2 c-sections due to asynclitic heads- Need a game plan for VBA2C!

[SAMarshall]

My youngest is almost 10 months old now and we're starting to plan for our 3rd child. I've had two c-sections, both of which have been because the babies' heads would not engage in the pelvis and their heart rates started to drop. It took me a long time in both labors to become fully dilated and I pushed for 2 hours with each.

With my second, I did everything I could (so I thought). I hired a doula, I read everything I could read on VBAC, I was on the forums every day, chatting and making plans. Still, though, my daughter's head simply would not come down. 

So my question is, what if I am in that exact situation, yet again, in the middle of labor and the baby's head will not engage properly? The head is crooked in the pelvis, I'm fully dilated, but pushing is doing no good. Is there anything I can do? I didn't think it would happen to me twice in a row! I thought if I just used positions and pain management and relaxation, she would position herself correctly and come out. What else can I do in the moment of labor? I think during my first labor, the midwife even tried to reach up and turn my son's head, but he was stuck at an odd angle. 

One worry I have is that I really can't get a baby out. I mean, I'm 5'1, petite, and my babies have been 8lbs and 9lbs 2oz. They both have heads in the 90-95th percentile for size. Am I just not capable of getting them out vaginally?

Anyway, any insights would be great. 

Oh, and also, the doctors told me after my second surgery that they recommend waiting until my youngest is at least 15 months old before getting pregnant again. Does anyone know if that is really necessary or will do any good? We'd like our children to be pretty close together, so I'm not sure that we want to wait that long. 

Thanks!

[TiffanyToo]

Originally Posted by SAMarshall 

My youngest is almost 10 months old now and we're starting to plan for our 3rd child. I've had two c-sections, both of which have been because the babies' heads would not engage in the pelvis and their heart rates started to drop. It took me a long time in both labors to become fully dilated and I pushed for 2 hours with each.

Were either of these labors induced? If so how? Did your care providers rupture your membranes or did they rupture spontaneously during labor? Were you in bed during labor or up and about?

So my question is, what if I am in that exact situation, yet again, in the middle of labor and the baby's head will not engage properly? The head is crooked in the pelvis, I'm fully dilated, but pushing is doing no good. Is there anything I can do? I didn't think it would happen to me twice in a row! I thought if I just used positions and pain management and relaxation, she would position herself correctly and come out. What else can I do in the moment of labor? I think during my first labor, the midwife even tried to reach up and turn my son's head, but he was stuck at an odd angle. 

I think about diaphramic release http://www.naturalchildbirth.org/natural/resources/labor/labor29.htm and http://www.midwiferytoday.com/articles/transcript.asp I would also be seeing a Webster or Begnell trained chiropractor and practicing optimum fetal positioning, http://www.spinningbabies.com/

Oh, and also, the doctors told me after my second surgery that they recommend waiting until my youngest is at least 15 months old before getting pregnant again. Does anyone know if that is really necessary or will do any good? We'd like our children to be pretty close together, so I'm not sure that we want to wait that long. 

I can't answer this one. But wish you luck with your efforts.

[cairomama]

Don't let anyone break your water.

Walcher's Position can help a baby engage. 

http://www.spinningbabies.com/techniques/activities-for-fetal-positioning/walchers-trochanter-roll

Chriopractic care throughout pregnancy.

Birthing Better with The Pink Kit can help you map your pelvis so you know what you are working with and how to help yourself in labor. http://www.birthingbetter.com

Many providers like to see 18-24 months between births. If you got pregnant today you'd have that. Whether less is a problem or not is debatable, but the comfort level of your provider does have a lot to do with your chances of success. 

[SAMarshall]

Thanks for the replies.

To answer questions:

Neither labor was induced at all. For the first, I went into labor at 42 weeks. I arrived at the hospital at 5cm dilated and as soon as they put the monitors on, there was a concern about his heart rate. I ended up staying in bed, which, of course, made labor more painful. I ended up with an epidural after being in labor for 14 hours. About 11 hours later, we ended with the c-section. My water broke during an exam at about 7cm, so it wasn't officially ruptured by the midwife, but it might not have ruptured if she hadn't been doing an exam. 

