What should I be declining with the intention to VBAC?
Jessimurph
member
My husband has been super supportive, I now have a great doula and the information on this forum has been invaluable. I had the c-section because of a growth ultrasound and "huge baby" so the plan is to decline a growth ultrasound because it was so inaccurate last time.
I've heard of women declining internals. What is the reason for this? So the OB doesn't tell you it's unfavorable based on no softening/dilation? Anything else I should research so I'm able to decline things that aren't medically necessary and will give me a higher chance of being bullied into RCS? I'm ready to stand my ground and fight for my VBAC and much more educated this time, but I am afraid of the scare tactics like were used last time...especially if it's something I haven't researched.
When I found out my son will be born with bilateral clubfeet I had decided to not decline any further ultrasounds, but now that I have had time to think about it his clubfeet is not a good reason to keep checking on him and find out he's supposedly ginormous.
Re: What should I be declining with the intention to VBAC?
Internals: many women are declining them for 2 reasons, A~ its is very uncomfortable if you have not started progressing. B~ Dialation and effacment progress are not good indicators of when you will go into labor. Women can be 2-3cm and 50%+ eff. and still waddle around for a month.
Inquire with your doula as well, but many interventions can lead to a higher chance of RCS. For instance, my OB agrees, no induction, the drugs can cause to hard a contraction and increase chance or UR. Epidurals can stall labor, leading to the need for those drugs to restart things as well.
People often decline internals because they're worthless. They tell you if you're dilating, sure, but that information means nothing. You can be walking around a couple cm dilated for weeks, or go from 0 - 10 within hours. With my last pregnancy, my doctor didn't do them routinely because he didn't see the point. But yes, I can see some unscrupulous doctors telling you that because things aren't progressing you should consider another c-section.
To be honest, I'm surprised by the amount of women on the Nest who are even offered "growth ultrasounds." I've never come across anyone who has had one in real life. Maybe it's regional? I was 10 days overdue with my son and it was never even mentioned that he might be "too big."
Consider yourself lucky. When I walked into my 1st OB appt for my first pregnancy at 5ft and 95lbs with my 6ft 4 inch 230lb husband "size" was an immediate issue and it was discussed at every appt. It didn't help that my DH was a 10lb baby. DD measured ahead at all my ultrasounds and I had at least 2 aditional for growth alone including the one the day before I went into labor which ultimately sealed my fate. And it doesn't just stop with the the ultrasounds then came the fear mongering...the X, X, X, and X that could happen to your baby if you don't do what we say. Add this to being awake for 48 hours and contracting for 14 hours...FWIW, all the ultrasounds were way off and DD was 7lbs 14oz so I'm now using a free standing birth center and am trying to stay far away from any late ultrasounds.
I think it happens a lot and you are not going to find anything in main stream pregnancy books or hospital classes that tell you can refuse the ultrasounds or what the actual ACOG guidelines are for suspected fetal macrosomia.
I declined internals the first time around - until like 41 weeks, then I just had to know. Of course I was completely closed and high. After that I also had a growth ultrasound and a NST, because I wanted to make sure everything was ok with baby and fluid levels to wait another week. For me, having them did not make my provider jump the gun or anything. I had my c-section at 42wks1dy after a failed induction.
This time, I have a super midwife who I know is VBAC supportive. She doesn't do growth scans, but she will have to do an internal at 41wks to see if I'm favorable for an induction.
I've seen a lot of doctors on the boards use internals as a way to bait and switch at 37-38 weeks. "You're not making any progress and the baby hasn't dropped at all. I don't think you're going to be able to VBAC. You'll be 39 weeks on Monday so let's schedule your c/s for that morning."
I also think internals often just add stress without being helpful. They don't tell you when you'll go into labor or whether you'll need a c/s. They don't improve maternal or fetal outcomes. But think about how many posts you've seen on here where people are freaking out about whether they are dilated or not. It's not worth the stress IMO, nor the opportunity for a doctor to use it against you when it comes to a VBAC.
I can't think of any specific thing you should refuse. I think the important thing is to remember you can always ask a lot of questions--why is this recommended, are there any alternatives, what happens if I don't do this, what are the risks and benefits, etc.
GL
I wish I had declined internals. It puts you on their clock and they started pushing me toward a c/s because I was "stuck" at 7cm for over 12 hours.
Monitoring during labor is another thing I'd be inclined to refuse. I could feel him moving around during labor and they were freaking out that his HR was dropping because my monitor was sliding around. It really broke my concentration to have them messing with the monitors constantly. Intermittent monitoring is another thing to look into. I would refuse an internal contraction monitor. It really hurts and they're pretty useless. I refused mine for HOURS until she wouldn't shut up about it so I let them put it in, which was a mistake.
Basically read my birth story and look for all the interventions they pushed on me to avoid! LOL.
I was thinking that you probably want to look into internal monitoring, also. Constant monitoring is pretty standard no matter where you are (hospital-based), but requesting external monitoring is completely reasonable - I would only do internal if something came up. You can ask for just a hep/saline lock instead of a full IV. I agree with everyone else about internals - I had none with my second son, but part of that was also because I didn't show up at the hospital until I was pushing (it's a great tactic to avoid them, hee hee).
Do you know the book "The Thinking Woman's Guide to a Better Birth"? It's by Henci Goer, and she writes about all the standard interventions in hospitals...some might not apply because you're a VBAC, but it's a good reference in general.
