broken pelvis = c section?

[aztraea]

Hi mamas,
Long story short, I am considering a third baby after 2 previous sections. About 20 years ago, I was in a car accident where I fractured my pelvis in three places. Hospitalized for a month and had to use a walker for a few months afterward. I get adjusted by the chiro regularly and can tell when the area is out of whack. I chose to go with a very good (ie, not pushy or quick to cut) o/b practice for my births as I knew there was some question as to whether vag birth would be an option and I wanted to be in the hospital "just in case."

I labored with both children, the first for more than 24 hours, and neither ever engaged. I know that there are many stories of babies not dropping until the end, but I really wonder if my children just can't get into my pelvis due to my injury.

I am pretty sure that there is nobody nearby that will help with a vba2c, midwife or ob/gyn, but I just can't get excited about another pregnancy right now if I know it will absolutely end in a C, kwim?

Jeez, ok, so I guess what I am wondering is if anyone knows anyone who has ever had a broken pelvis and had a vag birth (vbac or no). I don't know how much my desire for a third child is wrapped up in the idea that THIS TIME, I can have the birth I want! But I'm really trying to get as informed as I can before I make a decision either way Thanks!

[jess152]

That's a tough situation to be in, facing the prospect of another c/s, ugh!

I know pelvimetry is a very inexact science, but maybe in this case it would help determine if your pelvis would let a baby pass. I know at the pubic bone it separates during labour, not sure about the other parts of the pelvis though. Ask your chiro about that, they'd know all the nuts and bolts of how it works.

Also, the position you laboured in could make a difference. I read in one of Ina May's books that your pelvis opens something like 25% wider in a squat than if you were flat on your back. Do you know if your babies were sunny side up? That might have made a difference in how they were presenting, leading you to make little progress.

[AlexisT]

A broken pelvis is one of the few known causes of true CPD, unfortunately.

What does your OB say? Does s/he have any experience in this area that might be applicable?

[MsBlack]

Speaking of Ina May, you might want to actually try to consult with her--or some other highly experienced midwife that give a good assessment of your pelvis and what your chances are of getting a baby through. The shape of your pelvis, and it's ability to flex and open during pregnancy and labor, may have been impacted by your prior injury. Seems likely--and yet, there are many women whose babies don't descend much until far beyond 24 hrs labor such as you had before. I just recently had the honor of being a doula for a VBA3C mom--she got her vag birth at last--but she labored on and off for about 3 days, and then fairly continuously for 2+ more days (didn't go to hosp until the last few hours, when we were sure baby WAS descending, and dilation was well underway). Now that may have been different under different circumstances--I was not able to arrive until the last 15hrs or so of her labor, nor was her other major support person...who knows tho, if our earlier presence would have helped). Not saying that you would labor that long, but with the right preparation and support, perhaps a vag birth is possible for you tho it might take a long time to achieve.

Get the honest and skilled appraisal of your pelvis from someone who fully supports VBAC and understands very well women's desire and true ability to give birth--that might be the best place to start.

[JessicaS]

I would work with your chiro on that area and discuss it with them. I would also seek the opinion of a very experienced midwife.

You might try utilizing "ask the Experts" feature on Mothering

http://mothering.com/experts

[aztraea]

Thanks, guys! I may try the "ask the experts" idea. My ob/gyn let me try both times, but I don't think they'd go for a third attempt. I think they would probably say it wasn't possible based on the two failed attempts alone. And they are the only vbac doctors anywhere near me. Since none of the midwives here will do vba2cs, I don't know if they'd want to take the time to figure out if it is even possible, but I'll check I am getting a new chiro soon who is super family-oriented and pro-homebirth, so she may be able to give me some answers.Thanks again!

[aztraea]

Just realized that my reply sort of raises the question of - um, so WHY try to find this out?? I figure I can find a midwife SOMEWHERE in this state that would do vba2c if I can at least find out if my pelvis will work properly!

[DocsNemesis]

Have they done any xrays or anything else to show where/how your pelvis may affect birthing? I'm talking recently, not from the accident/post accident.

I'm not saying it hasn't, don't get me wrong-as others have said, this is one of the rare scenarios where CPD actually can occur-but its also entirely possible you don't have a problem. I posted a long explanation in another thread a minute ago, but a shorter version is thus: All but my last were vaginal births (his was a cesarean due to HELLP) and NONE of mine have engaged until well into labor. I'm not sure exactly when the first 2 engaged, though I know towards the end they were still -2 station, but I do know the second 2 didn't engage until very far along. With one I had been stuck at 9cms for hours and hours, broke water manually, another 30 minutes of walking and she finally dropped. She was high and floating the whole time. The other I had PROM with, still high and floaty, didn't feel her really drop until the very end when I'd been standing and rocking back and forth. Both of them were also at least -2 station when I started pushing. Nothing is wrong with my pelvis.

I would definitely talk to the chiro, maybe see a doc that deals with those injuries, and talk to a couple of doctors/midwives about it. Get a range of opinions.

One thing I'm curious about is, did you have an epidural with your first 2? Were you up and moving about? Did you try a bunch of different positions, water, etc? Was your water broken? Did either of the babies have any signs of distress?

Also, keep in mind many doctors are quick to call for failure to progress when really mom has just stalled for a bit or needs more time in general. 24 hours really isn't a long time for a first time mom.

