The VBAC/HBAC thread « Back to Group Discussions

[keeptryst]

Hi ladies,

Thought it would be good to have a place for the ladies planning a vbac or hbac to share the ups and downs of our journeys.

DS was born by c-sec five years ago for cord around the neck and going post dates (yes, hugely unnecessary!) basically because we caved to the doctor's threat that we'd end up with a "blue baby" if we went ahead with a normal delivery. DS was healthy and strong, and I swore I'd never make a decision from fear again. I consciously made decisions not based on fear in deciding not to vaccinate him, send him to an alternative kind of school, etc.

Now I'm 35 weeks with this little one, and strongly drawn to a homebirth. There are no practicing midwives in my city, but I've located a midwife working in a birth center in another city who's willing to travel to attend our birth at home.

We asked my doc if she would be my backup doc in case of transfer if I should choose a homebirth. She readily agreed with a smile that totally stunned me - it seemed too good to be true. Then I reminded her it would be a vbac birth (she had forgotten I had a prior c-sec) and then she totally backed off. She said she would absolutely not recommend a homebirth for a vbac - that a rupture would mean a dead baby and a mother who could die too without immediate medical intervention, that the time it would take to reach the hospital and get the OR ready might be too late. Plus the hospital nearby (7 mins away) where I plan to transfer does not have a blood bank and is thus not really equipped to handle a major emergency. She said, though, that if we still wanted to take the risk, she's there to help in whatever way she can.

She scared me good and proper - I know the risk of rupture in a natural labour is 1 in 200, but for that one woman in 200, the rarity of it is meaningless because it happened to her and is very real and tragic for her. And in a crazy way, I don't care about the risk to baby or myself, but what I care about most is that my 5 yr old son not face the possibility of anything happening to his mother just because of a choice I made. That's the only thing that holds me back.

I have a huge hankering for a homebirth, though, it just feels right, and intuitively I feel like the birth will be beautiful and straightforward. At the same time I have these misgivings about the what-ifs and also the fear of blame - like Buko said, we women tend to make choices that will not get us blamed, especially with childbirth.

So I'm in that place once more - will we make a decision based on fear again?

The resources that are helping me stay centered are these two, and interestingly they have nothing to do with vbac, and everything to do with attitude and perspective:

A story so deep and liberating, it gets down right to the crux of the matter: http://thegiftofgivinglife.blogspot.in/2010/02/rebecca-oversons-story.html

An article on Buddhism and childbirth - rather profound - making a great case for liberation from fear and learning to trust implicitly in the goodness of life:

http://www.sevenwindsyoga.com/writing/articles/buddhism-and-childbirth

What are you ladies planning? What are your challenges and how are you working past them?

Good luck to all of us!

[buko]

Keeptryst, *hugs*. I'm sure you know that ruptures are rarely catastrophic (even if they happen at home)? I apologize I don't have the actual numbers at hand, but I believe a truly bad outcome from a VBAC (having a catastrophic rupture) is .06%, as opposed to having any rupture (0.5%, as you mentioned). So more like 1 in 2000, if I'm not way off.

Like you said, if you're that one, well... But of course, there are significant risks to a repeat C as well, and in a position where you are more likely to end up with one, then you weigh the risks of that risk and compare. It's tough, I know (not from experience with VBAC, but other things).

I do think women make decisions less likely to get themselves blamed, but not to abdicate responsibility, not to avoid the blame of others, but more to avoid a layer on top of the blame we always place on ourselves. It's really rough out there in a misogynist world.

[Tear78]

Fwiw, my caregivers told me that the risk f rupture is really only a realistic concern in an induction, and they just won't induce me. Good luck with your decision!

[Chapsie]

Originally Posted by buko 

Keeptryst, *hugs*. I'm sure you know that ruptures are rarely catastrophic (even if they happen at home)? I apologize I don't have the actual numbers at hand, but I believe a truly bad outcome from a VBAC (having a catastrophic rupture) is .06%, as opposed to having any rupture (0.5%, as you mentioned). So more like 1 in 2000, if I'm not way off.

Like you said, if you're that one, well... But of course, there are significant risks to a repeat C as well, and in a position where you are more likely to end up with one, then you weigh the risks of that risk and compare. It's tough, I know (not from experience with VBAC, but other things).

I do think women make decisions less likely to get themselves blamed, but not to abdicate responsibility, not to avoid the blame of others, but more to avoid a layer on top of the blame we always place on ourselves. It's really rough out there in a misogynist world.

