VBAC...........with conditions?

[starangelk]

I saw my Ob today and he again was very supportive towards a VBAC. He said that as I have an untested pelvis he is very happy to support whatever choice I make. The conversation was raised as he asked me if I had made a decision which way I wanted to go and I still haven't. He asked if I had any questions about VBAC or a repeat CS and we began talking. It turns out that he is only really comfortable in giving me 12 hours from established labour to have the baby due to the risk of dramas with my scar and rupture etc etc. I understand the risks and his position and he really is flexible and willing to talk further about it once I have done some further reading and educated myself BUT I was wondering whether this is a standard thing or whether this is just a "My Ob" thing. Anyone??

[BellyBelly]

Ob = Abnormal/dangerous until proven otherwise
Midwife= Normal/safe until proven otherwise

[Fleur]

I think a lot of VBAC conditions are up to the OB you get. Just like people, they all have different ideas on stuff.

FWIW time constraints were mentioned by the doctor I saw but for a different reason - the theory being, I had had a short labour previously & if it went for ages then it was likely because there was a problem. (Not sure how I feel about that theory mind you, but that was the idea anyway).

I don't think the risk of rupture increases with the length of labour; if anything affects it, it is the intensity of contractions which is why synto etc are contraindicated - too much too hard too fast on the scar. But I don't think labouring for a certain time is such a big deal. Especially if it's your first labour, you would expect it to be a bit longer. I am sure I have heard of VBACs which were over 24 hours, being first labours.

I would be asking what happens, if you hit that 12 hour mark & your labour is still progressing well... and remember, if that happens, if you do get there & things are going well, there is no need for them to then perform a CS just because you didn't make it in under 12 hours. And (I would hope!) that is highly unlikely - but still , get him to clarify things for you.

What is 'established' labour to him? When you know for sure, or when your contractions are x minutes apart, or when you are 4cm+ dilated? All things to consider.

Good luck

[zap]

Also who will be determining start if established labour? Doc or midwives? If it's the doc hopefully he runs late. I was given the time restriction jargon too but since only ob was allowed to do VE to check dialation I was in luck! She arrived 40mins before I gave birth! (I had being waiting 3 hours for her!) So don't be too overwhelmed by their time frames sooo many things can change. Good luck!

[starangelk]

Thanks Fleur. I am happy because I asked all those questions!! He said he classes established labour as regular contractions and that the 12 hour guideline is just his general length of time before assessing the options (being CS.) He said that he considers the main problem to be the fact that we are forcing the uterus to contract and that means extra pressure on the scar and if I get to 7cms and then sit there for quite a while, then there is increased stress and pressure on the scar and it is stretched for a long time and that's when he would be getting concerned if that happened and it was around the 12 hour mark and there was no progression for a period of time. I was actually fairly satisfied with his answers, he was really quite open to the fact that I would want to labour naturally even though he said that most of his patients elect to have a repeat CS. He said I don't even need to make the decision until 38/39 weeks and I only need to decide if I want to elect for a CS. We just left it that I would keep thinking and do some reading and ask more questions next time if I had anything further.

The only sort of negative things he said and he didn't say it negatively - just some further considerations were that DD was a big baby for my size and that second babies are likely to be a bit bigger and that being a boy, potentially that could also mean a bit bigger. But he said they are all maybes and that they can't tell the actual size and even if they have a guess, it's usually 20% variance and that's alot when you are talking about a little baby. He said he wouldn't use that to sway me either way. We also had a bit of a joke about how if I elect and then regret it, I'll be saying to DH that we are having another baby just so I get the opportunity to VBAC. LOL

[Fleur]

Big babies...another thing I don't think is really a factor. But I like that he admits that it's a 'maybe' and they can't actually tell. It sounds really like he's trying to give you the full drill as he sees it, not trying to sway you into a CS. It actually sounds pretty reasonable to me - and coming from an OB, keeping in mind they are there to intervene if needed, that's where their head is at. And of course if you are happy with his answers & feeling good about it, that counts for most of all

[LimeSlice]

[FAKing]

The Thinking Woman's Guide to Better Birth, Henci Goer - This should be your new best friend.
Plus, New Active Birth, Janet Balaskas.

You can get Goer from Belly Belly, not sure about the other, or you can borrow mine if you can't afford it. PM me if you like.

[Yeddi]

If I had your OB I would not have achieved a vaginal birth. 36 hours, 4.3kg - I had no issues with my scar, in fact it didn't even cross my mind. It is really important to do your research so you know when OBGYNs are just going with what they are comfortable with so they can keep control, and not necessarily because it is what is best for you or bub. A little bit of perspective - rupturing membranes comes with a 2.5% change of cord prolapse but they still do it all the time without going into any fear mongering. VBAC without using induction drugs has a 1% chance (if we're being generous) of rupture.

