Should I try to find a new OB?

[KrisM]

I had a c-section with DS and really want a VBAC this time. I used a midwife/OB practice with DS and am at an OB at a different hospital now. I'm wondering if I'm at the best place or not.

Old practice:
1. Has a bunch of strict "rules" for VBACs - 40 weeks and then a c-section, must be continuous EFM, etc.
2. Midwives can not deliver VBACs.
3. The hospital has great rooms that are very comfortable and huge.
4. The hospital has EFM that operates on telemetry, which means if I do need an IV and EFM for some reason, I can move around the whole floor and still be monitored.
5. The hospital has all private Mom and Baby rooms.

New practice:
1. The OB treats me much more as an individual and if all is fine, I can go to at least 41 weeks and then he'll try "light" induction.
2. The hosptial's rooms are very hosptial like and fairly small.
3. No telemetry, so if I am hooked up, I am limited to where I can go while attached to a machine.
4. The doctor seriously overbooks and I always have a long (45-90 minute) wait for my appointment.
5. The hosptial has all "semi-private" Mom and Baby rooms, which means I can potentially have a roommate.

I'm almost 28 weeks now. Everything has been just fine. I plan on Hypnobabies and no epidural for this birth.

Should I try to find another OB at the first hospital? There is a 3rd hospital that is further away and harder to get to that will allow me to use the midwife practice, but not their birthing center. I don't know much about the hospital as far as VBAC and telemetry goes.

I am working on finding a doula, too. I really, really don't want a c-section so I want to be at the best place with the best people if I can. I just don't know what to do.

[HannaAddict]

I only reply since you asked. I would stick with your current/old practice, if you like them aside from their approach to VBAC. I don't consider it strict at all that they don't induce for VBAC, that is for your and the baby's safety, really. I would be wary of any OB who was willing to induce for a VBAC or go past your due date. Even if midwives can't deliver VBAC's, can you have a doula for support? It sounds like the hospital is nice, etc. too. My OB also supports VBAC at a terrific hospital. And she doesn't induce for VBAC either, etc. The strict rules you referenced are pretty standard obstetrical practice standards. Since with VBAC there can be very rare, though catastrophic consequences, my own feeling would be to take the more convservative approach. I know c-sections can have serious complications too.

And shallow as it sounds, I would not want a semi-private room after having a baby. But, that of course, would not be my main concern. :)

Good luck with your decision.

Kimberly

[american_mama]

I'd make a list of your priorities. For my second birth, the hospital rooms were not homey in the slightest, but I decided it didn't matter. Private rooms would have cost significantly more money, so I unhappily resigned myself to a shared room (which was 100 times better than I expected, BTW.) Make your own list of what matters most or what tradeoffs you can accept.

[pritchettzoo]

Well, "rule" #1 is only their suggestion you know. They can't make you have a c/s. :) If you refuse until 41 weeks, then you go until 41 weeks, kwim?

I researched and planned for a VBAC with Eli, but it did not work out for us.

Continuous monitoring during labor I think is an ACOG recommendation. As is the no induction. It's very uncommon to induce with a VBAC because of the increased risk for uterine rupture. My midwife recommended all sorts of non-medical induction techniques (accupuncture, massage, having sex, etc.) though.

The rule about midwives not delivering is more than likely set by the hospital and/or the physicians' malpractice insurance. I would bet that if you are really comfortable with the midwife/midwives, they could be there to assist with a doctor supervising. The ACOG guidelines require a doctor/surgeon to be on call on site while a VBAC labors. The practice I used would not have called the doctor into the room unless I requested him (they were all males, I'm not just using "him" randomly ;) ) or unless the midwife requested assistance or medical necessity.

If you really want one, I would recommend a doula. Ours was wonderful even though I wound up with a c/s. Your doctor won't actually spend much time with you while you labor, whereas the doula will be with you the entire time. Also, I bet the midwives in the practice would be willing to assist in your labor even if they can't "deliver" the baby.

Room comfort would be a huge concern of mine. As would the overbooking. If he has that many patients, how much time will he have to spend with you when you go into labor? The long waits will be a huge PITA as you get farther along and have to go every week, especially if you have a toddler in tow. My practice was horrible about the waits and it sucked. They were the best for VBACs in the area, so it was a tradeoff for me.

I would find a doula and get some recs from her on where she has had success. The doulas I interviewed all recommended the practice and the hospital we chose.

Good luck!

Anna
Mama to Gracie (Sept '03) and Eli (July '05)

[muskiesusan]

Kris,

I would find a doula first and get her opinion. She most likely will be up to date on what hospitals and ob offices are the most VBAC friendly and help you sort out what you need. Mine was invaluable in this respect. The doulas around here tend to keep in contact and have a meeting monthly to share information, so she really had the most realiable info that I could find. Oh, and I would ask these questions of even the doulas you interview just to get the most information!

