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-   -   De facto ban? Choosing between midwife and ob.. Help!! (https://www.justmommies.com/forums/f501-vbac-vaginal-birth-after-caesarean/2636847-de-facto-ban-choosing-between-midwife-and-ob-help.html)

MommieMouse March 21st, 2013 10:42 PM

De facto ban? Choosing between midwife and ob.. Help!!
Although I'm not preggo again, I'm getting a head start on choosing a new doc/midwife for my care that would maximize my success of a vbac. I live in Florida, which is already an impediment. Here goes...

I've narrowed it down to an ob that delivers at st lukes in jax who I've read is vbac friendly, and she'll let you go to 41 weeks (so I've read) Cons: she far (45 minutes), the office has now rescheduled with me for the 3rd time (my appointment was originally in January and now it's late April. St Lukes from what I've read has a 'timeline' that you have to sign to deliver there that basically says: if you don't progress at xyz you will have interventions, no birthing balls.. Etc. I'm so upset at the hassle and delay at the ob's office at this point I'm close to just canceling... But I've heard she's the natural birth/vbac doctor of jacksonville.

my second option: a midwife at flagler hospital in St Augustine. Pros: midwives should produce a better result. Flagler Hospital (although I dislike the hospital itself, supposedly is good for l&d. They allow birthing balls etc. Cons: I saw on ican there is a de facto vbac ban. I called the midwife, and I learned that I'd be transferred to their doc to see if I'm cleared to vbac. So, I made a consultation appointment for next week... I'm really anxious.

What exactly is a de facto ban? How do I go about deciding between the two? I'm torn between the doc everyone recommends, and the midwife that has had vbacs herself. Help!

KMH March 22nd, 2013 06:20 AM

Re: De facto ban? Choosing between midwife and ob.. Help!!

Originally Posted by MommieMouse (Post 27218657)
What exactly is a de facto ban?

It usually means that while they do not have a specific "no VBAC" policy, they are very VBAC unfriendly and/or that no doctors at that hospital will attend your birth. One nurse put it to me like this: "unless the baby is crowning when you get to the hospital, you will have a c-section."

I don't think you can really decide anything until you meet with the care providers and ask questions...you should be able to get a better feel for things that way. Also you may want to speak with doulas in the area...they often know which hospitals and doctors/midwives are the most accommodating to your wishes. L&D nurses are also a good source of info.

I think it is awesome that you are starting now to give yourself every opportunity at a VBAC...I can promise you it is worth the effort!

lhug_nar March 22nd, 2013 08:27 PM

Re: De facto ban? Choosing between midwife and ob.. Help!!
I would meet with the care providers before making a decision. Once meeting with them I would make sure that you ask all the questions you want to ask -- go with a list! If you feel that there are any red-flags, I'd be wary IMO. Also, see if your area has an ICAN group or at least one near you.

Here's some of the questions I asked:
What is your primary c/s rate?

Approximately how many VBACs have you attended?

Of those patients in your practice who wanted a VBAC, how many were

How many times have you seen uterine ruptures and what were the out comes?

What is your rate of cesarean sections and under what circumstances do you usually advise them?

Who is your back-up?* Is he/she VBAC friendly?* Would he/she support my birth plan?

What do you think of Birth Plans/ Preferences?

How do you usually manage a postdate pregnancy?* Or a suspected Cephalopelvic Disproportion (CPD)?

Do you have a vacation scheduled near my estimated due date?

What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy? When do you consider it a "failed trial of labor"?

True emergency c-section - how long does it take to get mom to OR and baby born? what kind of incision used?

*Do you know any kind of restriction I should expect from the hospital on a VBAC?* (Who do I need to have policy exceptions approved through?)

How many people can I have with me during the labor and birth?*

How do you feel about doulas?*

What is your usual recommendation for IVs?* Pitocin?* Confinement to bed?* AROM?

What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?

How often do women in your care give birth un-medicated?* How many with minimal medication?* In what percentage of your patients do you induce labor?

Do you do breech deliveries?

What would you suggest if I had a breech baby?* (Before labor?* During?)

What process do you use to determine nuchal cord or any complication?

Would you be willing to do an u/s to determine what the cause of the problem (i.e. mom says baby is stuck and ends up with a c/s due to nuchal arm) truly is?

At what point do you arrive at the hospital during labor/delivery? Will we be able to have you specifically in the event of a transfer?

What labor positions do you recommend to your patients? Do you encourage movement during labor?

How much fetal monitoring do you routinely use during labor?* Intermittent?

How many times do you preform cervical checks during labor?

Do you allow light eating/ drinking during labor?

Are you OK with No IV – but a Hep Lock?

Required Epidural for vbac moms?

Possible to have Epidural instead of general if need c-section upon transfer as long as we have the time to do so?

What do you consider unassuring FHTs and when do you consider FHTs to become a problem?

KMH March 23rd, 2013 10:54 AM

Re: De facto ban? Choosing between midwife and ob.. Help!!
Those are really great questions...I am going to bookmark this list :)

Just wanted to add that even if you don't find someone who will answer all of those questions the right way, please don't give up. A VBAC under less-than-ideal circumstances is still better than a c-section.

Case in point...I delivered at a hospital (had no choice) that had 16 OBs...4 would attend VBACs, but only 2 would do it since I was having twins. I had to deliver in an OR, flat on my back, couldn't eat or drink, had to have an IV and an epidural (I just had to have the catheter placed but didn't have to get any meds in it)...absolutely everything I didn't want. Baby A was a forceps delivery...something I feel could have been avoided if I could have labored differently. STILL, I would take a VBAC over a c-section any day of the week.

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