Attempt a VBAC??? My midwife recommends a csection.

[readyfor2]

Not sure if I should attempt a VBAC. My midwife recommends that I have a planned c-section (she works at a hospital that does not do VBACs). She told me my hips are too small on the inside (but I have a large healthy frame). 1st baby-42 weeks, water broke, 48 hours later she started me on pitocin, 12 hours later I still had not dialated (OK, I got to .5) and he never dropped-csection that evening. His position was good, no cord around neck-and my midwife just said the inside of my hips were too small (I have had some lower back problems-but who does not when they are pregnant). I cannot believe her that my hips are too small....still wondering why I needed a csection the first time and what will happen with baby #2. I am 8 weeks pregnant...trying to decide what to do....any advice?

[AustinMom]

I think a lot of moms are told this and it can never be proven. It is obviously more likely if you have rickets, dwarfism, or had a VERY traumatic accident and injured your pelvis. Even then, I would go into labor on my own and not schedule anything.

I tell women a lot this here, (as I need encouragement for the same thing, I'm HBACing) Our Doula does a lot of work with ICAN locally, and her co-facilitator is 4'11'', and he HBACed her 10lb baby at home. She says that during her pregnancy, of course, she ate right and exercised, but also went to see a chiropractor. Her hips were a little uneven, and she had work done off and on through her pregnancy, and an adjustment in early labor. She believes that is why she was able to HBAC. The adjustments created more space for baby, and helped baby get into better position before labor (low in pelvis) and get her hips even.

I personally, don't believe a woman's body will grow a baby that is impossible to birth due to size. I think there are other factors that come into play that can cause a cs to be necessary of course. Here are some things you can keep in mind. A baby's head in built to mold to mom's pelvis, and every baby is different in this, some heads bigger/smaller, some mold more/less. At the end of pregnancy, relaxin is at the highest which allows your pelvic ligaments to give and open up to create more room, every pregnancy is different in the amount of relaxin you have. Hip squeezes, squatting, lunging, figure eights, and other maneuvers open up your pelvis and slide the baby down.

Also, if a woman has some mis-alignment issues like the story I told you, you should get those fixed. It doesn't hurt to go to a chiro and ask them to give you their opinion.

I'd contact your local ICAN group and find a Doula that believes in your body, and a midwife as well. Also, they can recommend Chiropractors and much more for help, and things you can do when pregnant.

Yes, you can birth a baby. Maybe the last cs was necessary or not, with us, it was the same type of thing (only stuck at 4-6 cm for 27 hrs) and I believe that our birth team did the best they could with the situation with the knowledge they had. This time, my birth team has a lot more knowledge, as do I.

No I would not schedule a cs. No matter what. Unless you have placenta previa, or some other life threatening complication. Keep this in mind, if labored as long as you did with such little progress, and there was no distress to the baby, going into labor on your own, is going to be nothing but a good thing for the two of you.

[Sk8ermaiden]

I agree with everything said above.

I would bet money the induction due to rupture of membranes was the culprit. Many/most women do not respond the same to Pit as to natural hormones. They are NOT even close to the same.

Like the PP said, there is no way to know. BUT there is absolutely no reason you should not attempt VBAC based on the info you have presented. Most of the women I know who have attempted VBAC after being told their pelvis was too small went on to successfully birth even larger babies. But what gets me, is there is NO way to tell from your birth whether you would have pushed him out or not. You never dilated! It is impossible to tell whether a woman can or can't push her baby out until she tries it!

I pushed for 9 hours and could not get my baby out. She was malpositioned and never even moved down. There is still no reason to believe I can not push out a baby.
I will be attempting HBAC, and if I have to have a c-section anyway, well then
1) my baby will get to pick its birthday,
2) my baby will get the benefit of all the good labor hormones in preperation for birth (babies sectioned after labor do better than those born by scheduled c)
3) I will get the benefit of labor hormones (I believe studies show it helps your milk come in faster)
4) I will know it was necessary and not have to wonder.

Of course your midwife is recommending a ERCS, her hospital doesn't do VBACS! Go find yourself the local ICAN and find out who the supportive providers are. Good luck!

