VBAC or breastfeed? Long.

[egfmba]

I'm relatively new here. Long time lurker, second time poster.
A bit about me: I have one DS, 4.5 yrs old. Married several years. I enjoy candlelit dinners and long walks on the beach. : But seriously. I have a question I have been struggling with for several months now.

I went into labor w/ DS on a Monday, on Friday they finally did a c-section. DS was facing up and his head was tilted (acynclitic?) so that he wasn't bearing down on my cervix correctly. I dilated to 6 centimeters (I was 5 when I came in that morning around 1 a.m.). Then the nazi nurse said the baby wasn't handling labor well anymore and moved me to the OR. Crappy nurse, crappy doctor, crappy birth experience.

I put DS to breast as soon as I came out of the meds, and did my best to breastfeed. My supply ended up being too low. I went through fenugreek, an LLL consult, no formula, and several crying jags (both mine and DS's). I was only able to give him about 2 ounces each feeding and supplemented with formula. This went on until we weaned at 16 months. DH tried to be supportive, but freaked and was a major reason we gave DS formula in the first place.

I'm older, wiser, and expecting a new baby in March. I'm also in law school, and it turns out DS is on the autism spectrum. So, in short, busy life. Baby's due March 16th. I can only miss about 3 weeks of school without violating bar association attendance requirements. I'm looking into this, but, either way, I'm worried.

See, I can try for a VBAC, but my doc would only want me to try this if I go into labor on my own by my due date (since 'failure to progress' was the 'diagnosis' for DS, she advised I have a 50% chance of success with this one). If I choose a c-section, doc wants to schedule the birth for the 7th, the weekend before spring break. I could take that extra week to work on making this breastfeeding experience completely successful (by which I mean this baby gets nothing but breastmilk).

I am seriously torn about this birth. I want a VBAC, but I also want to maximize my chances of breastfeeding. I know a bit more now (and plan on learning even more before the birth) about both. What can I do to increase/ensure success?

There’s one more thing: DH may be going back to Iraq next April. I’m pretty sure stress was a major reason I wasn’t as successful at breastfeeding as I’d like to have been. How do I handle this birth decision?

I don't know what to do. What do I need to know to make this decision? What would you personally choose? I'm seeking educated opinions here to help educate and inform my own decision. Thanks if you made it this far. I’ve x-posted this in VBAC, Breastfeeding, and the BBB board for the most information/education.

TIA,
eva

[alegna]

Get rid of the OB. Find a midwife. FTP is a BS diagnoses. Get someone who will actually support your VBAC. A section will seriously reduce your chance of breastfeeding successfully.

-Angela

[rmzbm]

I find it nearly impossible to believe that you had this problem as a result of a section. The stress you describe, maybe. Most mothers who have sections BF successfully, I know many & myself have, I even had oversupply. I am sorry I don't have advise but the tone around here re: sections is REALLY getting to me lately. One has nothing to do with the other. I mean, maybe for some woman it can for certain reasons, but AS A RULE moms who have sections BF just fine. My point is just that it DOESN'T have to be either/or. You can have a surgical delivery and BF. The fact you had low supply before would make me worry that it would happen again though...but moms have this problem with natural deliveries, too. It's not so uncommon. Again, no advise...but please don't go right to formula just b/c you have a section! Good luck!

[amygoforth]

Wow, Eva. I'm sorry things are so complicated and stressful for you during a time that should be nothing but joyful.

If I were in your shoes, I'd choose the VBAC and seek out good LCs and LLL groups near you. Seriously, you'll have the best chance at a successful breastfeeding relationship if you can avoid the c. Think about it: you'll be able to nurse right away, without waiting for the stitches for the meds to wear off. Plus, you won't have the extra pain and healing from the surgery. All you'll have to focus on is your baby.

Angela made a good point. Are there any midwives near you? You'd probably have a better chance with a midwife. You shouldn't let your OB pressure you about due dates, since we all know they're pretty much arbitrary. Consider a doula as well.

Re: law school... can you sling your babe and wear him to class? You can BF quite modestly in a wrap (although honestly I haven't tried it... I've seen my friends do it...)

Good luck, mama!

[rmzbm]

There's no reason you can't nurse right away after a section. They can't tell you otherwise if you want to. I nursed in the OR.

