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    Posting Addict Jenn0113's Avatar
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    Default VBAC questions

    I've been going back and forth with my OB about a VBAC since I delivered DS 3 years ago. I was actually on this board when I had him. I was going for a natural, med free birth and that didn't happen. In surgery my OB told me he stitched me up really good so I could VBAC later. Fast forward 3 years and he is really wishy washy about it. So much so that its like every other appt he says yes and the others he acts like there is no way my body can do it.

    With DS I didn't get past 9 and in the end I tried pushing but couldn't get him out. I finally begged for a csection after 53 hours.

    Now that I am 3 weeks from being full term I am really wanting to jump on the VBAC band wagon but he says I only have like a 60% chance of it working and he and one other doc at the hospital are the only ones that will try them. So, I have to get one of them or I can't have it. Making it even more complicated is that I am due 1/1 and he and the other doc may not be in town. Ugh!

    So, my questions are:

    1. Have any of you VBACd after FTP? How far did you get the first time?
    2. Have any of you gone into labor and the hospital tried to get you to go for a repeat section and you refused? How did that work out for you?

    Thanks in advance for any responses!
    Jenn & Jus 1.13.06
    Deacon: 11.11.08
    Kara: 12.27.11


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    Mega Poster krazykat's Avatar
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    Do you have a local ICAN group? If so, I think you should make contact asap.

    If not, if you have a Facebook page, add me and I will add you to our ICAN group which is very active. Search my email: ariel_elizabeth2002@yahoo (dot com)

    If your doc is being wishy washy, that does not bode well for getting what you want without a fight.
    Ariel & John: Military Family since May 17, 2006

    Sylvia: 12/18/08, Justus: 9/17/10, Bunni: 5/11/12, Surprise Baby: Guess Date 11/5/13



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    1. Have any of you VBACd after FTP? How far did you get the first time? I did. My first was a case of SROM at 39 2, GBS positive, and presenting to hospital at a fingertip dilated. On the "clock" with a full rupture and positive for GBS, the interventions cascaded. Enter Pit, a asynclitic baby with a 15 1/2 round head, and a swollen cervix from his wonky positioning applying very uneven pressure on my cervix. "got to" an 8 before swelling was such that vaginal birth was out. CS it was.


    2. Have any of you gone into labor and the hospital tried to get you to go for a repeat section and you refused? How did that work out for you? At my 39 w 2 day appt my OB told me that I was still thick and very posterior, and even though he had been very VBAC supportive up to that point (this birth was only 13 months after my CS) he started pressuring me to schedule a RCS at 40 + 1. I refused, took castor oil that night, and had a smooth, straightforward and easy (vaginal) 3 push delivery of an 8'4 oz baby girl the next day

    If I can help with anything specific or encourage you in any way please please feel free to PM me. Best of luck to you!
    Last edited by Potter75; 11-22-2011 at 06:32 PM.

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    Posting Addict Jenn0113's Avatar
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    Thanks Ariel - I added you. Jennifer F. I'd be interested to see the ICAN page. I haven't even looked it up here.

    Thank you for the responses. I have a feeling he will try to guide me more towards a repeat section but depending on my "fighting ability" if I actually go into labor on my own I was wondering what it would be like to just say NO to a csection once I get to the hospital. I assume I can do that since I don't have to consent to surgery, right?

    But in all honesty - I can't see my DH sticking up for my demands and I may be in that battle alone (see thread on DH's being supportive, lol).

    I just hate that only 2 OBs will do VBACs at my hospital. They aren't super common around here that I know of. Not if you don't want to travel far. So even if my OB was 100% all for it its not guaranteed if he is out of town that day. Ugh!
    Jenn & Jus 1.13.06
    Deacon: 11.11.08
    Kara: 12.27.11


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    Posting Addict jolly11sd's Avatar
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    1. Have any of you VBACd after FTP? How far did you get the first time?
    I don't know what FTP stand for? But yes, I did VBAC with my second. My first was SROM that lead to no contractions. 24 hours of pit. with progress only to 4cm. Then a c-section was required by the hospital I was at. My 2nd was a homebirth with a transfer to the hosptial after 34 hours of active labor for pain relief. I labored 6 or so more hours (about 40 total) and did have a VBAC.


