Uterine Rupture - the facts? - Page 2

[channelofpeace]

Thanks for the clarification majormajor.

I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?

[joy2bmom]

Sorry but i didn't read all the posts so forgive me if this has already been said but when i looked into VBAC with my last pg what finally convinced me to do it is that there IS a risk for UR for women that DIDN'T have a previous c-section too, and we're all taking risks, I know we hate to think of it but we run the risk of dieing in a car accident, and the risk is WAY higher than a UR. I'm not trying to take the risk lightly but these are the things that were told to me when i was deciding for or against a VBAC and i had my VBAC, Such a wonderful experience

[kltroy]

Originally Posted by milkydoula

I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?

I think there are just more complications in general (for *all* births) after 42 weeks. Sometimes babies fail to engage, and that's why labor doesn't start earlier. Sometimes it's a positioning issue. Sometimes there may be just something goofy with the hormonal cascade so labor doesn't get initiated when the baby is "cooked"? These are the same reasons that still births go up after 42 weeks - fortunately only a *very* small percentage of babies/moms actually have these issues. (Figure that only 5-10% of all babies go past 42 weeks, and the vast majority of them come out just fine). Also babies that late may tend to be larger, so if there are any legitimate "tight fit" issues, they may manifest more often in post-dates babies.

There's probably a higher rate of inductions at this point (care providers freaking out), and that can lead to lower VBAC success rates too.

[majormajor]

Originally Posted by milkydoula

Thanks for the clarification majormajor.

I wonder why the failure rates go up after 42 weeks? Is it a flaw in women's bodies, or that care providers start to freak out?

speculating here, but i am guessing failure rates go up because as babies get older and the placentas age, they're less able to tolerate labor. and i think if you have heart-rate fluctuations that might have been ok with a non-VBAC labor, a dr is more likely to want to c/s just in case it's a sign of UR-related distress. that, and babies get bigger, and there's going to be at least some that are less likely to fit. esp. since it's a second baby, but a first delivery.

oh, and i agree with the PP about doing a non-chemical induction if at all possible. i think i'd even be ok with augmenting an underway labor with pit just a bit (increases UR risk a bit, but not as bad as a full-on induction) before i c/s'ed.

[majormajor]

and everything kltroy said (we posted at the same time)

[Ironica]

This actually came up when we were meeting with our doula today... and her inference on the issues with "postdates" babies was the same as mine: Ok, there are more issues (not just for VBAC, but in general). But, what's the causality? The assumption is that baby staying in longer is bad for baby... but it seems just as likely, if not moreso, that babies who HAVE a problem of some kind are more likely to go post-dates. Granted, it may be that the problem is easier to address outside the womb, but if they're tangled in their cord, or can't get a good position, or whatever, the birth is probably not going to go as well.

But, on the other hand, there are babies who go to 42, 43 weeks, and then are born with no issues at all, and don't look at all "overcooked." Some women ALWAYS go that long with each pregnancy. So... is it necessarily a good idea to get all freaked out about postdates babies when for some, it's totally normal, and for others, it may be that they're staying in because of a problem, not that they're going to have problems from staying in too long?

[Storm Bride]

Originally Posted by Ironica

This actually came up when we were meeting with our doula today... and her inference on the issues with "postdates" babies was the same as mine: Ok, there are more issues (not just for VBAC, but in general). But, what's the causality? The assumption is that baby staying in longer is bad for baby... but it seems just as likely, if not moreso, that babies who HAVE a problem of some kind are more likely to go post-dates. Granted, it may be that the problem is easier to address outside the womb, but if they're tangled in their cord, or can't get a good position, or whatever, the birth is probably not going to go as well.

This has been my gut feeling about it for a while.

But, on the other hand, there are babies who go to 42, 43 weeks, and then are born with no issues at all, and don't look at all "overcooked." Some women ALWAYS go that long with each pregnancy. So... is it necessarily a good idea to get all freaked out about postdates babies when for some, it's totally normal, and for others, it may be that they're staying in because of a problem, not that they're going to have problems from staying in too long?

At the very least, I wish they'd look at family history - on both sides. I had a 38w,5d pregnancy with ds1. His dad's (my ex) mom didn't have long gestations. Neither did mine, as far as we know (her first was an emergency section and my sister and I were scheduled repeats).

DH's kids: DD went to 39w,2d, and then I let myself be bullied into a scheduled repeat because she was breech (and apparently if I waited for labour to start, then went to the hospital, we'd both keel over and die at the first contraction...bitter - who, me??). She was too early - I have no doubts that she was at least a full week from being ready to be born, and I'd guess more like two. I caved on the repeat with ds2, as well...bu I went into labour the night before...at 41w, 4d. The section was done at 41w, 5d, and I was barely starting to dilate (under 1cm). I suspect I'd have gone to 42 weeks or very close with him. True labour started at about 43 weeks with Aaron (bad example, perhaps, as he was stillborn...but I laboured a long time before that, and there's the multiple section part of the equation, too). DH's mom carried all four of her boys to over 42 weeks, with no problems at all. They were all over 9lbs. and they were all born vaginally.

I really think dh's kids are just genetically inclined to "cook" longer.