no reason to rush in and spend a day or two being "observed" flat on your back attached to machines in your bed. I've never heard of a normal, healthy mother (and yes, a VBAC is included in that statement) needing to leave for the hospital until contractions without signs of problems were 5-6 minutes apart. 


Never give up your rights

chicken3.gif waterbirth.jpg vbac.gif

Mother of 4 boys, 5 if you count my husband

VBACmama4 is offline  
#3 of 16 Old 04-19-2012, 09:31 PM - Thread Starter
 
RachealDD's Avatar
 
Join Date: Apr 2012
Posts: 3
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

VBACmama4,

Thank you so much for your words of inspiration.  We have 2 hospitals in town and the other one has just built a new birth center.  I've also researched the VBAC's rates for the hospitals and the other hospital has over double the success rate.  I'm in my 7th month have considered changing drs, which is what I'd have to do to use the other hospital.

Thanks again.

RachealDD is offline  
#4 of 16 Old 04-19-2012, 09:41 PM
 
tangledblue's Avatar
 
Join Date: Apr 2008
Posts: 268
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

One thing to be aware of is that fetal heart decelerations are sometimes a "leading sign" of rupture (according to Wikipedia). That's probably why your doc wants monitoring. 

tangledblue is offline  
#5 of 16 Old 04-20-2012, 01:58 PM
 
CamoShades's Avatar
 
Join Date: Aug 2009
Posts: 336
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
I did not. I was in labor for 22 hours, and I spent 19 of them at home. I got to the hospital at 9 p.m. (6 cm) and delivered just past midnight. I left home when my contractions were about three minutes apart, and in the car (a 40-minute drive) they started coming every minute and a half. It wasn't a fun ride, but staying home was one key to success, IMO. My doula was with me at home, and she told me ahead of time that she'd let me know if she thought I wasn't ready to go, and when I asked her if we should leave, she said, "I'll go tell your DH!" So I knew it was a good time (not too early) to head to the hospital. DD1 was breech, hence the reason for my c-section, so I was a great VBAC candidate. However, I guarantee they would have deemed me FTP if I had been at the hospital for 22 hours attempting a VBAC.

I did plenty of research, and uterine rupture was not at all a concern of mine. If I were you, and I only had a 10-minute ride to the hospital, I'd be waiting until the last minute to head there. But I'm the type that would have rather delivered in the car than have another c-section.

Married 6.10.06   Mommied 4.17.08 and 4.12.10

CamoShades is offline  
#6 of 16 Old 04-20-2012, 08:56 PM
 
VBACmama4's Avatar
 
Join Date: Mar 2012
Location: Maryland
Posts: 89
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

You're welcome honey! You can do it!!

 

One quick note in response to the comment above: fetal distress is one symptom of uterine rupture but in a true rupture (called a frank or catastrophic rupture) there is almost always at least one other symptom, usually pain or bleeding. And fetal heart decelerations can occur at any time for many reasons, and are one major cause of cesarean, but the difference between serious fetal distress and normal decelerations and accelerations is that in normal labor your baby's heart rate may change slightly at times but will recover quickly, which can totally be determined in a 20 minute strip. 


Never give up your rights

chicken3.gif waterbirth.jpg vbac.gif

Mother of 4 boys, 5 if you count my husband

VBACmama4 is offline  
#7 of 16 Old 04-21-2012, 12:17 PM
 
folkgirl's Avatar
 
Join Date: Jun 2006
Posts: 362
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

My personal preference is to labor at home for as long as possible. My last labor I got to the hospital at about 5 cm and that was fine; contractions were pretty intense at that point, I was not able to talk through them, and I had the baby a few hours later. I am planning to do the same this time and, I hope, even get there a little further along because the trip to the hospital will be 15-20 minutes as opposed to the ~2 hours (during a snow storm, coming from a different location) last time. I have only had one cesarean. I might want to get to the hospital earlier if I was laboring after 3+ cesareans.

 

The hospital where I am giving birth requires continuous EFM after active labor begins. A few years ago it was possible to have intermittent monitoring, which would be preferable, but because of hospital politics, for some women it's more trouble than it is worth to fight about the monitoring. My ICAN group has ~100 births a year at this hospital so we're pretty well-advised of the ins and outs of hospital policy. My plan in my last birth is that I would try the monitors and if they were getting in the way, I would either go to the bathroom and get in the shower or I would flat-out refuse. As it turned out, they were not an issue for me. As long as I was able to remain upright and moving, I didn't even notice the monitors. I didn't want to walk big laps, more like kind of dance in place and squat during the peak of my contractions. I will revisit the monitor issue in my next labor if I feel differently about them than I did last time. I do think as a patient it's my right to refuse.

 

One thing I would not agree to, though, is laboring prone on the bed. That's just because as I mentioned, I benefited SO much from movement. I am convinced my labor would not have progressed as smoothly as it did without the movement.

