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"Your chances are about 10%"

post #1 of 40
Thread Starter 
Ugh. I'm getting my prenatal care through a large group of hospital midwives that are part of a large OB group. Not ideal, I know, but my choices are limited in this area and HB isn't an option for me.

Today the midwife I saw heard my story [pushed for 4 hours, DS was only lbs. 14.5oz, and tall] and told me that with a case like mine, my chances of a VBAC are pretty low. 10% in fact.


Is that true? What can I do to change that? [and yes, I'd love to change providers, but there really aren't too many choices in my area, so I don't see that happening].
I am already seeing a chiro, and hope to get some prenatal massages. I'm doing yoga, hypno-babies, a few of the Tupler things.

She just really battered my Bubble of Peace though.
post #2 of 40
What was the reason given for your C-section? Did you have an epidural? Were you on your back? What is she basing this 10% on? How do you even come up with an estimate like that? I call shenanigans.

I was told I could only VBAC if my baby was going to be "smaller than 6 lbs." I, too, pushed for 4 hours, with a smallish baby. Well, my HBAC baby was a whopping 8 lbs. 4 oz. (I know that's not huge but it's a lot bigger than 6 lbs!), and I only pushed for 2 hours that time, PLUS, I was not on my back! So there!

You say you don't see yourself changing providers. Well, to be quite blunt, I don't see you having a VBAC unless you do.
post #3 of 40
Thread Starter 
Quote:
Originally Posted by barefootpoetry View Post
What was the reason given for your C-section? Did you have an epidural? Were you on your back? What is she basing this 10% on? How do you even come up with an estimate like that? I call shenanigans.

I was told I could only VBAC if my baby was going to be "smaller than 6 lbs." I, too, pushed for 4 hours, with a smallish baby. Well, my HBAC baby was a whopping 8 lbs. 4 oz. (I know that's not huge but it's a lot bigger than 6 lbs!), and I only pushed for 2 hours that time, PLUS, I was not on my back! So there!

You say you don't see yourself changing providers. Well, to be quite blunt, I don't see you having a VBAC unless you do.
Actually, what I said is that I don't have any better choices.

I have no idea what the "official" reason was for my c/s. I did not have an epidural until I'd already been pushing for hours [when I transferred to the hospital from the birth center, they wanted me to stop pushing cuz my cervix was swelling]. I pushed in every imaginable position before the transfer.
She's basing that 10% on the idea that if I pushed that long with a baby of normal size that I must be in that rare category of women who have true CPD. At least that's my understanding.
post #4 of 40
Quote:
Originally Posted by Mama Rana View Post
Actually, what I said is that I don't have any better choices.

I have no idea what the "official" reason was for my c/s. I did not have an epidural until I'd already been pushing for hours [when I transferred to the hospital from the birth center, they wanted me to stop pushing cuz my cervix was swelling]. I pushed in every imaginable position before the transfer.
She's basing that 10% on the idea that if I pushed that long with a baby of normal size that I must be in that rare category of women who have true CPD. At least that's my understanding.
Why don't you have any other choices?

What position was your baby in?

Did your MW give you some kind of uncommon criteria that would make you fall into that 10%?

Do you have your surgical records? It would have the reason for C-section in there.
post #5 of 40
Can you go back to the birthing center?
post #6 of 40
Thread Starter 
Quote:
Originally Posted by barefootpoetry View Post
Why don't you have any other choices?

What position was your baby in?

Did your MW give you some kind of uncommon criteria that would make you fall into that 10%?
As I said, homebirth isn't an option. DH is ADAMANTLY opposed, and I'm not 100% comfy myself for various reasons. The only other MW in this county doesn't catch babies. Of the 2 "independent" CNM in my area, one can no longer do VBACs, and the other is over-booked and understaffed. The only birth centers left are both over an hour away, neither do VBACs, and did I mention they're over an hour away? [I know to some this isn't an obstacle, but it really is for us.]
Quote:
Originally Posted by ShwarmaQueen View Post
Can you go back to the birthing center?
The birth center I worked with during my first pregnancy closed shortly after I delivered. They are reorganizing to reopen, but that won't happen in time to help me, plus I've heard they won't be able to do primary VBACs either.

