|Originally posted by its_our_family
My question... What is a trial of labor? Is that if I'm in early labor for 8 hours and nothing happens? Active labor? How strong do contractions have to be to be considered real labor?
In the best case scenario, the doctors wouldn't be watching the early labor because you would be at home. Once your contractions get close together and build in strength and intensity to the point where you feel like you are in active labor and you go to the hospital, hopefully you will have had some cervical change. If not, I would highly recommend checking yourself out again, unless the hospital is really, really far from home. Once you do get admitted to the hospital, you will be expected to make progress at a relatively steady pace, probably 1 cm every hour or two. If that process slows down, you may find that doc #2 would start pushing for a section. The important thing to keep on the tip of your tongue is "Is my baby in immediate danger?" and if the question is no, and you feel up to continuing, ask for a specific amount of time before a recheck, like, say, 2 hours. Then do your best to get up, get mobile, change position, listen to your body, etc. to see if you can move the baby down.
From the docs point of view, they want to limit the amount of time spent attempting a vbac because they don't want a super-exhausted mom who has to have a c-section anyway. There is a lot of evidence arguing against augmenting vbacs with drugs to increase the strength of contractions, so they feel like one of their favorite tools has been taken away. In their minds, if a mom's labor slows down or progression stalls during a vbac, nothing will get it started again anyway, so why keep her up 12 more hours? What they don't take into account is the fact that many labors have natural lulls as babies shift into new positions, bodies readjust, etc. and that things like changing mom's position can have a major impact on the strength of contractions and the way the baby moves down.
I have attended quite a few vbacs, but only at two separate hospitals (and a bunch of homebirths, but that is different), so my experience reflects the habits of those hospitals, but I have to say that a lack of strength of contractions in early labor is treated like no big deal and moms are often sent home to finish their early laboring, while a lack of strength later on is seen as a tired mom who just isn't going to make it. The two vbacs that I have attended which led to repeat sections had moms who were just cooking along very nicely until they got epidurals, then the contraction strength just fizzled out. In one case the mom had an intense, short labor and made it to 10cm but had no strength for pushing (and was also being rushed because of an epidural fever that was diagnosed as an infection), in the other case the mom had a very, very long labor and made it to 5cm and then got the epidural and fizzled out.