Vacuum?

[bananabee]

I had my usual OB appt yesterday, and we were discussing birthing options. It's been my assumption that I'll need a scheduled c-section because I had back surgery (spinal fusion L-5 to S-1) in December and it takes a long time for that to become truly healed/fused. My chiropractor thinks I'll have extreme difficulty bearing down, to the point of possibly not being able to deliver naturally (and she had homebirths w/all her kids, so she's not the type to recommend a c-section).

My OB says she would never recommend surgery as the first option, but that she will do whatever I want. She said an alternative is to wait till I'm in labor and fully dilated, and use a vacuum to suck my baby out. Uhhh!!? She said it won't harm her, and would leave a hickey on her head at the least...at the most, an abrasion we would just put bacitracin (sp?) on until it healed. She said she's done that with heart patients in the past. Interesting...

I am mainly scared of ending up with an emergency c-section.

DH agrees with me that a scheduled c-section would be a lot less stressful. Recovery would take a while, but I'm not afraid of that. At least I'd be able to walk and lift my baby, not to mention DH will be done w/school and has plenty of leave saved up and I get the feeling he'd enjoy the chance to pamper me now that our marriage is straightened out. He's great w/babies, too. I have friends who've offered to pick me up for events if I can't drive, and several who would bring us meals, some who would help keep the house clean, etc, so I know we'll be just fine.

I know it's better for a baby to be born naturally, as it jump-starts their system, but by vacuum? I don't know if that would be better for Karina than a c-section. I also know that this hospital is very nice about things, as far as letting me nurse my baby right away and keeping her near me at all times.

I'm 5'2", and have a very small frame. Baby is head-down already, and hopefully will stay that way. My OB said she'll take a look at my pelvis when we do a cervical check later and see if it looks like it will be easy for baby to get through.

Does anyone have any opinions, experience, thoughts?

[feminist~mama]

I have no idea what your OB is talking about!!!! That's crazy! A vacuum-assisted delivery is absolutely not a "I'll pull your baby out" situation- mom still really needs to push. The accepted standard of care is that the vacuum doesn't "pop off" the baby's head more than 3 times during delivery- which happens all the time when moms are pushing like crazy! In addition, a vacuum is used for a low assisted delivery, which your baby wouldn't be! I don't even know a practitioner who would be willing to try a forcep delivery if the baby is that high.

I'm stunned that she would have claimed that the baby would just have a "hickey" on the top of it's head and said that it won't harm her. The vacuum comes with risks, just like everything else. It's not uncommon at all to have an excoriated area on the top of the babe's head along with a bunch of swelling and discoloration. Usually that subsides within a day or two and the excoriated area heals within a week. About 5-6% of vacuum-assisted deliveries end up with a cephalohematoma- bleeding under the skin of the scalp. This does resolve on it's own after a few weeks to months, but the baby has a nice lump on it's head for quite a while.

There are more serious risks too that have real health consequences for the baby- but the point is that I really don't think this plan of vacuuming the baby out will work...

I'd really do some research on vacuum deliveries if I was you!

[pippasmum]

I do not have a lot of advice since I don't have any experience with this but I do remember someone telling me recently that the hospital I am delivering at has almost discontinued vacuum deliveries but I am not sure why... you would certainly want to do some research.
Best of luck and I am SO happy to hear that things are better with Dh!

[bananabee]

Thank you, ladies. I knew I had a really bad feeling about it. For one thing, they need to practically sedate me to get anywhere near my girl parts. I just do not tolerate that well at all. So yeah, no way is anyone sticking a vacuum up inside me. I know I've heard it can cause bleeding under the skin and even a mis-shapen head, if I recall. I've done a little research just now, and I am just not going down that road. A scheduled c-section sounds like a much more sensible option that is going to be less traumatic for baby and me.

I do find it odd my OB suggested that, because generally she is just great and has the best OB reputation in town, esp from other healthcare personelle and people who are more crunchy.

[Burnindinner]

It would give me a weird feeling too. I would want a lot more information!

[Shachar613]

Just wanted to add my .02 as someone whose DD was an attempted vacuum delivery. IT WAS AWFUL. DD was malpositioned and after several days of hard labor and hours and hours of pushing, they attempted to help her out with 4 vacuum attempts. She ended up being delivered by c/s anyway, but she was extremely, extremely bruised and actually ended up in the NICU with very high bilirubin levels that the ped said was due to birth trauma. Now, obviously, some of that could have been from her original malpositioning, but I really think a lot of it had to do with the vacuum. And she had marks on her head where they had attached it that were apparent for months. I say go with the scheduled c/s!

