feeling completely deflated (VBAC)

My hospital's policy has just changed where patients trying for VBAC have to have a standard consult with and OB at 32 weeks to discuss the VBAC etc.

So, me being nearly 37 weeks already went to see one I was referred to by my Dr who is a GP specialising in obstetrics. I knew it wasn't going to go well as soon as he walked in the room, he was so uncomfortable with my 2 year old being there and playing a tad roughly (but behaving) with some toys I took for him on the floor - but I guess that is beside the point!

Anyway he was basically anti VBAC saying that it wasn't safe for me to attempt a vaginal birth having a c/s scar as he believes this baby is going to be 7.5 - 8 pound, and going by my pelvimitry which was done in previous PG that showed my pelvis is around 2cm under average.

I am totally confused, I am due to have my baby in a few weeks time and so far I have been told by my midwives and Dr that I can attempt a VBAC no probs, that the hospital don't even use pelvimitry's anymore because they do not give a clear indication as to how much your pelvis will open up and the pelvis is measured while you are on your back which is when it is most closed - so therefore it is a medically inconclusive test. Now the OB has sent a letter to my DR saying he believes it is unsafe for me to attempt and that he will not manage my pregnancy if I decide to attempt the VBAC!

I have got an appointment with my Dr tomorrow, I don't know how much say this OB has, that if he recommends I don't have one, the hospital will say they will not take me on as a VBAC, in which case I am stuffed because no other hospital nearby to us accepts VBAC deliveries at all.

I am worried about recovering from surgery when I have a very demanding mummy's boy 2 year old at home - let alone leaving him alone for 3-4 days, he would just crumble without me! I am worried I will have the same problems that I had with my 1st c/s even though I have stated I don't want the same OB delivering Leo. and I am worried that this is going to increase my chances of PND recurring because I do still have a lot of emotional baggage re Jackson's birth.

I just don't know what to think or feel anymore

Hi Min,

Can you get your GP to refer you to another OB in the same hospital who is more supportive of VBACs? i'm going private and am not sure how the public system works, but is it possible for you to nominate an OB at the hospital that you wish to use, or are you just stuck with whomever is rostered on that day? maybe speak to your midwives who are supportive of the VBAC - they may have come across this hurdle before and know how to get around it...
sorry that this has been dropped on you at the eleventh hour - i hope you can find a solution and put your mind at ease soon...
best of luck, and lots of hugs!!

You know what, that silly ob was just covering his own arse by sending that letter, in the off-chance that something does happen, which is very unlikely anyway! I have booked into a hospital, but am having a home vbac and the ob sent a letter to my gp and midwife saying he doesn't recommend it, it is dangerous blah blah blah, (because of course I hadn't looked into it carefully?), it is just so you can't sue them if something happens that they mentioned may be a possibility. But is still less of a possibility than ending up with another c/s because they can't keep their noses out!
Don't give the weight thing another thought, womens bodies were designed to birth our babies. The hospital cannot do anything that you don't give permission too, so you go in there knowing what you want and don't let them bully you. Have you got an advocate, something that can speak on your behalf if you are unable??? Make sure you tell whoever is going in with you what you do and don't want.
You can have a vbac. If the ob wants to be negative that is his problem but trust your body and your decisions!!!
Good Luck, stick up for yourself and your bub!
My decision to have a home birth, while a really really hard one, was to avoid all the unnecessary stress that you are being put through now. A vbac is just a birth, but for some reason we are treated like crazy, unrealistic women, just because we want a safer outcome for our baby and ourselves.

oh min... I am totally disgusted by that OB.

Jovie was my VBAC baby and with heaps of OB's at the hospital giving me reasons why I couldn't possibly give birth to her. I had a scan at 41 + 2 weeks which showed that Jovie was 10lb 11oz... in reality she was 4kg or 8lb 13oz... a reasonable size but no where near what they estimated her to be. They said I should have a c/s, that I was risking the strength of the scar.

In reality your uterus is amazing, your risk for a uterine rupture is the same as if you were having your first baby via induction.

I would definately phone the hospital or your GP and ask to be refered to an OB who is more likely to support a VBAC.

min... okay lets look at the facts here so we can get your confidence back on track. There are PLENTY of studies to show that VBAC is safe and beneficial to you and the baby. There are studies showing that the more c/s you have, the more it increases risks to you, including haemorrhage, hysterectomy, and even mortality. Your scar is strong.

From the article, Caesarean Myths Exploded:

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CAESAREAN MYTH NO. 2

Once a caesarean, always a caesarean

After one caesarean section, VBAC (pronounced vee-back – vaginal birth after caesarean) is widely accepted as appropriate and safe. However, after two or more caesareans, it is common policy for a mother to be automatically scheduled for an elective (planned) caesarean since it is believed that the risks of caesarean scar rupture increase with the number of caesarean operations.

