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Natural Birth
iris427
member
Has anyone heard this before?
iris427
member
A friend of mine is 39 weeks and hoping for a VBAC. Her OB is not supportive and scheduled her for a RCS next week, the day before her EDD. She still really wants a VBAC, so I suggested she ask her OB about membrane stripping, amniotomy and a Foley bulb induction. Her OB told her she won't do a membrane sweep because she is GBS+ and it could force the germs into her uterus. But she did a cervical check, so couldn't that theoretically do the same thing? OB told her that breaking her water as a last ditch effort before the RCS would be pointless unless they also used Pitocin, so there was no point in even trying. I feel like I have heard success stories from amniotomy, and my friend dilated all the way before her c/s so it seems like it might be worth a shot. OB won't do Foley bulb because she saw a woman die during one during her residency. Has anyone heard or been told no membrane stripping if you are GBS+, or no amniotomy without Pitocin?
This discussion has been closed.
Re: Has anyone heard this before?
The only think I can say is about is breaking her water and pitocin. Yes she can try to be induced if she really wants to but breaking her water alone may not be enough. Just because you do a AROM (or even SROM) does not mean a woman will get ANY contractions let alone ones that are strong enough to get the cervix to dilate. Also once you are ruptured your clock is ticking 24hrs and thats it, even more so with GBS+ regardless of the fact of giving antibiotics its to much of a risk for infection for mom and baby at that point. Trust me you dont want either mom or baby to go septic its a bad situation. No ones goal is a sick mom, baby or both.
Also there is more risk of urterine rupture with pit if had a prev c/sec. Where I work we will not enduce with pit, either you go into labor on your own or its the scheduled c/sec. If the person comes in in labor but has not broken waters we will break them but no pit to put any kind of extra stress on the old uterine scar. Uterine rupture is just to much of a risk to both mom and baby. When that uterus rips open blood loss happens very fast and in large amounts, again both can die and fast. Or mom may need a hyterectomy and yes saves her life but can never have a child again of her own.
And when it comes to the foley bulb I hate to say it we JUST two nights ago had a girl that as the doc was doing the foley bulb to just start her induction her urterus ruptured and mom is now in ICU (severe blood loss!) and baby had a short stay in NICU. And this wasnt even someone that had a prev c/section there is no answer as to why it happened but it did.
For me personally I dont think I would ever risk trying to VBAC, I have seen way to many things go wrong because a patient insisted on doing a VBAC. I know its easy to have your heart set on one thing but I would just hate to see something happen to mom/baby to have a VBAC.
::Head desk:: You do realize 65-80% of VBAC attempts are successful, right? And that there is more risk with a RCS than a VBAC? And that pitocin is ACOG approved for VBACs?
Iris, it really just sounds like this OB just doesn't want to do a VBAC and is citing anecdotes over facts to get out of it.
This is a recommendation slide for TOLAC from an OB in California and it seems to point to exactly the opposite of what your friend's OB is saying: https://www.slideshare.net/bjebelli/vbac2010a
To add to breaking water, when I was pregnant with DD, my ob wanted to break my water to induce me, and kept saying he didn't forsee pitocin being necessary. And to add, once he broke my water, I started having contractions within 10 minutes, and they were only 5 minutes apart.
Thanks for posting this. I had wondered why I wasn't offer misoprostol for my loss.
Totally agree.
On further Googling, it looks like there is no real evidence either way about membrane sweeping and GBS+ status. From what I know about membrane sweeping in general, it does carry a risk of rupturing the membranes, but the risk is small. So it seems like the odds of a membrane sweep posing a threat to the baby are small, but some doctors just want to be cautious? My question then is do these same doctors take steps to limit cervical checks in mothers with GBS, especially once their water is broken? Do they do AROM on those moms?
Can you find anything on AROM with GBS+? I imagine that protocol for membrane sweep/AROM/cervical checks should be similar for all cases of GBS+ women. But if she consents to the two rounds of abx (or tries the garlic/other natural methods and then asks for a recheck before birth) it should alleviate/negate any concern he has for the baby due to her GBS+ status, I would think.
Orrrr she could tell the doc to STFU and she's just not doing a RCS. But I'm in a pissy mood and would love to tell off her OB for her.
Def sounds like bait and switch, esp bc of the vervical checks, but refusal to do membrane sweeps or AROM. Navelgazing Midwife has talked about providers who will break waters/do cervical checks on GBS+ women, and how it's totally contradictory. If she's fairly dilated, AROM might work without Pitocin. Hope she gets her VBAC.
Disneycrazy, how are you a medical provider if you're terrified of VBAC? Stats and facts are on the side of VBAC being a reasonable and safe option for most women. It's opinions like yours that's helping drive the c-section rate up in this country.
DS2 - Oct 2010 (my VBAC baby!)
Oh, where to start?
DS2 - Oct 2010 (my VBAC baby!)
It's amazing we're even alive to post this.
I was GBS+ and had my membranes stripped. Seems like this may be one of those provider specific things. I can't see anyway it could be a problem unless her membranes ruptured and then she would just be on the clock.
And as far as the septic part I want you to see a adult and baby septic before anyone just wants to brush it off. You see someone DIE because of it and then tell me its not something to be very concerned about.
Ah, so by your "logic", Disney, I should never get back on a bike again bc I saw a bicyclist get hit by a car and that means riding a bike at all is dangerous.
Got it.
My SIL became septic after her c-section, does that mean no one should have sections?
She spent the first month of her daughter's life in and out of the hospital & wound care clinics.