I have a loooong post that I want to write here when I have the time.  I had a cesarean in 2008 and a natural hospital VBAC in 2010.  My VBAC was so empowering and just beautiful... I was on a "birth high" for 6 weeks!  It was incredibly healing.  I will post links to my stories later today.  

It boggles my mind how people perceive risk in obstetrics today.  A first time mom undergoing pitocin induction has an increased risk of uterine rupture as well, but you don't have the same kind of shaming and requiring of special consults and whatnot with that.  Pit inductions and augmentation happen every day.  I really wish more providers would be truly supportive of VBAC.  

It has been 5 years since your cesarean-- that's a good long time for that scar to heal up nicely.  Yes, there are risks involved... but there are risks to everything.  

This is obviously an issue near and dear to my heart, so I will be sure to post more later!!!

[Chapsie]

Here is a link to a blog post I wrote a while ago that compared the differences between my c/s and my VBAC:

http://glorybirthing.blogspot.com/2010/08/comparison.html

[cabbitdancer]

I've told this story so many times on here, I'm sure everyone has read it at least once... ;) 

My daughter was born five and a half years ago by a scheduled cesarean due to breech presentation. I fought it as best I could, but it was hard with what little knowledge I actually had. I am quite proud of the fact that I managed to push them to wait until the day before my due date, but, in retrospect, I kind of wish I'd pushed further. I don't know whether I would've had the strength to do it, or whether I could now, even knowing what I know. The "dead baby card" is pretty powerful stuff.

I'm fairly certain I suffered from PPD, but I was so good at hiding it even from myself that I never had myself officially diagnosed. I struggled for a long time with the way I had been treated (pushed, told that I was being unrealistic, that all that mattered was a healthy baby, and that I was taking up too much of my midwives' time, and then as though I were a piece of meat on a slab in the OR...) that I didn't think I would ever want to get pregnant again.

Right around the time I started considering number two, I was diagnosed with diabetes and then, a year later, the meds stopped working and I was put on insulin, which not only put my desires to get pregnant on hold, but also ended any dream I might have had of giving birth at home. I've come to terms with that, but it meant that I went into this pregnancy with a lot of apprehension as to how I would be treated.

I am lucky to have found an OB who is far more trusting of me than I am of him. I need to relax, and it's been hard, between the struggle to keep my sugars in line, and now dealing with a second breech baby. That spinning babies site actually pissed me off, because there's a portion in there that basically implies that, if a baby is breech, maybe the mother's fear is at fault. That is so not fair, and doesn't do anything to relieve the tension that I've been feeling for the past month since finding that my daughter has decided to turn breech like her sister.

I DON'T WANT ANOTHER C-SECTION. I don't want to deal with all of the side-effects that made my last c-section so unbearable, despite having a fairly textbook recovery. I lost my voice and I DON'T KNOW WHY and could neither sing nor read to my daughter for almost a year, and I am afraid it will happen again. Intercourse was unbearable, even with lubrication, for at least a year, and my marriage has suffered as a result. I still can't feel portions of my abdomen, and don't get me started on that first post-surgery bowel movement... These are things that I'm going to have to address with my OB, should the topic come up, and I'm so scared that I won't be a strong enough advocate for myself.

I'm so sorry to dump on you guys like this, but this is the sort of stuff that has been plaguing me for the past month or so... How do I find that peace that allows me to just accept what comes when all is said and done?

[Chapsie]

Oh Cabbitdancer!!!  Big HUG!!!  I so know how you felt after the c/s!  I also had PPD but was never diagnosed because I tried to hide it.  Only my DH really knew the depth of my depression (the nightmares, the uncontrollable weeping, the moodiness..).  It was so hard, even though my recovery was pretty textbook, too.   People don't understand how a new mom can be depressed.  The baby is beautiful and healthy and so "you need to get over it."  You feel so ungrateful and embarrassed even if you admit that you are struggling.  That's not fair.  

" I struggled for a long time with the way I had been treated (pushed, told that I was being unrealistic, that all that mattered was a healthy baby..."  This was exactly it for me, too.  I felt so manipulated (I was pushed into an unwanted induction which led to the c/s).  You're right, the "dead baby card" is powerful stuff.  As a mom who has had two losses, I can honestly say that in some ways, the cesarean was as traumatic as my miscarriages/hemorrhage.  I can't stand the phrase "all that matters is a healthy baby."  There is SO much that matters!  Dignity, respect, autonomy.  Trust. 

Oh... and the first post surgery bowel movement... yep.  I totally understand that!

