Post c-section birth plan

So today, during our regular appt, DH asked the question that had been on my mind, but was afraid to ask - what is my new OBGYN's VBAC policy. In a nutshell, her policy is if I agree to induce labor when she is scheduled to be in the hospital she MIGHT be willing to attempt it. Otherwise, if I go into labor and any other OBGYN in her practice group is the one scheduled to be in-hospital, even if she is in the office, it would have to be another c-section. She said if this wasn't OK, I needed to transfer out of her practice ASAP since we're 28 weeks. This is not the answer I wanted.

I know most don't get the birth story they want, but I felt really robbed of the birthing experience when my twins came early via c-section due to Twin B's sac rupturing. I was depressed about it for some time and was (and still am) jealous when my friends give birth naturally. I know VBACs aren't favored these days and am aware of the various reasons given. Regardless, I really had it in my head again that this time around I would finally get the normal, natural birth I had been wanting. Today's answer devastated me. I left the appt, drove to a parking lot, and cried. Then, I came home and started doing research.

There are only 3 OBGYNs who are "known" to do a VBAC in Tucson. Two are in the practice group I left due to their "misdiagnosis" of my pregnancy for the first 19 weeks - in fact, one is my former OBGYN (see post in this forum). The remaining is a man who all commenters said gave them their VBAC, but it came with his quirky personality and sense of humor. There is a birthing center here that uses only midwifes and does allow VBACS, but if anything goes wrong and you need an emergency c-section, you get pot luck OBGYN availability at the hospital they contract with. My research on induction also has me worried because of possible risk to the baby.

So, I am at a loss right now about what to do. I don't want to risk my baby's health, but I also feel a huge loss over being denied a natural birth. I am not sure I am emotionally over my first c-section and suspect I am still grieving that situation, even though I have two beautiful, healthy girls to show for it. Induction sounds simple, but if I choose this option am selfishly subjecting my baby to unneeded risks just to have an experience? Pre-twins,I had dreamed of a water birth, and even now I think my old OBGYN (who since retired) rushed into a c-section, but I also appreciate the care we all received and feel that my twins had quick access to and needed the medical expertise available only in a hospital. So, to be redundant, I am lost.

How do I decide what to do and how do I make peace with my decision?

 

First of all, you are not alone in your feelings of being "robbed" of the birth experience you wanted. A c-section and transfer of my babies was not in my plan either... but I have two healthy girls to show for it now. It really bothered me for a long time after they were born though. For me, my Dr. is willing to attempt a VBAC, but it's hospital policy not to induce previous c-section patients. That is fine... I don't want to risk anything. I'm going to try for a VBAC if all goes well, but really it was the separating from my babies for 2 days that bothered me most.
To answer your question, hopefully you can come up with a solution that will put your mind and heart at ease. Do what best for your babies, then let your heart follow that.

 

I can definitely identify, I just posted about this in the first years section!

If you are 28 weeks you still have plenty of time to make the switch. Start asking everybody, and I mean EVERYBODY, you encounter if they know a doc who does VBACs. Other moms, people in your church/synagogue/whatever, coworkers, people who comment on your pregnancy like cashiers, your hairstylist, various receptionists... I live in south Florida, truly America's wasteland of quality medical care, and I talk to everybody about their OBGYNs I am always, always hunting for my perfect doctor, even when I'm not pregnant lol. Seriously, within reason, anyone who comments on your pregnancy can be a help. You can also try calling the hospital and see if they can give you a list of doctors who do VBACs. Or call midwives groups and ask them to recommend somebody. Heck, if you feel comfortable enough, post it on facebook. Have you considered a homebirth?

I feel really strongly about this, if you can't tell lol. It's ridiculous that women have so few options and so little control over their birthing experience!!! I really hope you can work this out! Keep pushing and you just might find somebody. Good luck!

 

I posted something similar while I was pregnant because one dr told me at the regular antenatal clinic that I would need to be induced at 36 weeks and I was determined to go as long as I could and I was pretty damn scared of c-sections so vaginal was my first (and only) choice, haha... Well, I got some great advice here, and the one that stuck in my mind was to do whatever it took to deliver the babies safely.

I stood my ground to go to as near as possible to 38 weeks but as it was I had emergency c/s, 3 days before scheduled induction at 37.4 weeks and looking back, like Cindy, it was the separation from my babies I missed most and found the hardest to deal with.. I even made it through my c/s pain to walk and see my baby two levels up, the next day.

Sometimes though when I look back at that time, I wonder maybe I should have listened to that doctor who wanted to induce at 36weeks and maybe then Liara wouldn't have had seizures from the respiratory distress and I wonder about my choices.

 

You are not wrong in any way to want someone to deliver your baby vaginally. I didn't have any NICU issues but felt very cheated and angry after my C-section with my boys. (A was breech and I didn't know anybody who'd deliver a breech A).

