had my OB consult — The Bump
VBAC

had my OB consult

All in all, went well.  She asked questions about DS's birth, and said that depending on exactly how he was coming down (the most technical I ever got was off to the side - STILL waiting on records requested months ago.. which reminds me, I need to call them AGAIN) there was very little to only a small chance of that happening again.  She's open to an induction, utilizing pit if needs be (she says the increased risks are minimal).  She doesn't recommend waiting past 41 weeks, which... well... I asked if it was because of baby size and she said it was partially that and partially the extra strain on the scar, and a belief that since I waited until 41 1/2 weeks last time without anything happening, that going past 41 this time isn't going to do much. 

She did have me schedule one more visit for questions and discussing induction, which makes me a bit nervous, but not too bad, as really she's not my primary and I'll be making those decisions ultimately through my primary. 

All in all, while she stated the risks of the uterine rupture, she said they were about 1% and no scare tactics or "your 8 lb 13 oz baby was too big/pelvis was too small" or "we'll check baby size when you get closer" like my old OB suggested at 13 wks.

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Re: had my OB consult

  • Sounds good overall.  What are your thoughts on the 41 week thing?  
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  • Yeah, sounds pretty good, but it suprises me that she's ok with Pit but not waiting past 41 weeks. Does she have evidence to back that up? I think both may carry some risk, but I'm under the impression that Pit is implicated in more uterine ruptures.
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  • imageLittleEgypt:
    Yeah, sounds pretty good, but it suprises me that she's ok with Pit but not waiting past 41 weeks. Does she have evidence to back that up? I think both may carry some risk, but I'm under the impression that Pit is implicated in more uterine ruptures.

    I thought the same thing.  I would think it is more dangerous to induce at 41 weeks with pitocin then to go to 42 weeks.

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  • imageLittleEgypt:
    Yeah, sounds pretty good, but it suprises me that she's ok with Pit but not waiting past 41 weeks. Does she have evidence to back that up? I think both may carry some risk, but I'm under the impression that Pit is implicated in more uterine ruptures.

    I thought that was interesting too because its the opposite of what my new OB said. I'm obviously not pregnant, but had tons of questions when I was switching providers. I was told they would let me go to 41 1/2 weeks, but would prefer other methods of induction and avoiding pitocin.

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  • imageShansBride:

    imageLittleEgypt:
    Yeah, sounds pretty good, but it suprises me that she's ok with Pit but not waiting past 41 weeks. Does she have evidence to back that up? I think both may carry some risk, but I'm under the impression that Pit is implicated in more uterine ruptures.

    I thought the same thing.  I would think it is more dangerous to induce at 41 weeks with pitocin then to go to 42 weeks.

    I agree.  I've read studies finding that while VBAC success rates drop after 40 weeks, the risk of uterine rupture does not go up significantly.  

    I also would take it with a grain of salt that because of how your last pregnancy went, there's no point in letting you go past 41.  Each pregnancy is different and there's no way to know what will happen.

    But I do think it's good that the doctor would be willing to induce you if you went 41+ weeks instead of just telling you that it would be an automatic RCS.  And I suppose if you do go past 41, you can always just not consent to the induction until 42 weeks if that is what you want. 

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  • Here's my deal on the 41 weeks thing:

    My doctor is going out of town around 41 1/2 weeks or so, so I'd be transferred to one of her partners.  She warned me of this when I interviewed her, but I still liked the idea of having her be able to help me at least set up care after she was gone (rather than whatever OB was on call with an OB practice) so I figured it was worth the risk.  So, for that reason, the induction at 41 weeks, when I'll have my own care provider is something I'm open to thinking about.  

    I've never heard of increased rupture past 41 weeks, either.  I have heard the entire success rate deal, but I have always had a feeling that it has more to do with starting inductions and perhaps babies that just weren't going to descend & therefore didn't start labor on their own as opposed to the entire timing thing.  

    It helps a bit that, while I wasn't charting at the time, with the timing of everything, I'm pretty sure I ovulated a few days early (or DH has super sperm) and baby measured 3 days ahead in both early & 20 week u/s, so I feel like if I do go to 41 weeks, I'm nearly at 41 1/2 anyway.  I'm honestly not really comfortable waiting past 42 at all, so...