I really think that under different circumstances with a compassionate and caring doctor, that a cesarean can be beautiful and empowering.  The most empowering thing for me about my second birth (the VBAC) was that I was respected and well cared for.  That was missing in the first birth.  I really think that if you do need a second cesarean for breech, you, your family, and your doctor can make it a MUCH MORE POSITIVE experience than before!  

One thing that the c/s did do for me was to help me learn to advocate for myself.  I am allowed to have a voice and I feel good about it.  I deserve to be respected and taken seriously... and so do you!  

Much love to you!  I hope you are able to find the peace about your upcoming birth that you are searching for!  

[SlimP]

Cabbit Dancer, that's a heart-rending story so firstly big hugs. I believe losing your voice relates directly to your feeling that your wishes were overlooked during your previous delivery......your words fell on deaf ears. Your treatment is typical of the orthodox medical establishment ignoring any intuition or instinct we might have about our own health and what might be better for us and our babies. Even the way you say you had trouble admitting to yourself that you suffered from PPD is linked. Healing will come with voicing your unexpressed emotions, if not to a loved one or practitioner, then by writing or singing or even shouting, so long as you put words out there.
Similarly, the bowels relate to letting go of waste or old unneeded material. Yes, that first bowel movement post-partum is difficult but particularly so if there is an emotional element attached.
Obviously this is not evidence-based Science but I believe our emotional side is inextricably linked to our physical health! Figure out what you need this time and you'll be a stronger advocate for yourself.

Keeptryst, it sounds like you are pretty sure of what you want and are open to trusting your instinct. I was bullied into an induction with my DS although my gut, and heart, told me baby was fine. I sooo want to avoid that this time and hope to be strong enough to rely on my intuition at the time. Good luck.

[keeptryst]

Originally Posted by buko 

Keeptryst, *hugs*. I'm sure you know that ruptures are rarely catastrophic (even if they happen at home)? I apologize I don't have the actual numbers at hand, but I believe a truly bad outcome from a VBAC (having a catastrophic rupture) is .06%, as opposed to having any rupture (0.5%, as you mentioned). So more like 1 in 2000, if I'm not way off.

Buko, thanks for jumping in, appreciate the support. Apparently, the 0.4% (1 in 200 women) statistic does refer to true, complete, uterine ruptures in spontaneous labors after one prior low, transverse cesarean. The statistic “Only 6% of uterine ruptures are catastrophic” refers to the rate of infant death due to uterine rupture: of the women who had uterine ruptures, 6.2% (1 in 16) resulted in infant deaths.

Originally Posted by Chapsie   

It has been 5 years since your cesarean-- that's a good long time for that scar to heal up nicely.  Yes, there are risks involved... but there are risks to everything.  

This is obviously an issue near and dear to my heart, so I will be sure to post more later!!!

Chapsie, I agree - that's what it all comes down to - yes, there is risk, and how are you going to react to that? Like you said there is risk to every facet of living. The saying "birth is as safe as life gets" is so true! We have a choice to live from fear or faith, but when it comes to childbirth and people playing the dead baby/dead mother card, it is not easy...

Originally Posted by cabbitdancer 

I am lucky to have found an OB who is far more trusting of me than I am of him. I need to relax, and it's been hard, between the struggle to keep my sugars in line, and now dealing with a second breech baby. That spinning babies site actually pissed me off, because there's a portion in there that basically implies that, if a baby is breech, maybe the mother's fear is at fault. That is so not fair, and doesn't do anything to relieve the tension that I've been feeling for the past month since finding that my daughter has decided to turn breech like her sister.

I DON'T WANT ANOTHER C-SECTION. I don't want to deal with all of the side-effects that made my last c-section so unbearable, despite having a fairly textbook recovery. I lost my voice and I DON'T KNOW WHY and could neither sing nor read to my daughter for almost a year, and I am afraid it will happen again. Intercourse was unbearable, even with lubrication, for at least a year, and my marriage has suffered as a result. I still can't feel portions of my abdomen, and don't get me started on that first post-surgery bowel movement... These are things that I'm going to have to address with my OB, should the topic come up, and I'm so scared that I won't be a strong enough advocate for myself.

I'm so sorry to dump on you guys like this, but this is the sort of stuff that has been plaguing me for the past month or so... How do I find that peace that allows me to just accept what comes when all is said and done?

cabbitdancer, yes the journey matters as much as the destination and when we are treated like the means to an end it robs us of our right to make authentic decisions that we are at peace with. I'm glad you're with a supportive OB this time - I know homebirth is ruled out, but are you/he open to giving vaginal breech birth in hospital a chance? I've heard certain types of breech, like frank breech, are relatively less risky to deliver.

