I am a bad VBAC candidate... Feel like a failure.

[MomRunner]

I want more than anything to have a wonderful, blissful, vaginal delivery, but I don't think it can happen.  I had a c-section almost a year ago for failure to descend. Here is my story in a nutshell.

I was 41 1/7 weeks pregnant, and for reasons I won't get into right now, my midwife and I thought it was best to induce labor.  I went to the hospital, found that I was having contractions about 6 minutes apart.  I had been having some bloody show, was losing chunks of my mucus plug, having a decent amount of braxton hicks, nesting like crazy, couldn't sleep - it looked like I was going to go into labor shortly anyway.  At any rate, cervix was about 1 cm, 80% effaced.  We were going to try to do a half dose of cytotec to soften things up, see how it worked.  Well about 4 hours later when the effects of the cytotec should have worn off, I started to have some real contractions.  They were painful and seemed to be productive and about after 1 hour of painful contractions, my water spontaneously broke.  To cut to the chase, the labor was fast, hard, and I wasn't getting any breaks between contractions.  I had a few doses of fentanyl to take the edge off, but I was still getting out of bed, walking, going to the bathroom, sitting on the birthing ball, eating a bit, drinking, etc.  Basically doing the things you are "supposed" to do during labor.

I started feeling the urge to push when I was around 8 cms, and had to try so hard to stop myself from pushing!  Labor kept progressing quickly and then I just HAD to push.  I had a persistant anterior cervical lip which my midwife pushed back and then I was "allowed" to start pushing (as if I could have stopped my self, haha!)  Anyway, I pushed and pushed and pushed and pushed.  I was squatting on the bar, pushing on my sides, on all fours, standing, sitting, on my back doing this backwards somersault type thing- everything you could think of.  And I just couldn't get him out...  After over 2.5 hours of pushing I was completely exhausted.  I have heard stories about women who pushed for 4+ hours and I have no idea how they did that.  There was no more I could give and the baby just hadn't budged in the entire time.  So I got an epidural and a c-section...  My baby was 9 lbs 11 oz and had a head size in the 90-95 percentile.  Everybody was very supportive.  My L/D nurse and midwife both agreed that there was nothing else that I could have done to get him out.  My midwife said that in her 25 years of practice I was in her top 10 list for most effective pushers.   I feel like such a failure.  Why wouldn't he come out?  What is wrong with me that I can't birth a baby?

I know I didn't do EVERYTHING right.  Yes, I was induced.  But it was only half the normal dose of cytotec, it wore off, and then my labor started, membranes ruptured spontaneously, he wasn't posterior, and I stayed mobile the whole time and pushed HARD and effectively in every position imaginable, I was with a midwife and very supportive natural labor and delivery nurse...  And I just couldn't get him out.  Was this a case of true CPD?  I am 5 foot 6 and very thin with narrow hips and he was very big (and no, I wasn't diabetic and only gained 30 lbs).  I want so badly to have a VBAC next time, but I don't know what is going to change from the last labor to my next one.  I know that if you get to the pushing stage and can't get the baby out, the odds of a successful VBAC are very, very low.  And if you have big babies the odds of VBAC go lower.  And if you go post-dates, the odds are even lower. 

I am just so sad.  I feel like my body failed me.  From the dawn of mankind, all of my mothers, grandmothers, great-grandmothers, etc. had been able to vaginally birth a live baby, except for me.  And based on my history it doesn't look like it can happen.  This was no classical case of cascade of interventions that led me to being flat on my back, with an epidural, stuck to a bed, not having any urge to push, and being pumped full of drugs that distressed my baby.  I should have been able to get him out, but I couldn't...  Any thoughts or encouraging stories?   

[Monkey Keeper]

I am so sorry you feel so defeated.

I am of the opinion that it doesn't hurt to try (unless medically contraindicated). There are no guarantees that your son was optimally positioned. In fact, the persistent lip indicates he probably wasn't. Perhaps his head was askew or he was at just the slightest odd angle. You'll never know for sure if that was the case and how it affected pushing. There also is no guarantee that your next baby will be as large or as late. I have a friend whose 2nd daughter was almost 10lbs and her 3rd was mid-7s. And HER friend had two over 10 lbs but a later baby at just over 7. You just can't know.

