Hi OP here!!

Hew! So I did have my talk with OB and want to update everyone... It went ok but not as well as I hoped. He did elaborate on his number of 10% success rate. He did clarify that for a general VBAC candidate, chance would be 70-80%, but specifically for my case (where labor started naturally, no pitocin, water broke on its own, pushed for two+ hours with almost zero progress) it is around 10%. He basically said that it is the shape of the pelvis combined with head size that contributed to my c section, doesn't believe epidural has, even though it could have resulted in longer pushing time. He encourages me to try for one if I want to, but still stands by the stance that I am not a good candidate. He says if I go into labor early (maybe at 38 weeks or something like that) and baby is smaller, I would have a better chance. If I chose VBAC route, he said I can wait till 41 weeks but at that point we will have to have a c section.

OB pointed out around 1% risk of uterine rupture, and about 1 out of 5 of those resulting in significant risk to mom and baby, but in a hospital like Fairfax with staff ready all the time, the risk of something serious happening is slim. He said the c section has usual risk that I already was aware of, with risk of placenta placement increasing to 0.6% after two c sections. He thinks with VBAC, risk is more shared with baby/mom, with csec it is more toward mom and future pregnancies.

He said it is my choice to get epidural or not during VBAC, and he won't require epidural/IV to be put in. He said he does VBAC's but most successful VBAC candidates are those with breech or placenta previa the first round.

It seems that he supports whatever I want to do, but doesn't believe it will be successful...

I also had a chance to talk to a midwife at a birth center after that, who in turn thought I would be a good candidate for VBAC and that many women hear that from OB and still succeed at VBAC. Although center was really nice and I really liked the midwife, I am not comfortable giving birth in a non hospital setting...

I am trying to get a second opinion from another OB, but when I called a couple, it looks like they require all my medical records to be transferred? But I am not set on or ready to switch yet. All the doctors that are recommended do not have as nearly stellar rating/reviews as my current one and I keep suspecting if I am doing the right thing by leaving his practice.

I am getting really nervous because I am three weeks away from hitting my third trimester!

Help!!!

For a doula, I would highly recommend Jenn Whitaker. She is an expert when it comes to VBACs (having had one herself) and is also the local ICAN leader. You should definitely check out an ICAN meeting too. You can email her for more info.

http://jenndoula.com/

(P.S. I am not Jenn, but I am a doula in Montgomery County. I don't work in VA, but I do really respect the work Jenn does and would suggest you contact her for advice.)

OP here again!! No it didn't sound snotty. That's kind of how I felt too, but at that time I was exhausted and scared and not informed, and just went with the c section.

I live very close to Fair Oaks hospital, but Fairfax, Fair Oaks and Loudon are all within 20 minute. I have looked into a couple of potential new OB's but just hesitant to switch OB because I really do like him, and he has wonderful reputation and I have always been happy with his care. I have a visit with him tomorrow where I want to discuss the VBAC more seriously and hopefully get a better feel as to what his thoughts are. Then I plan to decide whether I want to switch or not.

I have started looking at doula options, although many seem to be booked for my delivery... But I just recently contacted them, so still awaiting replies.

Anonymous wrote:Honestly, sounds like you would have had a vaginal delivery the first time if you hadn't gotten the second epidural and hadn't given up after 2.5 hours (I pushed for 3 hours and everything happened in the last 18 minutes -- seriously).

The fact that your baby's head was visible in your birth canal for the last labor sounds to me like your birth canal is partially patent. I would think that would increase your success rate for #2, also.

Sounds like your OB is trying to limit liability and do something he's good at (OBs are surgeons, after all). I had an OB for my unmedicated vaginal delivery, but she was very natural-birth-friendly and that made all the difference (she was willing to let me push a long time, willing to let me take as long as I safely needed to for labor, etc).

I would:

1. Hire a doula who has experience with VBAC
2. Take a birth class
3. Find a VBAC-friendly provider (where are you located? we can help with recommendations)

Sounds like you want the VBAC, so go for it!

PP again, just realized my first sentence sounds snotty when I meant it to be supportive, like "you were really close, you can totally do it again"

Honestly, sounds like you would have had a vaginal delivery the first time if you hadn't gotten the second epidural and hadn't given up after 2.5 hours (I pushed for 3 hours and everything happened in the last 18 minutes -- seriously).

The fact that your baby's head was visible in your birth canal for the last labor sounds to me like your birth canal is partially patent. I would think that would increase your success rate for #2, also.

Sounds like your OB is trying to limit liability and do something he's good at (OBs are surgeons, after all). I had an OB for my unmedicated vaginal delivery, but she was very natural-birth-friendly and that made all the difference (she was willing to let me push a long time, willing to let me take as long as I safely needed to for labor, etc).

I would:

1. Hire a doula who has experience with VBAC
2. Take a birth class
3. Find a VBAC-friendly provider (where are you located? we can help with recommendations)

Sounds like you want the VBAC, so go for it!

OP here!

PP - http://consensus.nih.gov/2010/vbac.htm
Is this what you are talking about? I will definitely read it through! Thank you!

If you'd like unbiased information, there was a VBAC conference at NIH a few years ago and you can order the booklet of studies presented there. I found this incredibly helpful because it depends on your past and present situation. You can order the booklet for free online...google "VBAC symposium NIH." I was in a similar situation and after understanding the research and how it pertains to my situation, I learned it's about 3 times safer for me to go with a VBAC. Sure, there are a small percentage of complications associated with it. However, there is a greater chance for me to encounter life long complications from another c-section so I'd like to avoid these if possible. Then I talked with 3 providers to get their take and I knew when to ask why their opinions differed, etc....it helps one understand that going for a VBAC is actually a different question for each individual. Good luck and I hope this helps paint a clearer picture for you!

