Let's Argue! (About Babies!)

[v-girl]

I've got a new one:
For those of you who have had C-Sections - what are your thoughts on VBACs? Have you attempted a VBAC?
(I realized my first questions were somewhat exclusivist, and I wanted to apologize about that).
*I recently had an acquaintance deliver who saw a physician an hour away to "get her VBAC."

I've never dilated so it's not an option for me. And my uterine wall is very thin and "irritable" (as my OBGYN calls it). I get put on restriction at month 6 or 7. And K still came early. LOL

[Thirteen]

I saw this today:
http://www.slate.com/articles/health...epidurals.html

It's pretty pertinent to my original question regarding epidurals - I think the author is quite balanced, and did use outside source material to look at both sides.
She did have an epidural, and stands by her choice.

[PrincessFiona]

I insisted on a vbac delivery because at the time it felt so important to me. I had the rare complication of tearing at the scar and had to gave emergency surgery. I am not sure how I feel about vbacs now...

I've got a new one:
For those of you who have had C-Sections - what are your thoughts on VBACs? Have you attempted a VBAC?
(I realized my first questions were somewhat exclusivist, and I wanted to apologize about that).
*I recently had an acquaintance deliver who saw a physician an hour away to "get her VBAC."

I have had 2 VBACs. My first son was born by c-section due to fetal intolerance of labor (induction- high dose pit, hyperstim, late decels). My next to babies VBACs with midwives. If I got pregnant again, I would only go with a doc that did VBACs (and really did VBACs, not just said he/she did VBACs). The literature is pretty clear that VBAC is a safe alternative for many (but not all) women. There is a VBAC success calculator that you can use to determine how likely it is that you will get a VBAC. ACOG also has a VBAC statement and the NIH consensus conference statement on VBAC is also a good read.

[samssugarmomma]

As a procedure, I have no issues with a VBAC. For myself, I was terrifed to have one!

My first was born at 36 weeks due to failing her ... not APGAR (that's after birth) ...... what are those things called - when they give them numbers for the amount that they are moving and their heart rate and stuff? I can't remember what it is called - but my DD1 wasn't moving. Her HR was normal and they couldn't figure out why she wasn't moving. They decided to do an emergent c-section. It turns out the her cord was wrapped around her neck and she had started to drop. If she had dropped further or if we had tried to do a vaginal delivery she would have gone into distress as the cord wrapped tighter around her neck.

We haven't had the easiest road to parenthood (4 miscarriages and 1 infant death) so I've always been scared of VBACs for fear of uterine rupture and losing my ability to conceive and carry a child. Surgery isn't without risks as well, but FOR ME, the risks of surgery were better that the risks of rupture.

[samssugarmomma]

To answer one of the first questions - about selective induction - I think that unless mom or baby requires medical intervention that they shouldn't be done. My sister's OB has induced her early with all 3 of her boys to fit her (the OB's) schedule. One time she was going to be on vacation, and I can't remember the reasons for the other two. I'm appaled!

[houseelf]

First, Kate, your strength and candor about your road to parenthood always amaze me. Thanks for including us on your journey.

Second, I'll cop to getting induced at 40+ weeks to ensure that my baby daddy would be able to attend. (There is a joke in there about the baby daddy because we're pretty unsure when/how q was conceived during fellowship. Let's keep that on the downlow, no? LOL)

We scheduled around DH's schedule because you know, the whole residency and fellowship program would have gone to hell in a handcart if he had to take more than a scheduled three day weekend. :: :eyeroll: I get that induction does add a layer of risk, but I know that sometimes it is important to have an out-of-town Grandma available to help a crazy post partum mom. I was pretty fragile and needed a bit of help. Yes, selective induction is a slippery slope, but when it is carefully instituted, I'm not sure I see the controversy.

[mommax3]

ACOG guidelines for elective inductions say after 39 weeks it is okay, but DH says they are even pushing back from that and thinks that soon there will be reimbursement issues for docs that don't follow the guidelines.

[Phoebe]

I was induced at 40w and 5 days so I would have help at home. I am opposed for myself to have that done again though.

[alison]

Correct me if I'm mistaken, but the incidence of uterine rupture is less than 1%. Of that 1%, 50% result in fetal death or cerebral damage. That is a big enough number for me not to do a vbac and my chances of having another large-ish baby are pretty high. I also think the reason for a previous csection is kept in mind with the decision to go ahead with a vbac and the likelihood of a successful one.

[alison]

That's my armchair doctor assessment of the whole vbac question.

[samssugarmomma]

Why? Your sister could turn down the offer of scheduling induction if she wanted to. I deliberately scheduled one of my births with an induction to guarantee that my obstetrician would deliver my baby (yes, he was going on a much-deserved vacation). I'm not seeing how it's appalling to be convenient if it doesn't interfere with health or well-being of mother or child.

