Had successful HBAC last time, thinking about hospital VBAC this time - need advice!

[JFTB1177]

I think I may have posted about this a long time ago before I was PG, but now I am 15 weeks PG with #3 and am badly needing some advice!

My first child was a c/s after a failed induction.

I then had a successful HBAC last year. It was a very difficult labor and delivery, not going to lie... almost 40 hours of labor and 6 hours pushing. I was pretty close to transferring (baby was doing great but I was in so much pain and felt my HBAC was just not going to happen). In the end, my DS2 was born perfectly healthy and I had only 2 small tears! It was a great achievement and I am so glad I did it.

But this time I am thinking about a hospital VBAC. The OB I am seeing right now will let me push for 4 hrs and go to 42 weeks. I went to 42 weeks and 4 days with DS2 before my MW stripped my membranes and I went into labor the very next day, so that is the plan this time as well (to strip membranes). The reason I am leaning towards a hospital VBAC this time is because the pain was so great last time, I just can't go through that again without pain medication. I know the risks of epidurals, etc. I know the risks of trying for a hospital VBAC. I've done all the research, taken the Bradley classes, read the books, etc. I just can't go through that again, screaming and crying for hours and hours. I think if I had been able to have a little pain medication I would not have been SO exhausted while pushing and would not have had to push for so long.

I just don't know. I have a good friend who has had several successful VBACs in the hospital I would be going to. But... she also pushes for 20 minutes. Is something wrong with my body? Why is it so hard to get my little ones out (I pushed for 3 hours with DS1 before having the section. I should add my OB did not truly force me to have a section but asked me if I would rather have a section or try forceps, and I chose a section)?? I know this is something I should probably talk to my MW (the one who delivered my DS2) about. I mean, who pushes for 6 hours?? I remember my MW saying (after she delivered DS2) that she had to push him down, up and around my pelvic bone. Is that normal?

Have any of you had a HBAC and then had a hospital VBAC afterwards??

[CherryBomb]

Hmm, kind of. Dd2 was a planned HBAC, but we wound up needing to transfer and she was born by c/s. Dd3 was a hospital vba2c.

FWIW, there's no gurantee you'll be in that kind of pain again. Dd2 was OP and asynclitic and the pain was just absolutely excruciating. And I was in labor for a few days before I stalled out (I want to say it had been about 72 hours when I had the c/s, but I can't remember exactly), so I definitely empathize with you (never got to pushing, I got to 8cm and then my contractions went to 15-20 minutes and closed up to 5cm). It was just utterly horrible. Dd3, otoh, was perfectly positioned and I had a pretty easy and pain free birth (up to transition, then it got pretty intense and painful).

[AustinMom]

I'm HBACing my baby in Sept after a birthing center transfer with my first that lead to CS, he was malpostioned and that is what lead to lack of progress, etc.

I would say HBAC for ME, but that is ME and MY choice, and you should really do what you feel comfortable with, but not make a decision based on 'fear' or past trauma from a previous birth. It sounds like it was really rocky and painful, and something you don't want to relive, so in that, i applaud you not just scheduling a ERC, and actually trusting in your body to birth. I think that is great.

I would say this, baby position does have a lot to do with it, and after a mom has pushed a baby out her pelvis IS then more open to another baby coming through it, so I would suspect you NOT have the issues you had before, especially with optimal fetal positioning.

It sounds like you do want a natural birth, but the pain part is what is keeping you from fully feeling comfortable with that due to *possibly* some doubts as to how your body is going to birth the next baby. I would suggest Hypnobabies either route you go, as it helps you to believe in your body, communicate with you baby to get in the best place, and you can use it for a homebirth or a hospital birth, and it's much much easier to use than the Bradley Method, although, I do like the Bradley method as well, just Hypnobabies I think is more about control and really believing birth CAN be painfree, even after a traumatic birth. It also has a fear cleansing part that allows you to really open up and heal from previous birth/sexual trauma, so that's a perk.

It is your choice and as long as you make an educated choice I think that you will have no regrets.

I also think you're going to have a beautiful amazing birth!

Much Love!

[roadfamily6now]

My 3rd baby (2nd VBAC) was born after 2 hours and 22 minutes of labor. Maybe you will be as lucky??

Good Luck with your decision.