I know some people will accuse me of not being committed to my VBAC because I won't drive over an hour away to reach a practitioner. I honestly don't see how people do it though. I have no family in the area, and now babysitter to watch my son, so getting to appointments would be difficult just from that angle. Plus factor in traffic [the one MW that would do a hospital VBAC is 30 minutes without traffic, and is in a major metro area where traffic is always a strong possibility.]
It's just so frustrating to me that 1) I have to justify myself and 2) our system is such that it's even an issue. Call me stubborn but I'm of the opinion that I shouldn't have to fight to do what's best for me and my babe, and that attitude is really clouding my judgment. I'm tired, and frustrated, and yeah...
post #7 of 40
Most birthing centers won't take VBACs because they're regulated by the AABC which doesn't allow it.

Your chances are lower than a woman whose CS was for a nonrepeating reason, but I'm quite surprised she'd put a figure on it, because I don't see how she has any way of knowing. I would also want to know about the position--if you didn't have an epidural till the end and had pushed in multiple positions, that seems like a fairly good possibility. True CPD isn't impossible, but it is very rare unless you were malnourished or have a malformed or injured pelvis, so it's not the conclusion I'd leap to. Also, with only one birth to draw any conclusions from, it might be one of those flukes. You were pushing a long time for some reason, your cervix swelled, and it went downhill from there.
post #8 of 40
I would get your medical records and sit down with a CP and study them. That might give you a lot of answers about what really happened during your labor/C-section.

Other than that I don't really know what to tell you. No midwives around here would take me as a VBAC either. I live in a rural area, so it would have been a schlep regardless since everything is so spread out here. I wound up driving across state lines to find my midwife. My DH was opposed to HB too, so I did it without him. I guess I am just more committed than most? (Well, not as committed as my friend G who drove 9 hours to the Farm to have her VBAC. I think she wins the committment medal there! )
post #9 of 40
Quote:
Originally Posted by Mama Rana View Post
I have no idea what the "official" reason was for my c/s. I did not have an epidural until I'd already been pushing for hours [when I transferred to the hospital from the birth center, they wanted me to stop pushing cuz my cervix was swelling]. I pushed in every imaginable position before the transfer.
She's basing that 10% on the idea that if I pushed that long with a baby of normal size that I must be in that rare category of women who have true CPD. At least that's my understanding.
going off this very little information, it sounds like you were instructed to push against a cervix that was not completely dilated. it wouldn't matter how small your baby was/is if your cervix was swelling, because there would be no room to push baby out. that is not CPD. that is mismanagement of the second stage. :

it sounds like you are very limited in your choices. my suggestion would be to labor at home as long as possible, when you can't stay on top of the contractions/feel like you just can't do it anymore, it's time to go in. that would give your cervix a chance to open up naturally all the way, and give you a pretty darn good chance of a hospital vbac.

many moms with successful vbacs use the tag line "show up pushing!". this ensures that when you arrive at the hospital, you are ready to push that baby out!

my other suggestion is to labor upright/hands and knees/squatting. the pressure of baby's head on your cervix will help your body achieve full dilation more quickly. your pelvic outlet is 30% smaller when laying on your back. your tailbone actually moves out of the way as baby is moving down through your pelvis. when you are on your back, your tailbone can't move! this is the main cause of the 30% reduction of your pelvic outlet. other reasons have to do with angle of the pelvis etc.,.

hth!
post #10 of 40
Thread Starter 
Quote:
Originally Posted by AlexisT View Post
Most birthing centers won't take VBACs because they're regulated by the AABC which doesn't allow it.

Your chances are lower than a woman whose CS was for a nonrepeating reason, but I'm quite surprised she'd put a figure on it, because I don't see how she has any way of knowing. I would also want to know about the position--if you didn't have an epidural till the end and had pushed in multiple positions, that seems like a fairly good possibility. True CPD isn't impossible, but it is very rare unless you were malnourished or have a malformed or injured pelvis, so it's not the conclusion I'd leap to. Also, with only one birth to draw any conclusions from, it might be one of those flukes. You were pushing a long time for some reason, your cervix swelled, and it went downhill from there.
Oh, position, I forgot to comment on that. I'm not sure, actually. I KNOW he was asynclitic, and that I had horrible back labor. I do not know for sure if he was posterior. I do know that one of the positions the birth center midwife had me in was a squat, which is not good for asynclitic or posterior presentations [I know now, I didn't then]
Quote:
Originally Posted by barefootpoetry View Post
I would get your medical records and sit down with a CP and study them. That might give you a lot of answers about what really happened during your labor/C-section.

Other than that I don't really know what to tell you. No midwives around here would take me as a VBAC either. I live in a rural area, so it would have been a schlep regardless since everything is so spread out here. I wound up driving across state lines to find my midwife. My DH was opposed to HB too, so I did it without him. I guess I am just more committed than most? (Well, not as committed as my friend G who drove 9 hours to the Farm to have her VBAC. I think she wins the commitment medal there! )
My brain isn't functioning, so I'm not sure what you mean by CP.

