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Forum: VBAC: Vaginal Birth After a Caesarean

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  #1  
January 12th, 2011, 08:05 PM
blessedx7's Avatar I <3 my big family!
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I was told I couldn't go past 39 weeks for my vbac by one ob but I was able to slide under his radar by seeing the other ob for my 39 week appt. She says I can't go past 40 weeks. Well, that's Friday and I have an appt with her that morning. I have no idea what she has in mind for the solution to not going past 40 weeks. I'm feeling quite confident there will be no spontaneous labor by Friday. I am trying to accept things but do my research too. I haven't even thought that far because I was certain I'd go into labor by my due date.

Here's my background: 1st child - c-section, 2nd & 3rd kids induced with pit and cytotec VBACs (scary now), 4th child repeat c-section. So I have had 2 c-sections but also 2 extremely strong VBACs with no problems. I was checked a week ago at my appt and was found to be a very very stretchy 2cm, extremely soft cervix, and 50-75% effaced.

What would you all suggest I ask for? What carries the least risk IYO?

1. Non-chemical methods of induction - foley bulb (although I'm pretty sure that only works to 3cm and I'm at least that now), AROM, etc.? (I have tried every form of natural induction at home already out there to no avail).

2. extremely low dose pitocin

3. repeat c-section
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Last edited by blessedx7; January 12th, 2011 at 08:09 PM.
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  #2  
January 13th, 2011, 08:13 AM
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Why can't you just wait for labor? It's your medical care and the fact that you would have to sign a consent for an induction or a surgery means they can't force anything on you that you don't want. The risks for vbac don't go up after 39 weeks, in fact the risks for vbac don't go up after 42 weeks. And the risks for baby don't start to increase drastically until close to 43 weeks. The lowest risk route for you and baby is still a spontaneous labor with no interventions. As for the foley or AROM, they are still inductions and if your body and baby aren't ready for labor they won't work.
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  #3  
January 13th, 2011, 09:27 AM
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Just continue to dodge them. As the above poster said, you don't have to consent to anything and you aren't putting baby at any added risk.

I was told the same thing and I didn't seek info or support and I just signed on the dotted line for a repeat section at 40 wks. I regret it every day.
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  #4  
January 13th, 2011, 09:35 AM
blessedx7's Avatar I <3 my big family!
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My fear is being "fired" from my practice for refusing. They are by far the most liberal group within a 2hr drive because I searched for weeks when I found out I was pregnant. No one else would even consider a vba2c. I guess I will just go to my appt tomorrow and see what I can talk them into again. I'm having some serious early labor stuff now so if I haven't had her by then, maybe that will be enough to hold them off a day or two.
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Our Family Blog: www.thecashcrew.blogspot.com

Kerrigan Elizabeth born on her duedate- 100% natural, hypnobabies, VBA2C


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  #5  
January 13th, 2011, 10:57 AM
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Well, it's actually in direct violation of the Hypocratic Oath (so not illegal but highly frowned upon) for your care provider to abandon you at this stage of pregnancy so they'd be opening themselves up to quite a PR nightmare should they try that, and I'm sure they know it.

Another approach would be begging . You know, "please just 4 more days, I'm begging you! I have other children at home to care for and not much help. Please." Or a little white lie...."well, I thought dr. so and so said 41 weeks?"
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  #6  
January 13th, 2011, 11:10 AM
Gray_baby's Avatar Platinum Supermommy
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Quote:
Originally Posted by MichelleNB View Post
Well, it's actually in direct violation of the Hypocratic Oath (so not illegal but highly frowned upon) for your care provider to abandon you at this stage of pregnancy so they'd be opening themselves up to quite a PR nightmare should they try that, and I'm sure they know it.

Another approach would be begging . You know, "please just 4 more days, I'm begging you! I have other children at home to care for and not much help. Please." Or a little white lie...."well, I thought dr. so and so said 41 weeks?"

Yep, patient abandonment can lead to official complaints on their record with the state that licenses them along with a nice malpractice lawsuit. They can't just "fire" you, they have to give you notice that they intend to drop you as a patient AND help you find comparable care somewhere else. If they do try to just fire you then you can file a complaint and possibly a lawsuit against them. There is no specific statute out there about this in most states, but it's a legal public policy that we don't want our doctors dropping patients in an unprofessional and unethical manner. There is case law in many states supporting this notion - even a case of a pregnant woman who went into labor only to find out her OB went "fishing" for the weekend without letting his patients know. She claimed patient abandonment and won her case (this was in ME many years ago, but it's an example of how this works).

Furthermore, if/when you show up to the hospital in labor there are attending docs there who can take care of you if your doc doesn't show (which if they don't I'd complain!). As long as the hospital doesn't have a ban on VBACs you should be ok going there without facing a big struggle. And no, you don't have to consent to a c-section just because you hit 39 or 40 weeks (or 41 or 42!).

And you could always let them schedule you for an induction or c-section and then just not show up. It's unlikely they will show up at your house to make you go through with it!


To answer your original question: I'd go with the non-chemical induction route before pitocin, specifically the foley bulb. I've done lots of research and I'm not all that comfortable with a pitocin induced labor, maybe augmentation after I go into labor on my own but it still worries me. I know lots of docs do it though. But hopefully you won't have to worry about that and you'll go into labor on your own soon!!!



Good luck!
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Last edited by Gray_baby; January 13th, 2011 at 11:15 AM.
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  #7  
January 13th, 2011, 01:52 PM
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To add to Gray_baby's comment, the VBAC ban is also just a hospital policy but not an enforceable law. If you arrive in labor and refuse a c-section they'll just have to deliver you. You'd still get all the same care, etc.

