q's about VBAC

[oatmeal]

Why is it that Vbac is considered impossible if one is induced? Don't many women have children vaginally when they are induced?

Also, does VBAC exclude an kind of pain drugs, epidural etc?

I had a c-section with an 11 pound baby, but I progressed very quickly and had optimal pelvic and vaginal specs for a vaginal birth - it was just that she was so big she couldn't get out of my cervix.

I can't imagine having a baby without drugs. I "trained" in yoga for 6 months before I went into labor for a natural birth and the moment I had the first contraction it was over for me. I couldn't handle the pain and shot to 8 cm within 45 minutes of starting. My water broke on the first contraction.

just curious about these questions. I want to VBAC next time but feel I need an epidural to make it through labor. Wondering if this is an oxymoron.

[sweetfeet]

In the research I have done I have read that Pitocin which is used to induce labor can increase ones chance of rupturing.
Take it with a grain of salt as I have yet to VBAC. Just TTC still
I dont know why it would have to be completely drug free.

[dotcommama]

luv4sophie - yup that would be the reason. Pitocin doubles your chance of rupture - that doesn't mean it's never used during a VBAC, but if it is used you are highly monitored.

oatmeal - you can have an epidural with a VBAC. I've read some VBAC stories here where Mom's have had sucessful VBAC's and did have an epi. The only concern is that the use of pain relief often leads to the use of Pitocin which then increases your chance of rupture. But there is no rule that says you must have an all natural, drug free birth in order to have a VBAC.

[applejuice]

Yes, pitocin increases your chances of rupturing regardless of this being a vbac or regular birth.

Read the package inserts for pitocin. and then make up your mind. It also causes high blood pressure, stroke, amniotic embolism, and of course death. Intervention upon intervention avalanches after you take pitocin, so it is just not the pitocin.


Maybe you should just take your chances with another c/sec.

[OnTheFence]

Just in case you didnt know but they give us csection gals pit after our csections to get our uterus' to contract down.

Yes pit will increase your chances of rupture, so will other types of induction methods, including natural ones. Nipple stimulation would be one.

I do know people who have used Pit for VBAC and they did not rupture. They had low doses, were monitored, etc. The risks of PIT are small. Yes it is a scarey drug, but arent they all? The risk of pit with a VBAC is less than a csection in and of itself. You have to be the one to determine what is right for you! Goodluck!

Kim

[CanOBeans]

oatmeal, I'm not sure I understand your question on induction. Were you induced with your first? It sounds like you had either a very fast natural labor or a very hard induction -- perhaps with cytotec (just a guess due to the speed of your labor). Would you like to explore more of your labor and birth story here? I am musing on the whole idea of your daughter being unable to pass through your cervix, what that meant for her birth and what that might mean for preparing for a next birth.

Induction has a higher c-section rate for both first time mothers and women with a prior c-sec. It isn't impossible to VBAC with induction, it just lowers your chances. Yes, in studies the use of pitocin and other induction drugs increases the risk of rupture, but it is important to remember that the results of a study are not necessarily applicaple on a case-by-case basis. There are many things you would want to take into account if you were deciding on induction, and you would want to know the specific protocols recommended. The increase in rupture rate can often be directly tied to the way in which labor was induced; dosages of meds, timing, condition of cervix, etc.

I know many women who have had VBACs with epidurals. In some cases they increase the chance of c-sec, and in others they are the key to achieving VBAC. Again, it is a very complex set of variables at work. I'd be happy to discuss how to maximize the chance of VBAC with an epidural if it would help.

[chichimama]

Oatmeal,

Considering your history of having a large baby, I would avoid induction. Well, I would avoid induction for just about most reasons, as an unnecesary risk to myself and baby.

A lot of women are told that they should induce at 38 weeks in order to have a smaller baby, the "fear of a big baby" syndrome. But, at 38 weeks, your body might not handle an induction, and you might just end up with a cesarean for a "failed induction" anyway. And your baby's risk for respiratory problems rises with a 38 week birth or a cesarean.

I believe your body could have birthed an 11 pound baby. I too would be interested to hear the story of the birth.