Good luck! I can't believe how hard they make it on us to birth!

Susan
Mom to Nick 10/01
& Alex 04/04

[bubbaray]

The "old" ob's rules seem reasonable to me. Personally, if all other things are close to equal, I would choose the hospital private rooms. The thought of sharing a room during/after labor weirds me out. But, then again if I can ever get and stay PG again, I am looking at a scheduled c/s, not VBAC, so my choice is based in part on the length of time I know I'll be in the hospital, KWIM?

I would think that telemetry would be conducive to a successful VBAC, as opposed to being confined to bed to monitor. And, the overbooking/late appt thing would drive me mental.

Good luck.

Melissa

Maya Papaya!
http://lilypie.com/baby2/040411/3/4/1/-8/.png[/img][/url]

[KrisM]

>Continuous monitoring during labor I think is an ACOG
>recommendation. As is the no induction. It's very uncommon to
>induce with a VBAC because of the increased risk for uterine
>rupture. My midwife recommended all sorts of non-medical
>induction techniques (accupuncture, massage, having sex, etc.)
>though.
>

Actually, the ACOG says only that Pitocin and prostaglandins shouldn't be used. They don't say anything about stripping membranes or breaking waters to try to induce labor. I don't think either of those procedures increase the risk of uterine rupture. The first practice won't even consider those things.

The midwife not delivering rule is set by the hospital.

I am definitely getting a doula. I have to get moving on that!

Trust me, the long waits are already a PITA! They don't have a very child friendly waiting area, either. Last time, once we got in the room, DS made a mess because I let him play with the water in the sink (I cleaned it up). But, really, we'd been there for 1.5 hours at that point. What do they expect?

thanks for your input. The 2nd guy was written up in the newspaper for his support on VBACs and is well known around here for them. I am completely afraid of another c-section, so I really need everything going for VBAC as I can.

Oh, another major difference in the hospital is the 1st allows me in the tub even after my water breaks. The 2nd won't.

[KrisM]

That's a great idea! I will definitely be asking that question of the doulas.

Thanks.

ETA: I sent an e-mail to a few doulas. I received 1 reply so far and she recommends the OB I have switched to (#2). She thinks everything is great, except the waiting time for his appointments. Kind of funny.

[KrisM]

According to the ACOG guidelines, going past 40 weeks will decrease my chances of a VBAC, but does not increase the risk of a scar rupture. I'm willing to take that chance to avoid a c-section.

Another thing - I did the full screen for Down Syndrome back at about 12.5 weeks. The ultrasound that is done moved by due date to 8 days earlier! The old practice changed my due date from May 23 to May 15 and the new practice doesn't change them until they are 10 or more days off. So, I would be given a c-section even earlier. As we were moving, etc., I am pretty darn sure of my dates!

I agree about the semi-private room thing. That would just seem odd.

[essnce629]

I'd suggest hiring a doula and reading the book "The Thinking Woman's Guide to a Better Birth" by Henci Goer. There's a whole chapter in it devoted to VBACs and what you can do to increase your success. There's also a list of questions to ask your provider and hospital to find out how "VBAC-friendly" they really are. I have the book and can post some of the things later. It's an excellent book though and I suggest it to every pregnant woman I talk to. And remember, it's never too late to switch providers-- I've heard of several woman who switch as late as 36 and 38 weeks, which is a time when a lot of providers true colors come out!

***Latia (DONA-trained doula--Yay!)
Conner, my homebirthed water baby, 8/19/03
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months! http://www.windsorpeak.com/dc/user_files/9870.gif

[brittone2]

I just wanted to add that I also think it would be great to ask doulas....all of them that you interview, as that will give you some ideas.

We ended up switching practices (from OB to midwifery practice, which I had wanted but originally didn't want to do a 45 min drive to the hospital and the midwives' office. ) after talking to our doula. She was very very nice, but I was able to read between the lines based on her experiences w/ the original OB practice and the hospital they delivered at. I also found out that hospital 1 required things like a hep lock, no eating/drinking in labor, no laboring in any sort of tub possible, etc. and I knew I didn't want that. I am sooo glad that we worked with a doula and figured all of that out in advance.

I have no personal experience w/ vbacs but I'll bet if you interview several doulas you could probably get some great advice. Great advice from the PP that recommended it originally.

[KrisM]

I've read it! Great book.

I think what I'm going to do is as the doulas their opinions on doctor's and call the old hospital and see what the nurses say about OBs who do VBACs. Maybe I can get a recommendation from them. I think that my current OB is extremely VBAC friendly and is very good at treating me as an individual rather than a VBAC "case", but I worry about the hospital end of things. Hopefully, I'll find something in the middle.

