what if it doesn't work?

[MAveggiemom]

Hi Mamas,

I had a very traumatic c/s a little over two years ago, and am now 20 weeks pregnant, planning an HBAC. We have hired a wonderful midwife with a great VBAC record, and she also specializes in working with women who've suffered past birth trauma or sexual abuse. I feel much more in control and better informed this time around, and I am confident that I'm doing everything possible to have a healthy pregnancy and surround myself with the right support for a successful home birth.

However... one of my best friends was in exactly this boat, and ended up having a repeat c/s after a 36 hour HBAC attempt recently. I thought I was doing okay processing my birth trauma and preparing for my second birth, but I have completely lost it since her surgery. I cried uncontrollably when I found out she was in the hospital, and have been depressed for her and fearful for myself ever since. She was healthy, did everything right, had a fabulous HB midwife, but it happened anyway. And I couldn't help having a very strong gut reaction that, necessary or not, something terribly violent was happening to my friend. And I am afraid of it happening to me.

So, my question for you is this: How do you mentally prepare for the *possibility* that your birth will end in a c/s, no matter how hard you try, without letting that interfere with your resolve to birth at home? I need to be in a better place mentally and emotionally so that if I do end up having another c/s, it won't destroy me. BUT, I don't want my mental acceptance of the possibility, and my attempt to be prepared for it, to allow the surgery to get its foot in my psychological door. I need to be prepared for the *possibility* without seeing it as an *option*, know what I mean?

I'm seriously considering seeing a counselor who specializes in birth trauma, but I thought I'd see what other mamas in this situation have done, or would recommend. I'm very interested in your experiences in preparing for this, and also those of you who have ultimately had a repeat c/s. Just please no horror stories, I'm a bit fragile right now.

Thank you in advance!!

p.s. AG, if you're reading this, please know I haven't tried to talk about it with you yet because I am waiting for you to initiate the conversation, and I have no expectation that you'll want to talk about it in the immediate future. But I'm all ears if/when you want to talk, and I think we could both benefit greatly by processing and crying over it together. *hugs*

[AustinMom]

I think just about every mom who has had a CS or any type of traumatic birth fears this. I KNOW I did. We are planning an HBAC in Sept, after a planned BC birth turned into a transfer and CS, PPD, no BF, etc.

I spent about 2 hrs with our Doula one day just talking about how sucky our CS was. I knew that if I had to get a CS, I was fine with that, like if the baby was transverse and we couldn't turn her, or if we had placenta abruption etc. I found out, for me not saying this is your case but it sounds like it is, that i was more scared of the trauma of a CS and/or having an unnecessary CS. I trust my body and my baby and my birth team that they know what they are doing, so if baby is in a bad position, they will be able to change it if they can, and with their knowledge, if they can't change it, no one can, so we 'did our best'.

Our Doula told us something, I think every MW/Doula should tell their mom, "I can't promise you a vaginal birth, but I can promise you it won't be traumatic." That's what I needed to hear. We will have choice, baby won't be separated, we will Breastfeed, they will help postpartum, etc.

Yeah, it will majorly suck if we have another CS, but I know if we do have one this time, it won't be like last time.

I hope this helps. PM me if you want to chat!

Much Love!

[momtoafireteam]

I have made a very conscious decision to surrender. You can plan for a home birth, and obviously you can try very hard to do it all correctly, but ultimately it is out of your hands. I have really worked very hard at letting go and coming to terms with both outcomes. My horrific c/s delivery was 27 months ago and this zen feeling of calm is a fairly new development, in fact if you search my old posts you can clearly see the transition I made on this site from my manic posts reeling after my section to my more "surrender" attitude.

Here is what helped me the most: not obsessing. With DD3 I was INSANE about my VBAC. Looking back, it was extremely unhealthy how over focused I was on it. It controlled my life. And it failed anyway. Even now I have moments when I suddenly find myself knee deep in research studies and on page 57 of MDC's search feature of "uterine rupture" when I have to physically FORCE myself to click X, walk away, rub my belly and remind myself to stop. When I got pregnant late 2009, the first thing I said to myself was that I wasnt going to do that again. That I would enjoy my pregnancy and while I would plan for a VBA3C, I would prepare for a happy birth however it came. If my happy birth of a healthy baby comes to me on a surgical table then thats that. If it is a VBA3C, great. So much of it is out of our hands....

