Just met with my midwife.. VBAC option? - Mothering Forums

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#1 of 19 Old 06-30-2008, 04:58 AM - Thread Starter
 
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Hi All. This is my first post to the VBAC forum since I didn't even KNOW there was one until i saw someone talk about it on my due date club! I have a 3yo who was born via C-section b/c she was breech. We did try everything possible for weeks to get her to turn - Webster technique, boards, version, etc. Didnt work and went into labor at 38 weeks - rushed into C-section. So I'm now 9 weeks pregnant with #2 and just met with my midwife for the first time on THursday. I felt so happy because I am able to go back to the practice that I had my dd with since they now accept our insurance again. She decided immediately I was a good candidate for VBAC since my dd was only breech BUT there are some terms that come along with it. My midwives only work with one doctor as their back-up (same guy who delivered my dd) and his rule is he doesn't like a VBAC candidate to go over 41 weeks. I had the same issue with that doctor regarding breech births and I fought like hell to get my scheduled section closer to 2 weeks overdue (so I could pray longer that she's be flipped by the time i went into labor) - which didn't happen anyway. Didn't win that fight, they still had me scheduled for a week before (I showed them by going into labor even earlier - ha!)

So, basically my options are (per my midwife):

1. wait out til 41 weeks and if the baby is not here, I get a C-section (not what I want obviously). no option of induction at this point since she says my doctor believes you then have a higher rate of rupture after C-section when being induced at that point.

2. at week 40, they do a "gentle induction" (still drugs) so i have a better chance of vaginal (is that really a better chance??)

3. hope like hell that this baby comes 2 weeks early like ella and that it all goes smoothly... (this really isn't an option as much as a wish)

With that being said, I really like this practice so this leaves me in a bad spot. I've had all these issues with spotting and bleeding over the past 4 weeks and they have been great. I call, they call me right back.. they work with me to go to labs and ultrasounds near my house cause they're far away from my house. They know who I am and remember everything I went through with Ella and it's more like a personal relationship. I love that there is ONE receptionist, ONE nurse and a midwife there during the day and they know who you are when you call. I love that when i was bleeding horribly the other day, my midwife made it a point to say if it gets any worse please call me so I can talk you through it. But, uggh! I almost feel like this really isn't a VBAC option - maybe a 60% VBAC option.

There is another doctor in the area that I went to for my last annual that does VBAC's - a couple of my girlfriends have used him with success.. he even let one try a VBA2C last year. Of course, it's a bigger practice with less of a warm, fuzzy feeling. I guess I have to decide what I want more.. more time to try or a practice I love.. AHH!

Any thoughts?

homeschooling mama to ella (9) and maya (5)
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#2 of 19 Old 06-30-2008, 01:13 PM
 
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I would be very cautious about doing an induction, even a gentle one as it could increase your risk of UR.
Have you checked out any of the other VBAC care providers in your area? I would try to find one that is more comfortable with you going to 42 weeks (I don't have the research on hand, but I believe the risk of stillbirth does not increase until 42 weeks).
I would look in your local tribe section or contact your local ican group to find out about other providers in your area.
And yes, I think you are an excellent candidate for a vbac since your c-section was for breech.
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#3 of 19 Old 06-30-2008, 01:42 PM
 
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Originally Posted by MommyToElla View Post
With that being said, I really like this practice so this leaves me in a bad spot. I've had all these issues with spotting and bleeding over the past 4 weeks and they have been great. I call, they call me right back.. they work with me to go to labs and ultrasounds near my house cause they're far away from my house. They know who I am and remember everything I went through with Ella and it's more like a personal relationship. I love that there is ONE receptionist, ONE nurse and a midwife there during the day and they know who you are when you call. I love that when i was bleeding horribly the other day, my midwife made it a point to say if it gets any worse please call me so I can talk you through it. But, uggh! I almost feel like this really isn't a VBAC option - maybe a 60% VBAC option.
Do you think there is a chance that you might like another practice as much? Do you think you'd be happier going with a practice that didn't put as many restrictions on you?

