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Can't decide whether I should stay with my OB


Forum: VBAC: Vaginal Birth After a Caesarean

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  #1  
September 29th, 2010, 10:29 AM
Gray_baby's Avatar Platinum Supermommy
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I had a consult with my new OB on Monday (I also found out my EDD is 4/30/11!). It's a group so I will see different docs at every appointment and any one of them could deliver the baby. All the docs are peris not just OBs so I feel confident that if something were to go wrong they would be great people to have by my side. The doc I met with said I'm a good candidate and said I have a 60% chance of having a successful VBAC. When my DH asked about the risks, especially the risks of uterine rupture and possible outcomes, she was very honest and laid it all out there. I felt like she was supportive of me trying for a VBAC and she never tried to talk me out of it. However, I had some concerns whens he said a) they won't let me go past 41 weeks, b) they prefer you to get an epidural in case you need an emergency c-section but they wouldn't pressure me to get one if I didn't want one (I'm undecided), and c) they won't induce, but if I go into labor on my own and need some "help" they will offer small amounts of pitocin.

My first question was - why the 41 week rule. I know the risks go up but not significantly after 41 weeks. Has anyone else dealt with this?

Second, I feel like saying you "prefer" me to get an epidural "in case" means you think I'm going to fail at the VBAC. That statement didn't sound all that confident that I'd have a successful VBAC.

And last, I've read a ton about inducing labor for VBAC increasing risks of uterine rupture but I've also heard of docs doing it. Is it unusual for a doctor to REFUSE to induce and just go to planned c-section if I don't go into labor on my own?

I'm so confused. I don't know if I should meet with another doctor in another practice and see what he thinks (I have one in mind who I've heard is great), or if I should just stick with my current OB. Ugh. Any advice?
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  #2  
September 29th, 2010, 11:44 AM
lhug_nar's Avatar Platinum Supermommy
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Personally, I'd contact your local ICAN chapter and see who they'd recommend as a doc. But I'd also go and interview this other doc that you have in mind. I don't know that -if it were me- I'd stick with the office you're at now because to me, she's setting you up for 1) bait and switch 2) failure to progress and 3) another c-section because she doesn't have the confidence in herself or you. JMO though.
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  #3  
September 29th, 2010, 01:26 PM
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My doctors told me if I haven't gone into labor naturally by 40 weeks they want to schedule a cs. I asked if that was set in stone and was told IF I am showing progress and everything looks good, they MIGHT consider letting me go to 41 weeks, but that is the max.

They haven't said anything about an epidural. But I know what you mean about things like that feeling like they have little faith in you succeeding. Like how at EVERY appointment each doctor gives me the same spill about how vbac is risky. They list all the things that could possibly go wrong and ultimately "end in a c-section" (or as one doctor so nicely put it "kill" my baby). And they ask me if after knowing all this I still want to attempt. The first few times I thought it was just a coincidence that each doctor gave me a similar spill... but after so many appointments I realize it is their protocol at each appointment. I try to remind myself that they are just trying to do what they can to avoid lawsuits. If something goes wrong they have the whole "the risks were clearly stated at EVERY appointment and the patient still agreed".

They also will not induce me and will only give a small amount of pitocin if labor has naturally started but is not progressing. I don't want pitocin, but it does make me feel more overwelmed knowing I don't have the option (knowing it's got to be all me). My water broke at 40 weeks 5 days last time and I was given pitocin after 4 hours of no progress.

It's so stressful not knowing how things will go. I use to think it was all so simple. I don't have any advice, but just wanted to say I know what you are going through. Due to limited doctors in my area and insurance reasons I am stuck with the doctors I chose. But if you can look around, I say go for it.
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  #4  
September 29th, 2010, 04:14 PM
Gray_baby's Avatar Platinum Supermommy
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That's one of biggest worries Tiff - the bait and switch - I dread it.

