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VBAC/TOLAC "rules" from your provider?

VitaLunaVitaLuna member
in VBAC
We just met with the OB in our MW practice for VBAC/TOLAC counseling and they have the following "rules". Wondering how in line they are with your provider?

-18 months between deliveries
-not past 41wks and must be spontaneous labor (they won't induce anyone with a prior c/s)
-only one prior c/s
-requires continuous fetal monitoring
-requires IV (saline locked ok)

I understand their reasoning behind all the rules, but my meeting with the OB was not very reassuring :( I've had one prior c/s for a frank breech baby (at 37w due to IUGR/oligo). I'm very concerned that my body won't go into labor on it's own before 41w, particularly because I was measuring a week behind at my first u/s and anatomy scan, but they didn't change the due date.

I'm also worried that I'll never have a "normal" vaginal delivery, or even be in labor, because we're done after this one. I though this visit would make me feel better, but it made it worse.

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Re: VBAC/TOLAC "rules" from your provider?

  • april&aaronapril&aaron member
    I'm currently due next week, 10/24, and hoping to VBAC.  Those rules sound fairly usual for most OBs.  Although, my original OB (who performed my c/s 3 years ago) wouldn't let me go past my due date at all; plus they wouldn't induce, so if I hadn't gone into labor on my own by my EDD, she'd just schedule a RCS.  

    I had a similar reaction to you, thinking how disappointed I would be at never having a vaginal delivery.  I wanted to have the absolute best chance possible to have the birth that I wanted, so I talked to my local ICAN (International Cesarean Awareness Network) group, and they pointed me towards a midwife/OB practice that has great VBAC success rates. I switched to that practice at 20w, and felt a lot better about their recommendations: 
    - They are ok with VBACs going to 42 weeks.
    - They will induce before going straight to c/s.
    - They require continuous monitoring, but they have wireless monitors that can be in water, so I can still labor in their tub. Yay!
    - They require a saline lock, but not required to be attached to IV.
    - They also only do VBACs with one prior c/s.  (In fact in my area, the choices for VBA2+C are practically non-existent.  It's really sad.)
    Neither practice said anything about required time between c/s and VBAC, although I've heard that 18 months is a normal guideline, though certainly not necessary.  I've read wonderful VBAC stories where the mama had only 12 or 13 months since c/s.

    I love the site vbacfacts.com for great info about the risks of VBAC vs c/s.

    Good Luck with whatever decision you end up making!  You are already on the path toward an empowered birth because you are asking questions and looking at the best option for you and your baby!  Wishing you a wonderful birth experience. :)
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  • katiedid0907katiedid0907 member
    The rules that you have seem to be in line with the rules that my provider has given me too. Hoping for the best, but not feeling like she's very confident about it happening...
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  • WickiBabyWickiBaby member
    The rules sound about right to me - very common. 
    If you aren't comfortable with them though, do your research and discuss it more with your doctor.  

    You need to be comfortable with your birth plan and not feel forced into anything.


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  • edan3579edan3579 member
    Sound pretty normal. Keep in mind those rules are there for a reason. They are not trying to make you fail, they are really just trying to make everything safe for you and baby... In a perfect situation vbacing may be safer than c-section, but as you begin adding variables like induction and going overdue you add risk. At some point the risk isn't worth it. The main goal is healthy baby and mom :)
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  • nosoup4unosoup4u member
    edited October 2015
    You can push back and ask them for non-stress tests and u/s monitoring past 41 weeks. Unfortunately, you can't get a provider to induce if they aren't willing to. How far along are you? Can you look around for someone with a more liberal VBAC policy? Have you asked them about the u/s dating?