I'm the last poster before your latest response. I delivered at Georgetown so I don't know VA hospitals. But my doula is in NoVa. Her name is Lori Cooper. I liked her because she has had a vbac. I felt like she understood where I was coming from being a hopeful vbac'er. Plus, she didn't judge me when I got an epidural.

OP here! Thank you for all the responses again! I feel like I am having so much support! Meeting with by OB this Wednesday.

I did research a little on potential OB's I could contact for second opinion and also doulas. As for OB, it sounds like Dr. Tchabo is nearing retirements and does not deliver as much anymore (and other doctor's in rotation with him is not VBAC friendly). Dr. Gonzales in MAnasses and Dr. Ayoub in Leesburg seems to be two other options I can consider. I did look into birthing centers and midwifries, but we are not comfortable with birthing in non-hospital setting, or tranferring and just getting the OB who is available at the moment in case of emergency. Although I am still hesitant to switch OB... I think I will have to make the call on stay/leave after this talk because I am over 23 weeks now. If I end up in c section for any reason, I wouldn't trust anyone more than my current OB. I do know that baby and I will be in good hands with him. Not a single negative review/tought among his patients about him - I just hope that he had more VBAC records and less in favor of interventions! But again I haven't had a serious talk with him, so I will have to wait and see.

I will ask all the questions and report back for sure! I have a super long list of questions now haha. Once I talk to my OB this week, I think I will proceed with further actions.

PP - Can I ask you if you delivered at Fairfax or somewhere else?

Does anyone have recommendations on any specific doulas that have worked at Fairfax hospital?

I had an emergency c/s under general anesthesia with my first (no labor). I wanted to attempt a vbac for my second for a number of reasons. First, I wanted to avoid having major surgery again. Even though my c/s recovery went well, it was still recovery from surgery. I also now have a 3 1/2 year old and the thought of recovering from surgery with him too was less appealing. I am also not sure we are done with 2 kids. Each subsequent c/s increases the risks of things going wrong like placenta accreta, placenta previa, etc. As my mfm specialists said, the first c/s is easy because you're cutting into pristine muscle. Each c/s gets increasingly complicated because of the scar tissue. There are also advantages to the baby going through the birth canal like helping clear out their lungs.

I really saw no reason not to try in my instance. Of course I didn't have a trial of labor with my first so my doctor gave me good chances for a vbac. Although that changed when my baby started measuring big. I got a lot of big baby/shoulder dystocia talk from my OB. I insisted on a trial of labor. I had a successful vbac with my 9 lb, 11 oz baby. I'm not a tall woman either (5'2"). His head size was in the 50th percentile so I can see why OP would have cause for concern given her past history.

One thing you may consider is getting growth ultrasounds later in your pregnancy. While those are not always accurate, they can give you a guide post to help you determine what you are comfortable doing. You can pay special attention to the head size estimate. In my case, my baby measured in the normal range except for abdominal circumference. Which my OB laughed when he saw that and said it meant I had a fat baby. Fat is malleable. In my case, I had a really easy delivery. But if your baby's head is also measuring on the large side, then that can help you decide whether you want to schedule a c/s or not.

I felt amazing after my vbac. It was so different from my c/s experience. If given the opportunity, I would do the vbac again. Even when my doctors were pushing my odds of success lower than 50% because of my baby's estimated size, I still wanted to attempt it. Even if I ended up in a c/s again, at least I gave it a shot. I did hire a doula. She helped me advocate for myself and helped me a lot during the pushing phase. I also did get an epidural. But I didn't have difficulty feeling when to push or how to push.

i am in a similar situation, with my first i arrived to the hospital already at 10 cm an dully effaced. Ended up with a c due to cephalic pelvic disproportion after pushing for 3 hrs. with this current pregnancy i had honest adult conversations with my ob about a possibility of a Vbac. i also did an extensive Ovid search and read the 2009 ACOG guidelines. Basically your chances of a VBac with cephalic pelvic disproportion are about 66%. based on the studies that i read a vbac is safer then a scheduled c, however a scheduled c is safer then a failed TOLAC (trial of labor after a csection). i personally am leaning toward a c because if i labor and end up with another c it ll just make me feel pretty crappy.

#1 was emergency c-section, then I had two planned c-sections. Really good experiences.

OP it certainly could not hurt for you to consult with a known VBAC friendly provider to get their take. You could try Dr. Tchabo out of VHC. There is also Dr. Ayoub in Leesburg.

Good luck with whatever you decide. If it were me and I were contemplating another c-section vs a VBAC I would want to consult more than one medical authority, especially since your OB does not have a high success rate with VBAC mothers.

I would also ask your OB where he came up with the 10 percent chance of you being able to birth vaginally. This is not to call into question his expertise but to give you greater understanding.

Agreed, but I am curious what an OB would say is safest for the BABY.

If the OP asks this specific question, I would truly be interested to hear the ultimate answer. I'm less interested in hearing whether a VBAC is possible (let's face it, anything is possible). More interested in what would be safest for the baby.

2309 - also want to point out you're talking to two different users - that was not me posting earlier.