With my second, I was at 41 weeks, 4 days. I arrived at the hospital at 8cm. The midwife was concerned because I had twice the amount of amniotic fluid normal women have, and the baby wasn't engaged. She worried about cord prolapse, so she suggested we try to make a small hole in the amniotic sac. After discussing it with my doula, we decided to go ahead with that because it seemed like the cord prolapse concern was valid. Unfortunately, though, the procedure ended up breaking the bag entirely. I was able to be up and about the whole time, though, but the baby just didn't come down. 

Both babies also had meconium in the fluid and both ended up in the NICU for breathing troubles (which I know is common with c-section births). 

I would really like to avoid this next time around!

[TiffanyToo]

You might start seeing a Webster or Begnell trained chiropractor or sacral/cranio therapist to make sure that everything is in good alignment during the TTC phase an then during pregnancy.

[mamagranola28]

I wonder if maya abdominal massage might help if the way your uterus is tilted is causing the problem with your babies not moving down.  I've had an asynclitic baby and looking back on it now I think I could have gotten him in a better position during pregnancy if I'd done specific things like suggested on spinningbabies.com.  Good Luck!

[TiffanyToo]

Originally Posted by mamagranola28 

I wonder if maya abdominal massage might help if the way your uterus is tilted is causing the problem with your babies not moving down.

I am not sure can Mayan be done during pregnancy?

[Monkey Keeper]

Originally Posted by mamagranola28 

I wonder if maya abdominal massage might help if the way your uterus is tilted is causing the problem with your babies not moving down.  I've had an asynclitic baby and looking back on it now I think I could have gotten him in a better position during pregnancy if I'd done specific things like suggested on spinningbabies.com.  Good Luck!

My VBAC baby turned breech 2x, and massage DEFINITELY helped his positioning (along with Webster chiro).  It wasn't an abdominal massage, though--mostly hip, lower back, upper thigh, and pelvic work. He still was asynclitic; it's just how my babies like to be.  But an adjustment and a  good massage would always get him nice and LOA before he migrated back to the right with his head in my hip.

[buckeyedoc]

I thought chiropractic care helped me, but some of it might be luck, as I was able to push out my asynclitic VBAC baby. I blame his positioning on the SROM 40 hours before his birth.

[SAMarshall]

Thanks everyone!

I will definitely look into a chiropractor and some massage techniques. I'm still a bit worried that despite all the preparation, the baby will still be stuck during labor. I found that while I was in labor, I was in too much pain to try too many different positions. I wanted to just stand and sway a lot. Maybe if I had been able to try something else, it might have dislodged the baby.

Third time's the charm, though, right?

[Monkey Keeper]

Originally Posted by SAMarshall 
I found that while I was in labor, I was in too much pain to try too many different positions. I wanted to just stand and sway a lot. Maybe if I had been able to try something else, it might have dislodged the baby.

In the end, the very position that was the most painful for me and that my body screamed NOT to be in was the one that allowed my guy to get into a better position.  Sometimes, the only way "to" is "through". 

Best of luck to you!

[neveraim]

your size and baby's size has nothing to do with it.  It depends much more on position or the shape of your pelvis.  What I'm wondering is if you have some other issue.  I, for example, have a fused sacrum...it doesn't move.  I attempted VBAC twice before I knew what I was dealing with.  finally got my VBA3C but it was not easy.

anyway, It sounds like you might have a real issue...please explore www.spinningbabies.com and look at pelvis shapes.

also, I'm irritated with the midwife that tried to break your water to prevent prolapse...she could have easily caused prolapse.  You NEVER break the water unless baby is engaged and there is no chance of the cord coming between the baby and your pelvis (I learned that after having my water broken for my second baby...for the same reason, we were both lucky to avoid a prolapsed cord)  =)

you might want to x-ray your pelvis before you become pregnant to see if you've got an abnormality.  A chiropractor w/experience with pregnant women would be ideal to look at your pelvic shape.

Good luck!!! 

