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VBAC over 40 wks

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#1 bikingbubs

Posted 30 May 2012 - 08:34 PM

I have been debating between a VBAC & ECS since I got my BFP.  I was induced at 42 weeks last time ending in a c/s after 36 hrs of labour (short version!).  So when I had my first appt at the hospital I was told by an OB that everyone you speak to will have a different gestation that they like you to go to before they will recommend a ECS (her personal stance was 39wks).  
Anyway, I am going through a midwife program and have the same midwife as last time which is faaaantastic. Had my first appt with her today and she asked me if I had thought about birth options this time.  Have learnt that within the midwife practice, things are a bit more relaxed.  They have their own OB they consult with who very much has the mothers interests as a priority unless there is a medical reason for intervention (he was consulted last time with me, and was happy for me to go to 42 weeks).  My midwife said they are usually happy for you to go over 40 weeks but she has had cases where it has been recommended at 41 weeks to have a ECS (i didnt ask why, but should have original.gif)
So I guesss I am just after experiences/knowledge/advice on if you have had a VBAC over 40 weeks and what the risks with going overdue are?  I always process stuff after I leave and dont have another appt for 3 weeks but of course my curiosity wants to know now original.gif
From the first OB I saw at a clinic appt, seems that 38-39 weeks was the norm so just wondering why that may be, when one of the head OB's is happy to go past due dates.
Deciding is so confusing sad.gif Even though I dont technically have to decide until a lot further on (or not at all, can just wait to see if I go into labour

#2 sharkie81

Posted 30 May 2012 - 08:52 PM

I will be watching this thread with interest.

I too went to 42 weeks before my OB recommended induction. Long labour, obstructed labour, so ended up with c-section. I wasn't unhappy with my birthing experience but am going to attempt VBAC this time too. DS was 9 pd 11 oz.

#3 ali2

Posted 30 May 2012 - 09:28 PM

I was aiming for a VBAC with my now 3week old DS. First born was 4.8kg at 40wks+5 and was an ECS after labour didn't progress. We all assumed I didn't progress because of his size so I had a growth scan at 36wks (on the heavier side but not looking huge). I was seeing a combination of midwives and Dr through a public hospital and there was no mention of going for an c-section at a particular time (ie not going past due). My aim was always to go into spontaneous labour, and then progress. If I didn't go into spontaneous (ie not induced) labour I was going for c-section but I didn't put a timeline on it. At 40wks I saw the Dr and my cervix was tightly closed so I went away feeling a bit deflated, thinking I wouldn't be going into labour on my own. At 41 wks I had another growth scan (again big but not huge), the baby was monitored (all ok) but again my cervix was tightly closed. I was over being pregnant and lost hope that I would naturally go into labour and so booked in for c-section the following day. This was totally my decision, there was no pushing from the Dr. I'm sure if I had wanted to I could have waited a few more days. I was simply over being pregnant, and did not think I would spontaneously labour. Turns out the internal exam I think stimulated my cervix and over dinner that night contractions started. I laboured until around lunch the next day but ended up at only 5cm - and made the call to go for another c-section. I wasn't advised there were risks with going overdue, only the fairly equal risks with another c-section (mine were only 18mths apart) vs labouring and the uterine rupture risk. Don't forget if you need to be induced, options are reduced with VBAC and once you have some intervention, it is likely more will follow leading to a higher likelihood of ECS. Also be aware with a VBAC when you are in labour they will most likely want to continually monitor you, limiting labouring positions including water therapy, walking etc.

#4 Sockergris

Posted 30 May 2012 - 09:36 PM

I went to 42 weeks with DD1, was induced and had an ECS 2 days later.  I wanted a VBAC for DD2 and found a supportive OB who was happy to leave me until 42 weeks again if all was well. The only thing was that I had to go into labour naturally as she would not do an induction.
Unfortunately I never got to try as I had a cord prolapse at 41 weeks and another CS.

Good luck OP!

#5 Puggle

Posted 30 May 2012 - 09:41 PM

I had a VBAC at 40+4. At my first appointment my OB said he'd be OK with me going to 42 weeks - that may well have been tweaked towards the end as circumstances changed (my VBAC baby was 5.76 kg at 40+4)

Another EBer Thatsnotmyname had the same OB as I did and she negotiated longer (with regular monitoring) - she got to nearly 43 weeks before going into spontaneous labour. She might pop in and add in anything I left out.

Good luck!

