Had HBAC last year, PG again and thinking of having another VBAC, but in hospital

[JFTB1177]

I just found out today I am PG. It's early to be talking about this since I miscarry a lot and have no idea if this pregnancy is a "sticky" or not. But I am already thinking about my last birth, a VBAC at home. The homebirth was fine, nothing went wrong. Baby was born totally healthy and I was fine too.

But here's my problem... my labor was 36+ hours and I pushed for 6 hours (yes, 6). My labor was EXTREMELY painful, I was literally screaming for hours and hours. I can't imagine going through that again without drugs. And the pushing- I did finally get my baby out but my MW (who was amazing, no doubt) had to work hard to help get him out. I worry about this happening again, but I know had I been in a hospital I would have had a c/s. This is the delimma I'm having. i definitely want another VBAC, and I know my chances are *probably* better at home since there won't be time limits on pushing, etc, but the thought of going through another labor and pushing stage like that (without pain meds) makes me want to faint.

Help?? Should I talk to my MW to find out why she thinks I had such a hard time delivering? Anyone here ever had a similiar situation- had a successful VBAC but chose a different route the next time?

[AlexisT]

I would talk to the midwife to find out if anything about your birth was exceptional, but ultimately, this is one of those choices that is your call. No one else can tell you how much it hurts or whether you need pain meds.

I can say that even in a hospital setting, your providers may be more relaxed this time than they would have been with a primary VBAC. Proven pelvis and proven scar count.

[JFTB1177]

Originally Posted by AlexisT

I can say that even in a hospital setting, your providers may be more relaxed this time than they would have been with a primary VBAC. Proven pelvis and proven scar count.

Do you think so?? Even though I pushed for 6 hours? The MW I used told me she only had one other mom in her entire career who pushed longer than I did (that lady was 8 hours).

[mizznicole]

What happened in your birth that caused you to push so long? Was there a positioning problem? I'm not an expert - it's just that with my DS I pushed for 2 hours and "timed-out" with the mw. He was OP.

[wombatclay]

I'd talk with the midwife and ask about her thoughts. Then I'd take a haaaaaaaard look at the options you have for a hospital vbac. I've had two hospy vbacs (first one with an OB team that trained with Ina May, the second with a midwife team) but where I had the choice of several care providers and hospitals in 2007 with dd2, when ds was born 9 months ago there was just ONE provider/hospital that would attend a vbac (even with a proven pelvis/scar). And it was an hour away. So you may find that there isn't a lot of choice.

That said... maybe you could plan a hbac but have a much tighter birth plan? I pushed for ~4 hours in my first vbac, dd2 developed shoulder dystocia that didn't resolve with the gaskin maneuver, I had a 4th degree tear and pph, she needed oxygen/resuss. When planning ds's birth I knew I wanted another vbac but I didn't want a vbac "at any cost". I discussed this with my midwives, their backup ob, my dh, my doula, etc and decided that I wanted to move directly to a c/s if I had a long pushing stage (in my book, that was "I'll push for 2hrs but if progress is minimal at that point I want to move to c/s"). In the end my second vbac birth was ~4hrs from start to finish with just a little sticky shoulders. so you never know!

Anyway, maybe you could plan an hbac with the understanding that IF your pushing phase was long you'd transfer. Or plan an hbac using something like hypnobabies and the understanding that you'd have a "safe word"... you know, something like "the third time I tell you X we will leave for the hospital". And then be very clear when discussing your birth plan that you want/need support but you also need to trust that your team will honor your wishes regarding transfer so that you can relax/focus on the birth.

Obviously, birth is impossible to plan for. Spinning babies, Optimal fetal positioning, EPO/RRL, webster technique, acupressure, etc can only take things so far. You just can't know for sure what will happen! My first birth was 32+hrs and my third was less than 5 hours. My smallest babe had a true shoulder dystocia while my largest was just a bit sticky. You never know. But having plans and backup plans helped me relax... it may work for you too.

good luck!

[MNHall]

Our situations are a little different, but pushing is my concern too. My son, granted induced, so I have a lot of opinion on that, I pushed for 2 hours and was made to believe my time was up and I had a c/s! So yup, like you said, put under the knife because pushing took so long.

So my DD, my VBAC, when 90 minutes of pushing came, my new OB started sort of putting the clock time pressure...which freaked me out. At this point though, he said that baby's head was sideways and with an epidural he could rotate her head and help her come down. He did rotate her, but we also needed an episiotomy, forceps and blah blah blah with another hour of pushing.

So anyway, again, I switch to an amazing amazing provider and we've already discussed pushing. Basically, he feels like there is no reason to time limit and he does push with women for 4 hours sometimes, if that's what they need. BUT, being that my DS AND DD were turned sideways and not interested in turning as they came down the birth canal, spinningbabies, yoga, visits to the chiropractor during 3rd trimester are all part of my plan. So, I've decided that yes, my provider and his willingness to push with me is important, but this time I'm going to make sure that my body is in prime and optimal condition too! Fingers crossed that pushing this time is easier for the both of us!

[wombatclay]

MNHall- good luck! My dd1 was totally asynclitic (and posterior too boot), that ended in a c/s. My dd2 was probably a bit funky in terms of positioning but we made it work. Then ds was lined up and ready to rock! I'm a big fan of doing everything humanly possible to get a babe lined up... it's made a huge difference in my births.

[AlexisT]

Originally Posted by JFTB1177

Do you think so?? Even though I pushed for 6 hours? The MW I used told me she only had one other mom in her entire career who pushed longer than I did (that lady was 8 hours).

I don't think they're likely to okay a 6 hour pushing stage (keep in mind--not all HB MWs would be comfortable with that either) but they might well be okay with you going longer than they would for a woman who has never given birth vaginally. The "proven pelvis" thing affects how they think about your entire labor and birth, whether they'll admit to it or not. They may give more time; they may be more likely to think an intervention will help you give birth vaginally rather than running to repeat CS. Women who have had a vaginal birth tend to go on to have more, and I don't think physiological reasons alone can explain it. If you go in with the attitude that it's going to end in CS, the chances are already massively higher that it will. Positive thinking won't get you all the way there, but it sure doesn't hurt.