Help me read between the lines...

[JLeigh29]

Thanks in advance for reading my monumental and quite possibly muddled post.

So, I had an Ob appointment yesterday. My ob seems pretty supportive of my VBAC hopes....I think. I've been doing a lot of research and have become involved with a great support group too, so I was ready with my list of wants and needs to discuss with the ob (fully prepared to look elsewhere if I didn't feel happy with his responses). So here's what he said:

No, he will not induce me (ie with drugs)
Yes, I can go past 40 weeks, and 41 weeks too, providing all is well with Bub and I (and I'm not saying I've had enough, lol!) If I do want/need to be 'helped along', it'll be with other methods - Stretch and sweep, break my waters if my cervix is soft and I've dilated a bit, etc
No need for continuous monitoring throughout labour
Yes, I can use the shower and bath throughout labour (though he does not do waterbirths)
Yes, he encourages me to be as active as I want throughout labour and birth
No, there's no time limit for the labour

On the not ideal, but understandable side (when your EDD is 27/12), he will be on hols between 39 and 41 weeks, so there's a pretty good chance he won't actually be there at all. However, he's assured me (at every appointment, as I keep asking!) that his on call people will support whatever he says (even if they personally don't agree with it) - so they won't be pushing me into a CS when I go in for my 39/40 week appointments, or when I'm in labour I won't have anyone telling me to get out of the bath/induce me/I need continuous monitoring etc

Here's the bit I'm not too sure how to read...
He'd like to do a stretch and sweep at 38-39 weeks if Bub is nicely engaged. I'm guessing that, ideally, he'd like to be around when his patient delivers, so if he can encourage me to go into labour before he goes... I get that. Not sure I necessarily agree that its a reason for a S and S. But....

.... (and I wasn't thinking clearly enough to ask this at the time), what happens if that doesn't work? And what if Bub isn't 'nicely engaged'? Will he be trying to book me in for a CS? If Bub isn't engaged, and in a good position at 39 weeks, is there a chance that could still change? Would manually rotating Bub be an option if he was breech? Does that only work when Bub isn't engaged yet? If he's happy for me to go to 41 weeks, is there a need to do a S and S at all?

What else should I be asking? Should I be suspicious of his assertions that I can try for a VBAC?

[little_O]

I didn't have a vbac, but I was 2cm dilated at 36 weeks when he did an internal. At 38 weeks I was 3cm so I asked for a ss.

I don't think you need to be worried (vbac ers may know more). You can say no to it, tbh I think it only works if your about to go into labour.

[misty]

I would be asking to meet his fill in's now and asking them the same questions.

[Arimeh]

I personally wouldn't agree to a s&s without being at least a week overdue - I just feel its unnecessary and could lead to interventions when they are not needed.

Ob's are quite commonly seen as really supportive of a vbac in your earlier trimesters, its when you get past 36 weeks that they start freaking out and pressuring you to have interventions etc when there is just no need for it. If the baby is fine and comfortable and happy I wouldn't feel there is a need to do anything but wait for its birthday

I would let them know now that you will agree to a s&s - but not at that gestation

[Arimeh]

Double post

[Cricket]

I don't think that having a s&s would lead to unnecessary intervention UNLESS he accidentally breaks your water, which does happen occasionally. If that happened, you would be looking at an induction in the next 12-24 hr, depending on his (or the hospital's) policy. A s&s can nudge you into labour if you're just about there (especially if you can have 2 done over 2-3 days), but they can also just cause a lot of cramping and discomfort if you're not ready.
So, you'd be taking on a bit of risk, with the chance that your water might break, and also risking some useless discomfort, and gaining the chance of delivering with that ob. You have to decide how much it's worth to you I guess.
All the best for a lovely VBAC when the day arrives!

[Trillian]

I would decline the S&S because it's just not needed at that time. I think the dates might work in your favour though - at that time of year no one is going to be pushing for you to do anything (pardon the pun ) and they would probably much rather let you wait it out.

[JLeigh29]

Thanks ladies. A S and S isn't out of the question for me, but I can't say I'm keen on having one so early. My thinking is that if Bub is happy to wait until after Xmas, and all is well with me, why would I (or anyone else) want to do anything to rush him out?

I'm hoping that I can have my last appointment before Xmas at around the 38 week mark, that then buys me two weeks before anyone is likely to be back on duty, and by then I'll be 40ish weeks Or, another option is to be the last one in on their last day so they really won't want to be doing things like S and S just before they head off for Xmas celebrations

Cricket - The hospital itself has no policy regarding a time limit after waters breaking, but they follow the ob's instructions. Forgot to ask him about this, despite it being on the list I took in with me. I've heard some obs still refuse to induce, and go straight to CS if that happens.....they'll have a fight on their hands if they want to go that route!!

Trillion - hadn't thought of it like that - more along the lines that they'd want Bub here before so they can have their holidays in peace, lol!

