Expert: Catherine Beier MS CBE - 7/30/2008

Question
Hi,
I am a 29 year old woman in good health.  I had my first baby in December of 2005 via C-section following a failed induction (induction took place on due date). I was induced because the baby had a congenital lung defect.  I had my second baby in November of 2007 via planned C-section.  While I was desperate to have a natural birth, I had been diagnosed with gestational diabetes (failed the 3-hour test but never had a single high reading on my monitor and was never put on insulin) and they wouldn't let me go more than 4 days overdue.  So when I reached that point they checked me, found me not at all dialated or effaced, and proceeded with c-section.  
I spent a lot of time grieving the loss of the experience of going into labor (something I have never done) and giving birth naturally, without (too much) medical intervention.
So, what is your advice about how best to approach my next pregnancy?  I'm not pregnant yet, but I know I want another and I know that I really want a birth experience closer to what I want.  In this age of hospitals refusing to allow VBAC's at all, how can I find a doctor or hospital with experience or a willingness to attempt a VBA2C?  What questions do I need to ask?  What are the chances that a midwife would take me on?  A birth center?  
Also, any advice on how to handle the gestational diabetes thing next time around?  I'm considering not taking the test, but agreeing to monitor myself.  Just, the diagnosis itself last time meant I had to be seen at a special clinic by a team of doctors (read: I never saw the same one twice) and had to abide by stricter rules about what they would allow me to do about labor/delivery.
Thanks for your help!

Answer
Beth,


You're doing the best thing possible by seeking out accurate information beforehand.  Let's tackle the issues one at a time...


First, having a VBA2C is a definite possibility.  As you already seem to realize, having a supportive care provider will be the deciding factor.   You'll have to actively seek out a care provider who will actually be supportive of a VBAC, not simply pay lip service to it until your due date approaches.  


You will most likely find more support with a midwife or birth center than an OB, but this will depend on the area in which you live.  Some midwives and birth centers may say you risk out of their care while others would be happy to take you.  Given your history, it doesn't sound like the section c-section was medically indicated and the first wasn't due to an issue with your body either.


You can start your search by contacting area groups, such as your local La Leche  League, any mothers groups such as attachment parenting groups, etc for recommendations.


You can also call the area birth centers and hospitals to ask for a private tour.  Then you'll have a one-on-one chance to ask questions pertaining to VBAC and their standard policies in general.


Some questions to ask include how many VBACs are successfully performed, what protocols are taken for VBAC moms, what their guidelines are for interventions such as fetal monitoring and what their stance is on induction for VBAC (they should be against it).


VBACfacts.com is a great resource about VBAC and can give you more suggestions that may help in your situation.


As for the GD, if you were diet-controlled alone, then there was simply no need to schedule a c-section and "only allow" you to go 4 days overdue.  When a woman has diet-controlled GD, her risks decrease to those of a woman with normal blood sugars.  It should not be considered a high risk condition in that instance.  I would feel confident in refusing the test as it's a horrible indicator based on inaccurate, outdated research.  For more information on GD, visit http://www.givingbirthnaturally.com/treatment-for-gestational-diabetes.html


Remember, you are the boss.  I know the medical system isn't set up to make you feel that way, but truly, you have the final say in what happens to your body and your baby.

You can refuse any and all procedures.  If you are getting close to your due date with no progress, then you can opt for weekly non-stress tests to monitor the baby rather than scheduling a RCS.  


Hopefully some (or any) of this has been helpful.  Good luck!
Catherine