Part of me says not to worry so much since this OB Group has a reputation of being VBAC friendly. The doc I met with was pretty reassuring about the risks and didn't go into great details until my DH asked specific questions - I don't honestly believe she was trying to scare me, instead I think she was being honest with my DH. She repeated several times that she thought I was a good candidate and even said if I was obese or diabetic she'd have a different opinion.

The great thing about this OB office is they have a local office in my town so I can go to several appointments locally. That means my DH will be able to go to several of them since he works on the Army base here and can't travel to Tucson (80+ miles away) on a work day. If I go with the other doc I know of I have to go to Tucson for all my prenatal appointments which isn't ideal.

I hate this not knowing for sure. Ugh.

Neads - that stinks that your OB is saying 40 weeks! I thought 41 was bad, but I'd feel even more pressure if they said 40 weeks. I wonder if I can talk my OB into letting me go past 41 if I'm showing progress too. I did go into labor on my own with my DD but not until 40w 3d - so I know I'll be stressing once I hit 40 weeks.
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  #5  
September 30th, 2010, 05:34 AM
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I'd be nervous in your situation, too.

Quote:
My first question was - why the 41 week rule. I know the risks go up but not significantly after 41 weeks. Has anyone else dealt with this?
I had this issue. My doctor said I couldn't go past 41 weeks, and that if I did, it meant a cesarean. However, I never scheduled anything, and my midwife didn't ever mention it. I went into labor when I was 41w4d - according to them. (based on ovulation, I was already past 42w). I don't know why they say this. I really can't see what the problem is.

Quote:
Second, I feel like saying you "prefer" me to get an epidural "in case" means you think I'm going to fail at the VBAC. That statement didn't sound all that confident that I'd have a successful VBAC.
I agree. If you have a true, true emergency, they most likely wont have time to get you an epidural. But, in my mind, if they have the anesthesiologist there and able to get you under general, then they should be able to give you a spinal just as quickly. However, that still doesn't excuse the recommendation. If you stay with this group, just understand that they will probably put a lot of stress on you to get one when you're in labor. So you might want to figure out what you want to do first, and be firm in that conviction either way.

Quote:
And last, I've read a ton about inducing labor for VBAC increasing risks of uterine rupture but I've also heard of docs doing it. Is it unusual for a doctor to REFUSE to induce and just go to planned c-section if I don't go into labor on my own?
No, that is very typical. So, when 41 weeks comes and goes you need to really think about how dedicated you are to having a VBAC.

One thing to keep in mind, is that you don't have to schedule the cesarean. Or, if you feel pressured into making it, you can call the hospital and cancel it. Or, call and reschedule it for later. Remember that it is still your body, and your choice. You don't have to go and have surgery just because the doctors decide you aren't following their timeline well enough.

Oh, another reason to stay with your group is because if you do go over 40w, they start making you have non-stress tests all the time. I had to drive over 2 hours each way to my doctor. Luckily, I worked out a co-care situation with a local doctor so that when I had to do them - twice a week - I could stay local. So that would be good for you, too.

Good luck! And congratulations.
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  #6  
October 7th, 2010, 08:50 AM
Tofu Bacon
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Personally, I think its good that she's laying it all out on the table; I had the opposite experience if being pressured into an epidural while I was in labor, despite 9 months of reassurances to the contrary. Just keep in mind that these are their standard policies, but ultimately you can say no to anything you don't want to do, not matter what their rules are. As long as they are flexible with their "policies" then it shouldn't be an issue, but its never a bad idea to interview other providers as well.
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  #7  
November 9th, 2010, 07:02 PM
wintereast's Avatar Theresa334
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My doc said similiar things, but hasn't mentioned the epidural. I agree it's better they are honest and upfront so you know. It sounded like they won't let me go past 41 weeks and no inducing.
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  #8  
November 9th, 2010, 10:49 PM
NutMeg76's Avatar Platinum Supermommy
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Megan, your doc only makes me slightly nervous, but there are some alarm bells and red flags waving for sure.

Neads, your doc scares the beegeezus out of me, I wouldn't stick with them if they were my docs!!!!
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