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#1 of 20 Old 03-04-2005, 02:46 PM - Thread Starter
 
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As many of you have seen from my other post, I am having some provider "problems". I have decided that I will meet with the medical director of the OB/Midwife clinic that I go to based on the recommendation of my midwife and a doula. It is my hope to work out our differences. I have not sceduled the appointment yet, but I want to go to the appointment prepared. I have heard the numbers for the "risks" involved with having a VBAC, but I would like to have documentation to support my view that a VBAC is only at a 1% greater risk for rupture than any vaginal birth, the CFM does not detect rupture and that CFM increases the risk of c-section.

I have just begun my search for the actual articles, studies and stats, but I thought some of you ladies might have links for the information. If you do, I appreciate any help you might provide.

Thanks.
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#2 of 20 Old 03-04-2005, 05:03 PM
 
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the most recently published study was in NEJM, I think in December. There's a thread in this forum discussing that study. Here's the link.
it's the same statistics, just put in a different light, it seems to me.

try www.pubmed.com to find more! But, honestly, put the burden of proof on the doctor instead. Make him show you the info that backs up his opinion, or make him admit that he's just going along with ACOG and what his insurance company wants him to do, rather than placing the highest importance on his patients' safety.
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#3 of 20 Old 03-04-2005, 07:55 PM
 
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Henci Goer's book The Thinking Womans Guide to a Better Birth has a whole chapter on VBAC - eloquently researched and with references.
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#4 of 20 Old 03-04-2005, 09:39 PM - Thread Starter
 
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Thanks ladies,

I was told that the "new" rules are based on recommendations by a lawyer. So I don't know if I am going to have any luck getting what I want anyway. Although, as a Chiropractor, I never base my recommendations for a patient off of what any laywer says. I will mention that.
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#5 of 20 Old 03-09-2005, 12:33 PM - Thread Starter
 
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Hi Ladies,

We met with one of the OB's at the office yesterday. I still don't have a good answer on intermittent monitoring. He said he would have to check with the hospital.

I also will be meeting with some different midwives on Monday. When I called, I was able to talk to one of the midwives and she explained all the policies for VBAC. They include intermittent monitoring and water births. She told me that their VBAC rate is 100%, but if the cervix is not favorable they do not attempt a VBAC and go straight to a repeat c-section so those ladies are not part of theat statistic. I need to ask what % of women fall into that category.

So I am still weighing my options. I am 31.5 weeks currently, so I need to be figuring this out quickly.
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#6 of 20 Old 03-09-2005, 12:46 PM
 
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Did you check out Henci Goer's book yet? Very good with the references to studies. And she makes the very good point that the increase in ruptures for VBACs has to do with chemically inducing or augmenting labor.

"if the cervix is not favorable they do not attempt a VBAC and go straight to a repeat c-section"

What does this mean? Are they talking about when inducing? Or is there some point during the labor, if it's not progressing at a certain pace, that they will recommend c-sec?
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#7 of 20 Old 03-09-2005, 03:08 PM - Thread Starter
 
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Yes, I just finished reading that book and found it enlightening. I wish I had read it earlier.

What that comment means, I really don't know and I need to ask more questions. I think that it has to do with before labor starts - she mentioned using herbs to help prepare the cervix. I am working on my list of questions.
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#8 of 20 Old 03-09-2005, 04:07 PM
 
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#9 of 20 Old 03-09-2005, 07:35 PM - Thread Starter
 
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Didn't expect this:

I talked to the maternity coordinator at the hospital this afternoon. They have no policy on CFM or IFM for VBAC - they said that is up to the Dr. The policy they do have is hydrotherapy (tub or shower) is contra-indicated for women with previous c-sections. That policy hit me from out of the blue and makes no sense. SO I guess that I will be making other plans. Just don't know what those plans are.
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#10 of 20 Old 03-09-2005, 08:19 PM
 
