VBAC

OB won't let me go past 41 weeks due to placental worries. Common or should I question?

I am seeing the only VBAC doc in town, and her policy is to not go past 41 weeks because the placenta could break down, but her regular OB patients can go to 42 with monitoring. Should I fight for that extra week? 
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Re: OB won't let me go past 41 weeks due to placental worries. Common or should I question?

  • Having a c/s or a VBAC does not affect your placenta.  Why is she assuming yours is different from her other patients?  I'd at least ask about it.  I wasn't allowed to go past 41 weeks because it was the hospital policy.  I was induced and able to VBAC, though.  Will she induce?
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  • image MAprincess:
    I was induced and able to VBAC, though.  Will she induce?

    I don't know if she will yet. She's only made one passing reference to how "now we are limited with how we can use pit", but my last birth was a failed induction at 42 weeks and it was a horrible experience from beginning to end, so I don't know if I want to be induced again, even if it means I can VBAC, you know?  

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  • I agree with PP your placenta is no different for a VBAC vs regular vaginal vs C section so I would question her a little bit about this.  I ended up delivering (VBAC) at exactly 42 weeks. I told my doctor that I wanted to keep waiting and they were supportive of that. They had me coming in twice a week for non stress tests and once a week for fluid checks but as long as the baby was healthy they were okay with waiting. I would give a little push back to them  and ask some more questions. You don't have to induce at 41 weeks what are they going to do come pick  you up at your house and drive you to the hospital Stick out tongue
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  • They can confirm whether your placenta is still in working order with an ultrasound. She doesn't have to guess. I'd push back on that one and try to bargain more ultrasounds for a later deadline.  

    Also, it's not a matter of her "letting" you. You don't need her permission to go past 41 weeks; it's the opposite actually. She needs your permission to induce/rcs you. If you refuse, then she can drop you as a patient but no hospital will turn you away as a laboring woman and they always have OBs on call. 

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  • image cecilyandgautam:

    If you refuse, then she can drop you as a patient but no hospital will turn you away as a laboring woman and they always have OBs on call. 

    She's the only one who VBACs though, so what would I do? Would another OB force me to have a section?  

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  • image nycnola:
    image cecilyandgautam:

    If you refuse, then she can drop you as a patient but no hospital will turn you away as a laboring woman and they always have OBs on call. 

    She's the only one who VBACs though, so what would I do? Would another OB force me to have a section?  

     It's not a great option at all, but I was ready to go for it when a terrible midwife was on call the day after my EDD. Basically if you labor at home and show up as a walk in patient at the closest L&D very far along, there won't be much time to intervene. If you hire a doula who does cervical checks, she can help you transfer at the key window. The on-call OB also can't section you without your permission so even if they "don't do VBACs", they can't turn you away and the doula could advocate on your behalf while you push. 

    The Business of Being Born VBAC edition includes a crazy story of a lady laboring in the back of her car in the hospital parking lot until she reached 9 cm when she couldn't find a VBAC supportive attendant. I'm not recommending that this be your first line of defense - hopefully your OB will not drop you if 41 weeks comes & goes, and hopefully she'd be willing to make recommendations based on evidence (like an ultrasound), but I'm just saying you always have options. Some women change providers in the 41st week - I personally didn't feel comfortable with that, so I kept with my practice and just knew in the back of my head what my out option was in case of the worst scenario. 

    It's very likely you'll go into labor by the 41st week, so if this really is your only option, I'd stick with her for now and try not to worry about unlikely scenarios. Try to make peace with whatever backup option you decide on in the case of 41+weeks - whether you decide you're ok with a rcs, you want to try for an induction, or you'll just labor at home as long as you can and take your chances as a walk-in.  

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  • image Lucky_N_Love:
    I agree with PP your placenta is no different for a VBAC vs regular vaginal vs C section so I would question her a little bit about this.  I ended up delivering (VBAC) at exactly 42 weeks. I told my doctor that I wanted to keep waiting and they were supportive of that. They had me coming in twice a week for non stress tests and once a week for fluid checks but as long as the baby was healthy they were okay with waiting. I would give a little push back to them  and ask some more questions. You don't have to induce at 41 weeks what are they going to do come pick  you up at your house and drive you to the hospital Stick out tongue

    No, but if I tried to be one of those people who ignored the rules and just showed up in labor, I wouldn't be able to be attended to by my midwife (I'd have to use the doctor on call) and my MW would have been at risk of losing her delivery privileges at that hospital.  Not worth it to me.  If she were ever to lose her hospital rights, what good would that do for future VBACs? (Not to mention her career!)

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  • image nycnola:

    image MAprincess:
    I was induced and able to VBAC, though.  Will she induce?