I identify with your angst that you are the only one in your family line to have had a c/s. I am too. I chose mine, and I feel still that it was the right choice for that birth since everything including my gut pointed me in that direction, and I have no regrets. But I do feel like it is unfair that I am the only one to have "needed' a surgical birth. Still, it does not mean that you are broken--it means that that was the best way for THAT baby to come into the world. He chose his birth. It takes some time and some healing to get to that point, though.  Sending some love your way.

[Spirit Dancer]

Actually I disagree with you. :) You are an excellant canditate for a VBAC. MAny women including myself are the same build as you and give birth vaginally to even bigger babies. I say that to encourage you. Also remember each birth and baby is different. No one can say for sure why your baby did not desend (perhaps it was the induction as some babies do not get into a good position for labour until one is in labour. So being pushed into labour sometimes does not give them the chance too) but there is every chance it will be completely different this next time.

A few things you can do are:

1) I would suggest you find some way to get rid of the guilt you have- C-section or vaginal birth you are NOT a failure :hugs

2) Try to find a community of women who have had positive birth experiences especially VBACs. Read positive birth stories ect. Statistics and horror birth stories will not help you at all.

Going into a birth with confidence in your body and the power of knowledge to make informed choices will really help and whatever the outcome you are a powerful woman!

[SAMarshall]

Well, I don't really have a positive story to tell, but I am trying again despite being in the same situation! With both babies, I went well past my due date, became fully dilated, but both babies refused to engage and descend. Stubborn kids, I guess! I'm a pretty small person (5'1") and my babies were 8lbs and 9lbs2oz. 

Not to be discouraging since my first VBAC did not work out, but I am trying for a VBA2C in March. I look at it as- who really knows what happened during those first two tries? This time around could be different! I, personally, will never be able to just schedule a repeat c-section without at least trying! For some women, it may not be worth the effort if it ends in another c-section, but I want to feel like I did everything in my power to get these babies out! 

This time around, I am going to a chiropractor, which I did not do the first two times. I am thinking maybe the babies were not aligned correctly because of something misaligned in my body. I am sure as heck not going to give up hope yet! I hope you can get to the point where you can feel confident to try again. I am really looking forward to finally achieving a vaginal birth! Good luck to you!

[womenswisdom]

IME, an anterior lip has always meant a posterior baby. If you decide that a vbac is right for you, look into the various things you could do to help ensure a baby in a better position. Chiropractic, massage therapy, spinning babies, no AROM. I also pushed HARD for hours with my first and could not get him to descend (he was posterior). Second time, did not have my water broken and baby was able to rotate during labor (after an anterior lip was found) and I pushed her out. Same sized baby, very different labor.

[cameragirl]

You never know if you can do it unless you try. If your hospital allows it, and you can find a willing doctor, it doesn't hurt to try. Spinning babies and chiropractic care are great resources, as well. I gave in to a c-section for size after weeks of prodromal labor and knowing I had a big posterior baby. Baby keeps flipping into a vertex position this time, but I'm really hoping for a VBAC.

I'm guessing that last time the baby was in a bad position. The persistent lip and lack of progress sounds a lot like what my sister dealt with when she had a posterior baby with chin that wasn't tucked.

[MommyDOK]

Don't GIVE UP!!!
 

I had a cesarean for failure to descend.  Baby never changed stations.  I pushed for 2 1/2 hours.  For my vbac, I went without the epidural, which was a huge benefit bc I could feel to push.  I pushed out a 14" head posterior baby.  ANd my second vbac was 9lbs 4 oz.  And he was posterior too.  It really hurt, I'm not going to lie, but going w/out the epidural helped me so much.  I also had a chiropractor doula that adjusted me during labor.  Oh, and I have a hooked tailbone....the most my chiro has ever seen. 

Many doctors told me it would never happen.  One female ob even used these exact words, "You've already proven you can't get a baby out of your pelvis."  I remember going in to the hospital w/ my first vbac and I pressed the button for the elevator and I thought, "Well, we'll see if she's right or not."  She was wrong.

I couldn't have done it w/out my ICAN chapter, ICAN yahoo group, doula, and my amazing DH who looked at me in labor (in the shower) and said, "You're having this baby!!!"  I was in transition and was begging for a cs!!! 

