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VBA2C, I need opinions


Forum: VBAC: Vaginal Birth After a Caesarean

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  #1  
March 7th, 2011, 06:48 PM
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Hi girls, I was here when I was planning my VBAC with DD, unfortunately she was breech so I had another c/s. This time since my doc was so great about my first VBAC I guess I just assumed that he would be ok with letting me try for another but he has basically told me no without actually saying no. Our hospital doesn't have any ban against VBACs but leave it to the discretion of the docs. First he told me that he can't tell me yes without getting a consensus of the other 5 docs that deliver on call at the hospital (pretty much all of the OBs in town). So I called their offices individually and three of them told me that they would allow me to try for a VBA2C but when I talked to my doc he said that those same docs told him NO. He went on to say that our hospital is just not equipt to handle an emergency c/s due to uterine rupture because the oncall anestetist (sp) might not be available immediately and the same thing for the O/R since there is only one room. He basically told me I needed to call the big hospitals in the city 45 minutes away in order to have a VBAC. He told me to absolutely not labor at home at all regardless of where I deliver, but how would that be possible if I end up having to deliver in anothetown? I called some midwives in town but didn't have any luck until one of them called me back tonight and said that she would be willing to take me. She also said though that it would basically be a homebirth and if transport was needed she delivers in another smaller town hospital about 30 minutes away. I guess I'm wondering how smart it would be to use this midwife? I mean a homebirth would be my dream come true but what happens if worst case scenario my uterus does rupture and then I have to be transported 30 minutes away? Isn't that way too long? I also found an OB in the big city 45 minutes away that said after reviewing my records she could give me a definitive yes or no answer whether he would take me as a VBA2C. So I guess now at least I have options but really I just want to deliver here at our hospital with my doc and I don't see WHY trying for a VBA2C is such a bigger deal than trying for my first vbac. I am not going to give up my hope for a VBAC and I told DH that I would just rather labor at home until I know its baby time and then head to the hospital when they can't tell me no but there is always that huge WHAT IF something goes wrong here at home and we don't get there in time which is my basic worry with using the midwife and then that her hospital is even farther than the one here in town. Any advice or opinions are much appreciated. I guess I am asking WWYD? Thanks so much in advance.
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  #2  
March 7th, 2011, 11:16 PM
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Well, for me your OB would be off the table. Either he is lying to you or the other doctors lied to you. I find it odd that three other doctors would lie to you independent of the others, what would that accomplish?

Your doctor is also obviously uninformed of the ACOG guidelines and the research that shows the risk of UR after 2 surgical births is really not that much more than after one surgical birth. The difference is so minute that it isn't even statistically significant. Meaning, if the hospital can handle a VBAC, it can handle a VBA2C. And of it CAN"T handle a VBAC, then really it cant handle ANY birth because there are other obstetrical emergencies that can happen to ANY woman during labor that happen as frequently or even more frequently than UR happens to VBAC mommas that are allowed to labor without induction or augmentation.

If I were in your shoes I would go for the home birth if I could have a medical professional deliver me. My only option because of where I live is to deliver in a hospital, or unassisted- unless I pay a traveling midwife to come here, which would probably be too expensive.

How close is the local hospital? If you needed to transfer for TRUE emergency could you be there within a few minutes? If so that is where you would go regardless of which provider you were using. It is an emergency. Your midwife might not normally transfer patients there, but in this case you or your husband could insist on it.

If you needed to transfer for other reason that did not require a crash c-section then you would go to the hospital your midwife has privileges. This would be for a non emergent transfer, like failure to progress or maternal exhaustion or if you wanted an epidural.
http://www.medscape.com/viewarticle/725597
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  #3  
March 8th, 2011, 06:43 AM
~*3 little bears*~'s Avatar Jack~Mack~Brooke~Baby
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Thanks you meghan for your very helpful reply. The local hospital is about 15 minutes away driving the speed limit or if I labor at my moms its about 6 minutes away. I really like my ob a lot but he is being so weird about this and I'm wondering if the other obs just say yes we will take you as a vba2c just to get you in then just pressure you to have another section the whole time. There is a water birth facility in the big city that I would not ming delivering at and obs deliver there because it is part of the womens hospital. The homebirth makes my dh and my mom super uncomfortable I do have a little bit of concern but am totally willing to do it. Do you think it would be worth giving that ob in the big city my records to see if they would take me? My doc said the hospitals there have already done a lot of vba2cs whereas our hospital has never has one done.
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  #4  
March 8th, 2011, 08:13 AM
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It doesn't hurt to try. What is the worst that will happen? They say no and you move on. If you don't send them your records the answer is already no and you might later regret not trying everything you could.

