Feeling disheartened about VBAC

[cameragirl]

I've been planning for a VBAC after feeling pushed into a c-section for macrosomia with my daughter. DD was estimated at almost 11 lbs, but was born at 9.9lbs at 39 weeks. I consistently measured 2-3 weeks ahead with her. This pregnancy, I have been measuring ahead about 3 weeks as well. My blood sugar has been good, so it isn't a GD issue. My Ob has a good reputation for natural birth, and was positive about a VBAC at our last appointment. She said if anyone can birth a big baby, my body is perfectly adequate to do the job. She wanted an ultrasound to check on the size, AFI, etc. I put it off of for weeks, and finally gave in after our last appointment going well. At that point, she was fine with me going into labor on my own, but said that the option of induction or an RCS were there if I want them.

Today I had the ultrasound at 36w2d. The average of measurements put my due date as today, even though it is actually March 11th. His estimated weight is 8lbs 14 oz. I know that they can be off by 10-20%, but I'm know he's going to be big regardless. Big babies just run in the family. I'm worried about my chances for a VBAC, though. I have my OB checkup tomorrow, and I need to stand up for myself and tell her I'd rather labor first and give this a shot than give in to an RCS. I don't want a medical induction if at all possible.

I do not want him out before he's ready, but I'm feeling conflicted because getting him out earlier than later raises our chance for a VBAC. How do you ladies feel about natural methods to get things moving along? (Not necessarily induction, more dilation/effacement/prep.) Has anything worked for you in the past?

[Ivy53]

I'm also from a big baby family. All five of us were over 9 lbs and I have a brother who was 11 lbs, 9 oz. My first son was a c-section, but not for size - for induction issues and probably "failure to wait" partially. He was 12 lbs, 2 oz. I was determined to have my second vaginally. I knew if I had that size ultrasound it would be a disaster, that they would never stop pushing me for a RCS. So I walked. I walked everywhere, all the time. He was born three days before the u/s appt, 10 lbs, 9 oz, at right around 37 weeks. So, I would say, if there are things you can do to nudge labor, it might be a good idea. Maybe you can talk to your OB tomorrow about things you can do, though OBs probably don't usually put much stock into natural induction methods.

But if your blood sugar is fine and you don't have GD and big babies just run in your family, don't be discouraged! Your body won't start flashing "WEIGHT LIMIT EXCEEDED" or "TILT." :) I'll tell you something my midwife said - you are the product of generations of women who had adequate pelvises to birth their babies. See if your hospital will let you get into other positions for pushing other than laying flat on your back, which gives the baby less room. One thing in your favor is that most doctors and hospitals won't use most medical induction methods on you because things like pitocin increase the chance of uterine rupture.

If you want to have a VBAC, and you're in good health, and the only thing standing in your way is that your baby might be big...I would be assertive and tell your doctor that's what you want, and that you will not schedule a RCS. You don't have to consent to it.

[cameragirl]

Thank you. I do have some health issues that they've been monitoring, but nothing that affects the baby. (It's a muscle issue with rigidity and spasms, but VBAC was ok'd by a perinatologist and my neurologist.) The doctor did offer induction with pit at 39 weeks, but she didn't pressure that at all. She just said it is there if I want it. I told her that I'd prefer to avoid induction if we can.

I do know that the hospital is fairly progressive and does keep squat bars, kneelers, and different shapes of balls available. My only limitation with positioning is symphysis pubis disorder. Luckily, being upright or on all fours is the best way to birth with SPD. My pelvis is ridiculously loose, and it may be wishful thinking, but I'm hoping that the extra space helps with labor.

I'm really hoping that this little guy is done cooking before that all becomes and issue, though.

[mamagolu]

The women in my family also have big babies.

Although mine have not been that big, I understand the pressure you feel about the measurements.  My 9 lbs 1 oz baby boy was measuring up to 5 cm ahead on fundal height and had a weight estimate aroung 10 lbs on ultrasound.  I had an OB who was very uncomfortable with me delivering a baby of that size (I'm petite) and she was really pushing the c-section.  In the end, that is how my son was delivered after 2 hours of pushing with a very strong epidural.

My second was a girl who measured 3 cm ahead on fundal height and was estimated at 9+ lbs.  I was induced at 40 weeks and 1 day with pitocin (my membranes had been stripped three days earlier in the office, and that had gotten things started).  For this delivery I had a very supportive OB and I asked for a spinal with a low-dose epidural so that I would have some sensation to be able to push with contractions.  She weighed 8 lbs 4 oz and her labor and delivery went great, about 5 hours with 20 minutes of pushing.