[akind1]

The day before I went into labor (not even a full 24 hours) my OB expressed doubt I'd birth vaginally. Proved him wrong!

with my first, he never decended, and I never dilated fully, so he was a c-section (at 41+6) - oh and he was very posterior.

my VBAC baby was also born at 41+6, nearly a lb bigger than her brother. I tore very badly, but she did come out! Not sure whether she was posterior or not. I know she didn't have any molding of her head, and I didn't push for very long (about 40 minutes). Also, I gained 25 lbs with my first (a 6lb 14 oz baby) and only 8 with my second (a 7 lb 12 oz baby)

I know they are nowhere near the size of yours; but I'm only 4'11''. I'm pretty sure their heads were about the same size, although, if anything, my second baby -the VBAC may have had a slightly larger head.

Even though I can honestly say the recovery from my vaginal birth was more difficult than my surgical birth (major 4th degree tear sucks), I still wouldn't choose to birth surgically unless it was an absolutely needful thing.

I definitely recommend chiropractic treatment. I did this prior to my second pregnancy and nearly all the way during it too. I also added massage therapy by the therapist he has on staff - I think it's important to adjust both the bones and your soft tissue.  Between them and my doula, and an awesome L&D nurse, we made it happen!

[cairomama]

As others have said, his head was probably tilted which makes it harder for a big head to come down. Your external dimensions have nothing to do with your ability to birth. As a doula, some of the easiest births I have attended have been with petite women with boyish figures. 

Looking into Spinning Babies. If baby won't engage, Walcher's Trochanter Roll has worked miracles in my experience. In one case, mom was at 8cm and -1 for 16 hours and after Walcher's she got to 10 and baby came down to +1/+2.

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

Hip circles on the birth ball can help baby tuck chin and straighten head. Abdominal lift and tuck can help as well.

As others have said, every birth is different.

Reducing sugar consumption (even from fruit, juice and milk) can supposedly help you have a smaller baby. It is worth trying, but I wouldn't worry about size too much because you can't fully control it and it often doesn't matter.

[Lisa1970]

Your baby was possibly not properly situated. My first csect was induced...but not like yours. Mine was a very forced induction 2 weeks early. He did not come out after 4.5 hrs of pushing.

My next baby, 17 months later, was a very rewarding vbac. I think you should go for it!

[kaliyah'smama]

I'm in a similar situation - about which I posted last night - though only planning for a third pregnancy.  My post-date pregnancies, big babies and my second's failure to engage/descend (and become distressed as a result) is leaving me wondering about how to proceed in the next pregnancy.  SAMarshall, how are you feeling about the chiropractic support you're receiving?  What kind of provider did you choose and why?

MomRunner, I hope all these responses feel supportive!

Thanks in advance!!
 

Originally Posted by SAMarshall 

Well, I don't really have a positive story to tell, but I am trying again despite being in the same situation! With both babies, I went well past my due date, became fully dilated, but both babies refused to engage and descend. Stubborn kids, I guess! I'm a pretty small person (5'1") and my babies were 8lbs and 9lbs2oz. 

Not to be discouraging since my first VBAC did not work out, but I am trying for a VBA2C in March. I look at it as- who really knows what happened during those first two tries? This time around could be different! I, personally, will never be able to just schedule a repeat c-section without at least trying! For some women, it may not be worth the effort if it ends in another c-section, but I want to feel like I did everything in my power to get these babies out! 

This time around, I am going to a chiropractor, which I did not do the first two times. I am thinking maybe the babies were not aligned correctly because of something misaligned in my body. I am sure as heck not going to give up hope yet! I hope you can get to the point where you can feel confident to try again. I am really looking forward to finally achieving a vaginal birth! Good luck to you!

[SAMarshall]

Originally Posted by kaliyah'smama 

SAMarshall, how are you feeling about the chiropractic support you're receiving?  What kind of provider did you choose and why?

To be honest, I'm not feeling terribly confident about my VBAC this time around, but I feel like I HAVE to try! I'm seeing a chiropractor who was recommended to me by members of my local ICAN chapter and a few doulas. (There were a few names given, but she was the closest that was covered by my insurance.) This chiropractor has worked with many pregnant women and is familiar with the Webster technique.

At my initial consultation, she found that my hips (sacrum?) were a bit uneven and there are some things I can do to work with my body and try to keep things lined up. She'll want to see me more often as the pregnancy progresses to readjust things. She recommended a lot of squatting and to be very aware of how I am sitting throughout the day (no leaning to one side, try to sit straight up instead of slouching.) She also recommended eating plenty of protein and to just keep up a healthy diet. 

