VBAC - what questions to ask my OB?

[psophia17]

My next OB appt is going to include (I hope) some detailed info on how the hospital I'm delivering at handles VBACs.

I've done research, and I feel prepared, but the nerves are setting in, and I want to make sure I cover every single base before I go into labor.

If you've gone through a VBAC (or had a trial of labor followed by c/s), what questions did you ask beforehand that helped you prepare? What questions do you wish you had asked?

Any guidance would help me a lot - thanks!

[spu]

Hi Petra,

I just went through the same thing, and ended up switching hospitals as a result... I presented a list of q's to both parties (my old perinatologist/ob, and the midwives and l/d nurses at the new hospital), in such a way that was not reflective of my opinion so I didn't sway their answers. I knew right away what I needed to do. Here are some of my q's:

What's your opinion on, or approach to:
• risks of vbac
• risks of repeat c
• what's your preference?
• what are the hospital rates for vbac and repeat c? (if they don't know this, or the c rate is high, run!)
• % of natural births (letting nature take its course, w/o drugs or intervention)
• % of epidurals, pitocin, other induction meds (avoid these if you truly want a vbac!)
• explain hospital protocols: ie: routine intervention - what and when, if there is no fetal distress
• do you perform episotomies routinely? amniotomies? when and why?
• how about forceps and vacuums?
• do you do an induction with vbacs? (absolutely a no-no!)
• can I walk around during labor? (a must)
• is there a time limit for labor (a clue to hospital protocol, and a repeat c...)
• liklihood of using showers, tubs, telemetry monitors, birthing balls?
• can I eat/drink during labor?
• is there any medical reason from my previous history that suggests I should have another c for medical reasons?
• how do you feel about doulas?
• what birth positions do you recommend (avoid lying on your back if you're trying to avoid another c)
• % of elective c-sections

There's a great vbac discussion group on mothering.com:
http://www.mothering.com/discussions/forumdisplay.php?f=21

and another:
www.ican-online.org

Also, get your hands on a few books from the library in advance to help you gain confidence on approaching your dr:

Ian May's Guide to Natural Childbirth by Ian May Gaskin

The Thinking Woman's Guide to Childbirth by Henci Goer

Natural Childbirth the Bradley Way

These books were so insightful and in tune with my own thoughts, that I bought them on Amazon, and they're getting pretty crinkly from all my flags and notes.

I switched at 18 weeks pg from a highly respected peri (who cared for me and delivered my twins via c, after a failed induction) to a completely different hospital with midwifery care (and back-up o.b.s in case I truly need a c for medical necessity.) From my 8w appointment, my peri was pushing me to have a repeat c, using everything up his sleeve including scare tactics, which was a big red flag. It's easier for surgeons to perform a c rather than let nature take its course, plus they get the $ since it's scheduled.

I'd be happy to talk more, or just listen, as you go through the process. best wishes!


susan

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nursed for 3 years!
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charlotte + else

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[KrisM]

Excellent questions! I have a few to add.

- how many weeks can you go before "requiring" a c-section? Some places won't let you go past your due date.
- is there a size estimation that would put you in a c-section class?
- will you induce - you can have your water broken with no risks as a VBAC. You can also have monitored Pitocin as a VBAC. This is within current ACOG guidelines. You can NOT have cervical gel, as it will increase your rupture risk.
- if it's important to you to be able to move during labor, do they require continuous fetal monitoring or will intermittent work?

I also switched at 20 weeks to a different OB and hospital. My first said I only had until 40 weeks to deliver naturally and if it looked like more than a 8 lbs baby, it would be a c-s. I ended up with another c-s, but I went to 41w5d before going into labor. I got fully dilated and pushed for 3 hours before deciding on the repeat. I am happy that I switched because I never would have had any of that with my original OB.

Good luck!

[jennifer13]

The biggest issue for me was that my OB was very pro-vbac, but the other doctors in the practice were not. My questions were what to do if I went into labor and she wasn't on call and i had to deal with a different OB.

Turns out I had to be induced, but in some ways it was good because we did it with my outstanding OB, and all went well.

HTH

Jennifer
Mom to Norah 5/23/03
and Leah 3/24/05

[dowlinal]

I think you've already gotten great advice. My doula sent me this link for questions http://www.awomansstrength.com/questions.php It's not specific to VBAC but it has a good list of questions.

One thing I would add is that in addition to checking out your OB, I would check out the rules at the hospital you plan to deliver at. One of my local hospitals was known to be VBAC friendly while another had a horrible reputation.

Good luck and remember to trust your instincts. I really hope that you get to have the birth experience that you want.