Does posterior baby really mean a repeat C? - Mothering Forums

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#1 of 26 Old 05-28-2008, 10:16 PM - Thread Starter
 
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Today I met the "other" OB in the practice I go to. When I told him my previous C was due (mostly) to a stuck posterior baby he said several things that sound like BS to me but I wanted to check it out. He proceeded to reel off the "types" of pelvis a woman can have (I guess kind of like variations of design) and said some just naturally lead to posterior babies. Then he said if that happens and this one is posterior then that will lead to a longer labor and that will lead to a much higher risk of uterine rupture.

I am not really conveying how annoying this guy was but trust me, he was. I am sure you have all been there. My doula has assured me that even if the baby is posterior it can still turn during labor and it does not automatically mean another C (besides of course all the things we can do to encourage baby to turn in labor).

I guess my overriding fear is that someone will announce during labor "posterior" and that will be that.

Anyway, looking for any stats either way and comments.

Thanks.
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#2 of 26 Old 05-28-2008, 11:02 PM
 
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I am having a vba2c at home in August. I have a anterior placenta, which often times means a posterior baby. My midwife has said this is not a problem, babies come out posterior. BUT, most posterior babies will turn while in the birth canal. You can be a 10, and pushing, and the baby will turn. Dont let him scare you, I would definatly consider someone else if you think they are going to be quick to jump on another csection for a posterior baby.

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#3 of 26 Old 05-28-2008, 11:09 PM
 
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Does a posterior baby require a repeat c-section? No. Is that the policy of your OBs? It sounds like it. I'd get ahold of a copy of Heart and Hands, it's got a TON of info on how to prevent an OP baby and plenty of things to do when you are in labor with an OP baby. If you have a doula I'd discuss it with her because you want that baby to turn before going to the hospital if at all possible. Also check out www.spinningbabies.com

I birthed an OP baby and am hoping to avoid one this time. Just remember that just because the baby is OP doesn't meant there aren't variations of that position and this time he/she could be easier to birth.

Good luck!

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#4 of 26 Old 05-28-2008, 11:09 PM
 
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Another posterior baby does not mean another automatic C-section. I had a patient recently that had an awesome VBAC. Her first baby was posterior and apparently "never even entered the pelvis". That's what she had been told and she had pushed for few hours with him before her C-Section. Her second baby was posterior, a pound bigger, and she pushed for 2.5 hours. I pushed with her (OB nurse) and she was doing great...the baby would go back up high between pushes but she was making slow and steady progress. The baby initially had no molding and she had a lot of room posterior. We did a lot of position changes, even with her epidural. The MD came in to assess progress and apparently wasn't impressed with the baby not yet staying down between pushes and left the room(basically giving the patient another half hour to push then "re-evaluate" meaning "go to section". The patient was really determined to have a VBAC and I knew she could do it! There was room in her pelvis, the baby had been molding (her baby was doing what it was designed to do to fit through her pelvis) and she had a lot of strength left to push for longer. Literally, three pushes later, the baby was rotating to anterior on her perineum and didn't disappear between pushes! Just enough time to open the delivery tray and get the OB back in the room to catch the baby We do a lot of VBACs at the hospital I work at. Our 2007 stats were incredible, 85 successful VBACs out of 93 attempted. (and just under 10% of patients with previous C-Sections elected for repeat C-sections instead of trial of labor)


This situation made me wonder about the circumstances surrounding her first birth. I wonder if they just didn't give her enough time. Maybe her pelvis was one of those who didn't allow the baby to rotate until really late in the game. I think it was a situation where she was with a midwife and per their protocol they have to consult with the back-up OB after 2 hours of pushing, it was the middle of the night, and the OB thought the baby was stuck too high in her pelvis to have a vag delivery.


I'm glad you have a supportive doula.

Laura...part-time OB nurse, and full-time mom to two sweet boysnocirc.gifintactlact.gif
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#5 of 26 Old 05-29-2008, 12:12 AM
 
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I had a stuck posterior baby the first time, (and he was really posterior, and definitely stuck), and then proceeded to have an uncomplicated VBAC with my second baby who was perfectly positioned.

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Mama to T, 5; L, 2; and EDD 12/20/08
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#6 of 26 Old 05-29-2008, 12:31 AM
 
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posterior babies get born vaginally. It can mean a slower birth, but doesn't necessarily mean that, either. My first was posterior until she was +2. Then she turned and popped out. The active portion of my labor was about 4.5 hours. Yes, that is on the shorter end of normal. Go figure.