[majormajor]

Originally Posted by SAMarshall 
 

Both babies also had meconium in the fluid and both ended up in the NICU for breathing troubles (which I know is common with c-section births). 

actually, c-section after a labor doesn't increase the risk of breathing troubles. it's cold c-section, without labor, that does it. the thought had been that the squeeze through the birth canal was what helped but that didn't prove to be the case when they did some research. i'm sorry that happened, it must be scary. :-(

i feel for you too, my first c/s was because DD had the cord around her neck, but it was exacerbated by her awful position. i wonder if she was better positioned, and able to come out fairly quickly, if a vaginal delivery could have happened. with #2, her head was tipped so far to the right that she had torticollis and needed 9 months of physical therapy. i wonder if there's something about my pelvis that keeps them so poorly positioned. i did all the spinning babies stuff with both and got awfully positioned babies, so i don't think it does anything. but can't hurt to try either!

i guess i'm no help. but good luck!!

[neveraim]

Correctly positioning baby in your pelvis is much more than just a few excercises.  You have to be mindful of it your entire pregnancy.  Simple things like wearing heels and reclining when you sit can cause major problems.

I spent 2-3 hours every night of my last trimester in the hands and knees position.  Reclining or laying on your back cause posterior babies.  A misaligned pelvis and pubic sympyhsis can cause a crooked head or make your baby asyclitic.  That is why chiropractic helps so much.  Walking every day help baby to 'settle down' correctly.  Doing belly lefts and short inversions late in pregnancy can help baby reposition correctly.

Wear flat shoes...heels cause your pelvis to tip forward, making it that much harder for your baby to make his/her way down.  Use a pillow between your legs when you sleep so your hips don't sit uneven on your pelvis.  Be mindful of your posture all the time.

I did yoga too and it helped tremendously...with both positioning and with my flexibility, strength, and ability to relax...you learn breathing techniques that help coax baby down.

I know it's hard to put all this effort into something when you doubt it's even going to happen.  I've been there.  I completely emotionally shut down for my last pregnancy and didn't do as much as I could have...but I did what I was able.  Some of you will not get your VBAC..for whatever reason, but at least you'll take comfort knowing you did everything to improve your chances.  I struggled for 14 years with it.  I finally feel like I fully understand what it takes to have your best chance at VBAC. 

[SAMarshall]

I think as long as I know I've done everything I could have done to achieve a VBAC, I will be okay with the end result- even if it means another c-section. So I am taking in any information I can get and I will try everything! I'm looking into chiropractors in my area and I will start watching how I sit and sleep. I don't know if I will be able to have a baby vaginally, but I will certainly give it my best shot.  

It just bothers me so much that I might have to limit the number of children I have due to these dang surgeries. We want at least 4 children, but I just don't think I can do more than 4 c-sections (physically or emotionally). So I might have had 5 or 6 kids, but because I have to have c-sections, I might end up with only 4. Or maybe we would have stuck with 4 anyway, but we might never know! I don't like this decision being made for me.

Well, I guess we'll cross that bridge when we come to it. But thanks for all the info so far!

[majormajor]

just wanted to respond about c-sections limiting family size. my  understanding is that it's different for every woman, but some women just get more scar tissue than others, and repeat c/s can be less dangerous for some than others. your DR should be able to tell you whether you're good to go for another pregnancy after a c-section. my college roommate has had 4 c/s so far, and hasn't closed the door on another baby. so, it's not like you HAVE to stop after 3 or 4 if you don't want to.

[jenniro]

Just thought I would throw out the idea that maybe this next time not allowing anyone to break your water, even if that means no cervical exams, which aren't really necessary anyway.  The bag of waters can allow a baby to get into an ideal position.  Prematurely breaking your water can "cement" a baby in a bad position with no cushion to change it.  Just a thought!

[SAMarshall]

So far my plan is to visit the chiropractor throughout pregnancy and follow some exercises on spinningbabies.com. Hopefully a professional can help me figure out if I have a real issue with my pelvis.