I really really hope this post isnt coming off as some kind of holier than thou "look at how cool I am" bragfest. Because like I said, it wasnt that long ago I was in the exact same place you are. I wish I had some magical answer for you, I really do. I totally get the feeling of panic and terror. I too used to start shaking and crying when I thought of having another section. I wish I could give you a big hug...its really going to be OK. xxx

[kltroy]

I really think the key is not so much how the baby ends up coming out - though of course we all hope for a VBAC - but the process leading up to the birth. As moms who have had rotten first births, we have taken the time to educate ourselves and learn how to advocate for ourselves. We research our care providers more carefully. We ask more questions. We are in control. We speak up for ourselves an are not afraid to "fire" our doctor if we do not agree with their philosophy. My point is, that if you end up with a repeat c-section, it will be because you know in your heart that it is the best decision. YOU will make the call, not someone else. And you will feel confident that you, and your birth team, did everything possible to make your VBAC happen. You will feel disappointed of course, but you will have taken a very different path to get to that second c-section than you did to get to the first, and sometimes that makes all the difference. I think the most useful thing you can do when preparing for a VBAC birth -- or in processing the experience no matter what the outcome -- is to ask yourself if you made the best decisions you could at the time, with the information available to you. If you did, and given the same information you'd do it again the same way, you know you've done the absolute best you can. And that helps with the disappointment I think.

[MAveggiemom]

Hi Mamas,

Thanks for your words of encouragement. I do understand about surrendering, and finding peace in the knowledge that I was informed, and tried the best I could, even if it doesn't work out.

I guess what I'm really asking is if there are ways I can prepare myself to not be traumatized by the surgery itself. It was horrific last time, I felt as though I was being raped. I was crying and screaming hysterically, as I was drugged, stripped naked, tied down, and sliced open by a room full of strangers who then ripped my baby out of me through a gaping hole in my middle. And although I now realize it was completely unnecessary, at the time I did think it was the best decision. So, if it ends up truly being the best decision this time around, how can I perceive it less violently? I don't see how I can possibly end up on the operating table again and NOT re-live that experience, even if some details of the circumstances are different.

Ever since getting pregnant again, I started having flashbacks and nightmares about the surgery, and nightmares about being raped (even though I have never been raped in the traditional sense... and please, I do not mean to trivialize any other woman's experience of rape by my use of the word in this context... it's just that my subconscious clearly perceives it that way and I don't know of any better way to describe it). I have lost my sex drive completely, because I can't shake the feeling of being violated. I am at a total loss to find a way to make experiencing it all over again less traumatic.

I want to enjoy this pregnancy and stop feeling like preparing for an HBAC is my full-time job. I want to be as excited about this baby's birth as I was about my son's. And, if I have to have surgery again, I want to come out of it not feeling destroyed, not having nightmares, and not feeling defective for failing twice. Is this possible?

Sorry to sound like such a downer. But I have to work through these things and not hide from them, so there they are.

[AustinMom]

There are a lot of things you can do. First off, hire a Doula. Personally, if I end up with another CS, I would fight as hard as I could to have Doula and dad in the OR with me, and if I had to choose, I'd choose Doula. She can again, help you advocate, walk you through the process gently, and have you visualize the baby being born vaginally, you don't have to have your arms tied down, the OR Drs, don't have to talk about random things above you, the lights can be low, you can have your own type of music (maybe something with water/waves?) You can have the curtain lowered when baby is emerging, and baby brought to your chest directly after (in the absence of crazy medical conditions), if baby does need to be examined, you should be able to have your bed turned to watch baby be examined or have baby examined while you hold him/her, you can delay cord cutting for at least a minute, you can delay the Hep B, eye drops, weight, measurements, etc till a few hrs after so you and baby can be together, you can nurse while they sew you back up, as your Doula walks you through what they are doing (like the fundal massage), baby can wheel back with you (on your chest, not in side baby basket thingy) from the OR to the recovery room, and you CAN have an empowering Cesarean. They are rare, and they do take a lot of fighting for, and there is only one Dr. locally who will try to go this route.

