just a couple of questions about VBAC

hi there

I am pg with #2, expected early April. I am going for a VBAC after almost birthing vaginally (got over 9cm) but DS was posterior (unknown) and his head was obstructing my cervix and therefore I was swelling and un-dilating! Things didn't turn out how I would have liked, but I know that I can birth vaginally, my body was telling me to push... I got that far along.

I am now in the process of editing my birth plan to account for the VBAC. A few things that my dr and the midwife that booked me into the hospital mentioned to me have got me thinking and I just wanted to ask some questions.

1 (from the dr) I'm not sure about a natural 3rd stage (as I had wanted first time). He said the risk of bleeding is higher. I argued this with my dr for DS (not the same) and had agreement in the end. I'm wondering if this is the standard "natural 3rd stage increases haemmorage" or if there really is increased risk for VBAC? Given he has advised no induction will occur, if there is no intervention, I can't see how it's any different to a birth without prior CS?

2 (from the midwife) We usually do a stretch and sweep for VBAC patients at 38 weeks and 39 weeks (if 39 is necessary) because we can't induce and we don't want you to go over your dates. I bristled at this straight away (but chose to speak to my dr than argue with the mw). I understand the no syntocinin (and don't want it anyway) but why are they worried about going over with a VBAC? I know s+s can take time and obviously if I was left and did go to 41 or even 42 no synto would leave little option than another CS, but couldn't the s+s be done at edd or something?

3 (also from dr) If the baby was transverse at time of labour I would have to have another CS as it would put pressure on my scar. Is it possible that the baby couldn't be moved from transverse and would it put pressure on my scar (that is strong as I have read).

Thanks for anyone who has some info. I want to be prepared so when I start standing up to my dr I am not arguing against good medical reason.

I have not heard of any of those things being a problem mellybelly. You can always ask if they can show you research that says there is more chance of bleeding, etc?? Why can you not just have a natural 3rd stage but if it becomes apparent after birth that there is too much bleeding have the injection then?

The S&S thing is ridiculous. I would just be refusing that straight away. Way to stress you out and make you feel pressured to go into labour! Not helpful.

xx

I'm attempting a VBAC this time around. I'm having my baby in a public hospital under midwife care.

I'm not aware of any increased risk of natural third stage with VBAC. It is the same as non VBAC from what I'm aware. I'm also requesting natural third stage and if needed due to lots of bleeding fine we can have the injection but otherwise no. I believe there is an overall risk that is higher of bleeding with a natural third stage which is why they prefer to give the needle, but if you want natural I don't see how that would have anything to do with VBAC.

The S&S sounds stupid I wouldn't be consenting to that and the information given about induction sounds incorrect. I've been advised that they can use both catheter and synto if needed, only thing they don't use is the gel as they can't remove it or stop it if something goes wrong.

The baby being transverse, I don't see how that would apply anymore pressure to your scar than a contraction? I would be seeking a second opinion here or getting them to provide you with information on it.

They don't sound very experienced with VBAC or supporting women for VBAC to me?

Hope you get it sorted xx

thanks for the replies :) I had a chat with my dr and feel a bit more comfortable about what was said and that I may have misunderstood slightly. He isn't a dr that likes the phys 3rd stage but still said its up to me and apparently there are legal issues with using synto (apparently the manufacturers put that stupid cover-their-butt statement about not beng quitable for VBAC and it was apparently tested) so they don't use any induction drugs, but he did say that the catheter can be used. Also said the s&s was up to me. Baby isn't transverse anymore so hopefully that won't be an issue.

Hi mellybelly81 :)

It's good to hear you are feeling more comfortable with your Dr now.
I had a VBAC in 2011, but I was public so a little different to your situation. I got really different reactions and advice depending on which Dr I saw at appointments, as they were always differerent. You just have to know what you want and stick to it, don't let them scare you into anything. I did a lot of research leading up to my VBAC, and I don't recall reading anything about increased chance of haemmorage with VBAC?? I had natural 3rd stage and delayed cord clamping. Once the cord stopped pulsing and was cut the midwife asked me again if I wanted the injection ( I guess she thought I may have just not wanted the drugs going to bub while still attached) but I still declined and they didn't push the issue. I don't see any reason to intervene unless you are obviously losing a lot of blood.

Are you hiring a doula? It is a great idea to have a doula with you for a hospital birth to stand up for you should your care providers start trying to push you into things while you are in labour. Something to look into if you haven't already.

Good luck with everything :)

Glad your feeling more comfortable. Still strange about the Synto. I'm going via a large public hospital so it is interesting how they have different policies.
Where are you located? If your around the central coast pm me, I'm using a Doula and I find her reasonably priced and really lovely.

LOL stick up for yourself with the phys 3rd stage. Tough if he likes it or not. Make sure it's in your birth plan and the midwives are aware of what you want.

The common way to induce is using synto, which is why he was mentioning it, because it raises the rate of rupture but quite a substantial amount. First time mothers being induced with it have the same rupture risk as a VBAC mum - so you can imagine how the use of it can be bad if there is already a scar in place.

I've had two VBA2C's and with all my reading, I never read anything about the increased rate of bleeding if you have a natural 3rd stage. I did have a natural 3rd stage, and had a bleed with my last one (800ml) and it was then that they gave me the needle. But not until after they tried to slow down the bleeding with a massage to my belly.

As for transverse, I've read most babies who are transverse when you go into labour most likely are to be born by c-section - just bad positioning. My last one wasn't engaged and was still floating however was in the right position (head down!) so there are exercises you can do to help get your baby into a good position for birthing.

