VBAC and 42 weeks? - Page 2 - Mothering Forums

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#31 of 38 Old 09-05-2008, 11:50 AM
 
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Scarring of the uterus is not the issue. The issue is that most practices will not induce a VBAC, and most practices also strongly encourage delivery at or just after 42 weeks. So if you can't induce, but the baby needs to be delivered, guess how it will come out?

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#32 of 38 Old 09-05-2008, 12:16 PM - Thread Starter
 
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Originally Posted by cathicog View Post
Given the kind of CNM she seems to be, I highly doubt you will have a VBAC under thier care, no matter how many studies you show them. Have a homebirth. It is the only way you will probably ever be able to have a "normal" labor and birth, and to give birth when you are ready, not when a professional tells you to be... i am glad the OBs office seems more relaxed, but they arent the ones who issue the paychecks, or cover insurance, I would bet...I have a feeling it is probably the hospital they are associated with who Really Calls the Shots....
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Originally Posted by AlexisT View Post
I think this is a huge leap, and based on the evidence given you can't say that. It may be nicer if your OB/MW does everything the way you want without a question, but having protocols doesn't automatically mean they're going to pull the bait and switch.
Alexis is right, and you did make a whole lot of judgement. My CNM is incredibly liberal, so for her to say something like "your risk of dying is higher the farther post-dates you go with a VBAC" is sobering for me. She's wholly supportive of my homebirth and my homebirth midwives and will be giving me prenatal care in tandem with them. The visit we had was not long enough for her to start pulling studies and statistics out, and I am planning on making that appointment with her in a few months. What I'm looking for, here, is to have my own set of research done, so I'm not just taking her word for it, I've seen some of the studies myself.

I would never want a provider who would make decisions based on anecdotal evidence. If I went in to see her and said, "I had 11 people on Mothering.com say they had a VBAC or knew someone who had a VBAC after 42 weeks and their babies were fine" and she was like, "Oh, well then we'll just let you go into labor whenever then, because obviously it's safe," that would be a huge red flag for me. Likewise, I am expecting her to back up her statement that post-dates is risky with research. I don't want her making any decisions about my care based on stories she's heard from other people. I want to know the facts.
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i guess im not getting this.

its almost as if the dr's dont have to "prove" what they are saying. if THEY say it, its golden and should be listened to. the patients are the ones who have to scramble and find the research proving what they are saying is not accurate.

so...if we cant prove them wrong, we have to accept what they say?

thats just not the way i accept my health care professionals providing care for me and my children. If they want to suggest something, or have a concern, they need to be able to back up what they are saying.
I am expecting my CNM and her governing OBs to back up what they say. My research is to decide whether I'm going to listen to them, or whether I'm going to do what I want, anyways. How much risk is too much risk for me? How do I want to manage my pregnancy as I anticipate labor? What factors need to exist for me to agree to a RCS? These are decisions that I am responsible for, whether I have a home or a hospital birth, an attended or unassisted labor.

The beauty of having people who do birth for a living assist me with my pregnancy and labor is that I get their experience, education, and wisdom to assist me in making all those decisions. The difficulty is reminding all of them--CNM, HBMW, and OB--that the decisions, and their consequences, are MINE and mine alone.

knit.gifWife to Ageek.gif since 7-7-2006, Mother to Mnocirc.gif since 11-23-2007ribboncesarean.gif, and N slinggirl.gifborn on 4-9-2010vbac.gif
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#33 of 38 Old 09-05-2008, 12:57 PM
 
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Originally Posted by maxmama View Post
Scarring of the uterus is not the issue. The issue is that most practices will not induce a VBAC, and most practices also strongly encourage delivery at or just after 42 weeks. So if you can't induce, but the baby needs to be delivered, guess how it will come out?
Maybe DRs here are more liberal, I don't know. I was induced at 39 wks w/ my last VBAC and will probably be induced again at 39 wks if baby is not here by then. We have a panel discussion after BOBB and the DR they had there also mentioned inducing a VBAC as long as the baby was already working on it. I was contracting on my own and at 4cm when I went in and Ilana was born 3.5hrs after I went in.

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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#34 of 38 Old 09-05-2008, 01:54 PM
 
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From the sound of it, you weren't induced--you started on your own. You were augmented, which some docs will do under controlled circumstances (pit raises the UR risk). What can't be done with a VBAC is the standard induction using prostaglandins (Cervidil and Cytotec) because it raises the UR risk by several times. I've heard of VBACs being induced using a Foley cath, which sounds like it wouldn't raise the risk of UR (no drugs involved) but you'd have to be close to going on your own for it to work.

Routine induction at 39 weeks is a bad idea in general, though. Why does your OB think it's a good idea for you to go early?

DD 01/2007, DS 09/2011

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#35 of 38 Old 09-05-2008, 01:58 PM
 
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Originally Posted by thepeach80 View Post
Maybe DRs here are more liberal, I don't know. I was induced at 39 wks w/ my last VBAC and will probably be induced again at 39 wks if baby is not here by then. We have a panel discussion after BOBB and the DR they had there also mentioned inducing a VBAC as long as the baby was already working on it. I was contracting on my own and at 4cm when I went in and Ilana was born 3.5hrs after I went in.
Liberal isn't the issue. Increased rate of UR with pitocin and prostins is. At 4cm, it's really an augmentation, not induction.

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#36 of 38 Old 09-05-2008, 06:22 PM
 
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I was not in active labor though when I went in and might not have been for several days, so I do consider it an induction. Semantics I guess?

My DR gives everyone the option of going in at 39 wks if they want. I chose to go in. It's hard to coordinate care for my kids while I'm in the hospital having a baby and I had bad SPD and was ready to be out of pain. I will probably be induced again at 39 wks this time as well if baby is not here by then. Not my top reccomendation for anyone, but I would rather go in and be induced, or at least try, then go straight to another c/s on anyday.

Jennifer, LPN and nursing student, Doula, CPST, and VBAC mama x3 to
AJ (5/03), Evan (12/04), Ilana (11/06), Olivia (2/09), and Unity (8/2012)

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#37 of 38 Old 09-05-2008, 08:07 PM
 
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Originally Posted by thepeach80 View Post
I was not in active labor though when I went in and might not have been for several days, so I do consider it an induction. Semantics I guess?

My DR gives everyone the option of going in at 39 wks if they want. I chose to go in. It's hard to coordinate care for my kids while I'm in the hospital having a baby and I had bad SPD and was ready to be out of pain. I will probably be induced again at 39 wks this time as well if baby is not here by then. Not my top reccomendation for anyone, but I would rather go in and be induced, or at least try, then go straight to another c/s on anyday.
I'd be more concerned about your doc offering elective induction at 39 weeks, which is not condoned by ACOG or supported by th research, and is known to increase the risk of cesarean, iatrogenic prematurity and fetal distress.

At 4cm, you may not have been actively laboring, but that's what an augmentation is for!

mama to Max (2/02) and Sophie (10/06); wife to my fabulous girl
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#38 of 38 Old 09-07-2008, 09:50 PM
 
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Originally Posted by AlexisT View Post
I think this is a huge leap, and based on the evidence given you can't say that. It may be nicer if your OB/MW does everything the way you want without a question, but having protocols doesn't automatically mean they're going to pull the bait and switch.
You are probably right, and I guess I haven't seen too many flexible OBs. It is good you have someone who will work with you. They are rare. Enjoy your birth.
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