I really have no idea if chiropractic care will actually help me achieve my VBAC, but as I was telling my husband, maybe it will have a "placebo effect" on me and I will be confident enough to get through it! :o)  I've never been to a chiropractor before and am pretty skeptical of their practices, but I am willing to try whatever I can to make this work. Good luck to you!

[thorn]

I really hate the whole "bad candidate" thing.  It just plants this seed in your mind for nothing - I have known SO many "bad" candidates go on to have amazing, straightforward vbacs.  And plenty who had amazing, not-so-straightforward ones, too.  You will never know unless you try.  Every pregnancy, every baby, every birth is different!

[mollikins]

Discuss it with your doctor/ midwife, but you are not necessarily a bad candidate just because you made it to 10 cm and pushed.  I did the same with DD1, pushed for 2.5 hours with no progress.  She was posterior and wedged in my pelvis and just not budging,so csection.  With dd2 I did a lot of research.  There is one study out ther, often quoted, that gives women in our situation about a 10-15% chance of successful vbac.  However, every other study I found besids that one gave the chances at between 40-80% - so about the same as any other vbac (I believe the average is 70%).  Anyway, I went on to have a perfect textbook vbac ( I did end up with an epidural due to stalling at transition, after several hours at 8 cm I was exhausted and unable to relax btwn cntx).  Luckily my team was super supportive, assisted me with rolling from side to side to help baby move down.  Dd2 was a hair bigger and longer than dd1, with a larger head, but still came out the front door!  As others have said - it doesn't hurt to try!

[konayossie]

I was also told that I'd never birth vaginally after DS, who was a tiny little, not quite 5-lber. The OB found an physical abnormality when she did the cs that she said had caused his arrested descent. My CNM said, "You can try for a VBAC, but it's not going to happen--it's just not physically possible." well, I just had a completely uneventful VBAC in Oct! So now I definitely believe that if a woman wants to try again and there's no medical contraindications, she should be encouraged to try.

[Nicole730]

I was a c-section baby because I didn't descend and my mom's body didn't really open up to get the baby out.  She had two successful vaginal births after that with no problems.  It is possible!

[holly6737]

IMO, there's nothing wrong with a trial of labor so long as all other things are well, if you are really motivated. However, if the babe doesn't descend again, know that you will probably get another section. It is possible that you have a small pelvis (google platypelloid pelvis, which is not common but is a reason why some babies don't descend). Or it's possible your baby was malpositioned. (IME, anterior lip does NOT always mean OP, but the babe definitely could have been some combination of asynclitic, posterior, etc. It's possible.)  The benefit of going straight to section when you don't have a high likelihood of a vaginal birth is that it is more difficult to recover from both labor, pushing AND a c-section. Also, a c-section is much more difficult for the provider to perform after you've been in labor for so long and pushing. For the baby, the safest method of birth is c-section without labor, followed by vaginal birth, followed by c-section after labor. The absolute risk is small, of course, but these are things you should take into consideration when deciding what to do. If I were in your shoes, I would probably do a trial of labor myself, but it's up to you.

Don't feel discouraged. Birth is one day in your babies life. I'm not saying that to downplay the significance of your birth experience, but to highlight all of the other wonderful experiences you will have as a parent. What I would NOT do is a homebirth. Given your labor history, I think that's just way too risky for you. You might be able to have a vaginal birth, but the risks of PPH if you have to push for a really long time, or shoulders, or depressed baby, etc. is just too great IMO. If you are dead set on a VBAC attempt, go with a CNM hospital birth. You didn't do anything wrong in your last birth. Even the induction, it sounds like it must have been a good reason to induce and it sounds like your Bishop's score must have been very high. The induction isn't what caused the c-section. Inductions increase your risk of c-section in nulliparas if you have an unfavorable cervix. It sounds like your cervix was very favorable. Don't beat yourself up about that. Some women give birth better via c-section. I know it's disappointing, but it's true. It doesn't make you a bad mother, it doesn't mean you did anything "wrong", it doesn't mean your midwife did anything wrong. Birth is unpredictable. You did the best that you could and that's all that you should expect of yourself. Good luck with your quest and I hope you find peace with your birth experiences, however they come to you. :)

[crystal_buffaloe]

Originally Posted by MomRunner 

I want more than anything to have a wonderful, blissful, vaginal delivery.