#6 tibs

Posted 30 May 2012 - 09:46 PM

My Ob's 'policy' is that if you have had a previous c-sec she won't let you go over 40 weeks and she won't induce.  My first was a c-sec so with my second I went in for my 40 week appt and as my daughter was sitting high, posterior and measuring large and I was no where near going naturally I had the c-sec.  I'm glad I didn't push her to wait longer though as my daughter was over 4 kgs born and had meconium in the waters so as it is I don't think I did her any favours by waiting until 40 weeks (my Ob would have preferred me have the c-sec at 39 weeks).  Oh well live and learn, I guess that is why she is the Ob and I'm not  wink.gif

#7 ell80

Posted 30 May 2012 - 10:08 PM

I wanted a VBAC...  The hospital (midwife prog) originally had me booked in for a CS at 38.5 weeks to reduce the chance that I would go into labour naturally.  
When I explained that I would prefer a VBAC, they allowed me to go to 41+4 days.
Unfortunately no natural labour occured in that time and I had the c/s - all good in the end original.gif

The chances of having a larger baby if it's overdue may be a risk..?  Apart from that, I can't see why it would make any difference.

Good luck with your decision.  It's a tough one.  original.gif

#8 rustysand

Posted 30 May 2012 - 10:22 PM

I couldn't not reply to this, having just gone through it 3 months ago!

I ended up with a c-sect with DS1 after he failed to descend after 3 hours of pushing (he was posterior, 11 days over). I went through the midwife clinic when I got pregnant with DD and they were more than happy to allow me to attempt a VBAC but was told I wouldn't be 'allowed' to go over 41 weeks without being either induced or ECS. Fast forward to 41 weeks and still not in labour, I was booked in to have a catheter induction. When I rang the hospital to go in the OB on that night refused to do it as in his experience induced VBACs always failed and it is much better to go into natural labour. I agreed, but got very upset with him so he agreed to see me in clinic the next day. He ended up convincing me to book a CS at 42 weeks (5 days later, next available time slot) but gave me a S&S just in case and found I was already 3cm dilated. I went into labour that afternoon, convinced I would end up having a CS anyway (the ultrasound that morning showed DD was posterior) but thanks to my awesome midwife she was born naturally 6 hours later!

As far as the risks of going overdue go, I'm not sure (and feel free to correct me), but they are the same as normal pregnancy (placenta breakdown etc), however you can't be induced with the prostaglandin gel or syntocin because of the risk of uterine rupture along the CS scar. So if you go overdue they don't like to induce you and prefer to just do a CS.

I'm so, so glad I had the opportunity to VBAC and I'm lucky that I had no medical reason to need a CS earlier. I debated my decision so much until DH pointed out 'If DS had been birthed naturally it wouldn't even be a question of whether or not to have another natural birth or ECS' (meaning, that if the midwives were happy to treat me no differently to any other pregnancy then why even contemplate an ECS). It was such a relief to just start going with the flow! Sorry it's long but hope it helps  original.gif

#9 ThatsNotMyName

Posted 30 May 2012 - 10:41 PM

Yes as Puggle said I went into spontaneous labour at 42+6, 6 hr labour (after no natural labour the first time) and had a successful VBA of a 4.26kg baby.
Our OB was very supportive and was happy to let me go to 42 weeks with standard monitoring, after that I had monitoring every 2 days & everything looked good. My one concession to intervention was 2 stretch & sweeps after 42 weeks, other than that he was very hands off during the pg. Mind you he was getting a bit antsy by the end which was funny given he assured me I'd give in before he did lol!
I think most Obs seem to err strongly on the side of caution which is fine & sensible except that they seem to think that means automatic intervention which in the majority of cases is unwarranted and potentially as dangerous as a lack of intervention when it is actually needed.

#10 bikingbubs

Posted 31 May 2012 - 10:01 AM

Thanks for all the replies original.gif It does make me feel much more positive.  I guess my thing is that if I wait until a cutoff I am happy with (I am sure if there is no medical reason I will be able to go over 41 weeks) then I couldnt do anything more to at least TRY for a vbac.  I had/have no issues with having a c/s again, but part of me just wants to try again! My midwife & OB think it was a positioning thing rather than anything else preventing him from coming out.  He wasnt overly huge either for 42 weeks (3.49kg).

ThatsNotMyName: Did you have any extra monitoring going over 41weeks? Just wondering if they treat VBAC any different to normal birth.  When I went 2 weeks over I only had to have a CTG at 41 weeks and I (and they) were happy with that.  I wont mind if I have to, more of a curiosity thing than anything original.gif

In terms of helping labour etc along, would having a S&S earlier help? I didnt have one until 41 weeks, and again 4 days later, but I was given the option from 39 weeks if I wanted to.  So wondering if this time if I had one done a bit earlier if that would help?

