Vaginal Varicosities = C-section?!

[soybeansmama]

I am not very knowlegable about the subject and I have some questions about what kind of risk they pose to a mom delivering vaginally. I am a Bradley Teacher and one of my students has them severe enough on the vaginal wall for her doc to recommend a c-section. I have never heard about this as a reason to c-section and I am looking for some insight. I really want to be able to discuss what her options/alternatives are but I simply do not know if their are other treatments before the birth so that she can birth vaginally.

TIA!
Jessica

[pamamidwife]

definitely not an indication for cesarean by normal standards. according to an OB, however, they have different standards.

[heartandhandsdoula]

I had them and my MW suggested lying with my pelvis raised. It helped every time they would start to hurt.

[MsBlack]

No, should not be an indicator for csec. Should be an indicator for less-upright pushing positions (like sidelying or H&K), no 'purple pushing' (breathe through pushes as much as possible, only short pushes even if several per ctx). Should be an indicator for care provider being alert, providing manual support maybe.

[Midwife Kris]

Well I would wonder how pronounced her varicosities are for her doctor to make such a recommendation. I have seen two extremely worrisome hemorrhages in my life, one of them being the result of a vaginal varicosity that burst during *natural, not coached* pushing. Rather than bleed out, she bled "in" meaning the blood she lost just seeped into the tissues causing extensive, painful swelling along with everything else associated with large volume blood loss.

[Carolinamidwife]

Well I would wonder how pronounced her varicosities are for her doctor to make such a recommendation.

Same here. Before I could make a blanket statement that it is never a reason for a surgical birth I would need more information about how severe. Severe to a doctor is not always severe to a midwife however I would not like to see varicosities burst.

[mendomidwife]

Agree with some the above.....
I would have to know the doctors reputation/c-section rate...if they are prone to offer c-sections for the slightest reason, or if there is a real indication. I hate to second guess someone who might have a real concern for a women.

Carla

[MommytoTwo]

I can only say that a friend of mine had them and had a vaginal birth.

[Carolinamidwife]

Well, yes, you could have them and have a minor case that would not preclude a vag birth or you could have very severe ones. Some doctors are so untrustworthy it's hard to say without clinical information.

[homemademomma]

just an anecdote- i had a mom about 2 months ago with labial varicosities. she pushed L side lying (varicosities were on the right side), and i gave the area gentle support as the head started to fill the vaginal opening. birth went fine. my assistant was doing postpartum care while i was filling out paperwork and she comes and gets me and says " i think she has a little swelling"
so i come in and look, and she had a hematoma the size of a softball.

we had to transfer her to our backup, and the hematoma was so extensive that he put her under general to repair all the bleeders. yikes!!

[soybeansmama]

Thanks for your replies. I will have more info after our next class, but one thing that she did mention is that one of them was the size of a pencil in diameter and that the OB was afraid of it bursting, then her hemmorhaging.

I guess I just feel a little helpless as her Bradley teacher and I am not really sure how I can better support her. This is a "first" for me, and I can't give her medical advice or anything, but it would be really nice to get some more info so that I can talk to her about choices she may have...Thanks again for reading!

[pamamidwife]

I've definitely done births with women who had more than one varicosity that size. In fact, many, many women I've seen have had that. It's all anecdotal, but I haven't ever had any issue with them rupturing or if they have, not causing serious bleeds.

Definitely a bleed from a varicosity in the hospital is far less risk than a cesarean section.

Here's some info from a midwife's email list that could offer some insight: http://gentlebirth.org/archives/miscdisc.html#Vulvar

[soybeansmama]

Is there a difference in the risks between labial variscosities and variscosities that are deep within the vagina? The OB's that she has seen seem to be more concerned with the large one inside...

