The real risks - Page 2

[JayJay]

Wow - your OB is full of it. 80% risk of the baby dying with any uterine rupture? That's clearly BS - let me just put it that way.

Really, most UR's are very mild and actually either go undetected or are detected only after labor is done with. Huge, catastrophic ruptures are rare and when they happen, with a good team in place, the risk still is not 80% infant mortality. These just are not real statistics!

For my VBAC, I am indeed being induced with a mild dose of pit. I am in a bit of an odd situation: lost my last daughter to placental abruption, and not 100% of all the factors that contributed to that, so this time, I'll need to be in hospital. The only hospital in our area that does VBACs is a half hour away, and actually only has the capability to do them in the daytime - no adequate anesthesia team during night hours. So, in order to get my VBAC, in our current situation, pit will have to be used in small doses.

Because there is noooooOOOoo way I am going to have a repeat C. Not without a good shot at a vaginal birth. And I'm not going to stand there and argue in the middle of labor either, should it happen at night. I'm not afraid - even WITH pit, the risks are low.

Actually ironically, having had one placental abruption, the statistical risk of my having another one is 10%. That's an awful lot higher than a uterine rupture, or the risks of an induction with pit in the middle of a freezing cold Minnesota winter...

If I had your OB, I would switch, pronto. My OB loves VBACs. He's against the current hospital policy of no VBACs at night and wants to change it. I'm going with him, because he respects my birth plan, and will be letting me wear my own clothes, use the shower, the birth ball, push the baby out and labor wherever I want, even with the induction. I don't think I'd feel at all comfortable with someone who was so dead set against VBAC... I don't think you'll get a fair shot at what you want with this OB.

Good luck!

[MommyDOK]

Originally Posted by JayJay

Really, most UR's are very mild and actually either go undetected or are detected only after labor is done with. Huge, catastrophic ruptures are rare and when they happen, with a good team in place, the risk still is not 80% infant mortality. These just are not real statistics!

Help me understand here. I agree the ob is giving bogus stats, and I agree w/ the mild (iow, not catastrophic) but how are most ur undetected? I mean, how do they know that most are undetected? If you've had a vbac, then they don't see the uterus.


And I'm very sorry for the loss of your daughter. All my prayers in your next delivery.

[JayJay]

Well if your uterine muscle starts to separate, it's called a uterine dehiscence. Usually after the fact, they can tell because of localized pain - or even, if a healthcare provider for any reason needs to manually detach the placenta. Most mild cases of uterine dehiscence are therefor discovered after the fact, and had no bearing on labor. Sometimes, one needs a little repair, but much of the time in a mild case, the uterus naturally heals on it's own

[MamieCole]

Originally Posted by DocsNemesis

Finally-in regards to catching UR's-I'm making an assumption here, but if you are not using pain meds, your chances of catching a UR quickly go up by leaps and bounds. Think about it-with an epidural in place, a mom will most likely not be able to feel anything, maybe pressure or something being off, but not pain. Now think about how many moms get epidurals. A LOT. The vast majority. Its entirely possible that the baby/mom would've been ok had they caught the rupture early. With mom not being able to recognize a rupture, all they have left to rely on is fetal heart tones and sometimes bleeding/odd contractions (which aren't guaranteed to happen). By the time the fetal heart tones are getting whacky enough to notice, they're already in some serious trouble. Then with all the time it takes to get to an OR, get surgery started, etc....yeah, it can be something like 5, 10 minutes, fast, but when a baby is in major distress, that may not be fast enough.

I personally wouldn't attempt a VBAC with pain meds in place. I WANT to feel the pain and everything else. I want to be able to say "WHOA, that's not right" and get attention immediately. I can't imagine not having some major pain with any sort of UR...although I admit thats an assumption. I should see if I can find anything on that specifically, from moms that have been there. Knowing what to look for yourself can make all the difference!

I had a UR with my HBAC attempt last month. I can only speak for myself, but yes, there is a significant pain involved. My MW decided it was time to transfer after I had been complete and pushing for several hours with no progress. Baby was stuck at +3. There was also an increase in the amount of meconium we were seeing. At some point during the trip from home to hospital, my pain went from the regular pain that comes and goes with contractions to a constant pain that was immobilizing and excruciating and did not go away.

Unfortunately, no one at the hospital believed me when I kept yelling "Something is wrong. This hurts so much. Somebody help me!" They tsked tsked me and wrote me off as just not being able to handle the pain of labor because the baby's heartrate looked great. (as it had the entire labor.) They gave me a shot of some sort of pain med that didn't help at all. They finally checked me and discovered the baby was at zero station. Instead of recognizing this as a sign of UR, (baby ascending back up the birth canal) the doctor just wrote off my MW as being "mistaken" about the +3 she had reported.

It was only after I insisted on a c-section (which was the only way they'd agree to give me more pain meds) that they discovered that I had experienced a UR that had also caused my bladder to rupture in the process. Most likely because of some shotty work by the OB who did my primary cesarean that caused my bladder and uterus to adhere to each other.

Baby was fine. I had to go through 5 hours of surgery to repair my uterus and bladder, but managed to avoid needing a transfusion or hysterectomy.

So, yes, there are signs of UR, but because UR are so rare, many doctors do not know what to look for and rely solely on fetal heart rate as an indicator of something going wrong. I would highly recommend avoiding pain meds to anyone attempting a vbac so that you can insist to your care providers something is wrong if your pain becomes constant and different than regular labor contractions.

[ACsMom]

Originally Posted by forestrymom

The OB who is using scare tactics to attempt to persuade me into another surgery was open about the risks of another surgery. However, his point was that those rarely result in death to the mother or baby, while a uterine rupture often does. What are the risks of death of infant and mother when a uterus ruptures?

My apologies if this has already been said - I didn't read the whole thread yet - but uterine rupture actually does not often result in the mother's or baby's death. Most ruptures are partial and happen rather slowly and may not even affect the delivery, not this big, dramatic rip and you bleed out and that's it. I'll try to find the stats on it - I read about it in Open Season and other sources. If you were induced with pitocin for your first vbac, that actually put you at a slightly higher risk of rupture than if you hadn't been induced, and you were fine. So....yeah, I'd be highly suspicious of your ob's scare tactics. The risks of major surgery are still much higher.

[Bluegoat]

Originally Posted by Realrellim

From what I understand, a "window" is not necessarily a rupture. Apparently it's possible to have those for a large part of a pregnancy, and they don't necessarily pose any threat to the baby or mother. I can't remember if I read that in Silent Knife or in Natural Birth After Cesarean: A Practical Guide, but one of them included information on that.

This is in Silent Knife for sure. It is an older book, but it says that there is no actual evidence that having a window is even abnormal, much less a problem. There are probably a lot more than people realize, because often no one checks for them.

Myself, there is something fishy about the stats this OB is using, and I doubt it is because he doesn't know any better.

But why not talk to the MW about it if you are having one?

[springfever]

Everything I would say has already been said... but I would HIGHLY recommend you (OP, and anyone else who hasn't ) read Silent Knife. EXCELLENT book, anyone wanting a VBAC should read it!!