rate of success

[mizznicole]

I had a not-so-stellar check up the other day. I'm in a birth center with 5 midwives. You meet with all of them over the course of your pregnancy. The first appt I had a "temp" midwife and liked her a lot - but will never see her again.

This second time I had a midwife that I just did not click with. I brought my toddler with me, somewhat on purpose, because I believed MW practices were supposed to be family friendly. Maybe she was having a bad day, but all my son's actions seemed to distract and bother her. Even just walking from one place to another. It was like she'd never dealt with a mom with a 2 year old before.

Anyhow, the visit was 80% signing "I promise not to sue you" forms. During that process, she told me that moms with CPD have a 50% success rate. She said that because I was OP, I would have between 50%-80% chance. Those numbers keep going around in my head and I feel very down. The owner of the practice made me feel like my chance was 95%.

I don't want people to sugar coat things for me, but I don't want them to be unnecessarily negative either. I would have thought from the ICAN materials that CPD had a much higher success. What's the story here? And how do I process this information?

Honestly, I am TERRIFIED of another c/s. I am terrified of just getting some random OB at the hospital and what he'll do to me. On top of that we don't have maternity coverage and we'll be absolutely sunk if we have to pay for the c/s on top of the mw bill. AAAAAAAAAAAA. Help!

[thorn]

CPD is almost always situational. Your baby was OP. Will this baby be OP? hopefully not if you can help it!

our ICAN chapter has awesome stats, for ANY reason prior c/s. we have had several people with "cpd" vbac babies that were a pound or more bigger than their c/s baby.

it's impossible to study success rates in vbac, because you can't control for things like confidence and supportive care providers. so even though some studies might say that c/s for cpd have lower vbac success rates, there is no way to know if that was because the entire pregnancy their care providers were saying "gosh, this baby is looking big - you couldn't push out your last big baby. maybe we should [induce, go right to c/s]"

[kltroy]

It's true that moms whose first c/s was for CPD have a lower VBAC success rate. But remember, the odds are heavily influenced by you, your care provider and support team, and of course a bit of luck. There's a nice calculator here that can help you see how the odds change when you vary different factors. The MW was probably just trying to be realistic and quoting the statistics that are available in the literature, rather than *her practice's* own VBAC success rates.

Basic calculator:
http://www.bsc.gwu.edu/mfmu/vagbirth.html

Calculator that has additional data that would be available upon admission into the hospital:
http://www.bsc.gwu.edu/mfmu/vagbrth2.html

Also remember that odds do NOT tell you how things will turn out for YOU. Don't be discouraged!! Remember that even if the general odds for someone in your situation were only 50%, that still means that half the women who give VBAC a shot get one *despite* having care providers that may or may not be supportive, health problems, etc etc. And that's pretty good.

[kitkat5505]

That's better than the odds my OB gave me for my vbac. She said because of the reason for my c/s "cpd and suspected macrosomia" I had less than 20% chance of success. Luckily she was still very supportive of it and I did have a perfectly fine vbac despite those odds. I think all OB/MWs will have different odds based on their experience and the info they have (or haven't) researched, maybe the odds she gave you were just what she has seen personally for those kind of cases. I think most "cpd" cases are just mislabelled and usually really just malpositioned baby (my first was asynclitic) and that it has no bearing on how the next one will be able to come out.

[AustinMom]

Maybe in TRUE cases of CPD this is accurate. But, again, you have to factor in things like OP, and acynclitism (which is more frequent cause for CS, and less frequently diagnosed), positions for laboring/pushing, emotional trauma/sexual abuse, etc. CPD is actually extrememly rare, and that's usually in moms with rickets, dwafism, etc.

I would mention to you that if you have a fear of having another CS, I would deal with that before labor and birth. That of course will inhibit your birthing and cause more 'failure to progress' and make a not-so-supportive care provider lean more towards a CPD diagnosis. Hire a Doula, of course, especially if you are in a birthing center, and especially if you have a care set up where midwives are on rounds and you get who get, and especially if you are a VBAC. They help prenatally work through all that mess and help you loose all fears of birthing no matter how your birth turns out. Don't get me wrong, don't expect another CS, and don't be okay if you get one, obviously do everything in your power to NOT have one, and part of that is healing emotionally from your previous birth. I can't stress how important that is for a healthy pregnancy, birth, and motherhood.

[thorn]

Originally Posted by kltroy

It's true that moms whose first c/s was for CPD have a lower VBAC success rate. But remember, the odds are heavily influenced by you, your care provider and support team, and of course a bit of luck. There's a nice calculator here that can help you see how the odds change when you vary different factors. The MW was probably just trying to be realistic and quoting the statistics that are available in the literature, rather than *her practice's* own VBAC success rates.

Basic calculator:
http://www.bsc.gwu.edu/mfmu/vagbirth.html

Calculator that has additional data that would be available upon admission into the hospital:
http://www.bsc.gwu.edu/mfmu/vagbrth2.html

Also remember that odds do NOT tell you how things will turn out for YOU. Don't be discouraged!! Remember that even if the general odds for someone in your situation were only 50%, that still means that half the women who give VBAC a shot get one *despite* having care providers that may or may not be supportive, health problems, etc etc. And that's pretty good.

I don't think that those calculators are great, for the same reasons I mentioned above. I realize that they are based on data of attempted vbacs, but it is impossible to control for things like a truly supportive care provider, motivation to vbac, etc.

Like your chance of vbac falls greatly if you are obese - is that because fat women can't give birth, or because providers think they can't? they might be saying "well, you will have a lower chance of vbac because you are so overweight" and then the mom starts to believe that.

It can be hard for people to keep in mind "that still means that half the women who give VBAC a shot get one *despite* having care providers that may or may not be supportive, health problems, etc etc." - all they may see is "this calculator says I only have a 20% chance!" and be discouraged by that.

I know one thing for sure. You have a 0% chance if you don't try!!

[mamalade]

Originally Posted by thorn

I don't think that those calculators are great, for the same reasons I mentioned above. I realize that they are based on data of attempted vbacs, but it is impossible to control for things like a truly supportive care provider, motivation to vbac, etc.

Like your chance of vbac falls greatly if you are obese - is that because fat women can't give birth, or because providers think they can't? they might be saying "well, you will have a lower chance of vbac because you are so overweight" and then the mom starts to believe that.

It can be hard for people to keep in mind "that still means that half the women who give VBAC a shot get one *despite* having care providers that may or may not be supportive, health problems, etc etc." - all they may see is "this calculator says I only have a 20% chance!" and be discouraged by that.

I know one thing for sure. You have a 0% chance if you don't try!!

I totally agree. I am 34 and overweight, I changed the weight in the calculator and got much different odds. Now, I know being a healthy weight is important for lots of reasons, but I seriously doubt that it makes such a huge difference and will determine my success or not.
Many doctors are fat-phobic. That is a fact. Add that to their mistrust and ignorance of the female body and you get a higher c-sec rate for overweight women. That is why I will be birthing at home next time with a skilled midwife and a doula.

[eastkygal]

The NIH conference papers say that VBACs are successful 74-80% of the time. I think about the same stats are quoted in Pushed by Jennifer Block. As others have mentioned, supportive caregivers and a doula can be the change all to an otherwise surgery situation. We don't really know what factors cause VBAC to be unsuccessful. In my situation it was an OP baby with cocked head and 11 pounds with cord wrapped. I had the supportive caregivers. I also recommend chiropractic during pregnancy to help with your back and the baby's positioning.