[cairomama]

You might want to look into the Pink Kit. http://www.thepinkkit.com

The Pink Kit has you map your pelvis so that you understand what you are working with. It personalizes the anatomy for you. If there are any tricky issues with your pelvis, knowing in advance can help you manage it during birth.

It also runs you through various positions so you can feel the difference in how open you are in different positions. It also teaches you to relax your soft tissue so you aren't working against your body.

Between the Pink Kit for Anatomy/Body Awareness and Spinning Babies for Optimal Fetal Positioning you will improve your understanding and preparation. As others have said, it may be a lot easier than last time. You won't know until it happens, however, if there are anatomical issues, it is important to recognize them and know what to do. The help for anatomical issues in labor involves maternal positioning and maneuvers.


I would definitely talked to the midwife who was there for your HBAC about what she thinks happened. You can share what you learn about your anatomy from that birth and the Pink Kit and see how she feels about things that can be done to prevent or shorten another birth if it seems to be going the same way.

A few things to consider when choosing between home and hospital:

1. More freedom of position at home.
2. Midwives have more awareness of positioning/maneuvers to try to correct issues.
3. Mother-directed pushing is more likely at home. Even if your pushing phase is long, it won't be as exhausting (to you or your uterus) if you are pushing with your urges.
4. If you are at home, you can transfer to the hospital if you need to, but once you are in the hospital there's nowhere to go. I was just at an incredible homebirth that wouldn't have happened in the hospital. We were really prepared, but the mom and baby needed time. The preparation and understanding of her body were key to our understanding. Baby was also big (15 inch head, over 9lbs) and mom had an anthropoid pelvis (long and narrow) and an alternative scar (inverted t). There were several things that would have happened in the hospital that might have prevented this birth. Though it was long 44 hours, it was not traumatic or terribly painful. She did feel pain, but it was manageable with Hypnobabies and positioning.

I also recommend Hypnobabies. I had a nearly pain-free, but intense Hypnobabies hospital VBAC. It can help keep you focused and relaxed even if you aren't pain free.
Hire a doula, even for a homebirth. It helps to have a person dedicated exclusively to your emotional/physical needs).

I think a better understanding of what happened last time and preparation to address the situation to prevent (if possible) or deal with the issues (like ways to get baby to engage) will help you make your decision and help you no matter where you give birth.

[rainbowmoon]

I have had 6 hour pushing phases with both my kids. I resent the fact that others may think there is something "wrong" with me because of it.

My first labor was horrid (c/s babe) my second MUCH much less painful (VBAC).

[womenswisdom]

Keep in mind too that now you have had one vaginal birth so the next is quite likely (though of course not guaranteed) to be more manageable and shorter. GL w/ the decision!

[shells_n_cheese]

Just go with your gut. If a hospital VBAC feels right, then go with it.

I also had a c/s after failed induction for #1. I had a HBAC with #2, I also had a VERY painful labor and wanted to go to the hopsital for an epidural. The HBAC was pretty traumatic, not only due to the horrific pain, but it ended with shoulder dystocia and a hospital transfer... we thought our baby was dying.

Needless to say, if we do indeed have #3, it will be back at the hospital NO QUESTION. I am actually EXCITED about the thought of going to the hospital, where there are pain medications available, a team ready for full resuscitation, a NICU, and an OR down the hall if there was ever an emergency.

Remember, if you go to the hospital, and you get that epidural, you don't have to answer to ANYONE. It is nobody's business.

Good luck in your decision.

[JFTB1177]

Thank you everyone for all of your advice! I am leaning towards the hospital VBAC about 90% or more... it just feels more right to me this time.

As far as freedom for positioning... when I was in labor with DS2 I tried other positions (like squatting and hands & knees) but they were SO painful that they made everything much worse. In the end, he was born by the traditional "stirrups" position on my bed. That actually seemed to work best for me!

Thank you shells_n_cheese! I'm so glad everything was okay with your baby. My labor was also horrifically painful, so much so that the thought of not having pain meds again makes me tremble. Last time I was screaming and screaming and begging everyone- my 2 doulas, my MW, my DH - for pain meds. It was awful! Do some of us just have more pain during labor? I hear these stories of women saying they felt almost no pain and it just seems to hard to believe... makes me so jealous!

Cherrybomb, I'm hoping that'll be the case and this labor will be less painful!

