why are repeat c-sections so dangerous? - Page 3

[Storm Bride]

Originally Posted by Electra375

I think there comes a point where we accept our fate and do what is medically sound. It is hard to discern the information out there, this I know first hand. As a HBA2C mom, I will tell you if my 3rd had been a c/s I would not have attempted another vbac. And my OB at the time was so against women with c/s having more than 3 children due to complications from the c/s. I cried that Dec w my 3rd child knowing that more children was a huge risk.

Yeah - and my OB said four. So, people will - and have - had fewer children than they wanted, because even the OBs can't agree on how many surgeries is a "safe" number. It's funny - I don't ever recall asking the OBs opinion on what size family would be best for me...but he was always more than happy to give it to me.

The risk I'm refering to -- every subsequent pregnancy after c/s #3 increases the risk of uterine rupture during pregnancy (I used to know the exact figure), just the stress of carrying the child! Not even talking about labor here. To me, that risk was unacceptable.

You know...the big Landon study found a rupture rate of 0.7% after one c/s...and a rate of 0.9% after multiple c/s. That's a far cry from the 3.7% risk my OB cited after two c/s - and Landon actually provided numbers and details, which my OB kindly declined from doing.

I know if I made it to 24 weeks my baby would likely survive, but if baby didn't, I knew I would not be able to live knowing I had choosen to carry a baby against medical advice and he or she died in utero from a rupture.

You know...I understand the heartbreak. I really do. But, it really depends on our personal perspective. In my view of things, the only reason that I'm considered high risk is because of the medical "advice" I've been given. I've never had the cold comfort of believing my c/s were necessary, because I don't - I never have. Frankly, the last people I would trust with my baby or myself are the doctors who put me here.

I would also loose my uterus and not be able to fill that void with another baby from me.

Is that necessarily true? I've talked to women who have had ruptures and have had subsequent pregnancies.

PS - I do know mothers with 5 children all from c/s. And my loving mother reminded me that Rose (I think) Kennedy had 11 children via c/s and that was back in the day they did vertical incisions.

Yeah - Ethel Kennedy had however many c-sections (I've seen numbers from 9 to 14)...funny how my mom wasn't "allowed" to have more than three. I wonder if that's a difference of opinion among OBs...or whether you get different care if your last name is Kennedy.

[egoldber]

Is that necessarily true? I've talked to women who have had ruptures and have had subsequent pregnancies

No, its not necessarily true. My third child was born after I lost my second to uterine rupture. But hysterectomy is a common complication of uterine rupture. Many women on my UR support group have lost their uterus as well as their child. But having another baby in no way at all replaces the baby you have lost nor lessens your grief for that child.

I do have a lot of guilt about choosing to attempt VBAC with Leah and losing her. Anyone who loses a child experiences guilt and what ifs. Its part of the grieving process. But at some point you have to let that guilt go or else it takes over your life. I will always wish I had chosen to do a repeat C with her, but I no longer feel guilty for choosing to try VBAC. All you can do is make the best decision you can with the best info you have at the time.

[Electra375]

I'd like to just summarize my main thought after re-reading some stuff here -- listen to what your doctors say to you, think about it, ask questions, read about what they say, ask for references and make an informed decision YOU can live with.

The latest issue of Mothering Magazine has a section on c-sections. I personally could not read all of it due to my horrible experiences -- so horrible that when I met my mw's co-midwife just last month, she used to be a surgical scrub nurse and she remembers my first birth and c/s, I asked how could you remember mine from nearly 9 years ago over all the others. Because it was so horrific! I guess inverted Ts are not a common practice or having the OB not be able to the baby out. I didn't know, but I do know I was in so much pain it was months before I was even 50% better. I would not wish that on any one and that OB still practices in our town!!! I never saw them again.

[spu]

uterine rupture

thanks to everyone for sharing such personal and sensitive information!!!