Good luck - and enjoy the ride!

Yeah I just find it interesting Mrs NB, I told the hospital if we have to use Synto I want it very low and under my control and they indicated that they would not be in a rush to turn it up due to the scar. The interesting part is that mellybelly's Dr won't use it at all is all.

Just as interesting as the hospital won't use the Gel in my case due to similar reasons.

Yeah different ob's - different risks they are willing to take. Some are fine with synto because they also have you on the bed for continuous monitoring and are quick to whip you off for a c-section if the baby starts being in distress (which most do at some point because there are drugs injected making your uterus contract unnaturally!)

I prefer the all hands off approach myself. We can do this ourselves, we're women - of course we don't need any help ;) LOL

I concur with the others. Also wanted to add that an early s&s has risks of PROM, plus as with all VEs increased risk of infection.

I do not understand the insistence on sticking things inside a pregnant or labouring woman's vagina, fingers or instruments. It does nothing to help and potentially a lot to hinder!

You can refuse anything you are uncomfortable with, they are there to provide the care you want. No one can force you to accept their recommendation. If you do your own research, you can be confident of what you want and why. It sounds like you're trying to gather as much info as possible.

I just read a fantastic blog post by midwifethinking on cervical lips today too.

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I just read a fantastic blog post by midwifethinking on cervical lips today too.

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she has excellent, well referenced & evidence based posts about VBAC, 3rd stage and induction ;)

hi ladies

I haven;t been able to get on here much lately so really sorry I haven't been able to respond!

I went over all my questions again (and more at my last appt) and the synto thing is apparent a legal one. Synto is apparently safe for VBAC because it can be controlled unlike the gel, but the manufacturers have put some disclaimer on it about not for VBAC so their legal policy (not sure if the hospital or all publics in WA) is not to use it, so that's why they use S&S or Foley's catheter. Both I'm not really fond of either. Thing is, I only had the CS due to obstruction (DS being undiagnosed posterior and head engaged at bad angle). Otherwise I was basically fully dilated and body was telling me to push (technically didnt get to 10cm but I think DS head swelling my cervix had something to do with that - afterall it was 9.5cm and that was with swelling).

He's gone through all the standard stuff, continuous monitoring is reccomended to VBAC, as is 1cm/hour progression.... also told me about how his last patient to want phys 3rd stage haemmoraged - but then mentioned that she had a needle phobia so even when she started bleeding she was still freaking out about the needle, so she haemmoraged really badly... I'm not stupid, if I start bleeding I'll ask for the needle.

He did say though that it was all up to me to consent. I guess he has to present the standard garbage, but at least it wasn't a straight up this is how it will be. Encouragingly he did say that if I didn't want a S&S or FC then that's ok and he and the specialist at the hospital (who I have to meet with due to being VBAC) wouldn't have an issue leaving me to +10 to go into spontaneous labour.

Just to add to what Arimeh said, my last CS was due to obstruction, so probably inevitable - however I do believe that my dr turned the synto up too quick (after 16hrs labour and 5hrs on an epi to stop pushing and let swelling go down they tried synto - now not sure why - it was a bit of a haze then) and DS went into distress which was when they said CS time. So yeah, synto is a sure way to distress bubs!

Again thanks for all the responses. Eutra_phalia do you have a link to that MW blog you can PM me? thanks :)

Just a quick question - when did you get into labour previously? Did you go way overdue or close to the EDD? Just asking as it seems that most of my friends who have gone a bit early or near their EDD, tended to do the same again (although, I know that every birth is different and some bubs arrive early and their siblings are stubbornly late).

My two boys decided to sit snug for a long time over 40 weeks and they couldn't induce me with DS2 when trying for my VBAC. I did the S&S after 40 weeks and then did AROM after 41 weeks (I think 12 days over?) and was on my feet and walking and trying to get some regular contractions. That was in a public hospital which had a strict 4 hr+ 4hr policy and if I wasn't close to popping a baby out, off to theatre. I'd ask a few other private obs what their timeframes are re: vbac, just so you have some comparisons and where your Dr sits. Who says that labour progresses smoothly at 1cm/hr?
I went private with DD last year and she was a lot more relaxed than the public hospital re: going overdue and length of time for labouring etc. To s&s was totally up to me, but she did say that if my body wasn't ready, it wasn't going to do a lot and that the baby will come when it's ready.

The only thing that I couldn't argue with her, was the natural 3rd stage. She was dead against it, having seen really, really bad bleeds in her time. She said that public hospitals were more likely to allow it but more private obs weren't keen.

I was 3 days before edd with DS and as I said before everything really was quite great until the obstruction became apparent. No drugs, no thought of drugs or anything. My dr said that things will quite possibly go the same as before (the straight forward labour that is).

Do you mind if I ask where you are delivering?

The synto thing is not a legal issue, either, by the way, there is actually reasons why they do not use induction hormones for VBAC women.

http://www.academia.edu/233476/Holis...A_cohort_study

Study showing that natural 3rd stage doesn't increase risk of PPH


I bled heaps after my second but still didn't need synto, breastfeeding/nipple stimulation to get natural oxytocin working is great in most cases.

LimeSlice - Armadale. My dr said all the others were medical risks but synto not, which I've read in other guidelines and studies too. Either way I didn't want induction last time and don't this time, so I guess the synto thing didn't really matter much to me anyway.

thanks for the link em.