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Would you vbac or not?

post #1 of 21
Thread Starter 

I had a c-sec 2 years ago for failure to progress. Could not take pitocin b/c baby did not like it, only dilated to 6 then the cervix started to swell and close. Things just were not working out! 2 weeks after the c-sec I was back in the hospital from peritonitis from my c-section. This is extremely rare to get from a cesarean, as usually it is a complication from the appendix bursting. It was awful and painful and I was in the hospital that time 9 days, could not see my baby, etc. 

 

Now I am expecting #2 and my dr is recommending another c-section. I was fine with this at first but the more I think about it, I am terrified I am going to get the same infection! What if my body just hates surgery? I really want to try a vbac and found a dr. who is willing to let me try. He is not under my insurance so I would have to pay about $3000 out of pocket. I have seen this dr. before and know he is wonderful. I am just so torn b/c of course I will have to pay him if the result is c-section as well. I know the chances are not as great too since my reason for c-sec in the first place was a dilation problem.

 

Would you do it? Do you think it's worth it or it's best to just have it scheduled?

 

Thanks in advance!

post #2 of 21

I'm not the super-knowledgeable medical type (many of the women who post here are), but I'm wondering how long you were in labor, whether you were comfortable in your surroundings (I know labor isn't comfortable!  I mean no one was freaking you out or trying to make you hurry), whether you had dedicated support like a doula to help with position, etc., and stuff like that.  I've seen a lot of posts from women whose cervixes began to swell, and who were then allowed to take time to let them go down again.  Of course, if the babe was genuinely doing badly, maybe there wasn't time, but it sounds like ~perhaps~ you were much too rushed along.  In any case, as someone who survived a c/s and HATED it, even without any complication, I would say do not, not, not schedule one if you are in any doubt that that is what you want.  Your experience is excellent testimony that this is MAJOR surgery.  Why on earth do it if you don't have to????  Could you at least consult with a midwife for advice?  Even if you must have a ob for insurance or other reasons, a midwife can give a whole different perspective and a lot of good advice.  And if you go for a VBAC, have a whole battalion of advocates (or just one good doula!) to make sure no one is pushing anything on you.

post #3 of 21
Thread Starter 

Here is more info...I was having contractions for a few days, my water broke on it's own so I went in and I was not even dilated. I was having painful contractions trying to walk around to get myself to dilate. It was really slow after that...Like 1 cm every 2 hours. I got an epidural at 3 cm (I know I am embarrassed to say...way too early now I know, I was getting  faint, seeing blurry, hearing buzzing sounds and just feel like I couldn't do it anymore after a few days on no sleep). Now I am mad at myself for getting it so early. I did not have a doula, just the nurses and my hubby. After the epi I dilated at the same rate...1 cm every 2 hours until it just stopped. After 15 hrs I had surgery. In hindsight I wish I had educated myself better. I just assumed I would go in and pop out a baby like all the other women in my family and did not worry about it too much before labor.

post #4 of 21

I would find a way to pay for it.  WHat type of insurance do you have?  Some will cover a portion of the doctor, even if they are out of network.  If not can you get Medicaid?

post #5 of 21

Hindsight is 20/20, that's for sure.  But now you know, and it seems to me that since you wish you'd done differently last time, you should take advantage of that knowledge and really try to hedge your bets for next time.  (Needless to say, you can't hedge them too much where birth is concerned.)  But (again, this is just my impression) I get the feeling if you do a planned c/s without a clear indication, you may end up with another set of regrets for this one.  So yeah, as I said before, maybe talk to a midwife for medical advice, get a doula, and check out your ICAN chapter for dr. recommendations.  They may know of a good one who takes your insurance that you haven't heard of.  I wish you VERY MUCH luck!

post #6 of 21

Just because you weren't dilating well last time does not have anything to do with how you will dilate this time! Your baby might have been in a position that wasn't putting adequate pressure on your cervix. Different baby, different pregnancy, different labor. 

post #7 of 21

I would absolutely try!

post #8 of 21

I say go for it!  I've had two VBACs (and both of those labors were 30 hours+) and they were great experiences.  I agree with the PP, if you aren't 110% sure that you want a repeat c-section, I'd find a great doula and give it a go.

post #9 of 21

I would try no doubt.

post #10 of 21
Thread Starter 

Thanks so much for all the input, support and advice! I am going to check out my local ICAN and call the insurance company Monday. To be honest both options (VBAC and C-sec) scare me. I read a horror story last night on a VBAC and it just has me on the fence. I know the chances are slim of uterus rupturing but if that happened and something happened to my baby I don't know if I would ever forgive myself! I am just wondering if it is worth it. But I def agree it's a different pregnancy and everything could be completely fine! With my son it turns out his head was not in there correctly, so that was part of the problem with me not dilating.

post #11 of 21

your body is not broken!  from your first labor it sounds like you can and do dilate just fine--you just don't dilate on someone else's schedule.  steady progress is, after all, progress.  a wonky baby head position definitely affects dilation, as well as being on your back--or in any one position--too long during labor. 