As for commitment, I really don't think it's fair to judge someone's commitment by how far they are willing to drive, or whether I'm willing to go against my husband's wishes. I dunno, I feel awful darn committed. I have no intention of letting them cut me. But I don't understand why I have to fight for the right to my bodily integrity. Good for you for getting your VBAC though.
post #11 of 40
Quote:
Originally Posted by Mama Rana View Post
Oh, position, I forgot to comment on that. I'm not sure, actually. I KNOW he was asynclitic, and that I had horrible back labor. I do not know for sure if he was posterior. I do know that one of the positions the birth center midwife had me in was a squat, which is not good for asynclitic or posterior presentations [I know now, I didn't then]

My brain isn't functioning, so I'm not sure what you mean by CP.

As for commitment, I really don't think it's fair to judge someone's commitment by how far they are willing to drive, or whether I'm willing to go against my husband's wishes. I dunno, I feel awful darn committed. I have no intention of letting them cut me. But I don't understand why I have to fight for the right to my bodily integrity. Good for you for getting your VBAC though.
CP=care provider.

My first was posterior. It's possible yours was too. Some women have no problem birthing posterior babies. Some do.

Sometimes you just have to fight for what you really want. In a perfect world we would get our VBACs handed to us on a silver platter. But this isn't a perfect world.

No one is judging you. My point is that VBAC is possible even in the face of these obstacles. You just have to decide if you can surmount them. It's your choice either way.
post #12 of 40
Thread Starter 
Quote:
Originally Posted by ScarletBegonias View Post
going off this very little information, it sounds like you were instructed to push against a cervix that was not completely dilated. it wouldn't matter how small your baby was/is if your cervix was swelling, because there would be no room to push baby out. that is not CPD. that is mismanagement of the second stage. :

it sounds like you are very limited in your choices. my suggestion would be to labor at home as long as possible, when you can't stay on top of the contractions/feel like you just can't do it anymore, it's time to go in. that would give your cervix a chance to open up naturally all the way, and give you a pretty darn good chance of a hospital vbac.

many moms with successful vbacs use the tag line "show up pushing!". this ensures that when you arrive at the hospital, you are ready to push that baby out!

my other suggestion is to labor upright/hands and knees/squatting. the pressure of baby's head on your cervix will help your body achieve full dilation more quickly. your pelvic outlet is 30% smaller when laying on your back. your tailbone actually moves out of the way as baby is moving down through your pelvis. when you are on your back, your tailbone can't move! this is the main cause of the 30% reduction of your pelvic outlet. other reasons have to do with angle of the pelvis etc.,.

hth!
I was 10 with a lip when I started pushing. The MW pulled the lip out of the way or whatever it is they do. I'm pretty sure this is not unusual. My cervix swelled to about 9.5 by the time I got to the hospital.

I do plan to wait as long as possible to go in. I've hired a monitrice to help me labor at home as long as possible.
post #13 of 40
Quote:
Originally Posted by Mama Rana View Post

I do plan to wait as long as possible to go in. I've hired a monitrice to help me labor at home as long as possible.
That's probably your best bet. If I hadn't been able to HB, I would have just walked in pushing and let the baby fall out on the floor (well, not really, but you get my drift! ) By the time they figure out "OMG YOU'RE A VBAC OH THE SKY IS GOING TO FALL" the birth is already over!
post #14 of 40
I think you'll dialate like a multip - because you've done all that before. So you won't be as tired going into second stage (pushing). You also know how to push, that's a big part of the reason second time moms push (statistically) half the time of first time pushers.
As long as this baby is in a good position, you should be able to push it out without a problem.
post #15 of 40
My oldest was asynclitic, I pushed for 1.5 hrs and we used forceps to try and move him into position etc, nothing worked. He was 7#3oz w/ a 14.75" head. I just had my 3rd VBAC on Thurs. to an 8#2oz baby w/ a 14.25" head! It was all in the positioning for my oldest, it just didn't work out right. I had my first VBAC 18 mos after my c/s and my OB supported me 100% and never told me I wasn't a good candidate. My consent form clearly states that 70% of moms who attempt a VBAC, get one! It sounds like the MW you saw just doesn't want to do it. I never understood that, what's the harm in trying? I wanted to try even if it ended up in another c/s.
post #16 of 40
I don't see how in the world your caregivers gave you a 10% chance...that seems like a random number to me! I can totally see how this would be a huge downer and hard to keep your spirits up and keep positive. But I like how someone pointed out that with a swelling cervix, something different was up. Was it maybe like someone suggested where you were pushing on a cervix that wasn't fully dilated? Or whatever the reason your cervix swelled, fingers crossed that doesn't repeat and you'll be delivering this baby without a swollen cervix and right out of your vagina!