[GatorNNP]

I cared for a postpartum pt that transferred after birth for a very large vaginal hematoma secondary to a bursted varicosity (so large the mother knew it was there and could feel it the week before) after delivering at a birth center with a mw. She had a very uncomfortable time getting it dealt with, however, it got dealt with as soon as she came in to the hospital, got a little drain tube and some pain meds for the procedure. After that she was doing fine with out extra drugs and her baby was a "visitor" so all we could do was say how cute she was. She did consent to accepting a little pointer on the breastfeeding later but overall it was probably less trauma than a c/sec since she went home the next morning and it was baseball sized.

[homemademomma]

Originally Posted by homemademomma

just an anecdote- i had a mom about 2 months ago with labial varicosities. she pushed L side lying (varicosities were on the right side), and i gave the area gentle support as the head started to fill the vaginal opening. birth went fine. my assistant was doing postpartum care while i was filling out paperwork and she comes and gets me and says " i think she has a little swelling"
so i come in and look, and she had a hematoma the size of a softball.

we had to transfer her to our backup, and the hematoma was so extensive that he put her under general to repair all the bleeders. yikes!!

Originally Posted by GatorNNP

I cared for a postpartum pt that transferred after birth for a very large vaginal hematoma secondary to a bursted varicosity (so large the mother knew it was there and could feel it the week before) after delivering at a birth center with a mw. She had a very uncomfortable time getting it dealt with, however, it got dealt with as soon as she came in to the hospital, got a little drain tube and some pain meds for the procedure. After that she was doing fine with out extra drugs and her baby was a "visitor" so all we could do was say how cute she was. She did consent to accepting a little pointer on the breastfeeding later but overall it was probably less trauma than a c/sec since she went home the next morning and it was baseball sized.

i wonder if we are talking about the same person?

[GatorNNP]

I think the person had only IV meds as it was in a room. I wouldn't confirm or deny more than that.

[soybeansmama]

I am just brain-storming here but...

If the mom has such severe varicosities down below, couldn't she also have them where they would be cutting to section the baby?????? Isn't there a possibility that there would be some inside? What if they cut her open and create what they are trying to prevent? Her OB seems to think that the bleeding could be much better controlled under these circumstances...:

Anyway, after talking to the mom in class last week she mentioned that her concern ( as well as the OB suggesting the cs) is that one of her varicosities might rupture and she might hemmorhage while the baby is just coming down into the birth canal. Then what? push baby back up and section or continue pushing and bleeding, etc? Is this a likely scenerio?! It seems to me that the likelihood of something like this happening would be pretty slim. I am interested in your thoughts...this is keeping me up at night

[Sileree]

Originally Posted by soybeansmama

the OB was afraid of it bursting, then her hemmorhaging.

If she has a C-section, she's going to hemorrhage anyway, probably alot more. This reminds me of the excuse of cutting in case she "tears."

Preventative damage.

[mamato3cherubs]

Has she considered a second opinion???? I have them, and they were terrible to me with my last pregnancy. Maybe not quite as sever as what you describe, but close. I asked my OB at hte time about it, he was actually a very good, non-interventive doctor and he told me that it was of course most uncomfortable at the end of pregnancy, but in most cases as baby comes thought the body manages to compensate and the blood will move and essetially sqeeze out of the way. That there was more concern of watching for a clot developing at the end of pregnancy, that there was trouble at delivery and the bursting is really not that common.
this is the only experience i have had with this and I know i have a fairly difficult delivery of a large baby, naturally without intervention and no complications. All went as he had described. Now recovery was painful, but im certain much less so than a rediculous c-section.

I think she should talk to someone else. not in the same practice.
If she is already delivering in the hospital, it seems that dealing with the possibily of a complication would be much better than a c-section and the complications that are possible with that.

most drs will find it is easier to steer people toward section, because then they have control. They dont have to worry about a law suit due to something during delivery going wrong. and they. They dont want to take any risk, it is to expensive and too much trouble. Then they might actually have to pay attention to a patient and deal with a problem. They are comfortable doing surgery.

those are my thoughts

[soybeansmama]

well said mama, I agree. She hasn't yet sought out a 3rd opinion. There are 2 OB's that are recommending the same thing...but she was referred to one by the other... hhhmmmmm....