 

most practitioners don't learn how to re-position mother's body to affect the baby's position.  anymore if the baby doesn't come out like butter, it's off to the OR you go.  that middle ground of skills in  being cognizant of baby's position and how it affects labor patterns is sadly being lost.  that's why midwives and doulas are so amazing and such important allies to have on your birth team. 

 

only you can decide what level of fear you are willing to face and work through, what is most important to you right now, and what you are "willing to live with".  best of luck with your decisions!

post #12 of 21
Quote:
Originally Posted by katiepip View Post

Thanks so much for all the input, support and advice! I am going to check out my local ICAN and call the insurance company Monday. To be honest both options (VBAC and C-sec) scare me. I read a horror story last night on a VBAC and it just has me on the fence. I know the chances are slim of uterus rupturing but if that happened and something happened to my baby I don't know if I would ever forgive myself! I am just wondering if it is worth it. But I def agree it's a different pregnancy and everything could be completely fine! With my son it turns out his head was not in there correctly, so that was part of the problem with me not dilating.



What would be your choice for birth if you did not have a previous c-section.  Would you even consider an elective c-section without a previous surgical birth?

 

If not, why?  Do you know the risks of vaginal birth without previous surgery?  There are risks with birth, all birth.  

post #13 of 21

I really like this site for putting the risks of VBAC in perspective. Its all research based *fact*. http://vbacfacts.com/vbac/ Here's a quote:

 

"while the rate of uterine rupture in a spontaneous labor with one prior cesarean is approximately 1 in 250 (0.4%), 1 in 2000 (0.05%) VBAC babies will have a bad outcome.

However this rate is inflated as Landon (2004) included women who had pre-labor stillbirths in this statistic.  In other words, women whose babies passed away before labor, had VBACs rather than repeat cesareans, and so those deaths were counted towards the 0.05% statistic.  Please read Henci Goer’s analysis for more information.

In Table 6 entitled “Perinatal Outcomes After Uterine Rupture in Term Pregnancies” Landon (2004) stated that from 114 ruptures at term, 7 (6.2%) babies had hypoxic-ischemic encephalopathy (oxygen deprivation), 2 (1.8%) died, 46 (40.4%) were admitted to the NICU, 16 (14.0%) had 5-minute apgar scores less than or equal to 5 and 23 (33.3%) had umbilical artery blood pH less than or equal to 7.0. So, there was a “bad outcome” for VBAC babies in 1 out of 2000 trials of labor.  That’s a very small number."

 

 

post #14 of 21

I haven't had my VBAC yet. I'm due in just 5 weeks. I was a home birth turned hospital transfer last time. I'm going for another home birth this time, as I know that despite what happened with my DS my body is not broken. Here is my story in case it helps.

 

My waters broke just before 1am Monday morning, and 20 min later my contractions started at only 5 min apart. DH & I foolishly thought this meant we would have a quick labor. Even though contractions were close together I could easily talk through them. We were excited first timers and after a few hours called the MW (LM) to come to the house (bad idea, still way too early) as she lived on the same street as us. It was about 10am before she checked me for the first time and I was only 2cm. It was at this point we realised this was going to be a really long slow labor. I tried using the tub a few times but found it much more comfortale to be on my feet leaning on DH for support during contractions. They were not getting closer together, but were very slowly getting longer and more intense. By late afternoon I had gotten to 4-5cm and then by 10pm I was at 7-8cm. It was at this point the MW first mentioned the possibility of a transfer if I reached 24 hours without getting to the pushing the bay out stage. By the time I reached 24 hours after ROM I was still only at 8cm so I had to transfer to the hospital (stupid Florida law for LMs.)