I didn't have the cajones for this, but I wish every day that I had.

Pitocin is very iffy, my VBAC dr will use it but very carefully, slowly and judiciously. Most will not.
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  #8  
January 13th, 2011, 03:15 PM
Jenna's Avatar AWESOME!!!
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Check your state's laws. In Maine, an OB can't 'fire' their patient if childbirth is imminent. Something like within 30 days of the due date I think.
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  #9  
January 13th, 2011, 05:27 PM
Gray_baby's Avatar Platinum Supermommy
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Quote:
Originally Posted by MichelleNB View Post
To add to Gray_baby's comment, the VBAC ban is also just a hospital policy but not an enforceable law. If you arrive in labor and refuse a c-section they'll just have to deliver you. You'd still get all the same care, etc.

I didn't have the cajones for this, but I wish every day that I had.

Pitocin is very iffy, my VBAC dr will use it but very carefully, slowly and judiciously. Most will not.

Thanks for clarifying that - I meant to add something like that and then forgot. They can't just cut you without your consent!
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  #10  
January 13th, 2011, 09:24 PM
Sk8ermaiden's Avatar Platinum Supermommy
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I would do one of two things. Tell them ACOG supports VBA2C, but not induction until 42 weeks and that you will be following the evidence-based guidelines. The can NOT legally fire you. They have you give you like 30 days notice AND help you find a new provider.

OR, if you want to go the non-adversarial route, schedule a cesarean and then call the hospital/OB's office and cancel for a family emergency. Reschedule for several days later and then get a cold. You only have to skate by for 2 weeks (and probably less than that) and I think you can do it.

Although, to answer the question you actually asked, lol, I would go with a very, very low dose Pit, with the promise the will turn it off if your body takes over. Everyone has a different comfort level with this, but to me personally, I feel that if I am in a hospital on (very low) Pit, they're going to be watching me like a hawk anyway, and the chances of anything going wrong are so absolutely low that the risks or c/s are almost certainly higher. If they have this 39 week policy though, I will be really surprised if they induce VBACs.

I would not AROM unless it was a last option, like 42 weeks and looming c/s no Pit allowed. The chances of infection, or baby being locked in a bad position, no thanks!
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  #11  
January 14th, 2011, 09:27 AM
lhug_nar's Avatar Platinum Supermommy
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I agree with Kelli. I'd give them the ACOG guidelines on VBA2C and tell them you'd prefer to follow those guidelines. I also agree with the non-adverasarial route too if you need to do that. I'd really go with the ACOG guidelines route first though.

If you HAVE to have an induction, I'd go with an extremely low dose of pit. I would definitely not let them AROM without being in labor and dilated to at least a 7 or 8.
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  #12  
January 14th, 2011, 09:48 AM
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A foley bulb induction is not AROM, it's not intended to break your water - I wouldn't want my water broken to induce either. A foley bulb is used to mechanically dilate the cervix and in addition it acts similar to a membrane sweep, lifting the membranes off the cervix which stimulates hormone production. Since your water isn't broken the risks of infection are low and it's considered one of the safest induction methods for VBACs. I'd honestly be more afraid of getting on the pitocin train and having trouble getting off when your body starts to do it's own thing.

Here are two articles about foley bulb inductions if you're interested: Foley Catheter for Starting Labor - from Ronnie Falcão's Midwife Archives and Induction of Labour | Induce Labour | Bringing on Labour
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  #13  
January 14th, 2011, 11:45 AM
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I don't think anyone including the OP thought a foley included AROM?

The OP DID say that she thinks it only dilates you to 3 cms (which is pretty correct) and that she is already dilated to 3 cms, so it's basically not a viable option.
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  #14  
January 14th, 2011, 11:58 AM
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I agree about AROM.
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  #15  
January 14th, 2011, 02:23 PM
Gray_baby's Avatar Platinum Supermommy
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Quote:
Originally Posted by Sk8ermaiden View Post
I don't think anyone including the OP thought a foley included AROM?

The OP DID say that she thinks it only dilates you to 3 cms (which is pretty correct) and that she is already dilated to 3 cms, so it's basically not a viable option.

Yeah that's probably my bad - I was a rushed this morning and probably misread something.

There may be some use since foleys can be used up to about 4cm and they aren't just to open the cervix but to help lift the membranes from cervix - so maybe that would help? I'd be wary of it but you never know I guess.


I hope the OP will come back and update us on how her appointment went today!
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  #16  
January 14th, 2011, 02:35 PM
Sk8ermaiden's Avatar Platinum Supermommy
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I hope she updates us soon too! I am not a patient sort of person.

Based on what I read from your links, the foley is generally ineffective to start labor and they usually have to break your water to actually get it going.
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  #17  
January 14th, 2011, 04:33 PM
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I'm a little late to the party but was just wondering what their rationale was for not letting you go past 39 or 40 weeks, depending on the practice?? If the risks don't increase I don't see any medical reason for this.
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  #18  
January 14th, 2011, 04:49 PM
MamaRN's Avatar Platinum Supermommy
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lurked in the Jan DDC and looks like she got her VBAC on her EDD!

http://www.justmommies.com/forums/f1...-her-baby.html
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  #19  
January 14th, 2011, 10:15 PM
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Congratulations Kelly!
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  #20  
January 15th, 2011, 10:28 AM
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Woohoo awesome news, can't wait for her to come tell us!
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