Facing another C/S...:( - Mothering Forums

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#1 of 28 Old 04-28-2007, 03:32 PM - Thread Starter
 
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Hi ladies,

Just curious as to wwyd....

I will be 39 weeks on Tuesday...my next OB visit is Thursday. My doctor will not "let" me go past 40 weeks....so if faced with induction or C/S...what would you choose? (you know, the lesser of two evils thing?)

In the meantime, what can I do to ahem...get things going, if you will?

For the record I am 3cms (well I was when I went into PTL at 30 weeks, I could be more now, I haven't been checked since then) and "at least" 50% effaced. For the past week I've had somewhat strong menstrual cramping like sensations...but no baby. (With DD1 I went into labor at 27 weeks, and I went QUICK with very very minimal discomfort to 6 cms before it was known she was footling breech and had her via c/s)

DH and I dtd often (not because I want to! ) and that hasn't helped...I pumped on and off all day yesterday...nothing...obviously it just means baby isn't ready...but tell that to the doctor. :

What can I do?
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#2 of 28 Old 04-28-2007, 03:54 PM
 
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Personally? I would do neither. I could not in good conscience agree to a surgery that wasn't necessary (IOW, if the baby is fine, plenty of amniotic fluid, placenta looks good, etc.). The risk of surgery is too great for me to take it without cause. And I would not want a baby to come before he is ready - not only could lung problems be at issue, but there are lactogenesis issue, tone issues, etc.

I would never induce (I'm having a VBAC soon myself) because the risk of rupture is so great with a scarred uterus and induction.

I'd start by talking to the doctor about why he's recommending c-sec or induction, ask him to compromise by doing BPP or stress test, ask him to let you sign a form AMA and continue care, fully knowing that you don't feel it's wise to take a baby before it's ready and 40 weeks is an average, not an absolute.

If it were me, I'd cry a lot and be stressed out (((HUGS))) then I would look into the legality of my doctor discontinuing care, or if he had to continue care until I found another OB. I would hope the doctor would continue to monitor my baby's health through the time of labor and birth. If nothing else, I would show up at the hospital when in labor (as late in labor as possible), list my doctor, and if he refused to deliver the doctor on call would have to.

Nothing is a good option, it stinks. I'm sorry.
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#3 of 28 Old 04-28-2007, 04:08 PM
 
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You can flat out refuse either one. Remember YOU are the one who has to live with whatever you choose....not him. I personally would not choose to induce as a vbac, but to put a limit of 40 weeks on it is nuts.
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#4 of 28 Old 04-28-2007, 04:42 PM
 
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#5 of 28 Old 04-28-2007, 04:44 PM
 
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There's no evidence that I know of which would make a VBAC more or a risk going beyond 40 weeks than a non-VBAC patient... discuss this with your doctor. Is there a reason he's placing this limit on YOU specifically? Perhaps it is just a miscommunication, maybe he needs to look more closely at your chart & talk with you more in detail - to really understand your point of view, and gauge your understanding of your own health. I believe a lot of care providers feel that their patient needs constant guidance & guidelines, and may assume that you haven't done any research.

I would really really really not recommend inducing... I can't believe your docotor would even suggest it to you as a possibility, because of the risk of rupture. What sort of induction was he suggesting?

Really, I'd take a deep breath, gather your thoughts, make sure your concerns are down on paper (to help you focus), get on the same page as DH, then both of you go to the doctor openly & honestly. Discuss your options & concerns.

I'd ask for a nonstress test after the 40 week point. As often as they want you to do this, to make them, and yourself feel better. And like PPs have said, you can always refuse a C-section. I suppose you could even agree to one, and not show up, if worse came to worse. But, I'm more of the mind that open discussion is a better path to take for everyone's well being.

FWIW, my doctor indicated 41 weeks would be her comfort level before talking about a C-section. So DH & I are ready to have the same discussion I'm recommending to you, at the 41 week point, if DS hasn't arrived yet.

Good luck to you - keep us posted!

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#6 of 28 Old 04-28-2007, 04:56 PM
 
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Not much time to type nut hoping my story offers some encouragement.
I had my dd at 26 weeks with a c/s. My son they took out at 36 weeks because I was having menstrual like cramps.
With my 3rd, I went to 41 weeks, hired a midwife, had a great home birth, and am very happy with my decision.
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#7 of 28 Old 04-28-2007, 05:38 PM
 
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I've just gotta chime in with basically the same thing that other mom's are saying... be patient!!! You're doing awesome! Your body is preparing for labor, and your baby is doing the last bits of growing and lung maturation before the big day (or days, LOL). Unless there is some CAUSE for concern (low amniotic fluid, gestational diabetes, etc) there's no reason to consider going past 40 weeks (which is early for most mom's to deliver, anyway) as any sort of hazard. Most women deliver between 37-42 weeks. Meaning, AFTER 42 weeks (a whole 3 weeks away!) you can consider the baby 'late.'