[allthetimemom]

This is none of my business, but...

I had my first baby by c-section. My husband was quite adamanat about natural birth and very much wanted us to try VBAC for 2nd. Now, my ob is a high c-section rate doctor anyway, but told me that the recommendations on VBACS has changed in recent years to be much more conservative because there was a greater risk of rupture than originally thought. He'd seen rupture. He was blunt and said that because if I tried VBAC I'd have a good chance of being dead on the table, and so, he would not be the doctor for a VBAC.

Of course our circumstances could be very different. It's just from your posts that your first ob sounds conservative and wise. I feel most obs really want a healthy mommy and baby. Being too natural with midwives could put you at risk. I'd go for whoever has the most medical training, experience, skill, because in childbirth, you never know...

Re: rooms. I sure wouldn't want a roomate after childbirth! Some moms have an easy time and are cheerful; some moms are wretched and cry in the hospital. Some have tons of visitors which is disruptive and brings in that many more germs to your newborn. The wrong mix could be quite painful. After childbirth is so personal. Definitely the private room is worth quite a bit.

[mommy111]

Which doctor is better? Which hospital has better nurses? Which hospital/doctor has better stats for VBACs...and I mean not conversion to C-section but also mortality/morbidity stats.
My baby and I nearly, to be blunt, died during my delivery and although a natural birth and all is great (our family really wanted that), I realized at that point that the only really important thing is for the mom and the baby both to be well and healthy and that everything else is secondary.
Please be safe in whatever decision you make...and I hope you end up delivering naturally and happily.

[KrisM]

My c-section was something I don't want to repeat. Neither the epidural nor the spinal worked completely. I felt the cutting and it hurt. I do not want to experience that again. I feel that the risk of 2.8 in 10,000 of dying from a VBAC is worth it to me. It only goes down to 2.4 in 10,000 with an elective c-section. Both are pretty small, in my opinion (source: http://www.ican-online.org/resources/statistics4.php)

Yes the first doctor is more conservative, but he also just treats everyone as a VBAC case. I think being treated as a woman who is pregnant is more benefitial and my current OB looks at me as an individual instead of a statistic. Of course he wants a healthy mom and baby. He also wants a happy mom and baby.

With the midwife practice, with DS, a OB from their office would be at the hospital when I reached 7 cm in case of a c-section. In my case last time, I only got to 4 and an OB from their practice did the c-section. The hospital also has OBs who are staffed 24 hours/day, so it's not like I wouldn't have that available. The biggest plus with a midwife is they are more willing to stay with you and work through things instead of popping in for a minute or two.

Thanks for your opinion. I do appreciate the input as it gets me researching different things!

I wish I knew now if I'd have a private room or not. They say "usually" they end up private, but...Sharing would be bad.

[KrisM]

I will call and see if I can find those stats. Good idea. I believe both doctors are good. My current (new) one has been asked by the old hospital to go there numerous times, but because of his home location and a few other reasons, he has chosen not to. I had a nurse from hell with DS, so I'm not sure I can answer that question!

I'm glad you and your baby made it through. As I said above, I felt my c-section and that is awful, although it is over in just a few minutes. Not as bad as nearly dying, of that I am sure, but not something I need to do again, either. It's so hard to know what to do.

[squimp]

Oh man, that tub thing would be the dealbreaker for me. I spent all of my labor in the tub, save the 20 minutes of pushing. I really think being in the nice warm tub helped me avoid pain meds and tearing. And I stayed at home as long as I could before I went in, so I was almost in transition - just far enough along that I had no interest in walking around. I just wanted to crouch in the tub.

Honestly, the 1st hospital sounds like a better overall experience. I cannot imagine sharing a room after having a baby. But I know nothing of c/s or VBAC.

[mommy111]

I am sending good vibes your way...

[HannaAddict]

Just wanted to say let you know I totally understand a less than desireable c-section experience. I had a c-section for fetal distress, after a very easy pregnancy. The spinal did not work at all and I had a "fifties" baby as in I was under general and didn't experience any of it. It was very scary.

But, I view it as a good and successful birth since my son was great and yelling the minute they reached him (per my husband) and I was fine too. Was it the ideal experience or what I imagined, no. But I have a healthy baby and in the end that is all that matters. I was thrilled to find out my OB does support VBAC, with the reasonable safeguards I mentioned in my first post. It is really hard to know what to do, especially since what you plan on doing can literally change in minutes.

I wouldn't be surprised if the hospitals would not release stats though, or that they don't have them compiled for you to review. Good luck and I hope you have a much better birth experience this time!! (and congrats on your soon to arrive little one.)

