Broken Cervix...is considering a VBA2C worth it?

[JTA Mom]

My first baby was born at 16 weeks gestation, vaginally. He was born alive, I went through labor (3.5hrs total), no reason given.

My second son, I was induced at 37 weeks for pre-e. Put on magnesium sulfate, took forever to dilate to 7 cm, regressed to 6cms, then was c/s at 22hrs of labor.

This baby I was in labor for 50hrs. One 24hr chunk (sunday) was 10-12min apart contrax. The second 24hrs (monday) was 3-5 min apart contrax. NEVER progressed passed 4cm. NEVER. Had a c/s tuesday morning, after having been on super light pitocin (due to contraxs taking a long time and water being broken for a while). Ds did not tolerate the later contractions well at all. The closer they came, the more he deceled, and then started crashing in between contractions. "Officially" I was termed failure to progress, with a minor not of fetal intolerance of labor.

So, why won't I dilate? Is it worth it to go through another trial of labor? Are my chances at this point so close to zero that it makes no sense to do it?

Also, why in the WORLD won't I dilate????

My uterus obviously works. My ability to carry to term works. My breasts work. But not my cervix. WHY???

Ami

[WifeofAnt]

Have you been checked for cervical scarring?

[JTA Mom]

No. I haven't had any gynecological stuff done, other than a d&C after ds1 was born because my placenta wouldn't detach (common in 2nd trimester miscarriages). Would that cause this?

Also why would I dilate less this time than I did before?

Ami

[laurata]

Originally Posted by JTA Mom

Also why would I dilate less this time than I did before?

Stress? Dehydration? Poor fetal positioning (ie, not applying adequate pressure)?

[WifeofAnt]

This is the first I heard about it: http://www.birthresourcenetwork.org/...talking-about/
From what I've read the D&C can cause scarring, its even listed as a possible complication of the procedure here: http://www.americanpregnancy.org/pre...ons/dandc.html


If you have the scar tissue it can keep the cervix from dilating but there are ways (like massaging the cervix) that can break it up.

[ariatrance]

Without getting into the cervical issues (because I know nothing!), in my opinion it is worth it to go into labor even if you choose to have a cesarean and not a vaginal birth. Why? Because there are valuable, valuable hormones that are released into your body when labor starts. These hormones can set you up for successful breastfeeding, successful post-partum health and lessen the chances of post-partum depression.

I debated all this myself when considering my vbac. I absolutely knew that if, for whatever reason, I needed another cesarean, I wanted to go into labor to get off to a good hormonal start. I missed out on that with my first (no labor, pre-term cesarean) and I truly believe it effected everything (and still does) about my health and my relationship with my son.

[bella99]

Sorry to forum crash, I've never had a c-section, so obviously, no VBAC either, but I agree with the PP.

But my SIL chose a primary elective section and then another elective section for her second (she's a physician married to a surgeon so she's obviously informed of the risks0.

Anyway, although she was having "scheduled" sections both times, she chose to wait until she went into labor both times and then have the surgery. The first at 38.5 weeks and the second at 39 weeks.

[AlexisT]

Well, first, I wouldn't put too much stock in your first labor. You were induced at 37w, which means they were trying very hard to coax your body into doing something it didn't want to do. I am NOT criticizing that decision (BTDT with pre-e) but the risk of a failed induction is fairly high. So we're left with your 2nd, and maybe it's a problem, and maybe not. It's not as clear cut as you might think.

At this point, I would look at it this way: Say you did go through labor again, and it ended in a CS. Would you feel happy that you had given it your best shot, or would you feel awful that you'd had to go through labor and have the CS anyway? They're both completely valid perspectives and I know women who have felt both ways.

That said, I would have your OB/MW check your cervix for scar tissue. It is possible to have scarring after a D&C.

[Jane]

Being 6 and regressing to 7 speaks to a malpositioned baby. Mag is also a muscle relaxant, and directly contradicts labor. Neccesary to prevent seizures, tho. But a pain to try to get the uterus to contract nicely while on it. And it makes mamas and babies kind of unwell feeling - out of it. That doesn't help with laboring/decision making.

Not dialating past a 4...since 4 is where "labor" is diagnosed...not a lot to say there. Need more information. But, if baby was distressed, a c-section makes sense. Could have a been a too gentle to dilate VBAC labor - sometimes the body is gentle with a scarred uterus.

I think given your situation, you could easily decide on a repeat scheduled c-section, without 24+ hours of labor to make recovery easier. You could also lobby for a VBA2C - will a well-positioned baby and no mag sulfate on board, you could easily have your baby. There's nothing here to say your cervix is broken.

I am so sorry about the loss of your first son.

[CookAMH]

My first thought was positioning (more than just vertex vs breech) - it can happen more than once but not prevent a VBAC in the future with proper care. Do you know anything about the position of your last babe?

[JTA Mom]

I would definitely wait until labor starts before getting another c/s, so that's not a 'worry' in and of itself.

