Heyla!
My dh and I have been discussing having more children but I do not want to TTC if I know for sure the best birth option would be via c/s. I'm ok with a c/s situation developing but wont go into this knowing it's a "sure thing". So I kind of wondered if anyone here has an opinion about my birth history?
My first birth labor began at 42wks 3 days with SROM. Contractions didn't begin for another day (I was at home). When they did start I dilated quickly to 7cm and then stopped progressing. The c/s was done after ~32 hours of non-stop back labor, 19 of those hours at 7cm. DD1 was large-ish (9lbs 5oz) with an extremely large head. She was posterior and asynclitic with pronounced molding over her ear. I had a wonderfully supportive care provider (family practice) and amazingly pro-birth hospital. There were no restrictions on my moving, eating, drinking, walking the halls, etc. I had full access to a birth pool, birth ball, stool, etc and the staff was very much "in the background/call us if you need us". I had a doula and supportive partner. The eventual c/s was without incident, I healed quickly, but I was later diagnosed with PPD and mild PTSD which I attribute in large part to the difficult labor and unwanted/unexpected surgery.
With dd2 I again had two wonderfully supportive VBAC OBs (trained and birthed their own child on the Farm, 110% pro natural birth supporters) and was again at a very vbac/birth friendly hospital. Again my water broke on it's own but this time contractions picked up right away and I was only a few days past 40 weeks. There was no back labor (there were breaks between contractions!), everything progressed quickly until the pushing phase. Although I again had total freedom of movement (only "requirements" for a vbac mama were a heplock and a blood pressure check for me/a heart tone check for babe via doppler every 15 minutes while pushing), a supportive VBAC doula and partner, and eventually as much assistance as necessary to help me move into different positions... I still pushed for roughly 4 hours.
It seemed that dd's head was impacted (hadn't moved visibly in an hour despite being "right there") so I agreed to a small episiotomy and the use of the vacuum. They pulled during one contraction, stopped, and a contraction later I birthed her head. She then developed a shoulder dystocia lasting ~4 minutes. I was in a squatting position when her head was delivered, then moved into the gaskin position, then on my back with legs waaaaaay back, then into gaskin again, and finally my OB basically "reached in" to manually twist dd down and out. I had a 4th degree tear as a result (it didn't exactly follow the epi though, so I had two "lines" of stitiches. One short and one looooooong). DD was a little smaller than her sister... 9lbs even with a tiny head. She recovered well with oxygen and massage (on my belly, and they had me on O2 as well with delayed cord cutting to help get as much oxygen into her as possible) and had no obvious nerve damage or broken bones. She did have a very odd "crest" on her head though where she was pushing against the bone during the time she was stuck. It lasted longer than the rest of the molding.
I am still healing physically (8.5mo after the birth) with a decent amount of pain along the scar line. I also developed a mild uterine and mild-moderate bladder prolapse. We wouldn't TTC for at least another 4-5 months so this is very much a "down the road a ways" situation.
Anyway, I am a reference librarian and I did the research. There aren't a heck of a lot of studies out there on 4th tears and sd but... what are your opinions or professional experiences? The "once a c/s always a c/s" statement is obviously out the window IMO. But now I have to add the "once a shoulder dystocia always a c/s" and "once a 4th degree tear always a c/s" statements into the mix. Then top that mix with the prolapse situation (though I'm of the opinion that c/s aggravates prolapse instead of reducing it).
I know some mamas here at mdc have had a 4th degree and gone on to have happy, tear free, births. I know some mamas have had shoulder dystocia and gone on to birth without incident. But I don't know...
Of the two OBs I birthed with the husband suggested that I consider ercs for future births, the wife suggested I give it time and then perhaps get an u/s to measure the babe's head circumfrence when I reached 38 or 39 weeks before deciding about ercs. But I don't want to TTC if I KNOW it will be a c/s ending, you know?
Thanks for reading this far... any ideas?
