I am so disappointed that there is no information on VBA2C in this area. Why don't Dr's do more of this? After reading about this on the ICAN and ACOG websites, it should be a standard medical procedure.

Anyone know more about VBA2C...what Dr's support it?

Can someone help me exercise my patient rights and refuse a 3rd c-section. I am a perfect candidate for a VBA2C according to ACOG.
I simply refuse to allow anyone to inject me with drugs and cut out my baby for unnecessary non-medical reasons...nothing is medically wrong with me or the baby. This will be a 7.5 pound baby, and I have vaginally delivered a 9lbs baby.
I have a great doctor (a local favorite) who is scared because he has never delivered a VBA2C. On Friday he said he would, Monday he changed his mind.

Can anyone give me advice...I could really use some words of encouragement and support.

I don't understand why there is so much more fear because of the second cesearean... So I am assuming you have had a vaginal, two sections and now trying for another vaginal? What reasons did your doctor give for being scared? have you talked with other vbac, natural friendly docs in the area? Maybe try a different birthplace all together. I don't think they can force you into another section if you refuse to consent. My best advice, not knowing anything about your history or current situation, would be to wait till labor is well underway to go to the hospital, bring a doula with you, and once there stay on top of what is going on, if you and baby are doing well don't consent to anything. Know ahead of time what is a good heart tone pattern, and stuff like that, so that you will know if baby is fine. Trust your own instincts and listen to your body. Educate yourself (which it sounds like you have done that already) so that you can not be bullied into anything. Don't go in refusing any and all treatment, you don't want the doc even more scared than he already is because he feels if an emergency does arise you won't allow him to care for you. There is a way to be strong without being unwaivering. Let him and the nurses know that you are taking responsibility and that if you feel there is a real need for intervention you will allow it, otherwise you will be laboring on your own terms.

((HUGS)) you sound so frustrated, and I can only imagine you are. keep fighting for your, and your baby's, rights. help to ease your doctors fears by letting him know what you know. again let him know you are taking responsibility and that you will cooperate with him, if he cooperates and respects you.

The rest of the story.......
Baby #1 was induced for no medical reason by Dr. Brown at Woman's.

#2- Dr. Mooney at North Oaks scared me into having a NON MEDICAL section. There was NO NO NO reason for this.

#3 I started posting here about 15 months ago because I was expecting a BIG baby and North Oaks was calling me everyday and harassing me to have a section. At 42 weeks I agreed to the section, he was 11.2.
Dr. Mabrey closed the section with a single layer stitch, my current OBGYN (Dickerson) is scared that the single layer won't hold through contractions.

I feel so violated the North Oaks would take my future into their hands and assume a single layer stitch would be fine for my future.

Now what do I do?
I am due 9/5/10

I don't know if this will do any good but I'm sorry to hear you went through all of that.

What has Dr. Dickerson said are your options?

This is what I would do....

make sure I went into labor on my own, however I might try natural ways of stimulating labor early on (like 39wks)...including nipple stimulation, sex, walking, affirmations and visualization. Under NO circumstances would I take pit or anything to artificially augment labor.

I would agree to check into the hospital early enough that I was in active labor but contrx were not too intense or forceful.

I would not take anything for pain. I would be in touch with my body so that I would know if something were not right.

I would agree to a good bit of monitoring but not continuous. I would want to be free to move around and able to surrender to the birth.

I would agree to heploc, just to give those attending me a lil peace of mind and show that I am willing to cooperate. I would not agree to an IV unless it became necessary.

I would discuss at length my fears, my desires, and my options with the doctor. I would not allow fear to be a reason to do another section. I would stress that the doctor trust in me as a mother to know what my body is and is not capable of.

I would bring the research with me to prenatal visits and discuss the findings.

i want to correct the words "I would" and change it to "I think I would". Your situation is one that I have not been in and can only imagine what I would and would not do. I am just throwing some stuff out there, hope it is helpful.

Amy-
Can I pick and choose what is right for me at Woman's Hosp.?
What if Dickerson drops me and can I refuse a section?

Dr. Dickerson changed his mind over the weekend and wants to do a section. I might call him today and ask him about me signing a waiver and hiring my own doula. Should I sign a waiver?

Nicole-
I talked with his nurse Debrah, she said that he wanted to do a section because my closure was a single stitch and not a double.

Does anyone have any strong articles on VBA2C and single closures?