I would also question whether you want to stay in a practice where you will be on a clock.

I also attended a mother recently who had a VBAC after four days of labor. Malpositioned baby. She was born. Mamas don't always need cesareans...but oftentimes the OBs in our country could do with learning a little patience...

I agree with the suggestions to practice Optimal fetal positioning (what spinning babies will teach you). I would also STRONGLY suggest that you see a chiropractor who can adjust your pelvis if it needs it, as well as perform the Webster technique...sometimes it just needs a little proper alignment on your part, of the pelvis as well as the soft tissues, to get the baby in the right position. But if baby doesn't turn before labor, it does NOT mean that you can't have baby vaginally. *Harumph.*: What an annoying thing to say to a woman.

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#7 of 26 Old 05-29-2008, 02:43 AM
 
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My first DS was born by cesarean after labor started on its own and then is was taking a long time and so I had the whole cascade of interventions that ultimately set me up for him to be cut out of me. He was 6 pounds 6 ounces (im a small person so perfect size for me) he was right anterior (so not the perfect but good position) and had a 33cm head and well I didnt end up dialating past 6cm. I then had my baby girl 18 months later and had 5 days worth of start and stop labor not hard or bad but very annoying and uncomfortable and then my water broke on the fifth day at 1:30am and I started pushing at 5:50am and pushed her out by 6:21am and she came out with her head facing up. I new she would be posterior coming out and I just never doubted once that I couldnt do it. Her head was quite molded and had a huge bruise and my back labor was extreamly painful and pushing was horrific because it wasnt relief but I felt like my clitoris and labia was being torn apart and seriously thought I was going to have to have a gazillion stitches but I never had to have any just a small laceration that healed on its own. Anyway your Doctor is feeding you crap just like you think he is. You CAN do it.
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#8 of 26 Old 05-29-2008, 02:59 AM
 
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DD was a posterior baby who got stuck and ended with a c-section. DS was also posterior, however I was home with a midwife who stood me on my head and turned him. . .he came out about 20 minutes after she turned him. I do everything during pg to prevent posterior babies, and when I go into labor they are not posterior, but for some reason they turn during labor. I guess it's the shape of my pelvis. You might want to check into someone well versed in turning babies or read Heart and Hands where they have a section on how to do this.

Barbara:  an always learning SAHM of Ilana (11) and Aiden (8) living in Belgium with my amazing husband.

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#9 of 26 Old 05-29-2008, 03:07 AM
 
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dd was posterier, so i had back labor from hell, but she came out fine, no bruising, prettiest roundest head you ever saw. 8lb15oz eta: fast too, 12 hrs from first fluttery contrax to holding her in my arms.

Erin, 33, salty southern mama, sitting by the sea with my DH35, DD10, DS4, &DD2!
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#10 of 26 Old 05-29-2008, 04:40 AM - Thread Starter
 
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Hi,
I'm the OP. Thanks for the replies and encouragement.

Which part of Heart and Hands is the most relevant? Can anyone point me to a chapter (I have it on hold at the library).

I can't leave the practice but the other OB I've been seeing I am a lot more comfortable with and I will request him on the day. I've been able to stay really positive up till now but obviously this particular appointment really got to me. I have a great doula and I am determined to stay home to labor as long as possible.

One of the posters said that their baby just needed longer - that it turned eventually. It's interesting because that is what my doula and I concluded - that my original midwives were kind of nervous about how long my waters had broken and had me pushing at 8cm. If I had just labored along a few more hours it may have all been different.

Thanks.
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#11 of 26 Old 05-29-2008, 11:06 AM
 
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Like OPs have said, poor positioning can lead to a longer/harder labor, and some moms may have trouble getting the kid out because of it. But it's most definitely not a done deal! AND, just because your baby was posterior, doesn't mean that this one will be. Practice good posture and positioning techniques (see spinningbabies) diligently and don't worry about it. One of the docs I spoke with said that the most important factor in determining the success of a VBAC was how motivated mom was to having one. I truly believe this to be the case.

FWIW, my younger brother was 10#11 oz, posterior, and was delivered completely naturally back in the 1970's (though my mom said she did burst the blood vessels in her eyes because she had to push so hard).