I would recommend Ina May Gaskin's "Guide to Childbirth" as a good resource- having had twins I'd been conditioned to think in terms of 'what ifs' and worst case scenarios. I needed to re-train my brain to know that this was 1 baby and I was a good candidate for a VBAC - according to my midwifery practice who works in conjunction with OBs at a teaching hospital in Colorado.

I called my local birth center (attached to a hospital) but they weren't allowed by state law to take VBAC women; had they been able that's where I would have gone. Instead they recommended me to the Center for Midwifery- they have an 80% VBAC success rate and fortunately I was part of the 80%. I had an awesome VBAC and the experience was better than I could have imagined. Of course if my baby or I had needed a C-section I would have had one. But to put your baby and yourself through something you do not want to do unnecessarily; ehh, I'm just not a fan.

As to induction, I questioned my practice about it and they really encouraged natural methods. I did not need any- my water broke at 40 weeks exactly. I would not induce, personally, as there are risks (esp with Cytotec in VBACs) but did get an ankle rubbing the night before. :grouphug:

 

The first step--which maybe you've done, but you didn't mention--it to try to determine for yourself if you are a good candidate for VBAC or not. I did that by reading about 10 different lists on the subject on-line. Once you determine that you are then do what the others recommend and start calling around.
In my case, I determined I was not. The most important thing for me was that the birth be as complication free as possible and that I and my baby be fine afterwards. Focusing on the outcome, not the process helped me accept the conditions of both of my births.
In the mean time you should also investigate some recent developments that make c-sections, more like vaginal births Here is a video I posted about it some time ago.

The natural saesarean

 

I've been thinking a lot about your post & how you're feeling & really wish we could sit down, have a tea & chat. :hug: It sounds like there's a lot going on emotionally for you right now. Have you thought about hiring a birth doula? She would be a fabulous resource for you in so many ways - she could help you in continuing to process your feelings from your first birth, she could help you research all of your options for your area (she probably knows which docs/hospitals/midwives are VBAC supportive), and she could help you & your partner prepare for your upcoming birth, whether you choose a VBAC or a repeat cesarean birth. Check out www.dona.org for more information on doulas.

Something to keep in mind as you process & ponder is that repeat cesarean births carry their own set of risks to both you AND babe. Choosing between VBAC & repeat cesarean birth is not choosing between a risky option (VBAC) and a safe option (repeat cesarean). Both choices carry their own risks & you'll need to figure out which set of risks are more acceptable to you. More than that though is taking a look at the benefits that each choice offers. There are quantifiable physical & emotional benefits for mom & babe with undisturbed vaginal birth. But then there are times when complications arise that cesarean birth absolutely becomes the safer option for you and/or babe. I think the hard thing for all of us is that there is no way to know 100% in advance which option will be the safest/best.

A blog that I really love is www.birthingbeautifulideas.com. It's written by a doula who had a cesarean birth with her 1st, a hospital VBAC with her 2nd, and just in January a HBAC (home birth after cesarean) for her 3rd. She has a great series of posts on common VBAC scare tactics and how to take a critical look at them with lots of links to additional info. I think it's a great resource and hopefully will be helpful to you on your journey.

 

I have considered this, but am not sure DH will buy in to the idea. His dad is a DR. Although DH is a reformed hippie (complete with VW bus), he appreciates medicine. That said, he has been (proudly) giving me progestin shots each week. Maybe he'd be up to the home birth challenge. More chance to play DR.

Isn't it amazing what we moms can do? After the twins were born, I got a call that I could come see them in the NICU. DH was out cold, so I tried to walk myself. I ended out stalling out in a hallway, unable to take another step, and being found by DH clinging to the wheelchair rail. He rescued me and "drove" me the rest of the way there, while gently chastising me for not getting help. But come hell or high water, I was going to see those babies. The memory of my first recovery does, however, make me worry about the post c-section down time I will need if we repeat. The hospital where the girls were born had rooms where parents could stay while their babies were in the NICU. I lived in the hospital for 3 weeks and honestly cannot remember when I was really moving on my own after the c-section. I do, however, think it is more than the 2 - 3 days c-section patients can stay with a non-NICU baby (my goal). This would mean I will be going home to 3 under 3, but have limited functionality. Scary prospect.

I'd welcome that cup of tea (or scoop of ice cream ) and the shoulder. I'm adopted, so my mother (who I am very close with) doesn't really get where I am coming from. None of my closest friends have had c-sections. Instead, I hear their labor stories and think, "Gee, I didn't feel a single thing." No contractions, no bonding experience with DH as we brought new life into the world, just the panic of "Oh, Sh*&. They're not supposed to come for 6 more weeks." Followed by panic as everyone tried to find DH, get me to the hospital, and then get the girls out and into the NICU.