Another thing to consider with induction, besides the obvious increased risk of uterine rupture, is the increased risk of... another c-section! Your body's not ready (if it were, you'd be in labor), and your baby's not ready (ditto), so pumping a bunch of harmful drugs into you is NOT going to help matters. It'll only give the doctors another excuse to cut you when things don't go exactly as planned.

Tell your doc that you're not ready to have this baby. If he threatens to drop your care if you don't, then remember as another PP said... the doctor on call at the hospital WILL HAVE TO deliver your baby.

Keep up the good work! You're doing what's best for yourself and your baby.

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#8 of 28 Old 04-28-2007, 08:02 PM
 
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Wait that baby out! Dr can not do a cesarean if you don't show up. Same goes for an induction. You didn't mention there was any medical indication that baby needs to be born, so wait! Remember, you are hiring that dr for a service, you are in charge. Induction increases your chance of UR and usually introduces a lot of unnecessary interventions. Cesarean birth without medical necessaity creates more problems as well.

With my last birth, I went so far as to signing a legal statement during labor while being admitted to the hospital that it was my idea to VBAC and I knew I was going against my dr's advice to have a cesarean right then just because I was in labor. : I'm telling you, they can't touch you without your okay!
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#9 of 28 Old 04-28-2007, 10:45 PM
 
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I agree w/the other moms of course. It depends on your personality how you want to handle it though. You can fight it or you can go along w/scheduling the induction and just not show up!!! Personally I'd fire my doc and switch to a midwife or UC. It took me 2 c/s though to fight like that w/this pregnancy!

I know it's hard at the end of the pregnancy to be patient, but just remind yourself of what you'll be happiest with when you look back on your experience. Talk to positive ppl and stay away from anyone who will put any doubt into your head! Basically become a hermit and hang out on MDC!
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#10 of 28 Old 04-29-2007, 01:55 AM
 
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Also, make sure your dh is on board with you when you go to talk to the OB, so you don't have to make a decision on the spot without support.

Is it too late for you to find a doula?
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#11 of 28 Old 04-29-2007, 02:20 AM
 
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I agree with everyone else! I personally wouldn't even *think* about doing something until 42 weeks. Even then I would be very very hesitant. You don't have to make a move at 40 weeks, you really don't. As far as what to do to move things along, I would keep dtd (if you feel like it) and go for walks. But don't wear yourself out. You will be in labor before you know it!
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#12 of 28 Old 04-29-2007, 07:57 AM
 
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I agree to what everyone else's is saying here!! Legally your doctor cannot drop you unless you have a new caregiver that will take you..and you don't have to show for c-sec or induction. And remember, when you do go into labor, the ER cannot reject you, now matter how far along you are. 40 weeks is nothing..baby knows when it's the right time..trust your baby..and your body..you'll have less chance of a nicu baby that way.

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#13 of 28 Old 04-29-2007, 09:21 AM
 
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I had my doctor tell me at 20 weeks that he would schedule my cs at 38 weeks.....I got so scared that I gt myself a midwife......the doctor made me feel as there was something wrong with my body, and even with an induction, if you think there is something wrong with your body, no baby will come......I would definately get a mifwife fast.....and a DOULA.....I will have a doula who has done many vbacs and a midwife who believes in my body's abilty to birth, and I know I will be fine...2 supporting women.

As I said, I got so scared when this "doctor" who did not even ask me about my body comes out with, "I would do a cs at 38 weeks". Can you imagine such boldness....I told my midwife this and she too was disgusted. Don'e let this doctor take away an chance to birth your baby.......believe in your body, focus on your bosy openning up at birth and allowing the pain to drive the baby out.....drink plenty of water......you are doign great.....why induce...baby might not be ready and you end up getting a cs....that is what happened to me....I got induced, and my baby was not ready and refused to come.....then I got a CS...I am now pregnant again and I have bene doing lots of mind healing.....thinking and meditating working on past disappointment with not having the natural birth I wanted.....also getting my body ready, I do squats, pelvic tils and drink raspberry tea....I feel ready to have the successful vbac I so yearned for.....

I wish you all the luck....don't feel it's too late to switch......get online and look around, call around.....not all midwives are okay...but the one that makes you feel like all is normal is the one I would go for.....you cannot have people around you at birth that think you are "broken" from the very beginning....it does something to your confidence.