[CorasMama]

I'm freaked the heck out about my scheduled c/s, and I think in your situation, I'd still probably (after some research, and a second or third opinion, about vacuum extraction) go for a cesarean birth.

[crbyard]

l totally agree with the pps. My first was VE after they wouldn't let me push any longer. First, it was the most acutely painful part of the birth. Second, the vacuum does much more than bruise the baby's skull. My daughter wouldn't latch on and nurse properly for 4 months due to damage to her jaw muscles. It was terrible. This is one case where a c-section is truly the better option.

[bananabee]

Thank you all! I am totally convinced that vacuum is not for us. I am going to sleep much better tonight now that my mind is settled. My OB said she'd do whatever I want, so I will just make it very clear to her that a scheduled CS is it. She said she'll talk to my neurosurgeon to see what he thinks about me delivering vaginally, but honestly even if he says I should be able to, I'm still not willing to so soon after a spinal fusion. No way. My surgery was so very successful that I am not willing to risk messing with my pelvis and spine right now. Another thing, I'm not supposed to let a chiropractor adjust me for a long while yet, so I don't want to risk throwing things out of alignment w/birth and potentially having a lot of hip/back pain after giving birth. My mom had a lot of issues with that after giving birth and seeing a chiro was the only thing that helped.

[GoBecGo]

Here are my thoughts....

Is the issue that your BACK cannot deal with a vaginal birth? Or that you will not be able to actively push "hard enough"? I would suggest your Ob is not the ideal person to talk to about that - talk to the surgeon who worked on your back, they will have a better idea than a chiro because they know exactly how it all looked when they operated on it, and will likely have other patients who have subsequently had kids after surgery of this kind.

Because if it's your back which cannot deal then a vacuum delivery will make no difference - the baby will still come down past your sacrum and whatever damage a vaginal birth would have done (if that IS the issue) will be a risk anyway, plus the muscle activity of your body is a lot less likely to hurt you than a third party pulling the baby out when they see fit (i agree by the way, you do have to push with a vacuum delivery). I would imagine IF the ob was going to use vacuum they would give you an epidural and let your body labour the baby down without you feeling or pushing, and just do the last bit with the vacuum, telling you when to push to help with the expulsion. Women in coma's have vaginal births, because the uterus CAN push a baby out on its own, without in/voluntary efforts from mom, it's just nature has designed us to push, because in first time mama's the perineum usually needs a bit more force to stretch enough, and it probably limits the riskier bit of the labour if you're living "in the wild" and cannot be laying in a cave for 6 hours fully dilated and unable to move while your body brings the baby down.

If it's a question of whether or not YOU can push, well, i'd possibly look into all the options before i made a decision either way. Remember, these are just my rambly thoughts! Can you birth in water? Would you be able to learn about breathing the baby out? Do you WANT to try for a vaginal birth in this situation?

Along with all of those thoughts i would offer the usual advice with regard to c-sections. How many kids do you want? If your back problem means you'll never have a VBAC, you might want to think about the size of your future family, risks increase with every one, and dramatically so after a 3rd c-section. How big of a gap do you want between your kids, will you have to adjust it to minimise the risks in surgery? If you could have a VBAC if your back were better healed is there good provision for that sort of birth where you are/will be? I know it's weird to think of those things when you're still looking at your rounded belly with your first baby in it, but the future is a big concern when it comes to surgical birth, probably bigger than the immediate situation if we're talking about a non-emergent c-section.

Ultimately only you can make the decision. C-sections are risky and the recovery can be no picnic, but the same is definitely true of vaginal births and your back problem throws a big "unknown" spanner into the works to navigate. I would talk to your back surgeon, your OB, a couple of midwives and at least one OTHER ob, to see what other opinions you can get.

Also a third possibility is to have an early-labour c-section. That wouldn't be an emergency because the baby would be fine and you would be fine, but it would mean you knew the baby had decided it was ready for eviction and it'd get the benefits of the initial hormonal cascade which brings on labour. My food for thought

Best of luck deciding.