Also, I had realized that there were repeat c-section risks to me (which probably wouldn't sway my decision), but I hadn't realized there were risks to the baby, too - and this does matter to me. But my research is just beginning. So, I will look into this further. Thanks for letting me know.

EVERYONE, thanks so much for hearing me out, your kind words, and the resources for further research. I will look at them all. I am in a better, more rational place today, and not ready to decide or throw up my hands just yet.

 

If you have a trained, good midwife, you wouldn't be without medicine. Obviously not the standard hospital equipment but midwives do carry meds with them - like Pitocin to stop hemorrhaging and a Doppler to listen to the baby's heart rate, off the top of my head.

Now that I've had one VBAC if we were to have another I'd do an HBAC in a heartbeat but it would be assisted with a doula (Rachel's right- doula's ROCK!) and a midwife. For me, there is nothing more annoying than having to sign a C-section release form as I'm successfully pushing a baby out (yes, this happened to me). :crazy:

 

Arizonatwins - I wish this could be an easier process for you! You seem like a quite an advocate for yourself and I hope that you are able to find a group that will give you a shot at a VBAC. My regular OB and high risk OB both have supported a VBAC but have said that I could not be induced nor go past my due date. In order to have a VBAC in our practice you have to sign off on a consent that discusses all the remote possibilities of poor outcomes. I have a medical background so these consents don't phase me much, I look more at the odds of a good outcome...my husband on the other hand is really upset by the consent as it discusses so many scary outcomes for the baby (many of these are the same outcomes that we worried about with our twins...luckily they are healthy little champs). We're struggling with the decision and have a C-Sect scheduled for my due date...not sure how we are going to decide this one!

 

Have you checked out ICAN (International Cesarean Awareness Network)? They have tons of amazing resources & information.

 

For what it's worth, I chose to deliver at a hospital an hour from where I live because our local, small town hospitals do not do VBACs. I had a C/S with my twins due to A being breech and B being transverse, so I was a good candidate. I had the same fears of dealing with 3 under 3 if I was recovering from surgery. In the end, I ended up having a second C/S because baby girl decided to be transverse, but I actually had a much easier recovery the second time around. I was up out of bed the same day and walking the halls the next day. Since my C/S was scheduled for after 39 weeks, the baby had no issues and stayed in the room with me 24/7. This hospital was a baby friendly hospital and had DH do skin to skin with her in the OR until I could hold her. It was a very healing, bonding birth even though it was still a C/S.

Coming home, it wasn't too bad to deal with the twins because I had DH home to help me. I explained to them that I couldn't pick them up because I had an ouchy belly and they learned to climb onto the changing table themselves. If they needed me for comfort, I sat on the couch and let them climb into my lap.

Good luck with your decision!

 

Forgive me for taking so long to get to this one, but WHAT A GREAT BLOG! It's like she crawled into my head. Thanks for the resource.

UPDATE FOR ALL:
I still haven't given up, but am waiting through the painfully slow process of getting my medical records released to me so I can shop around. My HIPAA forms are in, so now I wait. Hopefully in 7 - 10 business days (seriously people??) I will able to be more proactive and not feel so benched. I did, however, contact the local birth center in the interim and the lady I spoke with there was great. She also found humor in my path to her e-mail box. So here's to hope for me yet. ta ta for now.

 

I know heh? She's awesome. I really appreciate her voice.

I'm excited for you as you begin your search for a more supportive care provider! Let us know how it's going. :good:

 

Good for you!!! There's gotta be something out there and I'm sure you will find it!! Lots and lots of luck!!

 

I'm just now logging back on to twinstuff... been so busy with this pregnancy... and all of what you are feeling!

#1 do NOT induce to have a vbac. it's the main reason that uteruses rupture...

#2 very cool that you are getting your records and researching what to do.

I was going to suggest your local ICAN network, I'm in Central Florida, and our local group has a "yahoo groups" and there are many women who are a phenomenal resource. I chose at 30 wks to quit my dr... and go with a local midwife. She does over 30 homebirth vbacs a year, nearly half her practice. I'm SO excited, and we're planning a waterbirth too. Another thing that I always thought about but never pursued with the twins because it seemed like everyone makes twins into a medical issue... though for me, if they hadn't have induced me at 39 weeks I probably would have had a vaginal birth... ugh for induction, the meds worked against my blood pressure and I never progressed very far and then now looking back they didn't even give my body enough time to work... from 6a to about 3p... what?!

anyway, hope all is going well! i'm still trying to get my midwife ok'd as at in network rates since there are no other home birth options on my plan... ugh for insurance issues.

In Florida vbacs at a birthing center are illegal but not in all states. a friend in Texas had 2 vbacs at a birthing center and raves about it.

I wish you lots of good vibes, and hope you get the birth you want!