Okay, ladies. I finally got my hospital records from DS's birth 19 mos ago. It was an interesting experience reading through them and seeing the clinical perspective of what happened. My purpose in posting here is to see whether any of you have heard of my physical anomaly (a steep, 90 degree bend in my sacral promonotory, according to the OB's c/s report) and what you think my chances for a VBAC are, as the OB and CNM just said they think there is 0 chance if I couldn't birth DS who was just under 5 lbs.
Ok, so here are notable notes from my birth story and records; sorry for the novel--it was a pretty long labor:
Me: healthy, normal weight, primip, 29 years
Prep: Seeing a CNM and planning an unmedicated/natural birth at the only baby friendly hospital in my state. Did Hypnobabies Homestudy religiously from 30 weeks on. I also had a doula (and soula when the labor got into the 2nd day).
Complications: Diagnosed with IUGR at 36 weeks. Induction scheduled at 38w4d after my fundal height actually started getting lower.
Labor: The day before induction "night," I woke around 4 a.m. on Wed. with contrax. They continued all day--assumed they were BH until SROM around 4 p.m. Went to hospital b/c of the IUGR--baby needed to be monitored occasionally. They couldn't get my contrax to register with the external monitor and didn't believe I was in labor. Finally submitted to an internal monitor as they gave me the "choice" between that and pit. Discovered I was in fact having quite strong contractions though they were fairly irregular.
Because I wasn't dilating quickly, they started pit that first night in the hospital (at a 1), but discontinued it when I began hyperstimming and the baby began having some concerning hearttones b/c of that. They started amnio-infusion, which seemed to fix both problems.
The CNM's notes also note "gestational hypertension" at midnight the first night, although I did not have any signs of Pre-E as far as protein in urine, etc. At that point, I was 4 cm, 80% effaced, and -2.
Labored for another 20 hours or so on my own, mostly in bed, left-sidelying as baby's heartreat did not recover well and he had a continually (but gradually) lowering baseline throughout my labor. At some point during the day, the baby's hearttones got very concerning, and they discontinued the amnio-infusion, which made baby happier. After it was turned off, I did get out of bed and sat on the birth ball, squatting.
At 3:45 p.m., I was 5-6/95% effaced/+1 station.
Soon thereafter, I squatted in the shower for 2 hours, which was really good. Soon after that I experienced what I think was transition--everything suddenly felt different to me, and I got very tearful and people who were in the room thought I was in pain, although I just felt everything more intensely and suddenly got scared. I also felt the urge to push and felt my body push maybe a couple of times. The CNM checked and said I was a stretchy 7.5/95% effaced/0 station and that when I felt like pushing between contrax to call her, and she thought it would be soon.
A couple more hours go by, and I stopped feeling the urge to push. The CNM reports I was a 5-6/90% effaced/0 station. At that point, since I was "un-dialating," the MW recommended an epidural to see if it was a matter of relaxation--I asked if we could try the pit again instead, and she said no b/c it wasn't a matter of contrax not being there and they didn't want to start the hyperstimming again. Got the epidural. No change--restarted pit, and the heart-rate monitor then went off steadily for the next hour (so annoying). They also had me wearing an oxygen mask starting sometime shortly before the epidural. They flipped me around trying to find a position to make baby happy, but couldn't seem to find one.
The OB & CNM finally came and in said it was "time" to go for a c/s (this is about 44 hrs after contrax started and 36 after ROM). The MW said she felt that something was wrong that was keeping things from happening--she mentioned maybe a short cord. It's funny b/c my records state they discussed "expectant management v. c/s" with me and I chose the c/s, but they definitely presented as the only option at that point.
Ok, so the C/s report says my pre-op and post-op diagnosis was "arrest of dialation" and "fetal intolerance to labor." OB says that baby was "occiput posterior presentation" (which I know could definitely make a difference in how difficult/slowly labor might progress) though the CNM report says that he was LOA (and that is always what we saw during labor--I had 2 u/s). The OB notes that my uterus was exteriorized and noted to be "somewhat arcuate" but without a septum. She also says, "of note, prior to completing the procedure, the sacral promontory was palpated and it was noted to have a sharp 90 degree bend, which likely contributed to the arrested labor." The CNM and OB also reported that I had the tightest abs they had ever worked on.
After the surgery, the OB said that she did the c/s in such a way as to make me a good VBAC candidate (we had talked about it before the c/s) but that she did not think I would be able to birth vaginally with the sacral anomaly. The CNM has rehearsed the same with me in several follow-up appointments. She said that taking into account DS's tiny size (he was 4 lb 15 oz), my overly tight abs, and the sacral bend thing, she definitely did not think I'd be able to birth a normal-sized baby if I couldn't birth him.
I just continue to wonder whether the IUGR might have caused my body to not respond correctly somehow. The CNM also specifically said that my issue (the sacral promontory) wasn't one of those bones that could be moved with ligaments loosening when I asked about that.
Overall, I was interested to see that my official diagnosis was "failure to descend" when from mine and DH's recollection, they told us we needed to do this for the baby's safety (I know, it's the same line most c/s moms get; it still just surprises me having been there and heard those alarms going off non-stop for the last 2 hours of labor!).
If anyone is still reading, thank you and i'd love to hear your thoughts. I plan to get an appt with a homebirth midwife (no dog in the fight) for some help in deciphering the parts of my records I can't read/understand (the handwriting--OMG!) and getting another perspective. Just hoping to hear from some who might have BTDT in the meantime...