[bananabee]

My OB is very pro-VBAC, so I know she'll stitch me up well, and in the future I plan to birth naturally. I'm hoping to have 3 or 4 kids spaced about 3 yrs apart if possible. At this time in this hospital, a water birth is not an option. In the future there is no guarantee that I'll find an OB who is VBAC-friendly, but I'll cross that road when I get there. I'm sure we'll be able to afford a midwife then.

I realize there are risks and recovery takes longer with a c-sec, but like I said, we are prepared to handle recovery at least. It would be nice to wait till early stages of labor, but my concern is that I wouldn't get my OB, and might end up with someone who wouldn't take my requests as seriously. But I have several appts coming up and we will be discussing birth plans from here on out. The way my back feels now, I really do not think I could handle a vaginal birth. My entire body is not very strong yet, and I get a lot of nerve pain if I move in certain ways, or even if I step a little bit wrong. I feel fine as long as I don't do that, and eventually my back should be completely healed and back to normal, since I only had one level fused. I've heard it takes about a year to fuse completely.

[mediumcrunch]

Women do give birth without every bearing down or only bearing down a little. If your LO is tolerating labor well (and you have a good epidural) you could labor her down to crowning and only have to push once or twice to get her out vs. pushing once you feel the urge (if you are unmedicated) or pushing as soon as you hit 10cm.
At the very least I would probably want to wait to do the C-section until you were in labor to give baby benefit of the labor hormones and picking her own day.

[whozeyermamma]

I think you've gotten a lot of great feedback - but just wanted to add my vaccum-related experience.

I had an epi with DD and OB used the vacuum b/c I stalled (thanks epi! )

It IS more than just an abrasion on the baby's head. My DD _ like the PP _ had nursing problems from it too. Thankfully not as bad as her experience - but vacuum birth led to DD having a massively hard latch (her jaw muscles were stressed and tensed.) That led to her needing to suck for extended periods (like 5 hours before my milk came in) leading to cracked nipples, bleeding, etc. We got thru it in a few weeks but it was not pleasant and it was one of the reasons why I'm doing NCB this time.

Good luck - we're all thinking about you!

[Mommabean]

I wanted to say that even with my fused spine we are going with the MW and a birth center. I know my surgery will be 2 years prior at time of birth, and it's different than yours, but having the fusion doesn't mean you HAVE to have a section. Many doctors even assume that if you've had a fusion ANY time in the past you can NOT deliver a baby at all and HAVE to have a section. This isn't true at all and it's all up to your own comfort level.


I would try to let your body work on it's own, let nature take it's course and see where it leads you. I know it's a tough decision and for my dh and I it was clear I didn't want to deal with any other surgeries. My dh is VERY supportive of me and against sections as much as I. So he knew how important it was for me to RUN from the OB practice we were in and get to the MW this January.

I wish you the best of luck in making your decision, and I would try to look around see what I can find out for you too.

[Paige, CPM]

I am guessing that the pps have had experiences where their dilation was checked and were told to start pushing right away instead of waiting for physiological pushing (the reflexive uncontrollable urge) when the bb's head is down low and ready to come out.

Why does this waiting for normal urge not happen more in a typical hospital birth? Providers have never been trained or have really experienced the concept, and arbitrary (Freedman's curve, or bed, dinner, you name it time...) and psychological time constraints placed upon women by their care providers.

I have seen plenty of hospital births over the years to know that 10cm pushing vs physiologically directed pushing is standard of care with almost all in hospital practitioners (except for the rare rare rare ob and some CNM's).

Funny it is how many of my cleint's babies come out without me ever even giving them a single vaginal exam. This waiting is also one of the larger reasons why CPM's have a 3%-6% c/s rate vs a 30% c/s rate that is typical in hospital.

Have a look at this discussion, it might help you to have a better discussion with your doctor, or to understand more where she is coming from? ...because if this is what she is thinking about then I think it is a very legit option because it will not cause a lot of stress on your body/back...AND the likelihood of you needing a vacuum extraction in this scenario is very low... in fact I would print out this link and bring it to her and ask her if this is what she is talking about. Also, if this method doesn't work for you you can ask for a c/s instead of vacuum at the time. Like GoBeccaGo said it is safer for the baby to initiate birth then to schedule a c/s. Personally I would rather have vacuum then major surgery, only because from a medical evidence based stand point I feel for me the risks of major surgery outweigh the risk of judicial use of a vacuum device, but that is me....AND I have not had painful back surgery either!

http://www.mothering.com/discussions....php?t=1217522

Good luck with your decisions!

