VBAC so close...yet so far.

[Meleroo]

I'm 37 weeks 5 days.  I have wanted a VBAC since the moment I signed the consent for the last c-section (pre-eclampsia) four years ago.  The pregnancy has been uneventful but we have felt as though there were a lot of bridges to cross.

#1:  We had to hope the pre-eclampsia would not re-occur or we would likely end up in c-section again.  I'm still wearing my wedding rings, we are way past the time it started last time,  and my blood pressure remains on the low side of normal so we are ecstatic to cross that off the list.  Yeah!

#2:  We live in a small community where the one of the surgeons moved away.  We were told that if the other family doc who does c-sections is not available when I go into labour we would have to travel 1.5 hours away to a hospital with c-section coverage in order to VBAC.  Although we might have still VBAC'd at this hospital we would lose our midwife, get the OB on call and basically be strangers with no idea about hospital policies or the scope within which a VBAC would be managed.  But, we met with the family doctor and he is essentially around for the next five weeks and, as it turns out the new locum surgeon will also do c-sections so it is very unlikely that we would have to travel.  Yeah!

#3:  On my 20 week ultrasound they had a look at a small ovarian cyst that I have had for awhile that is now a mass.  We were worried they would recommend a c-section so they could take it out at the same time.  As it turns out, unless it is big (which it is not) they don't want to touch it until after the birth.  We had to meet with a very unsupportive to VBAC OBGYN to get this information but all in all he really had no good reason to recommend against a VBAC at that point.  Yeah!  (not for having a cyst but for not having to have a c-section).

#4:  Although my mid-wife is great the other doctors we have met with have all expressed concern about my "big baby."  My first was 7 pounds, 7 oz. at 37 weeks so would have been a good sized girl at 40 weeks.  I have tried not to concern myself too much with this as I am a woman with broad hips and many women in my family have delivered big babies naturally (up to 11 pound - and yes, she deserves a medal).

The baby has been head down since about 28 weeks.  I actually started to put things in my homebirth box as we seem to have jumped many hoops to be candidates.  Our midwife was very honest about the risks for a VBAC but was still willing to do it in our situation.  We are in Ontario so she is a Registered Midwife.  

Then the baby moved a lot on the weekend.  Then I went for an ultrasound to confirm that the cyst hadn't grown so as to impede labour and the baby is breech.  I remember saying to my husband on Sunday that I thought the baby had changed position because I no longer had this line from the top and curving down the side where the baby had been laying on its side for weeks.  I had hoped it had just maybe started to line up more vertically in time for the big day.  So, baby is breech.  The ultrasound tech wouldn't give me much information at all (liability) and I don't have the full report from the radiologist yet but the midwife confirmed it at my weekly appointment.  

I am doing what I can to turn the baby including acupuncture, inversions, diving in the pool, visualizing, cold packs, heat packs, talking to baby etc.  I'm hoping the baby will turn.  I had a dream tonight that the baby turned and we had a beautiful birth.  I'm just also preparing for a c-section.  My midwife will always give me a choice but strongly cautioned about VBAC'ing a breech baby in our facility.  She doesn't have a lot of experience with breech babies (the profession was established after they basically stopped doing them) and neither do very many doctors.  We also have no NICU.  I can respect her honesty about the local conditions.  I would imagine we will schedule the c-section in a week or so if the baby hasn't turned .

I will be thrilled for a healthy baby as everyone keeps reminding me but am mourning the process of birth.  It is funny that we mourn something we are taught to dread and fear is something to mourn later in life.  My midwife will ensure that I don't lose my baby for two hours after the c-section this time and make some things a little better than last time.  Any thoughts on your own experiences preparing for a c-section after planning for a VBAC (home or hospital) would be appreciated.  Any well wishes and happy baby turning thoughts would also be appreciated.  

Thank you for the space to write about this.

[justKate]

  What a roller coaster you've been on!

Honestly, it sounds like you're doing everything you can to get baby to turn.  Do you have a care provider that would consider doing an ECV?  Other than that, I would just wait it out rather than scheduling a c-section.  I don't think I would be comfortable VBACing a breech baby either, especially under those conditions. But you can wait until you go into labor to have the c-section, right?  Or at least until closer to 40 weeks?

It is really a hard situation, and I can completely understand your disappointment.  Hopefully baby turns really soon and you can go on to your VBAC!

