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Cesarean Section Support Only Thread June 2005 - Page 7

post #121 of 339
Thread Starter 

Update on Latest OB appointment

Well I thought this was going to be my last OB appointment but she wants to see me one more time before my scheduled csection on the 24th. I am going on the afternoon 23rd.

She was really booked this time, and Jeff and I had to wait nearly an hour to see her. I gained half a pound. So my total so far is 8.5lbs, my BP was great, urine great too. I am retaining some fluid. However it was 100 degrees yesterday, I think some of it has to do with the heat. Staying hydrated right now is my biggest problem, because I get parched so quickly if I go out anywhere.

We discussed the planned csection. I just really wanted to touch up on things I had talked about with her before. She said that someone needs to remind her to use stitches instead of staples because she will forget. I told her not to worry, my sister would! She says that she really thinks it will be possible for Jeff to cut the cord too. I am very excited about that!

Next week I am going to get checked to see if I have dilated any. I have serious doubts I have, but since I am still planning to get the IUD I am hoping for just a little bit of dilation.

I have 8 days to go.
post #122 of 339
Quote:
Originally Posted by OnTheFence
Alison,

At least with a csection *I* know my risks, and while something can go wrong things are less likely to be catastrophic. Of course this is my personal view, but I thought I would share it since you brought this up.

Kim

Hi Kim, and everyone... thank you for sharing your thoughts.

I feel very much like you do about this. And I have been through a C-section and had a great recovery, so I naturally have less fear of the C-section.

I've often felt that having a VBAC vs. Cesarean can be compared to travelling by Car vs. Airplane.

The risks of having an accident are greater if you are travelling by car... but if you happen to be the 1% that gets into a plane wreck, your results are much more likely to be catastrophic.

I think one thing that really scares me about VBAC is that they often don't even know that you've ruptured (or dehisced) until it's too late.


I talked about my feelings w/dh last night and he didn't even realize that he'd been putting this pressure on me. Turns out, he's totally supportive of whatever decision I make.

I was up at 3 a.m. looking up articles on PubMed and it still didn't really help me much... and now I'm soooo sleeepy!

thanks again,
ali
post #123 of 339
Quote:
Originally Posted by OnTheFence
I cried during my last csection when they pulled Jack out. Remember though I had the epidural and didn't have any pain.

Kim
I probably could have cried in OR, but there actually were a few minutes afterwards when I was too blissed at finally having my baby - 10 years is a long time to wait. I mean more in the several days post-op. I can't cry out the emotions I'm feeling, and I think it makes it worse because I effectively end up "stuffing" the disappointment and depression.

Well...maybe I'll see if I can bawl my eyes out while the anesthetic is still working. The release might help.
post #124 of 339
Well...had an appointment with my doctor (not the OB) yesterday. She asked again if I wanted to schedule a section, and I said no. She's been putting on the pressure (gently, and I do believe out of genuine concern) for the last several appointments, so I finally told her how I felt about it. As far as I can recall, my words were "from my standpoint as the patient, not as a medical professional, you want to give me a 100% chance of physical and emotional trauma in order to avoid the slight chance that I may experience something worse. That's not acceptable to me.". She stood there looking sad, but said "okay". I think she gets where I'm coming from, but is still really worried.

DH is having a bit of trouble. He asked me last night if me or the baby is going to die...don't think he really believes it will happen, but the whole thing is freaking him out a bit. DH has never been around pregnant women until we got together - I think the whole "good pregnancy, ending in c-section" thing with dd really rattled him. I re-assured him that the odds are good, but that I obviously can't make any guarantees. He's definitely behind me on this, but he's scared. I think he always thought of birth as something that always went okay until he hooked up with me and my "VBAC vs. ERCS" issues.

