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C-sections
VBAC
Hi everyone, I am currently pregnant with my second child. My first pregnancy resulted in a csection. My husband really wants for me to have a vaginal birth but I'm terrified giving the fact that I wasn't able to push DS out. What are the risk of pursing a VBAC? What are some questions I should ask my doctor? TIA!
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Re: VBAC
https://community.thebump.com/cs/ks/forums/9841109/ShowForum.aspx
Here's the link to the VBAC board.
VBAC has about a .5% of uterine rupture. VBAC and a second CS have about the same rate of risk (though the risks are different), so either choice is equally safe.
I will say, if you want to have more than two kids, it may be worth thinking seriously about VBAC, as the risks associated with CS go up with the more you have.
Here are some good links with more info about VBAC:
https://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/
https://www.childbirthconnection.org/article.asp?ck=10213&ClickedLink=293&area=27
https://vbacfacts.com/quick-facts/
DS2 - Oct 2010 (my VBAC baby!)
Do you work with a lot of VBAC moms? How often do they have a vaginal delivery?
Under what circumstances do you advise a mom to have a repeat cesarean instead of a VBAC? During labor what would cause you to suggest another cesarean? (Cesareans are advised in cases of transverse presentation of the baby, complete placenta previa, and a few other circumstances that may become apparent during labor such as cord prolapse. They are not necessarily needed due to an estimated ?big? baby, going past 40 weeks gestation, breech presentation, twins, water broken more than 24 hours, etc. It will of course depend on a variety of factors but those cases should not automatically rule out a VBAC.)
What do you feel the risks are for a VBAC? How often do you see serious complications? How often do you see uterine ruptures? What were the circumstances and outcomes? (The generally accepted uterine rupture rate based on numerous studies is 0.48% for moms with no prior vaginal deliveries, and even lower for someone who has delivered vaginally before. ACOG says 0.4%-0.9% based on mom?s personal situation. If the doctor says rupture rates are higher than one percent, be concerned!)
What is your protocol when working with a VBAC mom? (This is an incredibly open ended question if you want to hear the doctor?s genuine response, and not have them be biased by the questions you ask. If you want examples of more questions to facilitate discussion then keep reading!)
What if I go past my due date? To 42 weeks? What methods would you use to induce or augment labor? (Pitocin CAN be used with VBAC moms with close monitoring, but other types of medication can be riskier ? do your research. You also want to be able to bake your baby up to 42 weeks without them insisting on a repeat cesarean.)
What if my baby is estimated to be larger than average? (This is NOT a good reason to schedule a repeat cesarean unless there are other factors at play.)
How long are you comfortable with me laboring? Pushing? If my water is broken? (If your water is broken the standard answer is you need to deliver with 24 hours, but if there?s no indication of fever or distress then this is something important to discuss ? will your doctor automatically advise a c-section at that 24 hour mark? In that case will your doctor avoid amniotomy during your labor so as to not start that countdown?)
At what point in labor do you advise a VBAC mom to come into the hospital? What if my water breaks and contractions have not begun? (The sooner you come into the hospital the higher the risk of interventions and infection, so it?s good to wait until active labor is established ? which may not happen for a few hours after your water breaks.)
What type of monitoring do you advise for VBAC moms? Constant, intermittent, internal, external? (Baseline monitoring of 20 minutes is standard, with intermittent monitoring for a few minutes at intervals advised by your doctor ? it may be 15, 30, or 60 minutes. They need to see certain behaviors from your baby?s heart rate and see how the baby responds before, during, and after contractions so you may be monitored longer at times to assess those things.)
How often do you perform episiotomies? Vacuum or forceps assisted deliveries? (Episiotomies should be RARELY performed, and assisted deliveries should also be unusual.)
What comfort measures for labor? May I get in the shower, sit on the birth ball, get into the tub, etc?
Do you advise moms to have an epidural? If a cesarean becomes necessary, how is anesthesia handled? If I need an emergency cesarean how quickly will the hospital be able to be prepared? May my partner be with me? (The hospital should be prepared with an anesthesiologist in house and the ability to get you into the OR promptly ? in a true emergency you have minutes, not an hour. If they do not have someone ready then they are not prepared for emergencies for any laboring mom ? not just VBAC moms. An epidural is NOT necessary for a VBAC mom and in fact can increase the risk of a repeat cesarean because of the associated interventions.)
How much time do you spend with a mom in labor? A VBAC mom? (Many doctors aren?t called in until mom is pushing, but current ACOG guidelines advise the OB to be quickly accessible for the duration of labor with a VBAC mom. This may be in their office on the hospital campus, they generally are not in the L&D with you the entire time.)