I think it's really important to have a provider that totally believes in you and doesn't put restrictions on your vbac. I had a c-section with a group of midwives nearly 4 years ago. I loved 2 of the midwives and felt only so-so about the one at my delivery (who wound up being the one who pushed me into a c-section). When I asked about vbac, she said don't bother. The other 2 midwives were much more supportive and wanted me to try. The problem is that they practiced with doctors who had "rules" for vbacs. I had to go into labor by 41 weeks (dd #1 came at 41.5 weeks). No induction or augmentation (which was fine with me - did NOT want any of that). Couldn't labor as long.

After 2.5 years of questioning them, I finally admitted that they were NOT going to be as supportive as I needed them to be. So I found 2 midwives who were awesome! Totally supportive right from the beginning and didn't place restrictions on my vbac attempt. DD#2 came 5 days early... after nearly a week of labor. It never would have happened with the old practice. if you do a search in the FYT forum, i'm sure you'll get lots of recommendations for vbac providers.

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#4 of 19 Old 06-30-2008, 03:01 PM - Thread Starter
 
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thanks for the responses. I do have another place in mind already and they don't have the same rules.. don't think there is a time limit. This area of NJ is rough.. there aren't too many midwives (or at least midwives that act like true midwives).. believe me, my friends and I have researched so many in the area.

I know I have to make an appt. with the other practice, just wanted to keep things the same. :

homeschooling mama to ella (9) and maya (5)
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#5 of 19 Old 06-30-2008, 04:51 PM
 
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1. wait out til 41 weeks and if the baby is not here, I get a C-section (not what I want obviously). no option of induction at this point since she says my doctor believes you then have a higher rate of rupture after C-section when being induced at that point. You don't HAVE to schedule. You're not doing this for what this Dr likes. If you're comfortable waiting tell your Midwife and the dr will have to deal with it. If you feel you must schedule to make everyone happy you can always have a 'flat tire' when it's time to go...

2. at week 40, they do a "gentle induction" (still drugs) so i have a better chance of vaginal (is that really a better chance??) The only way to induce after a C is usually pitocen because it can be turned off. Cervical creams are a huge risk because they cannot be stopped if they begin to cause problems. My OB said he'd use Pitocen if I wanted it but would not under any circumstances use cervidal to ripen or get things going.

3. hope like hell that this baby comes 2 weeks early like ella and that it all goes smoothly... (this really isn't an option as much as a wish) Honey, you can ALWAYS hope.. Put energies into it.. pray for it.. walk! Have intercourse! Do everything you know of to get your body ready and get it giong! Take your EPO and drink your Red Raspberry leaf tea.... You can do it!!
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#6 of 19 Old 06-30-2008, 06:39 PM
 
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The safest induction technique for a mama with a previous c is a foley cath. There's a good chart here (bottom of the page) that compares ur risk by induction technique: http://www.homebirth.org.uk/vbacinduction.htm (but keep in mind any induction increases your risks so it's a trade off... it sounds like your care provider/backup is thinking about some studies that show vbac success rates go down after 40 weeks. but those studies don't look at WHY the rates decrease... it's possible the decrease is due to care providers pushing interventions at that point so it's a bit muddy in terms of being a predictive tool!).

I've not seen any research suggesting that earlier inductions are less risky... maybe ask them for their documentation on that?

I agree with pp though... if there is a different practice that really is vbac supportive (natural birth supportive in general) then that could be a better match for you. If this practice really is the one you want though you can always decline the c/s or simply "not show up". It's your body and your right to choose the birth that is best for you and your babe. But I'd see what else is available in your area before deciding to either schedule or lie to your provider about your unltimate birth plans.

Happy birthing mama, you deserve a care provider who believes in you 110%! Good luck!

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#7 of 19 Old 06-30-2008, 08:09 PM
 
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other options???