So...my doctor is using the u/s due date - July 7th (got it wrong in my sig...thought they said the 9th), and my OB is using my original due date - July 14th. My OB is away for two weeks right now, and I went into labour with ds at 38.5 weeks - of course, dd was born 5 days before due date, with no labour at all. I'm getting a little freaked about this, as I could very well go into labour while my OB is still away. A scheduled section wouldn't have changed that, though - it wouldn't have been set up until around the 8th. My OB says that when u/s is so close to the original due date, he stays with the original date, because women know their cycles, and he'd rather rely on that than on the u/s.

I'm rambling. Anyway - I'm seeing my doctor weekly, and see my OB again on July 4th (if I haven't already gone into labour). At that time, we'll once again discuss my options. I just hope my OB doesn't bring up a tubal again. He seems to forget that he's already asked me and I said no. :LOL
post #125 of 339
Quote:
Originally Posted by OnTheFence
However my rupture rate ranges from 3% to 20% depending on what you read about uterine anomalies with an already cut uterus. My OB doesn't know what the risks are *for me*, and at this point we aren't sure what my uterus may do next. At least with a csection *I* know my risks, and while something can go wrong things are less likely to be catastrophic.
You do have a point, Kim. This one has been eating at me a lot. If something goes wrong with my VBA2C attempt, I know I'll be kicking myself for the rest of my life. And, I really can't find good stats on my risks, anyway. My first section was 12 years ago. There seems to be no consensus on whether such a long time makes a difference in the risk of rupture. I know that dd being fully 2-years-old is a plus, but how much of one?

And, I've had a really hard time finding anything that separates the risk factor for 2 previous c-sections...the studies all seem to break into "one previous incision" and "two or more previous incisions". If two increases the risk, then it's a safe bet that three increases the risk even more - but by how much? Maternal age...size of baby...how much difference do they make?

I wish I had more answers...
post #126 of 339
A study just came out examining the vba2c rupture rates. It was a good study. I am going from memory here.. but the rate was less than 2%..

I will go find the study..

Chantal
post #127 of 339
Thread Starter 
Quote:
Originally Posted by Storm Bride
You do have a point, Kim. This one has been eating at me a lot. If something goes wrong with my VBA2C attempt, I know I'll be kicking myself for the rest of my life. And, I really can't find good stats on my risks, anyway. My first section was 12 years ago. There seems to be no consensus on whether such a long time makes a difference in the risk of rupture. I know that dd being fully 2-years-old is a plus, but how much of one?

And, I've had a really hard time finding anything that separates the risk factor for 2 previous c-sections...the studies all seem to break into "one previous incision" and "two or more previous incisions". If two increases the risk, then it's a safe bet that three increases the risk even more - but by how much? Maternal age...size of baby...how much difference do they make?

I wish I had more answers...
I am not sure how you were sutured before. Some studies suggest double layer sutures help prevent against rupture, while others do not. Some say a VBAC after a csection for malposition is more likely than if your csection was for some other reasons. Everything contradicts everything else. I personally think its hard to say *all* VBAC attempts have a less than 1% rupture rate without induction methods, etc. In the last three months I have read about four different mothers who have had ruptures, only one had pitocin given AFTER an already spontaneous labor and they believe that the problem did not happen because of the pit. If it's so rare then why do we read about it so often -- is it because we are looking for it?

When I discovered that Katie had turned vertex I started to research VBAC once again, and like you having had 2 previous csections was looking for something that gave more numbers or at least some evidence based advice on rupture rate and rate of success. It really was hard looking for that, because there really isn't much to go on.

Kim
post #128 of 339
Thread Starter 
Quote:
Originally Posted by chantald
A study just came out examining the vba2c rupture rates. It was a good study. I am going from memory here.. but the rate was less than 2%..

I will go find the study..