 

Here is a slideshow my ICAN group put together. It's pictures of women laboring in various positions while on the monitors, just to show it can be done. http://www.icanofatlanta.com/?page_id=159


Blair, mom to the amazing Nora (8/06) ribboncesarean.gif, sweet Anneliese (2/10) vbac.gif, and super Henry (8/12) vbac.gif

folkgirl is offline  
#8 of 16 Old 05-02-2012, 09:41 PM
 
CountryIvy's Avatar
 
Join Date: May 2012
Posts: 1
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Hi :) New to this site.

VBACmama4, do you have the reference for continuous fetal monitoring not being better than intermittent monitoring?  I do not wish for it myself when I vbac this fall and am looking for the resource that states this.  I have the ACOG statement from 2010 which says:

 

"Personnel familiar with the potential complications of TOLAC should be present to watch for fetal heart rate patterns that are associated with uterine rupture. Uterine rupture is often sudden and may be catastrophic, and accurate antenatal predictors of uterine rupture do not exist (115, 116). Acute signs and symptoms of uterine rupture are variable and may include fetal bradycardia,

increased uterine contractions, vaginal bleeding, loss of fetal station, or new onset of intense uterine pain (25, 84, 112). However, the most common sign associated with uterine rupture is fetal heart rate abnormality, which has been associated with up to 70% of cases of uterine rup tures. This supports the recommendation of continuous fetal heart rate monitoring in labor (25, 29, 84)."

 

Link to 2010 published ACOG statement

 

 

I think one of the other VBAC resources I've used, vbacfacts.com, which is very resource heavy with original evidence, also does not indicate shying away from continuous EFM.  I feel much more comfortable making the case to my DH and OB with the literature on hand, and while I feel like it's crossed my path at some point, I can't quite remember where I found it.  It's also not in the NIH consensus statement which urged ACOG to reconsider it's previously released statement about needing emergency staff on hand.

 

Thanks!

CountryIvy is offline  
#9 of 16 Old 05-03-2012, 07:13 PM
 
VBACmama4's Avatar
 
Join Date: Mar 2012
Location: Maryland
Posts: 89
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

CountryIvy, I do indeed have a link for you my dear: http://www.ourbodiesourblog.org/blog/2009/07/acog-issues-new-practice-bulletin-on-continuous-electronic-fetal-monitoring

 

This is hard to find because they revised a practice bulletin with a press release under a different title. If you google risks of continuous fetal monitoring you also end up with a list of a ton of articles and medical studies stating plainly that continuous fetal monitoring increases the rate of Cesarean up to 20%, It's also COMPLETELY within your rights as a patient to refuse continuous monitoring and ask for intermittent fetal dopptone monitoring (using a hand held device every so often) or to ask that they base the need for monitoring on a 20 minute test strip. 


Never give up your rights

chicken3.gif waterbirth.jpg vbac.gif

Mother of 4 boys, 5 if you count my husband

VBACmama4 is offline  
#10 of 16 Old 05-04-2012, 02:25 PM - Thread Starter
 
RachealDD's Avatar
 
Join Date: Apr 2012
Posts: 3
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

Thank you for the info.  I've switched drs and now giving birth at the hospital birth center.  They are more flexible and more vbac friendly, but I know it's still a hospital.  I'm creating a folder with information for natural/alternative solutions and/or arguments in case problems come about that may lead to unnecessary procedures.  I have suggestions to help with inducing, positions if baby is breech or OP, cont. EFM and helping baby with 2nd stage (dialation and effacement).    I was thinking Postpartum Hemorrhaging.  Does anyone know of other complications and/or possible options for them?
 

RachealDD is offline  
#11 of 16 Old 05-04-2012, 08:39 PM
 
marrymeflyfree's Avatar
 
Join Date: Jan 2008
Posts: 456
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)
Quote:
Originally Posted by VBACmama4 View Post

Dehiscense (a small window of opening usually in one end of your uterine scar that can leak fluid into the area between your uterus and your skin) comes with pain, sometimes bloody discharge, and often a bubble or bulge in the skin on the outside of the body.

 

 

Can you tell me more about a visible bulge with dehiscence?  I've never seen this mentioned in any vbac info, and I do have a puffy horizontal bulge a bit above my scar - and no comments on it from any of the many midwives that have been palpating and measuring my belly.  I'm just shy of 39 weeks, now wondering if I should be making a call over the weekend to check up on this...

marrymeflyfree is offline  
#12 of 16 Old 05-04-2012, 09:40 PM
 
VBACmama4's Avatar
 
Join Date: Mar 2012
Location: Maryland
Posts: 89
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

A bulge on the outside of the body is usually discolored (think bruise or blood blister colored), typically there is soreness or pain and sometimes swelling surrounding the bulge (in cases of infection). It's most common for this type of symptom to appear within a year or so of a cesarean. Most of the time dehiscense doesn't penetrate through both the uterine wall and the skin after the first few months unless during birth, straining during bowel movements or extremely hard coughing (basically abdominal pressure). Most dehiscenses heal on their own. If your midwives are seeing the bulge you mentioned and not feeling that there is an issue, it's most likely not associated with dehiscense so I wouldn't worry, but if you're concerned you can always ask them to take a look.

