VBAC - hospital won't let you go past 41 weeks?

[olek]

Hospital seems to be indicating they won't let me go past 41 weeks for a VBAC. Meeting them in two weeks, when I will be 40 weeks to discuss it. Have searched on the web, but can't seem to find anything on it.

My friend just had c-section at UCH (where I will be) and they have said the same thing to her about their policy.

Anyone heard of it? I want to be prepared when i talk to them.

thanks!

I had vbac with ds2 (in Sheffield) at 40 weeks + 7 days. I had an appt booked with consultant for 2 days after, at which I suspect he was going to invite me to the operating theatre.

Not clear what the problem would be in going to 42 weeks if the alternative (to starting on your own) would be c/s at 42 weeks, given that induction out of the question.

My hospital let me go to 42+2 with ds before inducing me.

The french meassure gestation at 42 weeks before considereing you overdue.

Put a call out for Mears she may be able to give you some advice as she is a midwife.

My hospital allowed me to go 40+13 before induction.. Are you determined to have a vbac? Did you have an emergency c-section last time?

thanks for replies. another question if anyone has time...!

ive read different things about inducing. some say not at all because of danger of rupture. some say not gel (can't control strength) but can do oxytocin. though i was on the lowest dosage of oxytcin last time and they came fast!

also not keen on the constant monitering, cannula and all that, but understand their reasoning. so a bit torn. some ladies do have the guts to insist on intermmitant montering, but im too scared. though i think if i was made to stay in same room for as long as last labour i would go mad...more likely c-section

yes was emergency c-section. fetal distress from start of labour. failure to progress, 30 hours labour still would not open up. fetal distress even greater. the cord was really tight i think twice round my dd.

I think you just have to be sure on what you do and don't want. I'm going for a VBAC in March, and I know that I do not want constant monitoring. I think a lot depends on the reasons you had a c-section last time; if it was something unlikely to happen again they are probably more likely to allow intermittent monitoring.
The other thing to remember, as I often see repeated on MN, is that they cannot force you to do anything. It is your right to labour and give birth the way you want to. So try to be strong and insist on the things that are important to you.
Hope it all goes well for you!

Hi olek - my c/s was for very similar reasons to yours. Ds got stuck and I was around 7-8cm dilated when he just got too distressed.

Sorry, I have no experience of induction, I was lucky enough to kick off on my own both times. I think anything that gives you artificially strong contractions could risk rupture of scar (don't know how low the risk is though - hold out for someone else with more facts)

For vbac, I was very keen not to have constant monitoring but my lovely MW persuaded me that it needn't restrict my movements - within the room, withing reason - I could get into any position I wanted. Nobody mentioned canula to me - even when they threatened visit to theatre for forceps, or c/s if still not progressing (I did force him out on my own in the end!)

Having laboured once, I think that chances are that you will progress more quickly second time around.

However, do try get Mears' advice on this (even if you do a thread just to direct her to this one, I don't think she'd mind....)

Hi Olek,

It is your decision when you will have your baby, not the hospital's. They can advise but the decision is yours. Have a look at this website here regarding induction of labour and going post dates.

If you want to try for a VBAC you are best to wait and go into labour naturally. Our unit does not have a policy of induction at 41 weeks. If all was well we would wait for labour, even if was 42 weeks. I have seen successful inductions with prostin gel and also synocinon used sccessfully. It really depends on the individual clinical situation.

Here is another link about induction of labour

Hopefully these will help you in making your decision

Totally agree with MEARS - at the end of the day they can't force you,.... I know my local trust says 42 weeks and you can even wait longer! So it's a postcode thing!
Good luck

I should also have added that I have looked after women with previous C/S using the pool for pain relief. If the pregnancy is OK and initial monitoring is OK then I am happy to listen in intermittently with hand held monitor to allow mobility. You really can choose how you want to labour if all is well.