Chantal
I would love to read it! Please post it if you can locate it again.
post #129 of 339
I feel the exact same way as you..
I have 12 weeks to go but have been given the choice of a repeat cesarean or attempting Vbac, I am so nervous.. as this baby is due only 17 months after my last cesarean.. I am scared to VBAC because of rupture, is 17 months too early to even attempt a vaginal birth, but scared of the recovery after a cesarean, especially with a little one at home.. I have been doing research like crazy.. and don't have a clue what to do.
I feel for you.
post #130 of 339
Quote:
Originally Posted by OnTheFence
When I discovered that Katie had turned vertex I started to research VBAC once again, and like you having had 2 previous csections was looking for something that gave more numbers or at least some evidence based advice on rupture rate and rate of success. It really was hard looking for that, because there really isn't much to go on.

Kim
Of course, your research is even more complicated because of your uterine anomaly. If this baby turns again, I may ask my OB to look into that - find out if I also have one. Mind you - if this one goes to c-section, I'm not that interested in pursuing a VBA3C with the next one. Do you know if uterine anomalies have any repercussions outside of childbearing?

It is frustrating. Despite the fact that I'm fighting another c-section, I am putting a lot of trust in my doctors to handle an emergency. The whole thing is difficult, as I'm not sure I trust doctors at all at this point. But, we'll see how it goes. Baby-under-construction is thriving and active...and still head down...
post #131 of 339
Quote:
Originally Posted by chantald
A study just came out examining the vba2c rupture rates. It was a good study. I am going from memory here.. but the rate was less than 2%..

I will go find the study..

Chantal
That sounds pretty good. My OB uses 3% as his working estimate. Of course....I really wish I knew if the length of time between sections makes any difference. I found numbers that suggested anything over 2 years is good. But, I can't tell if the odds improve with even more time. Emotionally, I tend to wonder how relevant my first c-section even is...it was over 12 years ago!

Kim: I have no idea about the sutures, either. I think I'm just going to leave things where they are. The fact is at this point, there's a pretty good chance I'll go into labour before they would have scheduled my surgery, anyway!
post #132 of 339
Quote:
Originally Posted by caramia
I feel the exact same way as you..
I have 12 weeks to go but have been given the choice of a repeat cesarean or attempting Vbac, I am so nervous.. as this baby is due only 17 months after my last cesarean.. I am scared to VBAC because of rupture, is 17 months too early to even attempt a vaginal birth, but scared of the recovery after a cesarean, especially with a little one at home.. I have been doing research like crazy.. and don't have a clue what to do.
I feel for you.
I think they prefer 18 months, but I don't think 17 months is crazy. My first vbac was 18 months after my c-section. My second vbac was 18 months after my first vbac.

It's sad they make it sound so scary. I'm all for people being informed, but I wasn't even scared when I had my 2 vbac's, back in the 90's, and they went totally fine.
post #133 of 339
Thread Starter 
Quote:
Originally Posted by Storm Bride
Of course, your research is even more complicated because of your uterine anomaly. If this baby turns again, I may ask my OB to look into that - find out if I also have one. Mind you - if this one goes to c-section, I'm not that interested in pursuing a VBA3C with the next one. Do you know if uterine anomalies have any repercussions outside of childbearing?
Not really. Some women have problems with their kidneys and are more prone to infection. That is all I can find. Mostly its with reproduction, higher incidence of miscarriage, implantation problems, ovulation problems and of course, birth problems.
post #134 of 339
I'm almost done having children - well, maybe I am done...dh & I are still negotiating number 4.

I may not bother getting this checked out. If I'm finished having children, it doesn't seem likely that I can do anything about kidney difficulties or infections. From what you've posted, I don't think an anomaly is what's been going on with me, anyway - although it's certainly possible. The human body is too complicated...
post #135 of 339
Hi
The study is in Am J Obstet Gynecol. 2005 Apr;192(4):1223-8; discussion 1228-9.
PMID: 15846208 Macones GA, et al. Obstetric outcomes in women with two
prior cesarean deliveries: is vaginal birth after cesarean delivery a viable option?

I cannot quote it directly or post the summary because I dont' have permission. But it did find that the rupture rate for a VBA2C was in the 1-2% range, with an N of 1082 subjects and a vbac success rate of about 75%
20% of the ruptures were linked to prostiglanden use..

