Still not sure about the birth of this baby

[Denisemac96]

I am still in the process of trying to decide whether or not to try a VBAC or have an elective c-section for this child. I was really starting to get excited about having a VBAC and had pretty much made up my mind. but a friend of mine who had a rupture with her last pregnancy(at full term and the baby died) has advised me against this. She has met so many people who have suffered ruptures from attempted VBAC's through her uterine rupture support group, she just thinks it is too much of a risk to take. So, I then went back to my original position of an elected c-section, which I am fine with. the problem is...I have to have an amnio the day before my c-section to insure that the baby's lungs are developed. The doctor told me there is no risk involved in having an amnio at full term. However...at my support group last night, when I was talking about this, three women yelled out..."That's not true !!! There is a risk ANYTIME a procedure is done." Of course, a woman in the group (who wasn't there last night) had her cord nicked during the amnio at 38 weeks and had a very complicated delivery resulting in her son having many delays and difficulties to this day.

So, now I am so confused. My doctor will not do the elected c-section without the amnio. I am too scared to try for a VBAC. Do I really start another seach for a fifth doctor at this late stage of the game??? I am not a difficult patient, really I'm not. But I am beginning to wonder how the heck this baby is going to get out of me.
Any suggestions or comments at all would be helpful. thanks so much in advance.
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[hedra]

Probably a strange question, but have you asked the baby?

I say this because you are dealing with risk vs. risk vs. risk. All paths have risks. It is just a matter of choosing which you want to live with.

Having a good heart-to-heart with your baby may help you sort it out. You'd be amazed at how much information seems to pass back to you from the baby if you sit quietly, relax, and talk to them in your mind (or out loud).

Here's my opinion, though:

Good monitoring, with no induction/augmentation, and your VBAC risks are small. So, if you do expectant management of labor, with no pitocin, you'll be low risk for VBAC.

If you go overdue, you can probably opt for a c-section at that point without the amnio.

This way, you can let the baby decide - if you go into labor before, say, 41 weeks, then you try for VBAC. If your baby doesn't kick labor off before 41 weeks, then you c-section, without amnio. (This can be something you discuss with the baby.)

You also might want to find a monitrice who will stay with you during labor, so you have someone to back you up beyond the nurses/OB on the VBAC. They have medical skills beyond just doulaing - no idea if they can help monitor for rupture, but having someone there who knows what they are doing at all times in a medical sense may be a big help, both for your peace of mind and for risk.

Also, if you plan an epidural, I noted in a bunch of info on epidurals from an anesthesiologist that the slowdown of labor happens most if the epidural is applied before 5 cm, and often picks back up again about 20-30 minutes after the bolus of epidural meds are applied. So if you want to avoid augmentation, AND have an epidural, you may be able to do so by asking that they not give you Pitocin unless your labor slows and STAYS slow for more than 30 minutes after application of the meds (same for subsequent boluses... boli? of meds).

As I said in another thread elsewhere, there is no crystal ball. You have to make your best informed decision, and hope for the best. You cannot run the alternate experiment and see which would truly be best - you could be someone who would be fine either way, or not fine either way, even... there is just no way to know in advance.

Good luck!

[JulieD]

That's tough... on one hand there is always the "what if", but on the other hand, you have to have the baby right? :D I worried all the time until Logan was born and I didn't have anything to go through that would cause more worry than normal... but I think it's common and normal to feel like that.

I changed from a high-risk OB to a midwife when I was 30 weeks... it was the best choice I could have made. It was stressful but I know without a doubt that I would have had a c-section if I had stayed with the OB. We didn't get to have the homebirth that we wanted but that's a bit of another story and I'm sure it will happen next time.

SO, it's never to late to change if you do want to do that.

As far as an elective c-section vs. VBAC... health wise for the baby- VBAC would be best. I understand your worry re: rupture but I think hedra did a good job explaining what is okay when approaching a VBAC (good monitoring, no augmentation, etc.).

I know it sounds odd but I also suggest feeling out what you think the baby would like too. Logan was transverse for a looooong, long time... and then he was breech. I finally sat down and relaxed and just "listened, prayed", whatever you want to call it, to see what was causing him to not be head down. I don't know if I got an answer really but within the week he turned head down and stayed there. I think part of it was my nervousness that didn't allow him to move down... anyways, does that sound too "earthy" for you? :D

I hope that helps a little. Try not to be scared... I know you will make an excellent choice. Best wishes!
~Julie

[miche]

Nooo! I wrote a brilliant ;) reply and it is all gone! I put in too many images and hit back and poof! It was lost.

Ok. I'll go image free now and try to hilight the basics since I have a cranky child in my lap now.

First I suggest you wait until 40 weeks before your scheduled c-section. Or better yet wait until labor starts. Then you have no need for an amnio.

Second it is not too late in the game. I switched OB's at 32 weeks and am very happy I did! I had a wonderful VBAC btw.

Lastly I know it must be very scary having a friend who had a uterine rupture. When you are that close to the situation it hits you harder. If you still desire a VBAC in any way I encourage you to keep studying and thinking about it. It is healthier for mom and baby in most cases and uterine rupture is really not that big of a risk. You have more chance of having a prolapsed cord than a uterine rupture. In both cases you can get a quick c-section and with uterine rupture the outcome is rarely catastrophic. I also want you to ask yourself if you want more children. If uterine rupture is a great fear to you and you have another c-section it will continue to be a great fear. The more c-sections you have the greater your risk of uterine rupture DURING pregnancy, not just labor. And for that matter the more c-sections you have the more difficult the surgery becomes increasing the surgical time and risks to you and the baby. I'm not meaning to scare you, but please if you are having doubts keep researching. Be a difficult patient and keep questioning. :) Whoops...there I go putting in an image again. I better check to make sure I don't have too many because I'm not typing this again (my first time was much more eloquent and understanding...I apologize!)