My second babe was positioned fine, until the last hour of labor, when I felt him turn posterior. I also was forced to lie down the majority of my labor with him, and only dilated when sitting up.

This baby was definitely posterior. Honestly, his labor was pretty brutal, with intense back pain. Also, having been in continuous early labor for so long, I was exhausted by the time it was the second day. With contractions coming every 10 min, one can't really sleep, kwim?

I went in Monday morning with contractions between 3-5min apart, 1 min long. Checked, and a 3. Was admitted due to being VBAC. I was allowed to move during labor, and sit up. I was admitted at 4:30 am. At 1pm I only dilated to a 4. By this point I was tired and the pain was becoming intense. I asked for an epidural. Unfortunately, it turned into a light spinal, so they turned it off and I had to wait for it to wear off. In the meantime, my water broke. Still at 4. Went without pain relief until 9 pm when I couldn't take it anymore. It felt like my pelvis was shattering, with my back taking the brunt of it. Even with dh putting full weight on it, I couldn't control the pain. I can 'ride' contractions, but this was completely different. I couldn't ride it at all.

At 9pm had another epidural, but had the chief do it, so it was a light/walking one. Got checked, still at a 4. Even with epi, it HURT. And since it was light, it also wore off pretty quickly. At this point, I asked for some pitocin, to see if it would help things along. Honestly, the intense transition feeling I felt with ds1 had lasted HOURS by this point.

With each increase in pitocin, the contractions would come a bit closer, then space back out. Ds would start deceling a bit, so they had to increase the time in between increasing the pitocin. By 1am, his decels were starting to become bigger. And then he started deceling between contractions. Got checked, still at a 4. At this point, I saw my choice really being between waiting it out with more intense pain and facing an emergency c/s since ds was not doing well, or saying 'f it, c/s me now'.

Positioning wise, I made sure to sit up a lot, used a birth stool, etc. I kept feeling ds shifting around, unable to really get in position. I don't remember ds2 moving this much during labor.

The biggest thing with c/s that I fear is that it IS major surgery. I know the risks. Recovery is also a bear. Right now I have a lot of family help, and it's still tough. I also don't want to necessarily limit the number of children I can have. I mean, what am I going to do if they tell me at the next surgery 'no more' and I get pregnant again?


Ami

[CherryBomb]

Well, my first I was induced, never dilated past 1cm and had a c/s for ftp and fetal distress. My second was a planned hbac, stalled out after nearly 72 hours of labor, poorly positioned baby that wouldn't turn, cervix closed up, and her heart rate was going bad. So transferred and had a c/s. I never got past 7cm that time. She also had underlying health issues (prenatal stroke) and is permantely disabled. So, deciding to vba2c with my third was a really hard decision. But I found a good OB and went over my history and really felt like the first 2 c/s were not the result of an innate issue with my body. I had an easy hospital vba2c with her.

I did have some scarring that the mw I had for dd2 mentioned. I had "purse strings" from a LEEP procedures, she took care of them prior to labor.

[JTA Mom]

Originally Posted by CherryBomb

Well, my first I was induced, never dilated past 1cm and had a c/s for ftp and fetal distress. My second was a planned hbac, stalled out after nearly 72 hours of labor, poorly positioned baby that wouldn't turn, cervix closed up, and her heart rate was going bad. So transferred and had a c/s. I never got past 7cm that time. She also had underlying health issues (prenatal stroke) and is permantely disabled. So, deciding to vba2c with my third was a really hard decision. But I found a good OB and went over my history and really felt like the first 2 c/s were not the result of an innate issue with my body. I had an easy hospital vba2c with her.

I did have some scarring that the mw I had for dd2 mentioned. I had "purse strings" from a LEEP procedures, she took care of them prior to labor.

Oh, thank you Katie for this!

How did you find your vba2c friendly OB?

If need be, I'd do a HBA2C, but with 2 surgeries, I want to be able to transfer fast, if need be. However, if my only choice is repeat c/s vs. homebirth, homebirth it is!

Ami

[CherryBomb]

I lucked out, honestly! The first OB I called just happened to be very hands off. I told her I wanted a vba2c and she gave me the ACOG rec, and I said "does that mean I have to have another c-section" and she said "Of course not!" Now that the ACOG has revised their position on vba2c, I hope it's easier for people to find OBs to do it!

Good luck with whatever you decide to do

[smeep]

Originally Posted by bella99

But my SIL chose a primary elective section and then another elective section for her second (she's a physician married to a surgeon so she's obviously informed of the risks0.

I hope I don't come off as snarky, but being a physician married to a surgeon doesn't necessary mean she's informed of the risks. A LOT of HCPs, including OBs who perform sections, don't know all the risks or they know the list but don't know the actual reality and likelihood of them. Maybe she was totally informed, but I just wanted to point out that simply being a physician herself and married to a surgeon doesn't necessarily mean she's fully informed. Again, didn't mean to sound snarky.