I'll see the same team of midwives as with my second pregnancy, but I will be more cautious about trusting them. During my second labor, the midwife did not purposefully break my water, but she tried to create a small leak in the sac. She thought that if we could get some of that excess fluid out, the baby could settle down into a better position. My husband, though, watching from the outside perspective, felt that the midwife did rupture it on purpose. Instead of stopping the procedure once she got a small leak accomplished, she decided to go back in for "one more hole," which caused the rupture. She didn't really have the best supportive attitude that I would have liked to see in a midwife. She acted like she didn't think I was going to achieve a vaginal birth from the beginning- not outrightly, but just subtle things she did and said made it seem that way. I'll be requesting a different midwife from the team. There are several to choose from.

I did appreciate my doula's help, but maybe I should find one with more experience with VBACs, and even one with experience with "stuck" babies. I needed someone to tell me what to do in the moment to get my baby unstuck, but no one had any insights in the labor and delivery room.  My midwife just kept telling me to lay down on the bed because I seemed tired and needed to rest, and my doula just supported me in whatever I felt most comfortable with. I need someone there with me who knows exactly what to do!

I'm getting a little anxious, actually, because I'm still breastfeeding my daughter, who is now almost 11 months old, and my period hasn't started up yet. I'm hoping to get pregnant soon, and I'd like to be able to get a good idea of when it happens! If I don't have a period, I know I can still get pregnant, but I won't have a very good idea of when conception took place without a LMP to date. Anyway, that's just a random worry I have. My period returned at 9 months with my son, so I guess I was expecting the same thing with my daughter. We shall see!

[neveraim]

I just don't even know if creating a small leak instead of breaking the water is even reasonable.  Sounds like she didn't know what she was doing.  Here's why...there's already a ton of pressure on the amniotic sac even when you are not in labor....once your cervix starts to open all that pressure is pushing on that one area where there is some give.  If you are squeezing a balloon (which is much thicker and than the amniotic sac) and you try to create a "tear" vs. "breaking"....I guess I don't even know how one would reasonably not 'break' it no matter how gentle or how small the hole is.  Even if you did accomplish a small tear....one contraction is going to squeeze all the water out and break it anyway.

It's only ever ok (and even then I'd refuse) to break water if the baby is already in the perfect position....that's why it usually breaks on it's own late in labor...because if it were to break sooner, then baby is cemented into a bad position like the other poster said.  The water should never be broken while baby is high up...it can cause a prolapsed cord.

Anyway, I'm sorry that you had to go through that.  I hope you have a much better experience next time!

Originally Posted by SAMarshall 

I'll see the same team of midwives as with my second pregnancy, but I will be more cautious about trusting them. During my second labor, the midwife did not purposefully break my water, but she tried to create a small leak in the sac. She thought that if we could get some of that excess fluid out, the baby could settle down into a better position. My husband, though, watching from the outside perspective, felt that the midwife did rupture it on purpose. Instead of stopping the procedure once she got a small leak accomplished, she decided to go back in for "one more hole," which caused the rupture. She didn't really have the best supportive attitude that I would have liked to see in a midwife. She acted like she didn't think I was going to achieve a vaginal birth from the beginning- not outrightly, but just subtle things she did and said made it seem that way. I'll be requesting a different midwife from the team. There are several to choose from.

[SAMarshall]

Originally Posted by neveraim 

I just don't even know if creating a small leak instead of breaking the water is even reasonable.  Sounds like she didn't know what she was doing.  Here's why...there's already a ton of pressure on the amniotic sac even when you are not in labor....once your cervix starts to open all that pressure is pushing on that one area where there is some give.  If you are squeezing a balloon (which is much thicker and than the amniotic sac) and you try to create a "tear" vs. "breaking"....I guess I don't even know how one would reasonably not 'break' it no matter how gentle or how small the hole is.  Even if you did accomplish a small tear....one contraction is going to squeeze all the water out and break it anyway.

You know, that's a good point. I guess it just seemed reasonable at the time. I wish that my doula would have had more knowledge about that. I would have listened to her if she would have explained it. My doula, however, agreed (although hesitantly), with the midwife. That is definitely a big regret I had with my last labor. It was the one and only intervention I had (until the c-section), and I wish I could have taken it back. Thanks for that explanation, though. I'll be prepared if that comes up next time!