Lack of evidence supporting this theory has led some researchers and obstetricians to question the basis for this accepted practice.8,9 Indeed, the highly respected Guide to Effective Care in Pregnancy and Childbirth concludes that: ’...the available evidence does not suggest that a woman that has had more than one previous caesarean section should be treated any differently from the woman who has had only one caesarean section’.10

While the number of obstetricians willing to support a mother through labour after two caesareans is believed to be small, that number does appear to be increasing, leading the authors to believe that the tide may be turning in this respect. However, it is rare to hear of a vaginal delivery after three sections and the authors know of no cases in this country following four or more caesareans, although cases have been documented in the United States.

One reason for such low numbers of vaginal deliveries after multiple caesareans is the low parity in this country and it is known that women who undergo caesarean operations tend to have fewer children than average, although the reasons for this are not clear.

It must also be accepted that many women who have had multiple caesareans will have no desire to embark on a labour, having come to terms with the caesarean section as a mode of delivery, and who may well have come to prefer the caesarean way of birth. Others may well take the attitude ‘better the devil you know’.

Consequently, the chances of an obstetrician encountering a woman in her fourth or subsequent pregnancy, who has had three or more caesarean sections and is well motivated to achieve a vaginal delivery, are slim at best, and he is unlikely to do so many times in his career. So few obstetricians are confronted with such a situation that knowledge of the true risks, or rather the lack of them, is sparse, and the confidence that comes with experience totally lacking. Individual mothers who wish to avoid further caesarean operations must therefore have access to information from other sources in order to facilitate truly ‘informed choice’.

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WHO Birth Recommendations:

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5. There is no evidence that a caesarean section is required after a previous transverse low segment caesarean section birth. Vaginal deliveries after caesarean should normally be encouraged wherever emergency surgical capacity is available.

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VBAC:

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A vaginal birth after a caesarean (VBAC), especially after a LUSC (lower uterine caesarean section), in the absence of medical complications associated with this pregnancy, is the safer choice for most women.

A meta-analysis of literature concluded that 7 out of 10 women, who undergo a trial of labour after a previous caesarean section, can expect to birth vaginally.

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Do whatever you can to get away from this man. See if you can request another Ob, or whatever you need to do. YOU are in control, they cannot force anything onto you and that would be legal grounds if they did - they can't take your temperature without your permission. Can you get a doula or student doula to help advocate for you?

You have little time I know, but get onto this now, reclaim your birth and have that birth you want!!! Good luck hon xx

Big hugs Min :hug: I hope that Kelly's info helps you some...

This is a classic case of opinion not evidence dictating here. So, try and separate that out. Remember that this is his opinion not factual evidence... Don't let him scare you...

I am assuming you are a public patient? Okay, so you need to find an obs at the hospital that is pro vbac - I can't help you with that as I am not in Melbourne but Kelly may be able to... You need to read as much as possible between now and when you consult with him/her so that you are informed and educated.

I am sending you lots of love and am hoping that you can find the strength to be assertive about what you need my love.. It's really difficult at this late stage of pregnancy but if a vbac is what you want - don't let this guy take away that right from you... :hug:

Thank you so much for that boost ladies- I really needed it. I will be asking my Dr if I have the option of seeing another OB as I have already ruled the one out that delivered Jackson for sooooo many reasons, I don't know who is left that actually delivers at my hospital, so will find all that info out tomorrow I guess.

Becmc & Christy, what were the reasons for having your c/s's in the 1st place? Were they actually because you had been diagnosed with CPD which is what happened in my case meaning that my pelvis is supposedly under average size - that is what the main issue is here. If I hadn't have had a c/s with Jackson then the OB said I could have tried for a vag birth with this baby even if my measurements are under, but he thinks that combined with the scar is too much to risk.

Kelly, thanks for that info, you are a legend! Just wondering if you know any stats or info on outcomes of VBAC's when the reason for the previous c/s were CPD? I think this is where a lot of the confusion lies, it is not just that I had a c/x for an emergency reason such as foetal distress or labour not progressing etc. DYKWIM?

