No laboring at home allowed? and Continuous monitoring?

704bride · August 2011

I'm reading about the risks of a repeat c/s vs. VBAC and one of the things I just read said that you have to go to the hospital promptly when your contractions start or when your water breaks because laboring at home with a c-section scar is not recommended. I'm wondering if anyone has been specifically told this by their doctor. I had these visions of myself laboring at home for as long as possible, taking walks, eating something, showering/bathing, etc. to help labor progress faster (or at least maybe feel a little faster).

Also, I realize that they'll need to monitor the baby more closely, but does this mean I'm going to be hooked up to a monitor the whole time? I want to try for a med-free birth and had hoped to be able to use the tub in the hospital and walk around a ton to keep labor progressing. I also have back issues and if I'm just laying in bed the whole time, it's going to make the whole process seem longer AND cause my back to have its own set of pain issues. Does anyone know if they check on things periodically or if I really am going to have to be in bed, hooked up to a monitor the whole time?

chicsub · August 2011

It really depends on how skittish the doc is about VBACs in the first place or if you have some other pre-existing condition. I labored at a hotel (my hospital was 45 min.-1 hr. away) as long as possible. I did have to have continuous monitoring in the alternative birth center attached the hospital. However, it was telemetry and I was free to move around and use the shower/tub. I agree that if I would have been stuck in bed that would have done me in since those were my worst contractions by far. There are still people that fare well with CFM by bouncing on the ball next to the bed, so you're not necessarily stuck in bed even without tele.

nosoup4u · August 2011

Like Chicsub said, it really depends. I think continuous monitoring is a standard requirement for VBAC - all the midwives I talked to said it wasn't optional. (One of the MWs we interviewed did say I could take lots of bathroom breaks to get off the monitors, though). Is telemetry an option? You should ask/request, bc some hospitals have them (wireless monitoring units), but you may have to be pretty aggressive about requesting it.

As for laboring at home, your doctor isn't going to come to your house and physically carry you to the hospital or anything if you end up staying there for awhile. I planned on staying home as long as possible, and it luckily worked out. I ignored my contractions until they got really insane (as in, I couldn't do anything but concentrate on them), and my water broke (both things happened within ten minutes of each other). At that point, my DH insisted we go to the hospital, and I showed up pushing. We only called the MW as we were on our way. Having a doula might be a good option, as she could help you determine how far along you are by how you are acting.

NicDave12 · August 2011

My doctor actually said my best chance at a VBAC would be to labor at home as long as possible. He is very supportive of VBAC but says once I am at the hospital I would need to be monitored and labor could stall out at that point for some women. He also said that if I am unsure of how far along I am I could go in, get checked, and if I am at the very early stages tell them I want to go home.

liv97 · August 2011

we're planning a hbac, but i think you'd want to labor at home as long as possible. the second you get to the hospital, they're going to start a clock for a RCS, and i wouldn't want to start that until as late as possible.

preg_amy · August 2011

I've been told by my midwives and the OB that I should labor at home as long as possible for my best chance at a VBAC.

I think if I had someone tell me I had to come in right away, I would choose a different practice.

My hospital does require continuous monitoring, but they have a few telemetry monitors available. So hopefully they aren't too busy and I'll be able to get one of those.

nosoup4u · August 2011

NicDave12:
He also said that if I am unsure of how far along I am I could go in, get checked, and if I am at the very early stages tell them I want to go home.

Honestly, I wouldn't believe this. I think if you were to show up they wouldn't let you go home, especially as a VBAC.

(Full disclosure: I got stuck at the hospital with DS1 in early labor, after my MW told me they just wanted to do some monitoring quick, and then they claimed DS's heart tones were worrisome, even though I labored for another 12+ hours with perfectly okay heart tones from him. So I might be a bit paranoid, but I haven't ever heard of a woman being released after going to the hospital.)

ILoveRunning · August 2011

nosoup4u:
NicDave12:
He also said that if I am unsure of how far along I am I could go in, get checked, and if I am at the very early stages tell them I want to go home.
Honestly, I wouldn't believe this. I think if you were to show up they wouldn't let you go home, especially as a VBAC.
(Full disclosure: I got stuck at the hospital with DS1 in early labor, after my MW told me they just wanted to do some monitoring quick, and then they claimed DS's heart tones were worrisome, even though I labored for another 12+ hours with perfectly okay heart tones from him. So I might be a bit paranoid, but I haven't ever heard of a woman being released after going to the hospital.)