Unfortunately I need to go but will look in on this thread again tomorrow night.

hi olek, i am going through the same thing at the moment. had an em-cs with ds1 (undiagnosed breech), and am now 40w4d. one thing that surprises me is the different opinions of the consultants i ave seen during my pregnancy. some are very pro-VBAC, others not at all. at first i thought i would have to fight for my right to go past 40-weeks, and that they would try to force me into a 2nd section. but fortunately i had my 40-week appointment (induction/planned cs) with consultant last week, with a very good and realistic doctor. he gave me all the facts, so here they come:
70% of women had succesful VBAC (though this includes ventouse/forceps assisted delivery)
0.3% risk of rupture
2.4% risk of rupture when induced (this increase is mostly because of the gel, as it is not possible to control the strength)

as my consultant put it, the risk of rupture is not the strongest factor why you would need another cs. so, if the reason why you had a section the first time around is likely to repeat itself (like small pelvis/disproportion), then a VBAC would not be recommended. induction would be more risky, if you haven't done anything yourself (cervix not soft/dilating etc), as then you'll need to do the gel.

i am set for induction now at 40+10, which is next monday (19/12). this baby is head down, so my reason for the first cs is not there now. they did make clear to me though that the birth process is entirely up to me: if i'd want a home birth, i could have it, but they wouldn't recommend it. same goes for the monitoring and the cannula, which i am happy to go ahead with. and if i change my mind at all, i can have a planned section. i am still hoping to go into labour spontaneously though (have had lots of false alarms already).
well, i can let you know the outcome in a week (probably).

good luck with your VBAC!

Olek - this information may be useful to you here

That was a useful article Mears, I am 40wks tomorrow and hoping for a vbac (after a diagnosed breech birth for dd) and have been told about the need for monitoring, their reluctance to let me use the pool for pain relief and general confusion over when I should go to hospital after contractions begin....
If I haven't delivered by next Wed, then I have another consultant appt, can't wait to hear what he has to say.....

Hi, thanks everyone for being so helpful. Apologies for being out of touch - unfortunately the baby hasn't put in an appearance! - ive just been madly busy.

Of course the hospital can't force me to do anything, they even said if i insisted i could have a home birth, though not suprisingly they wouldn't recommend it.

The issue is trying to judge when do they have my best interests at heart, and when are they just trying to cover themselves.

Ideally i would love to be in a pool (at least for part of labour), as i find water really soothing. The doctor couldn't believe me when i suggested it. I have found that the doctors do seem to have different opinions, so there seems little point anymore in asking them about policies in labour, as it will most likely depend on the consultant on duty when i go into labour.

I hope very much not to have a ceaserean, though my scar has been tender the past few days on and off - is that a bad sign? Baby has been more active than of late, so havent rung the hospital.

Thanks e/one!

Olek, I also want to use the water for pain relief and have been given differing advice on that by midwives and the 2 consultants I have seen. Definitely agree it all comes down to who is on duty at the time of labour/delivery, but I I have made my dh very aware of how I feel about things, so he can at least discuss things on my behalf, if needed.
I am now 1 day overdue.... will let you know what the consultant says on Wed & what they are willing to try, before trying to talk me into a c-section.
I have left a message for my reflexologist and am having acupuncture on Tues though, so fingers crossed either of those will start something

What is it that you really want ?

A healthy baby and healthy mother, or the 'experience' of vaginal birth ?

'They' DO have your best interests at heart. 'They' ARE trying to reduce your risk of a crap labour, flat baby or worse. 'They' have experience and knowledge that, with the best will in the world cannot be replicated here . Statistics mean nothing unless you are the one with a poorly child.

Childbirth 100 year ago resulted in a LOT of dead babies and mothers. Modern obsetrics does not. There is a reason for that

But you are right its your choice.

COI I am one of 'them'

Well, I'd personally hate to have a vaginal birth and my only regret with dd is that I was forced to endure hours of labour before I was given the section I wanted...HOWEVER... I would guess that, as a highly qualified and experienced midwife, Mears does have more experience of labour and birth that almost any consultant you could name and all this talk about dead babies when we are talking about a perfectly healthy mother who is happy to be monitored seems completely OTT.

Of course, without doubt, the 'goal' of childbirth is to have a healthy baby and mother. I do not feel upset that i had to have a ceaserean for my darling daughter. Just today I saw a very ill child and i thought, thank G-d i have such a healthy and delightful child.

It is just, given the choice, I would much rather have a natural birth. (faster recovery, more energy to look after my kids, easier to breastfeed...). Belive me, it is not for the 'experience' as most of my friends stories are rather frightening. Neither do i feel as some people do that my body 'let me down' or i am less femenine.

