Help me analyze my Feb '05 L&D?

[mum2James&Bean]

Hey everyone. I'm attempting a VBAC this time, and I'm really hoping I can get some help in analyzing what REALLY went wrong last time, what could have been prevented, and what was necessary. Of course, the ob/nurses felt as if it was ALL necessary, but I can't help but think perhaps my c/s might have been prevented if I had been more knowledgable. Even though the chances of this happening again are remote, I want to make sure I can make educated decisions next time if something similar happens... here's a timeline of my l & d...

Saturday Feb 19 to Friday Feb 25 - painful contractions ranging from 3 minutes to 10 minutes apart. No dilation, and no consistency.
Friday Feb 25 - contractions phase out and stop completely
11:00 Saturday morning - water breaks with meconium in it
2:00pm- induced (pitocin) with bishop's score of 2
4pm- contractions start, back labour begins
**Baby is having abnormal heart decels the whole labour (varying between 100 with a contraction to 190 after a contraction).
**Because of decels, I was forced to lie down in one of the only positions James's heart would tolerate, on my left side, but I was able to use the birth ball for part of the labour
12pm - after a few hours of transition like pain and back labour, I broke down and got an epidural (I was 6 cm and stretchy and had been for several hours at that point).
2:00pm - labour hasn't progressed, I was at 6cm for 5 hours in total.
2:40pm - James's heart rate went under 70 for 2 minutes, pitocin is turned off (contractions stopped immediately) and I we decided to do the c/s before things got any worse
2:56pm - He was born, posterior and asynclitic, with the cord around his neck 3 times... screaming before his shoulders were even out of my tummy!

Should I have taken the risk and held out longer? What would you have done?

ETA: James was "due" Feb 20, so he was born at 41 weeks... we don't know my true due date though because he was conceived on BCP's, and the date they gave me was from my u/s at 18 weeks. James was born at 6lbs 15.9 ounces (not very big for an "overdue" baby).

[jengacnm]

short version:

Before labor-optimal fetal positioning techniques to avoid posterior positioning. Some moms just have a pelvis that favors posterior positioning, but it's rare.

Supplemental vitamin c to strengthen the amniotic bag and avoid rupture without labor. Don't know how evidence based it is, but vit c is a collagen booster, which is what the bag is made out of.

After rupture-wait to start pit! I don't know how much choice you had, but I wait up to 24 hours, and some midwives here will wait much longer. No doubt the pit is what contributed to the heart rate going up and down.

Of course we'll never know, but I may have done the same thing. I *know* that a low heart rate does not always equal distress, but after several hours of an up and down heart rate and 2 minutes down to 70....can you honestly see yourself saying, "No, doc, please, wait...can we give it more time?" Retrospect is 20/20-sure, your baby came out screaming, but when his heart rate was low and the nurses, your doc, etc in the room were looking nervous, how were you supposed to be the courageous one?

I guess I'm saying that I can't see the last chapter having gone any differently. You did great with the information you had.

Best birth wishes on your journey!

Jennifer

[wannabe]

what did you do during the prodromal labour for those six days? Did you get much rest, get lots of walking done? Going into labour tired was huge for me.

As Jen said, google "optimum foetal positioning" to try and get the baby in a good position.

What was your cervix like when they started the induction? They could have tried to ripen it before starting pit. And, as Jen said, the average healthy woman has easily a good day to start labour before there's any need to talk pitocin. But maybe meconium changes the risks there?

But, at the end of the day, posterior and asynclitic says you probably didn't have much chance of avoiding a c-section. Think about when you put a really tight turtleneck on your baby - you have no hope unless you start right at the crown of their head. It's the same when they're trying to come out of your cervix - a slight variation from the perfect presentation can make it almost impossible for them to get out. And since the head helps your cervix to dilate, that may have been why you didn't dilate. It's possible that when your waters broke he slipped down in that bad position.

Maybe being able to be mobile in labour might have helped him shift? I have read that going on hands and knees with your head down for a while sometimes lets the baby slip out of the pelvis and come back in a better position?

My asynclitic baby was born vaginally after almost five hours of pushing, with the help of a vacuum. But her apgars were 2,5,8 and she had Sarnat stage 1 hypoxia. In the first few days I wished I'd had a c-section. I felt terribly guilty for pushing on her for so long and causing her such pain and distress. Now, I don't know. I'm glad I didn't have a c-section, but I wish she hadn't had such a hard birth.

[mum2James&Bean]

Thanks ladies! I'm definitely going to be more passionate about optimal fetal positioning this time around. I did have the knowledge last time, but I really thought that nature would do it's thing (I wasn't prepared for the possibility that I might have to be induced or that I would end up getting an epidural - both things I absolutely didn't want).

My cervix was high, posterior, hard and long... completely unfavorable. I believe my bishop's score was 2 (from scoring myself). But with the meconium, I guess the risk of infection increases dramatically so they don't really have time to wait for prostaglandins to do their thing (as far as I know anyway, I'm hoping someone might have more information on this!)...

That's interesting about the vitamin C. I'm going to google it, but it's not like you can OD on Vit. C, so I'll probably take a supplement just for the hell of it!

I think being more mobile in labour definitely would have helped. I'm starting a strict regimen of borage/EPO around 34 weeks to help soften things and I'm going to the chiropractor (I have SPD and a misaligned pelvis).

I just want to make sure I'm doing EVERYTHING possible to make this VBAC favorable. My OB has said they have no problem doing a pitocin augmentation with VBAC, and luckily the hospital I'm birthing at (near Ottawa, Canada) is very centered on more "natural" philosophies and only require hep. lock and intermittent monitoring on VBACs, so I don't even have to fight about it.

Sigh. So much to think of!