I share this just to say, how off these measurements can be.

Just curious, do you know if you are expecting a boy or girl?

[cameragirl]

I'm having a little boy. I've got a girl, as well. Luckily, the appointment went pretty well considering the ultrasound results. I'm 36w3d, and she'd like to induce at 39 weeks if I haven't gone into labor. Nothing is on the books, though. She said it is up to me, and that neither one of us expected a small baby. I'm going to try things to help things along next week, and hope that we won't need any kind of induction or an RCS.

[justKate]

cameragirl, I'm really not stalking you.  You just have good questions in your posts that I feel compelled to respond to....

I can't believe your babe is so close to arriving!  I don't know how the size of the babe affects VBAC chances, but I would say that natural methods of encouraging labor are probably fine options.  I'm not sure if they help more with a second than with a first pregnancy, but I have to admit that EPO (vaginally and orally), sex, and the cohoshes did nothing for me.  The cohoshes may have made my labor worse, I'm not sure.  So I would stick with activity (as well as you can), sex, and optimal fetal positioning.  Is he in a good position?  Have you seen a chiropractor to make sure that your pelvic bones are aligned as well as they can to give him the maximum amount of room to descend? 

Just random thoughts.  I really hope you get your VBAC, and soon! 

[cameragirl]

Honestly, I don't think EPO did much for me with DD, either. It's worth a shot, though. I haven't been able to have sex, because it just hurts so bad. I wish that were an option. The good news from the scan was that he is in a good position. I've been seeing a chiropractor since I got pregnant, and now I'm going twice a week. She specializes in maternity care, and she's been using the Webster method to keep my pelvis as aligned as possible. For what it is worth, she said that by palpating him, he doesn't feel like he's 9lbs yet. I don't feel like he is either, but he's definitely not going to be small.

I'm a little leery about the cohashes, since I'm with an OB and not a midwife. The information out there is kind of iffy, and the dosing protocols are so varied.

[justKate]

Well it seems like you're doing what you can.  Or at least as much as I'd do.  I think some people are just better at palpating than others.  If the chiro seems the most confident, I'd assume s/he's right.  Last pg everyone swore my DD was bigger than she was (probably due to my size) but the one midwife that I trusted swore she was 6.5-7 lbs. from 36 weeks until 40 when she was born, and she was right on.  (6 13 oz.)

Stay strong, mama.  Your EDD is so close!!

[cameragirl]

My Ob asked if this baby feels bigger, but it is really hard to say. For one thing, it has been nearly six years. My daughter sat really high, and always had her feet in my ribs. This guy has been super low the entire time, and has had his head wedged in my pelvis for a long time. DD had an anterior placenta, but this little guy has a posterior placenta, making him much easier to feel. It's super easy to make out his bum, back, leg, and shoulder. He's even been in ROA for a LONG time. The chiro has been working the ligaments to hopefully open it up for LOA for him, but I think that my c-section damaged the ligaments. On my first ultrasound, my uterus was tipped all the way to the right. We've been gently stretching the right side the entire time, to no avail. I'm much happier with ROA than the posterior position DD was in, though.

I told a few people that the doctor wants to induce, and now they're telling Pit horror stories. Before it was "are you sure you want a vaginal birth? That hurts like hell!" Yeah...birthing hurts for pretty much everyone, no matter how you do it. I'm sick right now and just want to give in and get it over with, but I know that's just the lack of sleep and icky feeling talking. I'm still hopeful that he'll decide to pop out early.

[phaedra13]

I just posted my story about a 10 pound 2 ounce VBAC. I had no idea he would be so huge. I am not a large woman at all (5'4'' and 135 pounds, pre pregnancy). No history of big babies in my family, either. But it was just fine. My doctor wasn't worried about it (he never guessed at size because he says it's all just a crapshoot - he told me after that he thought maybe 9 pounds but didn't say anything). I wasn't worried about it. I do think that the epidural helped immensely and there is no shame in that if it helps you get a non-surgical birth. 

Whatever you do will be the right thing for you and your family. Just be confident in what you want and listen to your baby about what feels right for you. You'll make the right decision.

I will say - it sounded like your doc is interested in inducing with pit at 39 weeks? (maybe I misread) Everyone is different, of course, but, personally, I would be very nervous about that. I did a lot of reading online and an actual induction with pit significantly increases your chances of a rupture (augmenting, not so much. I think I would have been open to that).

Good luck....