[egfmba]

Originally Posted by rmzbm

I find it nearly impossible to believe that you had this problem as a result of a section. ...but please don't go right to formula just b/c you have a section! Good luck!

Thanks. I don't think the supply issue was a direct result of the section. I think it was a combination of factors (stress, long labor, school was starting up again in a few weeks, no support from family or friends because they'd never breastfed or seen it done, and, of course, the pain of it all!). Also, last time, my breasts didn't change at all before birth. This time, I've felt fuller and tingling and it's like they're getting ready for the new one. So, hopefully, that's a good sign.

I'm just wondering if I should go ahead with a section this time to allow myself more time to recover and start breastfeeding on the best track. I know I'm taking a chance either way; I just want to know which chance to take. Does that make sense?

eva

[rmzbm]

Originally Posted by egfmba

Thanks. I don't think the supply issue was a direct result of the section. I think it was a combination of factors (stress, long labor, school was starting up again in a few weeks, no support from family or friends because they'd never breastfed or seen it done, and, of course, the pain of it all!). Also, last time, my breasts didn't change at all before birth. This time, I've felt fuller and tingling and it's like they're getting ready for the new one. So, hopefully, that's a good sign.

I'm just wondering if I should go ahead with a section this time to allow myself more time to recover and start breastfeeding on the best track. I know I'm taking a chance either way; I just want to know which chance to take. Does that make sense?

eva

I understand.
What you have described sounds like an awful stressful situation & likely that did contribute.
You CAN nurse after a section - don't let ANYONE tell you different.
That said, PLEASE consider a VBAC anyhow. Not so that you can BF, you can BF no matter what you decide, but because it's better for your body and your baby.
Beyond that, plan to BF...you can & you will!
Good luck!

[egfmba]

Also, although I'm told midwives are covered on my plan (an HMO), there's only one, Ann Jacob, here in Houston, TX on my plan, and I'd have to change provider groups to get a chance at getting to her. Not that I'm unwilling, but believe me, my HMO is no picnic already. I'm looking into the options.

Either way, the doc can't perform surgery if there's no patient, right? At the end of the day, she knows I'm not that gullible. Her DH went to law school here, and she's currently pregnant herself (her first). I think by the time my labor rolls around, she'll have a better outlook on it. She supports my desire for a VBAC, but she's like every other doc: worried about lawsuits.

I want to wait to go into labor on my own, but I just didn't know if I should forego one to ensure a great result on the other. And which one? Birth is huge, but I don't want to go through formula again.

eva

[rmzbm]

My advise is go for the VBAC. Then go on to BF. It doesn't have to be either/or - you can nurse after a section...but why have a section to begin with? Cuz the OB wants you to? That's the worst reason yet.

[alegna]

Oh! You're in Houston! That's great news. I bet you can get a homebirth midwife covered... do some searches here.

-Angela

[roadfamily6now]

i wholeheartedly agree with RMZBM (marie)

I see no reason why you cannot successfully BF,
Also, you can VBAC too!

Good LUck!

[Ruthla]

If you go for a VBAC, the baby will truly be ready to be born and will have a much better chance of BF sucessfully. Even if you end up with another c/s, by waiting until you go into labor naturally you'll avoid the risk of a "not quite ripe" baby. Babies born before they're ready (even if they're at or beyond the estimated "due date") are more likely to have problems with sucking, breathing, or co-ordinating the two.

I'd definitely look into taking the newborn to class with you, if you won't be able to take a full maternity leave. Would you consider putting school on hold for a year so you don't have to worry about this, or is that not a realistic option right now?

[alegna]

I'd be interested in who your OB is, or at least which hospital. There's a great variation in section rates at Houston hospitals. A few as low as ~27% Some as high as 40%+

I would homebirth. With a supportive midwife. Plan to be successful. As mentioned- take your baby to class with you to nurse. If that won't work- have someone bring babe to you on breaks to nurse. You CAN make this work

-Angela

[egfmba]

Putting school off for any amount of time (a semester or a year) is not feasible; DH works 3 jobs to take care of DS (who needs a lot of specific care because of the autism spectrum disorder).