My dh and I have been discussing having more children but I do not want to TTC if I know for sure the best birth option would be via c/s. I'm ok with a c/s situation developing but wont go into this knowing it's a "sure thing". So I kind of wondered if anyone here has an opinion about my birth history?
My first birth labor began at 42wks 3 days with SROM. Contractions didn't begin for another day (I was at home). When they did start I dilated quickly to 7cm and then stopped progressing. The c/s was done after ~32 hours of non-stop back labor, 19 of those hours at 7cm. DD1 was large-ish (9lbs 5oz) with an extremely large head. She was posterior and asynclitic with pronounced molding over her ear. I had a wonderfully supportive care provider (family practice) and amazingly pro-birth hospital. There were no restrictions on my moving, eating, drinking, walking the halls, etc. I had full access to a birth pool, birth ball, stool, etc and the staff was very much "in the background/call us if you need us". I had a doula and supportive partner. The eventual c/s was without incident, I healed quickly, but I was later diagnosed with PPD and mild PTSD which I attribute in large part to the difficult labor and unwanted/unexpected surgery.
With dd2 I again had two wonderfully supportive VBAC OBs (trained and birthed their own child on the Farm, 110% pro natural birth supporters) and was again at a very vbac/birth friendly hospital. Again my water broke on it's own but this time contractions picked up right away and I was only a few days past 40 weeks. There was no back labor (there were breaks between contractions!), everything progressed quickly until the pushing phase. Although I again had total freedom of movement (only "requirements" for a vbac mama were a heplock and a blood pressure check for me/a heart tone check for babe via doppler every 15 minutes while pushing), a supportive VBAC doula and partner, and eventually as much assistance as necessary to help me move into different positions... I still pushed for roughly 4 hours.
It seemed that dd's head was impacted (hadn't moved visibly in an hour despite being "right there") so I agreed to a small episiotomy and the use of the vacuum. They pulled during one contraction, stopped, and a contraction later I birthed her head. She then developed a shoulder dystocia lasting ~4 minutes. I was in a squatting position when her head was delivered, then moved into the gaskin position, then on my back with legs waaaaaay back, then into gaskin again, and finally my OB basically "reached in" to manually twist dd down and out. I had a 4th degree tear as a result (it didn't exactly follow the epi though, so I had two "lines" of stitiches. One short and one looooooong). DD was a little smaller than her sister... 9lbs even with a tiny head. She recovered well with oxygen and massage (on my belly, and they had me on O2 as well with delayed cord cutting to help get as much oxygen into her as possible) and had no obvious nerve damage or broken bones. She did have a very odd "crest" on her head though where she was pushing against the bone during the time she was stuck. It lasted longer than the rest of the molding.
I am still healing physically (8.5mo after the birth) with a decent amount of pain along the scar line. I also developed a mild uterine and mild-moderate bladder prolapse. We wouldn't TTC for at least another 4-5 months so this is very much a "down the road a ways" situation.
Anyway, I am a reference librarian and I did the research. There aren't a heck of a lot of studies out there on 4th tears and sd but... what are your opinions or professional experiences? The "once a c/s always a c/s" statement is obviously out the window IMO. But now I have to add the "once a shoulder dystocia always a c/s" and "once a 4th degree tear always a c/s" statements into the mix. Then top that mix with the prolapse situation (though I'm of the opinion that c/s aggravates prolapse instead of reducing it).
I know some mamas here at mdc have had a 4th degree and gone on to have happy, tear free, births. I know some mamas have had shoulder dystocia and gone on to birth without incident. But I don't know...
Of the two OBs I birthed with the husband suggested that I consider ercs for future births, the wife suggested I give it time and then perhaps get an u/s to measure the babe's head circumfrence when I reached 38 or 39 weeks before deciding about ercs. But I don't want to TTC if I KNOW it will be a c/s ending, you know?
Thanks for reading this far... any ideas?