[cameragirl]

She would like to induce, and feels that it is safer than an RCS *if* my body is ready. I'm doing what I can in hopes that we won't need to induce. My appointment this week will likely have to be rescheduled, so I will probably end up seeing an NP instead of my doctor. (I need to get IVIG treatment this week, and it trumps my OB appointment.) I'm going to ask that when they'll strip membranes, because I would prefer to try that before pit.

There aren't a lot of resources for information on pregnancy and stiff person syndrome, but I did talk with a mama that had a quick birth with a large baby. It hurt like hell from the muscle spasms, but she went from 3 to 10 in about 20 minutes and pushed him out in about five minutes. IIRC, he was over 10 lbs.

[justKate]

Oh mama, I'm sorry.  Anxious to hear what you decide to do. Fingers crossed that babe will surprise everyone and arrive this week on his own!

[folkgirl]

I wanted to share my experience and opinions.

I have had GD with all of my pregnancies. My first daughter was induced because of the GD at 39w5d. I was deemed "failure to progress" and had a cesarean. The only reason I was induced is that that's what doctors "like" to do with GD patients.

Second baby, I had a provider who assured me that he would not attempt to induce. He agreed with me that my best shot at a VBAC was if I went into spontaneous labor, and was willing to let me go up to 42 weeks with frequent monitoring, as long as the baby seemed to be okay.

I had an ultrasound at 37 weeks. My baby was measuring 9-10 lbs. At 37 weeks. My family is also full of large people. Currently 5 and 2 year old are at the top of the charts (although they are slim-appearing).

My peri assured me that late pregnancy ultrasound was often wrong. She also said if I had a 10 lb baby, she felt like I could birth it.

My OB agreed.

Baby was born after spontaneous labor at 39 weeks. She was 8 lbs, 11 oz.

I think that knowing there was no pressure on me was very freeing and actually helped my body to go into labor earlier. I felt so much pressure in my first pregnancy (when I was induced) and despite what my brain told me, felt very inadequate and like a failure when I did not labor "in time" to avoid the induction.

So obviously, I am in favor of avoiding inductions. I wouldn't go too far with the "natural" stuff either because I have heard of people who have had bad results after using some of them, like having PROM after EPO and then no contractions.

Good luck, mama. You can do this.

[roadfamily6now]

Why do you feel that birthing your baby at 39 weeks (via possible induction) would be more successful then waiting until your baby is ready?

[cameragirl]

I don't believe I said that I felt it would be more successful at 39 weeks. I'd prefer to go into labor on my own. However, I'm not dealing with a normal situation. I'm dealing with a serious illness that is flaring, leaving me mostly immobile and in horrible pain. I'm spending this week getting infusions of donor antibodies in hopes that it calms my body down enough for a vaginal birth without a lot of medication. Considering the situation, it is probably better not to wait. I don't like it, I don't want to be in this position, but I have to be at peace with the decisions I make.

[akind1]

I don't have big babies, so can't chime in there. 

My first was a c-section  - I was induced at 41+5, after 26 hours and stalling at 7 cm . . .he was all of 6lbs and 14 oz. Doc said he was classic OP, so just bad positioning.

With my 2nd, I did chiro, massage, hired a great doula, and at 41+5 still hadn't gone into labor on my own. I was walking, having sex, doing EPO . . . and it just wasn't happening. the appointment that morning showed I hadn't made much progress, and my blood pressure was going up, fluid levels down, and doc just didn't feel comfortable inducing me (he thought it wouldn't be successful). So that night, I got out the breast pump and voila! Water broke just after midnight and baby girl was born just after 10 a.m. For me the breast pump was really a last resort, but it did the trick.

And baby girl was almost a full pound bigger than her brother - 7 lbs 12 oz -

you can do this!

[cameragirl]

Originally Posted by akind1 

I don't have big babies, so can't chime in there. 

My first was a c-section  - I was induced at 41+5, after 26 hours and stalling at 7 cm . . .he was all of 6lbs and 14 oz. Doc said he was classic OP, so just bad positioning.

With my 2nd, I did chiro, massage, hired a great doula, and at 41+5 still hadn't gone into labor on my own. I was walking, having sex, doing EPO . . . and it just wasn't happening. the appointment that morning showed I hadn't made much progress, and my blood pressure was going up, fluid levels down, and doc just didn't feel comfortable inducing me (he thought it wouldn't be successful). So that night, I got out the breast pump and voila! Water broke just after midnight and baby girl was born just after 10 a.m. For me the breast pump was really a last resort, but it did the trick.

And baby girl was almost a full pound bigger than her brother - 7 lbs 12 oz -

you can do this!