    2. Have any of you gone into labor and the hospital tried to get you to go for a repeat section and you refused? How did that work out for you?

    When we tranferred during my 2nd labor they pretty much refused to let me labor even though it was a VBAC friendly hosptial. I refused and told them to find someone for me to talk to. The younger doctors kept telling me I was doing the wrong thing and that I needed to sign a waiver so I told them to find that waiver. They never did come back with any paperwork. My husband also had a few words with the doctors. My midwives were able to come with me and that was great cause even though I felt pushed around verbally, they were my silent cheerleads in the room giving me a thumbs up from the corner. I was pretty proud actually to stand up for what I wanted that 2nd time. It felt good. I knew that no one was going to make me do anything that I didn't agree too and I refused to sign anything.
    ~Joy~ DS1-8/5/05, DS2-10/18/10 (VBAC#1), DS3- 4/11/12 (VBAC#2!)


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    Posting Addict Jenn0113's Avatar
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    Quote Originally Posted by jolly11sd View Post
    1. Have any of you VBACd after FTP? How far did you get the first time?
    I don't know what FTP stand for? But yes, I did VBAC with my second. My first was SROM that lead to no contractions. 24 hours of pit. with progress only to 4cm. Then a c-section was required by the hospital I was at. My 2nd was a homebirth with a transfer to the hosptial after 34 hours of active labor for pain relief. I labored 6 or so more hours (about 40 total) and did have a VBAC.


    2. Have any of you gone into labor and the hospital tried to get you to go for a repeat section and you refused? How did that work out for you?

    When we tranferred during my 2nd labor they pretty much refused to let me labor even though it was a VBAC friendly hosptial. I refused and told them to find someone for me to talk to. The younger doctors kept telling me I was doing the wrong thing and that I needed to sign a waiver so I told them to find that waiver. They never did come back with any paperwork. My husband also had a few words with the doctors. My midwives were able to come with me and that was great cause even though I felt pushed around verbally, they were my silent cheerleads in the room giving me a thumbs up from the corner. I was pretty proud actually to stand up for what I wanted that 2nd time. It felt good. I knew that no one was going to make me do anything that I didn't agree too and I refused to sign anything.
    FTP - failure to progress

    The bolded is what I was hoping to hear from someone. I think if I labored as long as possible at home I could go in and just say I'll sign a waiver.

    I'm trying to figure out SROM...something rupture of membranes never mind, googled it. duh! lol
    Jenn & Jus 1.13.06
    Deacon: 11.11.08
    Kara: 12.27.11


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    Posting Addict Spacers's Avatar
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    Default Very long, I get pretty passionate about VBAC!

    Quote Originally Posted by jolly11sd View Post
    When we tranferred during my 2nd labor they pretty much refused to let me labor even though it was a VBAC friendly hosptial. I refused and told them to find someone for me to talk to. The younger doctors kept telling me I was doing the wrong thing and that I needed to sign a waiver so I told them to find that waiver.
    I had a similar experience. My hospital is known for being very VBAC friendly, and my OB is the Chief of Obstetrics and she was fully supportive of my VBAC. So imagine my surprise when I transferred from a homebirth and was told by a resident that I didn't have "authority" to VBAC. I told that resident that she had no authority over my birth and to go find her stupid piece of paper that I'd already signed & was already scanned into their system. And I told her to send someone else back when she'd found it because I was NOT dealing with her again.

    Three things you will absolutely NEED to be successful:

    #1 is to remember that they can NOT cut you without your agreement. Hospital policy doesn't matter, the doctors' personal opinions about VBAC don't matter, the only thing that matters is your autonomy to make your own medical decisions about your body and they are obligated to honor that. You always have the legal right to refuse any medical treatment, including cesarean surgery. The doctrine of informed refusal has been upheld by common law, case law, Constitutional law, federal law, state laws, and the ethical guidelines of the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG).

