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Opinions please

560 Views 12 Replies 10 Participants Last post by  boscopup
Hi ladies! And how is everyone doing??

Sooo, I am looking for opinions here, shoot em at me!

I am 31w1d, and hoping for a vbac, BUT, the hospitals that my insurance cover don't "do" vbac births. Realistically I can go to ANY hospital in an "emergency" and have it 100% covered, but I live in a small town and the nearest hospital that will "allow" vbac births would have me transported if I was in labor before 38weeks bacause they are only a level 1 hospital. I am worried that, with the case of irritable uterus, and the fact that I had DS at 36w4d, I will go into labor before 38weeks.
So, what I am considering doing, is laboring at home, checking myself, or having DP check when I am uh, not up to it, and go in as close to the end as possible to the hospital I want. But I had a placental abruption with DS, and again this stupid case of irritable uterus, so I worry, what if something goes wrong? I know I can handle laboring at home with just DP, and IF NEED BE, delivering at home, but is it too iffy? The placental abruption and emergency c/s was 8 1/2 years ago, and my first ob with this pregnancy said I am a great candidate for vbac, but I can't help worrying.
I don't know what to do, but I really can't handle another c/s. Well, unless something is medically wrong of course.
What are your thoughts? I am objective and realistic, so come on, lay em on me. please.
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Have you tried finding a midwife in your area to do VBAC? I'm assuming so, since you say you're okay with laboring at home.

Is there another hospital nearby that will do VBACs earlier than 38 weeks that you could just *happen* be near when you *go into labor*?
WTF - how do insurance companies not "do" VBAC's?! Thats like saying - we dont cover vaginal births. grrrr

Anyway - i can see how the abruption last time is making this an even harder decision for you, since you DID actually need a c-section.

So you have a few options - pretend like you're gonna do what they want and then hope and pray that everything falls into place and you're able to have a VBAC. OR you will have to be fighting and not consenting to a c-section at the end of your pregnancy.

You could also do what you were thinking and just stay home. Have you posted on the UC board at all? Is this something that you are comfortable with?

I would at the very least call around and try and talk to some homebirth midwives and see what they think. I know my midwife is the type of person who is someone called her WHILE IN LABOR and didnt want to go to the hospital she would totally go over and help them.

Keep us posted! I'm sorry you have to be dealing with this kind of environment right now.
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Yes, call some midwives and at least line up the research about your risks (and the benefits of vaginal birth too). You seem really open minded, so don't just rely on the doc to tell you the "facts". Many, many women come to homebirth late in their pregnancies. It should be one of the options that all women have the choice of considering. Good luck!
Personally, I'd go into the hospital you want to that allows VBACs, and if you're early...lie about your EDD! Apologize afterward if they say your baby is too small to be 38 weeks or whatever.

I had my 5th at a level 1 hospital. They induced me because of PIH. My OB swore up and down that I was 36 weeks... I knew better, because DH was traveling a lot the month I got pregnant, so I knew she was around 32 weeks. I was right. Nothing was wrong though, she did have to go through the car seat breathing test. She was only 4#8oz.

Had they listened to *me*, then they would have had to switch me to the level 3 hospital.

OTOH, I like to labor at home for as long as possible. I've never had an abruption though. That might scare the pants off of me! My labors are unusually fast, so really by the time I'm feeling ctx, the baby's almost out.

I guess I have no real, helpful advice.
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That sounds like a tough decision to work out, and I don't have any experience to help you, with the exception that I was told by my perinatalogist that chances of abruption do increase if you've had one before. This was 4 years ago, when it was a possible cause of a 2nd trimester loss we had, so don't know if that info is no longer accurate? Something maybe to check on, though, if you're not 100% sure about it.
Barging from the July DDC - I think you need to come up with two plans for yourself - one for delivery before 38w and one for after. After 38w sounds pretty easy, go to the hospital that allows vbacs.

Before 38w, where do they transport - to one of the other hospitals that do not allow vbacs?

How was your first abruption discovered? There is a increased chance of a recurrance - I have read different numbers, anywhere from 5% to 10% to 15% to 20%. (were you ever tested for clotting issues, i.e. thrombophilias? For some reason, even docs fail to consider this common cause of abruptions; perhaps because clotting effects in pregnancy seem to be a relatively more recent development in medicine - like the last decade or so.) Only you can decide whether you're comfortable with the risk of abruption, in terms of where you spend the majority of your labor time. If you feel comfortable waiting as long as possible at home (or at a nearby hotel), that may be one way to get your vbac, but then of course you forego monitoring that could discover abruption(?).

Maybe you want to break down your plan even further - to where to deliver prior to 36 weeks vs. where to deliver after (perhaps after 36 weeks, the level 1 hospital would be ok?). Personally, I would not be comfortable delivering prior to 36 weeks at a place without a nicu (having had 33-weekers myself, one of whom was in respiratory distress and put on a ventilator). The degree of prematurity is just another risk to consider.