How long did you need to pump for? I tried the other day to stimulate enough for a contraction, but I realized quickly that I needed a different sized breast shield.

[justKate]

cameragirl, just saw elsewhere that you may be having your baby tomorrow!  I hope it goes really well and will look for your birth story, no matter how it goes.  Good luck!

[Blue Eyed Baby]

I'm glad to see your repsonse to this post akind1, I had planned a VBA2C with my baby girl, went into labor at exactly 41 weeks (EPO orally and vaginally from 36 weeks on, lots of walking), dilated fully, spent 50 hours in labor (2 pushing) and she would not descend past 0 station due to being OP, she was all of 7 pounds. I've already found a Webster-certified Chiro that I plan on seeing before, during, and after I get pregnant again. And my Peri (I have a history of severe Pre-e with baby number 1) already approved me for a VBA3C at my post partum visit since I came so close to delivering her vaginally.

[cameragirl]

You know what they say about best laid plans? I didn't get my VBAC, or most of what I wanted for the birth. It has been a very difficult week, but I'll try to sum it up. Sorry that the short version is actually so long!

I started Monday morning at 6:30 at the hospital. Because I have a port and horrible veins, it took several hours to get a specialized nurse down to start a line because of some traumas that came in. I spent the time resting and sitting on a ball. Pit was started at around 9:30, and I started getting little contractions soon after. I handled the pain very well for 11 hours, until there were issues with contraction monitoring. Because I was a VBAC, they wanted either an external or internal monitor, but neither were working. The nurse went in to put another internal monitor in, only for me to contract while her hand was in me and she had nothing on the monitor. I started screaming because it felt like I was being split in pain. Immediately my pain level went from completely manageable to excruciating. I asked for iv pain medication, and that took the edge off. The contractions kept getting stronger and were back to back with no break, and no change in dilation or descent for hours. (I was at a five.) I saw some meconium on a pad around this point, but they weren't concerned at the small amount.

At that point, I decided that an epidural might be my best chance at getting rest without setting off my muscle condition even worse. The insertion went well, but as soon as they got me laid down, my bp started crashing. I was at 54/48. They got me stable with epi, only to have my bp crash again right after. My OB asked me if I'd like to keep going for a few more hours to allow for dilation, or if I'd like an RCS. I was devastated, but I chose the RCS. Luckily, baby looked great on the monitors through everything. They quickly got me prepped for surgery.

During surgery, I kept crashing. It was HORRIBLE to have to vomit without being able to sit up or completely move my head to the side. I don't remember how many times my bp crashed, but it was the entire surgery. I had my port connected with fluids being dumped in, but they wanted another line just in case. I lost about 30% of my blood volume, but luckily had good enough labs that they didn't require a transfusion. In recovery, the anesthesiologists tried over and over to get lines started. I'm bruised from armpits to fingers from that. I kept crashing in recovery, and I felt SO horrible. My son had been rushed to the NICU, and because I was unstable, I couldn't have family with me. The doctor kept paging trauma and ICU to get a line started. Eventually they got a line in my wrist and got me stable.

My son was looking stable, so they let me nurse him. He nursed slowly but very well for a good two hours. After that, it was decided that his respiration was too fast and he was back in the NICU. I had a horrible nurse and no clue of what was going on for hours. He was on bubble pap and antibiotics for meconium aspiration. The next night he tore off the bubble pap, so they switched to a nasal cannula. Eventually he ripped that out as well as his IV. He was confused at feeding time, but he's coordinated to nurse and feed from a bottle now. We've heard from several nurses that we're getting a less "conservative" doctor tomorrow, and the nurses and my OB feel that it is unnecessary for him to stay in NICU. I am praying that he'll be able to come home tomorrow or Sunday. Luckily my milk has come in, and I'm able to nurse, feed him what I've pumped, and then do bottle feeds. I'm on IV antibiotics due to a fever, and I may be going home tomorrow.

I don't blame the c-section on my doctor or the nurses. They let me set the course because of my other health issues. It is a crap shoot with bp and an epidural to begin with, and my condition complicates that. I feel that my body just had too much, and an RCS was the best choice considering. I still regret that I didn't get my VB, but I can't beat myself up over it. I knew going into this that an RCS was a definite possibility, and knew that it would be the best choice if I felt my body couldn't handle it. I am so happy to have my little guy, and I can't wait to bring him home for lots of skin to skin and nursing.


Avery Reed - 10 lbs 4.5 oz, 21 inches

s

More pictures, including him peeing all over myself and the OB.

http://www.flickr.com/photos/jillianjordan/sets/72157629173404374/