I had one NST with my second pregnancy, and I made a point of declining the u/s portion of it. I had to explain my reasoning (the NST showed that my placenta was fine, and the baby was fine - the u/s is just another level of intervention to see the same thing), and I had to sign an AMA form, but the nurse and MW were pretty nice about it. It's hard turning things down, though! Good luck.
DS2 - Oct 2010 (my VBAC baby!)
Ok, so you can decline internals even in the hospital? I am hoping to get to the hospital as close to pushing as possible. A lot of things are presented in a way that it seems to be not optional. I remember at 34 weeks the nurse had me undress and put the drape over my legs in the office and the OB did a cervical check. No explanation or anything...
So if he wants to do a growth ultrasound before 40 weeks and fights me a little for other medical reasons it would be justified for me to ask for an NST instead of the growth u/s? How are fluid level checked?
I'm good asking for a hep/saline lock although I would rather have nothing.
I will also look into intermittent monitoring and the foley bulb...I've never even heard of the foley bulb before.
I have been trying to avoid being a difficult patient with my OB, but we're not even close to my 41 week deadline to go into labor and he's already suggesting my baby is huge and that a c/s will probably be best for everyone. I have a huge list of things we will talk about next appointment and expect a pain in the butt label. Oh well.
Keegan Patrick - Bilateral Clubfeet found at Anatomy Scan.
www.facebook.com/portraitave
I personally am okay with an internal when I first show up at the hospital, but it's your call. I would think you'd get a pretty hard time declining that one, unless the baby is crowning when you walk in, you know? But if you're at the office and they request one, just say no. Every time I've declined something, the nurse or who ever is always been a lot nicer than I expect them to be about it.
Part of a NST is an u/s, and they look at the fluid levels, if the baby is doing practice breathing, things like that. I was told by my MW and my doula that if the non-stress test portion is okay (the baby's heartbeat reacts to any contractions, and shows variables), then the placenta is working. I had mine at 41+ weeks, bc I had gone past 40 weeks. But it's really up to you and your comfort level with whether you can decline it. I *think* you can request no size estimates if they do an u/s, but I don't know if they would honor that request...
https://www.americanpregnancy.org/prenataltesting/biophysicalprofile.html
Last thing: Would you be willing to switch providers this late, or even? He doesn't sound very VBAC friendly, in all honesty.
DS2 - Oct 2010 (my VBAC baby!)
He's not, but it's a huge problem in my area. The only two REAL vbac friendly options where I wouldn't have to put up a fight and could trust them 100% would be one of a few homebirth midwives and one midwife that delivers in the hospital. I wanted to go with the midwife that delivers in the hospital, but the OB that oversee's her patients requires a CASH medical mangement fee of $3000. That is more than we are able to handle and I think it's sleazy of the OB.
I really would love a homebirth, but I am afraid that if something went wrong I wouldn't get to the hospital on time and would never forgive myself.
Keegan Patrick - Bilateral Clubfeet found at Anatomy Scan.
www.facebook.com/portraitave
I had a foley bulb to start my induction and it was great. I don't know why it's not discussed more often. I'd never heard of it before my midwife suggested it. You should ask if they'll let you put it in and go home, I had to stay at the hospital once it was in but some will let you go home to see what happens.
Sorry if you have already said... but why does he think the baby is huge?
We had to have additional ultrasounds because of his birth defect and he was measuring 2 weeks ahead. My belly is also measuring 2 weeks ahead. He keeps saying since your daughter was 8lbs 12oz at 39 weeks, this one will likely be even bigger.... I'm going with my the 'my body is unlikely to grow a baby too big for me to get out' way of thinking. I was 8lbs 12oz and my brother was over 9 and my mom had us both med free.
Keegan Patrick - Bilateral Clubfeet found at Anatomy Scan.
www.facebook.com/portraitave
My blog
Keegan Patrick - Bilateral Clubfeet found at Anatomy Scan.
www.facebook.com/portraitave
Ah. Did you post that on this board awhile back? I think I remember reading that before, sorry if you did!
Anyhoo, yeah, that sucks all around! I guess the best plan of attack is politely declining what you want to decline, and then stay at home until you're pushing, so you hopefully won't have to deal with being on the clock. I hope it works out for you!!
DS2 - Oct 2010 (my VBAC baby!)
I would decline anything that they offer to "help" you along. The more interventions you accept the more likely you are to end up with a RCS because they'll "rescue" you from one intervention with another intervention and it just spirals out. Talk to your doula about alternative inducements/augmentations should you need them. Also, try to labor at home for the majority of the time...certainly don't show up pushing, but if you are laboring at home (and your doula will follow you from home to hospital) you won't have hospital staff trying to offer you anything early in the process...particularly at weak moments.
You can continue with ultrasounds if you want to measure/track things like fluid and placenta but can decline things like growth measuring if you feel that might be an issue. I'd personally continue with NST.
You can ask that internals be limited to that which is absolutely necessary. I'm asking my OB to hold off on things like water breaking and membrane scrapping until I've had a fair trial of labor and before they think of introducing medical interventions like pitocin (even on low dosage). In addition to some of the reasons already presented about internals...it's because a cm isn't always a cm. Everyone's fingers are different, so what will be 3 cm to one person checking you might only feel like a 2 cm...or maybe a 4 cm. Remember, nothing here is exact, it is just a best guess scenario. My doula suggested if I were going to submit to interal exams that I should request that only the OB do it (same set of hands, LOL) and that everyone else should back off. You might also see if your hospital/doc will agree to only a hep lock rather than an IV and if they'll agree to intermitent external monitoring of the baby unless and until the baby shows signs of distress. Not all hospitals offer that, though.