I know my post doesn't help much...but I too call this doctor/NP on pish posh for saying 10%! VBAC power and when you go into labor, remind yourself that this time will be different, and you WILL succeed! Think about the things you are doing this time, chiro, massage, yoga, the preperations, the relaxations...it's all only going to help! PLUS, you said that you were pushing in a position that you now know wasn't ideal....so, see, you are more educated on what is best this time!!!

Any chance you can get a doula? That could help emotionally a GREAT deal!

Sending you lots of hugs, positive vibes, and praying that you indeed get your VBAC!
post #17 of 40
Sorry, I started writing my previous post a couple hours ago and came back to it...so I re-read and saw that you've mentioned more about the swelling cervix and you've hired a monitrise and such. So, I probably sound like I wasn't paying attention since my post was started before all of those posts were added! LOL!
post #18 of 40
It sounds like you are doing what you can to get your VBAC. If you avoid/refuse interventions, use your doula (I'm assuming this is what a monitrise is?), use your coping methods you should be fine. You already went 99% of the way so you should get there again and since no birth is the same your circumstances should not repeat. Or it seems unlikely they will. Educate yourself and don't let the midwives comments into your bubble of peace.
post #19 of 40
After having read your story, it seems like the best way to try and birth woudl be to NOT do a cervical exam to "see how dilated" you are...I think the "10 cm with a lip" thing means nothing...if you wait until your body is pushing the baby out whether you want to or not, THAT is when you are "ready to push". So i would strongly consider that as the primary part of your birth plan.

I also think the malpositioned baby migth have had everythign to do with it....my tiny ds, who at 5 lbs 10, was a full 3 POUNDS lighter than my large ( 8 lbs 10) dd, was a bear to get out..his head was cocked and it was really hard, and then he got caught on the way out, right at the "ring of fire" position, making me FRANTIC with the pain...whereas dd just FLEW right on out..granted, she tore straight through everything in her path requiring reconstruction the likes of which isn't seen often, but she just FLEW right on out.

The 10% number has to be completely made up, because there is no way to come close to approximating such a figure....

As to the driving..why do you not take your child with you to the appts? My midwife had a play area set up for kids and going to the appts was a fun little adventure....1 hr really isn't that far away...it just depends on your point of view, i guess....

And yes, as to the "show up pushing"...really, we mean pushing...not "in active labor", but like...if you have to err, err on the side of baby landing in the car on the way there, versus being only 9 cm when you get to the hospital. that close.
post #20 of 40
It sounds to me like your baby was posterior - the persistent lip, back pain in labor, and failure to descend all are common with a posterior babe. Being posterior increase the diameter of the head and makes the mechanics of moving through the pelvis different and makes for a much harder birth. A second baby may well be better positioned and not have the same issue.

There are 2 issues for VBAC, right? 1. Chances of uterine rupture 2. Chances of success. So having a primary cesarean for failure to descend may reduce your chance of VBAC success (but 10% sounds way too low and like a number pulled out of thin air.) Having a primary cesarean for failure to descend does NOT increase your risk of uterine rupture. To me, that means you ought to be fine to go for it if you want to.

I have VBAC'd with several moms whose first cesarean was for failure to descend (unfortunately, I no longer attend VBACs due to hospital policy chance, though) and all succeeded. The 2 most remarkable were a mom whose first baby was a cesarean for failure to descend, and weighed 7 lbs 2 oz. Her second baby was born 15 years later when she was 36 years old and she was determined to VBAC. Her VBAC baby took quite a bit of pushing, but came out in the end - 8 lbs 14 oz. The second remarkable one was my most recent VBAC, which happened after the VBAC ban at my hospital. Mama arrived 3 hours early for her scheduled repeat cesarean because she was having contractions. She progressed quickly, and my OB backup was willing to back me up for her labor. She ended up having a totally unplanned primary VBAC of a baby 1/2 lb bigger than her failure to descend baby, about 45 minutes before her surgery was scheduled.

Without a way to see the future, no one can tell you what will happen, but I think if you are wanting to VBAC, it's completely reasonable to give it your best shot! You can always change your mind during labor or pushing if it's not going well.
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