In my sister's case - her doc pushed her to go early for all 3 births and my sister didn't feel like she could say no (I never met the doc so I don't know if my sister was intimidated or what). In one of the case's (her second son) there were issues either during birth or after and he was deprived of oxygen and is diagnosed with HIE. Of course there is no way to know if that would have happened even with an uninduced birth - but my sister lives with the guilt of wondering if things would have been different if she'd waited. Of course it could go the other way and he still could have HIE and she'd be wondering if she should have gone early.......

I don't think it's right for a doc to push to induce someone to suit their schedule. I don't understand all of the intricacies of reimbursement and payment in OB - and perhaps if I was more educated I'd have a different opinion - so I don't know how the payments work if doc A sees you for nine months and treats you and then doc B does the delivery. Does all of the money / bulk of the money go to doc B? Is it shared among the practice? I know with my first, my doc came in to do my c-section so that she could "claim" my birth and get her payment. I think that inducing for this reason (for financial reasons) isn't ok.

Now if the patient wants the induction for reasons of having help at home or so that the baby daddy can be there - I guess I change my answer. I guess with more thought - I think they should only be done if there is a good reason. I wouldn't consider "I'm tired of being pregnant" to be a good reason. I would consider "My husband works 100 hours a week and if we don't do it on Tuesday at noon, he won't see the baby for 2 weeks" to be a good one.

[samssugarmomma]

Oh, and I'm typing this on my Kindle so please excuse any spelling errors. I'm still getting used to it! 8 )

[Finding Equanimity]

I didn't read all of the threads so this may be going off the current topic, but I don't see a problem with asking for an induction. Towards the end of pregnancy, a mom just wants comfort and reassurance, and sometimes the prospect of an induction gives her peace. My DH was in his first year of residency and we had a tight schedule when he could be around (I was due right before July when all the new residents were coming in). It really helped to feel like we had a deadline in mind. That being said, I didn't make it to the induction date. But it was still something that helped me get by mentally.

[ms.conception]

You need to do what is right for you and your family and you need to be aware of the risks.

Things are different here (IMO) than in the US where there is much more malpractice litigation. In Canada, unless there is a blatant negligence, physicians are so well protected with insurance and the law, that malpractice suits are few and far between. So there is little benefit for people to sue, and there is little pay out if they do.

So that being said. C-section rates here are high, but lower than in the US. In my personal opinion (and this has been formulated by my experience working as a doula, and via my husbands experience in Obs/Gyne as an anesthetist), C-sections are driven by the Obstetrician on call. The fee for service is much higher at night, so most "emergency" which are generally non-emergent, are done at night. Elective sections are booked into the day slate.

VBAC is strongly encouraged here and supported.

Elective inductions are common.

So as for your question. These are answers that would be true for me.

Epidurals: do they possibly encourage a more severe degree of tearing than what could naturally occur during delivery?

I don't think so. I have had an epidural once. I think that if you're going to tear, you're going to tear. I think that pushing slowly and not being "forced into the PUSH PUSH PUSH" stuff, helps with gentle stretching.

Selective Induction: aside from mandating maternal/fetal health problems, do you believe this is a good idea?

I've had 4 children. 2 inductions. The first for true IUGR at 37weeks (he had stopped growing at 34w) and the second was "elective" for "post-dates" I was 41w 3d and was just sick of being pregnant.
The first induction was fine. I was induced and had an epidural put in prior to my labour even beginning. He was sick (had congenital malformation and rare genetic defect). It was truly necessary. The second, I regret. The labour was very long, the pushing stage was very hard and I had some complications requiring him needing support after birth. I believe if I had waited another few days, I would have gone into labour naturally and things would have been easier, because he was in a bad position when labour started. This is basically what I see in my experiences as a doula with people who opt to have elective inductions. Most perinatologists and OB's are willing to do a "wait and see" with inductions - going to 42 weeks and then assessing daily if need be. Most moms choose to "get that baby out". I wouldn't do another induction again, ever. Personally. I also try to support my moms to wait it out. I've seen many inductions go to section. Too many.

Episiotomy: an outdated practice, or something needed to prevent severe tears during deliver?

Outdated practice, imo. Barring emergency. I'd rather tear than be cut, honestly. I've never torn, so I can only say for myself. But I've had friends who have had routine episiotomy and have always had to have episiotomy after because the scar is so thick and doesn't stretch.

Perineal massage: crunchy and unnecessary, or a wise and helpful decision to prevent tearing?

I had perineal support and massage while I was pushing. I never tore. Ever, even with my 10lb baby So I believe it worked for me.