Set up for failure?

llsarmy · February 2013

At my doctors appointment yeaterday we were going over what it will be like when I am in labor.

She said because I am a VBAC I need to go to the hospital right away ( I think I will stay home a while though) She said I have to be hooked up to monitors right away and they will put the monitor in the babies scalp (sorry I dont know what thats called) I have to have an IV and the require me to have a epidural and I have to have it early. She also said they wil check me every 2 hours and I have to progress every time they check me.

I feel like I am being set up for failure being stuck to a bed.

My question is should I look around to see if maby a midwife would give me more freedom? or is this kind of the normal.

jegoffin · February 2013

I'd look around. I had this same discussion with my ob last week. I am required to have an IV but not an epidural and I will have to have monitoring but my hospital has the wireless. She also mentioned having to labor mostly at the hospital but she didnt push it hard maybe since I have so long still to go?. I think it's at least worth a second discussion with your current provider or a consult with another.

cecilyandgautam · February 2013

That sounds awful. I don't think that's universally the norm - ACOG issued "less restrictive" guidelines for VBAC patients in 2010 but I can't read the full paper without being a member. Basically, I doubt your OB's professional association recommends all those restrictions.

A VBAC-friendly OB, or a midwife should generally be more favorable to labor taking its natural time. I dilated more slowly when everyone was pressuring me and jumped 2 cm when everyone backed off - I doubt I could progress properly under the conditions you Dr is advising.

If he's your only option in town, I'd labor at home with a doula who can confirm I'm at least 7cm before transferring.

Edit: Just found this PDF with a somewhat vague summary from ACOG but it discourages excessive restrictions on VBAC patients: "The guidelines emphasize that restrictive VBAC policies should not be used to force a woman to undergo a repeat cesarean delivery against her will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient?s desire to undergo VBAC, it is appropriate to refer her to another physician or center. "

Source: https://www.acog.org/~/media/ACOG Today/acogToday0810.pdf?dmc=1&ts=20130201T1354263875

iris427 · February 2013

I would keep looking. That sounds ridiculously restrictive. You certainly do not need internal monitors to have a VBAC. Internal monitoring requires your water to be broken, increasing the risk of infection especially if they are checking you often. having your water broken also puts you on the clock, meaning they will do a c/s if you haven't delivered in a certain amount of time. You also do not need an epidural to have a safe VBAC. It does kind of sound like they are setting people up for a repeat c-section, whether intentionally or not. Have you asked how many VBACs they do and what the success rate is? I would be interested to hear.

shibby00 · February 2013

This is very similar to the policy at my hospital. I do not plan to go in early, I plan to wait as long as I can, hopefully transition before I go in. I do not want an epi, or internal monitoring. I will refuse those things. They cannot force you to get an epi or internal monitoring. If you have another option look into it. Unfortunately I do not.

jesselayne8 · February 2013

It sounds like they are doing the bait and switch and aren't very VBAC friendly. I understand having IV access but not an epi. Last time my epi didn't work and I had to have a spinal so what's the point of getting an epi for an emergency csec??

I would look around if that's an option or stay at home as long as possible.

nosoup4u · February 2013

Definitely find another practice. None of those things are real requirements for a safe VBAC. Continuous monitoring is standard with VBAC, as is a saline lock, but other than that, you don't really need anything special. FWIW, my MW told me not to show up until I was in "active" labor.

annabelle.27 · February 2013

That sounds awful. At my vbac the only monitoring I had was via doppler. I had a homebirth, though, and to be honest, this is exactly the reason why I chose to have one. All that intervention scares me.

penguingrrl · February 2013

It definitely sounds to me like your doctor is putting a lot of restrictions on your VBAC, especially given how far along you are. I ended up needing a pretty high intervention VBAC, but that was circumstantial, not my OBs standard practice. In my case I had a history of borderline pre-eclampsia with my first and my blood pressures suddenly spiked, so I was induced, which changes the game a lot.

I was induced, so I was obviously unable to labor at home. But had I not needed an induction my OB was not insisting I be at the hospital (although I would have chosen to be very quickly; my own comfort level and personal preference).

Constant monitoring was required, but that was partially because I was being induced as a VBAC. It was not otherwise her policy to require that. I never once heard about having to have the monitor on the baby's scalp due to a VBAC and it was never brought up. That sounds like overkill.

I tested positive for group B strep, so I was required to have the IV because I needed IV antibiotics while laboring.

My hospital's policy was that all VBAC mothers were required to have the epidural port put in. But we were not required to have meds through it. That was absolutely our own choice. My OB, who I trusted immensely (not many OBs would induce a hypertensive VBAC) convinced me to get the epidural since the port was going in anyway. Honestly, I'm so glad she did. I ended up pushing for 3 hours and needing forceps and had I spent my energy fighting the contractions all day I would without a doubt have been too tired to push effectively by the end (I barely made it as it was). And I believe they would not have used forceps if I did not have the epi. They had mostly turned the epi off while I was pushing so I could feel what I was doing but they turned it back up a few minutes before using the forceps for my comfort.

I really don't like that you must be checked every 2 hours and must have progressed. I had labor stall for a bit and then everything went quickly from there. That really sounds like they're setting you up to fail.

So, while some of the interventions they mention actually made it possible for me to VBAC, it's very situational and I don't like that they're putting a blanket statement that all VBAC moms must have them. It sounds like they don't truly support VBACs and really won't let you do one unless it goes so fast they don't have time to prep an OR.

pepomntpat · February 2013

That is pretty rigid. I was told I should come to the hospital at the same point as any other mom (5-1-1). The only caveat is constant monitoring, but it can be with telemetry units and even if I have to be on the regular monitor I can be in a chair or on a birthing ball. I don't have to be in bed. And it is not the internal monitor which requires breaking your water. I am pretty sure I have to have a hep lock too.

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