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Old 08-29-2005, 05:45 PM - Thread Starter
 
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At my 34 week appointment today, I was talking to my OB about my VBAC. I wanted to double check that they have a 24 hour anesthesiologist (they do) and that an OB from their group would be there if I were in labor. She said that they would come in based on where I was in labor... if I was only a cm or two and they baby looked good and it was 3am, they'd wait to come in. She said they all can get there in 10 minutes, though.

Is this a big deal? It makes me a little uneasy... I'm still pretty nervous about this b/c of UR.
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Old 08-29-2005, 06:27 PM
 
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I understand that your nervous, but the chance or UR is very very small.

No hospital has a "decision to incision" time of less than 20 minutes, so if the OB is only 10 minutes away that is plenty of time for them to get there in a true emergency.

Don't worry too much!
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Old 08-29-2005, 06:52 PM
 
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It might even be a good thing. If the OB is there the whole time and gets bored/ansy/whatever, they may try to push labor faster and that could cause risks (i.e. induction increases chances of UR). Most OB's aren't happy to sit and wait, at least not for very long. So being at home, watching TV, and having quick access might make for a calmer, well rested doc. =)
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Old 08-29-2005, 06:55 PM
 
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Did you read the most recent AAFP guidelines on VBACs? It said that the "immediate access" to anesthesia had not improved outcomes at all and hadn't decreased rupture/mortality rates.
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Old 08-29-2005, 07:01 PM
 
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Reader, I love your title and sig! It took me a long time to figure out I needed do that.
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Old 08-29-2005, 09:38 PM
 
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Thank you very muchly!
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Old 08-29-2005, 09:59 PM
 
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i would not worry at all. incase of complications you will be taken care of 100%. but i would think more about your fear of U/R. i am going to be a vbac too and i dont even think of U/R as a possibility. its so rare and vbacs are 99% effective. sometimes our fear about things can create complications so i would really concentrate on dealing with the fear of U/R so that you can be worry free and calmer at your birth.

Angela: Catholic Homeschooling Mom to Sierra(11/00), twins Addison & Kendall(3/03), Jack(4/06), Brielle (7/08), Levi (2/2011); due with#7 (9/13). Birthed every witch way.....hospital. C section. VbAC. Unassisted water birth (hypno/painless). Assisted waterbirth to an almost 10lber! (Not painless!)
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Old 08-29-2005, 11:40 PM
 
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Does the hospital have a staff OB who could do an emergency CS if necessary? If so, then I would not worry about your particular OB being actually on site.

"No hospital has a "decision to incision" time of less than 20 minutes"

Many hospitals actually do meet this criteria, but usually only larger hospitals.

"its so rare and vbacs are 99% effective"

The 12/04 NEJM article put the UR stats as .4% for unaugmented/uninduced labor, .9% for augmented labor and 1% for induced labors. Most studies I have seen quote VBAC success rates (granted, usually hospital VBAC success rates) at 70% to 80%.

Here's a link to info about UR from vbac.com. (Note that this site does not incorporate the data from the latest NEJM article.)

http://www.vbac.com/uterine.html

New WOHM to DD8 and DD3
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Old 08-30-2005, 12:07 AM
 
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Quote:
Originally Posted by egoldber

The 12/04 NEJM article put the UR stats as .4% for unaugmented/uninduced labor, .9% for augmented labor and 1% for induced labors. Most studies I have seen quote VBAC success rates (granted, usually hospital VBAC success rates) at 70% to 80%.
But that doesn't mean that the 20-30% are uterine ruptures, obviously. Another thing that skews the stats is that a big chunk of women who want a VBAC are not allowed an adequate trial of labor. They are sectioned early on for a (largely unfounded) fear of UR.
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Old 08-30-2005, 12:31 AM
 
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Quote:
Originally Posted by reader
But that doesn't mean that the 20-30% are uterine ruptures, obviously.
Of course not. And if what I wrote implied that, its certainly not what I meant.

New WOHM to DD8 and DD3
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Old 08-30-2005, 03:18 AM
 
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I'd be thrilled actually to hear that the people with sharp instruments were a long way away from me. Provided you labour and birth under your own steam, without being induced, lying down or having an epidural you have little likelihood of having repeat surgery or any issues with your scar. A friend of mine wrote this as a HBAC mama. Enjoy! I hope you have a beautiful birth!