[womenswisdom]

CPD would not cause you not to dilate. Your uterus does the work of dilating, not the baby's head fitting through your pelvis. I would agree with the suggestion for chiro, but I tell that to everyone Also, definitely go find your local ICAN group and get the skinny on the vbac-supportive providers in your area. Even if you wind up with a c/s this time (which you won't!!!), don't you want to know you did everything you safely could to give your baby the chance to be born vaginally?

[Sijae]

It doesn't sound like you went through enough of the labor process to know anything about your pelvis. It sounds more like you were sectioned for a failed induction coupled with failure to wait.

Ask her to back up her statement with exactly which diameter in your pelvis is small and what the measurement is. I am betting she not only didn't do a full pelvimetry exam but that she doesn't really even know how. In addition, even if you have a diameter that is small, the hormones of pregnancy and a physiological labor can usually overcome it especially if baby is in a good position. It's very rare for an american woman with no history of a disease like rickets or a traumatic pelvic injury to have a pelvis that's "too small." and remember that it's not really the size of your pelvis that matters but the size of your pelvis in relation to the size of your baby.

It's really bad of her to tell you that you failed, that your body isn't good enough to birth when it was most likely caused by their impatience in the first place. Of course it's not surprising she supports an ECRS, she works for an institution that denies women their right to choose the safer option.

The good news is that you have another chance

My advice is to dump the "midwife" who certainly doesn't deserve the title and plan a home-birth.

[roadfamily6now]

Originally Posted by Sijae

It doesn't sound like you went through enough of the labor process to know anything about your pelvis. It sounds more like you were sectioned for a failed induction coupled with failure to wait.

Ask her to back up her statement with exactly which diameter in your pelvis is small and what the measurement is. I am betting she not only didn't do a full pelvimetry exam but that she doesn't really even know how. In addition, even if you have a diameter that is small, the hormones of pregnancy and a physiological labor can usually overcome it especially if baby is in a good position. It's very rare for an american woman with no history of a disease like rickets or a traumatic pelvic injury to have a pelvis that's "too small." and remember that it's not really the size of your pelvis that matters but the size of your pelvis in relation to the size of your baby.

It's really bad of her to tell you that you failed, that your body isn't good enough to birth when it was most likely caused by their impatience in the first place. Of course it's not surprising she supports an ECRS, she works for an institution that denies women their right to choose the safer option.

The good news is that you have another chance

My advice is to dump the "midwife" who certainly doesn't deserve the title and plan a home-birth.

I totally agree with everything that everyone has said and this in particular.

Find a new care provider

[AustinMom]

Originally Posted by Sk8ermaiden

3) I will get the benefit of labor hormones (I believe studies show it helps your milk come in faster)

Not only milk production, but your body getting back to prepregnancy, and not only the uterus, but all the hormones. PPD and other PP issues are a lot less likely to occur if you labor and then have a cs (if you need one).

http://ican-online.org/chapter/search

ICAN is going to be very important in helping you in more ways than you can think right now. I'm also 8 wks preg and (when morning sickness allows) I'm gonna go to the monthly meetings, also because I want to get involved with the community more too, especially ICAN.

http://www.youtube.com/watch?v=lrgy29xbtmE

http://www.youtube.com/watch?v=3XmwE...eature=related

http://www.youtube.com/watch?v=LZRcT2p7OC0

http://www.youtube.com/watch?v=SxmM6...eature=related

Here are just a few wonderful VBAC births.

[cchrissyy]

Before going forward with this midwife or her cs plan, I think a second opinion is totally called for. good luck!

[kltroy]

Does your MW have any data (aside from failure to wait w/ last pregnancy) to support her notion that your pelvic outlet is too small? They can do "pelvimetry" (measurement of the size of your pelvis) with MRI these days if there is a true concern, but I doubt that's necessary. True CPD is generally only present in a small number of women due to conditions such as vitamin D deficiency (rickets) during growth. Remember that how your baby comes out has as much to do with positioning as it does with your pelvis size and shape. Given that your MW practices at a VBAC-ban hospital, she is probably obligated to recommend a RCS, don't you think? Sounds like a conflict of interest; I'd try and find a provider who works in a more supportive environment. Even if you like this person, the hospital is a no-go.

I second another poster's recommendation of contacting your local ICAN group. They certainly have a list of VBAC-friendly providers in your area. www.ican-online.org