Good luck.... am due June 13th.....you?


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#14 of 28 Old 04-30-2007, 01:16 PM - Thread Starter
 
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Thanks ladies,

Coming here sure gives me encouragement!

I am just sooo worried, you know? Of COURSE I absolutely do not want to be induced or have another c/s. I want things to be different this time. Of course I am just SO BLESSED to not worry about a 2 month long NICU stay for this baby, but with that I also want what so many other mamas here on MDC get to experience.

I would LOVE a UC, or a Midwife assisted delivery at home. But to go UC would be also really scary considering my last delivery...for some reason I can't get it through to my head that the baby would be okay. I'm not worried about me at all...it's the baby.

I have had ZERO problems with this pregnancy (no GD, GBS neg, ect ect) except for PTL at 30 weeks requiring a hospital stay.

DH and I can't really afford a doula, or a midwife. So it's either hospital with no midwife, or home by myself....

But I will not consent to being induced or another c/s....at least not till much further into this pregnancy...
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#15 of 28 Old 04-30-2007, 01:32 PM
 
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See if your doctor will "strip the membranes" right away. That usually results in a birth within 48 hours, especially if you're really active. I think it's the least evil of any of the options to encourage labor.

The doc will sweep his/her fingers along the sac to separate it from the wall. It is a bit uncomfortable, but not super painful. You can get this done daily if you need to, I believe.

That is what I would do before looking at induction. And that doctor cannot force you to have surgery or induction. If there's no medical reason, why not just say no? Is the baby really big? If not, then just say, "I am sorry, but no."

The worst that can happen is the doc says s/he won't care for you anymore. So what? When you go into labor and you show up at the L&D door, you tell them the doc fired you because you refused a 40 week induction and/or surgery. They'll find someone for you then I guess. They do that for homebirth and UCs that turn into tranfers, so they can do that for you.

I wouldn't worry about it! I would refuse induction and surgery at this point. Forcing a woman who is only 40 weeks is bullying and just wrong. I understand they're trying to cover their butts, however, you will most likely go into labor on your own within 2 weeks and be fine!

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#16 of 28 Old 04-30-2007, 01:57 PM
 
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Quote:
Originally Posted by BethLS View Post

DH and I can't really afford a doula, or a midwife. So it's either hospital with no midwife, or home by myself....

But I will not consent to being induced or another c/s....at least not till much further into this pregnancy...

So glad to hear you'll wait baby out. As for not being able to afford a doula or midwife.... Around here midwives will considering trading services. (They've done a homebirth for a complete website. Also done a homebirth for a professional to make a commercial, etc.) Also, sometimes you can find a student doula for free or at a reduced price. (We really do enjoy attending births just to get the experience.)

One thing I'd like to suggest, keep working through those feelings from your previous birth. The more you can overcome and deal with your fears now... the better off you will be in labor. Good luck!
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#17 of 28 Old 04-30-2007, 02:01 PM
 
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My OB had also said to me that they would not "let me" go beyond a certain point- I believe it was 41 weeks- and that we'd have to talk c/s or induction. But she also admitted that they could not make me do anything, and if that was not okay with me, then they would be open to watching me closely and watching baby closely with fetal monitoring, etc.
I don't think a VBAC mama or anyone else should have to choose between c/s or induction (unless there is something wrong)- I think you should allow your body to go into labor naturally.
I'm glad to hear that you plan to do that!
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#18 of 28 Old 04-30-2007, 02:53 PM
 
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Be careful of stripping the membranes. While this CAN hasten labor, it's also no different from other 'alternative' induction methods, meaning that if your body isn't ready, you can have a looong, slooow labor!

Also, stripping the membranes carries an increased risk of accidentally rupturing the membranes (breaking waters), which really puts you on a highly medical watch. It can also increase the risks of infection (with or without rupturing membranes).

Wait until AT LEAST 41 weeks before any 'natural induction' methods. Your body is working perfectly!

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#19 of 28 Old 04-30-2007, 02:59 PM
 
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Although I completely think you should be medically monitored throughout your ENTIRE pregnancy. I also believe that if you go past 40 weeks and your doctor won't "let" you go more without inducing then don't show up for your induction. I think another commentor said to simply show up at the hospital when you go into labor and the doctor on call will deliver your baby. I know, it's not the best solution, but seriously, 40 weeks is crazy to put a limit.
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#20 of 28 Old 04-30-2007, 03:04 PM
 
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Quote:
Originally Posted by BethLS View Post

DH and I can't really afford a doula, or a midwife. So it's either hospital with no midwife, or home by myself....
Have you looked into the doula/midwife thing? I know lots of doulas who are looking for their first few births who don't charge at all, and many many more who offer reduced rates if $$ are an issue.