[starangelk]

Thanks ladies. Yep, I am happy with his responses so far I just want to get a bit more self educated about the whole thing. THanks for the book ideas Limeslice, I'll see if I can borrow them from the library.

[berrme]

I was given the guideline of 1cm an hour, but when I asked more questions the ob said they only check about every 4 hours so it doesn't really have to be 1cm an hour, just reasonable progress from last time they checked. I was assured that I wouldn't be pushed to have a c/s unless there really was reason to believe labour had stalled and bub was having issues. I also agree with zap about the restrictions not mattering so much when the ob isn't around. I laboured mostly during the night so when the ob came round at 8.00 I was already 8cm. Noone was concerned too much before that.
I had an ob who told me straight out he didn't go out of his way to convince his patients to have a VBAC, but he would support me if that was what I wanted. He was always matter of fact about the risks and benefits and never tried to sway me either way. Sounds like yours is very similar, hopefully that means you will be well supported no matter what your decision.

[JennaJayen]

I was given the 12-24 hour time limit with DD because DS had become stuck against my pelvic bone when I was pushing and I ended up with the emergency c/sec, they said that I probably had cephalo-pelvic dysfunction - where the lower part of the pelvis is small that the upper part - and his head circ was 34cm.
My OB and the midwives gave me 6 hours once they broke my waters before the OB examine me again and assess bub & me, then let me go to 12 hours before reassessing, then 18 hours, then 24 at which point they would schedule an emergency c/sec even though I didn't want one (I made it to 41 hours from the induction with DS before they sent me down to theatre), and he was born just over 30 minutes after that.

They told me at 37wks that she was estimated at being 7pd 9, and I also had GD and was on insulin so everyone was saying I'd have a big baby.


I'll share this condensed version of DD's labour for you, to give something positive to give to your OB
DD was born at 40+2wks after AROM (artificial rupture of membranes), I'd been 1-2cm dilated for 3 weeks and had been having constant irregular contractions for those 3 weeks, so it's a lot easier whe your body is ready for it. Once the waters were broken I started getting contractions between 5 & 15 mins apart, they regulated within 1.5 hours, and a little over 4 hours after the waters were broken I started going through what felt like transition (I was only 5cm when I was examined, so they gave me pethideine and gas as I was losing the plot and demanding an epidural even though I had strictly specified that I never wanted to have another one), 20 mins later I felt the urge to push and they didn't believe me until they examined me and saw DD's head as I couldn't hold on any longer! She was born about 20 minutes after that with a 34cm head circ just like DS, and was only 8pd (DS was 8pd 3).
So I ended up with only a 4hr 43min labour after my loooooong 41hr 31min labour with DS.

[Laranna]

I think it really depends on the OB. Mine was comfortable with only around 8 hours. That was partly him and partly hospital policy. Fortunately, I was only in labour for 5 hours and 3 of that I spent labouring at home.

I agree with Fleur, it all sounds pretty reasonable. As long as you are happy with it all, then go for it

[Heaven]

Hmm...I don't think your OB seems supportive of VBAC at all actually. He thinks it's a high risk situation and what you want when you're having a VBAC is a caregiver who knows VBAC is a safe way to give birth. I would be getting a doula or independent midwife.

[WannabeMum]

Part of it is explaining all the perceived risks of VBAC as they see it. If he didn't tell you that time may be a factor (and the jury is certainly out!) and you ruptured after labouring for 25 hours, you might sue him and his practise goes down the gurgler. So if you think of half that is covering his butt, he sounds pretty supportive.

I would be asking him about other risk factors that may increase the risk of having another cs - does he want you to come straight to hospital (um, tell him no), does he want continuous monitoring (again, no), VEs etc. These can increase the risk of another cs.

My ob is similar, he's not concerned about rupture of scar aside from no drug induction - but I didn't want another one of them anyway, he's supportive of me having a VBAC and not even thinking about scheduling a cs until at least 42 weeks. I have yet to tell my ob (I'm only 14 weeks) that I'm not having continuous monitoring and I'm labouring at home as long as possible until I feel the need to come in.

I like what Kelly said - it's normal and just untried. The risk of rupture is so low, why would they think it couldn't work? I'm giving myself every opportunity to get this baby out the natural way, when my body's ready - I don't want milk coming in at day 6 again!

Good luck - I'll be watching for your successful VBAC announcement!

[starangelk]

Thank you everyone for your kind words and thoughts, it is really helpful to hear everyones different perspective on things. I am happy with the way my Ob is dealing with this issue and it's not his way or the highway, he is happy for me to go away, do more reading and then come back and discuss again. Def some food for thought from this thread - thanks again.