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Was just told I HAVE to have a C section. My last section was a disaster and I'm freaked out!!!

post #1 of 29
Thread Starter 
I am due with twins in late June. My first pregnancy was a C section that went horribly awry; my DS is fine, but I had a terrible infection (see below.) I found out I was having twins last week when I had an ultrasound. Before the ultrasound, my OB (who is not the same provider I had with my first pregnancy) was extremely supportive of me going for a VBAC, but since we've discovered I am carrying twins, she basically told me that due to how recent my previous section was and the poor quality of healing I experienced, she is too afraid of a uterine abruption to let me vbac, unless I happen to come in at like 8 centimeteres dilated with both babies head down.

I had a horrendous first birth experience and do not want to repeat it. In my first pregnancy with my DS (born 10/4/07) I had mild GD-- the only blood sugar number that was ever high was my fasting (typically around 95 or so) and the rest were fine because I took great care of myself, ate well, and exercised. I was talked into having an elective C section by my OB who said my son was going to be macrosomatic and that they'd have to break his arms to get him out of the birth canal. This terrified me and so I reluctantly agreed to the section.

I was also told my son would most likely wind up in the NICU even with the section because of my GD. My OB told me that his blood sugar would most likely be erratic and he would have problems. This was all conjecture. There was nothing to support this theory other than ultrasound weight estimations.

My son was sectioned at 39 1/2 weeks and I never experienced any labor. He was 9 lbs. 9 oz and 21 inches long. He was very well muscled and could almost hold his head up when he was born. He did not have macrosamia. His apgars were 9 and 9. His blood sugar was fine and steady from the get go. He was and always has been a healthy happy easy baby. I on the other hand suffered a massive infection that unfolded over seven months and eventually became life threatening. I had to be opened up and packed by a nurse every day for months. It was one of the most awful experiences I've ever had. Even though I was in enormous pain I managed to breastfeed my son who has just weaned at 14 months (didn't like the taste of the milk now that I am PG)-- this despite the fact that one of the OB's in the practice told me I shouldn't bother trying to nurse because I was too fat (???)

My new OB is very cool and a good friend of my mom's. She told me she would do everything in her power to make sure what happened to me last time doesn't happen again. But I am so so scared. How am I going to be able to take care of three babies if I am laid up like I was? Does anyone have any experience with this? Is my OB right or is vbacing safe?

Thanks in advance for any and all input!!!
post #2 of 29
I would get 2nd and 3rd opinions, from midwives. They follow a different model of care.

They may agree, but it will make you feel better at least.

Also visit ican.org. There is a lot of helpful vbac info there. I thought as long as the c section was more than a year ago you are safe. I could be wrong. As far as everything I have read the concern during labor that uteri will rupture is too strong of contrax. Which is very rarely a natural labor side effect, but one of pitocin or artificial prostaglandin induction.

I would avoid an ob. They use techno_medical model of care. She would most likely induce you and THAT risks rupture.

If twins were the concern for rupture, it would be a concern without labor anyway, kwim?
post #3 of 29
I would agree--both 2nd and 3rd opinions might be very helpful for your particular situation, since no one here is qualified to evaluate your personal medical history. Even if you end up with the same answer from a midwife (or two) and/or another OB, you'd at least have the reassurance that you sought other options.
:
post #4 of 29
I don't know if it helps or not, but the vast majority of ruptures (which is only like 3 out of 100 VBACs or something - not overly high chances, but maybe higher b/c of the multiples) are not even painful. No danger, just that your uterus won't push babies out at that time. The VAST majority are that way, from what I understand. Could be helpful to come in with some research on ruptures to ask her about what her thoughts are.

Beyond that sounds like a tough situation. I'm sure I'd be a wreck.
post #5 of 29
Thread Starter 
I've put in a call to two midwifes, one of which I've been talking to right along. I am waiting to hear back from them.

The midwife I've been talking to originally told me prior to even finding out I was having twins that even though she's a huge homebirth supporter she didn't feel that was the right choice for me due to my history. I am definitely curious to hear what she says now.