With DS I went to the hospital three times before I was admitted. I was at 3 cm the first and second time, and 6 cm the third time (when I was admitted). Contractions were 3-5/1/2 each time. I was using the hospital birthing center and they wouldn't allow anyone in who wasn't in active labor. I know several hospitals don't admit until a woman is 4+ cm.

chankins14 · August 2011

My MW has told me that I can & should labor at home as long as I feel comfortable doing that. Once I check in to the hospital, I have to be continually monitored.

704bride · August 2011

liv97:
we're planning a hbac, but i think you'd want to labor at home as long as possible. the second you get to the hospital, they're going to start a clock for a RCS, and i wouldn't want to start that until as late as possible.

What exactly does this mean? Are you only allowed to labor for a certain amount of time before they make you have a c-section?

nosoup4u · August 2011

704bride:
liv97:
we're planning a hbac, but i think you'd want to labor at home as long as possible. the second you get to the hospital, they're going to start a clock for a RCS, and i wouldn't want to start that until as late as possible.
What exactly does this mean? Are you only allowed to labor for a certain amount of time before they make you have a c-section?

It just depends on the provider. It's a good idea to talk to who will be there about possible scenarios - what happens if you push for x hours, or how fast they want you to dilate, what happens if you go past 40 weeks, things like that. It's a good way to see how truly supportive of VBAC a provider is.

It really might be worth it to look into a doula, bc they are familiar with hospital policies, and can talk you through things (and help you talk to your provider) if/when they come up. And being "on the clock" when you show up is a good reason to stay home longer .

ILoveRunning:

With DS I went to the hospital three times before I was admitted. I was at 3 cm the first and second time, and 6 cm the third time (when I was admitted). Contractions were 3-5/1/2 each time. I was using the hospital birthing center and they wouldn't allow anyone in who wasn't in active labor. I know several hospitals don't admit until a woman is 4+ cm.

That's really good, but it's definitely the exception. I'm just very doubtful that many (or any) hospitals in the US would let a VBAC woman go home once she shows up, even if she was in early labor.

erbear · August 2011

My doc told me to labor at home as long as I could or until contrax were 3 minutes apart then come in, bc once I was there, they have to continuously monitor vbac patients. I was at 6 cm when I got to the hospital

MissyOlivePants · August 2011

nosoup4u:
704bride:
liv97:
we're planning a hbac, but i think you'd want to labor at home as long as possible. the second you get to the hospital, they're going to start a clock for a RCS, and i wouldn't want to start that until as late as possible.
What exactly does this mean? Are you only allowed to labor for a certain amount of time before they make you have a c-section?
It just depends on the provider. It's a good idea to talk to who will be there about possible scenarios - what happens if you push for x hours, or how fast they want you to dilate, what happens if you go past 40 weeks, things like that. It's a good way to see how truly supportive of VBAC a provider is.
It really might be worth it to look into a doula, bc they are familiar with hospital policies, and can talk you through things (and help you talk to your provider) if/when they come up. And being "on the clock" when you show up is a good reason to stay home longer .
ILoveRunning:

With DS I went to the hospital three times before I was admitted. I was at 3 cm the first and second time, and 6 cm the third time (when I was admitted). Contractions were 3-5/1/2 each time. I was using the hospital birthing center and they wouldn't allow anyone in who wasn't in active labor. I know several hospitals don't admit until a woman is 4+ cm.
That's really good, but it's definitely the exception. I'm just very doubtful that many (or any) hospitals in the US would let a VBAC woman go home once she shows up, even if she was in early labor.

I am also planning a homebirth (come on little one...anytime now!), and had to have a consult with an OB last week...and she was smart enough to say that if I were doing it in the hospital to wait it out at home as LONG AS POSSIBLE because of the whole monitoring situation the hospital will put you on the second you walk in the door. And yes - they'll put you "on the clock" if you don't progress like they think it should happen. - These are just 2 of the reasons why I'm having a homebirth this time around!

Ceefome · August 2011

They can't make you go to the hospital. They can recommend it, but what are they going to do if you wait to call or show up? I agree with the PPs who said that might be a flag for a not very VBAC friendly provider.

As for the continuous monitoring - it doesn't have to mean being stuck in bed. Near the bed, maybe, but not necessarily in it. I labored on a birthing ball next to the bed wearing the monitor.

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