VBAC

VBAC might be taken away from me (I need to vent and hear feedback)

My state is #1 for repeat c-sections.  I'm a 42yo mother, whose very first pregnancy (back in 1989) was a c-section (placenta previa) followed by two successful natural births (the last, in 1992, was unmedicated).  The two successful VBACs were uneventful...in fact, the question of whether I could VBAC was never even brought up in conversation.  My last child - the unmedicated one - was teetering towards the 10lb marker and was three days late.

Fast forward to 2011, first child in 20 years, uneventful pregnancy...but laws and hospital/doctor practice insurance has changed to where VBACs are rarely supported much less allowed.  In my very large city, there is only one doctor and hospital combo who will allow the patient to try (because once a c-section, always a c-section...add to that my age as a factor they want to consider).  The only show stopper...if you hit 10lbs the doctor will c-section you no matter what.  

Today, at a couple days shy of 36 weeks, at our now weekly sonogram the baby measured 7lbs 14oz and in the 90th percentile.  Until this week he's been in the 50s for measurement purposes. 

I've been told that the sono/ultra sound is more accurate than the tapemeasure abdomen stuff they do at the OBs.  The OBs have stated that the sono/ultra can be off +/- 2lbs, so it's at their discretion (I guess using their tape measure).

In our state, anyone who has had a past c-section for any reason - even those who have successfully VBACd - are not allowed to give birth in a birthing center.

The magic number of 10lbs has been sitting in my DHs head (He has a cousin who was over that number at birth and suffered brain damage as a result of oxygen being cut off during delivery)...so he is not supportive of my only option of trying for a VBAC, which is homebirth...and honestly, at 36 weeks we are cutting it close.

The doc at the ultra sound place mentioned waiting a week (because apparently there is a difference in babies brains/mental capabilities being born at 37 weeks and those born earlier) and then doing whatever I can to "get things moving" ... and suggested that I speak to the OB about inducing labor (which is something else I did not want to do with this pregnancy...I'd like the baby to come when nature says he's ready).

Honestly, I do not know what to do at all.  If I skip my weekly appointments monitoring the baby at the ultrasound place, I worry about something happening with the fluid/placenta.  If I miss my bi-weekly appointments with my OBs office (whom I just switched to a month and a half ago to have the chance at VBAC) then I fear they will make even more of a snap judgement during L&D if the baby is just a couple of ounces *under*...too, it's been darned difficult to actually get an appointment with the OB herself, as they want me to see "everyone" in their office (because she's the one to go to for VBACs her schedule is so booked)...I haven't even had a chance to go to her with my birth plan.

I don't know what to do, and I feel very lost.  My husband is a very supportive fellow, but this number and c-sections have been so drilled into him... I don't want to give up myself, but I don't know what else to do.  I certainly don't want to be stubborn about this and cause something to be missed and maybe harmful to this child.   

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Re: VBAC might be taken away from me (I need to vent and hear feedback)

  • That sounds like a very stressful situation to be in!  Do you have access to a doula?  My best piece of advice is to not make any decision on the spot unless of course it is a life or death situation.  If you don't mind me asking, which state are you in?  I'm sure others could chime in with some more specific help in that case.  I'll be honest and say that I don't know enough about risks over 40 like I do about GD and stuff like that, so I don't want to throw out my usual recommendations about skipping bpps.
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  • sounds like your state kind of forces you to do the RCS. I am so sorry. what state do you live in? Are you absolutly sure the state laws make VBAC fairly impossible? You could likely get a free consult from a lawyer....
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  • I'm in FL, and certain cities (none nearby my own) make it easier than others..meaning there may be a doctor who is willing to fly in the face of it.  State law, for the last year and a half (maybe 2?) nixes the birthing center.  Hospital insurances and policies (note: not the individual's health ins.) prevents most VBACs.  The state is the highest rated in the country right now for repeats.  My original OB stated that there was no medical reason for me to have a c-section but that his hands were tied by the ban at the only hospital to which he was associated.  He gave me a list of 4 other doctors he personally recommend, from differing hospitals, and many would not take me.  Others, and this seems to be the opinion on my local I-Can boards, that many doctors will receive patients for VBACs but then will switch from promoting them into finding reasons (like this 10 lb deal as an example) to forcing c-sections.   The state deems birthing centers as too risky for VBACs, so homebirth is the only option open if a woman can't find a doctor *and* a hospital...of course that leaves me out since my DH is so unnerved about what could happen in a medical emergency at home for either myself or the baby. 
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  • I would continue to go to your weekly appointments, so you can be monitored.  Could they do a NST, instead of doing an US every week?  I'll only have 2 US during my whole pregnancy.  Are they doing them weekly because you're AMA? 