Originally Posted by SlimP 

I was bullied into an induction with my DS although my gut, and heart, told me baby was fine. I sooo want to avoid that this time and hope to be strong enough to rely on my intuition at the time. Good luck.

I often realize we are lucky to have second chances to apply the lessons we learned the first time around. I hope we are all strong enough to be at peace with our decisions this time around!

[cabbitdancer]

I would love to give birth to a breech baby, if my choice were between vaginal breech delivery and a repeat C, but I know my OB doesn't support that. It's funny. I've done soul-searching, regarding this pregnancy, and I am more comfortable having an "oops baby came too quickly" unassisted breech birth at home than I am with going into the hospital for another cesarean. The risks are there, but there are risks, either way and, for some reason, I feel better accepting the risks of an unassisted birth than the risks of a cesarean. My husband gave me a funny look when I mentioned it to him. He is NOT comfortable with the idea, though he supports my desire to wait at least until I go into labor before acquiescing to a C-section...

[Chapsie]

Yeah... I asked my midwife about breech at home a couple years ago, and she said that as a VBAC, that is just too many risk factors for her to feel comfortable with-- especially since I make bigger babies.  I agree with her.  In my mind, I was ok with having another c/s if it was twins or breech or previa or something like that... If there was a *good* reason in addition to the old c/s scar.    But that's just me, after a lot of soul searching and praying.  :)  

[velveeta]

Hi friends, we are all so similar, it sounds like. I believe my baby is now vertex, but we've been trying to turn him for the last two weeks -- doing everything we could think of. For me, it would mean a repeat c if baby stayed breech. I am planning HBAC, and so far, so good. I will have an u/s in the coming days to check position. My MW doesn't feel comfortable with VBAC plus breech. Weird to think it would either be HB or C at the hospital!

Prior to my cesarean birth, I had two vertex home births. I still carry PTSD from the C. Mainly bc my two older kids were scared when their dad and I had to leave so abruptly, and then I had no support (apart from my husband) when I came home (the following day, actually bc my kids were so upset). And the recovery pain was tremendous. Worst pain of my life. I know this time wouldn't be so bad, as I already have friends on standby in case of hospital transfer (for the older kids).

I am trying to be at peace, open to how this baby wants to enter the world, but gently inviting him to go/stay head down!

I do feel vaginal breech birth would be a great option to have. Since ACOG's position is that c section is safer for breech, based on the flawed Hannah Study, our hospitals won't allow it.

Even if I know breech for sure, I am going to try to labor as long as I can, as I did with DD. Like you, cabbitdancer, I would rather UC breech at home, but DH is just not comfortable with that, and I need support from him, and for him to feel safe and respected, too. That doesn't mean I won't try to convince him, though!

Good births for all of us!
Edited by velveeta - 2/24/13 at 8:05pm

[RainGardenMama]

Keeptryst- the birthstory you posted a link to was amazing!

And Chapsie- your story is so inspiring, as well!

Thanks for all for sharing. :)
 

[keeptryst]

Originally Posted by RainGardenMama 

Keeptryst- the birthstory you posted a link to was amazing!

Yes, that story just blew my mind, I actually took a print-out of it that I read whenever I get discouraged.

[akind1]

My c-section was nearly 3 1/2 years ago - failed induction, cascade of intervention . . . the usual story. And I can honestly say the only regret I have is what is has changed, permanently for any  and all future births. The surgery itself was not traumatic, my son and I bonded well, all that.

I had a VBAC not quite 18 months ago (October 2011) in the hospital. It was a healing experience, even if the recovery was actually far more difficult than my c-section recovery. A 4th degree tear will do that. It was in the hospital, with a doula, and generally as natural as it could be. One thing I've learned in navigating the medical establishment is to give when you can - I choose my battles, and I think makes my doctors and medical staff far more willing to work with me on other things. I listen to their opinions, but I don't always take their advice. Mutual respect goes a long way.

Both my previous 2 were born at 41+6. I am really hoping this little man does not go that far. For one thing, the practice I'm with has decided they don't really like their VBAC patients to go past 41, and will not induce, except for use of AROM. Also, I've DONE the waiting thing. I don't want to do it again! Having had one successful VBAC has given me such confidence that I can do it again.

I'm 39 weeks today. The ultrasound guesstimate last week had boy measured at 8 lbs 6 oz. I know that this late, those guesses are really just that, but I also have a gut feeling that the guess is not far off. So, if the general guidelines are baby adds 1/2 lb a week at this stage, I really don't want him cooking TOO much longer, IYWIM. my others were 6 14 and 7 12. My guess for this one is 8 10 when he's born. We'll see.

