VBAC doctor rec. needed for Fairfax Hospital

[Anonymous]

I want to try for a VBAC this pregnancy but I've already had more than one c-section so I'm having difficulty find a doctor that will deliver me at Fairfax hospital. I prefer Fairfax but I will consider other hospitals if I'm unable to find one. Can anyone recommend a GREAT doctor accepting of VBAC's? I'm not willing to give birth outside of a hospital or use a midwife because of the risk of complications. I'd appreciate any help.

[Anonymous]

Sorry, I don't really have any recommendations for you but I just wanted to say good luck! I tried for a VBAC with #2 but never went into labor. At 41 weeks my doctor wanted to schedule the c-section (wouldn't induce a VBAC). When I got pregnant with #3 I called a lot of practices in the area (I'm in Arlington) but most would not allow a trial of labor with more than one c-section.

You will probably get a lot of recommendations for Dr. Tchabo at VHC. I have heard he is wonderful and very experienced with VBACs. I called their practice and asked a few questions but basically decided not to go with him for scheduling reasons. The office assistant said I should be prepared to wait 1-2 hours for each appointment! Since he is a sole practioner he is often running late due to deliveries, etc. I just didn't think I could swing that with work, etc.

You might want to contact the local ICAN group. They might have some recommendations for you. Good luck!

[Anonymous]

OP here. Thanks for your insight. I've already had 2 c-sections and I'm going to be considered high risk while trying for a VBAC. I'm going to keep looking for providers.

[Anonymous]

I had a VBAC consult with Dr. Tchabo. He only delivers at VA Hosp. Center in Arlington. You may phone his office and inquire whether Dr. Tchabo could recommend an OB willing to work with you on a VBA2C who delivers at Fairfax.

Not to digress from your original post, but I am curious about a PP's comment that her OB would not induce for VBAC. Is not inducing standard protocol or does it vary from OB to OB? I am trying to learn as much as I can before I decide whether to stay with current OB practice or go with Dr. Tchabo (who I really liked).

[Anonymous]

Anonymous wrote:Is not inducing standard protocol or does it vary from OB to OB?

You should speak to your dr of course, but some research I've done on VBACs seems to indicate that chemical inductions (pitocin, cervical gel) increase the risk of uterine rupture. Here is a link to some studies. http://www.emedicine.com/med/topic3746.htm. To quote: "women who have had a cesarean delivery appear to have an increased risk of uterine rupture associated with the use of oxytocin for both labor augmentation and labor induction" and "Current ACOG guidelines discourage the use of prostaglandins to induce labor in most women with a previous cesarean delivery; this recommendation is based on considerable evidence for an increased risk of uterine rupture."

I would be curious to hear what the local OBs have to say on the subject. I haven't asked my dr, as I am not pg again and so have some time to do more research etc.

Good luck.

[Anonymous]

This is the 11:25 poster again - The above information is basically why my practice would not induce any VBAC. There has been further study that low doses of pitocin do not increase the risk for rupture but I don't think many OBs are willing to take that risk. I think some malpractice insurance companies may prohibit inductions for VBACs but I don't know that for sure. For my practice it was a firm policy, not a case by case basis. They did work with me on trying other methods of starting labor (membrane stripping, evening primrose, etc.) but no luck.

[Anonymous]

13:10 poster here. Thanks for answering my question and providing all the other information. I'll ask at my next OB appointment what the practice's policy is and how they'll respond if I go beyond estimated delivery date. (Given malpractice issues, I suspect that they do not induce in a VBAC situation). Even though risk of uterine rupture appears low, I am guessing one would need an immediate hysterectomy.

I took a quick look at the eMed link (thank you for including it!). I found it interesting that hospitals require an anethesiologist to be present during the active labor stage of a woman attempting VBAC (I will try to confirm what Sibley's policy is on this). Not sure how many hospitals have extra anethesiolgists on hand to stick around just in case an emergency c-section in needed. I could see this requirement having the effect of proceeding with a c-section if labor does not move fast. Thanks again for taking the time to share your experience and knowledge on this.

[Anonymous]

1:25 PP here. I can absolutely understand the requirement about anesthesiology being available for VBAC. The overall risk of uterine rupture is pretty low, but my understanding is that if it does happen, things can go bad very quickly and the baby would need to be taken out very promptly (via c-section, of course). If Sibley is "equipped" for VBACs, I would think that they either have an anesthesiologist on-call as a routine practice and/or could have one available for you once you are in labor. Good idea to check on that though. I had my baby at Georgetown, and there they have anesthesia available to L&D 24/7.

