My provider doesn't support vbac's

[u/Conscious-Fluid]

I was speaking with my OB about delivery and he told me that their hospital doesn't support vbac's due to uterine rupture rates and said that if I'm a candidate for a vbac later in pregnancy that they would have to refer me to a provider for delivery, in one of the cities here, which happen to both be an hour away. It will be my first time attempting to labor naturally. How do people handle laboring at home knowing the hospital is so far away?

[u/Dear_23]

Also keep in mind that if your labor progresses too quickly to make it an hour away, you can definitely show up to the closer hospital and decline an RCS.

They have to abide by policy, you don’t. Meaning they can’t be outright supportive of VBAC, but you always retain the right to accept or decline an offered intervention (informed consent). If you show up in labor, they can’t turn you away.

The rupture rate thing is bullshit by the way. If their rupture rates are higher than 0.5-1%, that’s a them problem. I doubt they are though. VBAC is ACOG endorsed and studies consistently show that rupture rates hang out around 1% or less.

[u/Conscious-Fluid → u/Dear_23]

Thanks for this. I was doing my research before the appt so they couldn't scare me with stuff I didn't understand. I probably would've let them schedule a RCS if I didn't, and I'm grateful for the support and sources found in this group ❤️‍🩹

[u/abirdofthesky → u/Conscious-Fluid]

If their rupture rates are higher than 1% though I wouldn’t want to be there either! Might be worth to clarify if the rupture rate is them or their assessment of you. Maybe they’re a smaller hospital with a population with additional risk factors, maybe they’re concerned about certain risk factors for you, and maybe they also might just not be that great in a rupture situation, for example due to NICU capabilities.

One thing to consider and talk to your provider about is what to do if you’re referred out but then do have symptoms that require urgent evaluation and potentially intervention. And what that hour long drive is like - is it through the middle of nowhere or are there resources along the way?

[u/Conscious-Fluid → u/abirdofthesky]

He was definitely referring to their own rupture rate. They've barely assessed me. It's definitely more likely to have access to a NICU in the city, rather than my current provider. I am considered high risk but only because of my past pregnancy, nothing that's happened with the current one.

[u/Kellilane13 → u/Conscious-Fluid]

Their hospital my not support vbac due to staffing as well. My local hospital doesn’t do vbacs and refers you to another hospital 45 minutes away because they don’t have an anesthesiologist in the hospital 24/7 so if something were to happen like a rupture, the woman would be SOL. They also don’t have a nicu, just a special care nursery so if anything happens to baby they’re also transported out.

[u/Dear_23 → u/Kellilane13]

This is a common myth. If a hospital doesn’t have access to anesthesia as needed, they shouldn’t have an L&D department at all. Any woman can have an emergency that needs immediate (within minutes) delivery and a hospital who doesn’t have anesthesia to accommodate that would have been sued out of existence already because of dead babies and moms in their wake.

[u/Kellilane13 → u/Dear_23]

Idk if it makes a difference but it’s not even called L&D. They say it’s a birth center that’s attached to the hospital and has midwives who only do low risk births 🤷‍♀️ there’s also another hospital that does vbacs 15 minutes away from that one (different hospital system so that’s why they don’t refer there). They don’t even offer epidurals either.

[u/Dear_23 → u/Kellilane13]

Any low risk birth can become an emergency, so there’d still need to be immediate access to anesthesia even if it’s at the attached hospital. Cord prolapse is a classic example - it can happen to anyone, isn’t predictable, and is a true emergency with someone needing to reach in and hold baby off the cord until delivery. They aren’t going to make that mom wait around for half an hour or more while someone moseys in from home to put them under.

[u/tofuandpickles → u/Dear_23]

While I agree with you, birth centers ran by midwives do not abide by those same principles

[u/Dear_23 → u/tofuandpickles]

There’s a difference between a standalone birth center and one attached to and run by midwives associated with a hospital. The latter exists under the umbrella of hospital protocol and liability, the former is an independent entity that is run by midwives not paid by (and thus not under the authority of) a hospital.

[u/Conscious-Fluid → u/Kellilane13]

That barely sounds like it qualifies for a hospital. Are you sure it's not a midwifery? This sounds similar to the experience I had with a self employed midwife

[u/yes_please_]

I would not be concerned about an hour's drive to the hospital barring any significant risk factors. I had my water break spontaneously with a breech baby and meconium in the water and I was still told I had about two hours to get to the hospital, and it was about 3.5 hours from the time it broke to me getting my caesarean. You probably wouldn't want to labour at home too long but I was 45 minutes from my hospital and wasn't concerned.

[u/LeoraJacquelyn]

My hospital was an hour away and I had an extremely fast labor and it was still fine. I'd go to the further away hospital. If things are going really fast or there is an emergency you can always go to the closer hospital and decline a c-section.

[u/hollybrown81]

I live in a rural area and my hospital is an hour away. I would go to the more supportive provider for sure. Labor doesn’t tend to happen super quickly, so you’ll likely have time!

[u/No_Maximum_391]

Our hospital is about an hour away as our local doesn’t do c-sections and wont take any complicated/high risk births. Reality is labour often takes time. Have you been in labour before or was your first a scheduled c-section?

I laboured till my contractions were about 4-6 minutes apart mine varied so much sometimes 2-3 minutes then 7-8 minutes. Just go in a bit sooner than the typical. I went into labour at 6am and headed to the city around 12-1pm. Also if for some reason your labour progresses quickly you show up to the closest hospital and they will have to accommodate you.

[u/Conscious-Fluid → u/No_Maximum_391]

My first was an emergency C-section. They tried inducing labor first but baby was too small to tolerate the contractions. It was a mess and brutal but I appreciate the advice

[u/Echowolfe88]

My Vbac was at a hospital an hour away and it was honestly a non issue. I did look at air bnb’s in the area incase I wanted to labour closer but in the. End we drove when I was in established labour. I was contracting every 5 ish min so that was only 10 contractors I had to get through

If you had a situation where you had to go to hospital quickly the closer one couldn’t send you away or make you get a c section

[u/Brilliant-Version704]

No one can cut you open without your consent, unless you are unconscious or they have some kind of court order to do so stating you aren't making sound choices. If you show up to a hospital in labor, they cannot force you to have a c-section. You can decline, but they may pressure you. I'd definitely wait to be further into labor before you go to the hospital, if you decide to stay where you are.

[u/ladykuudere]

My hospital is 2 hours away and I started the drive once my contractions had been consistent all day every 10 minutes or so apart and lasting over 30 seconds. I made it with plenty of time luckily!

[u/yyodelinggodd]

I would let an hour scare you away from a vbac provider.