Here is a diary of my quest to have a VBAC with this pregnancy.

March 27

I had my first prenatal appointment today.  I asked my doctor about having a VBAC.  She thinks I'm in the gray area for doing a VBAC since I had 6 hours of 'good' contractions with no progress.  Someone who had a c/s due to a breech baby would be a good candidate, not sure who exactly would be a bad candidate, I'm in the middle.  She did say she would want to push me to a c/s.  But she said we don't have to decide now, she would just like an idea by about 20 weeks (I'd meet with the doc who will do the c/s at that point).  So it really sounds like I could say 'I'm doing a VBAC' if I want - not sure what her response would be, I didn't think to ask.

I asked why someone wouldn't dilate (like I didn't) she said 'we don't really know' but that she would get me something on that for the next appt.
 

April 25

I've been crying about this off & on since leaving my appt yesterday afternoon.  David is being very patient & trying his best to understand but he's not a woman so there's only so much he can understand.

At my first appt, my doc said she didn't think I was a good candidate for a VBAC but that we don't have to make a decision now.  She did say that normally I would meet with whomever does the c-section at 20 weeks and then the week before the actual c/s.  So I interpreted this to mean that if I want to do a VBAC, I just need to say I want to. 

My doc doesn't think I'm a good candidate for a VBAC because I never really dilated while I was in labor when I was induced last time.  According to my research, contractions started by induction aren't exactly the same as contractions when you go into labor yourself and that I may not have dilated because of that difference or because my body & baby weren't quite ready (despite being at 40 weeks & 4 days).  Also, 75% of first time moms who are induced end up with a c/s.

So yesterday at my appt I said "Can we proceed under the assumption that I'm doing a VBAC?"  She said "but you aren't a good candidate and I don't think it would work".  She also commented on how nice it is to plan (which it is, it would be much easier to find someone to care for Augie if I knew exactly when this baby would be born).  She can't give percentage chances for anything (I wasn't really expecting her to, but David asked).  So we left it that I'll meet with the doc who did my c/s last time (she doesn't do surgery) and ask him what he thinks.  I guess the implication being that if he thinks I can try a VBAC, I can, otherwise she really wants me to do a c/s.  I have no idea how supportive this doc is of VBACs, which seems to be a key to how supportive he may be of me.  She did say I have a better chance of convincing this doc to wait on a c/s until 40 weeks than I would with the other options (waiting until 40 weeks if there isn't a medical need to go sooner is important to me).

I left the clinic ok, but was crying by the time I got home.  (Its only about a 7 minute drive, max, so I guess that didn't take long!)  I just hate that I'm being told that my body doesn't work.  I know the chance of a successful VBAC is less if your c/s was for 'failure to dilate' - 70% of women have VBACs, but the chance of success is lower if you didn't dilate the first time - so 50 - 60% I think.  But I just can't get over thinking that women are supposed to have babies vaginally.  I know there are good reasons for c/s, I am glad we live in a time where they are readily available when women need them. 

I just want to be able to try giving birth the way I think I'm supposed to!  I don't know if I can fight this my whole pregnancy.  I was enjoying my pregnancy up until yesterday.  Now everything is stressing me.  It would be easy to just say yes to a c/s (going through labor is a lot of work, Augie care would be easier if I know when to schedule it).  But I'm not sure what just saying yes would do to me emotionally.

Why can't I be one of those women who can just accept what her doctor says?
I did read somewhere that women over age 40 are less likely to have a vaginal birth.  Of course, I'm only 38.  But I don't think even someone over 40 should be told to have a c/s just due to her age.  Plus, my aunt just had a baby vaginally 1.5 weeks ago and she's 44.

The only issue with trying to find a different doc is the lack of options here.  The closest midwife is 70 miles away.  There are actually 2 midwives in the same practice as the perinatologist I saw, so I think I will go visit with one of them (since they should have access to my records) and see what they think.  There are two OBs in town, one doesn't do VBACs, the other one does but has a horrible bedside manner I've been told.  At least my current doc has a good bedside manner.