[essnce629]

The doulas will definately know what hospitals/providers are VBAC friendly. When I went through my doula training last month, the experienced doulas knew ALL the doctors that were natural childbirth and VBAC friendly and definately had a list of who was and was not recommended. Some doulas even turned down clients when they found out they were working with certain doctors who they had had bad experiences in the past. You may also want to get in contact with your local ICAN (International Cesarean Awareness Network) and attend a meeting. You can probably find out doctors and hospital c-section and VBAC rates through them. http://www.ican-online.org/ Click on "community" to find a chapter in your area. I know on the San Diego chapter's website there's a list of all the area hospitals and their c-section rates. Other people in the community that would know what doctors/hospitals are VBAC friendly are La Leche League leaders and Bradley/HypnoBabies/Hypnobirthing instructors. Are you planning a natural childbirth as well? Have you taken a childbirth class not associated with a hospital? I highly recommend Bradley (http://bradleybirth.com/) or HypnoBabies (http://hypnobabies.com/). I had a natural Bradley birth with my ds, but I plan on taking HypnoBabies next time.

When searching for a VBAC-friendly provider, you should look for an encouraging provider who performs only medically indicated repeat cesareans and who has a VBAC rate of 70% or more.

Also, I don't see why a doctor wouldn't let you go past your due date at all. The average first time mom goes into labor at 40 weeks 8 days, and the average second time mom goes into labor at 40 weeks 3 days, so you may not even be really due yet until after your "official" due date. I have a friend, with gestational diabetes mind you, who just gave birth a few days ago after a previous c-section two years ago. Her goal was a VBAC and her doctor had told her he would allow her to go a week past her due date. Her due date was on a Friday and she had a c-section scheduled for the following Saturday (8 days past her due date), if she hadn't gone into labor by then. Due to the gestational diabetes, she was going in 2-3 times a week for non-stress tests to make sure the baby was doing fine. She went into labor on her own 4 days past her due date. She spent most of her labor at home and then spent the rest of her labor in the hospital on a birthing ball. She only was required to have intermittent fetal monitoring, so she never was in bed (which helped tremendousely). She did have an IV though due to being GBS+. Maybe you can talk your doctor into having you come in for regular non-stress tests if you go past your due date to make sure that the baby is fine while continuing to wait for labor to begin on your own. There's no reason to have a repeat c-section just because you're past your due date as long as you and baby are doing fine.

My advice to you, no matter what hospital/provider you choose is:

* Take a Bradley or HypnoBabies childbirth class.
* Hire a doula.
* Labor at home for as long as physically possible.
* If you go to the hospital and find out you're less than 5cm, go home.
* Have limited vaginal exams and don't let anyone break your water.
* If labor stalls, use position changes and breast stimulation (this works great), instead of pitocin to get things going again.
* If you MUST have continuous fetal monitoring, have them hook it up with you sitting upright in a rocking chair or birthing ball next to the bed. The nurses may get pissy about this and they may need to come in more often to readjust it, but it is possible (I've gone through nursing school so I know). There's no reason why you MUST be flat on your back in bed. Even if you get an epidural, stay sitting upright or at least on your side. Laying down only increases your pain and the chance of fetal distess due to lack of oxygen.

Also have you heard of taking red raspberry leaf and evening primrose oil to prepare your body for an easier labor? I highly recommend both. I think they played a huge role in my super fast and easy birth.

***Latia
Conner, my homebirthed water baby, 8/19/03
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months! http://www.windsorpeak.com/dc/user_files/9870.gif

[essnce629]

>Now, my ob is a high c-section rate doctor
>anyway, but told me that the recommendations on VBACS has
>changed in recent years to be much more conservative because
>there was a greater risk of rupture than originally thought.
>He'd seen rupture. He was blunt and said that because if I
>tried VBAC I'd have a good chance of being dead on the table,
>and so, he would not be the doctor for a VBAC.

I'm sorry, but your doctor was clearly spouting off garbage in order to coerce his clients into having repeat c-sections. This is not INFORMED consent, it's lies. The chance of uterine rupture for women with one prior cesarean is less than 1%. So basically, a woman attempting a VBAC has more than a 99% chance that she will NOT have uterine rupture. That's pretty good odds. Even should this RARE event occur, few babies will be harmed if a c-section is promptly performed. In fact, the perinatal mortality rate (deaths around the time of birth) in 29 separate studies was less than 3 out of 10,000 for both VBAC labors AND planned c-sections.

HOWEVER, one large study found an increased rate of uterine rupture in women who were given oxytocin (Pitocin) before 2cm dilation (so induction of labor). So yes, women whose labors are induced with Pitocin have a higher chance of uterine rupture. Which is why most doctors won't induce VBAC clients. And I'd suggest any woman whose doctor suggested inducing them, to run away as fast as they can and switch providers. Maybe your c-section loving doctor was also a pitocin loving doctor (the use of pitocin increases your chance of c-section by the way). So yeah, if he was using pitocin on every woman, they do have a higher chance of "being dead on the table" as he puts it. JMHO.