If this is what you want, you should definitely go for it!

Originally Posted by MomRunner 

I feel like such a failure.  Why wouldn't he come out?  What is wrong with me that I can't birth a baby?

You are not a failure, and there is nothing wrong with your body. You grew a human being! How awesome is that?

Originally Posted by MomRunner 

Yes, I was induced.  But it was only half the normal dose of cytotec, it wore off, and then my labor started.

I'm not sure this is true -- if cytotec is the agent that starts your labor, even if it "wears off," that's still an induced labor -- maybe you'd have had another day or two of those contractions they told you you were already having when they hooked you up to the monitor, and things might have been set up differently and turned out differently. I'm definitely not trying to armchair quarterback your labor here -- I had a cytotec induction, too -- I just want to point out that just because the induction method worked easily doesn't mean it wasn't an induction, if that makes any sense.

Originally Posted by MomRunner 

All of my mothers, grandmothers, great-grandmothers, etc. had been able to vaginally birth a live baby, except for me. 

Mine, too

[folkgirl]

I agree with so much that has been said in this thread. I know a LOT of women who have been in your exact situation and gone on to VBAC even BIGGER babies than the ones that they couldn't push out. There are so many things that could make a difference. It is right that every pregnancy, birth, and baby was different. And I am a "bad candidate" for VBAC myself, by the way. Somewhere out there there's a calculator that supposedly predicts VBAC success based on several factors including the circumstances of your previous pregnancies and things like BMI, age, etc. I put my info in and it gave me a 30% chance of VBACing. 30%! But guess what? I did it. And it wasn't even a big deal. I went into labor, dilated, pushed, and my baby came out. Please have faith in yourself.

[ksea]

This happened to me too, and I went on to have a super easy INDUCED VBAC.  It can happen!  

With my first, my water broke, kiddo was horribly positioned (sunny-side up/diagonal, arched back/leading with forehead), and I was in labor forever,  finally got to 10 cm, pushed for 5 hours, tried to turn the baby, 2 vacuum attempts and finally a c-section.  I was not induced.  I had a lot of regret that I didn't have interventions SOONER, as I didn't have an epidural until after 15 hours of horrible, unceasing, pain.   And then I should never have pushed for so long, had them try to turn the baby, or do the vacuum.  I really wish I had asked for a c-section earlier. I felt like I had failed in many ways.

BUT, with the second baby, who was well positioned and 8 lbs, I was induced at 40+4, got an epidural literally the same minute I went into transition, and pushed the baby out in 45 minutes.  One stitch.  Easy recovery.  I did not find the induction to cause painful or too close together contractions.  Certainly the pain was WAY more manageable than my horrible first birth that was - natural, at least for the first 27 hours.  I got to 10 cm without pain medication with the induction.  Also, having a pushing experience that actually worked made it clear to me how unproductive the pushing was with the first one.  That was never going to work, and now it is clear.  Without a c-section, I would have been in labor until one or both of us had died.  And I can tell you, I truly believed in my body and was convinced that a natural birth was best and that I could do it.  I think it made it way worse to have it not work out when I was so convinced that with the right attitude all would be fine, and it was just a question of strength of will.  My experience has taught me that attitude is perhaps 2% of a successful birth.  Frankly, I was an anxious, doubting mess with the second one, and really considered having a scheduled c-section because I was so convinced laboring would be a horrible failure.  AND I was convinced that my lack of confidence would cause me to "fail" again.  Yet the birth was, dare I say, easy.  My husband and I were just sitting around reading for the first 5 hours.  My take-away - if you choose to try for a VBAC, go ahead and be an anxious, doubting mess who is convinced you will fail.  You just cause more stress if you try to fight what you are actually feeling.  It can still work!

Obviously, who knows what will happen to you, but there is hope.  Part of the reason I was induced is that I understood that the likelihood of a successful VBAC goes down after 41 weeks, and my OB who I liked and trusted was on call.  I did not want another emergency c-section after a failed labor, and I can tell you I had a lot of anxiety about whether I was making the right decision by going in to get induced. But, all is fine.  Kiddos and I are all well-bonded and attached.  They both nursed well.  I healed just fine.  All is well.  Or at least all is as well as it can be with both of us working and two willful and independent children, plus two willful and independent parents. 

Good luck!