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#12 of 26 Old 05-29-2008, 11:29 AM
 
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FWIW, I had a stuck posterior baby the first time and a really long and painful experience. I was so paranoid about posterior again because it would have sent me off in the "it will never come out right" place in my mind. The next baby was perfectly positioned and came out very easily. The labor was so incredibly different and a heck of a lot less painful.
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#13 of 26 Old 05-29-2008, 12:02 PM
 
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Posterior babe DOES NOT mean repeat c/s! Yes, positioning can mean a more painful or dysfunctional labor, but automatic surgery is ridiculous. I recently supported a birth - VBAC mom, long and erratic labor - she vaginally birthed a completely OP baby, who weighed 9.5 pounds. I don't think she really believed it could happen until she did it.

A supportive OB/MW can and will make all the difference! Find one who believes in you, and doesn't fill you head with fears and anxiety.
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#14 of 26 Old 05-29-2008, 12:12 PM
 
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So when does it not work? Not to put a negative spin on things, but I had a c/s for a 11lb(15" head) posterior baby that wouldn't turn. Made it to 9cm and he couldn't drop down in the position. I was told I had a huge pelvic cavity and am still confused by what happened even tho my awesome midwives(attempted homebirth) swear the c/s was the only option. I kinda need to believe it was, but also really want to understand what happened. None of the explanations seem to satisfy me.
We are looking to conceive again soon and I love my midwives in so many ways and want more than anything to VBAC with them at home, but want to know if this happens again if a c/s would be, really, my only option.

S, mama to boy M(6/07) and baby girl R(7/10). We do all the good natural family living stuff!
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#15 of 26 Old 05-29-2008, 01:19 PM
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My VBAC baby was posterior. And his shoulder got stuck in the birth canal, I pushed for 4.5 hours. And his umbilical cord was around his neck. No repeat c/s was necessary according to my OB. I cherish the beautiful memory of my baby's wonderful natural birth.

"Isn't life a series of images that change as they repeat themselves?" - Andy Warhol
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#16 of 26 Old 05-29-2008, 01:32 PM
 
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Quote:
Originally Posted by sharr610 View Post
So when does it not work?
Basically, it doesn't work when the baby can't get into a position that physically fits. The thing is, you never know until you try whether this is the case or not. And sometimes a vacuum or forceps can help get baby's head around and allow a vaginal delivery when it wasn't possible before (this is what happened to my sister's first birth. She pushed for 7 or 8 hours, tried nipple stim, various positions, pitocin, and finally they tried a vacuum. 2 pulls and they got his head around (MW said she was feeling an ear or something?) and he was born a couple pushes later - 8#14).

Mom to James (ribboncesarean.gif 5/2006), Claire (vbac.gif 6/2008), furry kitties Calvin and Bob, and wife to Dennis. 

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#17 of 26 Old 05-29-2008, 02:05 PM
 
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I have heard that having a retroverted uterus can lead to a posterior baby. I think I remember reading something on spinningbabies.com about pelvis shapes that can contribute to this too, but it escapes me at the moment. Something about how the baby settles in to the pelvis as he nears term that affects his position. Either way, the website is a great read, they are rearranging some stuff right now so it looks crazy but all the info is still there.
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#18 of 26 Old 05-29-2008, 05:11 PM - Thread Starter
 
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Yeah I gave up on the spinningbabies web site a while ago. Sure the info is great but SO hard to wade through. It is so disorganized! I am glad to hear they are reworking it so it will be more accessible :-)
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#19 of 26 Old 05-29-2008, 05:55 PM
 
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I don't want to freak you out, but I feel I need to tell the whole story instead of just a part of it. You see all three of my babes turned posterior in my birth canal. DD like I said before was a c-sec, DS was turned by my midwife in the states, with Naiya I had a new midwife who did not turn her (had full faith in my body working things out). . .I was at 9cm for 5 hours. . .she did finally turn, but it was stressful (she passed a lot of mec and died from severe mec aspiration syndrome). I now say that if I would ever get pg again, if I couldn't have the midwife I had in the states, because of the shape of my pelvis (none of my babes start posterior), I would have a c-sec--however, for me, I really don't ever want to get pg again. I'm sorry to bring you down or anything, but I felt I needed to give you the whole story.

Barbara:  an always learning SAHM of Ilana (11) and Aiden (8) living in Belgium with my amazing husband.

