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Forum: VBAC: Vaginal Birth After a Caesarean

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  #1  
September 3rd, 2010, 10:07 PM
MrsSarah1's Avatar Mega Super Mommy
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I had an girly appointment on Thursday to get the birth control patch because we want to wait a few years until we TTC our #3, and eventually #4. I really really really want to try a vbac.. however.. our hospital here does not do them. None of the doctors do them. I would have to drive at least an hour (both ways) for all of my appointments and for the delivery.

I looked into midwives that do home births but none are in our area for several hours. They are "willing to travel" but I'm sure that means hundreds of dollars in travel fees.

I asked my doctor what he thought about me having a VBA2C and he said that in his medical opinion, it was not advisable because I've had two (one due to failed induction due to pre-e, and the other a repeat scheduled c-section) and the risk of uterine rupture for me is high.

Thoughts? Is it even worth the shot to drive an hour and hope that in the end of the 9 months worth of appointments I get a vaginal delivery? Would anyone be willing to take me?

Of course, I'm way ahead of myself and not even TTC.. but just planning. It's what i do.
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  #2  
September 4th, 2010, 05:47 AM
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Welcome!

Oh my, yes! It is completely worth it to drive an hour each way to have a VBA2C!! That's exactly what I did. But, I actually drove over 2 hours each way to accomplish it. Like you, there were no hospitals nearby that would do it, and in IL, there are no midwives that can legally do home births near me. But I wouldn't let that stop me. I called around until I found someone that would. And, the best part is that I was able to use the midwife that worked with him. It was amazing! I used Hypnobabies and had a completely natural VBA2C in Feb 2008. My first was a c/s for breech and my second was a repeat.

The risk REALLY isn't higher. At All! Well, okay, it is a little bit. But, the risk of uterine rupture is still LESS than 1%! So, sorry to tell you, but your doctors professional opinion isn't worth much.

In fact, the ACOG has come out with new guidelines in July of this year. They state, "The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD

One reason why hospitals wont do VBAC's is because of the wording of the past ACOG guidelines. They said that emergency services needed to be immediately available. Man hospitals don't have anesthesiology on staff 24/7. So they took that to mean that if they didn't have that, they couldn't do VBAC's. So, the new guidelines say this:

"The risk of uterine rupture during a TOLAC is low—between 0.5% and 0.9%—but if it occurs, it is an emergency situation. A uterine rupture can cause serious injury to a mother and her baby. The College maintains that a TOLAC is most safely undertaken where staff can immediately provide an emergency cesarean, but recognizes that such resources may not be universally available.

"Given the onerous medical liability climate for ob-gyns, interpretation of The College's earlier guidelines led many hospitals to refuse allowing VBACs altogether," said Dr. Waldman. "Our primary goal is to promote the safest environment for labor and delivery, not to restrict women's access to VBAC."

Women and their physicians may still make a plan for a TOLAC in situations where there may not be "immediately available" staff to handle emergencies, but it requires a thorough discussion of the local health care system, the available resources, and the potential for incremental risk. "It is absolutely critical that a woman and her physician discuss VBAC early in the prenatal care period so that logistical plans can be made well in advance," said Dr. Grobman. And those hospitals that lack "immediately available" staff should develop a clear process for gathering them quickly and all hospitals should have a plan in place for managing emergency uterine ruptures, however rarely they may occur, Dr. Grobman added.

The College says that restrictive VBAC policies should not be used to force women to undergo a repeat cesarean delivery against their will if, for example, a woman in labor presents for care and declines a repeat cesarean delivery at a center that does not support TOLAC. On the other hand, if, during prenatal care, a physician is uncomfortable with a patient's desire to undergo VBAC, it is appropriate to refer her to another physician or center."

So, with all that said, you should take this time to do some research, get to know the risks and benefits to both cesarean and VBA2C. Because there is more risk with each cesarean you do, too. Get involved in your local ICAN chapter, and find out about care providers. Things will be changing in the next 3 years, so it's possible that you may end up with a hospital near you that will change it's policies. And, perhaps you could even be involved to help make that happen! If you know the in's and out's, you will have the medical info to back yourself up. And, a doctor that is practicing evidence-based medicine (which they all should), will have no choice but to agree with you.

Good luck!

Wendy
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  #3  
September 4th, 2010, 10:43 PM
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Thanks.

There really is a chance then? I really hope so. I really really do. I have a couple years, at least.

So when it comes time to find a doctor, do I just call around and say "Hi. I'm an hour away and I've had 2 c-sections before because of ____ and ____. Is there a possibility of you accepting me as a VBAC patient?" or something?
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  #4  
September 5th, 2010, 06:34 AM
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At the calling stage, here's what I did...

I found doulas phone numbers. I called them, told them that I was a VBA2C candidate, and did they know of any docs that would take me. They pointed me in a few directions.

Then I called the OB. Talked to the nurse that answered the phone. I said, "I would like to have a VBAC. I've had 2 cesareans. I've heard that Dr. ___ does that. Is that correct?" She said yes, but there were some criteria. Which I met. So I made an appointment with him. The distance thing was never something that was an issue. It came up because of timing appointments with taking my older kids to school, and picking them up. And, I wouldn't mention why you had cesareans before, either. I mean, you'll have to when you meet with the doctor, but I wouldn't bring it up just for the initial phone call.

I selected a doula that was halfway between me and the hospital. The plan was to go into labor, then go to her house when I felt I needed help. Then I stayed with her until it was time to go to the hospital. But, with you being an hour away, I would just get a doula near you. She will have a good idea of when to have you head in, knowing it will take an hour.

Of course it's possible!!! The biggest issue is just finding the OB/Midwife that is right for you.
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  #5  
September 5th, 2010, 08:48 AM
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Wendy's given you some good information. Welcome to the VBAC board and good luck!
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