We knew this wasn't the best time, but it's the best of the worst time to have another, KWIM? After I graduate, it'll be a few years before I could have another and then I'm 'high risk' because I'll be over 35. Bah!

Don't know about bringing baby to school, but I don't think it's out of the question. I also don't know about homebirth yet. I honestly think the only support on that I'd get is from the midwife. Seriously. Everyone else would be a PITA.

I'm so grateful for all the responses and help. Seriously. You guys are the only ones I can ask about this because everyone else says "midwife? whah? whaddya mean? are you speaking english?" : They seriously have no idea what it is to even consider anything outside of a hospital and a OB/GYN.

Thanks again for the insight. I'm going to talk more about this w/my peek-n-poke (OB/GYN) and look further into available midwives (if there are actually any available on my plan). If it's not covered by the insurance, we can't afford it right now.

eva

ETA: my doc is a Kelsey-Seybold doc, Purnima Rao, who is just lovely in all other ways as a doc, and she's only got privileges at Woman's Hospital of Texas (which is where the first crappy birth experience occurred). I've already told her I don't want to even see the nurse that attended me last time. Woman's hospital my hiney (can I say that here?).

[alegna]

oooo.... I'd run from Women's. They brag about their OVER 40% section rate.

:

-Angela

[Attached Mama]

I would def go for a VBAC and stay away from hsptls if it were me! I plan to have a home VBAC for the next one.

And some women do have problems BF with a c-section. For me, with the meds/drugs from the c/s i think my body was messed up and didn't know if it should produce milk yet or not. DD wouldn't latch on because she was so tiny (another reason to not have a c/s). It was about 3 days before my colostrum came and longer for the milk. So much to my dismay dd had some formula. Maybe if she had been latching instead of me having to pump milk etc would have come more quickly.

I don't think anyone asked this, but.... were you trying to breasfeed on a schedule? This can greatly reduce milk supply as can tyring to get baby to sleep thru the night.

I would homebirth (hsptls have awful vbac success rates!) and just don't even tell people your plans if necessary. Then I'd take that 3 weeks and plan NOTHING but baby time. Just wear the baby, hold the baby and breastfeed on demand. You will go back to school full of milk I also 2nd the suggestion to keep baby with you at school or at least have someone bring him/her to you to breastfeed.

read all you can on here to learn about how bad unnessecary c/s are and how most are unnecessary. and btw.. Welcome to MDC!! :-)

Good luck! and hear is hoping your DH does NOT have to go back to Iraq!

[Herausgeber]

I know I'm talking out of school here since my first isn't due for another 2 months and thus I have no direct personal experience with this, but wouldn't it be MUCH easier to physically recover (and get your butt back in school in 3 weeks) from a VBAC than another C-section? I'm sure there are exceptions, but of all the mamas I've known, I've never seen anybody be physically able to return to work or school that quickly after a C-section.

[egfmba]

I wish I could run from Woman's. But, it's the only place my ob/gyn is privileged. It's been hard for me to find a doc on my plan. I much prefer a woman (just my thing) and no independent practitioners take my HMO anymore.

I may not be able to bring baby to school (depends on the profs) but I have my handy dandy breast pump (Ameda PY) from DS, which did an admirable job last time (I had DS when I was in b-school). I had to return to school at 2.5 weeks after DS's birth and had the pump on hand knowing my situation.

I just keep doing the same thing, huh?

I'm doing research about VBAC and though I'm pretty sure I'm stuck w/ my ob/gyn, the positive is that she respects me enough not to take it personal when and if I have to ignore her medical advice.

eva

[coloradoalice]

You can have both. Go for it.

I agree with other pp's who say homebirth. Wish I had tried that again the second time.

And start working on breastfeeding now!! Go to LLL while you are pregnant.(your son can go with you, kids are more than welcome!). Read books, lurk on the breastfeeding forum, and learn, learn, learn!! You can do it VBAC or not. Get the basics down, learn the myths, and know what to do and how to overcome. I had two sections and breastfed (and am breastfeeding) successfully both times. It's knowing what to do and how to contact help if you need it that counts. Support is so important. You have it here, you just need some IRL!

Good luck!

[alegna]

If Women's is your only hospital choice, have a homebirth. I doubt there's any chance of a VBAC there.



-Angela