My OB isn't really a typical OB. She was originally a nurse and didn't become an OB until her 40's. She is very into holistic health and natural childbirth. That, and the fact hat she is a personal friend of my mother's who is a holistic health professional herself is what lead me to choose her.
post #6 of 29
I would get more opinions too, ob's and mw's. You have a difficult situation and I am sure the decision will not be easy for you but hearing from more ob's and/or mw's will help you I am sure. After what you have gone through I can only imagine how scared you must be to possibly have another c-section :
post #7 of 29
No advice, but couldn't read that w/o giving you a
post #8 of 29
You might try contacting a MW at the Farm, see if they could help or advise. For your peace of mind, if you stay with your OB, tell her your concerns and ask her to walk you through what happened to you before, explaining how things will be different this time.

And maybe your OB was opening a door for you with the "unless you come in 8 cm dilated with both babies head down" comment. Assuming the babes get into position, you could do just that. Do some spinning babies, chiropracting and yoga to encourage good position. Even get a MW to stay with you through labor and check your dilation at home if you wanted to be be real careful about it. Or learn to do it yourself. Maybe if you come to the hospital ready to push, you "let" your OB go along with your natural birth preferences.

:
post #9 of 29
Even if you end up with a cesarean, I think that no two cesareans are probably the same (just like no two births are).

If you know about it in advance, you may be able to be more assertive with your options, as well as ensuring you have ample support (such as a doula) no matter what.

My first surprise cesarean was actually...well, I don't know that I'd use the term "fun", but my doctor kept my spirits up, everyone was laughing and supportive and joyful, I was up walking within 12 hours, able to stop the percoset after 3 days, and healed without even a visible scar.

My second, which was planned because of my twins being transvers and TTTS babies, was so horrific that I've pretty much given up on ever writing a birth story for them, though at least I don't vomit from fear and anxiety when I drive past the hospital anymore (It took a year for that, and even now, 5 years later, I break out in a cold sweat when I get literature from that hospital--the same one that I'd had my happy section). There were a lot of different circumstances around that though, and also I didn't really plan as well as I should of, and I did not have birth attendants like I did for my DD.

So I would definitely explore all options, but also please know that if you take preparing seriously (unlike I did with round 2) I bet you may be able to have a better experience. So I wouldn't assume that you'd have the same experience at all. I know that I certainly experienced both sides of the spectrum. The first one I was far better prepared even though it was a last minute decision. The second one I kind of blew off thinking that it would just turn out like the first one, and that was a catastrophic mistake on my part.
post #10 of 29
Quote:
Originally Posted by Juvysen View Post
I don't know if it helps or not, but the vast majority of ruptures (which is only like 3 out of 100 VBACs or something - not overly high chances, but maybe higher b/c of the multiples) are not even painful. No danger, just that your uterus won't push babies out at that time. The VAST majority are that way, from what I understand. Could be helpful to come in with some research on ruptures to ask her about what her thoughts are.

Beyond that sounds like a tough situation. I'm sure I'd be a wreck.


The rupture rate for one previous cesarian is about 0.6%, which is 6 in 1000. That's a ton lower than the 3% rate you gave. Although, the study that produced this stat doesn't give any info re: number of babies.

And uterine rupture is a catastrophic complication of labor. Depending on the rupture and the location of the placenta (and subsequently whether it detatches because of the rupture), the baby can die within minutes, and the mother not long after. It's definately dangerous, and not something to take lightly. Symptoms of rupture can include pain between contraction and at the site of the old scar, among others.

That being said, it is still rare. It's a whole new game with a VBAC, especially with twins. Some people will VBAC at home with a midwife and are comfortable with it, some feel more comfortable doing it in a hospital with access to c-sections should a rupture occur (they say that the best outcomes are if a c/s is done within 18 minutes of rupture) and some even elect a repeat c/s. The problem is finding a provider that shares your point of view.