#11 jetage

Posted 31 May 2012 - 01:32 PM

I achieved my VBA2C August last year, my OB was awesome and he never gave me a time frame to fit into.  In fact he left it up to me to decide what my cut of was.  I was more or less given control of my birth, he trusted me and I trusted him.

I was 41+5 when I went into spontaneous labour, I would have been comfortable going to 42 weeks.  I had monitoring every third day, declined a S&S at 40 weeks but took the offer up at 41 weeks.

DD1 was an EMCS after induction, posterior, just plain awful.  DS was a VBAC attempt but the OB I had (also for DD1), was a control freak and really didn’t respect my desire to VBAC and more or less bullied me while fully dilated and ready to push, sadly I ended up with another ERCS.  DS was in a perfect position and my VBAC birth should have happened.

Induction along with a posterior bub is a recipe for an EMCS.

Trust your body, stick with carers you can trust and don’t put yourself on a time limit.  All of my bubs were at least 10 days late, just my gestation, if I had to stick to a time frame of 41 weeks or less I would never have entered into a spontaneous labour with DS and DD2.

Good luck with your VBAC.  biggrin.gif

Edited because I dont know why I quoted your last entry bikingbubs

Edited by jetage, 31 May 2012 - 01:38 PM.

#12 LovetheSun

Posted 31 May 2012 - 01:49 PM

My first vbac was spontaneous at 41+1. If she hadnt I was pushing to allow me to go to 42 weeks, then the Foley's catheter.
My first born was a EMC after a transferred homebirth at 43+3 so I knew I carried for longer than 40 weeks.
My second was induction at 41+3 which I only agreed to because I'd had pre labour for days and I knew he'd turned posterior so basically told them to break my waters and give me 2 hours before any further intervention. He was born before those 2 hours were even up!

#13 ThatsNotMyName

Posted 01 June 2012 - 08:11 PM

ThatsNotMyName: Did you have any extra monitoring going over 41weeks? Just wondering if they treat VBAC any different to normal birth. When I went 2 weeks over I only had to have a CTG at 41 weeks and I (and they) were happy with that. I wont mind if I have to, more of a curiosity thing than anything

In terms of helping labour etc along, would having a S&S earlier help? I didnt have one until 41 weeks, and again 4 days later, but I was given the option from 39 weeks if I wanted to. So wondering if this time if I had one done a bit earlier if that would help?

Bikingbubs: I just consulted my diary from last year to make sure I give you everything I did from 40 weeks (not that it's a manual for you, just what worked for me iykwim)
40+2 OB appt/monitoring
40+5 acupuncture
40+6 chiro (for optimal posture/positioning)
41 weeks - went to see comedian Danny Bhoy's show - thought I might be able to laugh baby out wink.gif
41+2 acupuncture, independent mw visit, OB
41+5 acupuncture
41+6 chiro and CTG at hosp
42+2 stretch & sweep 1cm long & 1cm dilation (really really painful)
42+3 CTG & independent mw visit, lost some plug
42+5 OB appt stretch & sweep. didn't record dilation but I think it was 2cm. Less painful.
42+6chiro & acupuncture, labour started 11am, DD born just after 5pm

A stretch & sweep will only be possible if you're dilated enough to do it & will only help if your body is ready. The only reason I agreed to have one at all was because I was already so far along & I felt like I had to try at that stage. It may have helped, who knows?

#14 meemee75

Posted 05 June 2012 - 07:28 PM

I work in a public hospital and most VBAC's usually go to 41/41+3.

There is no "extra" monitoring for being a VBAC just the normal CTG/AFI at 41 weeks.

Usually a Vaginal exam is done at 41 weeks to see if the cervix is favourable for an ARM ( which is the only  attempt at induction they will do).

If not an El C/S is usually booked around 41+3 but some women also choose to have a VE on the day of their C/S . If the cervix has changed and they want it ,they will be offered an ARM and wait to see if they go into labour. If the cervix is not favorable the woman usually has her C/S.

This is only a rough guide of what happens and it's all negotiated between the  woman/midwife & Dr . Some woman choose not to wait so long other women choose to go to 42 weeks but most fit within that rough guide I just gave you

Edited by meemee75, 05 June 2012 - 07:30 PM.

#15 bikingbubs

Posted 11 July 2012 - 02:31 PM

I'm still so confused as to what to do sad.gif the majority of people around me are very supportive (and more importantly my DH and care providers!!) but the niggling thought of having a failed VBAC is eating away at me. I know that I can only try,but it's the mental preparation that is getting to me.  Still ages away too so hoping that I realise that all I can do is try for a VBAC and if it fails it's not the end of the world (the logical side of me trying to reason with the emotional side original.gif)

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