Repeat C-sections and deaths? - Page 2

[labortrials]

I somehow fell behind on this thread.  Glad a few peeps re-invigorated the discussion!!  How you doin', seili!!??
 

Originally Posted by jenniro 
Right now, I am planning to have a homeirth, HBA2C.  I've tried to labor in the hospital twice now, and my long start-and-stop labors are not tolerated in a hospital.  I am not any more concerned with uterine rupture than I am about cord prolapse or any other unlikely complication with any pregnancy.  I have an experienced midwife that I trust, and I know that she is quite capable of detecting problems and transferring to the hosptal in a timely manner.  That is how I feel today, anyway.  I am usually a total science geek, looking at the studies and stats, trying to find the absolute safest choice, but the truth is, there are risks no matter what I decide.  So, I am following my gut on this one.  The frustrating aspect of following your gut, though, is that there is never a deadline to decision making.  I could be in early labor, decide that something is not right, and opt for a 3rd section.  I don't see myself doing that, especially after my last TOL, but if I have learned anything in this journey of pregnancy, birth and motherhood, it's that:  I am stronger than I give myself credit for and although the only thing I can control is my attitude, that's sometimes all it takes.   

Great stuff.  Totally resonates with me, and the whole 'risks no matter what I decide' is something my awesome hubby keeps reminding me.  I can find stuff to back up or dispute just about every cotton pickin' aspect of my upcoming birth.
 

Originally Posted by MsFortune 

Elective, scheduled c-sections have the best outcomes for babies. Better than standard vaginal birth.
 

If only it were that simple then we women wouldn't have to deal with those pesky vaginal births at all.  Actually, you might be onto something . . . 'standard' vaginal birth does pose quite a problem these days in the hospital setting.  This is why I'm doing my job here at home - I don't want a 'standard' vaginal birth; I want a (what should be) 'normal' one.

Originally Posted by seili 

Yeah, I definitely have concerns with both choices. Still the immediate dangers of VBAC still weigh on me, but my next step is to research if many of those cases were induced.

I'm sure no matter what I ultimately decide, I will still have concerns because that is just the nature of living and definitely can be more apparent when you are pregnant. And I do tend to over-analye.

I am sure if I choose the repeat c-section, that I will be a nervous wreck! Sometimes I get nervous just walking into a doctor's office. ha! My c-section with my first-born was so different because I was in so much pain that I could not wait for them to get the epi started again and get the c-section. It was almost heavenly.

I do wonder if any of the interventions caused me to stall, but I am really scared of what might happen if I try again. I do wonder if breaking my waters and the pitocin caused him to not position correctly. He was posterior the whole time, but he did try to turn. But for some reason, I am just rather scared of trying, even though I will be beyond nervous for surgery, I think I am more worried about what could go wrong during a VBAC. For me.

I don't mind not ever having a vaginal birth because even though I love the idea of a natural birth, when possible, I think that death is also natural, so in some situations, it is better to abandon natural and reach for life. It saddens me that so many women that have had c-sections feel so despondent, though...so despondent that they have a hard time celebrating their child's birth. I know not everyone is like that, but of course, through all of my reading, you see a lot of that utter depression over it, that I usually don't understand.

This is pretty typical 'fear' stuff I'm reading.  It's not anything you can't work through if you so desire.  (I just *hate* to see mamas making fear-based decisions!!  And I don't at all mean that as a criticism of you.)  But if you decide on RCS, you'll be able to plan/prepare for a good experience there.  No reason to feel guilty, IMO, about your decision.  And you can always change your mind - at 20w, at 30w, even at 39+6w and beyond!!!

Originally Posted by roadfamily6now 

And for what it's worth, I have no hard feelings about my first birth which ended in c-section.  I still choose to have a VBAC. :)

Ditto.  I was fine - felt like a friggin' awesome powerful mama.  But then when I went to the post partum appt and heard "rupture" and "small pelvis" and stuff, I felt betrayed to a certain extent.  Then I found ICAN in 2007 and the learning began . . . and I'm still learning!  Seriously, one of the best things for me was joining their yahoo group list.

Originally Posted by lawmama1984 

I think it's really wonderful that you are pondering both decisions so carefully.  I will say that if you do decide to VBAC, I think it takes very real commitment on your part.  I think you will find this post on The Unnecesarean very helpful.  I really loved reading it:

http://www.theunnecesarean.com/blog/2011/6/5/vbac-vs-repeat-cesarean-try-on-both-choices.html#comment13118899

Totes agree, lawmama!  kmom is the best.