I wish all of us lots of confidence and strength - the last few weeks of a VBAC pregnancy are the most challenging, with pressure from lots of sides to just schedule something, or to scare you out of a vaginal birth. We made it this far - not much more to go!

[buko]

akind1, I was under the impression that baby weights start leveling off a bit after 38 or 39 weeks... like maybe they only increase 1/4 lb/week after 39 weeks, and very little (if at all) after 41?  But I don't have a citation offhand...

[cabbitdancer]

Yeah. I'm pretty sure baby's growth levels off at this point.

My baby is measuring in the 59th percentile by u/s. Different practice and different tech, but my first measured much bigger than she actually came out as, so my guess is this one may top out around 7 lb, a couple ounces.

[nearlyelated]

Originally Posted by akind1 

And I can honestly say the only regret I have is what is has changed, permanently for any  and all future births. The surgery itself was not traumatic, my son and I bonded well, all that.

My experience is similar to this.  I ended up with a C/S due to poor positioning.  I was planning a home birth, and fortunately went into labour at 41w5 after a stretch and sweep.  I laboured through the night following the sweep, and called my midwife in the morning since I had an appointment with a OB at the hospital to discuss induction.  I wanted to know if I should still go since I was pretty sure I was in labour.  At the point my contractions were still 8 minutes apart, so I wouldn't have called her otherwise.  She said that I sounded fine, and that I should go, just in case, and the hospital was only a few minutes away anyway.  

At 9 a.m. DP and I got to the hospital and in to see the OB and as she was taking my information I had a contraction, so she asked if she could check me, since it seemed like an induction wasn't going to be necessary.  I agreed and when she checked I was already 7 cm.  Since I was planning a home birth, she sent us home, rather than to L&D.  I guess she also called my midwife.   I had decided to go home and go back to what I was doing which was dozing between contractions and generally relaxing, but at 10, the midwives called and asked if I had been planning on calling, but I said my contractions were still not 5 minutes apart so I didn't think there was a rush.  Either way she decided to come, despite having been up all night at another birth.  She was a new midwife, and technically needed to have another fully licensed midwife at the birth, but they were all with other clients.  So it was her and a student (who had also been up all night).  

They arrived and effectively put an end to my resting.  She asked me to start walking the stairs and I started playing hostess (big mistake!), and things slowly progressed to 8cm.  After a while there, she suggested they try AROM to get things moving.  Not knowing better I agreed.  At this point the pool was set up and so I got it and continued on.  I remember at one point drifting off while leaning against the side of the pool and I guess this freaked out the midwife who quickly tried to give me an IV with fluid because she thought I was passing out.  I think I was just tired, but it's impossible to know.  By this time it was 4:30 and I was wiped, at only 8.5 cm, the midwives suggested transferring so that I could get an epi and some rest.  I was tired, so I agreed.  We got to the hospital and into the birthing room and got the epi installed.  Before it could even kick in I was fully dilated, although after reviewing my post-op, apparently there was a lip.

One of the benefits of moving to the hospital, was that there were other midwives there who were able to help out my completely exhausted team.  They coached me in some pushing (which I couldn't feel, and hated), but with no luck.  I guess I pushed off and on for 2 hours, but after a while every time I would push, the baby's heart rate would drop.  It got to the point where the OBs came in to consult, and decided that they could try the vacuum, but it would likely end up in a section anyway.  So at 8:30ish DP and I decided to just do the section.  As it turns out baby was in a bad position that no one had diagnosed ahead of time.  I suspect that AROM locked him in a bad position, but again, no way to know.  The OB told me after the surgery that he couldn't think of any reason why I wouldn't be able to have a vaginal birth in the future.

My recovery was quick (aside from some swelling that the nurses forgot to give me ice for), and I was only in the hospital 2 nights, which considering he was born at 9 p.m. isn't too bad.  Nursing was easy and he had no issues.

So, long story short, I didn't have an awful birth experience the first time.  I know a lot of things that I'd do differently, and regret that I now have this risk factor on my record, but overall I have faith that this birth will go differently.  I wished I'd hired a doula last time, that's the one major thing I regret not doing.

I feel confident in my HBAC choice and am literally 5 minutes from the regional centre where they will have surgeons on duty at all times.  The only think I'm nervous about is my one of my midwives.  She's new (still in her first year) and has been upfront about not being comfortable about us being at home.  She's a former L&D nurse and so might skew towards the medical side more, but she will have a second with her (if she's the one on call when I go into labour).  I'm still hoping that my other midwife is on call, but that's out of my control.