***Latia
Conner, my homebirthed water baby, 8/19/03
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months! http://www.windsorpeak.com/dc/user_files/9870.gif

[KrisM]

I am planning on a natural birth. We did the Bradley classes with DS and I'm doing Hypnobabies now :).

I agree about the going past the due date. Everything I've read indicates it doesn't mean a problem. I was 40 weeks 4 days with DS. I understand that everyone woman is different, but apparently some doctor's think we're all the same and will all have the same complications if we go past 40 weeks.

Most of your list is already my plan. I've sent e-mails to some doulas as a starting point. The 2nd hospital did say that if I do need EFM, I can still move about 15 feet and use the birthing ball, etc. I'm not restrticted to bed. After my epidural (to try to avoid a c/s) last time, I literally moved myself to the operating table, so I imagine I could have continued to walk around. No guarantee that will repeat itself though.

I will look into the leaf and oil. Thanks!

[KBecks]

Just wanted to say that the safety of you and the baby is priority #1, vs the delivery method, so I wouldn't get hung up on a practice with stricter VBAC rules -- they're there for a reason, and I think it is good to have a care provider who will err on the cautious side, but also give you an opportunity to do VBAC. Does that make sense?

So, be prepared to be flexible with how you will deliver the baby. Go in with your VBAC birth plan, but if it doesn't work out and a C-section will ensure your and baby's safety, then that's a fine alternative. You might not be able to VBAC. I think you need to work on accepting that despite your desires and intentions, sometimes you get what you want, and sometimes it doesn't happen.

Good luck, and please don't stress over it.

ETA: Be sure to talk about your bad experience about the epidural / spinal with your care provider. It sounds like something went wrong, but they should be aware of your painful past experience so they can make adjustments and be more careful in case you require a repeat c-section. Good luck on the VBAC, I hope it works the way you want.

[KrisM]

>
>ETA: Be sure to talk about your bad experience about the
>epidural / spinal with your care provider. It sounds like
>something went wrong, but they should be aware of your painful
>past experience so they can make adjustments and be more
>careful in case you require a repeat c-section. Good luck on
>the VBAC, I hope it works the way you want.

I am prepared to be okay with another c-section if I need one. I just want to do everything I can to avoid it, if possible.

I thought about talking about the problems I had with the epidural and the spinal (had both), but worry that they'll just up the amount of medication so much that I'll be numb for 8 hours. While I prefer not to feel it, it was over in minutes and didn't have any lasting affects on my recovery. If I get a super-dose or something, I worry I would have to stay much longer in the hospital just working on recovery. I don't know which is worse. That is part of why I'm doing Hypnobabies - to help me relax and get through a c-section, if necessary, because the anticipation will be horrible!

[HannaAddict]

Please let your OB know about the problem with your pain meds. Based on my bad experience (spinal didn't work at all, despite well regarded anesthesiologist), my OB said I should arrange a consult with the anesthesia dept. for my next pregnancy (for epidural for VBAC or c-section). If they are aware of the problem, they might be able to fix it. As professionals, I don't think they will just increase the dose :) but maybe focus on placement more and checking with you to make sure that you are getting the appropriate relief.

Kimberly

[kellyotn]

ITA that you should talk to your doc! They likely have other options and won't just pump you full of more medicine. I had both the epi and the spinal, too. I happened to mention that I was getting a weird (metallic) taste in my mouth. Apparently the epi didn't take and that is a sign. They opted to wait and re-set it after the surgery as its for post-op pain.

Before they cut, they went thru a routine of pinching to see if I could feel things, etc. The spinal was working fine, as I could feel a bit of light something, but DH told me she was pinching the HECK out of me! But, my DD was very very stuck and by the time things were wrapping up, I was starting to feel things. Yes, my Hypnosis training DID come in handy! LOL.

What I'm saying is, there may be other signs (like the metal taste) that they can specifically look for, and they can VERY carefully question you to make sure everything is working before cutting, etc. Or alternate drugs. Whatever, but they need to know that what they did last time failed miserably so they can work with you instead of subjecting you to the same fate.

With my second c-sec I actually requested them to look into my file and make sure I was getting the same stuff. I doubted the epi thing would happen twice, and if it did, I'd just have them re-set it prior to the surgery this time. What they used for me worked, didn't make me sick afterwards, etc. so I wanted the same stuff. They were happy to check and confirm that it would be the same.

Obviously, I hope its all a moot point and you get a VBAC!!! :) But, just in case, I truly think you should discuss it with them. I think the peace of mind of NOT repeating that horror would help you relax, and relaxation is key. You don't want to be worrying about *any* c-sec in the back of your mind, let alone a barbaric one, KWIM?