Speaking of kmom, she has fantastic resources for plus-sized mamas AND for all mamas - http://www.plus-size-pregnancy.org/firstindex.html.  I've been over there a lot this pregnancy, especially mulling over the VBAmC stuff she has posted there.
 

[dogretro]

Uterine rupture is more likely by the tiniest of percentages: http://vbacfacts.com/vbac/  Something like .5% vs .7%.  And, as pp pointed out, uterine rupture could occur at any time during pregnancy, not just during labor.

Since you are on the fence about it and your ob is supportive, you could always plan to go ahead w/ a vbac & schedule last minute if you freak out and change your mind :)  Is there a reason that you need to be set in stone right this minute?  Also, and I know doctors probably hate this, but you could allow yourself to go into labor & if you feel too panicked about it, ask for a c/s then.  Will they tell you no?  Maybe, maybe not.  I had a scheduled breech c/s for dd1 and a natural vbac for dd2.  Both births went v smoothly and I will absolutely go for vaginal again in the future.  I had no doubts that I could birth vaginally & I also had no fear of the c/s, I just didn't want (another) one!  Another thing, try and schedule your c/s for a date past your due date & you may go into labor before then.  That may give you some calmness b/c you did schedule, but baby had other plans :)  Every baby and every pregnancy is different.  Just b/c you could not push out the first one does not mean that you are destined to be in that same exact situation again.  Good luck, I know it can be a v difficult decision.

[ablepearl]

I do wonder if breaking my waters and the pitocin caused him to not position correctly. He was posterior the whole time, but he did try to turn

Yes, this had everything to do with your inability to birth your son.  If he was posterior and the cushion around him (amniotic fluid) was removed there is no way he could get himself rotated.  You mentioned epidural being turned back on, does this mean you labored with the epi?  If so were you in a hands and knees position to help him turn?  Were you out of bed in a staggered squat?  What did you do to help him turn?  With my daughter's birth I was told at 6 p.m. that she was posterior, 20 minutes on hand and knees in the bed and she was born at 6:25.  I went from 6 cm to pushing in 20 minutes.  If she had stayed posterior that wouldn't have been the case.  She turned because she had room.

Rupturing membranes cements babies in bad positions.  Have you ever tried to take off a latex glove that is soaked?  It is really difficult.  A baby trying to turn in the birth canal without the cushion of the fluids is about the same.

My last birth ended in stillbirth.  He was 24 weeks, so it had nothing to do with the birthing process.  BUt I can tell you truthfully, I have other children and they need a mother, even a broken one.  This can come across as callous, but if my choices led to MY death and left my children without a mother that would be the worst case scenario.  Dealing with the death of a baby is difficult for sure, but I am an adult and have better coping mechanism than my children do for grief.  They would have a sad life without me.

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.

[cinderella08]

Wonderful information on this thread.

[seili]

Lawmama, that was a good link; thanks!

I am now nearly 35 weeks pregnant! I did so much research and I could...not...make up my mind! They both sounded good; they both sounded potentially bad.

RCS worries me because of danger to me, in particular; VBAC scares me because of danger to the baby and because of increased likelihood of lots of tearing and/or shoulder dystocia if I do indeed have a small pelvis/pubic bone. I know tearing probably shouldn't scare me so much.....that it is better than the worse outcome of RCS, but I feel like it is statistically a higher likelihood, so I definitely have kept it in mind.

So, right now, the plan is to RCS at 40 weeks 2 days, but if I go into labor before that....VBAC! But the doctors have said I can change my mind in either direction if I definitely decide! ha ha! I do feel kind of silly that I just cannot completely commit to either one! I am very nervous about heading into surgery, but at the same time, I am almost more afraid of VBAC...all the unknowns.

I tried to ask the doctors if I could just wait till labor and then decide and they said...that is basically just a VBAC! That if I don't schedule a RCS (or if I schedule one past 39 weeks, like I choose to do), then if I have to come in otherwise, they need to have the doctor and anesthesiologist already prepared. Basically, it is hospital policy, but I feel pretty comfortable with my doctors....I have asked if I can get an ultrasound later on to see if this baby boy is in the correct position and to check head size and potentially weight and they said they could try that, but that ultrasounds are not very accurate at predicting weight and head size. So, I don't really feel like they are trying to push me in either direction.