My reason was foetal distress after an induction(my ob talked me into it, said i would never go into labour naturally).
I now have my notes from the hospital(a long process, took nine weeks to get them), and i can tell you that everything they said to me when I was in labour was a load of c**p.
As far as I am aware, pelvises and bones move with labour. And i have read alot of info that the only women who have true CPD are those that have deformed pelvises from accidents etc, or in really really rare cases. I am not doubting your reason for your last c/s, just do some research on the net. I have also heard of a lot of women who were diagnosed with previous CPD, going on to have natural birth with 9 pound plus bubs.
Also some of the positions they get women into at hospital do not help with labour. Lying down is not the natural way to give birth, moving around, upright, squatting positions etc, help our pelvises to open far more, and you are working with gravity too.
Good Luck

I just read how you wrote your ob said you could have tried for a natural if you had not a previous c/s. So he is saying that even if you have CPD, you could have a natural birth except for the fact of the previous c/s!! That is very contradictory. He just sounds anti vbac, nothing to do with the CPD. Obviously he is more concerned with the vbac, not the CPD, which would be telling me that the apparent CPD is not an issue.
And uterine rupture isn't a huge risk either. So you really have nothing to worry about.

Perhaps even get a consult with a private obs who someone can recommend is vbac friendly. Just for opinion. For your own peace of mind.

Hi Min
Are you anywhere near Warberton? I have a couple of homebirths there a couple of weeks after you are due. If you are close to Warberton I will provide my services as a homebirth midwife for free or for whatever you can afford. No woman should be treated like you have been treated

Alan, what a fantastic offer that is.
Min, I am not sure that a public hospital can actually stop you from doing a VBAC. If you don't agree to an elective c/s and you have been going to their midwife clinic (sorry making assumptions that is what you are doing) and you turn up in labour, then they can't turn you away. But of course that would be a very stressful situation. My understanding is that you can't actually elect which OB you are admitted under in a Victorian public hospital, you just get who is on when you arrive there so it would be awful for you to be wondering if you were going to get one of the doctors you don't want. You would certainly need someone like Alan with you, who could get your point across strongly.
sorry I am not much help but want to add my support as it must be very distressing to have things change so much at this stage of your pregnancy.

becmc, what I meant was the OB believes that I could have laboured with Jackson given that he was a small baby (he was not the OB I had with Jackson who told me I couldn't) and that was where the mistake was made. He believes this baby is too big to coincide with a vaginal birth as well as a previous scar, that if this baby was around Jackson's side it would be a possibility.

We had our last antenatal class tonight, and I spoke to the midwife there who told me (even though she is not allowed to give personal opinions) that the OB i saw is generally happy to reccommend VBAC's as long as they are in the right circumstances and he would only reccomed against it if he truly thought there was reason to be unsafe. Whereas some are totally against VBAC, she said he is definately not, he is one of the good guys.

I guess this is sort of what I needed to hear, I needed to know whether to trust my Dr's opinion or the OB's opinion, and she said my particular Dr is generally happy to let anyone try a VBAC, but a high number of his labours end up in c/s which is not the odds I was hoping for - when it comes to the crunch, I want to do what's safe for me and my baby. I think I may have gone into the appointment today with an already negative attitude towards this OB thinking that he would talk me out of VBAC no matter what, and formed an opinion about him which doesn't seem to be true.

I think if I see my Dr. tomorrow and he agrees with what the OB was saying and reccomends I go for c/s I am "happy" to go with that decision - completely dissapointed, but feeling that I have chosen the sagest option. I guess things cant always go the way we picture them. The antenatal midwife also went through Jackson's birth with me and how to make sure that the things that happened with him didn't happen again etc. and how it could be a lot more of a positive experience even if it is a c/s.

anney - you can elect a private OB through a public hospital, but they have to be affiliated with that hospital, you can't just go and choose any OB, most Public hospitals give you a list of private OB's that deliver with them for you to choose from if you want to use an OB

Alan - I am not near warburton, but thank you soooo much for the more than generous offer, a really really lovely gesture that I appreciate more than I can express. it warms my heart to know that there are still kind caring people like you out there!

Min
If I can help in any way please let ne know

Small Pelvis? Here’s The Truth About Cephalopelvic Disproportion (CPD) includes studies about pelvimetry and CPD.

Also quite a few studies I have put in here:

https://www.bellybelly.com.au/forums...ad.php?t=18364

You just need to google it, there is HEAPS on it :) Also try birthrites.org and click, literature of interest.

It sounds like the ob and gp already have their doubts. So they may say they are supportive but when it comes to the time you will have so many restrictions placed on you that it will be really hard to get your vbac, like from the second you go into labour they will be timing you. That would be really hard circumstances to relax in and I personally would be find it hard to let go and succumb to the natural processes, which is where failure to progress can kick in.
I just cannot understand how your previous c/s has anything to do with having a big bub this time?? VBAC women can even birth breech bubs!It is just a birth and should have no impact on the decision to have a natural birth. Maybe Alan or someone could help with that, I just don't get it.

My previous c/s has a lot to do with having big bubs this time because the reason for the 1st c/s was pelvis size was under average, (by more than 2cm on I think the transverse diameter which apparently is quite a bit) so if a little baby was going to be difficult to get out for me then obviously a larger baby would be even harder to get out if I could get it out at all.

