VBAC Support

Hi! I posted some time ago before I was pregnant to ask what questions I should be asking my OB about VBAC. Thank you to everyone that helped out.

I am 13 weeks pregnant with #3 (had an emergency c-section because of placental abruption with twins 2 years ago). I had a great appt today, and the first thing she asked was "how would you like to deliver this one?" Here are her answers to my questions:

1. What is my success rate likely to be? 90%, basically I'm a great candidate based on my incision, and reasons for prior c-section. She actually told me that because we are considering more children after this one, that vaginal would be the way to go.

2. Abruption rate? The hospital says 5%, but she says it is probably closed to 2%.

3. How will I be monitored? Fetal heart tone monitor

4. Will I be induced? She does not do inductions with VBACs, but may do augmentation (whatever that means)

5. How long can I go? 41 weeks I will have a back up C-section date

6. Have to have an epidural in place? No.

7. All docs on call do VBACs? Yes there are 3 docs in the group

She has seen ruptures in the past, one of which was actually found during a c-section (partial rupture). She did not have a negative attitude towards it, and actually told me the risk was rupture, but didn't go into details like mortality of mother and child, etc. So I am not really well versed on what that actually means (ie instant death, hemmorhage, etc). Can someone enlighten me? Also, are these answers consistent with what you all know? Thank you!!

Laura

Wow, Laura!

Congratulations on your pg!  I am so happy for you!!

Your dr sounds great!!  Those answers sound sincere and not the kind of answers drs use to placate you when they really plan to just c/s you.

All of the answers sound great, but, imo, I would blow off the c/s at 41 weeks.  A full term baby isn't 40 weeks; it's actually 40w6d, but drs round off to 40 weeks.  So it is very normal for babies to be born after 41 weeks.  My vbac baby was born at exactly 42 weeks. 

Rose

Proud mom to 4 wonderful kids

and 4 angels in Heaven

 

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It all sounds pretty positive to me! I agree with Rose though, I'd blow off the c/s at 41 weeks... sitting here at EXACTLY 41 weeks right now, I can't tell you how great it feels to know I have 7 more days (not that I WANT to go 7 more days...) to go into labor before I'll have to allow the same interventions that led to my first c-section. 42 weeks is still perfectly normal - VBAC or not. If you get to 42 weeks, I'd INSIST on AROM before I agreed to a c/s. It might be enough to get you going on your own - and it's not going to hurt anything if they were going to section you anyway.

Oh, and as for augmentation, it usually means they're not against a little pitocin if your contractions aren't regular/fast enough for them. As long as you're not against the intervention, it doesn't really affect the rupture rate much if it's used sparingly. Rupture can mean a lot of things. Most hospitals quote the rupture rate a 1-2%, but these numbers INCLUDE women who are induced. If you aren't induced (chemically), your actual risk is much lower than this. Keep in mind, too, that the risk of MOST birth "emergencies" is about 1-2% (footling breach, cord prolapse, hemmorhage, etc.). This is no different, so don't be shy about insisting that you're not treated any differently just because of a scarred uterus. Most ruptures are minor, some aren't even noticed until after the baby has been delivered vaginally and the doc checks things out. It can be serious, but as long as you're paying attention to your body's and your baby's cues, you or the doc should be able to pick up on the warning signs before it's a catastrophic emergency.

If you've got the energy - head to the library and pick up a couple VBAC books. The more educated you are about your body and your birth before you're in the labor, the more likely you are to "succeed". Good luck and happy birthing!

 

Make a pregnancy ticker

Laura-

Just wanted to say hello and congratulations!  I didn't know you were pregnant.  How are the twins?

How wonderful your doc is recommending VBAC.

On #3- The question you might want to ask is how frequently will you be monitored- intermittently or continuously. If continuous, which is quite common, there are often options to get a telemetry monitoring unit which is basically wireless. You can still move around with wired monitoring, though. I had someone dedicated to just making sure the monitor in place and keeping the wires out of my way while I was in labor and that was wonderful, and it was not a problem.

4.- Augmentation is the use of pitocin after you've gone into labor, to help strengthen contractions.

5. I have found it hard to get actual mortality/morbidity rates for ruptures relating to VBAC. But it is way less than 1%. Here's my understanding of the risks, but be sure to look it up from a trusted medical source, including asking your doctor for the details. A true uterine rupture cuts off the blood and oxygen supply to the baby and risks the mother bleeding out. The mother may need a hysterectomy, or otherwise have permanent damage to reproductive organs, and the baby risks death or brain damage. It is an immediate medical emergency, but if detected immediately and c/s can be immediately performed, then chances are good of averting injury.

Elaine