I do have another sensitive question, and I understand if you do or don't want to answer, because I'm sure it's painful either way. Regarding uterine rupture, which I've heard is a risk for vbac after multiple c's, how did it all happen? Were there any warning signs? For some reason, I was thinking the uterus would rupture only during labor, and I never thought about it rupturing sometime during the course of the pregnancy - how scary!!! If during labor, were there hospital staff monitoring things? and were they willing to do an emergency c? what kinds of thing should I be aware of if I'm vbac'ing, and trying to avoid complications from a rupture? and at what point during a vbac would you then decide on plan b and have a c before it gets too late?

Were you told prior to the pregnancy in which the uterus ruptured anything about the condition of your uterus? My ob told me when stitching me up during my 2nd c that my uterus was thin, and that I should consider a c next time around. But is it still thin? Would wearing a bella band for support prevent it from overstretching since my abs are shot? Would you schedule a c to avoid anything scary from a vbac? or is a repeat c scarier?

thanks again. this thread really means alot.

susan

[wombatclay]

Heyla spu! Every mama's mileage will vary, but for me a repeat c/s is a lot riskier than a vbac (and so you know my bias, I've had one c/s, one vbac, and no recorded rupture)...

Yes, the scar can open before labor. However, many times the scar opens a little during the pregnancy or birth and there are no symptoms and no problems as a result (these "windows" and "dehiscences" are sometimes discovered when a c/s is done for another reason). The real "monster under the bed" stories come from catastrophic ruptures which are rare but do happen, and the more surgeries you've had on your utereus the higher your risk for rupture.

There are possible warning signs, but unfortunately not all women experiencing rupture have the same signs. My OBs prefered to monitor vbac mamas by doing blood pressure readings on mama and heartone readings (via doppler) on babe every 15 minutes during the pushing phase. They felt that the sharp drop in maternal blood pressure combined with poor heart tones would be the best indicator of problems like rupture. However, other care providers look for heavy bleeding, unusual pain not related to contractions and located in the front, a sudden "bulging" of mama's stomach, having a babe who is close to being born suddenly "pull back up" a significant distance, feeling baby body parts where they really shouldn't be, or general fetal distress (usually through continuous EFM) as signs of possible rupture.

At any facility should a rupture be suspected it's not a question of the staff being "willing to do a cesarean". The surgery wouldn't really be open for discussion at that point...in the case of a true rupture mama and babe are both at risk for death or disability and a c/s is usually done immediately (most often with mama under general since they need to do things FAST).

Regarding pre-birth planning...some care providers will schedule an ultrasound exam of the scar. This exam can tell you if your scar is "think" (less risk of rupture) or "thin" (which doesn't mean you're at higher risk for rupture, there hasn't been enough research done yet). And I did have a plan B for my vbac. After speaking with my care providers and doing my own research we decided we would go with a repeat c/s IF I had a prolonged pushing stage with significant contractions but no progress. Not just if I had slow progress though, and not just a stall of a few hours...we're talking NO progress despite significant contractions for a long period of time, coupled with fetal distress. I did in fact have a very long pushing stage (about 4 hours) but baby's heart was good, my blood pressure was good, and babe was moving sllllllooooooowly but surely. But I had very pro-vbac doctors. It would be a good idea to make a very clear plan to share with your care provider if you have any doubts about them being 110% supportive of you having a natural intervention free birth.

When vbac'ing (in terms of avoiding rupture or complications), the number one thing is confidence. Giving birth naturally is something you CAN do. A vbac is a birth like any other and there are risks, but it's "just" a birth. Next avoid induction or augmentation of your birth. Don't let them pressure you by saying your babe is too big or your placenta is getting old or whatever their story may be. Obviously pay attention to your baby, how they are moving and how you feel physically, but when your body is ready it will be ready. And augmentation and induction increase your risk of rupture (sometimes pushing the risk through the roof). Don't let them break your water and try to avoid epidural or spinal medication that limits your ability to move and feel. Have a doula who has worked with VBAC mamas before or had a successful VBAC herself, a care provider you trust and who is 100% supportive of natural normal vaginal birth for all women, and know what is going on. Ask questions and ask "why"!

