1st CS due to baby's head stuck; vbac possible?

[lisafalknerlmt]

I'm wondering if any of you moms out there had an experience in which a c-section was necessary because the baby's head was stuck, and were still able to have a vbac with your next child?  i don't know if another child is in our future or not, but if i do decide to have another, i want to know if anyone else has been in my shoes.

my entire pregnancy with ryleigh was fantastic, but at 36 weeks i started showing signs of pre-ecampsia.  i'm a massage therapist and have a lot of experience with meditation and relaxation techniques so i was doing everything in my power to stay calm and relaxed.  i had been planning a natural birth all along and had taking hypnobirthing classes.  but at my 37 week visit with my midwife, my blood pressure was sky high and feet and legs extremely swollen.  she send me for a NST and Ryleigh was looking great, did the 24 hour urine test, and everything was fine.  2 days later went for another NST, and my BP was just too high and i was sent to the hospital to be induced.  cervidil for 12 hours, then pitocin for another 12 hours and NOTHING.  some contractions but nothing regular and absolutely no dilation.  my blood pressure actually stabilized so i was sent home on strict bed rest.  back for another NST 3 days later and BP was high but not crazy, baby was still doing fantastic.  next day received acupuncture and did some self acupressure to try and get things moving.  i got super excited because contractions were regularly coming 4 minutes apart for 3 hours but then everything stalled.  next day went for another NST, and again was sent to be induced. 

this time i had cervidil for 12 hours, meso for 4 hours, a foley catheter in my uterus to help me dilate, and when i finally got to 4cm, they broke my water.  at this point everything becomes a blur.  i hadn't eaten in 24 hours, hadn't slept in 2 days.  i don't remember asking for the epidural (my husband tells me later i was sobbing as i asked for it) but i do remember 2 nurses trying to hold me still while i received it because i was shaking so bad.  i think i slept some that night but at some point the epidural wore off on the left side of my body and anesthesia came in to adjust it.  my midwife came in in the morning and told me the best thing i ever heard: "you're fully dilated and can start pushing!"  after almost 3 days of induction, i couldn't believe it was finally time.  i pushed for a hour and a half when my epidural wore off again.  i was making very little progress with each push so the midwife tried getting me into other positions but the epidural was still affecting me enough that i really couldn't.  i pushed for another hour when they had an OBGYN come in and check me and determine that i needed a CS, her head just wasn't going to fit.  it was at this time that i remembered my midwife telling me at my first prenatal visit that i had a very low lying pubic bone.  she had said not to worry, that the body is an amazing thing and moves and adjusts for pregnancy and delivery.  booooo.  the surgery itself was aweful, i kept vomiting (which i had done throughout the past 24 hours) and couldn't stop shaking.

through this entire crazy ordeal, Ryleigh never had a decel, never showed any distress at all.  she was perfectly happy in there.  she was born healthy and happy at 8lbs, 5oz.  my BP shot up again after the CS, so i was put on meds and sent back to L&D instead of the postpartum floor for another 24 hours.  6 days i was in the hospital!  i look back now and the 3 day process of bringing Ryleigh into this world is all a blur.  i don't remember what the pain felt like or crying into my husbands shirt, all i remember is holding that precious baby in the recovery room.

so here's the deal:  i will always wonder if i could have done it vaginally if i hadn't gotten the epidural and was able to get into a squatting position.  if i have another baby, and in some magical circumstance i don't develop pre-eclampsia and don't have to deal with an induction, would i be able to do a vbac?  i'd love to hear a story from someone that my have had a similar experience.

[kltroy]

I'm so sorry you had such a difficult first birth *hugs*  Yes, I know several women who have gone on to have successful VBACs, even after the first c-section was for a baby that got "stuck".  Often this is simply bad luck with baby positioning.  There are certainly some women with pelvis shapes that give a bit less clearance for a baby, so require "more perfect" positioning for the baby to fit through than someone whose pelvis has more wiggle room.  You may be one of those. 

In any case, I don't see any reason *not* to plan a VBAC for next time around.  I hope someone else will chime in with a personal story.  My c/s was for breech presentation, so I didn't even have a chance to labor the first time around.

[Monkey Keeper]

Hey there mama!  I too am a pre-e survivor with a long induction under my belt. My c/s was my next pregnancy, though.  

From the sounds of your story, I am guessing your baby was asynclitic, with her head off to the left. With my DS, my epidural "did not work" on the right, but mostly because his head/elbow were wedged against where my pelvis meets my right hip. That bone-on-bone pain was the reason I got the epidural in the first place, and it broke through to the point where the epidural was useless. I would wager that your baby wouldn't "fit" because the appropriate area of her head was not presenting.

Optimal fetal positioning will help you a lot, but much of her position probably was due to bedrest, the induction and having your waters broken so early in labor, before she was well engaged.