I do think that perhaps I need to make it clear to her how important this is to me.  While I would think someone could pick up on that by the fact that I'm discussing it with her, perhaps it just isn't obvious enough.  I was very calm & matter of fact during the appt.  She's not totally unreasonable (I don't think).  I made a comment about knowing that we need to work together after all this and she brushed that aside like it wasn't something she was concerned about.  David commented that I'm stubborn but not unreasonable, she said she can handle stubborn, she just doesn't like unreasonable (well, who does?).

April 28

Last Friday I made an appt with a midwife in Sioux Falls for next Monday (May 5).  She's in the same practice as the perinatologist I saw.  I was told she wouldn't have access to my records here in Marshall (despite everything being computerized & they are all part of the same system).  So I went to the clinic here today & filled out a request for my OB records to be sent to the midwife in Sioux Falls.  I also requested a copy for myself - and good thing I did!  I was able to go pick it up this afternoon and they just had the info from my current pregnancy, not from the pregnancy with Augie (which is what I want the midwife to have).  So I had to call them back & tell the dense lady what I needed and that yes, I had filled out the form.  I wanted her to just find the request from this morning for the address for the midwife, but decided that was too chancy given how dense she was acting.

If you haven't ever looked at your chart, you should request your info sometime.  I found it interesting to see what my doc had even written down this time - most of it was mundane, but she did have notes dictated in there about the first OB visit & how I was 'somewhat upset' by her saying I'm not a good VBAC candidate.  I was glad to see she picked up on that. 

I'm also doing a lot of VBAC research on pubmed.gov.  I've found studies confirming that you are less likely to have a successful VBAC if the reason for your c/s was 'failure to dilate'.  And that you are less likely to attempt a VBAC if you are AMA (no duh, the docs discourage it!) and that you are also less likely to be successful with a VBAC if you are AMA.  No study has said to not try a VBAC due to either the failure to progress or being AMA, perhaps the combination isn't so good, though.  I'm going to continue researching, though, and will definitely be interested in the midwife's opinion.
 

May 5

I talked to a midwife in Sioux Falls, SD (a 90 minute drive) for about 10 minutes this evening.  I had sent her my records from my last pregnancy so she had reviewed them before we talked.  She said she saw no reason why I couldn't have a VBAC this time.  She doesn't think my blood pressure was a big enough deal, my records indicate I was mildly pre-e, she said I wasn't sick enough to be rushed in the induction like I was.  She thinks I just wasn't given enough time.

She also said my age wasn't an issue as far as she was concerned.  She didn't see it impacting my ability to have a successful VBAC.

I asked about convincing my doctor to let me go VBAC.  She said "You won't change her mind".  We also discussed who would be my current docs backup if she wasn't available for some reason when I went into labor - it seems fairly likely to me that even if my current doc says yes to a VBAC that if she wasn't available (it would be due to illness, vacation or family emergency or something like that, otherwise she attends all her patients births) that the backup probably wouldn't be someone who does VBACs & then I'm stuck with a c/s.  She said "if you're serious about having a VBAC, you need to be in a more supportive environment".

So, David & I chatted about this and he's in favor of going to Sioux Falls to have our baby.  Of course, there is a lot to be figured out still.  I am going to call & set up an appt with this midwife for David & I.  The logistical situation needs to be figured out - getting there while in labor (when do you go?), what to do with Augie (which we obviously need to figure out anyway, but it seems like a bigger deal when we're that far away), does David stay there the whole time I'm in the hospital or drive back & forth (hopefully won't be a long stay).  I know there were a few other considerations that popped into my head earlier.
Actually, one interesting thing I learned - the surgeon who did my c/s closed my uterus  with a triple layer.  I had only heard of single (bad for doing a VBAC) or double.  If double layer is good, triple must be excellent!