There is some amazing information on the VBAC page at http://www.worldserver.com/turk/birthing/index.html This website has links to summaries of recent (and not so recent) VBAC literature, lists of VBAC questions to ask your care provider, lists of rupture warning signs and general vbac risks, etc. However, the page is maintained by a family that lost a child to a rupture so there is also a page about their personal story. If you are easily disturbed, scared, hormonal, etc (like I was for my entire pregnancy! ) then don't click through to their personal story page.

good luck!

[egoldber]

When vbac'ing (in terms of avoiding rupture or complications), the number one thing is confidence. Giving birth naturally is something you CAN do. A vbac is a birth like any other and there are risks, but it's "just" a birth. Next avoid induction or augmentation of your birth. Don't let them pressure you by saying your babe is too big or your placenta is getting old or whatever their story may be. Obviously pay attention to your baby, how they are moving and how you feel physically, but when your body is ready it will be ready. And augmentation and induction increase your risk of rupture (sometimes pushing the risk through the roof). Don't let them break your water and try to avoid epidural or spinal medication that limits your ability to move and feel. Have a doula who has worked with VBAC mamas before or had a successful VBAC herself, a care provider you trust and who is 100% supportive of natural normal vaginal birth for all women, and know what is going on. Ask questions and ask "why"!

I had one previous CS, a low transverse incision, 3 years from my last CS, a doula highly experienced with VBAC labors (local ICAN chapter president), THE go to VBAC OB in my area, spontaneous labor, stayed at home until close to transition, no augmentation or induction, no epi or other pain meds, and intermittent fetal monitoring. My rupture occured during pushing and the only sign was the drop in fetal heart tones picked up during monitoring. I had an emergnecy CS under GA within 15 minutes. My daughter was born with severe, irreversible brain damage. I had no warning signs other than the fetal heart tones, no pain, no bleeding.

You can do all of "the right things", and it is still no protection. I'm sorry, but you can think its a confidence game if you will, but its a statistical risk. Some women will rupture. Most will not. There are things you can do to minimize the risk, but you need to be comfortable with that risk.

[Storm Bride]

Originally Posted by egoldber

No, its not necessarily true. My third child was born after I lost my second to uterine rupture. But hysterectomy is a common complication of uterine rupture. Many women on my UR support group have lost their uterus as well as their child.

I know that. I wasn't trying to minimize the possibility of hysterectomy or the pain of having one, and I really hope I didn't come across that way.

This topic is one that people are passionate about, for obvious reasons, and I know how easy it is to speak in absolutes (eg. "if I rupture I will lose my uterus", etc.). It makes me uneasy when I see things stated as absolutes, when I know there are exceptions, which is the only reason I addressed that one. (It also makes me uneasy when I see women say, "you won't rupture if you're not induced" and other similar statements.)

People want one option or the other to be "safe"...and many people don't want to acknowledge that there are risks either way.

But having another baby in no way at all replaces the baby you have lost nor lessens your grief for that child.

I do have a lot of guilt about choosing to attempt VBAC with Leah and losing her. Anyone who loses a child experiences guilt and what ifs. Its part of the grieving process. But at some point you have to let that guilt go or else it takes over your life. I will always wish I had chosen to do a repeat C with her, but I no longer feel guilty for choosing to try VBAC. All you can do is make the best decision you can with the best info you have at the time.

[egoldber]

People want one option or the other to be "safe"...and many people don't want to acknowledge that there are risks either way.

Right. This is what gets me too. Once you have that scar on your uterus its a matter of weighing pros and cons for your own situation.

[wombatclay]

I'm sorry, but you can think its a confidence game if you will, but its a statistical risk.

I'm not saying confidence prevents rupture. And I certainly know that doing everything "right" is no promise that things will go right. It's the story of my c/s and my vbac proved that yet again. And I'm sorry you had such a traumatic experience...I wish there was some way to make birth risk free, but you're right. That isn't possible. There is always risk when giving birth.

However, I do believe that confidence is crucial to a vbac...confidence that your body will work is what helps you turn down induction (because you're past your due date, because your baby is big, because your hospital only "allows" vbac on certain days, etc) and decline augmentation. And these interventions do statistically increase rupture rates.