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#20 of 26 Old 05-30-2008, 11:42 AM
 
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I had a successful VBAC last September with a posterior baby. I had read about and tried optimal fetal positioning, but she was in a bad position from start to finish. In hindsight, I had a classic posterior labor. Contractions started but never picked up and then petered out, the next morning my water broke but contractions didn't return for almost 48 hours. I was planning a HBAC, but because of the slight merconium staining my midwife recommended transferring to the hospital. I was so afraid to go because I knew that all the odds were stacked against me. I didn't have an OB so I got the doctor on call. She turned out to be a very understanding laid back doctor who completely supported me in my VBAC goal. I labored in the hospital for a full 24 hours. My dd's heart rate never waivored and there was no more merconium although the contractions were like nothing else I have ever experienced! I did finally get the epidural and a very small amount of pitocin when the nurse checked me and said that the baby was facing right into my hip. I could feel this too and knew she was not moving at all without some help. With every contraction it felt as though she was hitting a brick wall in my pelvis. 3 hours after the epidural and pitocin the nurse checked and she had turned, we thought to a good position, after only 30 minutes of pushing my baby was born face up looking right at me! I reached down and pulled her up to my chest and never let her go. It was my biggest victory after the biggest fight of my life and it was worth all the pain! As far as OB's are concerned it may be that a posterier baby means a repeat CS, but your body is capable of birthing a baby in a posterior position. At my 6 week check with my midwife she backed up the decision to get the epidural and pitocin. I was sooo against it at the time because I thought it would certainly ruin my chances at a VBAC, but she said that if used correctly it is very sucessful for the vaginal delivery of a posterior baby. She said that because of the positioning usually a woman's own contractions don't have enough power to move the baby thru the birth canal and that the pitocin is necessary. In my case they only had to go up to 8, 20 being the acceptable limit for a VBAC.
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#21 of 26 Old 05-30-2008, 02:00 PM
 
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The Spinning Babies site can be a bit much. Try Optimal Fetal Positioning http://www.homebirth.org.uk/ofp.htm It's the same idea, same info, but a heck of a lot more "readable"

In addition I'd suggest getting a copy of The Labor Progress Handbook by Penny Simkin. It's written for care providers but the language is clear and easy to follow. The book basically starts in late pregnancy and walks through the birth detailing the physical, emotional, spiritual, social, etc "problems" that can happen during birth. It then details possible interventions for each problem (medical interventions as well as less invasive interventions) and provides a sort of "flow chart" of where each intervention may lead. It really helped me figure out what had happened in my first birth and then gave me an idea of what to keep an eye on in my vbac.

(1st birth was a large headed big babe, OP, sPROM at 42+ weeks, asynclitic and presenting with her ear... despite the long labor I never dilated past 7cm. There just wasn't enough room/fluid for her to wiggle into a better position. My vbac babe's birth took 12hrs start to finish, but I was ready for another OP babe.)

Oh, my OBs also said that the only time they'd worry about increased UR risk would be if I was having significant contractions for a significant period of time without any progress. And by that they meant a period of 3 or more hours without some sort of progress once active labor was well under way. Slow or uneven progress was totally fine with them though. And at that point they said they'd ask me to consider a telemetry unit to monitor the babe and a blood pressure cuff to monitor me (they go with the maternal bp/fetal heart school of UR detection). It wouldn't be an automatic c/s or anything. Perhaps see how that scenario would "fly" with your care provider?

Good luck mama!

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#22 of 26 Old 05-30-2008, 02:05 PM
 
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get to a chiropractor that is certified in the Webster technique.
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#23 of 26 Old 05-30-2008, 02:56 PM
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lots of great info from PPs! Great question to ask also!

With my 2nd pregnancy, DS was posterior and asynclitic and 10lbs 3 oz, all of which we did not know until he was delivered via an c. I had a fantastic labor, bradley trained, doula, midwives, plenty of time... but in my case, the big guy was literally stuck. They even tried going up manually and physically getting him out (ouch!)... and nada. His heart tones started lowering with no acel's, and we realized that it wasn't worth continuing. It was completely our choice to move on to a c, and even though I was completely bummed, as this was my first vbac attempt, I knew and our doula (who is a bradley teacher) knew that we did everything possible. btw - he was also 2w late.

With my 3rd pregnancy, I vba2c'd as perfectly as I could have hoped for - DS was 8lbs 10 oz, anterior. Everything worked as it should - I labored at home, in the tub, took a nap, pushed when I felt like it - basically trusted the animal instinct in me.