I also had a cesarean for an 11 pound baby. I didn't ever go into labor though, but I would have if I hadn't have taken the bad advice from my OB to just have a cesarean since my daughter was so big, that she would get "stuck". Anyway, she weighed 11 pounds 5 ounces.

This summer, I had a son at home, and he weighed 12 pounds 1.6 ounces. I had an unmedicated labor, I was in labor for about 5 days, with 4 hours of active labor. I don't for one second think that I would have avoided a cesarean if I had been with an OB in a hospital. With the way my labor was, I would have been induced, or "augmented". Then I would have needed an epidural. I would never have been able to push out a baby that big while being flat on my back, hooked to monitors, numb from the waist down. Don't forget that pelvis has the least amount of room for a baby to get out of if you are on your back, and that is how you have to be if you get an epidural.

I guess the answer is that you can be induced and get pain relieving drugs with a VBAC, but knowing what I do now, I, personally, would never want to take the risk of being induced, and I wouldn't want to take the risk of pain relieving drugs either, because it is a slippery slope from there.

Perhaps look into other forms of pain relief, such as hypnobirthing, having a doula, etc. The pain of childbirth is a good pain, and it comes only one contraction at a time, it is manageable.

I don't have any big tolerance of pain or anything, and if I could get through it, I think anyone can (and I mean only natural contractions, I am not talking about pitocin or cytotec evil contractions).

Hope this helps. My birth story is in the archives here, or on Birthlove.com if you are a member there, or I can email it to you if you are interested.

Good luck on your decision.

[oatmeal]

HOLY CRIPES!@#%#^&%$!!

12 pounds through your vagina??? Can you still hold your poop in?

Here's my birth story to answer your questions.

I am suspicious they got the due date wrong #1 because I went into labor in December (at "8 Mos") and they had to stop it and I stayed 3 cm dilated and very soft for the last 6 weeks. But that aside.

Baby was due Jan 18 according to their calcs. I was checked around the 18th and the subject of induction came up because they thought she was big. Doula and I nixed that - as I said I had wanted a natural childbirth and had changed OB at 5 months to try and insure that - on my Doula's suggestion.

No sign of labor ten days past due date. OB was freaking and sent me to a very pricey ultra sound expert to try and get an exact weight - it was a Friday. The guy charged me $500 and said the baby was 9 pounds, give or take five ounces. Being that I did not want to induce my doula and I strategized to naturally induce over the weekend because the OB said I was to check in the hospital at 4AM that Monday if I had still note gone into labor.