I hate having limitations on my body.
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#8 of 19 Old 07-01-2008, 01:20 AM
 
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I have had 2 vbacs after a c-section due to failed induction. I always go post dates so I understand your pain in that regard. What I do is to start accupuncture inductions at 40 weeks (it usually takes a week for my body to co-operate) and I have also done castor oil with both of my vbacs. I hate that I have to monkey with the process but I do it this way because I figure that at least if these methods "fail" then I am not forced into immediate c-section (which I was with my son because they had broken my water so I was trapped).

I wish I could just trust my body to do its job but honestly once I hit 40 weeks and they start talking about what my options are (due to the way OBs are scheduled in the hospital if I decided to do a foley cath induction I have to schedule it for a day when I have a co-operative OB so I can't just wait until 43 weeks and then induce).

With VBAC #1 I had 3 days of prodromal labour which stalled out for 30 hours (and my midwives wanted to bring me into the hospital to induce)...went into labour after castor oil 30 hours later and was immediately in active labour (literally 5 minutes after the castor oil was my first contraction). DD was born 5 hours later.

With VBAC #2 I had done 2 accupuncture inductions without result so my accupuncturist gave me some moxa herb (the same herb that turned DD#1 at 35 weeks actually) to bring home and apply to my hands and feet. I did castor oil and then followed it up with the moxa and within 10 minutes I was in labour. DD was born 5 hours later (thankfully skipped the 3 days of "practice" this time).

I make creamsicle shakes with the castor oil (orange juice, vanilla icecream and one ounce of castor oil). It doesn't taste too bad but you can tell there is something extra in there IYKWIM.

There are mixed opinions about castor oil but I figured my best chance at a successful vbac was to keep the medical types out of the induction process if at all possible. YMMV.

I wish I was brave enough to just leave my body alone and see if I would eventually go into labour on my own but quite frankly I go a little insane after 40 weeks so I just can't seem to keep myself from fiddling since I am always so afraid to "hit the wall" the way I did with Rhys.

Steph

Steph~~momma to Rhys 2002, Niamh 2004, Isla 2007 and Deirdre 2009
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#9 of 19 Old 07-01-2008, 03:17 AM
 
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I would go along with it, and then refuse a induction at the end.

 

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#10 of 19 Old 07-01-2008, 01:31 PM
 
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honestly, unless you want a battle at the end of your pregnancy, starting off w/ providers who put restrictions on you greatly reduces the chances of a successful VBAC. Im not saying it makes it impossible..but it makes it very difficult if that is your starting point and it takes away any type of peaceful birthing experience, b/c you are having to battle when you should be able to simply focus on your birth and your baby.

the way i am beginning to look at it is this: the hospitals and dr's are there in case of an emergency. 99.9% of the time, im going to be able to get there in case of an emergency. the hospitals cant guarantee me a 99.9% chance of "success" (meaning a life baby and mommy) so my chances of a homebirth are not increasing my risks...esp. w/ what the OB's want. And really, a MW who has to work under an OB is really an arm of the OB.

my advice is to find someone to work "underground" for you if you cant find someone who will work on YOUR terms. I know that sounds easy to say but im in a similar situation, though i cant even find a MW to touch me. The only way i was able to birth the way i want was to contact everyone individually...not through their offices...and find MWs who were willing to take a risk on me (as someone who has had a VBAC but after 2 c/s's).
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#11 of 19 Old 07-01-2008, 05:18 PM
 
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I second Chakra.
I went along with their "conditions". Then at 38 weeks i said no to scheduling anything.
I was planning on forgetting the 40 week appointment but he arrived before then. They can't force medical procedures on you.
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#12 of 19 Old 07-01-2008, 08:06 PM
 
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With my last baby, they said the same thing to me. I had never made it to my due date with any of my kids (1st c-section at 39 1/2 weeks due to breech, 2nd VBAC at 38 1/2 weeks), so I just figured I'd cross that bridge when I came to it. Baby came at just about 39 weeks with no problems. I guess you could ask around and see if anyone else is out there but if you are comfortable that they are not going to start putting up roadblocks at the end, I would probably stick with the same practice.
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#13 of 19 Old 07-01-2008, 10:15 PM
 
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My midwives asked me to schedule a c-section for my 41st week. I made it as late as I posably could.

