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Help me make my decision please

741 views 8 replies 8 participants last post by  wombatclay 
#1 ·
Mamas, please help me out here.
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I am very confident in my decision to go for a vbac. I have done loads of research and still am. My dilemma is where to do it and which provider to use.

I have been seeing a cnm at a practice of 4 cnms and an obgyn. The hospital I would deliver at has "banned" vbacs. Obviously, I know about my right of refusal. I am not sure if this is a battle that I want to fight while I am in labor. I spoke with the obgyn today and he likes to do internal monitoring which would confine me to bed. I am not happy with this. He also would not let me go past 41 weeks. After that he'd sweep membranes. He says he sometimes will use a small amount of pitocin to get things going if they slow down. I know this is a big no-no. Again, I can refuse all of this I know. But do I want to have to worry about this while in labor? The hospital does not have 24hr anesthesia either. He also let me know every other ob in the county is anti-vbac and would be very unhappy to comply if I get there when they are on call.

I had an initial consult with a homebirth midwife who I had heard wonderful things about. My dh and I would love a homebirth and felt comfortable speaking with her. I am about 10-15 minutes form the hospital in case I need a transport. She does a couple of vbacs a year, same as above ob. I am just worried about all the things that could go wrong although I know the possibility of that happening is low.

I am just so confused! Support or suggestions would me much appreciated.

Grethel
 
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#3 ·
I too feel that labor is not the time I need to be in an adversarial environment. I really believe the first step to my primary c/s was mine - when I left to go to the hospital.

Our risk of UR, while real, and not to be ignored, is similar to other birth risks faced by all women, vbac or not. Do we allow those other risks to be our deciding factor about where and with whom we birth? Why not?

I hope to reach a point where my response to the fear of complications is in balance with the actual risk. It's hard to do when there is so much focus on one risk and others equally serious are ignored.

I don't think a decision needs to be engraved in stone. If you feel so inclined, you can change your mind at any point before the actual birth. Why not try on a choice for a week and see what your heart says? Why not allow yourself to consider a flexible plan as a choice, where you say, I'll start with this and see how it feels.
 
#4 ·
Quote:

Originally Posted by OnTheBrink
Hi! Are you in Miami? I had my first in Miami 5 years ago. I used the homebirth MWs Deborah DiGiacomo and Mary Harris. When I ended up with a cesarean, Deborah's husband, Dr Wayne DiGiacomo was the doctor.

What midwife have you talked to? At a certain birth center?
No, I live in Charlotte county now. I would have more options in Miami


Thank you velcromom. I don't want to be in an adversarial emvironment either. I believe that would take my focus off of my labor and possibly cause it to stall or make my blood pressure rise.

I need to make a decision soon due to our insurance.

I am touring the hospital tomorrow to see how I feel about it and maybe get some insight from the nurses.
 
#5 ·
I would be concerned with a doc that is requiring internal monitoring. That requires them to break your water which starts you with two interventions right there. Once they break your water they put you on the clock. Then the fact that you have to stay in bed....that is just setting you up. Plus you are in a vbac unfriendly hospital. I know you plan on refusing certain things but those are a lot of things right there to fight for right from the get go. Not to mention other things (IV, etc) that you would have to have. I just don't know if I could be that strong. And then the hospital and most likely the doc would probably not give you much time before they want to move to the c/s. Those are just my thoughts.
Do you have another hospital/doc that you can look at?

I personally wish I could do a HBAC but mw's can't do them here. So I am all for the homebirth option. But you have to be comfortable with it.

Let us know what you decide!
 
#6 ·
I don't have too much experience since I just had my first baby six months ago, BUT.....

The most control you have is before you go to the hospital. I've learned a lot from other mammas in the months since dd's birth, and here are a couple of truths that should give you some strength:

1) You can still see a doc/MW for prenatal care even if you have no intention of letting them near you when you're in labor.

2) You don't HAVE to go to the hospital at any set time. Go when YOU feel you should. That means if he schedules an induction, and you don't want to go, just don't show up. If you know they'll rupture your membranes and require IFM, just don't show up.

3) If you're uncomfortable with VBAC outside a hospital setting, wait a little longer to go. If the hospital has banned VBAC, wait until you're in labor and go in through the ER-- it's the law that they have to admit you and abide by your treatment decisions once you're in labor.

Good luck and
 
#7 ·
If homebirth is something you and your husband are interested in then take the time to explore this option. It is a safe option for VBAC. The truth is, even when in the hospital it is rare for the time from "decision to incision" to be less than 20-30 minutes. If you have to transport, your midwife can phone ahead and have the OR prepped for your arrival. Otherwise, you wait in the hospital for the OB to show up, the OR to get prepped, and all the other things that go into a surgical birth. Your midwife will monitor the baby at home in a much less invasive way than this OB wants to do.

Imo, he says he supports VBAC, but he doesn't really if he's only going to "let" you go to a certain date or require two major interventions that will decrease your chance of success. If he truly believed in the safety of VBAC, he would do intermittent EFM and require a heplock at most. He is just waving bright, red flags to show you where he really stands.
 
#8 ·
Having had both a hospital VBAC and a HBAC, I'd recommend the homebirth. My hospital VBAC wasn't "bad" per se, but there were a few things that made the experience less than optimal. Continuous fetal monitoring, heploc in my hand that made hands-and-knees supremely uncomfy, answering a million questions after my arrival (in transition), a pull with the vacuum extractor when the baby wasn't decending "fast enough" and a fight between my DH and the anesthesiologist who insisted that I needed IV fluids. Overall, it was a nice, drug-free vaginal birth, which was my ultimate goal at the time though. For my third child, we opted for the homebirth and it was by far, the best birth I could have imagined. My MW has attended many VBAC births (and had two of her own as well) and I trust her completely.

Good luck with your decision
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#9 ·
Just an aside...I had internal monitoring (my water broke on it's own, the monitoring came somewhere around 28-30 hours after that) and was able to walk around with the monitor in place (it was a pressure monitor, not something attached to the babe). If you do wind up being in a hospital environment, ask for a telemetry unit so that your mobility isn't as affected.

However, it really sounds like you'd be best served by the homebirth...if you're going to "push" the boundaries at a hospital, why pick one that doesn't have the 24 hour OR support you'd need in case of a true emergency? If you are comfortable with the homebirth midwife the 15 minute transport time you've mentioned is probably less time than it would take to assemble an OR team at the hospital.

Good luck!
 
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