[Peekaboo]

I would try get in contact with others who have used the same OB for their VBAC and see how they went with him, whether he later pushed interventions or stuck to his word. Meeting his back ups would be a good idea too. I saw the team of hospital OBs for my VBA2C, and I met 3 out of 4 of them prior to going in to labour. Of course, the one I had not yet met was the one on call the night I went into labour

The S&S I think is totally up to you. You can decline if you feel it's not something you want to try at 38-39 weeks. You may want it by then, only time will tell. I've never had one so can't really comment! If he's happy for you to go past 41 weeks I'd be asking what sort of monitoring (if any) he'd want to ask of you. My OBs said CTG every 2nd day.

[Baby Dreamtime]

I had an attempted S&S at 40+1 I think but cervix was very unfavourable and very posterior ob couldn't hardly reach it. Another attempt 3 days later. No chance. At 40+5 OB suggested arm at 41 weeks as amino fluid looked low. I had the option of asking for a full scan to double check but didn't push for it. There was a limit I could go with dh before he would start to worry. OB said if I was his wife he wouldn't go past 41. I drank castor oil at 40+6 which worked and labour started. So for me S&S was pointless. If I was you I would wait it out. Do your own internals to see if you can feel where you are at. Stick to your guns. Good luck xx

[JLeigh29]

My ob is quite new to this hossy so I haven't found anyone who's seen him. There's nothing online either as you can't say stuff about ob's anymore. But when we were looking at hospitals, I stayed behind and asked the midwife who she'd recommend (mentioning my VBAC wishes) and this is who she said.

So Baby Dreamtime, sounds like your cervix changed a lot in those few days. Hmmm, thanks for that.

[Peekaboo]

Is it KEMH?

There is a VBAC AU support group on FB that you can join, if you haven't already. I know there are a few ladies in Perth/WA on there that you could talk to about diff OBs (in case you want/need to change). I am also in WA, but I didn't have my VBA2C in Perth.

[JLeigh29]

No, I'm going private. I've spoken to the NBAC clinic at KEMH (looked into birthing here, but it wasn't for us), joined the VBAC Aust FB page and have lots of info from Birthrites (been to a meeting with these lovely ladies too). No one knows this guy from personal experience! I did meet a midwife who works at the hossy with him, but had to go before we could speak properly....hoping to see her again soon. She said he was 'really nice' to work with and one of the 'better ones' to try for a VBAC with, but didn't get to anything more specific.

[Arimeh]

I've heard some obs still refuse to induce, and go straight to CS if that happens.....they'll have a fight on their hands if they want to go that route!!

Just wanted to say something about OB's refusing to induce and go straight to c-section - my OB with DD1 offered me an induction but she was pretty much against it - she did give me the option though. I refused to be induced for several reasons, DD1 wasn't engaged and there is a risk of cord prolapse if you break the waters before the baby is engaged. That was too risky for me, considering her state in there (compromised oxygen supply through the cord and my placenta was starting to calcify) plus I was 42 weeks.

Also, I didn't want to be put in a position of another high risk - being put on a drip to speed things up. The risk for uterine rupture is the same as a mother being induced when you are going for a vbac, so if you add that risk of rupture for a vbac PLUS the risk of rupture anyway by being on a drip to speed things up - too high risk for me. I'm all for vbac's and getting the birth you want, but I guess I'm also pretty conservative about what I consider high risk to be. I don't consider a straight vbac to be that high risk, after all women are induced every day with the same risk factors and OB's are happy to do that.

For me, I found the option of a second c-section less risky to me given those factors. I didn't want to be sitting on the bed being constantly monitored with everyone watching and it most likely ending up as an emergency c-section anyway. However, I did have DD1's compromised health to think about, which probably was a big factor in my final decision.

I'm not sure what the point of my post was, I've sort of forgotten and babbled a bit - but mostly its not necessarily a bad thing if some OB's refuse to induce - it could be based on things like my situation.

[JLeigh29]

Arimeh - I think so too. There will definitely be situations where a CS is the best option. I was meaning if he did a S and S at 38-39 weeks, accidentally broke my waters and then said, well I'm not inducing you so its straight in for a CS. I know there are ways to help things along if this were to happen, or I could be given the chance to wait and see.... I should only be letting him do a S and S if Bub is somewhat engaged then, is that right?

Or, if we got to 38-39 weeks and he says Bub isn't engaged 'enough', so straight to CS..... I just want the opportunity to go into labour naturally and birth my baby, providing there are no overarching medical reasons why I shouldn't/can't. Just want to have asked all the right questions of him beforehand so I can be sure I'm being supported (and look at alternatives if I don't feel that way).

Thanks again for letting me talk through all this

[Arimeh]

I personally wouldn't be surprised if bubs wasn't engaged at 39 weeks - only my first was engaged by then, none of my others engaged and that is perfectly normal, expected even for subsequent babies. Even DD3 hadn't engaged when I went into labour and she still came out through the slippery dip lol

[JLeigh29]

That's what I was thinking too, Arimeh....hmmm, could this be his way of trying to force the CS....

[Arimeh]

Dunno. Do you have any stats on the current rate of success for vbac at that hospital? That's a good place to start to see where they might really stand.