Ablepearl, I got an epi around 8cm and apparently, pitocin, too. I think they broke my waters around 6cm, though. They had me push with the epi on and they didn't think it was doing much, so ..they turned it off. That was terrible. I had horrible back labor the whole time and eventually it got so bad that I got the epi, so when they turned it off...it all came back! Before the epi, I labored by walking, birthing ball, showering, on hands and knees, etc, but they did keep putting me up to the external montior every half hour.....very uncomfortable! And they did seem to do lots of internals...and those hurt so much for some reason! (Later, during c-section, they realized that I did have an infection...maybe from all those checks and breaking the water?) With the epi on, they had me try to push on my back, that didn't work, so we tried hands and knees and  birthing ball. Nothing. Then they turned it off and we tried all of that again....but.....I was in so much continual pain again that it wasn't very productive. And...I still had no urge to push. (Apparently, he was stuck in there, by this time, with his head sideways...but he hadn't really descended.)

I'm very sorry for the loss of your little one.

You do bring up a good point about stats on c-sections being lower because it may extend further than just a few weeks. I have wondered that. That's why I wanted to wait until at least a bit past my due date....till labor, preferably. I think 39 weeks can be okay, but I just didn't feel quite comfortable with that. My first son was 9 to 11 days overdue, so he either was legitimately late or they were a little off on his due date. (He was 8.2- so not really big or small.)

Edited by seili - 6/17/11 at 12:41pm

[ablepearl]

My first VBAC had his head tilted, which almost resulted in a c-section.  I pushed for about 2.5 hours and then they used forceps to re-position his head ( a midwife would have doen this with her hands).  After that he was out in about 4-6 pushes.  He was almost 10 pounds and had a 15.75 inch head!  Had they not fixed his head position he would have never moved.

Pushing without on urge to push is really never a good thing.  You can be complete and wait a few hours before your body is ready to birth the baby.  It sounds to me that you had a c-section for malposition and a failure to wait.

[TCMoulton]

Originally Posted by ablepearl 

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.

What condition exactly that would take the life of an infant months aft birth can be directly tied to the mom's birthing method. Unless you have some concrete information this just sounds like another case of blame everything on the mom because she consented to a c section.

[ablepearl]

Originally Posted by TCMoulton 

Originally Posted by ablepearl 

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.

What condition exactly that would take the life of an infant months aft birth can be directly tied to the mom's birthing method. Unless you have some concrete information this just sounds like another case of blame everything on the mom because she consented to a c section.

One would be Bronchopulmonary Dysplasia as a result of RSD.  In the U.S. they do not count it as a result of birth if it happens 2-4 weeks after delivery, but if a baby dies at 6 weeks as a complication of respiratory distress and the only risk factor that baby had for developing it was the mode of delivery (c-section is a risk factor for RSD) then the mode of delivery caused the death.  But, we don't see that or hear that.  In actuality it is very likely that the parent was never informed that their baby developed RSD as a result of the delivery method.
 

[seili]

Originally Posted by ablepearl 

My first VBAC had his head tilted, which almost resulted in a c-section.  I pushed for about 2.5 hours and then they used forceps to re-position his head ( a midwife would have doen this with her hands).  After that he was out in about 4-6 pushes.  He was almost 10 pounds and had a 15.75 inch head!  Had they not fixed his head position he would have never moved.

Pushing without on urge to push is really never a good thing.  You can be complete and wait a few hours before your body is ready to birth the baby.  It sounds to me that you had a c-section for malposition and a failure to wait.

First off....15.75? That does sound big! My son's head was 13.78 and I know that was kind of big, too. Did they label you as having a small pelvis, too?

And I definitely had malposition problems. And ...a failure to wait....I think so. But that is where I think both I and the doctors will be similar again. I realized during my last birth that I really must believe in preemptive c-sections! Now, I do think there are too many, but I can see why we do have more now that years ago, especially since they can do low-cut scars now. I do think that my mom should have had a c-section with me and I even think that at least one of my grandmothers should have had one.

My mom had a partial previa with me- very bad labor, lots of blood. My grandmother had 4 boys in about 3 years. (One set of twins) With her last, they nearly lost her, she had to have an emergency hysterctomy.

