Tell me what you think! I got my medical records today.

[pinkmoonlight]

I got my medical records today and while I expected that it was going to be very emotional for me to read them it really wasn't.

Here is the short of what they say:

I was admitted at 3 cm dilated 80% effaced and a - 2 station

My operative reports give the following information: (Not to sure what all of this means but I think I got the idea of it. Tell me what you think.

Reason for C/S is stated as- Arrest of descent at 0 to +1 station after pushing at completely dilated and non reassuring fetal heart rate tracing.

In the written out notes it also stated that it states the my DD was in a ROA position with a large head very deep in pelvis at a +1 station. However it also says that the Dr. was able to deliver DD without difficulty by getting hand around head to dislodge head and deliver in a flexed position. It also states fetal heart rate returned to 120's.

My operative reports also state that I pushed for 1 hour- when really it might have been 1 hour over a period of 2 hours. Due to changing position for a bit.

As far as the type of incision it states that I have a low transverse incision and that it was extended bilaterally. The closer was a 0 Vicryl suture in a running and locked fashion with a second layer of the same suture to imbricate the first. Apparently they did the repair by removing my uterus and then returning it to my abdominal cavity. The report also talks about 3 other types of sutures that are used in closing.

It also states that my epidural was inadequate.

Please correct me if I am wrong, but what I am getting from this is pretty much a failure to progress with CPD (Large head that wouldn't fit) and that I have a two layer closure. The reason for the surgery really wasn't the fact that my DD heart rate dropped, because it dropped and clearly recovered it was really for FTP and CPD.

I was also talking with my mom tonight after showing her this report and she said she also thinks that the doctor said c/s because I was really stressed out, I could not relax and I was having a difficult time due to being in so much pain because the epidural was not working.

Please tell me what you think. I am new to all this VBAC stuff, but would DD position of ROA caused the difficulty in coming out? Was I really having difficulty- could the sliding down be because I was slowly stretching so that she could make it out? I don't know what measurement my daughters head was at birth but at 15 days old it was measured at 38 cm. Is this really a big head?- she didn't look like she had that big of a head. I also don't believe there was molding to her head- she didn't have any fluid at the top of her head from being stuck- her head was a little black and blue but it cleared up with in 2 days at the most.

I am definitely going to go see another doctor for my next pregnancy regardless of whether I have to do a repeat or I do a VBAC.

[MsBlack]

The one thing that stands out for me is nonreassuring heart tracing during pushing--as far as a reason for csec.  I imagine, since this is pretty standard hospital protocol, that you were found to be 10cms/fully dilated on vag exam, and were instructed to push before you felt any or much urge to push (few women feel that urge with the baby's head so high--your  baby was only starting descent).  And you were probably instructed to hold your breath and bear down as hard as you could...?  If so, then I would say that the baby was not ready for descent, and the 'purple pushing' was what caused the stress. 

Plus you had an epidural, which makes it much harder to feel and respond to what is going on with baby and delivery.  You say it wasn't working, but I think it must have been working to some degree, if not as much as you hoped.  In any event, for a variety of reasons, once you get an epi, your chance of csec skyrockets for many reasons related to the epi itself. 

ROA should not be a problem if your baby was trying to descend in that position.  Some mws say that a baby who starts ROA is more likely to try to spin to LOA during labor, which can mean the baby moves first into an OP position on the way--and the OP position can indeed make descent harder, especially if you are pushing then.  I have not seen this--instead have seen several ROA babies get born ROA just fine.  It's just a variation of normal most of the time. 

So--a couple of suggestions: first, labor naturally, prepare yourself for an unmedicated labor/birth, and forgo the epi if at all possible.  I will say that for some mamas, the epi does help with relaxation--but there are numerous risks to epi so I would be first prepared for natural labor and try to birth that way.  Consider the epi ONLY if circumstances leave you with no other option for a vag delivery.

second, stay home as long as possible, with doula or monitrice support (a monitrice can listen to baby's heart tones, check your dilation and other hands on stuff most doulas don't provide).  At home you are most likely to remain as relaxed as possible in the company of only people you choose, who are close and comfortable for you.  You can eat, drink, pee, move around at will--and all of that will help you to labor more freely and effectively.  I personally believe that choosing homebirth with the right provider for you, is among the best of ways to serve safe normal birth for a vbac.

3rd, don't let anyone tell you when or how to push.  In my hb practice, only a rare few really need to 'purple push' with breath holding and all, to get their baby down.  Most push only when they really can't deny the urge, and push with open throat for only a few seconds at a time before gathering another breath.  This can be so important to you and your baby!  Purple pushing can indeed make life harder for baby--making for longer periods without fresh oxygen--this is especially hard on babies who have a tight fit through the pelvis. 

Seems to me that your baby may simply have needed more time to 'labor down', which means time for head to mould adequately to get through the pelvis.  Being 'fully dilated' really doesn't amount to a hill of beans if baby is not real low yet.  This is one reason I most often do none, or only a couple of vag exams, usually mother-requested.  Some want to know if they are fully, just so they can start pushing even without the urge to push...I don't like encouraging that at all!  It leads to various issues, including mom getting tired before the baby is born. 

Focussing on one contraction at a time, seeing to comfort in all possible ways, letting labor take it's course without interference or pushing the river--these things can help a woman have a vaginal birth.  Almost no matter how long the labor is, as long as you are fed, hydrated, as comfortable as possible, you and baby can do very well.

Finally--have you checked out ICAN--the international cesarean network?  If not, then do!  www.ican-online.org and see if there is an ican support group meeting near you, they are SO helpful to vbac mamas.

good luck!

[sosurreal09]

I agree I think the baby just needed more time. I had an un-medicated birth and pushed  for 2 hours (which seemed like 20 mins) but only b/c I felt the urge. She was born with very robust cheeks and was all bruised on her face (aka she had a big head) and weighed 8lbs 6 oz. This was and is my firth child. I didn't have people with an agenda though (like at the hospitals) caring for me. So I took my time and it was wonderful.

I didn't want an epidural b/c of all the side effects and how you can have it and have it not take right so you are in the "pain" anyway and you and you're baby still suffer side effects or the possibility of it.

[pinkmoonlight]

Thank you so much. That totally makes since to me. I was instructed that I could push at 10, not knowning, first time and not well informed, I did and that is when everything started going down hill.

My plans for next time involve: 1- Getting a Better Doctor. 2- Laboring at home for as long as possiable and 3- Natural Un-medicated through the use of hypnobabies or hypnobirthing. I also will get a doula as I think I really need that extra support.

I am not opposed to getting an epi next time around if I truely need it. With DD I felt I was kind of pressured into getting it, they pretty much told me that if I wanted one I needed to get it now- I was only 4 cm at the time and while I wasnt feeling so much pain at the time, I was fearful that I would be in to much pain later. While it was not working I do believe that it took the edge off the contractions at least for a short time.

After my short period of time reading up on things at places like the I-Can website I found that there was alot of things that didnt work out well this time around.

[sosurreal09]

i did hypnobabies and let me tell you there is no reason to truly need an epi. I was 21 first kid with no family but I had DP I was scared!!! I couldnt have done it without hypnobabies. Good luck on the next one!

[TiffanyToo]

I think you have done great work towards taking control of any future pregnancies and births. You are questioning events from your first birth. You are thinking about the future pregnancies wanting something different. Great work! Keep asking your questions and persuing answers that work for you. Best wishes!