I encourage you to cross-post in the VBAC forum. There may also be members there who are going/have gone through what you have.
post #11 of 29
Quote:
Originally Posted by Fujiko View Post


The rupture rate for one previous cesarian is about 0.6%, which is 6 in 1000. That's a ton lower than the 3% rate you gave. Although, the study that produced this stat doesn't give any info re: number of babies.
sorry, I guessed on the rate

Quote:
And uterine rupture is a catastrophic complication of labor. Depending on the rupture and the location of the placenta (and subsequently whether it detatches because of the rupture), the baby can die within minutes, and the mother not long after. It's definately dangerous, and not something to take lightly. Symptoms of rupture can include pain between contraction and at the site of the old scar, among others.

That being said, it is still rare. It's a whole new game with a VBAC, especially with twins. Some people will VBAC at home with a midwife and are comfortable with it, some feel more comfortable doing it in a hospital with access to c-sections should a rupture occur (they say that the best outcomes are if a c/s is done within 18 minutes of rupture) and some even elect a repeat c/s. The problem is finding a provider that shares your point of view.

I encourage you to cross-post in the VBAC forum. There may also be members there who are going/have gone through what you have.
You're right, sometimes it is serious, but the homebirth midwife I went to told me that she's had a couple scar ruptures occur and had it just stall labor... that's the only way they knew it happened. She said she looked into it more and that's frequently what happens when there's a rupture. That takes your odds of something catastrophic happening down even lower is all I'm saying.
post #12 of 29
Quote:
Originally Posted by Gena 22 View Post
And maybe your OB was opening a door for you with the "unless you come in 8 cm dilated with both babies head down" comment. . . . Maybe if you come to the hospital ready to push, you "let" your OB go along with your natural birth preferences.
: Frankly, that was my first thought when I read that. Sounds to me like she recommended a c-section because she thinks she "should" - not necessarily because she thinks you really need one.

I'm actually surprised that she even said that much. If the matter ever went before a review (legal or otherwise) the case could certainly be made that you understood her comment as advice from her that you should arrive at the hospital pushing. If I was an OB worried about a potential uterine rupture, I don't think I would be even suggesting that my patient show up at the hospital at "show time".

While my experiences have me pretty firmly in the "anti-hospital camp" I can see why you might want to deliver in a hospital. If it was me, in your situation, I would definitely research it more (as several others have recommended). But I think it would be fully reasonable to vehemently avoid induction, and to labour naturally and spontaneously at a facility that could do a crash c-section if a uterine rupture developed. From my understanding, while uterine ruptures can be very, very serious, they are not usually life-threatening within minutes.

How long has it been since your previous c-section incision healed properly? (You mentioned infection problems lasting months, so we can't really go off your baby's age).

Also, if your OB was enthusiastic about VBAC before diagnosing twins, I don't see how this really changes it. I guess I'm thinking like this:

Quote:
Originally Posted by NaturalMindedMomma View Post
If twins were the concern for rupture, it would be a concern without labor anyway, kwim?
Is your uterus working harder to birth twins? We know it's strained more during the pregnancy. She's not suggesting to do a c-section really early to ensure the uterus doesn't rupture at the old incision site just because you'll be much bigger in late pregnancy with a singleton, is she?
post #13 of 29
You will probably have a hard time finding support for a twin VBAC. There is not a lot of research out there about VBAC with multiples. Search the old posts here and you'll find links to more information.

I had a HBAC with my first set of twins. My first c-section baby was a 11-lber and I also had a uterine infection. I got pregnant with my first set of twins when he was only 13 months old. I had a terrible time finding a midwife but I did have a wonderful birth in the end. I was convinced that a VBAC was far safer than a c-section and couldn't imagine recovering from another surgery with newborn twins to care for as well.