Friday I started walking 5 miles per day. I went to a famous place in LA where they serve a salad that is supposed to start labor, didn't work. On Sunday afternoon my Doula finally conceded that I could get some castor oil and take only one table spoon in some OJ at about 3PM - plus I walked 5 miles. Still nothing. Knowing I would have to go in that next early morning a friend came over to my house that night. I had a bag partially packed. At 7 I snuck another tablespoon of castor oil even though it had not been prescribed. I went to bed at 10 and my friend layed down on the couch downstairs to wait for our dawn car ride ot the hospital for induction. At 10:20 there came a burning fire in my abdomen. I got up and went to the toilet where my bowels completely emptied themselves from the oil. This took about 20 minutes and was not terribly fun. I wasn't sure it was all cool down there so I took a towel back to bed with me and layed it under my hips in case anything else came out of my bottom. When I layed down again the baby started dancing wildly in my tummy. It was bizarre. She was stretching and twisting and the fire hadn't toally gone out in my tummy. All of a sudden I heard a loud BANG as her head hit my pelvis and my water popped loudly like a balloon and dreched the towel with blood and water under me. I howled a little because it was weird and my friend called from downstairs. I got out that my water had broken as I headed for the toilet and sat on it. then I got my first contraction, which lasted for three minutes and sent me totally through the roof. My lungs opened wide and I threw my head back and did this guttural, loud, yell/scream that scared my friend (who had had 2 babies at home) so much she called the doula immediately. the pain was indescribable and I thought my back was going to burst open and let the Alien out. My friend was saying to get a grip and I got another contraction 1 minute later that again lasted 3 mintes - no lie, more side splitting then the last. I was naked and my friend threw something over me and I waddled down the stairs between contractions and she got me to the car somehow with my half-packed bag. I couldn't sit down from the pain so I draped myself over the back seat of her minivan doggie style and we started driving the 30 minutes ot the special hospital I had changed to wanting to have a natural birth. They had tubs there and everything. My howling almost sent my friend off the road I was in so much pain and the contractions were a minute apart - 90 seconds. We got to the hospital and a guard came out and draped me over a wheelchair doggie style. I was in so much pain all I could do was look down and see his feet running, pushing me to the elevators. We got onto the maternity floor and I was screaming as we came out of the elevators. The nurses got me into a room and kept saying to stop screaming because it was the middle of the night, etc. It was about 11:45 PM now and they checked me at 8 CM with contractions coming every 90 seconds. I was yelling demanding an epidural and they said the anesthesiologist was 45 minutes from seeing me and I screamed so they gave me a shot of Stadol which made me very happy, instantly. My doula walked in the room and blanched when she saw me getting the shot. I told her I couldn't do it, she said yes I could and I said no way. She said not to get an epi becuse the doctors wouldn't even show up until 4 AM then. I said sorry but I had to have it now. She gave in and held me when they put it in. I was pleasantly drugged and we turned out the lights and sort of hung out until 4 AM when the docotrs showed up and put things into play. I was at 9 Cm when they showed up and they got me ready and we started pushing around 6:00 AM - ? Contractions had slowed considerably by then. Pushing went slowly and we worked on getting her out until about 10:00 AM. They tried everything. Stirrups, standing, doggie style, walking around. At one point there were doctors on either side holding my legs and my doula was pulling me up with a towel to make me push harder. They said they just saw her little head turning back and forth over and over trying to find a way out. I kept saying no way - I'm pushing her out. My doctors left for ten minutes and came back. The male doctor - a sweet a gentle man who I like very much, and who really championed me going natural, said he really felt like it was time to go to surgery. He said that 1. She seemd much bigger thn the measurement ultra sound suggested and they were concerned about her getting stuck in the birth canal, not sure how big her head might be. They also said that if I pushed her out I would probably never be continent again. I looked at my Doula and she was resigned. It was so sad. I burst into tears. I am a single mother and I remember saying "I can't have a c-section! there's no one at home to help me." It took me an hour to sign the paper for the surgery i was so upset that my chance for vaginal delivery was over. I held them up so long we didn't get into the operaitng room until 2 and she was out at 2:19 PM. they all gasped and when she hit the scale all I heard was "11 POUNDS!!" and "She looks just like you!" and then they brought her around the sheet and I was just speechless at how big she was. She was huge. I felt relieved I hadn't pushed her out, but was also having drug convulsions and shaking uncontrollably - they had to hold her to my face so I could see her at first. It took me an hour to stop shaking and then she went on my breast quite easily. The nurses got peevedthat we slept together in my skinny little hospital cot. Also peeved because i wouldn't let them take her to the nurdery or give her any shots.

So that's the story of her birth. Comments? Observations?

The only reason I want to reserve the chance to use induction next time (if I ever do find a good man) is because if the baby is getting up past 9 pounds again I want to go into labor before she/he gets too big again... Not at all that I want induction, but if the size gets up there again I'll be hosed. I do not want another c-section. I still haven't recovered form the last one and it bugs me.

Thanks for following along this long! Sorry for any type-os.

[chichimama]

Oatmeal,

Thanks for sharing your birth story. And yes, I can still hold my poop in!! I am guessing you made that comment because the OB told you you might never be continent again if you pushed out a big baby. BS!!! I am very continent, an can even hold my pee in!! My son is almost 9 months old and I feel fully recovered, and have so, for many months. I only had one tiny tear and two skidmarks (not tears, but tiny something else). Recovery was so much easier having pushed out a big baby than having one cut out of me, that's for sure.

Trust me, I have read all the studies and there is no medical indication for induction to avoid a big baby. It doesn't make your labor any easier, and it is a risk for you as a mother, and a risk for your baby. Induction is just not good!!! You can push out a big baby, your body grows a baby that you can handle, trust me. I am speaking from experience.