On the whole the study says that, while there are more complications in the vba2c group but states that on a whole, the risks are low.

Chantal

If you go to the medical library of your local hospital and give them the pubmed ID you can request a copy.. which takes a while...
post #136 of 339
I think I'll probably have the baby before I could get the report - don't know if it works the same way in Canada or not. I might need a different ID??

Thanks, chantal. Every little bit helps, and 1-2% is within my risk tolerance. Besides, 75% success rate is not shabby! I'll cross my fingers and try to stay calm.
post #137 of 339
I have an odd question for those of you with more than one caesarean, particularly if the first was emergency, and the secon planned ahead. I'm wondering how you knew (if you did) that you'd be okay with the second or subsequent surgeries?

When I got pregnant with baby-under-construction, I'd already been told that it would have to be a c-section, and I'd have to accept it. I didn't like it, but I wanted another baby, and I thought I'd be okay with it. Once I found out I was pregnant, I just lost it - nightmares, insomnia - you name it. So...this one may be a VBA2C, but I know it may be a section. I think that I'd be okay with my next baby (if there is one) being another section if that happened...but how do you know for sure? I thought I'd be okay with this one, and when it came down to it, I'm not okay with it at all....
post #138 of 339
Thread Starter 
Quote:
Originally Posted by Storm Bride
I have an odd question for those of you with more than one caesarean, particularly if the first was emergency, and the secon planned ahead. I'm wondering how you knew (if you did) that you'd be okay with the second or subsequent surgeries?

When I got pregnant with baby-under-construction, I'd already been told that it would have to be a c-section, and I'd have to accept it. I didn't like it, but I wanted another baby, and I thought I'd be okay with it. Once I found out I was pregnant, I just lost it - nightmares, insomnia - you name it. So...this one may be a VBA2C, but I know it may be a section. I think that I'd be okay with my next baby (if there is one) being another section if that happened...but how do you know for sure? I thought I'd be okay with this one, and when it came down to it, I'm not okay with it at all....
I was told that I would never carry another pregnancy to term, that I would not have any biological children, so when it looked like my pregnancy was going to make it, I decided that I would make the best of the situation. I knew that I was given this chance by the gods and that I had confidence that in the end I would have a baby. I felt confident in my doctors skills, and the fact that she worked with me every step of the way in making sure I had a good experience in that OR. When they pulled Jack out, I cried and was saying "I can't believe my body did this again."

I am not going to lie, I've had a pretty uneventful pregnancy compared to my last one and I hope that I have that same kind of cesarean -- uneventful, as I planned, but I do have anxiety about it. Last time was a healing experience for me and again, I have a great doctor who is working to give me the best overall experience and at this point in my life a vaginal birth is the last of my wants or concerns -- I want happy healthy babies with no catastrophic events taking place.
post #139 of 339
Quote:
Originally Posted by caramia
I feel the exact same way as you..
I have 12 weeks to go but have been given the choice of a repeat cesarean or attempting Vbac, I am so nervous.. as this baby is due only 17 months after my last cesarean.. I am scared to VBAC because of rupture, is 17 months too early to even attempt a vaginal birth, but scared of the recovery after a cesarean, especially with a little one at home.. I have been doing research like crazy.. and don't have a clue what to do.
I feel for you.
I feel the same way. I am scheduled for a repeat c/s in 5 days. And I still am questioning myself. I hope I made the right decision. I still might change my mind and opt for a VBAC. I don't know. It is scary either way. I too have researched and researched and researched and am clueless and majorly anxious. If something goes wrong I know I will never forgive myself. I wish I had a magic ball and could look into the future and see which path is best for us. I'll let you know how it goes.
post #140 of 339
for all of you struggling with your decisions..

No one has a magic ball that they can tell what will happen by looking in it. Life would be so much easier if we did.

No matter what choices you make or will make.. try to find peace with them.
It can be easy to look back and say "I should have" or "If only" or to feel guilty about a choice made or not made. Be easy on yourselves.



Chantal
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