No matter what I will still be using a doula again this time, my doula was great last time and such a help! And I will be contacting my MW to talk to her about my last birth... I hope I won't hurt her feelings if/when I tell her I don't want another hb (she doesn't have hospital privledges anymore so can't use her ). She was awesome, this has nothing to do with her! I hope she'll understand that.

[JFTB1177]

My doula is really pressuring me to have another hb, and this is causing me so much anxiety. How do I handle this??? As of right now, at this moment, I do not want another hb. That could change but it's just how I feel right now.

[courtenay_e]

You are always safest where you feel most comfortable birthing. If you feel the need for a solid option for pain relief this time around, PLEASE take it, esp if you feel safe and comfortable with your care provider!

That said, I have a couple more comments...

Consider how you would feel with a repeat cesarean if it DOES take 6 hours for your baby to mold enough and come down enough to come through the pelvis.

Or.

Consider how you will feel when you tell your care provider that as long as baby is well and you are well, you will push until you are ready to call cesarean yourself, thank you very much (because although the OB "says" they will only "let" you push for four hours, they MUST have your signature on a consent form or have an emergency ruling from your local judge to simply do a cesarean after four hours...). This would ULTIMATELY be your choice. You can choose cesarean or not, you are the consumer. and you may feel better choosing cesarean, but you may also feel better (KNOWING that you DID get your last baby out after pushing six hours) choosing to push until you give birth vaginally. It may not make your doc happy, but if you want a repeat VBAC it may come to your refusing consent to a section.

As you say, with pain relief, and as a pp said, with your body having been there before, you may very well go faster this time.

That said, I just attended a first time mother who has a concave pubic bone, whose baby rocked under that pubic bone for four and a half hours while her head molded. I don't see her subsequent pregnancies ending much differently, unless they have smaller heads, and this baby was pretty petite. Babies' heads DO mold to fit through our pelvis if we let our babies choose their birth days...sometimes it just takes time...and as long as the baby and Mama are doing well, it is OKAY to take that time.

[JFTB1177]

Originally Posted by courtenay_e

That said, I just attended a first time mother who has a concave pubic bone, whose baby rocked under that pubic bone for four and a half hours while her head molded. I don't see her subsequent pregnancies ending much differently, unless they have smaller heads, and this baby was pretty petite. Babies' heads DO mold to fit through our pelvis if we let our babies choose their birth days...sometimes it just takes time...and as long as the baby and Mama are doing well, it is OKAY to take that time.

Wow- do you think this is what I have (concave pubic bone)??? What exactly is that?

[CookAMH]

Originally Posted by JFTB1177

Wow- do you think this is what I have (concave pubic bone)??? What exactly is that?

I don't think she was suggesting that at all. I would imagine that is extremely rare. I think her point was, even in that difficult situation, birth could still be done, and it needed TIME. And you need to be in an environment where you are given TIME to get the baby out. That's all.

[courtenay_e]

Originally Posted by CookAMH

I don't think she was suggesting that at all. I would imagine that is extremely rare. I think her point was, even in that difficult situation, birth could still be done, and it needed TIME. And you need to be in an environment where you are given TIME to get the baby out. That's all.

Yup, what she said. That your body might require your babies to take some time to mold, and if they are well while molding, why stop allowing that just because somebody is tired of waiting? Birth can be done through your pelvis, you know this, because you had a vaginal birth with your last baby. My thought is that allowing a doc to dictate pushing time length might end up in a repeat cesarean, for no other reason that they are tired of waiting. That would be sad.

[JudiAU]

I don't think there is a right answer and I can't imagine six hours of pushing. You are awesome to have birthed that baby. It also sounds very fresh in your mind.

Two really key points that I think you should consider:

a second vaginal birth is often a very different experience- it may be the same of course but it is often (key word) often a much faster pushing experience

Some people have long pushing experiences because of their body and sometimes they have malpositioned babies. It sounds like your midwife thought the second baby was malpositions. I had really, really good results from seeing a chiro with my second and that really helped my second birth go so much faster and smoother. Have you talked to your midwife about it.

[tangledblue]

Your doula should not be pressuring you into something you don't feel comfortable with. That is the opposite of her role. Find a doula (or talk to your doula to ensure) that is going to be an advocate for you during your hospital birth and give you the time you need in the setting you prefer this time.