VBAC for a Lady Who Has Had 2 Previous C-sections

[BabyRN2Be]

I'm writing this to get a feel of what other doctors are doing in other areas about VBACS. I'm a doula at a medium-sized city in the central US. I had a client call me and asked me if I could be her doula at a VBAC. Of course, I'm ready, willing and able, but then she says that it's a VBAC after two prior c-sections in which she never labored. It's kind of a long story, but she did consent to her first section after her OB, (not a cardiologist) discovered at one return visit that she had some slight tachycardia and that diagnosing the problem would have to wait after the baby was born. It turned out that her cardiac problem was benign, but she got pregnant again and was told that VBAC wasn't even an option in her area (she lives 3 hours from me in a rural area without any teaching schools or large hospitals nearby). But now, she is pregnant with her 3rd, and she desperately wants a VBAC despite the fact that she's had 2 c-sections, and that she's never labored before. She wasn't even given the option of TOL for her first.

She's called three different states and none of them will touch her with a ten foot pole. She's placing all her hopes on one doc in this area who says he'll do a VBAC after 2 sections. However, I do not have a lot of faith in this doctor for various reasons. I'm afraid that he's setting her up to fail - he says that he'll do the c-sections, but I'm afraid that she's going to get to the hospital on D-Day and he'll say that the hospital won't let him do a VBAC., and he knew this all along.

After writing that novel, I'll get to my point. In any of your places of employment, will the docs do a VBAC on a lady that has 2 prior c-sections who has never labored? Or even, if your hospital does them at all.

I am so curious about this and I appreciate all the responses. Thank you!:)

Kat

[EowynRN]

Are you a member at the childbirth collective? There are a ton of doulas there that would probably be able to give you better advice. That being said, remember you should always go with your instincts when doulaing. If you don't feel comfortable with the client and situation, you shouldn't do it. There are a few docs around here that would do VBACs after 2 c-sections and tons of homebirth midwives that will do it. It's out there and it's very doable if that's what the patient wants to do.

[jennylouwho]

I'd get in touch with your local ICAN chapter. I sat on a panel of four woman who'd had recent VBACs and two of them had had a VBA2C (out of four). It's really all going to depend upon the area. Good luck. :)

[BabyRN2Be]

Are you a member at the childbirth collective? There are a ton of doulas there that would probably be able to give you better advice. That being said, remember you should always go with your instincts when doulaing. If you don't feel comfortable with the client and situation, you shouldn't do it. There are a few docs around here that would do VBACs after 2 c-sections and tons of homebirth midwives that will do it. It's out there and it's very doable if that's what the patient wants to do.

Yes, I agree with you and I would help this client, but I'm not a doctor or a midwife. I guess my question is this done in hospitals on a routine basis. Most of the people on this website are nurses, and I was wondering what they see happen when a woman presents with 2 prior c-sections and wants a VBAC. How often in hospital is this done? Or is it totally against policy? And I do know to go with my guts. :) I've recently turned down clients when my 6th sense or "mommy/baby" radar goes off telling me that something is fishy. I've been in the childbirth industry since 1987, and a trained labor doula (beginning and advanced training - at different times). So I have developed this radar which tells me if something isn't quite right.

I'm just wondering how often is it that a woman has a successful VBAC after 2 section w/o laboring at all.

Thanks... if this is still unclear, let me know. :)

[EowynRN]

You've been in the childbirth industry for 23 years and this is your first run in with a VBAC after 2 c-sections? That's really surprising!

It really doesn't matter what other experiences are because like PP said, it depends on location and doctor. You will have completely different experiences depending on the situation. Is it possible? yes. Is it common? no. If she doesn't have the right doctor and you already know that, well you have our answer.

[VivaLasViejas, ASN, RN]

Only a generation ago, VBAC was common. I myself had one after 2 cesareans, and had no problems at all even though I was high risk (obesity + HTN)---labor lasted about 12 hours, and I had my son after pushing for only 15 minutes. Didn't even need a Tylenol during the entire experience. I was all set to do the same thing when I had my last child, but he turned out to be 10 lbs., 9 oz., so a third "section" was very necessary.

[klone, MSN, RN]

I think the fact that she has never labored before is a *good* sign. She didn't have a C/S because of labor dystocia or CPD, which would be more likely to happen again and necessitate another C/S.

As far as whether VBA2C is something that's done - I'm not a good person to answer that. I work at a smaller community hospital, where our policy is that VBAC is only allowed if the mother has had one previous successful vag birth after her C/S.

[babyktchr, BSN, RN]

We do not do VBAC's at my facility...small community hosptial.

[BabyRN2Be]

I think the fact that she has never labored before is a *good* sign. She didn't have a C/S because of labor dystocia or CPD, which would be more likely to happen again and necessitate another C/S.

As far as whether VBA2C is something that's done - I'm not a good person to answer that. I work at a smaller community hospital, where our policy is that VBAC is only allowed if the mother has had one previous successful vag birth after her C/S.

The fact that she's never labored before is a problem in the doc's eyes around here. They will only do a VBAC if a) she's had a vag birth once before (ie - labored) or b) will do a VBAC after one c-section in which the patient has labored (ie - not a scheduled c-section). The fact that she's never labored and has had scheduled c-sections in the past makes her a poor choice for a VBA2C.

Yes, I have been in the childbirth industry for 23 years and I have done VBACs. This isn't my first rodeo, so to speak. However, it's been the first time that someone has not been able to find a doctor either at a teaching hospital or private practice who's willing to take someone who's had 2 c-sections. This has become very common since as of January 2007 when PLICO dropped all coverage for docs even willing to try a VBAC. There's one reputable doctor who will do it, but she called him and he won't take her because of her hx of 2 scheduled c-sections. Before 2006 I took part in several VBACs as a doula, that year I did mostly vag births or stood by patients during c-sections. In 2007 I was pregnant and had a few complications so I didn't do any births that year, and I'm just getting back into things since having my daughter. That's why I'm asking because the VBAC atmosphere has changed so much within the last 3 years. I encouraged her to check out a freestanding childbirth center at which the midwives will do a VBAC, but I'm not sure what their policy is. That's why I'm asking here.

[HappyNurse2005, RN]

well, she could just straight up refuse a c/section. go to the hospital in labor, and refuse a c/s. you have to be tough to do this, though, because you will most certainly have them try to talk you out of it.

the hospital i worked at does vbac's. each doctor decided their own personal policy on vbac's. none of them encouraged vba2c. we had one woman who was attempting vba2c, and came in in labor and refused a c/s. the doctor tried to talk her into it repeatedly, and she refused. her baby was born, her uterus was fine.

another woman had 2 c/s's and no lady partsl deliveries, and asked a particular natural birth supporting ob and he agreed to attend her labor. she went into labor, and had the lady partsl delivery.

[Elvish, BSN, DNP, RN, NP]

I work at a hospital that's generally very supportive of VBACs and 2 prior c/s is not enough in itself to disqualify a woman for VBAC at my place. I've seen a good number of them go on to have great NSVDs. :)

[klone, MSN, RN]

well, she could just straight up refuse a c/section. go to the hospital in labor, and refuse a c/s. you have to be tough to do this, though, because you will most certainly have them try to talk you out of it.

Yes, there is always that option. They can't cut her unless she signs the consent. If there's enough time, they may try to get a court order (it's never happened at our hospital, but I've heard of it elsewhere), but if she waits long enough before coming in, there wouldn't be enough time.