I used to work in L&D, just FYI. I have seen life-threatening situations and dead babies. And my husband was hospitalized for sepsis just last month and is still recovering from it. So you are making an awful lot of assumptions here. I have a healthy appreciation for risk but you are fear-mongering and I have no respect for that. Amniotomy is a routine procedure done in probably every L&D in the country, so I am not sure why my question of whether it can be effective without Pit is met by ZOMG sepsis!!! Do you warn people about sepsis when they ask about c/s too? Do you presume they are too ignorant and irrational to look at the facts and make their own decisions, like you seem to be assuming about people here? Or are you just biased against VBAC and NB?
On average, 70% of women achieve VBAC. I bet it could be even higher if we had more providers truly supportive of VBAC.
Please stop feeling things so much, and start using facts when it comes to women who want to VBAC.
DS2 - Oct 2010 (my VBAC baby!)
That doesn't surprise me since it doesn't seem like where you work is very supportive of vbac. As others have posted, the success rate is generally quite high, but that probably depends a lot on having care providers who are knowledgeable and supportive of vbac.
Add me to the list of GBS+ mamas who had their membranes stripped, multiple times. Not once did any of my MWs mention that they were hesitant to do so because of my GBS+ status.
I didn't have AROM, but that's because my water broke on its own for both of my labors. I was GBS+ for both, and no one ever mentioned limiting cervical checks due to increased risk of infection.
Sounds like typical BS to me.
Not sure if this is showing as disneycrazy or not, can't get my two accounts to one and not on my home computer so may be logged in different.
I am for people that want to VBAC and have NB or repeat c/section if they choose to do so WITH knowing ALL the risks of the choices they are making and knowing what options they do have as far as pain mangement, AROM vs not and the list goes on from there. When you have a pt that wants either X,Y,or Z and cant even begin to verbalize any of the risks or have no idea what other options they have that is a problem. They should be able to tell you why they want X,Y,or Z and when they can't they are not making an informed choice.
I have had pts that I have helped to have a NB because that was the path they wanted.
And very early in the pregnancy in the OB office regardless of trying for NB, repeat c/section, VBAC, version for breech etc, every pt gets the current up to date pamplets on c/section VBACS, sepsis, post partum care,newborn care,breastfeeding ,epidural anesthesia, spinal anestesia etc and is asked to read them all write down all the question they may have and at the next visit bring the questions to go over. Also they are encouragd to take child birth classes, breastfeeding classes, parenting classes, and if other children sibling classes for the siblings to be prepared for the new baby. We try to have them make informed choices but it comes down to the pt wanting to learn as well. We do see people that simply dont care and will do whatever even once you try to educate them.
And before the doctors do any type of intervention the pt is told the risks and pros of it before it is done (things are different in true emergencies like prolapsed cord,uterine rupture,abruption etc). and if they pt refuses then they refuse it and have that right to.
Even with antibiotics a pt can still become septic esp being ruptured for 24+ hrs and the risk is only more if the pt is GBS+ ontop of that. A pt can become septic even without GBS and not being prolonged rupture.We do limit cervical checks once ruptured on all pts to reduce any risk of infection. If there is no GBS once ruptured for 12hrs + we start antibiotics to reduce the risk of any infection. And I am not saying that this will happen to every single person but people do need to know of the risk that this can happen to you, not everyone but there are many people out there that take this way to lightly.
In an ideal world, it's a provider's job to help a woman figure out what's the safest and best option for her. Even if that means teaching them and pointing them to the right literature, studies, etc. - not just the general brochures that ACOG has in every waiting room.
I didn't realize there's now a freaking poll tax for all women who aren't able to "verbalize" what they want.
DS2 - Oct 2010 (my VBAC baby!)
You give new OB patients pamphlets on sepsis? Seriously?
Disney, you are going on about stuff that has nothing to do with the OP. And for all the educating you are trying to do here, you did not even answer my original questions. You say you support people making their own choices, but your words and tone suggest otherwise.
And like nosoup said, it is the doctor's job to help inform the patient. It's not the patient's obligation to enter the healthcare setting with full knowledge of the risks and benefits of every option. It is entirely appropriate for a woman to say to her doctor "I prefer not to have surgery again. I have heard that foley bulb inductions/amniotomy/membrane stripping are safe for VBAC. Is that an option for me?"
And that infant loss and maternal death and other freak birth events don't occur during c-sections or regular vaginal births.
I have not posted my story yet but I had a succesful out of hospital VBAC 2 days ago and I pushed for 5.5 hours *gasp*. Thank god I had supportive providers who don't subscribe to your POV regarding birth...
Yay!!! This is the best thing in this post LOL. Congrats!!
I have some kids to put to bed so I just skimmed all the drama
But I was GBS+ with DD and my OB stripped my membranes twice and never mentioned anything about that being contraindicated due to my GBS status.
Also, my membranes ruptured spontaneously at about midnight and DD wasn't born until 9:30 PM. *I* knew I was likely "on the clock" to deliver, but I was making decent progress and so no one ever mentioned doing a C-section or other interventions to move things along faster. (I was already on Pitocin, so that wasn't an option.) I don't see why her OB couldn't at least try AROM. Worst case scenario, contractions don't start up or aren't strong enough soon enough, and she ends up with a C-section after 24 hours. (To avoid ZOMG! sepsis!) But at least she has a chance, however slight, of vaginal delivery after AROM. Whereas her chances of vaginal delivery with a RCS are exactly 0%.
Mommy to DD1 (June 2007), DS (January 2010), DD2 (July 2012), and The Next One (EDD 3/31/2015)
Thank you! I'm not up to writing a birth story yet but this hit too close to home to not reply.
I agree! Congrats! I'm looking forward to your birth story!
DS2 - Oct 2010 (my VBAC baby!)