ETA: DS also had "significant molding" of his head (of course) and a gouge on the side of his scalp toward the front, but on the side. I've always wondered where that came from--the CNM just said "birth trauma." I can still see the scar from it today.
Ok, so here are notable notes from my birth story and records; sorry for the novel--it was a pretty long labor:
Me: healthy, normal weight, primip, 29 years
Prep: Seeing a CNM and planning an unmedicated/natural birth at the only baby friendly hospital in my state. Did Hypnobabies Homestudy religiously from 30 weeks on. I also had a doula (and soula when the labor got into the 2nd day).
Complications: Diagnosed with IUGR at 36 weeks. Induction scheduled at 38w4d after my fundal height actually started getting lower.
Labor: The day before induction "night," I woke around 4 a.m. on Wed. with contrax. They continued all day--assumed they were BH until SROM around 4 p.m. Went to hospital b/c of the IUGR--baby needed to be monitored occasionally. They couldn't get my contrax to register with the external monitor and didn't believe I was in labor. Finally submitted to an internal monitor as they gave me the "choice" between that and pit. Discovered I was in fact having quite strong contractions though they were fairly irregular.
Because I wasn't dilating quickly, they started pit that first night in the hospital (at a 1), but discontinued it when I began hyperstimming and the baby began having some concerning hearttones b/c of that. They started amnio-infusion, which seemed to fix both problems.
The CNM's notes also note "gestational hypertension" at midnight the first night, although I did not have any signs of Pre-E as far as protein in urine, etc. At that point, I was 4 cm, 80% effaced, and -2.
Labored for another 20 hours or so on my own, mostly in bed, left-sidelying as baby's heartreat did not recover well and he had a continually (but gradually) lowering baseline throughout my labor. At some point during the day, the baby's hearttones got very concerning, and they discontinued the amnio-infusion, which made baby happier. After it was turned off, I did get out of bed and sat on the birth ball, squatting.
At 3:45 p.m., I was 5-6/95% effaced/+1 station.
Soon thereafter, I squatted in the shower for 2 hours, which was really good. Soon after that I experienced what I think was transition--everything suddenly felt different to me, and I got very tearful and people who were in the room thought I was in pain, although I just felt everything more intensely and suddenly got scared. I also felt the urge to push and felt my body push maybe a couple of times. The CNM checked and said I was a stretchy 7.5/95% effaced/0 station and that when I felt like pushing between contrax to call her, and she thought it would be soon.
A couple more hours go by, and I stopped feeling the urge to push. The CNM reports I was a 5-6/90% effaced/0 station. At that point, since I was "un-dialating," the MW recommended an epidural to see if it was a matter of relaxation--I asked if we could try the pit again instead, and she said no b/c it wasn't a matter of contrax not being there and they didn't want to start the hyperstimming again. Got the epidural. No change--restarted pit, and the heart-rate monitor then went off steadily for the next hour (so annoying). They also had me wearing an oxygen mask starting sometime shortly before the epidural. They flipped me around trying to find a position to make baby happy, but couldn't seem to find one.
The OB & CNM finally came and in said it was "time" to go for a c/s (this is about 44 hrs after contrax started and 36 after ROM). The MW said she felt that something was wrong that was keeping things from happening--she mentioned maybe a short cord. It's funny b/c my records state they discussed "expectant management v. c/s" with me and I chose the c/s, but they definitely presented as the only option at that point.
Ok, so the C/s report says my pre-op and post-op diagnosis was "arrest of dialation" and "fetal intolerance to labor." OB says that baby was "occiput posterior presentation" (which I know could definitely make a difference in how difficult/slowly labor might progress) though the CNM report says that he was LOA (and that is always what we saw during labor--I had 2 u/s). The OB notes that my uterus was exteriorized and noted to be "somewhat arcuate" but without a septum. She also says, "of note, prior to completing the procedure, the sacral promontory was palpated and it was noted to have a sharp 90 degree bend, which likely contributed to the arrested labor." The CNM and OB also reported that I had the tightest abs they had ever worked on.
After the surgery, the OB said that she did the c/s in such a way as to make me a good VBAC candidate (we had talked about it before the c/s) but that she did not think I would be able to birth vaginally with the sacral anomaly. The CNM has rehearsed the same with me in several follow-up appointments. She said that taking into account DS's tiny size (he was 4 lb 15 oz), my overly tight abs, and the sacral bend thing, she definitely did not think I'd be able to birth a normal-sized baby if I couldn't birth him.
I just continue to wonder whether the IUGR might have caused my body to not respond correctly somehow. The CNM also specifically said that my issue (the sacral promontory) wasn't one of those bones that could be moved with ligaments loosening when I asked about that.
Overall, I was interested to see that my official diagnosis was "failure to descend" when from mine and DH's recollection, they told us we needed to do this for the baby's safety (I know, it's the same line most c/s moms get; it still just surprises me having been there and heard those alarms going off non-stop for the last 2 hours of labor!).
If anyone is still reading, thank you and i'd love to hear your thoughts. I plan to get an appt with a homebirth midwife (no dog in the fight) for some help in deciphering the parts of my records I can't read/understand (the handwriting--OMG!) and getting another perspective. Just hoping to hear from some who might have BTDT in the meantime...
ETA: DS also had "significant molding" of his head (of course) and a gouge on the side of his scalp toward the front, but on the side. I've always wondered where that came from--the CNM just said "birth trauma." I can still see the scar from it today.
