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VBAC
catrinawaves
member
disappointing appointment-or overreacting?
catrinawaves
member
in VBAC
I see a rotating group of three MWs, who work in conjunction with a group of MDs. The MWs mentioned early in my pregnancy that I would meet with an MD as my EDD got closer, since I was a VBAC. I met today with the only MD that I've seen previously, and I've got very mixed feelings about the appt.
On the plus side: MD stated that they usually schedule a RCS around 39 weeks for VBACs. She noticed my surprised reaction to that news, since this was the first I had heard of such an early date, and after some discussion we agreed to schedule a backup CS at 41 weeks instead.
Also, the baby is measuring a little bit on the large side-77th percentile. They want me to have another growth U/S at my next appt. But she stated she has never recommended a CS due to baby's size (VBAC or no), and that keeping track of the growth is to primarily give me information, in case I decide I don't want to try and birth a large baby. She also mentioned that since my pelvis has never really been tested (I never got to push with DS) there was no reason to think I couldn't handle a larger baby anyway.
On the negative: We discussed what interventions were necessary, and I feel like what she said was a bit different from what I had heard from the MWs. The MWs had told me that I would need continuous fetal monitoring, but I had been under the impression that it would be external, and possibly even from a telemetry unit. The MD tells me that since I'm a VBAC (which makes me "high risk") that I'm at an increased chance of having to use an internal monitor! I'm planning a natural birth, and having an internal monitor in while laboring without an epidural doesn't seem like it would be a ton of fun. She also said I'd need to have an IV placed.
I suppose the good thing about this appointment is that the MD was very honest with me, and was flexible about scheduling the RCS. But I left with a bit of a defeated feeling, and cried in the car afterwards.
I'm going to discuss this with my doula, but would this be enough to make you consider changing practices so late in my pregnancy? (I'm at 34 weeks) Has anyone else been told they might have to be monitored internally?
This discussion has been closed.
Re: disappointing appointment-or overreacting?
I would talk to your MW about what the doctor said. At my hospital, sometimes the things they "require" depend on who is on-call when you go into labor. For instance, some OBs wouldn't let a VBAC mom use pit, others would. Also, some things might simply be to cover their butts and it could be a matter of just signing a consent form.
I hated my VBAC consult with the OB and I cried afterward too. He was perfectly nice, and wasn't hateful but his attitude just seemed a lot less trusting in my body's ability to birth. It was more like preparing for what was going to go wrong. Bleh.
I bet you'll feel better if you discuss these issues with your MW.
ugh ...
i'm only 29 weeks, and we haven't gotten to the question of fetal monitoring yet, but you are not alone with having all this 'extra' medical stuff pushed on you.
since i'm over 35, my ob practice won't allow me to go past 41 weeks, so if i haven't gone into labor by then, they will schedule a rcs. this is not based on ACOG or AMA recommendations ... so i'm not sure why they do it?
also, my ob practice will not induce for vbac ... so if i haven't gone into labor by 41 weeks, i won't even have an option to try and labor with an induction, my only choice is rcs. again, not ACOG or AMA recommendation.
also, my ob practice does not routinely 'sweep the membranes' in the office to get things moving ... so again, if labor doesn't start on it's own by their timetable, i won't have a chance to labor.
about a month ago i started looking at other obs and practices, and i couldn't find anyone who had different polies AND took my insurance. i felt (and still feel) a little defeated that decisions about my birth are being made based on liability, convenience and money instead of sound scientific evidence.
wow ... what a hijack ... so sorry.
i guess the short story is that docs do not make this easy on us ... and if it isn't one thing, it's another. some folks (yankeebear i think) have had luck changing docs pretty late in the game, and even if you don't change, it might be worth it for you to research with some other docs to see if internal monitoring is standard practice where you are. while i'm not happy with the policies at my ob practice, having checked around, i know that they are pretty standard and would have a tough time finding a way around them.
good luck.
Well, if you feel uncomfortable you should look into switching. I switched at 35 weeks and couldn't be happier.
My midwives and OB are all on the same page. I can go to 42 1/2 weeks. I do need continuous monitoring, but it is external telemetry monitoring (I'm able to have a waterbirth as well!) and they don't worry about the size of the baby.