I would imagine that it's not impossible that a midwife would similarly be willing to work with you on $$ issues, especially with the circumstances explained...

Good luck mama! Stay strong and don't let them bully you into another C/S "just because"!

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#21 of 28 Old 04-30-2007, 05:43 PM
 
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My midwife is assisting me at a hospital...there are many midwives that work under this model....so this does not nevesarily mean you have to birth at home...call your insurance....all insurances should cover midwives, at least that is what I have been told. My doula worked out a deal with me, and bought some art form me in exchange for services.....also, afetr reading more about it, I became convinced that having a doula is absolutely necessary for all births, especially a vbac...

I'd call my insurance right away and ask them if they have midwives in your area that they cover. All insurances I have ever had have included midwives....

Miriam
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#22 of 28 Old 04-30-2007, 07:13 PM
 
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Another option for getting a doula (or simply labor coach/partner), is to put your location out there on this list, mailing lists, ICAN groups, etc. There might not be a 'professional' doula who will be there, but you could get an informed mama who's VBACd before and knows the drill. You'd be amazed at how many women are willing to sit with you in a hospital, rub your back and tell you "You CAN Do This!"

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#23 of 28 Old 04-30-2007, 07:20 PM
 
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I would let my machine take all calls and not show up for any inductions or surgery. If you and the baby are fine, then you should not have to ask permission to use your own vagina!
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#24 of 28 Old 04-30-2007, 10:41 PM
 
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I have to agree about the membrane stripping/sweeping. Although it's at the most "interventionist" end of the natural induction methods, it's not a silver bullet! I had my membranes swept at 41 weeks and again at 42 weeks and it was still another 3 days before labor started. If you're ready to go it can push you into labor, but it may not!

I guess I'd come down on the side of asking the doctor WHY the 40 week limit. Is it related to the VBAC success scale? If so, the VBAC success rate didn't really drop till after 41 weeks. And there can be a big difference between 40 and 41 weeks! Or is there some sort of clause in their medical insurance or the hospital coverage? Can you sign a waiver and go with NST or other monitoring that would give you more time?

Since ou did ask specifically though, I'd choose and induction over a repeat c/s since with an induction there is a chance (and a pretty good chance) that you'll wind up with a c/s. But if you schedule a c/s then you have a 100% chance of getting that operation, you know?

My care providers are gung ho VBAC supporters and they are very much against any sort of medical/chemical induction for VBAC mamas. IF an induction is necessary (and they have a very very short list of reasons why an induction would be necessary) they use the foley cath method. It does increase the risk of UR, but not by anything near the levels seen with chemical induction agents, even those agents that can be removed/reduced should side effects become apparent.

Also, induction (especially with a VBAC mama) shouldn't be done unless you have a favorable bishop score. So ask your provider about that as well...it may be they think that you are absolutely positively ready to go and just need a nudge (and there is some reason they think that nudge would be a good idea). In which case, discuss the most basic natural interventions first, then move to a sweep, and perhaps eventually to a foley if there is not alternative.

But for me? I'd just say no unless they could give me a really really good reason for their request...not just some sort of blanket "40 weeks" thing.

Good luck and happy birthing!

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#25 of 28 Old 05-02-2007, 06:13 AM
 
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the problem is not you it is your doc.

DONT SHOW UP FOR YOUR INDUCTION OR A C-SECTION!
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#26 of 28 Old 05-03-2007, 11:58 PM
 
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I'd change docs.....sorry, I couldn't walk into either over a silly 40 weeks time frame. There is no increase in ur rate so what's the big deal??
Sorry I haven't read all the other posts.
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#27 of 28 Old 05-04-2007, 12:27 AM
 
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Just keep in mind that it's impossible to "not let" you give birth when you're ready if you don't give them your permission. I guarantee that if you wait and go into labor naturally, your OB will not be turning you away. Your OB will attempt to scare you, talk you into it, etc. I suggest reminding your OB that there's a reason why it's called the Estimated Due Date. Estimated. Period. This is your decision, not your OB's.

If you decide to do this your way, I would absolutely not allow any vaginal checks between now and when you go into labor. A check can turn into a sneaky membrane sweep in a second, and then you're on the clock. Just say no.
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#28 of 28 Old 05-04-2007, 11:37 AM
 
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Thinking of you, mama!
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