    I don't know if she will yet. She's only made one passing reference to how "now we are limited with how we can use pit", but my last birth was a failed induction at 42 weeks and it was a horrible experience from beginning to end, so I don't know if I want to be induced again, even if it means I can VBAC, you know?  

    I hear you- every deliver is different, though.  For me, I'd rather a failed induction than a c/s.  But since you went all the way to 42 weeks the first time, a long pregnancy is probably in the cards for you this time.  So, you definitely should talk to her about your options there.

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  • image MAprincess:

    I tried to be one of those people who ignored the rules and just showed up in labor, I wouldn't be able to be attended to by my midwife (I'd have to use the doctor on call) and my MW would have been at risk of losing her delivery privileges at that hospital.

    How does that work? If you refuse to schedule an induction or c-section, they can either keep you on and work with you or drop you as a patient. At least in my state, patients can legally get dropped at any time - it sucks, but no one seems to be loosing privileges over it. And then there's a practical matter of OBs & midwives not always making it in time to catch the baby - in those cases, the hospital's staff have to attend and no one seems to get in trouble for that either. 

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  • image nycnola:

    image MAprincess:
    I was induced and able to VBAC, though.  Will she induce?

    I don't know if she will yet. She's only made one passing reference to how "now we are limited with how we can use pit", but my last birth was a failed induction at 42 weeks and it was a horrible experience from beginning to end, so I don't know if I want to be induced again, even if it means I can VBAC, you know?  

    My first induction was at 42 weeks and was a 3 day long adventure that ended in a c-section.  My second induction (40wks 3 days) yielded a VBAC 9 hours later.  It was like night and day.  So, don't rule out pitocin completely.



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  • How about other towns near you, do they have more supportive MWs or OBs? I would try to contact the local ICAN chapter, if there is one, or see if you can find some local doulas. They might be able to help you find another provider. If you're willing to do a home birth, that's another option, too.

    I would ask her for specific studies, and ask why women who aren't VBAC can go to 42. Volunteer for non stress tests after you hit 41 weeks.

    It's all well and good to talk about how we all have rights not to be sectioned again, but hospitals and providers can make it very very difficult to refuse. There are MW practices in my city that do VBAC, but are very constrained by the OBs, who call the shots. Just because a MW is a CNM doesn't necessarily give her full autonomy to buck the system or hospital's policy.
    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • image cecilyandgautam:
    image MAprincess:

    I tried to be one of those people who ignored the rules and just showed up in labor, I wouldn't be able to be attended to by my midwife (I'd have to use the doctor on call) and my MW would have been at risk of losing her delivery privileges at that hospital.

    How does that work? If you refuse to schedule an induction or c-section, they can either keep you on and work with you or drop you as a patient. At least in my state, patients can legally get dropped at any time - it sucks, but no one seems to be loosing privileges over it. And then there's a practical matter of OBs & midwives not always making it in time to catch the baby - in those cases, the hospital's staff have to attend and no one seems to get in trouble for that either. 

    CNMs are on a slipperier slope- at least around here.  Many doctors don't want them in the hospitals.  A CNM doesn't do surgeries and has a back-up OB that calls the shots in those types of situations- and must be in the hospital while a VBAC is taking place.  It's not all black and white and some doctors would LOVE a situation in which the CNM goes against hospital policy- this would give them the right to push them out of the hospital and lose privileges there.  If my CNM lied to the hospital to get me to go longer, her back-up OB would be liable also if something went wrong, so she'd be putting herself, the back-up AND the hospital on the line.  If I went past 41 weeks, I would not be permitted to be taken care of by my CNM, I would have had to deal with the attending that day, who would have pushed a c/s on me.  I would have done anything to avoid an OB, frankly. And honestly, in my case, I was probably over 41 weeks anyway.  My CNM was very liberal with my due date.  She is awesome and the VBAC (and pregnancy in general) world needs her in that hospital.

     This has nothing to do with who catches a baby.  There's no written regulation at the hospital as to who does that.  These are very different things.

    Also, in your case, even if a provider "dropped" someone as a patient, they'd be required to care for them when they show up to the hospital in labor anyway.  So, it's not at all the same situation.  Because then they'd just badger the hell out of the patient for the c/s then.

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  • My OB is vbac friendly, but the reason he doesn't like to go past 41 weeks is because he colleagues are less vbac friendly and don't like when they have to take on his vbac patients after 41 weeks.  I don't have a hard and fast deadline at 41 weeks, but based on the weekends and when he'll be on, I may not get the opportunity to go all the way to 42 weeks.  

    Personally I'm okay with that because my first c-section was due to a placental abruption at 41w4d and there is a part of me that wonders what would have happened if I had been induced at or before 41 weeks.  At the time I was hoping to avoid a c-section, so I turned down the induction. Oh well, my placenta had other plans!  

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