Look up some info on 'natural cesarean'. I don't like the term, as I feel a cesarean can never be natural, but it CAN be gentle, and SHOULD be gentle.

Here is some info:
http://www.birthcut.com/thepositivec...vs.%20Epidural

Here is a study on the topic as well you can take with you to the back up OB or who ever you plan on having do the CS.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

Hope this helps!

[MAveggiemom]

Thank you, AustinMom! The scenario you describe would be infinitely superior to my last experience, but I don't think it's at all possible to pursue it and an HBAC at the same time. Unless I spend the rest of my pregnancy searching for an OB who will do it this way, I'll get stuck with whatever resident is on call at the hospital when I transfer. I'd have to arrive at the hospital, where they will already see me as a problem, and fight like crazy over it. When, presumably, I will already be completely exhausted from a long HBAC attempt.

My midwife is amazing and will accompany us to the hospital and stay the entire time if we have to transfer, so she could fill the role you describe for a doula. But I already know none of the hospitals around here will allow two support persons in the OR, and I don't think I could possibly ask my husband not to be present at the birth of our child. So I'd be stuck by myself during the second half of surgery. My friend who just transferred went to my preferred transfer hospital, because it is the best option around, and they wouldn't even let her husband remove the baby from the nursery. Both the mom and the baby were perfectly fine, but they refused to bring the baby to the mom until the recovery nurse called from a different wing to give approval... and she was too busy to call for quite some time. Her husband had to leave the baby alone in the nursery to track down the recovery nurse and make her call. It's inexcusable, but they get away with it several times a day, so what can you do????

I really appreciate your encouragement and the knowledge that it can be better. But I don't think it's realistic unless I plan to have a scheduled c-section with a doctor of my choosing. There is no way I can fight hospital policy upon arrival, is there?

I'm sorry I sound so cynical and argumentative. I just wish I could identify some concrete steps to take to make a potential c/s less traumatic for me, and a more natural transition to the world for my baby. But achieving that level of control over the surgery will require a lot of advanced planning and work, which is mutually exclusive to preparing for an HBAC. :-(

Btw, I CAN'T have a backup OB, which is why this is so difficult. The legal situation in Massachusetts is complicated, and basically you can only have an OB if you use a CNM, and CNMs can only attend in hospitals. So if you hire a CPM to attend your home birth, you can't have a backup. Unless you see a doctor and lie about your plans, but I think having to see a doctor for all those prenatal visits would be exhausting and weaken my resolve to HBAC. So I'm really stuck with whoever's on call when I transfer if it comes to that.

[jess152]

I probably felt the way you did now at that same stage in my pregnancy. I remember feeling so much doubt that it would ever unfold the way I wanted it to. I kept thinking about emergency transfers and could picture it in my mind happening that way.

Later in the pregnancy, my confidence overtook all of the self-doubt. I didn't pack a hospital bag. Part of me was superstitious, that if I had it I'd need it. I also rationed that if I was in need of an emergent transfer, my own pjs and slippers would be inconsequential! I also did not write a birth plan. My m/w knew my wishes...for a homebirth. If I wasn't getting it, chances were good it would be a c/s, because I was going to hang in like a stubborn bulldog and birth this baby at home, unless something like a rupture occurred. I had read so many birthstories, VBAC and otherwise, that bolstered my confidence. One stat that comforted me was the very low rate of c/s that is included in the transfer rate for homebirths. (My memory is patchy, but I think the national rate for homebirth transfer is around 12% with a subsequent 3% of those needing c/s. Your midwife will have her own numbers as well.) It's a very low number.

I was also selective in who I told about our HB plans. I didn't want to have to defend my choice to all the people who hadn't read the studies & books. That helped. After baby came along, I told anyone who would listen!

I felt that in the earlier part of my pregnancy, my doubt just led to negative thoughts and I worried that they would be self-fulfilling in a way. I got over that hump and in the end didn't really think too much about it not happening the way I pictured.

[lotus.blossom]

I understand where you are coming from and I am on the other side of things with a second c/s under my belt. But I am in a much better place than I was after my first c/s birth.

