what is the freakin' deal - or what would ina may say

[mizznicole]

I'm on my VBAC journey and trying to wade through a lot of information. I'm in the group of moms who dilated to 10 and pushed for 2 hours only to have a c-section at the end. So we made it practically to the finish line, but apparently all kinds of people claim we're the least successful group for VBAC.

Well what the heck. If the real rate of c-section should be under 10%, does this mean that poor positioning would be responsible for all necessary c-sections? Why wouldn't a mom with a better positioned baby be able to push one out even given previous c-section?

I am so frustrated.

[trimestersdoula]

Lieing on your back to birth a baby is one of the worst ways to do it (most of the time). If you give birth in a hospital this is probably the way you were pushing. When lieing like this you fight gravity the whole time. The baby has to try and be pushed up a hill. So yes, positioning does make a huge difference.
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[lyterae]

I'm in this group as well, baby never descended past +1 station due to ROT positioning (despite 2+hours of pushing)

I've been getting regular chiropractic adjustments for the past two years to make sure that my pelvis is aligned as best as it can be and I'll be doing all I can to ensure a good position for baby as well as finding a careprovider who is good at positioning.

Good luck! The journey is crazy...

[AustinMom]

I wouldn't dare compare myself to Ina May as she's a celebrity in my world , but I think that she would pretty much say fetal positioning is what it is all about. The midwives and Doulas in my area that have the lowest CS rate are the ones that focus most of fetal positioning in pregnancy and birth. Yes, sadly, obstetricly and anyone in the more medical model of care doesn't focus on this, so it's usually missed and does cause tons of issues in tons of women. This was our problem. It's more than just "oh, he's head down, it's fine," there is so much more to it, and so much more can be done and so much is done to inhibit good fetal positioning and rotation in most birthing situations.

Much Love to you! I wouldn't worry about being put in any group of least/most successful. It's all about where you are at, and what you know, and how to avoid some of the stupid stuff that goes on.

[alegna]

If I'd been in a hospital with a 2hr pushing limit both of mine would have been sections. By my count (when *I* started pushing) I pushed for 6hours with dd and 9 with ds.

-Angela

[trimestersdoula]

Just wanted to come back and say that I totally read the OPks post wrong. Please disregard my pregnancy brained rambling
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[trimestersdoula]

Double post
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[MsBlack]

I don't know what Ina May would say--but I know what I say

I have to guess that the reason your particular issue repeats itself so often for vbacs is because the *conditions of birthing* are being repeated. Everyone is right (on this thread) in a way--position is everything. NOT just baby's position, but mom's positioning, and movement too, throughout labor and pushing. If you dilate to 10 and can't push the baby out--well *maybe* there is a true pelvic issue, at least when your baby's head approaches from a malpositioned (posterior or transverse) attitude.

OR, maybe mom does not have the opportunity to move about during labor as is natural for laboring women, and is told what to do rather than choosing her own positions, and timing, and breathing, for pushing her baby out.

Most babies by far are born in hospitals, with restrictive policies and procedures where movement and positioning are concerned during labor and pushing. Most vbacs also occur in the hospital, with *even more* restrictive policies and procedures in place for so-called 'safety' of mother/baby. So it doesn't surprise me all that much that this issue (dilating fully, not being able to push baby out) repeats itself in vbac so strongly in the stats.

I'm not saying that NO mother has true cephalo-pelvic disproportion. I'm not saying that this issue never happens at homebirth. But I *am* saying that the statistics generated are taken from hospital birth--and in hospitals, there is far too much policy and procedure in place that does restrict the movements and positions which can best support successful birth.

Birth is a dance--a dance of mother and baby--and like any form of dance it involves complimentary movement amongst the partners. When that dance is unhindered, allowed to flow in accordance with mothers' own instincts on movement and positioning, her own instincts on when and how to push, there is a much smaller likelihood of baby getting stuck.

So, if you had a csec for dilating fully but then not being able to move the baby down, do things differently next time! Whether you choose a homebirth (HBAC), or to choose a more open-minded doc and hospital then labor at home with good doula support before going into the hospital for birthing, let yourself dance with your baby. Let the dance move you, knowing that same dance is also moving your baby...the baby is not an inert rock, a passive passenger! Babies also move and position themselves, they are active in that birth dance when they, too, are unhindered. When moms and babies can do their dance together, with support but no interference, most often birth unfolds just as it should.

[womenswisdom]

I was induced with AROM (for no medical reason). I pushed for four hours (c/s called after 3 hours, but not done for another hour) with my first. He was posterior. I know for sure because he has a scar across his nose from the scalpel blade used during the c/s.