For me, once they turned off the epi and my severe pain returned and they weren't permitted to turn the epi back on until they got the anesthesiologist again, I knew that I was then considering a c-section. Could they have been manipulating me into one? Maybe, but I think it was just life. I remember asking how the baby was and they said he didn't appear to be in distress. I asked if they could pull him out another way and they said that he wasn't far enough down to reach. No one actually suggested a c-section to me; I requested it. Or screamed it. I'm not sure! I figured that with the way I was feeling, it could turn very bad. I didn't want it to turn into an emergency. To me, I wanted him out before it was an emergency for him. Then after surgery, they told me he was stuck in there and probably woudn't have budged much.

-----------------------

TCMoulton, I think they are still trying to determine if c-section babies do have more problems later on. It's kind of hard to tell. Well, with anything with statistics, there can be so many variables, that it seems to me things can easily be skewed. But, a c-section before 39 weeks, is definitely more likely to end up with problems. The thing about 39 weeks, though, is that they could still be off by a week or so, so I tried to remember that when scheduling my RCS.

This reports on the first 28 days following birth: http://www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html

[Lisa1970]

There is much higher risk with repeat csects than vbacs. You should join ICAN and they have lots of statistics. I almost died from my repeat csect and will be having a vbac this next time.

[Lisa1970]

There is a study that shows a 3 times higher death rate in the first year of life for babies from completely elective csects..with no troubles that led to the csects. There is also a higher rate of Autism. Those are two studies I have seen for sure.

[Lisa1970]

Last time, while I was pregnant, 4 women from these boards and that I knew in non-virtual life died from csects. The only baby I have ever known to die from uterine rupture was an initial birth and not a vbac. I have a lot of experience in that area as I did have a baby die years ago and I have been on both VBAC groups and then boards (when WWW was invented, yes, I am that old) and infant loss boards since 2000 and that is it for babies to die from uterine rupture. So I think I would know of more if it were something that ever really happened. Even if you google...death from vbac, you will find no stories of it online. You just find a bunch of people saying it can happen or it will happen. Sort of like how the martians can invade and kill all of us. It is a theory that seems to not be happening. (knock on wood of course, I would hate to see the first vbac death happen now that I said this, but even if one happened now, it would have many more to go through to catch up with the csect deaths).

[TCMoulton]

Originally Posted by Lisa1970 

There is a study that shows a 3 times higher death rate in the first year of life for babies from completely elective csects..with no troubles that led to the csects. There is also a higher rate of Autism. Those are two studies I have seen for sure.

Link?

[seili]

Lisa, if you don't mind talking about it, what happened that you almost died? Just trying to categorize it fairly in my head.

The same with the many deaths from c-sections during your last pregnancy. -What happened? Oh, my. I know fluke things do go terribly wrong, but that does seem awfully high. I do remember that a few years ago here in this state (PA) or NJ, there were two younger women who were friends that died within weeks of each other after c-sections. They were both for first and elective c-sections.

I'm not quite sure what you mean by googling 'death by VBAC', though. Do you mean you won't find deaths of moms that way? Because I've looked up lots of that for babies and that is what initially alarmed me...there seemed to be quite a lot of VBAC deaths for babies. To be fair, once I started digging into it all, it seemed that almost all of those had been induced, though. On the other side, I didn't find a death for a healthy baby by RCS. Strange, because surely there are some, but I couldn't find them. Still, I concluded that both options are fairly safe. It really depends. RCS being more dangerous for mom and future pregnancies and VBAC being a little more dangerous for baby. (And RCS having more risks for baby if before 39 weeks. - Best if waiting until labor, worse if waiting till an emergency.)

[lawmama1984]

My personal bottom line is this. Am I or my baby going to die either during a RCS or during a vba2c? Probably not. Could I find horror stories either way? Yes. For sure, moms and babies die during both RCS and vbac. In the end, though, I think a vbac would be safer for both me and baby in the very likely event that it was successful. I also am comfortable with my proximity to a hospital in the event I needed to transport. Could I or my baby die during a hba2c attempt? Absolutely. But I'm prepared to accept responsibility for the decisions I make with regards to my next birth. I think that's what is important. You decide what your own comfort level and make a decision for you that you can own and be comfortable with.

I've really enjoyed this discussion

[ablepearl]

Something to keep in mind when looking at the statistics for fetal demise with VBAC is that when a baby is bornstill at term, the doctors REALLY encourage mom to VBAC.  So in some of the studies the babies that died in the VBAC births, were already dead before they were delivered.  They still include them in the statistics for fetal demise.  

