VBAC advice....

[Faither]

I'm currently pregnant with #2 and am due in late Feb/early March. After pushing for two hours with #1 I ended up with an emergency c-section due to baby being "stuck." At the time I was made to feel that she had turned her head and was just stuck. At a follow up OB appointment I found out she was in fetal distress.

Before I go any further, I should say that my doc has a very low CS rate and knew that I really did not want one unless it was absolutely necessary. She supported my wishes to use Hypnosis for pregnancy even though she warned me that she has seen other patients have trouble with it. She was wonderful throughout the pregnancy and I was planning on using her again this time around until yesterday.

At my appointment yesterday she told me that while she would be more than willing to do a VBAC that the hospital will under no circumstances let her do them. She said that she's tried and has almost lost her privileges at the hospital because of it. She also mentioned that if I had a small pelvis then, it would be even smaller for #2 because the next one is "always" bigger than the last.

So I guess my question is what would you do if you were me? Stick it out with a doc you know and trust or start looking for a midwife? The closest hospital with a "good" VBAC rate is over an hour away from me. My doc did mention that if the hospital changes the rules, she'd do it as long as it was safe for me and baby.

[LiLStar]

Sounds like your baby got wedged in your pelvis in a difficult position. posterior and/or asynclitic, perhaps? That is a VERY common reason for a c-section, especially in first time moms. It does not mean your pelvis is too small. it does not mean that you won't be able to birth a baby who is significantly larger.. I promise! Position matters much, MUCH more than size. My first baby was 8lbs 14oz and wasn't positioned well. Even after pushing several hours, I just couldn't move her, so I had a c-section. My 2nd was 10lbs 2oz and in an excellent position. He was born vbac. My story is not remotely unique. Its pretty much cliche in the VBAC community ;) You CAN do it! 

Have you gotten in contact with ICAN? http://www.ican-online.org/ from there you should be able to find the international ICAN forums, a link to join their yahoo group, as well as find your local chapter. Your chapter will have meetings and probably a yahoo group. They'll be able to point you in the direction of some truly supportive providers, and help you find your local options, both in hospital as well as out, if a home birth is something you might consider. ICAN as an organization does not endorse any specific providers, but the moms/members involved will share with you their experiences and tell you who they loved/didn't love! 

[MarineWife]

My first was born via C-section and my other 3 were born vaginally. I would do everything I could to find a HCP and birth place that will support my desire for a VBAC. For me, after my 2nd, that meant homebirth, which was the best thing ever. I could never go back to a hospital birth after my homebirths.

There are many factors during labor that could affect how your labor progresses and the position of your baby. Regardless of how supportive your OB says she is or was, hospital practices essentially put you in a position to fail (not you but your birth). Your OB may mean well but she probably does not have much, if any, experience with normal labor and birth. Hospital practices result in labors and births that are not normal no matter how you go about it.

I would take my body and my baby and my money (whether it's out of pocket or insurance) somewhere that truly supports VBACs rather than giving it all to a hospital that has something other than the well-being of mother and baby at heart.

[blessedwithboys]

Your pelvis is not too small for your baby!  Did you push standing/squatting or were you in bed for the whole duration of pushing? 

My friend had 6 babies:

1. 2lbs (preemie)
2. almost 7lbs
3. over 9lbs
4. not quite 8lbs
5. 7 and change
6. 8 and change

(As you can see, not every subsequent baby is larger than the last.)

Baby #3 required some serious squat-pushing, but he came out after only a 3 hr labor.  Not 3 hrs of pushing, 3 hrs from first contraction to first nursing.  And not a bit of tearing!

Baby #5 wouldn't come out no matter how much she pushed.  And neither would #6, which was an attempted HBAC no less.

It's not about fetal size, it's about position.  And it's not about the size of the mama.  My friend is quite a bit under 5ft tall and extremely small-framed.

In your shoes, I would do whatever it took to find a HB MW.  Best wishes!

[XanaduMama]

Originally Posted by Faither 

At my appointment yesterday she told me that while she would be more than willing to do a VBAC that the hospital will under no circumstances let her do them. She said that she's tried and has almost lost her privileges at the hospital because of it. She also mentioned that if I had a small pelvis then, it would be even smaller for #2 because the next one is "always" bigger than the last.

Honestly, I couldn't trust anyone who told me such nonsense. Second babies are definitely *not* "always bigger" than the first (), and the whole business of your labor, her attitude toward Hypnobabies, and the discrepancy between what you were told in labor and what the chart says would have me running for the hills. Genuine cephalopelvic disproportion is *extremely* rare (I'm 5'2" and small-framed, ftr, and I've had two really easy births): your pelvis is designed to open up to birth the babies it grows. Like PPs said, malpositioning is much more likely.

Find a midwife, check out ICAN and the VBAC forum here, and definitely work on optimal fetal positioning/spinning babies to get your little one into the best possible position for birth.

ETA: which position were you pushing in? If you were on your back, and/or in more or less one position the whole time, that could be another contributing factor. A good MW should be able to suggest different positions to push in, if baby's not progressing downward.

[cameragirl]

I would also recommend checking out ICANN and calling around to find a HCP that supports your choice for a VBAC. It is very rare to actually have a pelvis too small to deliver. Our bodies grow babies that we can birth. You know what is funny? If you look at the stats, there are a LOT of shoulder dystocia cases with small babies. Fat smooshes, and your pelvis is made to stretch and open. It has a lot to do with the position of the baby, and the position you labor and deliver in. If you are able to get up and move around, squat, sit on a birthing ball, etc. you allow your pelvis to open more widely.

[Faither]

Thank you everyone! There are two midwife practices near me and I'm going to call both later today. DH and I ultimately want me and baby safe and sound but I think for me (mentally) I need to at least try a VBAC. Which doesn't seem likely with my current doc.

I suppose I should edit my post to say that I ended up with an epidural (somewhere at 7cm) and then was stuck in bed for the rest of labor. I progressed quickly to 10 and pushed for 2 hours or so. But I couldn't feel a thing and had to have someone tell me when to push. It was awful. I was so scared from not knowing what to expect (despite reading and watching videos and talking to people) that I just gave in and got the epidural. Plus I was GBS+ so the doc wanted me at the hospital sooner rather than later. I labored at home for maybe three or four hours before going to the hospital.