    Continuous monitoring and saline locks are standard w VBACs. Induction of VBAC does carry a higher chance of uterine rupture, but it's still a very small chance (and one that should be available to women if they so choose and understand the risks). Good luck!
    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

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  • fishwife799fishwife799 member
    The only difference with my doctor when I had my VBAC is that she is willing to do low dose pitocin inductions. I also agree with PP about doing your own research and maybe finding a more VBAC friendly doctor if necessary. Having the support of your providor is very important IMO.


    babysizercom pregnancy ticker

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  • arwestover3arwestover3 member
    The hospital I'm at is going to induce me on Thursday, at 41+6. We're starting with a balloon, then breaking the water, then pitocin if we need to. The only thing they won't do is use cervical ripeners for a VBAC, but I'm fully effaced already so that doesn't affect me much. I do have to have continuous fetal monitoring, but it's waterproof and portable, so I can still walk around the halls and whatnot. I second asking your local ICAN chapter for advice, they are how I found the midwives and hospital I'm delivering with :)
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  • Kevang18Kevang18 member
    My OB pretty much said same thing except that I have to be dilated at least 1cm by 39 weeks to have my water broken and attempt the vbac. I hope it all works out!
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  • frieje17frieje17 member
    I would suggest that if having a VBAC is really important to you, you should switch providers. The key to success behind a VBAC is having a great support team and a lot of those rules are not in line with putting you in a good position to VBAC. I am planning a VBAC as well and saw three different OBs all of which either did not offer a VBAC or said I couldn't VBAC because the spacing between pregnancies wasn't 18 months or more. I now switched to a midwife who is completely supportive and will not hinder me with unnecessary rules like continuous monitoring or deadlines. I suggest reading Vaginal Birth After Caesarean The VBAC Handbook by Helen Churchill - it will give you a lot of information how successful VBACs are when they are attempted correctly and the ACTUAL risks associated with it. I don't know why the US is so far off with allowing women to have natural births, our C-section rate is just insanely high.
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  • Conky3000Conky3000 member

    This sounds similar to what I'm hearing (I'm in Canada). My midwife did mention that they would maybe use a foley catheter for induction, but no chemical induction because of the elevated risk of uterine rupture, so here's hoping I go into labour on my own and it progresses well. They're also requesting my delivery records from my C-section, in part to find out if I had a double layer or single layer incision. I'm not sure what happens if it was single layer...that has a higher risk of rupture as well.

    My previous C-section was due to breech twins.

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  • RunnerMegRunnerMeg member
    This is pretty much what my OB has told me. Though he said if we get to 41w, depending on what's going on at the time, I can go longer if I want.

    Please don't view continuous fetal monitoring as an unnecessary rule. CFM is the best and most accurate way to detect a uterine rupture. The incidence of rupture for a vbac Mom is 1 in 200. So it's low, but if it happens it is critical to have a stat c/s within 15 minutes. Many hospitals have wireless and waterproof monitoring, so CFM shouldn't hinder your labor.
    BFP #1 - EDD 4/18/13 | DS born 5/1/13. 9 lbs. 14 oz., 22 inches long.

    BFP #2 - EDD 1/25/16
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  • jesselayne8jesselayne8 member
    My OB was a little more relaxed. I was allowed to attempt with only 17 months between deliveries and she induced me at 40w4d by breaking my water and would have done pitocin if necessary.


    TTC#1 for 19 months with PCOS and MFI IUI#3 + injectables = BFP!!!!  Beta#1-134(13dpiui) Beta #2-392(15dpiui) 
    #1 born December 2011
    TTC#2 - Beta #1 -51@10dpo Beta#2 -1353 @16dpo
    #2 born May 2013
    TTC # 3 June 2014 BFP 12-1-14
    #3 born August 2015 
    #4!!!!!!! due June 2017 
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  • lucylove619lucylove619 member
    My OB hasn't given me any rules at all - he said if I haven't gone into labor by my due date we will see how in progressing and talk about options, but he didn't give me any deadlines or ultimatums, which makes me feel really good about it actually. My c-section was an emergency due to breech baby that wasn't descending, but my first delivery was an easy vaginal. I just love my OB and he acts like there's no reason I won't have a VBAC, he is very laid back about it. I would try to find someone that you feel super comfortable with and that you know is going to be fully supportive. I have barely given it a second thought because he is so confident about it, and it just takes a lot of the stress away.
    Due 3.27.14 (lame because I cannot figure out how to save a fun ticker.....)
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