Quote:
... just think for a minute. If you were in a terrible car
accident and had to have a piece of metal removed from your leg (sorry
for the visual there, ugh) .... say they had to cut in to get it.
Then they stitch you all back up. What do you expect the scar to do?
Do you expect it to fall open when you start to walk? No? Well, okay
maybe normal walking is okay, but what about running? Maybe running
will cause it to fall open. No? Alright maybe not normal running, but
I bet a marathon would cause enough pressure to just rip it open,
right? Hmmmm ... wait a second, maybe not. Perhaps if they hooked the
repaired leg up to a machine that mimicked running, it could cause
problems ... esp a machine that pulled the muscle further than normal
use would, that didn't do it "naturally" (kind of like pitocin!). But
for regular use, we expect ourselves to stay shut. We expect wounds to
have healed. We expect normal function to be obtainable for
straightforward injuries.

If we get a cut or have stitches anywhere else on our bodies, we expect
it to stay shut. If we looked at the doctor and said, "I don't think
this is going to stay shut", they would be highly offended because we
were doubting their skill as a surgeon AND we would be turning our
noses up at our body's ability to heal and reams of scientific evidence
that it does.

But then when we have a c-section, we look at that and think, OH NO
this thing isn't going to hold!!! Do you think the surgeon stitched
you up? Do you think s/he is a skilled surgeon? If your old surgeon
questions the integrity of your healing, then he or she is expressing a
complete lack of confidence in his/her work. Point that out. They
need to think about this. If your new OB or midwife is questioning the
integrity of your womb, then they need to be confronted about doubting
the surgical skill of your previous surgeon. If they doubt his or her
skill that seriously, perhaps they need to express their concern to the
medical board.

Anytime someone is stitched back together the ultimate goal is to
prepare the organ or muscle or whatever to perform its normal function.
I have had 2 c-sections. One was with my first and one was with my
fifth. The rest have been hbacs. All my births up through the second
c-section were to fairly tiny babies, weighing between 6.5 and 8
pounds. My sixth ... the fresh vbac who was testing out the surgeon's
skill ... was 11 pounds 4 ounces. I had some nifty pushing
contractions. And I can compliment my surgeon for a job well done
because her work held up under Normal Use. Giving birth is Normal Use,
yes even when giving birth to an 11 pounder. It is exactly what the
uterus was created to do. If we expect that a straightforward incision
and stitching should restore other muscles to regular use, then why do
we doubt the womb?

I will tell you what finally set my own mind to ease this last pg
because yes for the first time ever, I was actually nervous about UR
(something about hanging around ICAN where it is talked about all the
time, lol ... fear started rubbing off there!). My daughter used to
play with my LUS ... she would push and stretch and wedge herself in.
She would shove her hands right under where my external incision scar
was and do boxing drills. Maybe she could feel the ridge of my
external incision? I don't know. But what I do know is that I felt
very reassured that if she could do all that and it held together, then
what was a little labor?
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Old 08-30-2005, 11:46 AM
 
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The Farm study shows a vbac "success" rate of 98%. It totally depends on where you are. If the hospital only has a 70% success rate, that means that 30% of all women attempting vbac have cesareans anyway. Why is that? Is it because they are in the hospital in the first place? Is it because their doctor has no faith in the process of childbirth, or thinks those women's bodies are broken? Or is it because the women themselves don't have faith in their bodies' ability to give birth?

You need to address your fears. The chance that your uterus will rupture is very very small, unless you agree to certain interventions that greatly increase that chance. You need to rethink going in to the hospital when you are only 2 or 3 cm dilated. There is NOTHING they can do for you that early! Besides push drugs and interventions that would hinder your ability to give birth vaginally. There is no reason in the world to have someone stick their hands inside you to tell you how far you've progressed. It doesn't tell you how much longer you have to go, and it will put you on their clock. Hospitals have unrealistic expectations of how labor should progress. Natural labor and childbirth doesn't follow the same rules as augmented or induced labor (at my local hospital, it's like 87% of all women in labor are given pitocin). For one woman, it might take four days, and for another, it might be two hours. There is no way of knowing which one you will be, but in the hospital, it's guaranteed that if you are the former, they will want to induce, and they will use all the scare tactics they can think of to get you to comply.
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Old 08-30-2005, 01:12 PM
 
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Janet, thank you for that quote! I have never heard it spelled out like that. Mind if I copy that and save it? =)
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Old 08-30-2005, 09:19 PM
 
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Janet, I absolutely love that whole perspective. Can I repost it somewhere?
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Old 08-30-2005, 11:14 PM
 
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Post freely. Please credit Joyous Birth, the Australian home birth network. http://www.joyousbirth.info/forums
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Old 09-02-2005, 09:34 PM - Thread Starter
 
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Thank you all for your words of encouragement! Janet... I've never thought about it that way. I'm going to have my husband read that tonight.
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Old 09-03-2005, 01:28 PM
 
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When I was pg, I used a practice of obs and midwives. I was seeing the midwives but I wanted to know what would happen if I needed a c-s. They told me that for a non-emergency c-s, they call the ob on call. For an emergency, they call the ob at the nearby office. They said that for an emergency, another ob might have to start the c-s but an ob from my practice would get there to do most of it and do the closing. Incidentally, the office was 10 minutes from the hospital.