[Monkey Keeper]

If your babe just turned from vertex to breech, then there is room to turn back. My (not so) little VBAC guy was an unstable lie up until my due date and turned fully breech and back as late as 39w and change--he was 9lb, 5oz at 41w2d.  Do not lose hope!  I would wait to make the c/s decision until you are in labor if possible. Babies can turn at any time. Also, if you can find a massage therapist who works with pregnant women, that can help a lot.

[roadfamily6now]

What does your local hospital do if there is a non-vbac emergency c-section???

[justKate]

Any updates, OP?

[Meleroo]

Thanks for the support all.  I'm anxiously waiting to see my midwife tomorrow to see if the baby is turned.  We have a lot of conflicting signs here at home.  Heartbeat is low but kicks are also low.  We were supposed to see her Friday but she had another birth.  Our fingers are crossed.  39 weeks today and I think I may be losing my mucous plug so decision time might be at hand.

To answer one question, they will try to ship you North Bay if they think you can wait even in an emergency situation.  I'm not sure what they do with no c-section coverage.  They may try to send everyone to North Bay to birth or you may get a less qualified caregiver who can do a section but doesn't do them often.  The joys of rural medicine.  Up until a few months ago they have always had more than one person doing c-sections so this is a relatively new problem.

I will keep you posted!

[MrsRoss]

I am 31 weeks and hoping for a VBAC with this second baby. Like you, baby was head down from at least 24 weeks, which was very positive. Then I felt a turning last week and started feeling kicks in different places. I'm a bit worried baby is breech if not transverse.

Good luck with the midwife tomorrow. I am keeping my fingers crossed that your baby has turned vertex! Like others have said, wait until you are in labor to make the surgery decision.

Lots of positive thoughts your way

[Meleroo]

Well, I was indeed losing my mucous plug the last time I posted and contractions got very regular that day to 6-7 minutes apart.  We called the midwife because we had not yet had her check to see if the baby was head down  since the acupuncture treatments.  She came over to the house and found the head under my rib cage.  We trundled off to the hospital for an ultrasound and likely a c-section.  I refused to bring my overnight bag into the hospital until after the ultrasound confirmed the baby was breech.  My contractions were 3-4 minutes apart within an hour of arrival  Two hours later my baby was born by c-section.  Isabelle Beatrice was born at 6:23 November 27 at 39 weeks.  

I'm not that sad now to have "lost" my chance to birth vaginally.  The last time I didn't so much mourn the loss of a birth experience as the loss of a post-partum experience.  The week after my section was one of the most difficult of my life.  The combination of the pain, the helplessness (needing my husband to get me out of bed), the sleep deprivation and the breastfeeding difficulties caused by my milk coming in so late (6 days afterwards)  made that time very miserable instead of joyful.  Going to bed with your baby for a week to recover and nurse sounds lovely unless of course you can't even roll over on your own.  

This time, I have all the same issues.  I'm finding this week to be incredibly difficult.  My milk is just coming in and although I avoided supplements as long as possible dehydration became very real so we have had to formula feed (from tubes and syringes only) to keep her weight up.  As it was, we were dangerously close to having to have her admitted back to hospital.  I'm struggling with whether or not I fought too hard to avoid supplementation.  Thank goodness for the close eye of our midwife.  She is really helping us get through this while keeping the goal of healthy baby and long-term breastfeeding in mind.  The hospital nurses all seemed to want the short-term fix.  If the baby is hungry feed it a bottle.  It makes it easier for them in the short-term but then you have to go home with this baby and getting back to nursing is incredibly difficult.   We went through that last time and wanted other alternatives this time.  I'm happy to say that the baby gained weight today and is nursing really well today so I'm hoping we have turned a corner.  To be honest I have been hoping we have turned a corner for the last three days but I'm hoping today was a really big corner.  

I haven't reflected on my images of water birth.  I cried the day I heard the woman next door in delivery shout a big "whoohoo" as her baby emerged.  It will take some time to reflect.  Right now I'm just getting through the initial recovery and establishing breastfeeding.  There will be time to reflect on all of that later.

One great thing was that the midwife acted as the baby's "doctor" in the OR.  It meant that she was able to keep the baby with me during recovery so I didn't have to wait two hours to see the baby this time.  The baby nursed right away and was so beautiful, bright and alert.  Also, she has been by the house each day since we have been home to check on us.  The support in terms of nursing and not having to drag myself to see my GP has made this much easier.  She took my staples out in my own bedroom.

Also, my husband surprised me with a rented bar for the side of the bed because I hated not being able to get up on my own the last time.  He is such a romantic :)