 

At the hospital I was immediately put on EFM and kept in bed as they would loose the heartbeat whenever I moved. They also had problems finding my veins (a lifelong problem that I tried to warn them off) so instead of listening to me about my veins being deep they assumed I was dehydrated from the long labor and started pumping me full of fluids. I got put on pitocin to try to augment my own contractions. But I refused the epidural. I labored the rest of the night with the pitocin which wasn't even doing anything for me. (The problem was mal-positioning not contractions) I was checked by the on-call OB just before the morning shift change and was told I was fully dilated with just a cervial lip, and I'd be pushing within the hour. An hour later the new on-call OB checked me and I was back to 8cm, the same as when I was admitted. He was really pushy about an epidural, and as tired as DH & I both were (no sleep in 48+ hrs) we gave in. After I had the epidural I made no further progress. At noon it was decided I needed a c/s for stalled dilation. At 2:23pm after over 37 hours of labour DS was born by c/s.

 

Only 6 months later I got pregnant again with this LO due in just 5 weeks. DH & I have learned a lot about what went wrong and what we need to do differently this time. We didn't know LMs had a time restriction for ROM. This time we have a CNM as she doesn't have that restriction so the labor can take as long as it takes. We also called the MW too early and got too focused on the birth while still in very early labor so I become the proverbial watched pot. At the hospital I didn't get to move around enough to keep going, and didn't take in that my dilation reversed until months after. If I had realised at the time I would probably have fought against the c/s instead of consenting to it.

 

This time we are a lot more prepared to keep me eating for strength. To prepare for a long slow labor if it goes that way again. And more importantly we have learned a lot of physical things to do to help labor along, including positions that keep my pelvis open and what to do when progress appears to stall. I've also been working on better fetal positioning ahead of time to try to prevent the mal-positioning DS had.

 

While I know there are some risks to a HBAC everything I've read shows a greater risk to me of a ERCS and also of hospital protocol not being in my favor. I completely trust my CNM's judgement, and we have talked through as many of the different situations as we can think of. She is very confident in my ability to birth this baby naturally and at home.

 

Slow doesn't mean your body doesn't work. It just means your body takes labor slowly, and there can be benefits to a slower labor (less trauma & tears) if you are given the right support and environment.

 

Only you can decide what kind of birth is best for you. Just like only I could decide what kind of birth to aim for this time for me. Hopefully I'll have a good HBAC, but only time will tell. Even if it doesn't go according to my plan, I know that I am not broken, sometimes the baby just isn't quite in the right position.

post #15 of 21

I second the above opinions on getting a doula - having not only an informed advocate at the hospital but also an experienced person that can help you adjust so baby is in a more ideal birthing position is just a great thing, I think. I've not had my VBAC yet - I'm due the end of September - but I would really only choose an ERC if a vaginal birth were completely impossible. (complete placenta previa or something) -but that is me.

 

you were making progress, just slow progress. I stalled at 7 cm, more due to baby's malpostion than anything (that and I just did not do great with Pitocin).

 

As far as doulas, since you may already be footing a big doctor bill, you could check and see if there are any doulas in training that may be willing to attend you for free, or experienced ones willing to work with you on the price. Many are and do.

post #16 of 21

I was recently checking out some birthing centres - and many of them do not offer services to VBAC patients?! quite disappointing!

post #17 of 21

It may depend on where you are located and what regulations are there. For example, in SC, there are . . . .statutes or mandates (one of the two, whichever, it's not exactly illegal but strongly discouraged) against midwives attending VBAC's outside a hospital setting. However if a birthing center has an OB on staff, then it's ok - but I only know of one in the whole state that does.

 

Every state is different, and I am sure Canada has its own sets of rules that might vary by location.

post #18 of 21

Oh where I am currently living midwives aren't even regulated! There are no birthing centres of any kind here :) However we are moving to Houston very soon, and I was excited about the potentiality of a birthing centre but so far the ones I've looked at don't do VBAC's!

post #19 of 21
Thread Starter 

Thank you for all the tips and advice! Turns out the Dr who would agree to do it will be on vacation at the time I am due. I do have some other OBs to ask who I know are open to VBACs so I have not given up hope yet. The hospital I have to deliver at through my insurance is the only hospital in my county that allows them too, so I figure at least let me try! Just a little more research and hope it turns out well.smile.gif

post #20 of 21

I would most defiantly go for a VBAC.  Being induced increases your risk for having a cesarean so if you were induced last time and then had a (failure to progress) that would most likely be why.  And for a VBAC I would NOT be induced. 

More info at http://www.ican-online.org

http://www.vbacfacts.com

 

And read Henci Goers "The thinking womans guide to a better birth" http://www.amazon.com/Thinking-Womans-Guide-Better-Birth/dp/0399525173/ref=sr_1_1?ie=UTF8&qid=1312265402&sr=8-1

I think EVERY birthing woman VBAC or not should read this book. VERY informative.

 

Good Luck!! You can do it!

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