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VBAC, meds 
11th-Apr-2014 02:37 pm
Ollie

Hi ladies! I haven't really been active here since I had my ds 17 months ago, so I apologize if these ?'s have been asked before. My husband and I are ready to start TTC #2, we just have a few roadblocks.

1. My ds was a c section and I'd like to find a doctor who is willing to try a VBAC, but I'm not sure what resources there are out there to try to find one. My previous OB told me I'll most likely have c sections with every kid because I "make big babies", so he's out. I've asked a number of friends/co-workers but nobody seems to understand why I wouldn't just want to schedule a section. :/. Any tips or resources I can use?

2. I'm on 20 mg of Prozac a day for pretty severe PPD I had following the birth of ds. I feel like a different person on it and would like to stay on something, especially because I'm very nervous about having a recurrence of the PPD. My therapist has said the Prozac was ok for pregnancy but he didn't recommend it for nursing... he was very curt about it though and almost flippant. Just "oh, I wouldn't nurse". I wasn't able to nurse ds 1 for various reasons but want to try with #2. I'm finding contradicting information online about Prozac for pregnancy and nursing. Any feedback? I'm not sure if I should think about switching meds or weaning to a lower dose.

Thanks!

Comments 
11th-Apr-2014 06:59 pm (UTC)
Are you in the U.S.? If so, contact your local chapter of the ICAN group and they will have a list of doctors, midwives, doulas, etc. who are VBAC friendly. Also even if you want an OB instead of a midwife, local midwives might know which OBS are VBAC friendly.

Regarding antidepressants, the Kellymom website is considered a reputable source for things related to breastfeeding. There's also a breastfeeding group in LJ and the people there give good advice.
12th-Apr-2014 01:14 am (UTC)
Thanks! I found the website for my local ICAN group and they have a monthly VBAC group while I'll attend next month. I'm sure that'll lead me down the right path. Thanks for the tip!
11th-Apr-2014 07:01 pm (UTC)
PS. I had a VBAC. I used midwives for my care-- they are associated with a local birthing center but would only do a VBAC at the hospital so I had to have a hospital birth, but midwifery care is often an option even with VBACS.

11th-Apr-2014 07:24 pm (UTC)
1. I had a 10 lb 15 oz baby vaginally, so the "big baby" thing doesn't ever sit well with me.
If you want a VBAC, you absolutely cannot be induced. You will need to find a provider that is more willing to work with you. Your OB sounds like (s)he wouldn't be.

2. Prozac is cleared by the FDA for pregnancy. Dr. Hale's says that Zoloft is the safest for nursing. So you may want to talk to your provider about weaning from Prozac in the 3rd trimester and switching to Zoloft. http://kellymom.com/bf/can-i-breastfeed/meds/antidepressants-hale10-02/
12th-Apr-2014 08:04 pm (UTC)
Thanks!
11th-Apr-2014 07:24 pm (UTC)
I would not suggest asking your therapist about medication. Therapists can be knowledgeable sources regarding psych meds, but you really should ask the prescribing physician, whether it's a psychiatrist or a primary care doctor. They will be better informed about your physical health and the med you are on and can advise you better than the internet.
12th-Apr-2014 08:05 pm (UTC)
I should have said I spoke with my psychiatrist about my meds, but he only sees me to discuss meds and I feel was very dismissive. I am in the process of finding a new one, but in the meantime thought I'd see what other opinions were out there :)
11th-Apr-2014 08:29 pm (UTC)
Definitely get in touch with your local ICAN chapter. They will have the best and most up to date VBAC resources available in your area. Your current doctor definitely doesn't sound like he is VBAC friendly so you are smart to start looking before you are pregnant. Also, if you're into Facebook, join this group: https://www.facebook.com/groups/183444955077965/. You have to message a mod to get in, but it is a large, very active and very resourceful VBAC group. I VBACed a 9+ pound baby with no problems and no tearing, and I have read VBAC stories of babies MUCH larger than that so it can definitely be done.

Also in response to a previous commenter re: induction, VBACS *can* be induced but you would want to really weigh the risks/benefits and really think about the method of induction. For more info: http://vbacfacts.com/2012/05/27/myth-vbacs-should-never-be-induced/ I personally would not induce unless I was past 42 weeks or unless there was a serious medical concern and that was the only other option aside from signing up for a section.
11th-Apr-2014 09:54 pm (UTC)
Prozac is super long-acting compared to other SSRIs.It is pretty good during pregnancy because that long half life means that it is less likely to cause withdrawal in your baby. However, when you're breastfeeding, you don't want something so long acting. Sertraline (Zoloft) is another SSRI that's often used in pregnancy and can be continued while breastfeeding as well, so maybe look into that one.

Edited at 2014-04-11 09:55 pm (UTC)
12th-Apr-2014 08:05 pm (UTC)
Thanks!
11th-Apr-2014 09:57 pm (UTC)
I would also recommend midwives for a vbac. Definitely find your nearest ICAN chapter though!

Zoloft is generally considered the best ssri for nursing. I took a low dose of it in both pregnancies.
11th-Apr-2014 11:38 pm (UTC)
I'm newly pregnant with my second, whom I hope will be a vbac baby. I am getting care under midwives and will likely deliver in the hospital.

I'm also on an antidepressant, but I'm on Cipralex/Celexa. It's class C for pregnancy and what my doc prescribed while nursing my first.
12th-Apr-2014 02:31 am (UTC)
+1 for taking Citalopram while nursing (I went off it during my pregnancy though).

I just wanted to say best of luck to the OP! If you plan to breastfeed, head over to the breastfeeding comm and start reading about breastfeeding, it really does pay to be prepared and to troubleshoot the problems you had breastfeeding your first, should they occur again this time around.

Edited at 2014-04-12 02:31 am (UTC)
12th-Apr-2014 08:08 pm (UTC)
Thanks! The main reason why breastfeeding didn't work out for us was because I went into heart failure after I had my son and had to be re-hospitalized. I'm hoping that doesn't occur again!
12th-Apr-2014 08:07 pm (UTC)
Thanks! I was on Celexa in the past and had no issues, so I'll look into that.
12th-Apr-2014 01:10 am (UTC)
Here's a link for looking for your nearest ICAN chapter. They will likely know of the most supportive providers. The biggest factor in having a successful VBAC is a supportive provider, not one that will only let you go to 40 weeks, is scared of a big babies, inflates the rate of rupture, etc.
http://ican-online.org/chapter/search

Another really great Facebook group is VBAC Facts Community. https://www.facebook.com/groups/vbacfactscommunity/
12th-Apr-2014 08:08 pm (UTC)
Thanks!
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