I am on the national ICAN email list and I can't even count the # of women there who were induced at 38 weeks to avoid the big baby, and now they are at ICAN trying to heal emotionally and physically from the resulting cesarean, sometimes with a baby in NICU because they were born without being able to breathe well (a result of being born too soon and also a risk of a cesarean). I highly recommend this list, go to their website and you can get on from there, or PM me and I can give you instructions if you need them.

As far as your birth went, I know you did what you felt you needed to do. Sounds like the castor oil started your labor pretty well. I have heard that castor oil inductions can make things a lot more painful than natural labor.

And with an epidural, and in the positions you tried to push in, it probably made things harder for you. What would have been ideal is if you were unmedicated and pushed when your body told you to, in the positions that felt best. When I had my son, I told my midwife when I was pushing, no one told me when to do it. She gave me some pointers, that helped, but I just couldn't stop pushing during contractions. And I wasn't on my back, I was sort of on my knees, wiht my legs open, and reclining back (I was int he water, this is not a position I think I can get into on dry land) Oftentimes in a hospital, you are rushed. Your OB is supposed to be there, and they get a little impatient, maybe they don't want to wait around for hours waiting for your baby to be born. Much easier to scare the mother into thinking that she can't do it (and they would know, they are the supposed "experts"), and since she is likely exhausted, most likely she will agree.

I know how it goes, even though I never labored with my daughter. I took the advice because I thought that it was the safest thing for my daughter. I know better now. I have learned so much and it has made me somewhat cynical of hospital birth in general, unfortunately.

I knew, by the time I got pregnant with my son, that women had had larger babies than my daughter. Not many of them, that I knew of, but I knew it was possible. For example, my friend's husband (a big guy) was 13 pounds, and he had 4 older brothers that were 12 and 13 pounders too, 30 plus years ago when births wereen't so micro-managed, and Leilah, the owner of Birthlove.com, had a 12 pound 5 ounce son, unassisted, and after having a cesarean too, and there is a birth story on plus_size_pregnancy who had a 13 plus pounder after a cesarean too. I have no doubt that you can do it too, given time and REAL support, not "have the baby by Monday or get induced" kind of support.


Trust your body!!

[JessicaS]

The reason epidurals aren't always a good idea for VBACs is they can sometimes stall labor which makes them want to give you pictocin or oxytocin or something which can lower chances for a VBAC.

[alexa07]

Birth is not an area in which i am very AP.


My V-bac Story

My first birth was c-section because of "deep transverse arrest". My DD was turned to the side in the birth cannal and I pushed for about 3 hours without any movement on her part. I asked for c-section then because her heat rate was dipping and I wanted her out (I have a friend whose kid has CP and based on what I believe felt a c-section was safest for my dd).

I had a great recovery from my c-section and would have been happy to have another (see, not very AP). Dr. really wanted me to have VBAC with DD2 (this was 6 years ago, before new studies freaked them out)

Because of pre-eclaimsia I had an induction at 36 weeks (with pitocin). Due date was for sure because I'd had a misscarriage and d and c just the month before I got PG.

I had an epidural at 3 cm dilation (I told you, I am NOT AP when it comes to birth)

I went to 10 cm in three hours, while talking to DD1 on the phone from the hospital much of the time.

I pushed out DD #2 in four easy pushes (and for me I have had no problem feeling contractions on epidural once it is time to push, my epi's don't seem to go really low).

DD was 7lbs 9 oz. (four weeks early)

NO problems.

[weesej]

There are many more risks to inducing a VBAC. The risk of rupture is about 8 times as high. That is why ACOG put out those new regulations and so many hospitals and doctors stopped doing VBAC. It is not the VBAC that is dangerous, it is the induction drugs. I will also say I do think having an epidural with a VBAC is not the best idea. Certainly many VBAC mom can and do birth with one, but if you were one of the small % of moms who rupture (heaven forbid) you would not feel it and I truly believe our bodies are the best indicator of what is happening. All in all I work with many VBAC moms. Your body works and it sounds like it was doing a heck of a job of it last time, getting to 8 cms in 45 min is fabulous though very intense. You were in transition for your whole labor!!! I have no doubt your body will birth beautifully!