Though if you read peoples experiences of 3rd degree tears, I think a ceaserean is a much easier option...

Whilst i do agree the hospitals do have your best interests at heart, i do also think there are grey areas where they use judgement and some would rather play safer than others. Hence the reason every hospital/consultant has slightly different views on what is safe. Of course no one goes to extremes, otherwise we would all be in hospital from the minute we knew we were pregnant in case of something!

Today i am 39 weeks, i have an appt on thurs to discuss my birth. Hopefully the inducement by 41 weeks wont be necessary as no one else seems to have heard of it. Incidentally, my daughter was 7lb4oz. This baby at a 37 week scan was thought to be around 5lb, so definately not a problem of a big baby

Olek

I am sorry if I was inflammatory

I am sure you will make the best decision for you and have a wonderful healthy baby at the end

Good Luck

Sorry pushed the 'go ' button too soon

The concern - as I'm sure you are aware , is that intrauterine death rates rise after 41 weeks gestation: and that induction after caesarian section increases the risk of uterine rupture.

oh, i wasn't aware that intrauterine death rates rise after 41 weeks gestation. I presumed it was after 42 weeks, as that is when usually women are induced by. Is that particuarly for women who have a previous c-section (i have given up trying to spell it! ) or for anyone?

I would love for you to direct me to somewhere on the web regarding it.

BTW Arc2005 what does COI stand for? and what do you mean i am one of them. I hope you mean you are a doctor/midwife, and not that unfortunately you had a bad experience.

Arc this isn't a personal attack on consultants or midwives, it's a discussion about what we've been told during the course of our pregnancies, and sometimes how confusing the conflicting advice can be.
I've seen 2 consultants & various midwives this pregnancy and their opinions on things were quite different when I asked questions on certain issues relating to a vbac labour, which is why I have no idea what will be said on Wednesday, should I get that far. I left my last consultant appt at 36wks more confused than when I went in, as it contradicted most of what I had been told up until then.
Of course everyone's goal is for a healthy mother and child, it's insulting to suggest otherwise, but there is also nothing wrong with wanting to have some knowledge on what may happen & be suggested during labour, and to encourage a birth with as little intervention as possible, if things are progressing well.
Forums like this are helpful to hear what other people have been told at their appts, and what their experiences have been. Personally I know only 1 other person who had a vbac, and that was in another country about 6yrs ago, so to be able to read a variety of opinions on the subject has been interesting and given me things to think about that I wouldn't have initially, including the links that Mears sent through & what happens at her hospital.

I take too long to write things sometimes
Just read your other posts Arc, any info you have in addition to Mears would be helpful to anyone in Olek and my positions right now!
My dd was 8 days early, never thought I would be overdue and even have to think about this.....

I had a succesful VBAC last Friday. Was 41w, and had an appointment to be induced on Monday. I guess this is what scared ds2 into finally coming out..
In hindsight I am glad that it never came to me being induced. Though I wasn't too scared about the statistics of uterine rupture initially, during labour I did get pain in the area of my scar, which most probably would have been worse when I would have been induced. The team of midwives and doctors there were great, and I ended up with a spinal and a forceps delivery. It turned out that ds2 had the cord around his neck three times, and this made it quite difficult for him to get out, and I am glad that I had the forceps there to make sure that the whole process was better controlled. I would also really recommend the canula (even though it is uncomfortable..) and the monitoring (didn't bother me at all, I spend most of my labour bouncing on a birthing ball [): you really want to keep an eye on baby. In my case his heart rate dropped suddenly, which made them decide on the forceps delivery to get him out quickly.
For me having the VBAC was not important because of an urge to have a vaginal birth or because I felt I failed either, for me it was entirely because vaginal births are in most cases safer than c-sections. I have no regrets or bad feelings about my first c-section: ds1 was the wrong way around, and I am just glad that he now is the healthy boy he is. But considering that ds2 was not breech, and therefore the reason for the first section was not there second time around, a VBAC was the safest healthiest way.
Anyway, I just thought I'd share my experiences with you, Scully and Olek, as you both seem to go through the same confusion that I went through.
Good luck, and I hope you both end up with a good birthing experience.