I know VBAC women can even birth breech babies, but every case is different, and cannot neccesarily be compared to other cases, the reasons for the initial c/s do have a bearing on the outcome, as I said in a previous reply if my pelvis size wasn't an issue then of course a big baby would not be an issue either. And just because there is a low incidence of actual CPD does not mean that there is no incidence, and someone can't have genuine CPD, I could be one of those genuine cases.

Jackson was wedged in quite securely when I had my 1st c/s and they needed great force and forceps to get him out and he had a big ring around his forhead, and he had only just started to engage, so this could be an indication that he would not have fitted.

I guess the bottom line is at some point, you have to trust someone in the medical profession because ultimately they are there to do what is safe for you and baby, the hard part is just deciding who's opinion to take, but in the end I am the one that has to be happy with that decision.

Min, track down Deejoy17 - she was diagnosed with CPD and had a VBAC last year....

Min, did you read that article on CPD?

You definately are the one that has to be happy with your decision, and I wish you the best of luck in whatever you decide.:)

Min,

I hope you get the answers you are looking for. I’m not sure if you remember but I had the same Ob as you and after a long labour that didn’t progress and a baby in distress, I had an emergency c/s. I was happy with having a healthy baby and although I would have liked a natural delivery it wasn’t to be. This time I am having a c/s. I have changed Obs due to moving to Pakenham and this ob was pro VBAC but I have decided on a c/s for my own reasons. We are going private and I’m not sure if this Ob delivers to public hospitals and Dandenong would be the only option as it is halfway between you and him. Sorry not much help but I wish you all the best.

Hmm, I can't draw from my own experience 'cause i've never been there before, but Docs don't know everything. Your a consumer not a patient. I would take a good long hard look at the information available, arm yourself to the teeth and simply ask how they have come to their conclusion.

The most important thing at the end of the day is you and bubs.

I do know with my sister they insisted that her first was a baby of gigantic proportions, I can't remember te exact term, so they induced her early. Needless to say that baby was about 7lb, could have easily waited it out a week or so. But the induction lead to an emergency c section. Her second birth was a planed C section and she got the frowning of a lifetime frm the older midwives. There was no winning for her.

Min, you need to do what YOU believe is best for you and your child NO MATTER WHAT ANYONE ELSE SAYS. - I had a vbac bubs was 4625gm ( 10 pd 4) I had him in Warrigul Hospital - that has a great reputation for supporting vbac, BUT if you feel it is not the right decision for YOU , dont let ANYONE make you feel bad -

You can always do what I know a woman I was virtual friends with on a vbac site - her hospital didnt support vbac, she couldnt get an obs to support her decision, so she laboured at home, then when things were very progressed, called an ambulance - it took her to the nearest hospital ( who were anti vbac) and bubs was nearly crowning, so she had her vbac without their interference KWIM?????


Sorry Kelly - but a doula or student doula will not have any influence as far as the hospital are concerned, I mean they are great to support you and your decisions, but they wont change a narrow minded opinion.

But given any situation a doula can remind them of their options and that they are in power. As a result of the discussions I have had with clients, drips have been stopped or taken out, monitoring taken off, greatly increased 'time limits' (this is what the woman wanted, as a doula you don't do the ordering around or forcing of course). They can also be good support to you at home and help you stay there as long as you want and give you the confidence to do all this! They aren't the be all and end all, but they can be a great help, I think... :) But yes, in an ideal world, it would be different!

During labour yes, they can help to uphold a womans decisions, but I though your prob Min was getting into the hospital???

Even though I never had a pelvimetry, I too was told that because my first child was 9lb1oz I would have another big baby and I wouldn't be able to push them out. Well I did and he was 10oz's heavier! And I didn't even tear!

Goodluck I hope you can find the supportive care you want and need.

*hugs*
Cailin

Thanks Sarah, yes I can remember Deejoy's story. Kelly, yes I did read the article thanks, pretty much what I already knew, in fact I haven't really found any new info yet that I didn't already know, have reached a decision today anyway thank you eveyone for your help and support!

saw my Dr today and ge said he has known this OB professionally and privately for a long time and about him saying he would not manage my VBAC if that is whay I decided he has never said that to him about another PG, so he was deadly serious. He said that OB was a totally supportive VBAC OB who often assists him in his VBAC’s and that if he says it is out of the question he trusts his judgement.

Apparently the part of my pelvis which is under average size is the very top part which is stopping the baby from even engaging and if he can’t get engage he won’t be going anywhere as the pelvis is sort of a funnel shape and gets smaller as it goes down, so this is most likely why Jackson never engaged.

Vanita - thanks for the words, trust me, no one will make me feel bad about my decision, no matter how I birth this baby he will be loved and cherished and that is all that matters!