My homebirth transfer was a bummer, don't get me wrong. But I thoroughly enjoyed having an unmanaged blissful pregnancy. An unhindered and amazing labor. I dilated to 10 fast (unlike my first) got to experience pushing (5 hours) and while I wish I could have had my baby at home where I planned, I know that there was no way in hell he was coming out of me that way. Things were just not adding up. My c/s was uneventful. I didn't have a plan or a bag packed, or even an OB (it was a sunday at lunchtime) but the overwhelming joy of finally meeting my baby sort of trumped the way he came out.

So in retrospect, I would have had a bag packed and a short and to the point c/s birth plan written out. Its not going to derail your homebirth to be prepared. I bought into that whole mentality. Thats just being naive.

While I feel like I was robbed of the bragging rights of a homebirthed baby, I certainly will never forget the power of being in charge of my pregnancy and labor. And knowing 100% that my c/s was for good reason and not for interventions or a Doc who couldn't wait.

[keeptryst]

I think the main thing is to bring back the attention constantly back to the present whenever it gets stuck in fears of the past or worries of the future. I find daily meditation helps me a lot with this.

The other thing could be to make peace with the worst case scenario and then let it go. Chk out this fantastic video posted by midwife Gloria Lemay on how a c-sec can be made more mother-baby friendly:
http://www.glorialemay.com/blog/?p=310

[shenanegans]

I am less than 2 weeks from my due date and HBAC and only just started to have doubts because my backup family Dr. moved and was replaced by a much less supportive fear mongering guy. yuck. Even though I kept my cool and explained rationally my reasons for choosing a homebirth it was hard not to get stressed and affected by his negativity. He wants me to come next week and sign a form clearing the hospital of responsability if something goes wrong, but I don't need another opportunity for him to scare me. I am sensitive to these things!! Anyway, I think the main thing is trusting my midwifes and knowing that if we do transfer it is for a very good reason, not because of hospital protocol or because things were just too slow. I didn't trust my Dr last time and really think that interfered with my ability to labor there. I was in Japan so communication was limited but they were supportive of my birth plan until my water broke, when suddenly the first suggestion was a c-section. I was shocked and terrified that this would be their first option. Knowing now that my midwifes are on no schedule and have all the patience in the world makes me feel much more relaxed. They have had very few hospital transfers as well and a great success rate with their vbac patients. I will be looking for some more birth (vbac) affirmations to repeat regularly from now until the birth. I am trying not to get too hung up on the birth and just know that I have honestly done my best. good luck.

[AustinMom]

Originally Posted by MAveggiemom

Thank you, AustinMom! The scenario you describe would be infinitely superior to my last experience, but I don't think it's at all possible to pursue it and an HBAC at the same time. Unless I spend the rest of my pregnancy searching for an OB who will do it this way, I'll get stuck with whatever resident is on call at the hospital when I transfer. I'd have to arrive at the hospital, where they will already see me as a problem, and fight like crazy over it. When, presumably, I will already be completely exhausted from a long HBAC attempt.

My midwife is amazing and will accompany us to the hospital and stay the entire time if we have to transfer, so she could fill the role you describe for a doula. But I already know none of the hospitals around here will allow two support persons in the OR, and I don't think I could possibly ask my husband not to be present at the birth of our child. So I'd be stuck by myself during the second half of surgery. My friend who just transferred went to my preferred transfer hospital, because it is the best option around, and they wouldn't even let her husband remove the baby from the nursery. Both the mom and the baby were perfectly fine, but they refused to bring the baby to the mom until the recovery nurse called from a different wing to give approval... and she was too busy to call for quite some time. Her husband had to leave the baby alone in the nursery to track down the recovery nurse and make her call. It's inexcusable, but they get away with it several times a day, so what can you do????

I really appreciate your encouragement and the knowledge that it can be better. But I don't think it's realistic unless I plan to have a scheduled c-section with a doctor of my choosing. There is no way I can fight hospital policy upon arrival, is there?

