VBAC after HELLP syndrome in Ohio

[ashleyk21]

3 years ago I was pregnant with my first and diagnosed with hellp at 39/5 pregnant. I was induced, in labor for 36 hours and pushed for 2 hours. My son was posterior. Had to have a csection because I never went beyond 0 station.

I long for a VBAC more then anything. I don't know what I would do if I had to have a repeat section. I did not heal very well and it took me many months to not feel in pain. I have thought about a VBAC everyday for the last 3 years.

I recently met with a CPM and she said I would be able to VBAC. I would have to go to a specific hospital for a certain doctor on call. This midwife seemed great and I have read positive reviews of her on the internet. However she did mention induction at 41 weeks. And that I would have to go and see the doctor like every other visit so he could check me out since I am high risk, This scares me a little. I feel like I should be treated like only a VBAC, since HELLP does not repeat very often and since I had it so late in my pregnancy it would be less of a concern until the end of a future pregnancy,  I want absolutely no interference with my pregnancy as long as HELLP syndrome does not repeat.

Does anyone know of any midwives around that would be able to deliver me interference free as long as I was healthy? I dont want an epi, no pain meds, a hep lock, to walk around in labor, and not be checked EVER for dialation. Do I ask for too much?

I am located in Wooster Oh, but I am will to drive up to 2 hours for my wishes! Cleveland is about an hour from me and Columbus is 1.5 hrs.

thank you for any help! I am totally stressing about this dicision on a midwife! The stakes are just so high!

[mothercat]

HELLP may not repeat but preeclampsia could. There are several genetic mutations and clotting disorders like MTHFR , Factor V Leiden, and Lupus that can cause preeclampsia. Perhaps a preconception visits with a perinatologist so you have a realistic picture of your risks.

However, HELLP syndrome repeating does not address your baby having been posterior and not getting below zero station. Non-interference in labor is no guarantee that the next baby will fit any better. Sometimes the baby is posterior because it's the only way the baby has a chance to get into the pelvis. A lot will depend on your pelvic shape, and some of it may depend on how proactive you can be with exercise, diet, chiropractic care, etc.

Sounds like you need to work on some values clarification.  What are the most important things to you about the next birth and what are you willing to do or give up to meet that goal? I was sent this link this morning by HeleneVadenboncoeur. She is a midwife in Canada and wrote a book on VBAC. http://www.powertopush.ca/wp-content/uploads/2010/05/Best-Birth-Clinic-VBAC-Patient-Info-Booklet-with-BC-Data_web.pdf
 

[ashleyk21]

I actually did not have preeclampsia. I had low platelets and high liver enzymes only which gave me the hellp diagnosis. My doctor said some women don't develop pre e but just go straight to hellp.
I realized I did a typo in my first post I meant to say I saw a CNM for my appointment.
I have done 3 years of research on a VBAC and I know it's the right decision for me.
Do you mind explaining to me how you think my values need clarifying? Because I want a VBAC? I don't understand.

[mothercat]

Values clarification is a term used in Patient Decision Aids (PDAs). It is explained further in the link I posted.

 You state that HELLP syndrome doesn't recur very often, but what do you consider very often? I found a Family Practice review article with good reference articles and this quote comes from that article when discussing future pregnancies. The numbers would seem to make you high risk which is a separate issue from wanting a VBAC.

"Patients who have had HELLP syndrome should be counseled that they have a 19 to 27 percent risk of developing the syndrome in subsequent pregnancies.28 They also have up to a 43 percent risk of developing preeclampsia in another pregnancy.28 Patients with class I HELLP syndrome have the highest risk of recurrence.28 When the syndrome recurs, it tends to develop later in gestation and is generally less severe after two episodes. Patients who have had HELLP syndrome may subsequently use oral contraceptive pills safely.29 Patients who develop atypical early-onset preeclampsia or HELLP syndrome should be screened for the presence of antiphospholipid antibodies.30"

If you want to read more here is the link http://www.aafp.org/afp/1999/0901/p829.html

There seem to be be several issues here and your focus seems to be mostly on the VBAC.  Just so there aren't too many surprises, and so you are making informed choices about the entire pregnancy and birth, you should investigate all these areas. You may well be a good candidate for a VBAC, but the other issues may spoil your plan.

[ashleyk21]

Yeah I am aware of hellp completely. I have done lots of research on it and I have met a lot of other moms through a hellp group who have shared their experiences.
The reason I seem focused on vbac is because well, I am. I posted here to see if anyone knew of any midwives in the area. I know I could get hellp again again but I am not going to worry about that since I can not control it. In my original post I did say that all of the "interference free" was only if I was hellp free.