Do you attend your VBAC moms? births or do you share call? Do your partners share your views on VBAC? What experience do they have? (You do not want to go into labor one weekend and find out your OB isn?t on call and their partner isn?t supportive of a VBAC.)
What positions have moms used for birthing ? with a squat bar, all fours, assisted squat, etc? (You want an OB open to catching babies in whatever position is the most comfortable for you.)
How do you feel about working with midwives and doulas? (Whether or not you plan to receive some of your prenatal care from a midwife or hire a doula, if your doctor speaks negatively about other care providers then this is a red flag!!)
They passed out these questions at my ICAN meeting this weekend and I thought I would share them with everyone. They are interview questions to ask your VBAC provider. They also provided questions to ask an out-of-hospital provider so please let me know if anyone would like to see those. Some of the questions are a bit repetetive, but it covers a lot of info.
- What is your rate of inductions?
- What are your partners perspectives on VBAC?
- What percentage of your patients do you assist yourself? (most docs are in group practices and take turns being on call for births)
- What is your cesarian rate (beware if it is in the 20s or higher or doc can't answer)
- How many VBACs do you attend be year? (Don't expect a huge number. Look for enthusiasm and knowledge. Qualities are lacking if he/she asks you to sign a VBAC consent form that exaggerates the side effects of VBAC and includes none of the risks of a repeat c-section. These seem to be more common in Central Ohio)
- Of those patients in your practice who wanted VBACs, how many were successful (expect at least 35%)
- What do you think my chances are of VBAC success, given my childbirth history? (look for enthusiasm about VBACs, especially yours. Look for someone who treats you as an individual).
- In what instances is a repeat c-section necessary?
- What kind of monitoring would you require in labor?
- Do you support alternative birth positions?
- What are the hospital policies regarding VBACs (i.e. continuous monitoring, mandiorty epidural, allowed to eat/drink, etc.)
- What are some reasons that you might deny a trial of labor?
- If I go past 42 weeks what methods might you use to encourage labor?
- How do you usually manage a post-date pregnancy? (42 weeks per the World Health Organization) How do you manage suspected CPD?
- Ask for an example of when a repeat c-section would be medically necessary.
- Ask, "what if my labor stalled at 4cm? What would you do to help encourage labor to get going again?"
- Ask if a provider uses medications or non-invasive methods like moving and walking.
- What will you do to help prevent tearing?
- What's a reasonable length of time for a VBAC labor if I'm healthy and my baby appears to be healthy? (research indicates greater success rates when women have more leeway on length of labor)
- How many people can I have with me during labor? what is the hospital's policy?
- What are your usual recommendations about IVs, pitocin, prostaglandin gel, amniotomy, epidurals, confinment to bed, EFM, pushing positions and so on. (can also call L&D and ask the nurses what to expect with a particular provider. Some will discuss others will not.)
- How close together are your appointments? (the closer they are the more you'll have to wait and less time you'll have with your doctor)
- Look for someone with "heart." Is he/she empathetic? Attitude can enhance or inhibit the likelihood of VBAC. Does he/she make you feel good about your decision? Do they listen and answer your questions? Do they offer support when you voice your fears? Do they take your calls?
Those are the questions I found online.
They are great questions! Don't be afraid to switch providers once or twice. Your chance of a successful VBAC will increase with a supportive provider.
I couldn't push out my first child (8lb 15oz, 22 in long) after a failed induction.
I went into labor on my own with my second (8lb 1 oz and 21 in long) and pushed him out easily in about 4 contractions. You can do it!
I mean, that's great that your husband wants a VBAC, but what do YOU want? You know, the person who is actually responsible for getting the child out?
It is a partnership, for sure, but when it comes to delivery, I always think it is odd when a partner who is not the one who has to get the baby out voices a strong opinion one way or the other.
Just wanted to throw out there that the rupture rate is as low as .5% in some mass studies and I can't find one in the past 20 years or so that is as high as 1%. Rupture rate is under 1%.
But I agree that you should talk to your doctor about your concerns either way.
Definitely talk to your dr and do your own research as well. Do what is best for you and your family.
Just FYI, the rupture rate is about 0.5% or less. There have been studies that have shown it even lower.
You will find a lot of support from doctors for a RCS but not a lot for a VBAC. That is why it is up to you to gather up evidence based research and make an informed, educated decision if you're having trouble deciding. My doctor told me I wouldn't be able to have a vaginal delivery when I showed up at the hospital 8cm with my second . I pushed him out quite easily, actually.
You can contact your local ICAN chapter and they have lots of VBAC info, and they also have meetings.
Jen, you should post all those questions on the VBAC board. If you page Iris, she could put them on the website, too.
DS2 - Oct 2010 (my VBAC baby!)
ok!