Successful VBAC's please come in for some much needed advice

ShandaB · September 2012

I hope I'm posting this on the right board. Yesterday, I had an appointment with an OB in the same practice as my MW to determine if I'm a good candidate for a VBAC. When I had DS, I went into labor naturally at 38wks and labored for 30 hours. I got to 9cm and stopped dilating so I had a c-section. The baby was never in any distress and tolerated the contractions just fine. The issue was all me.

Fast forward to my appointment yesterday. The OB told me that I can try for the VBAC if that's what I want but I would have to have continuous fetal monitoring. I told him that I was disappointed to hear that because one of the things that helped me manage my pain during labor was to walk. He then told me walking was out and I would be confined to a bed. Is this standard procedure for a VBAC? Has anyone had a successful VBAC with intermittent monitoring? Is the OB being overly cautious?

Squirrel29 · September 2012

Sadly I think those regulations are somewhat standard practice for hospital VBAC's. I think you should start looking for a new provider who is more supportive / willing to allow you to labor naturally. I had a successful VBAC in May with an OB in a hospital but will admit that my OB was extremely supportive (and I drove 45 minutes to another state specifically to see him on the recommendation of my ICAN chapter). I was allowed to labor and birth in a tub without any drugs or IV's. I did allow continuous monitoring but the hospital I was at had the waterproof portable monitors so I did not have to get out of the tub. If they hadn't had those monitors I would have refused the monitoring. I know that the hospital I was at technically has a policy requiring all VBAC's to submit to continuous monitoring and to have a IV started as soon as they are admitted but my OB was okay with me refusing these things and told me that most of his VBAC's do refuse those interventions. I think the single most important factor in having a successful VBAC is having a truly supportive OB. Contact your local ICAN chapter and get some recommendations. Good Luck!

hopecounts · September 2012

External Continuous fetal monitoring is pretty standard for VBACs but being confined to bed isn't.

My doc is fine with me moving around pacing, squatting, using a birth ball, etc. as long as the baby's heart rate is fine and what have you.

If one of the telemetry units is available I'm free to walk as much as I want.

I'd see if I could find a more supportive provider, if that is absolutely not possible I would go along and then stay at home as long as possible then refuse to stay in bed once I was at the hospital.

MAprincess · September 2012

I was required to have continuous monitoring but I was also an induced VBAC. I was able to walk and stand near the bed and sit on the birth ball. They disconnected it whenever I needed to use the bathroom and were pretty cool about "taking their time" plugging me back in so I could walk a bit. I was cared for by a MW for my birth at a pretty VBAC friendly facility.

kortial · September 2012

as everyone else stated continuous monitoring is very common. and I was given the same "freedom" as the other girls. I was able to use a birthing ball, squatting, pacing as far as my cords would allow me and bathroom breaks that could be 15-20 mins.

Waterproof monitoring sounds AMAZING! I am thinking I might start looking for that for baby number 3 now! haha

babyike · September 2012

I've had two hospital VBACs, and with both of them I was given the wireless monitoring (telemetry) set. I was able to walk the halls, get into any position I desired, and even labor in the shower/tub. Ask if that is an option at all for you. If not, you might start looking for other providers that are willing to allow you movement with the telemetry set during labor Yes . It does sound like your OB is not "up to date" with the current VBAC recommendations IMO if he's unwilling to allow you movement while being monitored.

HTH and GL!

nosoup4u · September 2012

Being stuck in a bed is NOT standard for VBAC. CFM is, though. Does the hospital have a wireless telemetry unit? I'd look for another provider if e isn't willing to budge on it...

akbride25 · September 2012

I was supposed to have continuous monitoring, but the midwives told me that I would still be allowed off of it to go in the tub and to walk around some. In the end I was stuck in bed because of unexplained bleeding. I ended up hooked to an IV the whole time and on monitors the whole time (except for bathroom breaks). I ended up getting an epidural because it was too hard to deal with the contractions when I couldn't do anything to manage the pain. Even though it didn't go as planned, it was still worth it in the end because I got my VBAC.

I just wanted to let you know that I had the exact same situation with my c/s. I got stuck at 9 cm and never progressed. My daughter was fine, but it just wasn't happening. This time around I had a successful VBAC and had no issues dilating to 10. Hope everything works out for you.