Proud mommy 9/2004 ribboncesarean.gif , 11/2007 vbac.gif, 2/2011 ribboncesarean.gif
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Old 09-14-2005, 08:29 AM
 
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I wouldn't worry about the dr being right there.
I will be doing the SAMe thing. Birthing in a hospital with a midwife who will be there the whole time, and a dr around just in case.
I really didn't think about the uterine rupture much. The midwife told me it is pretty rare, and in most cases when it does happen, it is because the woman was induced with PItocin. Pit obviously causes your uterus to have unusually strong contractions.
she also told me that a uterine rupture can be detected before it actually happens. So, if your body feels good, please try not to worry yourself!
I loved that story about the muscles!! Its a great analogy!
Sarah<-----Who rarely posts at mdc, but will do so when I CAN'T sleep..
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Old 09-14-2005, 09:46 AM
 
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Most studies show ruptures occur more frequently in women who *haven't* had surgery but are given artificial oxytocin. How many ways can we prove that the drugs are baaaaaaaaaaaad? I want a poster of Nancy Reagan in one of those vile red suits, saying, "Drugs in birth? Just Say No!"
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Old 09-14-2005, 02:07 PM
 
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Quote:
Did you read the most recent AAFP guidelines on VBACs? It said that the "immediate access" to anesthesia had not improved outcomes at all and hadn't decreased rupture/mortality rates.
This might be so,but many hospitals that allow VBACs make this a requirement anyway. I work in a hospital, VBACs are good there. Until about a week ago. Now they are no longer allowing them in anyof our faciilities for anyone, evenwomen who have had VBAC before until this requirement is met. There area couple of doctors working very hard to see that a 24-hr emergency anesthetist and OB is available sothat there isn'tmuch jump in care, unfortunately, it will only be at one of our three facilities (and not the one I'm at, unfortunately, yet) It's really unnerving and the decision is based on some small study that came out recently (I forget the title now) rather than the years of succeessful VBACs. The good news is that they are cracking down on inductions/augmentations of VBACs now at least, i.e. not allowing either once VBACs are back whereas a month ago, augmentation was permitted.

Namaste, Tara
mama to Doodle (7), Butterfly (2), and Rythm (due at home 1/06)
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Old 09-14-2005, 05:55 PM - Thread Starter
 
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I actually researched my hospital a bit more and found out that there are two 24-hour in house anesthesiologists, and doctors who can perform stat C-Sections. So, if my doc isn't there and an emergency arises, we'll be taken care of. I know that we won't likely need that, but it's comforting to know just in case.
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Old 09-14-2005, 11:42 PM
 
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Try to ease up on your worry of repture or you will never get your successful VBAC. If they told me a doctor couldn't be there right away, I think I would be jumping up and down w/ glee.

Kelly
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Old 09-23-2005, 11:36 PM
 
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Just a little FYI that the Farm Midwifery Center in Tennessee (Ina May of Ina May's Guide to Childbirth and Spiritual Midwifery ) has a VBAC success rate of ninety-eight percent. That's right, 98%. I tell people this even if Tennessee is not an option for them, because people need to hear that it IS that safe, it IS that possible. Some of their ladies had even had more than one cesarean before multiple successful VBACs. Remember that rupture under competent care is very, very rare.
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Old 09-23-2005, 11:37 PM
 
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oh, and the "recent VBAC news" might be what I was just reading about on vbac.com, which says that VBACs should not be attempted in birth centers.
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Old 09-24-2005, 01:46 PM
 
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If you are told that your facility provides 24hr coverage and it makes you feel better to know that someone is there while you are, they darn better show up as soon as you are known to be in labor. I get really po'd that there is a double standard, it is soooooo important to be in a hosp. to labor and they want to drag their feet because it is 3am, I don't think so! It is your right to ask for their presence in the hosp. The fact of the matter is that if a rupture occurs and your OB is there then an emergent c/sec can be done much faster than 20 minutes, I know because I have seen them done. I have also seen a c /sec done under local to save a baby, and that wasn't fun for anyone there.

I am not trying to scare anyone, but you should be supported in your plan.
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