I would make an appt and sit down with him to discuss your case further. talk over your fears and his. You can pick and choose but doesn't mean it will be easy. If you can get your doctor to agree to your terms and sign off on your plan, you have a good chance of getting those needs met. You still NEED to have a doula present and make sure the rest of your support team knows your wishes and is just as educated as you are going into the birth. Digging your heels into the ground and being unwilling to listen to your doctor will set you off on the wrong path. He needs to feel confident that you will not allow harm to yourself and your baby because you are set on giving birth vaginally against all odds. You need to help him understand your motives.

I would not say that you are not consenting to a section...I would say that you want a trail of labor and a fair chance give birth vaginally.

I will look for some articles when I get back from brunch.

I would stay away from castor oil and the cohoshes..... just my two cents.

good point Jenny. I wouldn't try to take anything that would bring on labor before its ready or make contrx too intense. I would try natural things to encourage things along, if you can keep from going past 40wks and remain at a good wieght then you help your cause KWIM. sucks that you have to apease your doctor, I get that it is about you, but try and understnad where he is coming from. It is not that he just doesn't want you to have the birth you want, he is taught to fear your situation. Dickerson seems reasonable enough, I think he will listen if you explain to him how you feel about the safety of vaginal birth in your situation. Try and come to a place where he wants to give you what you want. dont' give in to fear that is unreasonable, if you have done your own research and feel that vaginal birth is the right decision for you, then don't give up that fight.

Looking now for some articles for you.

http://www.midwiferyt...

Types of Uterine Incisions
The type of uterine incision made at the previous cesarean section is important in evaluating suitability for a VBAC. The scar visible on the skin does not necessarily predict what type of uterine incision might be found underneath. Where in the uterus the incision was made affects its strength and integrity after healing. The upper part of the uterus is composed of a different type of tissue than the lower uterine segment and cervix. The fundus, together with the upper three-quarters of the uterus, is composed of a thick, muscular tissue that does not heal with a very durable scar, while the lower uterine segment is composed of a fibroelastic tissue that heals quite well and is more flexible and elastic when stretched after healing. Virtually any scar is weaker than the surrounding native tissue (like the old episiotomy scar that springs open during the most gentle birth). Usually the forces of labor will dilate a ripe cervix but labor will open the path of least resistance, which in a few cases will be the previous uterine incision. In addition, any incision that extends into the muscular portion of the uterus is much more vulnerable to disruption in a subsequent pregnancy and labor because of the poorer integrity of scars in the muscle. A low transverse, or low cervical, incision is the preferred uterine incision in any VBAC. Below are the types of uterine incisions and their published rates of uterine rupture.

Single- vs. Double-Layer Uterine Closure
In the early 1990s the double-layer uterine closure technique gave way to the single-layer closure technique. The single-layer technique was adopted because it shortened operative time and the very limited data on a few hundred women suggested that uterine rupture was no more common than with the double-layer technique. There is not enough data comparing these two techniques to know if one is superior in terms of uterine rupture, placenta previa or abnormal placentas (accreta and percreta) in subsequent pregnancies.

"Imbrication" is the word frequently used to describe the second layer of the uterine closure. The operative note of a double-layer closure might read something like this.

The uterine incision was closed with a locking suture of #1 Chromic. It was subsequently imbricated with a running suture of #1 Chromic.

In our practice we have resumed a double-layer closure for cesareans, because we think that a thicker uterine scar makes it less vulnerable to placenta percreta and uterine rupture, but we have no data on which to base that decision. We continue to offer VBACs to women who had a single-layer closure.

Most VBAC practitioners have their clients fill out a release of information form, requesting the operative note and the discharge summary from the hospital where the cesarean was performed. Hospitals generally keep obstetrical records longer than others, but they can be hard to locate in long-term storage. Medical records departments are not known for their prompt response, so it is prudent to seek these records early and persistently. The operative note, detailing the incision and its closure, together with the hospital discharge summary usually provide the level of detail needed to evaluate a VBAC candidate. In the event that the operative note cannot be located, it is a judgment call whether to proceed with a VBAC. The vast majority of uterine incisions in the United States are low transverse, except when the c-section is performed for a transverse lie or a premature breech. The University of Southern California, which cares for many undocumented immigrants, has permitted VBACs with an unknown scar, but they have 24-hour obstetrician and anesthesia coverage on Labor and Delivery to perform surgery within minutes