    They can't force you to have an RCS.  The same way doctors use the "bait and switch,"  you can too.  Keep going to your doctor to be monitored.  If they try to push the RCS, you can beg for more time, challenge their test results, or flat out refuse.   Depending on the practice and hospital policies, they may or may not be able to drop you as a patient.  If you show up at the hospital in labor, they have to help you.  You're not going to make any friends, but you'll get your VBAC.

    It's a very frustrating situation, since you've already proven you are able to birth vaginally and a large baby too.

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  • imagecchill01:

    I would continue to go to your weekly appointments, so you can be monitored.  Could they do a NST, instead of doing an US every week?  I'll only have 2 US during my whole pregnancy.  Are they doing them weekly because you're AMA? 

    They can't force you to have an RCS.  The same way doctors use the "bait and switch,"  you can too.  Keep going to your doctor to be monitored.  If they try to push the RCS, you can beg for more time, challenge their test results, or flat out refuse.   Depending on the practice and hospital policies, they may or may not be able to drop you as a patient.  If you show up at the hospital in labor, they have to help you.  You're not going to make any friends, but you'll get your VBAC.

    It's a very frustrating situation, since you've already proven you are able to birth vaginally and a large baby too.

    The non-stress test started yesterday and will be received weekly.  Yes, the sonograms are becoming weekly (and have been more frequent than normal pregnant women) because I'm considered AMA.  The AMA is the only thing putting me in the "high risk" category...everything about this pregnancy has been wonderful/healthy.  The only stress that has followed me along is the threat of an unnecessary (and forced) c-section because of my first child (again, I've had two vaginal deliveries since then).  Now that we add the likely 10lb potential, it's increased the squeeze.   

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  • I'd start looking for an experienced midwife for a home VBAC.  I'm planning a home VBAC though, so my opinion is a little biased ;-)  I'm so appalled at FL's laws!  If you're set on a hospital birth, I'd try the things cchill mentioned and basically show up at the hospital pushing.  Short of a true emergency, I'd refuse a c/s.  And I'd get a doula that is VBAC supportive.  Having one more person on your team will reduce your stress and might help a lot!

     Sorry I'm not much help!  I'm sorry you're in such a stressful situation when it sounds like you're a perfect candidate for a VBAC.  Big hugs to you! 

     

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  • Ah jeez, I'm so sorry you're going through all that. It sounds insanely stressful (and the last thing you want to deal with while very very pregnant). I have the contact info for a traveling midwife - she will come to you. She's done tons of VBACs, and was my sister's MW for her HBAC last year. It's last minute, but it might be worth contacting her. PM me if you want. And good luck!!!

    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • The first ob doc I had could not do vbac because the hospital did not allow she had told me she had done a couple because when the woman showed up at the hospital it was time to push.  If your wanting all nature hold out until u feel like your about to deliver then present yourself at hospital. I know it sounds horrible but it might work in your case espically since you have had succesful vbacs in the past

     

  • Those regulations suck donkey balls, but at the same time, they can't force you to have a c-section no matter what their policy states. If you show up to the hospital in labour, they have to take you, and they can't hold you down and give you a c-section without your consent.

    Hold strong for what you want. Don't go into the hospital until near the end of your labour, if you can at all help it.

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