    I'm not really excited by a pit induction, as it didn't seem to take (at least not in the first couple hours I was allowed to go with DS), so am happy that the OB was encouraging of starting with a foley if my cervix allows.  That said, I plan on finding a good acupuncturist and tossing DH some viagra to get things going naturally a week or so before my EDD to hopefully avoid the issue all together.

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  • My Ob told me that if i reach 41 1/2 weeks with no progress they will induce me w/ minimal amounts of Pitocin.  I'm not sure about what studies have been done but she said they wouldn't give me even half the dose they would a non-vbac'er.  Which I thought was kind of strange b/c why would they give someone more of a drug then they neccesarily need (if that makes sense.)

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  • imagepapagena:

    Here's my deal on the 41 weeks thing:

    My doctor is going out of town around 41 1/2 weeks or so, so I'd be transferred to one of her partners.  She warned me of this when I interviewed her, but I still liked the idea of having her be able to help me at least set up care after she was gone (rather than whatever OB was on call with an OB practice) so I figured it was worth the risk.  So, for that reason, the induction at 41 weeks, when I'll have my own care provider is something I'm open to thinking about.  

    I've never heard of increased rupture past 41 weeks, either.  I have heard the entire success rate deal, but I have always had a feeling that it has more to do with starting inductions and perhaps babies that just weren't going to descend & therefore didn't start labor on their own as opposed to the entire timing thing.  

    It helps a bit that, while I wasn't charting at the time, with the timing of everything, I'm pretty sure I ovulated a few days early (or DH has super sperm) and baby measured 3 days ahead in both early & 20 week u/s, so I feel like if I do go to 41 weeks, I'm nearly at 41 1/2 anyway.  I'm honestly not really comfortable waiting past 42 at all, so...

    I'm not really excited by a pit induction, as it didn't seem to take (at least not in the first couple hours I was allowed to go with DS), so am happy that the OB was encouraging of starting with a foley if my cervix allows.  That said, I plan on finding a good acupuncturist and tossing DH some viagra to get things going naturally a week or so before my EDD to hopefully avoid the issue all together.

    that makes sense.

    Also, I wanted to add that I was totally afraid of going post dates with DD (I never went into labor with DS and just had a scheduled c/s at 38 weeks so I had no point of reference, but I was scared).  I went into labor on my own at 39 weeks 1 day with DD.  I also have a girlfriend who had a c/s with her first at 41 1/2 weeks because he was measuring big and she hadn't gone into labor yet.  Her second was scheduled at 39 weeks and her VBA2C baby was born after spontaneous labor at 38 weeks 6 days.

    I have another girlfriend who went into labor with her first at 42 weeks and ended up with c/s.  Her second she went into labor at 38 weeks.

    So, I am sure it will still be a fear, but know that it doens't mean you will end up with an induction at 41 weeks just becuase you did before Smile

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  • imagepapagena:

    Here's my deal on the 41 weeks thing:

    My doctor is going out of town around 41 1/2 weeks or so, so I'd be transferred to one of her partners.  She warned me of this when I interviewed her, but I still liked the idea of having her be able to help me at least set up care after she was gone (rather than whatever OB was on call with an OB practice) so I figured it was worth the risk.  So, for that reason, the induction at 41 weeks, when I'll have my own care provider is something I'm open to thinking about.  

    I've never heard of increased rupture past 41 weeks, either.  I have heard the entire success rate deal, but I have always had a feeling that it has more to do with starting inductions and perhaps babies that just weren't going to descend & therefore didn't start labor on their own as opposed to the entire timing thing.  

    It helps a bit that, while I wasn't charting at the time, with the timing of everything, I'm pretty sure I ovulated a few days early (or DH has super sperm) and baby measured 3 days ahead in both early & 20 week u/s, so I feel like if I do go to 41 weeks, I'm nearly at 41 1/2 anyway.  I'm honestly not really comfortable waiting past 42 at all, so...

    I'm not really excited by a pit induction, as it didn't seem to take (at least not in the first couple hours I was allowed to go with DS), so am happy that the OB was encouraging of starting with a foley if my cervix allows.  That said, I plan on finding a good acupuncturist and tossing DH some viagra to get things going naturally a week or so before my EDD to hopefully avoid the issue all together.

    That makes sense and it sounds like you have some good options open to you.  Yay :) 

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