Hello!  Thank you for this great forum.  I have found it (and its predecessor) to be such a useful resource through many years of my doula work and my own mothering!

Today's question:  I have a friend  who is 39.5 weeks pregnant now and planning and passionately hoping for a VBAC.  She is working with a team of hospital-based CNMs who seem to be quite supportive of VBAC.  She and her care-providers decided together to schedule a repeat cesarean at 41 weeks, feeling that by that time, it will just feel like time to get the baby out.  I think the thinking has to do with their prediction that the baby will be large.  I think there is also a sense of not wanting to head down the same road she went down with baby #1.  My friend's first cersarean birth occured at 42 weeks for "failure to progress" after an induction. She had virtually no amniotic fluid.

I absolutely honor my friend's ability to makes choices that feel right to her, but I also feel how fervently she hopes for this VBAC, and I fear that this plan lowers her chances, both because it gives her less time to go into labor and because it creates a feeling of pressure now.  From the standpoint of research on the interactions between baby size and VBAC safety and success, does this plan make sense?  Can you think of any reason why it might be advisable to plan to operate at 41 weeks?

Thank you for any thoughts!

Some studies report greater likelihood of the scar giving way with pregnancies of longer duration, but the excess lay in induced labors. Spontaneous onset also maximizes the chances of vaginal birth with a big baby in any labor, not just VBAC labors. (That being said, inducing with a ripe cervix can eliminate the difference  in rates of symptomatic scar problems, and induction agents and protocols make a difference in scar rupture rates as well. In other words, spontaneous onset is optimal, but when induction is truly needed, it does not mean that planned cesarean is the better option only that  as the Wicked Witch of the West said, "These things must be done delicately.") I will be happy to provide more detailed information from the manuscript of the forthcoming new edition of Obstetric Myths Versus Research Realities to your friend and her midwives if one or the other wants to e-mail me at goersitemail@aol.com , but I emphasize the word "wants." From your post, it looks to me like your friend has made a considered and nuanced decision, and while you may have issues with her choice, she does not. You, of course, know the situation and your friend better than I, but be careful that you respect her right to make her choice even if it differs from what you think you would choose under her circumstances.

-- Henci