I wish birth was 100% safe, and I wish there was some way we all could avoid the eagle-eyed hindsight guilt that follows a traumatic birth. I'm still happy I had my vbac but a complication that affects only .5% of ALL birthing women (not just vbacs) nearly took my dd's life. Would I have vbac'd if I knew this complication would happen? I don't know. But there are risks to repeat c/s too. I think you have to gather your info, make your choice, and then follow that choice with confidence knowing you made the best choice you could.

[Ironica]

Originally Posted by egoldber

Right. This is what gets me too. Once you have that scar on your uterus its a matter of weighing pros and cons for your own situation.

Without a scar on your uterus, there are pros and cons, risks and benefits. The risk of UR is never zero, for any pregnancy or birth. That's significant; for most people, the difference between a zero risk and a .3% risk is much, MUCH bigger than the difference between a .1% risk and a .4% risk. But there is no perfectly safe way to have a baby. There are risks to every mother, and every child. The risks are slightly higher for women in certain situations, such as those with a c/s scar. They're still low, but they're still there, and they're still higher than for women who have never had a surgical birth.

One other thing to consider is that, in many cases, doctors simply do not KNOW what caused brain damage for sure. Oxygen deprivation is a most likely cause, and when there's something big and obvious like a UR then that's what will be assumed to be the cause... but it could have happened earlier, too. Or it might not have been oxygen deprivation. Or or or... there are so many unknowns, and we can second-guess and guilt ourselves into oblivion. We make the best decisions we can for ourselves and our babies, and a lot of that is playing a numbers game and guessing what will or won't happen for us. Sometimes, you've got to compare the worst-case scenarios... will I be more or less able to heal emotionally if my baby dies in a VBAC or if I'm maimed by elective surgery?

[grumpyshoegirl]

No, there's definitely no guarantees no matter what you choose. I think the question comes down to how much we're going to let the fear from the risk overtake us.

There are plenty of things besides rupture that can go wrong with a vaginal birth: placental abruption and cord prolapse are probably the worst two and require an emergency cs just like a rupture does. And I *think* (I do NOT have the numbers in front of me) that the risk of one of those is higher than the risk of a catastrophic rupture, possibly of any rupture. That's not to say that a catastrophic rupture can't happen, obviously it does, but when the other things happen, do mothers blame themselves for not scheduling an elective cs ahead of time? Even though the elective cs would have averted the problem? No, it's only done with VBAC, and practitioners only talk about the rupture risk with VBAC (nobody has EVER talked to me about the other two conditions!)....probably because of the insurance issue.

Honestly, all of that is cold comfort. Who wants to think about all the things that can go wrong when you're trying to build up your confidence, especially in the face of so many naysayers? I guess I'm lucky in that everyone around me who's pro-cs admits it's because they want (or wanted) to avoid labor pain above all, but gosh it's hard when everyone's accusing you of wanting a VBAC for selfish reasons.

Why am I choosing VBAC over a repeat CS? It's not to raise my crunchy cred, even though I'd certainly win crunch points on NFL sites for a successful VBAC and not for a repeat CS. It's because the risk of my baby not being ready on the scheduled date, the risk of something really bad happening to me (infection, death, injury) during the surgery, the risk of something happening to the baby (being cut, getting an infection, having breastfeeding problems).....when added together, they're much higher than the risk of a catastrophic rupture. That's before considering having to recover while taking care of a newborn and a toddler, and the almost certainty that the newborn will have pathological jaundice due to blood-type incompatibility (I'm an O and my husband's an AB-- the incompatibility is a for-sure but not all babies actually develop the jaundice). To me it's just not worth it.

I know I could rupture. I could get in a car accident on the way to work tomorrow. I work in a school-- we could have a school violence issue like Columbine at some point in my pregnancy. I could eat something with listeria or salmonella and that could harm or kill the baby. We have two cats, and I've changed their litter once or twice since getting pregnant; I could get toxoplasmosis. Any of that could happen. Of the above incidents, the car accident is actually the most likely, and of course preventable in the sense that I could avoid cars and public roadways. At some point you have to decide which risks are worth it, weigh the risks of two opposite choices, make the one that's best for you and then take responsibility for that choice.

[majormajor]

egoldber and LynneE73,


i'm so sorry for your losses.