What was the reson for your first surgery?
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  #5  
March 8th, 2011, 08:24 AM
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My first section was a result of my idiot ob (different one) who insisted that I was pre eclamptic because my blood pressure went up at the end of my pregnancy even though there was no protein in my urine and she never did any kind of tests or monitoring. She push and pushed me to schedule and induction at 38 weeks because she was going out of town I found out later. I labored naturally for 48 hours on pitocin at the max it can go and never dialated past a 3.
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  #6  
March 8th, 2011, 11:24 AM
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I forget, did they try a version with your DD? Iwould go with the home birth and the midwife no matter what, but that's my dream and may not be yours. And so you know the ACOG states that 30 minutes is sufficent time for most emergency c/s, so if your midwife were to call if you had to transfer they OR could be ready and waiting when you get there. Especially since it takes aabout 30 minutes to ready the OR anyway.
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  #7  
March 8th, 2011, 12:02 PM
~*3 little bears*~'s Avatar Jack~Mack~Brooke~Baby
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No I just got soooo upset in the moment when they told me she was breech after 20 hours of laboring that I completely forgot that both my acupuncturist and chiropractor are trained in turning babies so we didn't even try a version. I will always and forever regret that. And it was my fault for not even thinking about it.

I have an appt with the midwife next week to discuss all the options and details and hopefully my Dh can make it so he can ask questions and hopefully get enough answers to be comfortable with letting me do the homebirth. i think that if I am adamant about it he will let me but it is his baby and I am his wife so I think his opinion is important too, ya know?

My OB said that in the case of UR its basically life or death for me and baby within 15 minutes is that not true?
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  #8  
March 8th, 2011, 06:11 PM
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No, it is not 100% true. If it were a catastrophic rupture then yes it is very urgent. But, the majority of ruptures are not catastrophic.

How did you feel about UR when you were planning your first VBAC? Did you worry this much about it?
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  #9  
March 9th, 2011, 10:40 AM
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No I was not worried about UR at all and in truth I'm not really that worried about it this time either because the risk is still sooooo small and VBAC is still way safer than another section but my DH and my mom are kinda freaking out and I guess its making me a little more concerned since my doc was very on board with my first VBAC and now he is making such a big deal about it and not going to let me try to it after 2 sections.
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  #10  
March 9th, 2011, 11:54 AM
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Give them this to chew on, UR risk after 1 c/s is 0.4% after 2 (or more) it goes up to 0.9%. Leaving you still less than 1% risk. Maybe that will help them see that it's not more dangerous now.
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  #11  
March 9th, 2011, 01:24 PM
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Thanks for that info. After watching a bunch of youtube videos I am pretty set on the homebirth now!
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  #12  
March 9th, 2011, 05:13 PM
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  #13  
March 10th, 2011, 09:48 AM
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DH and I talked a bit last night after I did a bunch of research on homebirth stats and he seems alot more comfortable with it now. He even joked and asked if he could watch TV during the labor LOL. The only concern he really had that I didn't have an answer to was that if I lost alot of blood midwives don't have blood with them so in that aspect he says the hospital is safer if I were to need a transfusion. I think the odds of needing that are pretty unlikely and if we needed to get to the hospital would 15 minutes be ok? And I know midwives do have drugs to slow/stop hemmoraging right?
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  #14  
March 10th, 2011, 07:50 PM
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the risk of hemmorhage with vag birth is much lower than with c/s, but midwives do have pit they can inject to slow or stop hemmorhage.
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  #15  
March 10th, 2011, 10:38 PM
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Also, if you were to need a transfusion, it would take more than the time that it takes for you to transfer to get blood...even if you were IN the hospital.
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  #16  
March 11th, 2011, 07:10 AM
~*3 little bears*~'s Avatar Jack~Mack~Brooke~Baby
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Thank you so much ladies for your replies. You girls are awesome. I have one more question I have read in a couple places that homebirth with a DEM (CPM) is the "most dangerous" way to give birth being less safe than delivering at home with a CNM or using an OB. Is this true? We don't have any CNMs in our area only CPM's, Licensed Midwives.
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  #17  
March 11th, 2011, 12:10 PM
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A trained lay midwife is no more or less dangerous than a CNM, and possible less dangerous than an OB. Especiall if you count all the dangers of major abdominal surgery.
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  #18  
March 12th, 2011, 12:16 PM
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A DEM is not hte same as a CPM. The 'dangerous' kind is a lay midwife. Although, that just means they don't have formal education, but they also can be very skillful.

The CPM should be able to carry something to help with stopping hemorrhage and should have neonatal and adult resuscitation tools available the same way a CNM would.
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  #19  
March 12th, 2011, 04:26 PM
~*3 little bears*~'s Avatar Jack~Mack~Brooke~Baby
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OK well shoot, I am confused then. I was under the impression from some of the sites I've been on that a DEM and a CPM are the same thing. If not, how are a CPM and CNM different? Her info also says she is a Licensed Midwife.
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  #20  
March 12th, 2011, 06:38 PM
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Hi, I hope everything works out for you. When my husband and I concieve, we are going to use a midwife and have a home birth. I will be trying vba3c. I am not worried or scared. Whatever is going to happen is going to happen anyway no matter where I am. I have FAITH.
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