That being said, I went into labor a 39 weeks 6 days. I loved my midwives (I delivered in Maryland).

I used to live in NJ! I grew up in Monmouth County and lived in Middlesex and Somerset for a while.

Good luck!
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#14 of 19 Old 07-02-2008, 04:24 PM
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oh this is such a tough place to be in. My mw practice said the same thing.
1. 42w - schedule a c.
2. labor spontaneously
3. schedule a mild induction

My opinion is if everything is ready (ie. baby, positioning, etc.) then the baby will come. If not, then the baby will not come, even with an induction. though, I suppose before I would give into scheduling a c, I would opt for an induction provided I wasn't on my back and no epidural... but I'd also ask for lots of sweeps, a foley, lots of epo, eat lots of pineapple (bromelin), lots of walking, and get the baby into position early on with lots of swirls / belly dancing, hip rolls, etc.

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#15 of 19 Old 07-02-2008, 07:12 PM
 
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You could always try to learn more about unattended birth. There is a forum in B&B devoted to it.

Mom of three spunktastic kiddos, supported by super-partner while dabbling in midwifery and organic farming. Biting off more than I can chew since '03.
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#16 of 19 Old 07-02-2008, 08:56 PM - Thread Starter
 
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I have no desire to do an unattended birth. I want to do have this VBAC but I wouldn't risk my life (or my child's) for it - I am aware there are higher risks for problems, it's a fact. Most likely it won't happen, but there's still that chance. Not for me.. Thanks though!

homeschooling mama to ella (9) and maya (5)
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#17 of 19 Old 07-02-2008, 09:26 PM
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... I forgot to mention that with my first vbac, I was at 42w, so before going in for a scheduled induction, I took castor oil. I ended up taking half the dose by mistake (2T rather than 2 oz.) - mixed it with OJ and had spicy nacho doritos as a chaser to kill the slime factor. I went into labor about 18 hours later. Had a super-long, intense (albeit drug-free and bradley-style) labor, got to 10cm, but for reasons mentioned before, the big guy just wasn't budging.

I look back and think how important it was to know in advance the baby's positioning before trying the induction (castor oil or anything else). Perhaps if my huge DS was anterior and more aligned, he would have figured out a way to make his way down the canal. We didn't know of these positioning problems or his huge size until my c.

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#18 of 19 Old 07-02-2008, 09:37 PM
 
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Originally Posted by MommyToElla View Post
I have no desire to do an unattended birth. I want to do have this VBAC but I wouldn't risk my life (or my child's) for it - I am aware there are higher risks for problems, it's a fact. Most likely it won't happen, but there's still that chance. Not for me.. Thanks though!
its fine for you to chose an OB over an UC and understandable in many cases (including simply due to fear) but UC does not equal risking the life of mom or baby. many women here are, for one reason or another, unable to find a birth attendant and after much research, have concluded that it is still safer for them and their babies to UC than birth in a hospital. I realize you probably didn't mean to imply that these women were making such a decision, but I just have to state that for some...the less risky choice is to UC (if i hadnt been able to find a MW to attend a HB, i woudl have definitely been UC'ing, even if it meant i was UC'ing ALONE w/o my partner or anyone else....for me...its the safest birth i can have). Luckily, most aren't faced w/ that ultimatum but its becoming increasingly more common.
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#19 of 19 Old 07-03-2008, 12:51 AM - Thread Starter
 
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i wasn't implying that all women are making a "risky" decision.. everyone should have the right to birth in any way they choose. i just feel that for me, it's not worth the risk.

homeschooling mama to ella (9) and maya (5)
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