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Quote:
but if the cervix is not favorable they do not attempt a VBAC and go straight to a repeat c-section
I didn't start dilating or effacing until I was already in labor. My cervix started softening a couple weeks earlier, but had not dilated or effaced until after labor was going pretty good. I went from 3cm to holding my baby in a couple hours. But, if you refuse internal exams, you can skip all the problems and being put on the clock and stuff.
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#11 of 20 Old 03-09-2005, 09:59 PM - Thread Starter
 
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Update:

The midwife that is controlled by the OB's e-mailed me this afternoon. She doesn't feel like I would be able to get the support needed by their medical staff, so she recommended that I find another provider. So onto the search!
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#12 of 20 Old 03-09-2005, 10:34 PM
 
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#13 of 20 Old 03-10-2005, 04:59 PM
 
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Please let us know how it goes.
And good for you for asking questions!! I bet they don't get a lot of that around there.
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#14 of 20 Old 03-10-2005, 05:17 PM
 
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I attended a lovely natural VBAC on Tues. morning. The mama had come in for headache the morning before and asked to be checked. Her cervix was closed, not effaced at all, and the babe was floating above the pelvis. 12 hours later her water broke spontaneous and she came into the hospital after she'd been contracting regularly and strongly for 3 hours. She was 1 cm dilated at that point. She didn't want any other exams after that. I followed her from ball to toilet (we unfortunately don't have labor tubs yet - they've been built in just recently but the unit isn't open yet) to monitor intermittently. 7 hours after she arrived, she was holding her baby, born after about 45 minutes of undirected pushing.
So that unfavorable cervix thing just doesn't make any sense at all to me. She was as "unfavorable" as they come one morning and holding her baby the next!
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#15 of 20 Old 03-11-2005, 04:00 PM
 
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a little off-topic. What's a birthing ball? This forum is the first time I've come across any references to them.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#16 of 20 Old 03-11-2005, 08:15 PM
 
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you may have seen it as a yoga ball. A big slightly squishy inflated ball you can sit one. You can find them, among other places at sporting goods stores, or even at places like walmart and target in the sporting goods section. They are nice in pregnancy to, to give you a chage of position and some pelvic relief. They can come in sizes to give the best fit for your height.
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#17 of 20 Old 03-11-2005, 11:06 PM
 
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I find some moms love the ball in labor and some hate it with a passion. I personally love to sit on it while I'm attending a birth - it's great for my sore back! We have several of different sizes at my hospital.
A year ago I attended a marathon labor for a first time single mom. Her large family were all in and out supporting her throughout the long labor. Her mom took many pictures throughout the labor, and later gave me a bunch, including one of me bouncing on the ball looking more worn out than the laboring mom!
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#18 of 20 Old 03-11-2005, 11:17 PM
 
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I loved sitting on my ball during pregnancy. When I was actually in labor it was just too much for me, felt like baby was coming out too fast and I got back on the bed.
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#19 of 20 Old 03-12-2005, 01:14 PM
 
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I have a yoga ball, but it never occurred to me to use it as a comfort measure during the pregnancy. Maybe I'll try that...

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#20 of 20 Old 03-14-2005, 05:29 PM - Thread Starter
 
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I met with some other midwives today and am encouraged. They said that as long as this little girl is head down and I go into labor, I should be able to have a VBAC and utilize water for pain relief and even a water birth. I have a lot of positives for a successful VBAC: previous section for a breech, started labor the last time, and most importantly the desire. I toured the hospital as well and even though it is an older hospital and not as nice as the one Patricia was born in, it seemed pretty good. I have an appointment on Thursday to get started with them. Even though it is impossible to know if I am making the right decision, it seems like I have a better chance with this group.


I asked what was meant about the cervix being "not favorable" meant: I was told that she meant, if I didn't go into labor on my own AND we were way past the EDD AND fluid was getting low AND no change in cervix, then they would do a c-section. She told me they have only had that happen once. So it really wasn't involving time limits. I was concerned about the comment the more I thought about it, but I was encouraged today.
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