    #2 is someone who will be GOOD support. Your DH needs to step up and be the strong man you need him to be, and if he's not willing or able to do that, then you need to find someone else who will. Hire a doula, find a doula in training who needs birth experience & will help you for free or reduced cost, or even ask a friend who's been through NCB and is willing to be your advocate. A doula can't answer questions for you, but she can remind you of the answer you want to say.

    #3 is the Informed Decision Questions. You'll find them in the resources link at the top of this board. Memorize them, print them out on cards for DH, your doula, your nurses. Any time any one suggests any thing, ask those questions.

    And a few other things I would strongly suggest...

    Call your area hospitals and ask (anonymously!) what their VBAC rates are, and if they have residents in L&D who can deliver if your doctor can't make it. Ask to talk with the charge nurse in L&D if the person answering the phone doesn't know. It might be worth the trouble to go to a different hospital that has a better VBAC rate even if you have to deliver with a "stranger." If your hospital is OK but the back-up OBs are that much pro-surgery, then you might want to just take your chances with a resident at that hospital. You don't *have* to call the OB and you don't *have* to accept whomever is on-call.

    Also ask if the hospital receives any Federal funding, such as Medicare or Medicaid or research grants. If they do, then they are subject to the Emergency Medical Treatment and Active Labor Act (EMTALA) which obligates them to admit women who are in active labor and to abide by their treatment decisions until after the baby and placenta are delivered. Print a copy of the relevant parts of EMTALA to take with you to the hospital. Federal law trumps hospital policy every time.

    Pre-register at your chosen hospital (but no sooner than 30 days before your due date or you might find yourself "fired" by your OB) and take the documents home to carefully read everything. You might find that a "VBAC Admission" form says something like, "I agree to submit to an immediate c-section upon the advice of my physician." Anything like this that you don't agree with, cross out & initial & date. In an emergency, your verbal consent with witnesses is sufficient, and the hospital knows that. Be sure to keep copies of everything you sign.

    In the event that the hospital refuses to admit you unless you've signed their form without any amendments, sign it, get admitted, and then when you get to your room in labor, hand your nurse two copies of a statement, noting the date & time, saying that you hereby retract your prior written consent and will provide verbal consent for procedures as needed, and that you will consent to a c-section only if there is clear medical necessity. Sign both copies and ask for her to sign a copy for you to keep. Read pages 6-8 of this ICAN White Paper (actually, read the whole thing & click all the links, too!) for more information on this: http://www.collegeofmidwives.org/collegeofmidwives.org/VBAC_2006/ICAN_legalprimer_VBAC_07.pdf

    Remember that stress can stall labor, so if things start to get stressful, tell the doctors & nurses to leave your room so you can do the work you're there to do. If your labor stalls, they might use that as an excuse for c-section. You have three options: agree to it, refuse it and try other things, or try some Pitocin. I'd recommend other things first (that's where a doula can be very helpful!) but if other things don't work, then you're left with Pit or c-section. It's been shown that the judicial use of Pitocin to augment a truly stalled labor is prudent, even in a VBAC. I would absolutely insist on trying it before allowing myself to just be wheeled off to the OR (and I did!) The general rule of thumb with Pit is to double the dose every half hour, but with a VBAC you'll want to dose up gradually. Instead of going from 2 to 4 to 8 in an hour, go from 2 to 3 to 4. When your labor gets going again, have the Pit turned down & see if your body keeps it up on its own.

    Statistically, you have a better chance at succeeding at VBAC than you had with your first birth. In the U.S. first time moms have a c-section rate of 30+%, that means less than 70% had a vaginal birth, whereas 75% of moms who attempt VBAC can do it! You CAN do it! Good luck!!!

    ETA: full disclosure, I did end up with a repeat c-section. After 2.5 days of labor at home, and another 8 hours at the hospital with an epidural & Pitocin to try to resolve a stubborn cervical lip, my 10-pound, 10-ounce baby boy with a 15-inch head was born surgically. It was fully my decision, one made freely without coercion or pressure. I gave it a damned good try, that boy just wasn't coming out, and I'm thankful that c-section was an option! I just needed to make sure it was my last option & not some cut-happy doctor's first option, kwim?
    Last edited by Spacers; 11-22-2011 at 08:48 PM.
    David Letterman is retiring. Such great memories of watching him over the past thirty-two years!