I did not have my water broken by my care provider the second time, and my dd rotated through posterior just fine and I pushed her out in 1.5 hours. There are so many variables that can contribute to poor positioning that are standard practice in the hospital and so many ways to resolve it that hospitals do not use. I didn't even know that manual rotation of the baby's head was possible until I discussed it as a possibilty with my 2nd mw. All that to say every birth is different and encourage you to educate yourself about what happened in your first birth and try to make different choices for a different outcome next time.

[kltroy]

Well here's the reason this group is given lower odds of success: It also includes the entire subset of women with true, real CPD (figure, around 2% of the population). So if, say, 10% of all c/s occur in women who were fully dilated and just couldn't push the baby out, and 2% of those had *actual* CPD, this means that 20% of women who were fully dilated and couldn't push the baby out have actual CPD. In other words, they'll not have a successful VBAC for a real reason. For the other 80% it was probably just poor positioning, and they should have no problem the next time around.

However, compare this to another group (say, c-section for breech presentation). THIS group probably just has the usual 2% rate of CPD, which means that 98% of them would be expected to have a successful VBAC.

So right off the bat, there's an 18% difference in *possible* VBAC success rate between these two groups. (And then there's all of the other factors such as care providers, luck, etc that go into what the ACTUAL success rate is).
Does this make sense?

ETA: I don't know what the true rate of CPD is, so insert whatever the actual number is into your calculation. I'm using 2% just to illustrate the point.

[MsBlack]

Thanks for clarifying about 'rate of CPD' being a guess. I don't have the numbers at my fingertips--but true CPD occurs somewhat less than 2 per every 100 women! I'm thinking, less than 1% (less than 1 per 100 women), but if someone knows this stat, please do post it ...I haven't looked into this statistically in some time.

[Galatea]

I have to agree with the positioning issue - every one of my births, my body demanded a certain position, and it was different for each. The most profound one was dd's birth - I could only be kneeling on the floor, with my upper body leaning on the couch. I stayed that way the whole labor (3 hours) and never wanted to move. And then at the last minute, I clearly felt her whole body swing around inside me, and then she was born 3 pushes later. She just had to be in that one right position and my position made it happen and it was really amazing to feel it happen.

[EmTheWife]

The baby's position can make all the difference. Have you heard of Spinning Babies? It's a website devoted to the theory of optimal fetal postitioning for birth.
CPD: "According to the American College of Nurse Midwives(ACNM), CPD occurs in 1 out of 250 pregnancies." <http://www.americanpregnancy.org/labornbirth/cephalopelvicdisproportion.html>

[justKate]

Originally Posted by Galatea

I have to agree with the positioning issue - every one of my births, my body demanded a certain position, and it was different for each. The most profound one was dd's birth - I could only be kneeling on the floor, with my upper body leaning on the couch. I stayed that way the whole labor (3 hours) and never wanted to move. And then at the last minute, I clearly felt her whole body swing around inside me, and then she was born 3 pushes later. She just had to be in that one right position and my position made it happen and it was really amazing to feel it happen.

OT, but that came through really powerfully to me. Thanks for sharing.

[LiLStar]

I'm having trouble with the idea that 2% of the population have true CPD..that is, a real problem that is completely incompatible with vaginal birth. Is that REALLY the number? Or, would those women not be screened out prior to labor? (I'm thinking extreme cases.. severe pelvic injuries, congenital deformities, rickets, that kinda thing) Barring extreme circumstances.. I'm not sure I believe in TRUE CPD where no full term baby of any size will fit, regardless of baby's and mom's position. At least not 2%. No way. Lest I'm misunderstood.. this is not to say that I think anyone who ever had a cesarean for CPD just didn't do it right, try the right positions, wasn't patient enough or whatever.. I believe in "this baby, this time" didn't fit.. but an absolute "no baby will ever fit no matter what"..nope. Don't buy it.

I was one of those who dilated to 10 and purple pushed in like 900 positions for half a day or so before even considering going to the hospital. Malpositions SUCK. I credit regular chiropractic care for my 10lb HBAC! I kinda wonder if my pelvis shape is unique. Conventional wisdom is that LOA is best, and ROA is acceptable but, the baby will have to make a longer trip and turn OP for a bit before making it around to OA. I think my babies rotate the opposite direction. My LOA baby turned OP right away. My ROA baby never once considered being OP in labor, but turned OA right away.

[kltroy]

Originally Posted by LiLStar

I'm having trouble with the idea that 2% of the population have true CPD..that is, a real problem that is completely incompatible with vaginal birth. Is that REALLY the number?

No it's probably not - see my note at the bottom of my orig. post - I was using 2% to illustrate a point about why this particular group (dilate to 10, can't push baby out) would be expected to have a lower VBAC success rate. You can insert whatever the true percentage is and the point is still the same - that the group also happens to include the entire "true CPD" sub-set of women. That's all I was saying.