I'm sorry I sound so cynical and argumentative. I just wish I could identify some concrete steps to take to make a potential c/s less traumatic for me, and a more natural transition to the world for my baby. But achieving that level of control over the surgery will require a lot of advanced planning and work, which is mutually exclusive to preparing for an HBAC. :-(

Btw, I CAN'T have a backup OB, which is why this is so difficult. The legal situation in Massachusetts is complicated, and basically you can only have an OB if you use a CNM, and CNMs can only attend in hospitals. So if you hire a CPM to attend your home birth, you can't have a backup. Unless you see a doctor and lie about your plans, but I think having to see a doctor for all those prenatal visits would be exhausting and weaken my resolve to HBAC. So I'm really stuck with whoever's on call when I transfer if it comes to that.

I know what you mean about not being able to have a back up OB. Pretty much the only one here who 'allows' VBAC won't take any HBAC transfers because she has already stuck her neck out politically by allowing MWs to 'deliver' in the hospital under her practice. So I'm also stuck with which ever OB is on call at the hospital when I go. That's what we got last time when we transferred from the birthing center and it wasn't that bad compared to other stories, but I'll be D*&^ed if they take my baby for any amount of time in the absence of health issues. I say that, and I know what you say about, I'm not going to want to fight, especially after a long HBAC attempt, that's how I was, but we just got lucky getting an OB who 'let' us take baby back to room with us with no 'required' nursery stay.

I'm glad to commented back, because next week, I'm going to go meet with the chief of surgery/obstetrics/nursing, whoever it needs to be to get a 'birth plan' approved, and let them know what they can and can't do, so I don't fight if I do transfer, and there's no 'well, let me check and see if that's ok' and then disappear for 2 hrs kind of thing.

I'd love to hear what you have plans to do, and I'll definitely keep you updated on how things go for me if you want me to.

[lovestolearn]

I'm sorry I sound so cynical and argumentative. I just wish I could identify some concrete steps to take to make a potential c/s less traumatic for me, and a more natural transition to the world for my baby.

(((HUGS))) Not a VBAC mom, (I'm an EFT Practitioner, specializing in Birth Trauma and teaching EFT to birth professionals) and I would suggest EFT to help you resolve the PTSD from your CS. Healing this trauma will go a long way in helping you prepare for an HBAC and be at peace in the event that you do require a CS. EFT works relatively quickly and is great for birth preparation. PM me if you would like more information.

[BarnMomma]

Do your research and then...let it go. Stop thinking about it, stop reading about it, and tune people out who want to talk about risks or failure. our VBAC class was one on one- I told the teacher outright that I did not want to discuss anything negative or anything involving risks. That I had done my research months ago and now I just needed to remain in a good healthy place filled only with positive thoughts and images. even on our hospital tour I sort of tunred my attention away when they showed us the NICU, the OR, and anything that didn't have positive tones to it.

Focus on the positive and imagine your birth as a peaceful , calm, beautiful event. Look forward to it. Even the pain. Embrace every cramp or BH you have as practice and enjoy it.



Hypnobirthing(just a book that read and read and reread) really helped me let go and relax and BELIVE ME I'm a type A Capricorn OCD nutcase so if I can do it, you can do it.

And then also realize that you can only control so much. (as I mentioned before- I hate this concept lol)

Just let go. Let it go.

We just had our VBAC on 7/2


wow- sorry for typos- nursing and typing one handed

[lyterae]

I can fully relate to this post, as the previous poster suggested I am doing hypnobirthing. I'm finding that relaxing this pregnancy and not stressing is going to my biggest struggle. I'm trying to relax and enjoy it and planning on my beautiful VBAC.

[AustinMom]

Oh yeah, I forgot to mention, I'm doing Hynobabies, it's similar to hypnobirthing, only it's true 'medical' hypnosis (not the crazy, someone makes you dance like a chicken kind of hypnosis, I don't know if that really exists) and I can totally see how it works.

It talks about creating your "bubble of peace" that basically helps you only let the positve stuff in and blocks the negative out. It also have a lot of pregnancy and birth affirmations that birth is normal, healthy and positive. It pretty much just reprograms the mind from the warped mindset society has that birth is a horrible, painful, disasterous event.

[JTA Mom]

Originally Posted by MAveggiemom

I'm seriously considering seeing a counselor who specializes in birth trauma, but I thought I'd see what other mamas in this situation have done, or would recommend. I'm very interested in your experiences in preparing for this, and also those of you who have ultimately had a repeat c/s. Just please no horror stories, I'm a bit fragile right now.