 

Also, a boil (puss-filled lump caused by infected hair follicle) can resemble a dehiscense with less or no pain, and being close to a scar can increase the likelihood of having one because the skin has been disrupted and ingrown hairs are more common near the site of stitches/skin repair, so you might ask them to check for that as well. If the bulge you're seeing is fairly firm and not painful, it could just be a keloid which is an area of scar tissue that builds up because of certain types of proteins and cell turnover. Usually that will go away in time (I had that with my Csection, and after 11 years my scar is flat and even and very faint). Sometimes it's lighter than the rest of the scar tissue or skin around it and it can be itchy. As long as it's not reddish and doesn't look inflamed it's probably not a big deal. 

 

Key factor is pain. If it hurts, definitely ask!


Never give up your rights

chicken3.gif waterbirth.jpg vbac.gif

Mother of 4 boys, 5 if you count my husband

VBACmama4 is offline  
#13 of 16 Old 05-08-2012, 01:27 PM
 
Jenga's Avatar
 
Join Date: Sep 2011
Location: Mid-Atlantic area
Posts: 145
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I had two VBACs and I went to the hospital late. I mean... almost pushing in the lobby or car late.

 

The first VBAC I had no idea I was in labor at first. I had no idea what the signs were, no idea where I was in labor. Wish my doula could have made it to help guide me! Had the baby 40 mns after I got to the hospital. I think I had her in a triage room, I know it wasn't a regular birthing room.

 

Second VBAC I had the baby 20 mins after we got there. Got there at 9cm, so when I say I was almost pushing in the car I mean it! Labor was under 10hrs and progressed very quickly so it was not intentional, again, but worked out great.

The plus of something like that is they don't have time to do crazy things to you. I even came in my birthing "outfit" and though they gave me a gown I didn't put it on and no one fussed with me over it. Actually I think the conversation about that was "Honey, they want you to put this gown on" (husband) to which I responded "Honey, they can go F*** themselves" (this is what happens when I respond to a request during a contraction) and it was totally ok! :)

 

If I have another baby and I have another VBAC, the goal will be to get there as late as possible. Even if it means laboring in the car for a while.

Jenga is offline  
#14 of 16 Old 05-09-2012, 08:02 PM
 
VBACmama4's Avatar
 
Join Date: Mar 2012
Location: Maryland
Posts: 89
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

I had my 4th VBAC at a hospital on May 7th and we left in the absolute last few minutes between transition and pushing. I had been in labor for 3 days, getting very tired, and called the hospital to let them know to expect us within a day or so. They told me to come in immediately for monitoring, but I declined and we left on Monday night around 8:00pm. I got there at 9cm dilated and immediately told them no IV, no hospital gown, I'll get in whatever position I want, etc. At first they started giving me trouble about it ("but we need to put an IV in for access in case you need emergency medication") but my husband and I totally refused and they were a little cold after that but left us alone. I started pushing and realized that the baby wasn't moving down from my pelvic bone. The nurse kept checking me and telling me he was still "up there" and I kept almost screaming at her that it was because he was stuck and I needed to change position, which I finally did forcefully with my husbands help, and within ten seconds he was crowning. Three more pushes and there he was, placed on my chest (which this hospital doesn't usually do) and perfectly healthy at 10:39pm. 

 

We also signed out a day early because we were totally healthy and we're home now with our new tiny man, safe and sound, and happy that we stuck to our plan as much as possible :)


Never give up your rights

chicken3.gif waterbirth.jpg vbac.gif

Mother of 4 boys, 5 if you count my husband

VBACmama4 is offline  
#15 of 16 Old 05-29-2012, 11:44 PM
 
azzeps's Avatar
 
Join Date: Sep 2007
Posts: 545
Mentioned: 0 Post(s)
Tagged: 0 Thread(s)
Quoted: 0 Post(s)

This is one of the reasons I had a home birth for my VBAC.  I did not want to go most of my labor "un-monitored" which is what I would have done had I planned a hospital birth.  I would have stayed home as long as possible.  I felt safer hiring a midwife who could monitor me at home, instead of having to go to the hospital early on in labor.  Just thought I'd throw that out there.  I know it's not for everybody.  Maybe a monitrice could help?


Mama to a daughter (3/2008) and a son (7/2011)
azzeps is offline  
#16 of 16 Old 05-31-2012, 06:03 PM
 
LexiDrewMama's Avatar
 
Join Date: Nov 2011
Location: Grass Valley, CA
Posts: 99
Mentioned: 20 Post(s)
Tagged: 0 Thread(s)
Quoted: 1 Post(s)

My VBAC was in October and I labored for about 4 hours at home and than had my dd 4 hours after arriving at the hospital.  I think I would have waited longer to go if my labor hadn't been super INTENSE (contractions on top of eachother and felt like transition but wasn't), and my mom hadn't insisted it was TIME ; )

 

I am totally hoping for a HBAC for my next baby!


Mama to my angel baby Drew (9/22/06), Alexia (10/26/11) , and hoping for a in 3/2015!!

LexiDrewMama is offline  
Reply

User Tag List



Forum Jump: 

Posting Rules  
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off