Good luck again.

[Anonymous]

I can't give you any OB recommendations, but I can tell you I am currently a patient of Dr. Tchabo's, hoping for a VBAC in early March. I live in MD, so VHC is about 30-40 minutes from my home, but I could not find a really positive recommendation for any doctor besides Dr. Tchabo.

His office staff is correct--the wait is ridiculous. I would never stand for it elsewhere, but I feel like I have no choice. He does not turn patients away, and will add people, even though he is already overbooked. On the plus side, when you do get in with him he does not make you feel rushed and his staff is very pleasant.

I did talk w/him about induction, and he stated what a PP said--you can induce but have to do it very carefully. I also think I remember reading/hearing/discussing that not all prior C moms are good candidates for VBAC. I think a lot depends on why you had the first C, how far you got into labor/delivery, other pre-exisiting conditions. Also he recommended that I consider a doula which I have done/hired.

One thing that's sometimes frustrating being a VBAC is that this is my second pregnancy but I feel like I'm a first timer--I never went into labor the first time so I really have no idea what to expect.

On a side note: does anyone know of a VBAC support group?

Good luck to you! I think it's great you are considering a VBAC2.

[Anonymous]

One of the PPs here again - my understanding of "immediately available" means accessible within 90 seconds. So they have to be in the hospital, not necessarily hanging out in the room while you labor.

[Anonymous]

Just wanted to add, for the poster hoping for a VBA2C, you are not going to find a doctor anywhere near as flexible and encouraging as Dr. Tchabo. He is pretty much the only doctor (note: there are many homebirth midwives who are excellent with VBAC's) in the entire area who will help you get what you are looking for. If you are sincerely interested in making it work, switch to him!

And, also, just to clarify -- if you are one of the rare people who develop a uterine rupture, it does not necessarily mean a hysterectomy. With UR, as with most things in birth, there are a range of outcomes. Some UR's cause no problems at all, and yes, some very very rare situations do cause infant or even maternal mortality. Also wanted to point out that anyone can develop a uterine rupture in labor, even first time moms with no previous uterine surgery. Just one of those freak things that can happen.

[Anonymous]

I would stay away from FFX hospital if you want to try a VBAC. It's a very busy hospital, high risk and high intervention.

I know of personally, two doctors out at Loudoun that will do VBACs...it's more common than you think....

I know the smaller hospitals are more VBAC friendly, so depending on where you live, Fair Oaks or Reston might be a better choice. Dr. Tchabo is only one option in this area. If he isn't for you, check with other practices...

Best of luck!

[Anonymous]

Re: the question about VBAC support groups, definitely look up your local chapter of ICAN (International Cesarean Awareness Network). There's a No-VA one and a DC one. They're very helpful! (and will definitely point you toward Tchabo also, or HBAC.) I'm also preparing for a VBAC (in October, so early still).

[Anonymous]

I'm a PP-VBAC in early March (1 week away, we think!) Thanks for the ICAN reference. I also found some interesting yahoo groups for VBAC-ers, just by doing a search in the Yahoo Groups on VBAC.

It's strange how there seems to be many people looking for advice, support, referrals for VBACs, but so few able to provide the information.

[Anonymous]

Hi,

Yes, you can find lots of info on VBAC at http://ican-online.net/. Instead of only looking at the rate of uterine rupture (risk of having a VBAC), we need to look at the rate of complications associated with c section as well (risk of having a repeat C section). We will be able to make an informed choice only after looking at the risks and benefits of both options. read the article “what every pregnant woman should know about c section” for more info. http://www.childbirthconnection.org/pdf.asp?PDFDownload=Cesareanbooklet

The following are some of the clinical studies which demonstrated induction increases the risk of uterine rupture from 0.32% -- 0.4% to 1 – 2% for VBAC.

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=509342

http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6W9P-4CDYKYJ-2C&_user=10843&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000000150&_version=1&_urlVersion=0&_userid=10843&md5=27210dd0ace002693538730a0eefd3a4#secx2

http://content.nejm.org/cgi/content/full/351/25/2581/T3

Also the books: “silent knife” and “immaculate deception” are very good reads for VBAC moms.

Cry a little and be inspired by the birth videos/stories from other VBAC moms, just like us, at:
http://www.youtube.com/watch?v=eBHmuIFc0Oc
http://www.youtube.com/watch?v=dxTueyHYucI

Happy birthing!

Emily
Hypnobirthing and VBAC mom
www.amazing-birth.com