Sorry I'm no help, just thinking out loud... and commiserating on the disappointing hospital issue - I've had a premature vbac and I have clotting issues; I guess I'm just lucky to have landed in the right geographic locations (no problems getting my vbacs - hoping for my fourth one this summer). Are you sure they don't do any vbacs? Or might it depend on the individual OB?
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Just FYI- my mom has had 6 pregnancies; 4 abruptions, and 2 normal. In her case it was gender/sex related.
Ok, ladies, sorry if the post was a bit scattered, I was tired!

Sooo, the hospitals that don't allow vbac say they don't because it's like russian roulette. WOW. Nice. Great way to try to scare someone into a c/s.
Then, the docs from my birth with DS are pretty sure the abruption was caused by a medication given to me by my "midwife" during labor. It's called cytotec. Apparently, as it states on the bottle and everywhere online, you are not supposed to give it to someone during labor because it causes abruption. It can be used in hospitals sometimes in controlled amounts, but I was given more than what is considered "controlled", and after what happened I would NEVER let a doc give it to me.
LizzyQ- what gender where the abruptions consitent with for your mom?

Thanks for all the replies ladies, and please keep any ideas/advice coming, it's good to get outside perspective!

Oh, and I am going to look for a midwife in the area, and see if she will talk with me. My insurance doesn't cover midwives, and I don't have the funds for one, but maybe one would be willing to chat and give advice.....
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Not much advice (or experience) on the VBAC or abruption issue, but didn't you say you were having some irritable uterus issues/contractions? Were you ever tested for BV? Also, had you said in a different thread that you are taking both EPO and flax oil? Both can lead to premature labor from what I've read (although I sometimes add 1 tbsp flax oil to my oatmeal or smoothies for other health benefits) - is there a reason you are taking both so early on?

Originally Posted by kamane18 View Post
Not much advice (or experience) on the VBAC or abruption issue, but didn't you say you were having some irritable uterus issues/contractions? Were you ever tested for BV? Also, had you said in a different thread that you are taking both EPO and flax oil? Both can lead to premature labor from what I've read (although I sometimes add 1 tbsp flax oil to my oatmeal or smoothies for other health benefits) - is there a reason you are taking both so early on?
Hmmm, I was told I should be taking those right now, but I am taking the minimum daily amount. I am taking the flax oil for the omega 3's, and the epo for "pliability". maybe I should hold off on the epo? I would rather not stop the flax oil, and my most recent doc said it should be fine to take this early.

And yes I was tested for BV finally, and came through negative. I guess I just have an angry uterus!hahhaa

I'm just feeling alone and worried about everything. My family is all out of state, and I can't afford a doula, so I am trying the best I can to make decisions that I am having trouble making. It doesn't help that I am extremely indecisive.

And this is DP's first, and he was brought up by a mother who is VERY "western-medecine is the only way", so I am trying to educate him while not feeling too sure on things myself.
If I didn't have such crazy anxiety, I would just plan on staying home and doing UC. I know I could do it, but then the anxiety kicks in and whoosh, bye-bye confidence.
I need a massage.....
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Sorry for all the anxiety - can you spring for a prenatal massage? I'm debating one here. Money is super tight but I'm so sore/really need one!

I've heard that both EPO and flax oil can aggravate an irritable uterus and there have been recent studies about women who take flax oil in 2nd/3rd trimesters being much more likely to have a premature birth. I try to get my Omega's instead from eggs, walnuts, salmon, etc.
I'd probably either:

a) Go to the hospital that allows vbacs and fudge on dates, since a level 1 is FINE for 36-37 weeks anyway. All they need to be able to do is handle newborn resuscitation, which ANY hospital would be able to do - that's something that 40 week babies might need. 37 weeks is term, and 36 weeks is when baby *might* need O2 or might not. My own midwife will deliver outside of a hospital at 36 weeks, and most midwives will at least do 37 weeks, so there is simply NO reason why a hospital should turn you down at 37 weeks. That's stupid.

b) Go to the hospital that allows vbacs late in the game and repeatedly scream that you DO NOT CONSENT to a c/s and make sure your DH is on board and ready to support you in that as well. Unfortunately, they *can* use a court order and then later say "oops" when it gets overturned (after you've had the baby cut out of you
, but many hospitals will do the vaginal delivery if you don't consent to the c/s. My local hospital doesn't do vbacs, and a friend of mine still got a vaginal birth when she came in ready to push and just screamed that she didn't consent to a c/s.

In option a, if your baby needed to actually stay a few days in a NICU, they'd just transfer the baby to the other hospital. I wouldn't want to have a 25 weeker at the level 1 hospital, but a 36 weeker that needs a bit of help? They should be fine for a transfer if it's really necessary. It'd suck to be at different hospitals from your baby, of course. But that's unlikely to be necessary anyway if you have a normal birth caused by naturally going into labor.
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