FTR, the biggest thing that helped my DS's position (he was all over the place including breech and oblique just a couple weeks before he was born) was chiropractic and massage. My LMT could get him to move almost anywhere, and he still LOVES hearing her voice to this day :)

[ablepearl]

http://www.midwiferytoday.com/articles/pelvis.asp  Great article/essay discussing pelvises.

http://www.youtube.com/watch?v=roFVkDV45MM Video of women that had 'stuck' babies and went on to delivery future babies via VBAC.

[lisafalknerlmt]

thanks pinkbunch!  i did receive chiro care and massage throughout my pregnancy, did yoga poses to optimize position, and her head was in optimal position at every ultrasound, but who knows if it was through that last week or even that day.  shortly after they broke my water and the contractions became intense, my piriformis muscle in my right glut spasmed, which was more painful than the contractions.  but now you've got me wondering if that pain was actually something else, like her position.  poor ryleigh had a huge cone head when she was born even though it was a CS because i had pushed so long with her head poking through my pelvis that she had a lot of swelling (it was gone within hours).  thanks again for your input

[lisafalknerlmt]

ablepearl, great article and great video, thank you!

[cairomama]

A longer pushing time or waiting until you felt the urge to push might have helped. Walcher's position might benefit you next time if the same thing were to occur. 

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

I've seen it work in situations where there was no progress for 12-24 hours in a moms with narrow pubic arches. Pushing phase can still be long, but it causes definite change.

[dlm194]

Do you happen to know if your baby was posterior?  Chiro care and yoga should help prevent that but sometimes babies favor that position (e.g. babies often favor the posterior presentation with an anterior placenta).  There have been 2 women in my local ICAN group who pushed for hours without epidurals or inductions.  Their babies just got stuck.  The first one VBACed a baby that was over a pound bigger!  The 2nd had 2 VBACs since.

[lisafalknerlmt]

dlm194, her head was facing down, not up, which is optimal, right?  and i was actually on the verge of placenta previa around 20 weeks so i kept coming back for more ultrasounds and by 32 weeks it had moved far enough away from the cervix to not be a problem (at the time i felt so relieved to know that i didn't have to have a c-section, but i ended up with one anyway!).  from what my midwives said, ryleigh was in a perfect position the entire pregnancy.

[Monkey Keeper]

Originally Posted by lisafalknerlmt 

dlm194, her head was facing down, not up, which is optimal, right?  and i was actually on the verge of placenta previa around 20 weeks so i kept coming back for more ultrasounds and by 32 weeks it had moved far enough away from the cervix to not be a problem (at the time i felt so relieved to know that i didn't have to have a c-section, but i ended up with one anyway!).  from what my midwives said, ryleigh was in a perfect position the entire pregnancy.

Even if baby is head down, the head can present in a variety of ways that are less than optimal. Do you remember where the cone was, exactly, on her head? That could give some more information.

Generally, though, bedrest and an epidural often lead to posterior babies which may have trouble fitting through particular pelvic arch shapes. (Which I think was dlm194's point...)

[CookAMH]

Yep :). I had a HBAC three months ago after my first was stuck. You can absolutely do it.

[Lisa1970]

Your baby got stuck because she was not ready to be born yet and was induced. There are diets and such you can follow to reduce the chances of preE. Plus, it does not always repeat itself. I had a similar experience as yours with my first, the induction part anyway. And I went on to have a VBAC with my 2nd. Good luck! (((hugs)))

[dlm194]

Yes, the epidural can make things tougher even though it sounds like baby was positioned okay.  It's possible that her head was cocked slightly to the side,etc.  An induction was trying to force her out before she was ready, especially an induction that took that long.  It's also very possible that you were way too exhausted to push more effectively.   Labor is often compared to running a marathon, yet runners don't starve themselves in the process!  At any rate, there were so many factors contributing to your c-section that I think it's perfectly reasonable to plan and expect to birth vaginally next time.  I started pushing my VBAC baby (no epidural or other meds) around 3pm and finally pushed her out a little after 7pm (though I "officially" started pushing at 5:30; my baby was still floating so I had to push her down into my pelvis to push her out).  The Brewer's diet (you can google it) is supposed to help prevent pre-e.  I thought I remembering hearing that vitamin D helps as well (but I'd look that up because I'm not 100% sure on that).  Good luck!  :)

[Monkey Keeper]

Originally Posted by dlm194 

The Brewer's diet (you can google it) is supposed to help prevent pre-e.  I thought I remembering hearing that vitamin D helps as well (but I'd look that up because I'm not 100% sure on that).  Good luck!  :)

Originally Posted by Lisa1970 

There are diets and such you can follow to reduce the chances of preE. Plus, it does not always repeat itself. I had a similar experience as yours with my first, the induction part anyway. And I went on to have a VBAC with my 2nd. Good luck! (((hugs)))