But even though for me, my big posterior moose ended in a c, I think that posterior babies can certainly be born vag without a hitch. In my case, I was pushing way before I should have, which got DS's head stuck, and there was no way to manually rotate him, unless I stood on my head and let him float back up LOL!

With my vba2c, I did a lot of hands and knees motion (not just rocking, but scrubbing floors, etc...) and belly dancing, swirling/stirring of my hips constantly - even while in labor. It just felt good. I have absolutely no abdominal muscles whatsoever, so I knew I couldn't rely on my own muscles to push the baby out. I did, however, for the first time, feel the amazing urge to bear down that I never felt before. And what a feeling.

I really like all the books mentioned, and I esp. like Active Birth - it kept me moving and I think that helped me a ton.

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#24 of 26 Old 05-30-2008, 11:35 PM
 
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I had a successful vbac w/ a posterior baby. She came out that way too (many turn at last minute). She had a 14cm head to boot.

Key to my success----no epidural! I don't think I would have been able to do it w/ an epi (first time had an epidural w/ posterior baby and asynclitic head). W/ the epi I had no feeling of how I was pushing.

I'm not going to lie....it hurt tremendously and I tore really badly (interior vaginal tears). It was still way better than a c/s, but not my "dream vbac", ya know.

And oddly enough, the only position she descended in, was flat on my back pushing. I tried every position---all fours, side, front lower and finally she descended when I was on my back. Go figure.


I know the fear that if baby is posterior you won't be able to do it.....even my dr checked me once and said, "I think she's moved anterior". I'm sure he wasn't lying----he just was wrong, but thank G-d he was bc I would have been so discouraged if I had known she was posterior the whole time.

You can do it!! I am a wimp and have no tolerance for pain and I love drugs, but I was able to stay away....
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#25 of 26 Old 05-31-2008, 11:37 AM
 
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I hope you aren't frightened too much about posterior. We all know that there are variations on the ideal position, and those variations can be more painful or whatnot. But that shouldn't be an automatic deterrent from having a normal vaginal birth after a previous c/section, and my midwife, who had plenty of homebirths, even ones done after prior c/section, said that in her experience, a vaginal birth was a vaginal birth, so long as the labor is supported and the mother is comfortable. Matter of fact, she was shocked about the recent switch from "VBAC is safest" to "VBAC can only be attempted if everything goes according to textbook ideals." She became a midwife after having the experience of birthing one of her own babies posterior in an unassisted homebirth (which all her children were, unassisted) but realized that it was more painful and that in that situation, she could really have benefitted from some skilled, experienced help. But certainly it wasn't a variation from the norm that requires emergency measures and draconian interventions like major abdominal surgery!
Uterine ruptures occur rarely in all cases, but it is worth noting that they occur in unscarred uteri also, and that the routine use of "labor augmentation" or induction, increases risk of UR. Yet the "pro-VBAC" OB in my area was talking about how she induces on VBACs all the time!(Which in the 90's was known to be a no-no, but suddenly now, it's routine?!) That's when I knew I was not going one step further on this path with her, and found my homebirth midwife.
Sorry to digress... I wouldn't let the posterior thing get to you, and I would definitely recommend at least interviewing and talking with some experienced homebirth midwives /Certified Practical Midwives and asking them what their experiences with HBAC, and also posterior position, have been. Whether you have any intentions of switching providers or not, at least you will see that there are different viewpoints from what you get with OBs, and these women aren't stupid, nor do they want their professional necks on the chopping block for taking stupid risks, yet they seem, as a group, unimpressed by the usual variations of labor and birth that seem to terrify OBs and by extension, their patients. I was told by my "pro-VBAC" OB that 40 weeks was the absolute limit on how long I should go before inducing because of the frightening risks involved with VBAC, and that after 40 weeks the risk of RUPTURE went up dramatically. Well, oddly enough in the Netherlands, they don't consider anyone postdates until at least 42 weeks. My baby came 40 weeks, 2 days, at home, no drugs or interventions, nuchal arm, weighing over 10 lbs, and none of it meant anything terrible happened.
Hope this helps!

Urban Homesteader, secular homeschooler, HBACer, sewing cloth maxipads, reading Diana Gabaldon, (rhymes with 'cobblestone') hoping for a Star Trek future rather than a Firefly one.
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#26 of 26 Old 05-31-2008, 12:53 PM
 
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Since when is a posterior baby a reason for a caesarean delivery anyway?

Get a more educated practitioner. My first two were at home, posterior. Labor is longer, more painful, but with good management, do-able.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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