HSartteach · September 2012

I had a vbac with my second at a free standing birthing center. I did not have any fetal monitoring except for the doppler the mw would use to check heart rate. So, if you are up for that option, it is possible to have a vbac with no cfm.

annabelle.27 · September 2012

I had my vbac with a midwife at home. No continuous monitoring (doppler only), no being confined to bed. If I had chosen to deliver in hospital (midwives here have hospital privileges as well) it would have been the same. I think being confined to the bed is a ridiculous requirement. Is there any research that demonstrates that standing puts more strain on your uterine scar?

selockar · September 2012

I was allowed to walk the halls during my vbac. My ob wanted me to be monitored for 5-10 minutes every hour. If I choose to have an epidural then I would have been monitored continuously. Also, if i had any pitocin my ob required internal monitoring. Really as long as I did everything naturally my ob didn't restrict me anymore than her other patients.

VoiceOfR · September 2012

Sorry I feel like some of this is bad advice so had to chime in. The biggest risk with a VBAC is rupture. The ONLY way you know this may have happened is if the fetal heart rate drops. Once a significant drop is detected your doctor has about 25 min max to deliver the baby safely via csection (that includes moving you, prep etc.) Its not a lot of time.

You can fight against monitoring or settle on "every ten minutes" but it really isn't the safest.

All that being said, I was able to get up and walk around, use the bathroom etc. I would assume you can do the same unless you have an epi.

MAprincess · September 2012

VoiceOfR:

Sorry I feel like some of this is bad advice so had to chime in. The biggest risk with a VBAC is rupture. The ONLY way you know this may have happened is if the fetal heart rate drops. Once a significant drop is detected your doctor has about 25 min max to deliver the baby safely via csection (that includes moving you, prep etc.) Its not a lot of time.

You can fight against monitoring or settle on "every ten minutes" but it really isn't the safest.

All that being said, I was able to get up and walk around, use the bathroom etc. I would assume you can do the same unless you have an epi.

This is incorrect. The dropped heartrate is not the only way to identify uterine rupture. If a contraction goes away but you still feel an extreme sharp pain (and your belly is tender to the touch), then that is a sign. Often there is increased bleeding, and your contractions significantly slow or stop all together.

VoiceOfR · September 2012

That is news to me but makes sense so I am sure you are correct. There are probably some other things that can go wrong to watch out for as well. But that doesn't change the fetal heart rate being a major (I still think it is the primary) sign to look for and if you don't monitor it - you could miss it or lose very very valuable time.

VoiceOfR · September 2012

Do you have a link or reference that talks more about this? I am genuinely curious as mainly what I have seen has really been linked to heart rate.

MAprincess · September 2012

Surely- I just googled it. Every list that came up had all of those on it.

Here's wikipedia:https://en.wikipedia.org/wiki/Uterine_rupture#Signs_and_symptoms

Here's the list from vbac.com

Vaginal bleeding

Sharp pain between contractions

Contractions that slow down or become less intense

Unusual abdominal pain or tenderness

Recession of the fetal head (baby?s head moving back up into the birth canal)

Bulging under the pubic bone (baby?s head has protruded outside of the uterine scar)

Sharp onset of pain at the site of the previous scar

Uterine atony (loss of uterine muscle tone)

Maternal tachycardia (rapid heart rate) and hypotension

MAprincess · September 2012

FWIW, in my case, my midwife said I'd feel the pain immediately after it happened, so that was the primary sign we were looking for (I was monitored continuously anyway because I was induced) but my pain was what she was most interested in. Obviously, an epidural, etc would remove that symptom. But I think I would have definitely noticed the contractions stopping either way.

af2004rn · September 2012

I had a hospital VBAC. I declined the IV fluids on admission so I could get out of bed and shower. They did put a hep lock in, but I was okay with that. I am so glad I made that decision because everytime I got into bed, my labor stalled. When I opted for the epidural at 8cm then I was monitored continuously and confined to bed.

Twizzle · September 2012

Continuous monitoring was a requirement at my hospital, but they have 2 telemetry units so I was able to shower, get in tub, and move freely. I barely even noticed the monitors. The batteries did die after 12 hours or so but by the I had gotten an epidural so I was stuck in bed anyway

I did feel more comfortable with the continuous monitoring. I wouldn't have wanted to fight about it or try to keep taking it off. For me it would have been worse to have to get back in bed and hooked up to the monitor every 45 min. With the wireless unit I could just forget about it.

Successful VBAC's please come in for some much needed advice

Re: Successful VBAC's please come in for some much needed advice

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