Pre-e is largely a disease of primips (or first pregnancies with a particular partner); the risk of recurrence with no underlying factors like chronic hypertension or clotting disorders is usually quoted at well less than 10% unless onset was extremely early or the case was particularly severe. Of course optimal maternal nutrition is going to improve pregnancy outcomes, and that goes even further when it's a situation of maternal/fetal conflict like pre-e is theorized to be. But the Brewer diet is neither prevention nor cure; in fact, Dr. Brewer's study has long since been refuted. Please don't go selling snake oil to mamas who have been through the wringer that is pre-e.  As for vitamin D, current research does seem to indicate a correlation between vitamin D deficiency and pre-e; it is one of the more promising areas of research into the disease right now.

lisa, I wish you all the best!

[lisafalknerlmt]

thank you so much everybody!  i do feel confident that under different circumstances i could have had my dream natural birth and maybe next time i can do more to ensure that i get it.  thanks for all the info, it really does help.

[dlm194]

Uhm, what the heck???  Who said anything about snake oil? 

First of all, the incidence of a woman developing pre-e in her 2nd or subsequent pregnancies (when she didn't have it in her 1st pregnancy) is under 10%.  Women who have already had pre-e are at an increased risk of developing it again.  There are so many factors that go into developing pre-e, that you can't necessarily give someone an exact risk potential. 

The Brewer's diet is discussed in the Bradley method of childbirth.  It talks about how much dairy, protein, calcium, whole grains, fruits etc, one should eat.  It's hardly an "out there" kind of diet. No one is trying to encourage non-safety tested supplements.

Originally Posted by PinkBunch 

Pre-e is largely a disease of primips (or first pregnancies with a particular partner); the risk of recurrence with no underlying factors like chronic hypertension or clotting disorders is usually quoted at well less than 10% unless onset was extremely early or the case was particularly severe. Of course optimal maternal nutrition is going to improve pregnancy outcomes, and that goes even further when it's a situation of maternal/fetal conflict like pre-e is theorized to be. But the Brewer diet is neither prevention nor cure; in fact, Dr. Brewer's study has long since been refuted. Please don't go selling snake oil to mamas who have been through the wringer that is pre-e.  As for vitamin D, current research does seem to indicate a correlation between vitamin D deficiency and pre-e; it is one of the more promising areas of research into the disease right now.

lisa, I wish you all the best!

[Monkey Keeper]

Originally Posted by dlm194 

Uhm, what the heck???  Who said anything about snake oil? 

First of all, the incidence of a woman developing pre-e in her 2nd or subsequent pregnancies (when she didn't have it in her 1st pregnancy) is under 10%.  Women who have already had pre-e are at an increased risk of developing it again.  There are so many factors that go into developing pre-e, that you can't necessarily give someone an exact risk potential. 

The Brewer's diet is discussed in the Bradley method of childbirth.  It talks about how much dairy, protein, calcium, whole grains, fruits etc, one should eat.  It's hardly an "out there" kind of diet. No one is trying to encourage non-safety tested supplements.

It frustrates me the weight given the Brewer diet here when the results have NEVER been replicated and have in fact been refuted. I was using "snake oil" euphemistically to address that. I know what the Brewer diet is, and I firmly believe that proper nutrition improves pregnancy outcomes, but the Brewer diet is neither a prevention nor a cure for pre-eclampsia. Period.

I do apologize for my risk error. You are right, recurrence rates are closer to 20%, excluding underlying risk factors or early onset. I did offer the qualifiers, and I do understand that risk of recurrence is relative to the individual.

I'm sorry if you were offended. I just disagree with you regarding the Brewer diet. The rest of what you posted? I was nodding along in agreement.

[ablepearl]

I am not sure as to the Brewer diet specifically, but I also don't eat some of the foods on the list so, there is that.  I do know that there has been indication that pregnant women that eat higher levels of protein have less incidence of pre-e.  I think Brewer says 70 grams, whereas other things i have read say at least 80-120 grams of protein.

Other supplements aside from Vitamin D that have shown to be helpful are extra folic acid, L-arginine, calcium, magnesium, vitamin C and lycopene.

[dlm194]

No problem Pinkbunch.  I actually remember looking up the risks for a friend of mine several years ago who had a c-section for pre-e (failed induction).  She wanted a VBAC but she was met with a lot of opposition largely due to her pre-e (she was in fabulous shape otherwise).  She didn't have a VBAC that time but she did go on to have a VBA2C.  I don't have personal experience with pre-e but I think it's worth looking into diet modifications which could potentially help (as long as they are reasonable as far as nutrition goes).  I hate for any woman to feel she is doomed to a repeat c-section for a condition which may or may not repeat.  I knew that my last baby would likely be a cbac  based on positioning but I didn't give up on VBAC until I was in labor in the hospital and knew for sure that my baby wasn't budging otherwise.