Thank you in advance!!

Getting into therapy with a birth trauma specialist was the best thing I ever did. If you look at my siggy, I have a LOT of trauma around pregnancy and birth.

At this point, thanks to her help, I really do not fear having another c/s. Yes, I will do everything I can to VBAC, but if it's another c/s, then so be it. She really, really helped me work through the trauma. So, if there is any way to get in touch with one, please do so!

Also, I am going to dedicate half of my birthplan to c/s. By law, hospitals HAVE to follow it or ask you directly before doing anything you tell them not to do. For example, I stated no nipples for ds. When they wanted to give him something to eat (he was in the NICU) they legally had to call me and ask. Same with vaginal checks, etc. Followed them and if they needed to do something, they had to ask rather than just do it. This gave me a much better feeling of control. And control makes me feel better. This time, if I need a c/s I know what to expect, I know what I am within my rights to request, and what I can't.


Ami

[MAveggiemom]

Thanks again, mamas!

Lovestolearn, I have never heard of EFT, but will check out that link. Thank you!

AustinMom, you have been super helpful and I'm especially glad you mentioned HypnoBabies. I read the Hypnobirthing book during my last pregnancy, but couldn't even begin to take it seriously. I'm exploring HypnoBabies now, because if it appeals more to me, I think it could be a useful tool both for preparing for a VBAC and also to prevent being traumatized if I do end up in the OR again.

I've also realized in the past few weeks that part of my trauma is due to an inadequate epidural. I thought that it was normal to feel the surgery to the extent that I did, but I have since talked to many moms who've had c-sections and they were all horrified at how much I felt. Since I have a history of medical anxiety, being able to vividly recall every detail of the surgery itself is extremely traumatic for me. I have nightmares and flashbacks, and even though the knowledge that my experience was atypical doesn't change it, it is somehow cathartic to realize that I was not unduly traumatized by something others experience as normal. I think most women would be traumatized if they had to consciously experience the physical sensations that I did. For the record, it wasn't *painful*, but I could clearly feel everything, including my baby being yanked out rather violently. At least if I have another c/s, I will be sure to speak to the anesthesiologist about ensuring an adequate epidural!!!

Anyway, I just wanted to say thanks again to everyone for your suggestions and support. And AustinMom, I'm particularly interested in keeping in touch with you to share our ideas and experiences for preparing for our births!

[AustinMom]

I emailed you! I really want to stay in touch too! Hope to hear from you soon!

[mamaspirit]

First of all *hugs* to you mama! I too had a horrific, tramatic first c-section! Remember that if you do end up with another c-section, you still have choices! You can have that gentle birth you hope for.

With my third baby (my first attempted vbac) I had also planned a hbac with a great midwife. My labor was wonderful, but babe turned sideways during labor and I had to transfer. I was terrified. Fortunantly I had an excellent doula who raced to the hospital before me and set things in motion. I refused to let them wheel me in to the OR... I walked. I told them that they had to clear the music they played with me, and to not say anything out loud that they were not willing to repeat to me in a way i could understand. I refused to let them tie down my arms, I asked for minimal narcotics in the spinal, so that I wasn't so wonky when my baby was born. My hubby got to announce the sex, we refused eye ointment etc, and baby was immediately put by my face so I could touch her and kiss her while they were closing me up. they put her on me as they wheeled me to recovery and I was nursing her within 20 minutes of her being born. No one touched her while we were in the hospital without asking me first. She never once left my site. They did not even give her a bath. Despite me having to have another c-section, it was a beautiful birth and my recovery was much easier because of it.

My fourth baby (second vbac attempt) I also planned a homebirth, but ended up transfering because of a gut feeling something was wrong. When they cut me open I had a horrific infection, so bad you could smell it. So I'm glad we did it. It wasn't quite as easy as my second c-section, due to being so sick, but I still had choices and it still wasn't nearly as tramatic as my first c-section.

I wish for you a beautiful homebirth, but remember that you can still have a beautiful, gentle experience even if it doesn't happen the way you want.