Seeking your opinions
It's been quite a while since I posted on this board, so I'll give a quick background on my story. DD was born at 40w 3d via c/s due to fetal distress. My water broke the day before and I started having contractions, but they weren't really effective in changing my cervix. They started pitocin and I dilated to 10 shortly after. However, during the pushing stage, I developed a slight fever and the baby developed tachycardia. I was allowed to push for 45 minutes before baby's heartbeat got too high and they called the section. She was sunny side up and 8lb 2oz.
Now I just got a BFP! We are so excited and I think I am about 4-5 weeks along (my cycles have been a bit irregular, as I'm still BFing DD). Anyway, we went to our OB today for the first appointment to discuss VBAC and it did not go too well. Here are some of her "rules":
-If I don't go into labor by my due date, she wants to schedule c/s at 40 weeks. (Normally, she gives non-VBAC patients 40w 5d for the induction.)
-If growth ultrasound shows baby bigger than 8lb, she wants to do c/s at 39 weeks. On a related note, she wants me to gain no more than 20lbs throughout this pregnancy (I gained 43 last time, but lost it all within a month or two.)
-If labor stalls (dilations stops progressing regularly), then she wants to do the c/s right away.
-There will be no pitocin allowed for induction or augmentation.
Another troubling little topic we talked about was UR rate. She said "If VBACs were more widespread, the rate wouldn't be 1%. It would be much higher." Clearly, she thinks VBACs are somewhat dangerous. I do know she personally has had 2 c/s's.
I really like her as a doctor and would love to stay with her practice. Her bedside manner is wonderful, she spends plenty of time with patients, and her office is about 4 minutes from home. But clearly, her rules are not giving me the best chance of a VBAC. I could try to find another doctor, but it seems my county doesn't have too many pro-VBAC providers. I've checked my local ICAN chapter. I would much rather try to gently force my preferences on her, if possible, and stay with her.
I'm sorry this is so long. Thanks for reading. I'm just looking for input on whether these "rules" of hers are truly unacceptable or just a bit on the conservative side. Would you find another OB if you were in my position?
Re: Seeking your opinions
Uuuummmm. . . your doctor is lacking in math/statistics skills if she thinks that is how "rates" work. Yes, if that .5% was calculated with a sample size of 4, then adding more would make a difference, but the number of VBACs that occur in the country every year is well above the number it needs to be for an accurate and static calculation.
Also, the fact that she doesn't even let a regular pregnancy go past 40 weeks 5 days is troubling since the latest research has suggested that the average length of a pregnancy is closer to 41 weeks. This means she isn't letting ANYONE go to term.
And the weight gain thing is stupid along with her rule that you are not allowed to vaginally deliver a baby over 8 lbs (by HER estimation on a late term ultrasound?)
Nothing you have mentioned in your post suggests she's anyone you should be delivering with. Just because she is "nice" doesn't mean she has your or your baby's best interest in mind. She has decided her own way to do things regardless of what is safest or best for you.
I'm sorry if I am coming off as harsh. Your question was whether she was conservative or truly unacceptable, and the answer is "truly unacceptable". VBAC or not, her medical opinions are troubling. She will never let you force your preferences on her. The only thing I'll give her is that she was honest with you from the beginning. Definitely look into another OB.
Thanks for your reply. I think I needed to hear this type of opinion from a third party, because l do like her as a doctor and I had a positive experience with my first pregnancy with her.
As far as the statistics issue, I hear what you are saying, but I do not think she is so ignorant as to not understand the basic calculations of a percentage. I think when she was saying that UR is probably higher than 1%, she's basing that on her personal experience of seeing uterine scars and the mechanisms of rupture.
The studies do show a UR rate under 1%. So I guess she is not practicing evidence-based medicine in that case, and that's clearly a problem!
I agree with MA.
Also, after reading the above underlined sentence from you, I want to give you my two cents on that. I absolutely love my OB from when I was pregnant with DD. I always go back to seeing her after the post-partum check in-between pregnancies, and I plan to go back to her after this LO is born. That being said, she has very similar "restrictions/limitations" for VBACs to the ones your OB gave you. IMO, this means she is not only hesitant with VBACs, but it's also very likely that she's uncomfortable doing VBACs. I politely confronted my OB about her comfort level, and she was thankful I had "caught on" to her subtle hints. She provided me with references to a larger OB group at a hospital downtown with a great VBAC rate. Even though her office is less than 10 minutes away, I am so glad I switched to the downtown group that is 45 minutes away.
I think you would be in much better hands with a more VBAC-supportive and VBAC-experienced provider. If you stay with your provider and she is uncomfortable with VBACs, then you are putting both you and her in a touch situation.
Pitocin is safe at low levels for both induction and augmentation of VBAC labors. Growth u/s can be off by +/- 2 lbs, so going off of that is unreliable. And though your area may only have a few VBAC supportive providers, a few is better than none. Go to the local ICAN meetings, ask questions, and get recommendations for care providers
GL to you and congratulations on your BFP!
~Sweet Girl *8/18/08* c-section ~ Sweet Boy *12/2/10* VBAC ~ Sweet Boy *8/14/12* VBAC~
VBAC Birth Story 2VBAC Birth Story
Thanks for your opinion. DH and I have been talking about this all day since our appointment. And it's definitely looking like we are going to have to reserve her only for GYN appointments, not OB ones!