I was also suprised at how quickly David agreed that we could go to Sioux Falls.  He had been poopooing leaving Marshall to have the baby but when I told him what the midwife said, he was in favor of going to Sioux Falls.

May 22

I had an appt with the midwife in Sioux Falls yesterday.  We were able to arrange the appt for 2 hours after our plane was scheduled to land in Sioux Falls - so time for dinner first & no need for an extra trip.  She says I'm not the best candidate (mostly due to my PIH last time so increased chance of it this time) but she thinks I should try if I want to.  The biggest risk is driving so long in active labor when doing a VBAC (due to the risk of uterine rupture) but I would just go earlier than you might otherwise.  The drive, both when its time to have the baby & for all the appts, is our biggest concern.

I also had a prenatal visit with my doctor here in Marshall today.  All routine, I've lost weight since my last appt (due to my stomach bug of a few weeks ago) which she wasn't concerned about.  I also set up a VBAC consult with one of the OBs.  I asked to do it with the one who did a VBAC with someone I know.  She said he was very encouraging about doing a VBAC - and poopooed her concerns when she was wondering if she should just have a c/s.  (Poopooing someone's concerns isn't necessarily good, but being so encouraging about doing a VBAC is.)  So my VBAC consult with him is June 10.  My doc said she's going to tell him what she thinks, so I guess I discuss it with him & see what he thinks & then I'll meet with my doc again.  Depending on how all that goes, we'll make a final decision about going to Sioux Falls vs Marshall.
 

June 10

Today I met with the one OB in town who will do VBACs.  I'd heard he wasn't very personable or have a decent bedside manner, so I was pleasantly surprised by his demeanor.  He was 45 minutes late (which he apologized for) which meant David & I had to keep Augie happy for 45 minutes.  So by the time he got there, Augie was fussy & shreiky - that made it a little harder to have the conversation.

He went over the risks of VBACs, including the fact that I didn't really dilate last time and my age.  I asked why my age mattered and he said it was just because if this birth experience in traumatic and I need longer to recover, I'll be 40 by the time I'm trying to conceive my next baby.  (I didn't point out that David & I are 2 for 2 in conceiving when we get the timing right so I'm not concerned.)  I did find that an interesting rationale for being concerned about my age.

I asked him if he thought it was worth the risk for me to VBAC - he refused to say yes or no.  He said David & I have to assess the risk ourselves.  He talked about scheduling another appt at 36 or 37 weeks to make a final decision, until I said "I want to have a VBAC".  Then he said another appt wasn't necessary.

I think he wants us to have another appt with him, though, because he wants to discuss politics with David.  He found out David is a poli sci prof and the guy I guess he used to discuss politics with moved out of town.

So I guess I'll wait until my next appt with my doc on June 19 and see if she's willing to work with me for a VBAC now.  Since the OB didn't say no.  At that point we'll decide if we stay here in Marshall for this birth or if we drive to the midwife in Sioux Falls.

 

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Comments:

gusti...
Jun. 14, 2008 at 12:27 AM good luck i hope you get the birth plan you want and need

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mommy...
Jun. 14, 2008 at 12:54 PM Good Luck, Gwen! I hope everything ends up working out for you.

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nokit...
Jun. 17, 2008 at 9:17 PM Good luck Gwen - I hope you're able to figure out what will make you happiest & be healthy for you all.

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tytys...
Jul. 17, 2008 at 5:57 PM Sounds like this is becoming an adventure! I wonder why everyone is being so difficult about it?! It's your body, you know the risks, they should IMO be more willing to work with you AND have a postitive attitude about it! I sure hope everything works out for you guys....and you get to at the very least, ATTEMPT a vbac. How is David coping with all of this? I'm sure he's on your side 100%. How is Augie doing? 16  months already?! Crazy!

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Sweet...
Jul. 29, 2008 at 7:48 AM

It might help others understand your post better if you explain what the ititials VACB means. I  hope you are able to achieve your goal.

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