Best!

[KBecks]

I've had uterine surgery twice (one c-section) and both recovery times were 4 days in the hospital. I honestly think that a recovery from a painful c-section would be worse than from one where you receive appropriate and effective anesthesia.

I'm sure it's scary given your past experience, but I do still think it's worthwhile to discuss all your concerns thoroughly with the docs, and you can discuss your concerns about being over-medicated also. In the end, I believe the docs will respect your wishes as much as they possibly can. Take care and good luck.

[KrisM]

Thanks for the info.

They did test my legs after the spinal and I couldn't feel anything. It was the inside parts that I could feel. I wonder if they can test for that somehow. Even though I couldn't feel the pin, I never lost movement in my legs. In the recovery room, I lifted myself up so that they could change the pads underneath me.

I'm glad that your second was better. It gives me hope!

[KrisM]

I spent just over 2 days in the hospital. DS was born Friday at 3:35am and I left Sunday at 11am. I was up and walking around very early and I think my recovery was really quite fast and easy, compared to what some friends have experienced. But, hey, maybe I could cut it to 24 hours. That would be nice. Hospitals are not my favorite places.

My OB knows of my issues last time, but I will discuss it again. I tried discussing it with the old OB, but they moved to CYA mode and didn't really want to talk about it. I didn't want to sue, I just wanted info. Frustrating!

[KBecks]

ITA with hospitals being not-favorite places. I felt like I was getting out of jail after 4 days in hospital after DS's birth.

2 days recovery after a c-section is really fast, I think. Of course if you deliver vaginally, you probably will get out even faster if you and baby are feeling well.

[brittone2]

Midwives are a very safe alternative to OBs. For VBACs they almost always work with an OB backup. Yes, there are situations a midwife can't handle by herself, but there are also tradeoffs to having OBs who happen to have very high c-section rates (and there are very real risks to having a c/s that are higher than or equal to having a vbac from what I've read).

I don't know if you were speaking in generalities but midwife-attended births are very safe. The British Medical Journal published a relatively large-scale study showing midwife-attended *homebirths* were just as safe or safer than a hospital birth. (I'm not sure if you were speaking about midwives attending non-vbac births vs. vbac births, but even in that case I think midwives are a very safe alternative for many women.

ETA:
I haven't researched vbacs extensively by any means but have read a little bit.

Obstet Gynecol. 2005 Oct;106(4):700-6.
Safety and efficacy of vaginal birth after cesarean attempts at or beyond 40 weeks of gestation.

Coassolo KM, Stamilio DM, Pare E, Peipert JF, Stevens E, Nelson DB, Macones GA.

Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. [email protected]

OBJECTIVE: To compare rates of vaginal birth after cesarean (VBAC) failure and major complications in women attempting VBAC before and after the estimated date of delivery (EDD) METHODS: This was a 5-year retrospective cohort study in 17 university and community hospitals of women with at least 1 prior cesarean delivery. Women who attempted VBAC before the EDD were compared with those at or beyond 40 weeks of gestation. Logistic regression analyses were performed to assess the relationship between delivery beyond the EDD and VBAC failure or complication rate. RESULTS: A total of 11,587 women in the cohort attempted VBAC. Women past 40 weeks of gestation were more likely to have a failed VBAC. After controlling for confounders, the increased risk of a failed VBAC beyond 40 weeks remained significant (31.3% compared with 22.2%, odds ratio 1.36, 95% confidence interval 1.24-1.50). The risk of uterine rupture (1.1% compared with 1.0%) or overall morbidity (2.7% compared with 2.1%) was not significantly increased in the women attempting VBAC beyond the EDD. When the cohort was defined as 41 weeks or more of gestation, the risk of a failed VBAC was again significantly increased (35.4% compared with 24.3%, odds ratio 1.35, 95% confidence interval 1.20-1.53), but the risk of uterine rupture or overall morbidity was not increased. CONCLUSION: Women beyond 40 weeks of gestation can safely attempt VBAC, although the risk of VBAC failure is increased.

**Postdates should NOT be a contraindication to trial of labor***
Int J Gynaecol Obstet. 2005 Jun;89(3):319-31.
SOGC Clinical Practice Guidelines. Guidelines for vaginal birth after previous caesarean birth. Number 155 (Replaces guideline Number 147), February 2005.

Society of Obstetricians and Gynaecologists of Canada.