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    Mega Poster krazykat's Avatar
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    Quote Originally Posted by Spacers View Post
    ETA: full disclosure, I did end up with a repeat c-section. After 2.5 days of labor at home, and another 8 hours at the hospital with an epidural & Pitocin to try to resolve a stubborn cervical lip, my 10-pound, 10-ounce baby boy with a 15-inch head was born surgically. It was fully my decision, one made freely without coercion or pressure. I gave it a damned good try, that boy just wasn't coming out, and I'm thankful that c-section was an option! I just needed to make sure it was my last option & not some cut-happy doctor's first option, kwim?
    ITA with everything you said!!

    I also ended up with a repeat c/s after a planned HBAC, and 48 hours of labor at home. I became incredibly dehydrated, babe had thick meconium and then we started seeing some late decels. It wasn't an emergent c/s the second time, and I was fully in control of the decision. THAT made all the difference to me. I KNEW that it wasn't for lack of trying or education.
    Ariel & John: Military Family since May 17, 2006

    Sylvia: 12/18/08, Justus: 9/17/10, Bunni: 5/11/12, Surprise Baby: Guess Date 11/5/13



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    Posting Addict Jenn0113's Avatar
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    Spacers - OMG - thank you so much for all of that information! You have given me LOTS of work to do and lots to read up on. I know what I will be doing over my long Thanksgiving weekend.

    ETA: full disclosure, I did end up with a repeat c-section. After 2.5 days of labor at home, and another 8 hours at the hospital with an epidural & Pitocin to try to resolve a stubborn cervical lip, my 10-pound, 10-ounce baby boy with a 15-inch head was born surgically. It was fully my decision, one made freely without coercion or pressure. I gave it a damned good try, that boy just wasn't coming out, and I'm thankful that c-section was an option! I just needed to make sure it was my last option & not some cut-happy doctor's first option, kwim?
    Thank you for this as well. That's how my first birth was. I was hardcore NCB but after 30+ hours at home I wanted some relief. I was still only at 3 cm so I went in for an epi to help me rest and they broke my water. Hours later I was still at 3. That's when they started the pit. It was just like all the stories you hear - one intervention leading to another and ending in a csection. However, like you and Ariel I was 100% ok with my decisions because my OB let me make them all myself. He would present my options and leave the room to give me time to think about it and decide. He knew I wanted a NCB so he never pressured me into anything. The fact that I KNOW he was so great last time is what is annoying me this time. Part of me thinks he will be all for it if I go into labor on my own and the other part of me thinks he will just want to go home...if I VBAC the hospital policy is that he has to stay at the hospital the entire time I am in labor in case something goes wrong.

    My hospital has a horrible csection rate - I think I was told by some local doulas that it was like 40% or something. I need to call and ask what the VBAC rate is and I need to look at my registration papers - I registered a long time ago.
    Jenn & Jus 1.13.06
    Deacon: 11.11.08
    Kara: 12.27.11


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    Posting Addict Spacers's Avatar
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    Quote Originally Posted by Jenn0113 View Post
    Part of me thinks he will be all for it if I go into labor on my own and the other part of me thinks he will just want to go home...if I VBAC the hospital policy is that he has to stay at the hospital the entire time I am in labor in case something goes wrong.
    That's a horrible policy, and it makes absolutely no sense at all. They don't require an OB to be present 100% of the time for any other mom. If there's an emergency, the resident or even the E.R. surgeon can do a c-section. That's ridiculous, it's just one of the ways they try to ban VBACs without coming out & saying we won't do them. As I mentioned above, you can decline to notify him when you first arrive at the hospital & accept care from the residents for at least a while. I know of women in your situation whose doctor gave them a private number to call when they were in labor, maybe that's something your doctor might consider, so you can keep in touch with him when you've officially declined for the hospital to call him.

    After your birth, please consider getting involved in ICAN and/or "The Push for Midwives" advocacy. We need moms like you!
    David Letterman is retiring. Such great memories of watching him over the past thirty-two years!

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