[aztraea]

DocsNemesis,
I have had a recent x-ray done, but not gone over it with anyone. I just went in and paid for one at the hospital and received a call a few days later telling me that I didn't have a broken pelvis. Which, obviously, wasn't quite what I was asking!
Interventions in past labors - yes, yes, and yes. Which hits the nail on the head really. I really believe that, if everyone would leave me alone, I could go into labor and progress well and get a baby out of there!

For first DC, induced at 41w3days. 8am - midnight was that softening agent for the cervix (name escapes me), midnight on was pictocin, and then water broken, and then, finally, epidural after about 16 more hours. I made it to 5cm and 80% effaced, head never engaged. It was almost 48 hours of this "laboring" before the section. DS was 9lbs, 7 oz. All of that said, I felt pretty sure that the C was necessary.

For second DC, I had GD so had to get my fluid monitored 2X a week. On due date, fluid read low and I had to be admitted. This is the birth that I can't stop kicking myself over. I had to lie in bed for EIGHT hours hooked to baby monitors that were constantly needing readjusting as my body very slowly started to go into labor. At the end of the eight hours, I could feel it beginning, but couldn't get up due to the monitoring. Then the pictocin started and they broke my water. The contractions were awful and I couldn't do anything but thrash my head from one side to the other - no relief there! Baby's heart rate kept dropping and, after four hours, I got an epidural in order to get a C.

Sigh. Anyway, I've been researching like crazy and can't find anyone who will do vba2c here. Too chicken to plan for UC, so not sure if I'll go for another baby or not

[prancie]

i think it's worth exploring that you had 2 c-sections because of inductions and interventions and not being able to labor upright. I would think of both of those things as reasons long before a previous injury.

A lot of labors that are induced end up in c's because the baby never engaged. That is a consequence of asking the baby to be born before the baby is ready.

Next time seriously consider homebirth.

[aztraea]

Prancie,
I would absolutely go for a homebirth, in a heartbeat, if there was any midwife nearby who would attend. Since there isn't, I'm trying to figure out my situation a little better so that I can consider either UC or the drama of refusing a C and showing up at the hospital in labor, demanding a vag birth. Neither are really desirable options to me, but if I felt more confident in my body's ability, that could change.

[prancie]

I know that Florida is weird about vbacs. I wonder if there are any lay midwives that work under the radar there. Are you close to another state that you could travel to? Do you have family in another state that you could stay with and birth there? I'm not sure what I would do in your place, but if you want to try for a vbac you are going to have to get creative.

[Novella]

Originally Posted by aztraea

Jeez, ok, so I guess what I am wondering is if anyone knows anyone who has ever had a broken pelvis and had a vag birth (vbac or no).

Not that one anecdote constitutes a scientifically-significant statistic, but count me in! I hope it can be encouraging for you to know that I've done it and maybe this will pull a few more injury stories out of the woodwork.

(small disclaimer: your break sounds more serious than mine).

When I was 14, a horse reared up and "sat" backwards over on me during riding. So it was a slow-motion "crush-break" of one or two bones low in the middle of the pelvis. I did not have any surgery or any sort of cast. I laid in bed in the hospital for 10 days. Then I was at home and in a wheel chair for a number of weeks, and finally walking wobbly on crutches.

I could feel mild arthritis in the specific spot of the break when damp weather came, for about 4 years afterwards. I've never felt anything of it in the 15 years beyond that. Where I could "feel" this reminder of the break location was right around the birth canal.

All my children have arrived through good vaginal labours and deliveries without much of any broo-ha-ha.

In the several doctors I've seen over the course of those pregnancies, not one ever suggested the pelvis might be any sort of issue.

[cathicog]

Originally Posted by Novella

All my children have arrived through good vaginal labours and deliveries without much of any broo-ha-ha.

In the several doctors I've seen over the course of those pregnancies, not one ever suggested the pelvis might be any sort of issue.

And I see you have had twins vaginally as well! Congratulations. Wish Docs here weren't so quick to cut...

[liberal_chick]

A bit of encouragement from me too!

My mother was in a terrible car accident at age 19 (before she had any children). She spent 3 weeks in the hospital, went home to a hospital bed and was in bed for about 4 months total. She had 2 surgeries and about a week of physical therapy.

Four years after her accident, she had me. Three years later, she had my sister. We were both vaginal births.

Now, we were both forceps assisted and she said we both had brusing over one of our eyes (same eye on both of us) and she says she still feels "off center," but her L&Ds were pretty standard.

[aztraea]

Thanks for the encouraging stories, mamas! Unfortunately, after much much much research, it looks like there are no midwives within TWO HOURS of me that would assist a vba2c I really don't feel comfortable with UC due to my vag birth track record, so I have to decide if I want the drama of showing up to the hospital in labor. And hoping that they "let me" push. Doesn't seem too promising at this point! I have contacted a few midwives to see if they'd go over my records with me and help me get a better understanding of my last two births, but, so far, nobody has agreed to even do that. Sigh..... Next stop will be my new chiro, whenever I get the funds to get in there Thanks again for all the support, ladies!!

[aztraea]

Originally Posted by prancie

I wonder if there are any lay midwives that work under the radar there. Are you close to another state that you could travel to? Do you have family in another state that you could stay with and birth there?

Prancie, I don't think there are any lay midwives around. There was just a big court case against a family that delivered it's own babies due to religious ideas. A woman died and the women involved are being prosecuted, so the climate is definitely not good for lay midwifery in this area. And, sadly, I'm way down in Florida, about 6 hours from any other state line. And DH and I are here because our whole family is here, so I'd have to find a friend willing to let me crash....with my kids...and DH....and to be able to afford no work for DH.... argh, yeah, that doesn't look good either!