OBJECTIVE: To provide evidence-based guidelines for the provision of a trial of labor (TOL) after Caesarean section. OUTCOME: Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean (VBAC) and repeat Caesarean section. EVIDENCE: MEDLINE database was searched for articles published from January 1, 1995, to February 28, 2004, using the key words "vaginal birth after Caesarean (Cesarean) section". The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Force on the Periodic Health Exam. RECOMMENDATIONS: 1. Provided there are no contraindications, a woman with 1 previous transverse low-segment Caesarean section should be offered a trial of labor (TOL) with appropriate discussion of maternal and perinatal risks and benefits. The process of informed consent with appropriate documentation should be an important part of the birth plan in a woman with a previous Caesarean section (II-2B). 2. The intention of a woman undergoing a TOL after Caesarean section should be clearly stated, and documentation of the previous uterine scar should be clearly marked on the prenatal record (II-2B). 3. For a safe labor after Caesarean section, a woman should deliver in a hospital where a timely Caesarean section is available. The woman and her health care provider must be aware of the hospital resources and the availability of obstetric, anesthetic, pediatric, and operating-room staff (II-2A). 4. Each hospital should have a written policy in place regarding the notification and (or) consultation for the physicians responsible for a possible timely Caesarean section (III-B). 5. In the case of a TOL after Caesarean, an approximate time frame of 30 min should be considered adequate in the set-up of an urgent laparotomy (IIIC). 6. Continuous electronic fetal monitoring of women attempting a TOL after Caesarean section is recommended (II-2A). 7. Suspected uterine rupture requires urgent attention and expedited laparotomy to attempt to decrease maternal and perinatal morbidity and mortality (II-2A). 8. Oxytocin augmentation is not contraindicated in women undergoing a TOL after Caesarean section (II-2A). 9. Medical induction of labor with oxytocin may be associated with an increased risk of uterine rupture and should be used carefully after appropriate counseling (II-2B). 10. Medical induction of labor with prostaglandin E2 (dinoprostone) is associated with an increased risk of uterine rupture and should not be used except in rare circumstances and after appropriate counseling (II-2B). 11. Prostaglandin E1 (misoprostol) is associated with a high risk of uterine rupture and should not be used as part of a TOL after Caesarean section (II-2A). 12. A foley catheter may be safely used to ripen the cervix in a woman planning a TOL after Caesarean section (II-2A). 13. The available data suggest that a trial of labor in women with more than 1 previous Caesarean section is likely to be successful but is associated with a higher risk of uterine rupture (II-2B). 14. Multiple gestation is not a contraindication to TOL after Caesarean section (II-2B). 15. Diabetes mellitus is not a contraindication to TOL after Caesarean section (II-2B). 16. Suspected fetal macrosomia is not a contraindication to TOL after Caesarean section (II-2B). 17. Women delivering within 18-24 months of a Caesarean section should be counseled about an increased risk of uterine rupture in labor (II-2B). 18. Postdatism is not a contraindication to a TOL after Caesarean section (II-2B). 19. Every effort should be made to obtain the previous Caesarean section operative report to determine the type of uterine incision used. In situations where the scar is unknown, information concerning the circumstances of the previous delivery is helpful in determining the likelihood of a low transverse incision. If the likelihood of a lower transverse incision is high, a TOL after Caesarean section can be offered (II-2B). VALIDATION: These guidelines were approved by the Clinical Practice Obstetrics and Executive Committees of the Society of Obstetricians and Gynaecologists of Canada.

J Fam Pract. 2006 Feb;55(2):149-51.
How safe is vaginal birth after cesarean section for the mother and fetus?

Crawford P, Kaufmann L, De Armond L.

Eglin Air Force Base Family Medicine Residency, Eglin Air Force Base, Eglin, FL USA.

Compared with planned repeat low-transverse cesarean section, vaginal birth after cesarean section (VBAC) is not associated with increased risk of maternal or neonatal mortality (strength of recommendation [SOR]: B). Morbidity is slightly increased, as evidenced by higher uterine rupture rates and some neonatal outcome measures (SOR: B).

**VBAC even with TWINS quite safe**
Am J Obstet Gynecol. 2005 Sep;193(3 Pt 2):1050-5.
Vaginal birth after cesarean (VBAC) attempt in twin pregnancies: is it safe?

Cahill A, Stamilio DM, Pare E, Peipert JP, Stevens EJ, Nelson DB, Macones GA.

Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, USA. [email protected]

OBJECTIVE: The purpose of this study was to compare the rate of vaginal birth after cesarean (VBAC) attempt, VBAC failure, and major maternal adverse outcomes in women with a previous cesarean with twin or singleton pregnancies. STUDY DESIGN: This was a multicenter retrospective cohort study between the years 1996 and 2000. Subjects were identified by ICD-9 code. Trained research nurses collected medical record data on the outcome of VBAC attempts, and clinical outcomes, including uterine rupture and major operative injuries. We used bivariate and multivariable techniques to assess the association between twins and the outcomes. RESULTS: Of 25,005 patients with at least 1 previous cesarean, there were 535 twin pregnancies and 24,307 singleton pregnancies. Compared with patients with singleton gestations, patients with twins were less likely to attempt a VBAC (adjusted odds ratio [AOR] 0.3, 95% CI 0.2-0.4), but no more likely to have a VBAC failure (AOR 1.1, 95% CI 0.8-1.6), a uterine rupture (AOR 1.2, 95% CI 0.3-4.6), or a major maternal morbidity (AOR 1.6, 95% CI 0.7-3.7). CONCLUSION: Women with twin gestations are less likely to attempt a VBAC, but they are no more likely to fail a VBAC trial or experience a major morbid event compared with women with singleton gestations.

[Globetrotter]

Just a couple of things..

I had a midwife/OB practice for my vbac attempt. The OB was conservative, yet supportive of vbac, which was a good combination for me. I was able to wait until 42 weeks to go into labor (I didn't, so I ended up with a c/s) and my OB was *extremely* safety conscious. She wouldn't induce, however, nor did I want to be induced. It's getting harder to have a vbac, hence the regulations are getting stricter, and they're not all based on facts.

I wholeheartedly recommend a doula. It makes a big difference. Mine was there for the c/s, but also came in for a couple of days post partum, to relieve dh.

Kris

[essnce629]

>I am planning on a natural birth. We did the Bradley classes
>with DS and I'm doing Hypnobabies now :).

Awesome, I'm excited to hear how it turns out. Are you taking an actual class or doing the homestudy? I was over on their website the other day reading the birth stories on their message board. They sound so amazing. I actually can't wait to get pregnant again (which probably won't be for 3 years) just so I can go through the Hypnobabies class! My friend is pregnant right now and has decided on Hypnobabies as well and I'm hoping to attend the classes with her (I'll be her doula as well). What made you want to go with Hypnobabies instead of Bradley this time?

>I will look into the leaf and oil. Thanks!

Here's the exact regimen I followed:

Red Raspberry Leaf (tones uterus, prevents miscarriage, makes contractions more efficient so labor is faster and less painful, prevents postpartum hemorrhage, decreases postpartum bleeding)

1st trimester- 1 cup of tea or 2 465mg capsules a day orally
2nd trimester- 2 cups of tea or 3 capsules a day
3rd trimester- 3 cups of tea or 4 capsules a day
Continue with 3 cups of tea or 4 capsules daily until after your postpartum bleeding stops.

Evening Primrose Oil Regimen (softens cervix which leads to faster labor)

36 weeks- 2 1300mg capsules a day orally and 1 inserted vaginally at bedtime (wear a panty liner)
37 weeks- 2 capsules orally and 2 vaginally
38 weeks- 3 capsules orally and 2 vaginally
Continue with 3 capsules a day orally and 2 vaginally until you deliver.

I had a total labor of 9 hours, but the first 8 hours was completely pain-free even though I was having contractions every 1 1/2 minutes! I had my first "painful" contraction at 6:15am and my son was born 55 minutes later after 2 pushes! I'm a huge believer in RRL and EPO :).


***Latia
Conner, my homebirthed water baby, 8/19/03
http://www.babiesonline.com/babies/a/aug2003angel
http://www.gynosaur.com/assets/ribbons/ribbon_sapphire_24m.gif Self-weaned at 24 months! http://www.windsorpeak.com/dc/user_files/9870.gif

[kellyotn]

Yickes! I'm not sure what's normal "testing", but for me she pinched all over my midsection and asked if I could feel it. I COULD feel, so I squeeked "yes, I can feel a slight tug" (terrified). They all laughed b/c she was pinching me hard with clamps. ;) I totally couldn't move my legs until it was over for at least an hour or more. Even though the epi didn't take and the spinal started to wear off, it was not horrific. I just started getting scared and told them to hurry. Then I closed my eyes and did my hypno-training.

I'm sure they do get in CYA mode, but really, I'd just be clear that that surgery is over and you aren't suing over it, but that you clearly do not want it to happen again is all.

Again, I'm sending nothing but positive VBAC vibes your way!!

[denna]

<I can't believe how hard they make it on us to birth!>

I COMPLETELY agree with that. A little side note 'self-pity' moment. I'm currently overseas w/ my husband (who's in the military), and I have NO OPTIONS for my birth. I have to have the baby at their hospital, no option for home birth, no tubs, and only semi-private rooms w/ a shared bathroom DOWN THE HALL. So I know this is a side note. And I apologize, I just had to get it out.

As far as the topic at hand, I must say I dont really know anything about VBAC. But I wish you the best of luck w/ your labor and delivery I hope you dont have to go through another c/s since you really dont want too. Good Luck and Best wishes!!! I hope you are happy w/ whatever you choose.

Denna