Also, I'm 42 years old so well on the plus side of AMA but they are treating me like anyone else except for getting a weekly ultrasound starting at 39 weeks just to check for fluid levels.
Whatever you decide, I wish you the best of luck!
I don't know if I would consider changing practices or not. Depends on how comfortable you are with the MWs. Will you definitely get a MW in labor, or is their practice whoever is on call, MW or OB? That would affect my decision too.
I get annoyed with VBACs being called "high risk" as well, but if you're unlikely to have an OB during labor, who cares what she calls you?
There are very few circumstances in which I would consent to an internal fetal monitor, and DEFINITELY not just because you are a VBAC. Those screw into a baby's scalp. I would need to see some pretty strong evidence of the benefits over continuous EFM or intermittent doppler to even consider it.
My MW actually recommended the internal monitor for both contrax and the HR because baby's HR consistently dropped with each contrax and the monitors weren't exactly picking everything up. We figured that the cord was either pinched or wrapped and that was what was creating the drop (not an imminent rupture). As soon as they placed that monitor, EVERYONE (me, the nurses, the MW, the doctor) were all put at ease because we could consistently monitor the HR.
All that's noticeable on DS's head is a tiny scab.
That's not really what she's talking about though- you had a good reason for the internal monitors. That's what they are for. Automatically getting one because you're a "high risk" VBAC is what would bother me.
Ugh, sorry you had to hear all that! I call bullshite on all of it. If the OB thinks you should have a TOL even if the baby is large, then what's the point in having a sizing u/s late in your pregnancy anyway? If it's less stress for you not to have one, I'd just refuse it.
As for VBACs possibly needing internal monitoring - this is true for all labors. I would refuse internal monitoring if you're laboring fine and the baby is okay.
The IV is pretty standard, though I would request a hep/saline lock instead.
ETA: For everyone who is saying that internal monitoring isn't a big deal, that's not really true. Your water needs to be broken for it to be inserted, which adds another level of intervention to a woman's labor. So it might not feel any worse than external monitoring, but it's more invasive than external monitoring, no question.
DS2 - Oct 2010 (my VBAC baby!)
I had an internal monitor when I was induced with my daughter (no epidural), and honestly it was no big deal. I actually felt like I was able to move around more freely with the internal. With the external, the belly band kept moving out of place and they'd lose the baby's heartbeat, so they kept telling me to lie down and stay still. With internal I was able to walk around my room and labor on the birthing ball, go to the bathroom, etc....
I know I have to have continuous monitoring as a VBAC, but I'm not sure about internal vs external.Actually, that is what she's talking about. It would bother me too, but that's not what was said in the OP. It says higher CHANCE OF internal monitoring. Everyone who labors in a hospital has a chance of internal monitoring, and if you are a higher risk mama (I'm not going to say "high risk", but yes, of course VBAC is higher, however slightly, than not) then you have a higher risk for all kinds of interventions. They go hand in hand. As risk of problems increase, so do your chances of interventions, since they were invented to help with and/or prevent problems.
It seems to me this doc is just putting more emphasis on the "what-ifs" than the midwives are, but nothing's actually changed. I don't see "you need internal monitoring just because you're a VBAC" anywhere.
Thanks everyone. And you're right, she didn't say the internal monitoring was required, but she did place a lot of emphasis on the possibility, which is what threw me. But what I remembered afterwards is that she's not going to be actually attending the birth, one of the MWs is.
So, I'm going to talk with a MW at my next appointment and see what she says. My doula has had clients switch practices as late as 39 weeks, or at least ask for a second opinion as late as the day they gave birth, so I'm not as stuck as I originally thought I might be.
I think what I'm learning during this pregnancy that I didn't during my last one is that I have the right to consider the options presented to me, and say "no" if I chose. Obviously, if it's an emergency situation everything goes out the window, but otherwise I can refuse certain interventions in the hospital, even if it's framed to me as if I have no say in the matter (which is also how this particular MD was describing the scenarios). With DS' birth, I felt like I was treated more like a body than a person, and I think that bothered me more than the actual c-section.