Sorry but I agree with the other ladies. If you want a real shot at VBAC, you need to look for another provider. It sounds like the only way you will get one with this doctor is if you walk into L&D at 38 weeks with a head falling out of your vagina. Otherwise I would bet money that she will find a reason 8-9 months from now that you "need" a c/s. We have seen it happen with a lot of moms, unfortunately. You may be able to "force" a VBAC but why not try to find a doctor or midwife where you won't have to do that at all. My first delivery was with an OB who didn't really support me and my second was with one who fully supported me and I cannot even express what a difference that made in every aspect of birth.
And yeah, your doctor doesn't seem to understand what a rate is. You said this was an example of her not practicing evidence-based medicine, and I agree. And in fact, everything else she said in your OP were also examples of her not practicing it, at least in regard to VBAC.
Her rules sound really harsh to me. (especially the growth ultrasound - since we know how inaccurate those can be. Lots of women go on to vbac bigger babies with no problem) I understand liking your provider. I love my office. I could have switched to someone that was even more proVBAC. My office is supportive of vbacs (if the patient expresses an interest - not really going out of their way to provide one) and there were even times that I doubted myself for staying.
For example, the doctors all recommend scheduling at 39 weeks and I said I didn't feel comfortable with that and wanted to go to at least my due date. I liked her response to what I was telling her made me uncomfortable. She had no problem letting me go past my due date and told me as well that even if I have a scheduled c/s she won't come to my house to pick me up - that she would understand if I chose not to show up.
If you really feel like you have to stay there ask the WHY she feels this way. I liked my doctor's answers to all of the questions I asked. Unfortunately it looks like I'm not even going to get a chance to vbac unless this baby gets out of breech position.... but I am happy in my choice of providers and know that I haven't had to second guess myself which has made the pregnancy more enjoyable.
I agree with everyone. Having had two c-sections for FTP, it took me longer to learn that I was seeking medical care from the wrong place. I had such similar feelings to yours and attended an ICAN meeting to talk about my OB loyalty and get feedback. But switching to a more supporive caregiver this time was MUCH easier (practically and emotionally) than I thought it would be, and the door seems to be open for me to return to the OB if I choose for regular GYN checkups if I wish.
When you find a truly supportive provider, you'll know it. You'll start focusing on your birth and won't be wasting your time worrying about these restrictions.
Since you're early in pregnancy (congrats!!), I recommend reading Natural Childbirth After Cesarean by Crawford and Walters, two VBAC moms. It includes a chapter addressing the importance of finding the right caregiver. Good luck!
I agree too--I wouldn't want a csection because a baby was big (and 8 lbs really isn't big). I would want a chance to have the baby vaginally.
I love my OB but would have switched for this birth in a heartbeat if I didn't get the answers to my questions that I needed to hear/didn't have her support. She will let me go to 42 weeks and the only reason she said we would do a RCS is if the baby is breech/other health issues/I request.
You are still so early I would interview other OBs now to see what they say.
Good luck! This board has been great for me to read and post. Very supportive, empowering and knowledgable!
Thank you for all your support and opinions, ladies. I like her as a doctor not because she is "nice" but because she is compassionate, informed (in most things), and had my best interests during the last pregnancy AND delivery. The truth is, on our way home from the OB yesterday, I was telling DH that we will most likely have to switch OBs. I really needed to hear it from a third party.
I want to enjoy my pregnancy and birth and not have to walk on eggshells such that if I break one of her rules, she will use it against me. The 20lb weight gain rule seems so harsh, considering I am in the middle of the normal BMI range and have no medical complications. I feel like if I have one extra slush or something and gain 25 lbs, she will try to force the c/s. Not cool!
Your feedback, ladies, has given me the motivation to start looking for another OB. Thank you for that! I will start calling OB offices tomorrow and try scheduling "interviews" with the doctors. I pray I will find an OB that is more on board with this plan. I am looking forward to finding a supportive partner in this!
So glad you are comfortable with that decision! I also agree with the other posters who suggested part of your doctors problem might be that she is just not personally comfortable or really experienced with VBACs. If that's the case, I'd prefer to be with a doctor who IS comfortable with them rather than try to force it on her. Just like with any profession, some doctors are better at certain things than others. VBACs just aren't her specialty.
My midwife was so laid back about VBACs because so many of her patients were in the same camp as me. It made me more comfortable knowing that VBACs were a norm for her. If you find a provider like that, I am sure you'll feel the same comfort I did.
Good luck!
Ditto to what everyone else said. I had a very similar first birth as your (baby was OP, 8 lbs, pushed for a really long time and ended up with a c/s). I had a successful VBAC with my second son, and the MW I saw never gave me any restrictions on what I needed to do to be able to plan a VBAC.If anything, whenever I had misgivings about my second labor, she would shoo them away and assure me I was going to VBAC, no problem!
Good luck finding a new provider - sometimes family doctors are more supportive of VBAC, or hospital-based midwives. If you're having a really hard time finding someone, maybe look for a local doula or childbirth educator - they usually know the local providers pretty well.
DS2 - Oct 2010 (my VBAC baby!)
I agree with all the other ladies and I think you have made the right decision to look for a different provider for your pregnancy. I think it's very very important to fully trust your provider and feel that you are both on the same page about what you want. Trying to force your preferences on someone, especially when you are in labor and your brain's working differently, is not going to go well or be comfortable for anyone.
I have found ICAN to be a great source for good VBAC providers, as well as talking to local doulas who have VBAC experience. Good luck finding somone!