[bananabee]

Originally Posted by Mommabean

I wanted to say that even with my fused spine we are going with the MW and a birth center. I know my surgery will be 2 years prior at time of birth, and it's different than yours, but having the fusion doesn't mean you HAVE to have a section. Many doctors even assume that if you've had a fusion ANY time in the past you can NOT deliver a baby at all and HAVE to have a section. This isn't true at all and it's all up to your own comfort level.


I would try to let your body work on it's own, let nature take it's course and see where it leads you. I know it's a tough decision and for my dh and I it was clear I didn't want to deal with any other surgeries. My dh is VERY supportive of me and against sections as much as I. So he knew how important it was for me to RUN from the OB practice we were in and get to the MW this January.

I wish you the best of luck in making your decision, and I would try to look around see what I can find out for you too.

Hi!! And thanks, Mommabean. How are you doing??

I'm mostly worried that I'll end up w/a c-sec even if we try to go natural. I have a lot more talking to do w/my OB, and like I said, she'll talk to my surgeon. I realize I could give birth naturally later. I just don't feel my body is ready to handle that now, since I still have a lot of limitations. I really appreciate your input and do let me know if you find any info about situations like mine.

[bananabee]

Originally Posted by Paige, CPM

I am guessing that the pps have had experiences where their dilation was checked and were told to start pushing right away instead of waiting for physiological pushing (the reflexive uncontrollable urge) when the bb's head is down low and ready to come out.

Why does this waiting for normal urge not happen more in a typical hospital birth? Providers have never been trained or have really experienced the concept, and arbitrary (Freedman's curve, or bed, dinner, you name it time...) and psychological time constraints placed upon women by their care providers.

I have seen plenty of hospital births over the years to know that 10cm pushing vs physiologically directed pushing is standard of care with almost all in hospital practitioners (except for the rare rare rare ob and some CNM's).

Funny it is how many of my cleint's babies come out without me ever even giving them a single vaginal exam. This waiting is also one of the larger reasons why CPM's have a 3%-6% c/s rate vs a 30% c/s rate that is typical in hospital.

Have a look at this discussion, it might help you to have a better discussion with your doctor, or to understand more where she is coming from? ...because if this is what she is thinking about then I think it is a very legit option because it will not cause a lot of stress on your body/back...AND the likelihood of you needing a vacuum extraction in this scenario is very low... in fact I would print out this link and bring it to her and ask her if this is what she is talking about. Also, if this method doesn't work for you you can ask for a c/s instead of vacuum at the time. Like GoBeccaGo said it is safer for the baby to initiate birth then to schedule a c/s. Personally I would rather have vacuum then major surgery, only because from a medical evidence based stand point I feel for me the risks of major surgery outweigh the risk of judicial use of a vacuum device, but that is me....AND I have not had painful back surgery either!

http://www.mothering.com/discussions....php?t=1217522

Good luck with your decisions!

Thanks, Paige. I've read through that discussion a couple of times. Honestly, there is no way someone could stick a vacuum inside me or even get it between my legs unless I was sedated or totally numb, and I really don't want an epidural. I'd rather have a spinal because it doesn't stay in. I also especially don't want to risk harming my baby or risk latch problems with a vacuum. I realize a CS is major surgery, but I know I'm very resilient, I have a lot of support for recovery, and that my OB would do a good job to minimize VBAC difficulties in the future. A scheduled CS would be much more safe and less stressful than an emergency CS, which is really what my intuition is telling me would happen. My mind is pretty much made up, I just wanted to hear what others had to say about the vacuum issue. But next baby will definitely be born naturally in a tub at home with a MW if I can arrange it.

Thank you everyone for your very valuable input. I really really appreciate it and I don't mean to come across as stubborn and narrow-minded.

[neldabean]

I just want to add my experience. With ds1 they used a vacuum to help him out. His heart rate dropped really really low. In the moment they gave me a intrathecal a one time dose. Baby was still high and we got him out within a few contractions. He didn't have any sort of bruising, swelling nothing. He had no issue with nursing.

Now skip 5 years to ds2 birth. I never even pushed. My body did all the work for me. I also did not have anyone telling me when I should push. I agree with pp that your body knows how to deliver your baby with out your brain getting in the way. This is just what I have been through. I would also say that I would try the vacuum over a scheduled c section. But I am not you.

Good luck to you.