[labortrials]

Originally Posted by ablepearl 

Something to keep in mind when looking at the statistics for fetal demise with VBAC is that when a baby is bornstill at term, the doctors REALLY encourage mom to VBAC.  So in some of the studies the babies that died in the VBAC births, were already dead before they were delivered.  They still include them in the statistics for fetal demise.  

Really??  I didn't know those would be part of the stats.

Honestly, for a VBA1C, there are larger statistically likely 'emergencies' that have nothing to do with VBAC that every childbearing woman face whether they know it or not.  The risk for an un-induced, un-augmented, un-anesthetized VBACer to rupture is really quite low, not much elevated from a non-scarred mom.  It's if/when you start having 2ndary fertility issues or want to have more kids and are tired of getting cut open for it . . . after this RCS where things REALLY get complicated.  It's even HARDER for a mama to find a provider who will 'let' her VBAmC.  And even if she does find someone, it doesn't mean that the CP won't do things to undermine the likelihood of a successful VBAC.

IMO, you need to look at this birth and what's at stake but also look into the future at the size of family you want.  My fertility, my sanity, and my care options have been severely impacted by that first cut . . . and then that second cut . . . JME.

[phaedra13]

This is a fantastic VBAC story from a mama who sounds like she had a similar experience to yours - she was dilated and pushed for a long time, even though she never felt the urge. She and her care provider and doula did some amazing prep work in terms of thinking through what new choices she could make for her second birth and it resulted in a fantastic VBAC story. I share it just because I think it speaks to what can happen when a mama who had a mispositioned baby the first time around chooses to VBAC.

http://bloomingtonbirth.org/blog/2011/06/20/my-vbac-story/

Also, what about letting your body begin labor and then doing a semi-scheduled c-section? Or just winging it and seeing how it goes when you're in labor? I mean, if you birth in a hospital, you can have a lot monitoring happening and they can take life-saving measures so unbelievably quickly. Maybe that would put your mind more at ease? At the least, allowing labor to begin would ensure your baby is ready to be born, right?

[nanasmom]

I never posted my HBAC story but I really should to give others hope and strength for their VBACs.  Without going into major detail and hi-jacking this thread, I will share some details.

My first birth story is very similar to yours.  Per my OB's advice, I induced myself at about 41 weeks with castor oil.  I went into labor that night and my water was broken by my OB once I got to the hospital.  Labor was progressing perfectly (went from 2 cent to 10 in 5 hours with no pitocin) but when it came time to push I had no urge!  Needless to say, I pushed on my back for 2 1/2 hours with no progress and ultimately had a c-section.  My OB was concerned about shoulded dystocia and CPD so "didn't want to take any chances."  because the baby was measuring big.  3 years later, when I was reviewing my records because I was pregnant again, I found that DD was malpositioned - no one mentioned this to me before or after birth! 

For my second birth, I knew I wanted a VBAC but I was too afraid of all the unknowns - unterine rupture, shoulder dystocia, tearing, pain, etc,  Once I got over my fear of uterine rupture, I began to think of shoulder dystocia, then I got over that was afraid of tearing, and it went on and on.  I knew that I really wanted a VBAC and found a midwife with the experience, skills, and confidence in herself and my birth ability to have a perfect VBAC.  My labor was LONG and extremely painful from the start, but once I was in labor I never thought twice about rupture, shoulder dystocia, or tearing - I just let my body do the work.  After 13 hours of intesne labor and over 3 hours of pushing, I had a gorgeous baby girl weighing in at 9 pounds 2 ounces (bigger than my first) !!  And all I had was a little skid mark!! 

Knowing what my body is capable of doing and that all my fears were unwarranted, I can't imagine if I would have just scheduled a repeat c-section but having a VBAC is not for everyone.  I think the main point is just being confident in what you decide - whether that is a VBAC or RCS.  And if you ultimately decide on a VBAC, make sure you have an OB/midwife who is confident in your ability to have a VBAC. 

[Lisa1970]

Originally Posted by TCMoulton 



Link?

I am sorry. I do not always come back and check the posts so I did not see this sooner. I had great statistics printed out from ICAN, so I know I got it there. But it will take digging to find the website. I have a different computer now. I will post on the ICAN group and see if they can re-give me the links.