If you check out ICAN, www.ican-online.org, there are at least 2 other moms there that have VBAC'ed twins. One of them posts here too.
post #14 of 29
I also had a twin HBAC (see my sig). You could check out Dr. Landon's study (Ohio State University) that showed that while twin moms were less likely to attempt a VBAC, they were no more likely than singleton moms to have a rupture, and no more likely than non-VBAC twin moms to have vaginal birth complications. It really isn't any riskier than a singleton VBAC, so I don't know why your doctor is turning around on you.
post #15 of 29
If you like the OB then I would PUSH for a trial of labor. Inundate her with literature if you have to. Twins don't cause more ruptures even if the scar is weak. If you start to rupture then you section, but vbac should def not be ruled out because of multiple gestation. If she still says no, then you keep looking or you do it yourself. I had a toddler at home and had to recover from a section. I don't recommend it.
post #16 of 29
Thread Starter 
Thank you guys so much for this insight. I really appreciate it.
post #17 of 29
Quote:
Originally Posted by Novella View Post
: Frankly, that was my first thought when I read that. Sounds to me like she recommended a c-section because she thinks she "should" - not necessarily because she thinks you really need one.

I'm actually surprised that she even said that much. If the matter ever went before a review (legal or otherwise) the case could certainly be made that you understood her comment as advice from her that you should arrive at the hospital pushing. If I was an OB worried about a potential uterine rupture, I don't think I would be even suggesting that my patient show up at the hospital at "show time".

While my experiences have me pretty firmly in the "anti-hospital camp" I can see why you might want to deliver in a hospital. If it was me, in your situation, I would definitely research it more (as several others have recommended). But I think it would be fully reasonable to vehemently avoid induction, and to labour naturally and spontaneously at a facility that could do a crash c-section if a uterine rupture developed. From my understanding, while uterine ruptures can be very, very serious, they are not usually life-threatening within minutes.

How long has it been since your previous c-section incision healed properly? (You mentioned infection problems lasting months, so we can't really go off your baby's age).

Also, if your OB was enthusiastic about VBAC before diagnosing twins, I don't see how this really changes it. I guess I'm thinking like this:



Is your uterus working harder to birth twins? We know it's strained more during the pregnancy. She's not suggesting to do a c-section really early to ensure the uterus doesn't rupture at the old incision site just because you'll be much bigger in late pregnancy with a singleton, is she?
You know, I'm not sure if the body works harder (the uterus) to expell twins? I'm not sure why it would, seeing it's expelling a baby at a time. My point was, if it doesn't (of which I am not totally certain), than the only complication I can think of is the uterus stretching more, which would be the cause for concern in the pregnancy in totality. My suggestion was only a hypothetical one. I thought maybe the OP could do some research on that. Sorry if that was unclear.
post #18 of 29
Quote:
Originally Posted by christyc View Post
I also had a twin HBAC (see my sig). You could check out Dr. Landon's study (Ohio State University) that showed that while twin moms were less likely to attempt a VBAC, they were no more likely than singleton moms to have a rupture, and no more likely than non-VBAC twin moms to have vaginal birth complications. It really isn't any riskier than a singleton VBAC, so I don't know why your doctor is turning around on you.
I LIKE THIS POST!!! I LIKE THIS STUDY!!!!

I think twin moms are less likely to VBAC due to the pressure and guilt trips they endure from OB's.
post #19 of 29
Refusal of twin vag birth, refusal of twin vbac, refusal due to presentation of twin a, refusal due to presentation of twin b, refusal due to presentation of both, refusal due to complications, refusal due to age.... the list just keeps going. I think they're all out to CTAs as soon as the ultrasounds shows two and there are just SOOOOO many excuses. Of all people Twin mamas need to deliver vaginally, it's just so hard having twinfants, even harder with a c-section recovery on top of that!
post #20 of 29
Thread Starter 
I called the only homebirth midwife in the area and left two messages-- am waiting to hear back.

I have been talking to the women that run the Rochester Home Birth Circle and they have given me a recommendation of a CNM in Brockport whom she thinks would be the most likely to allow me to try for an in hospital VBAC. I am calling her tomorrow.

I was also told that I could try to birth in another state where they allow CM's.

It's really really infuriating to have to deal with these shenanigans just so I can birth properly. We live in the dark ages.
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