VBAC after "failure to descend" - Mothering Forums

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Old 02-14-2009, 03:09 AM - Thread Starter
 
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hello friends
I will be attempting a VBAC hopefully in a week or two with baby #2. My first labor ended with a C-section after I was told my baby wasn't descending and his heart rate was rising. Now as I plan to attempt a VBAC I am getting nothing but negative comments from my doctors and am being told that because I was a "failure to descend" patient that my chances of VBAC success are very low. My first labor I took the epidural and remained in the reclined position for most of the time...part of me feels like this had alot to do with my failure. I have hired a doula and am planning on trying for a natural birth..I know I will have to be hooked up to fetal monitors and an IV..but I'm feeling so discouraged right now...since every week I see a different doc at my practice and they all are shaking their heads and me as if I'm wasting my time. All of the excitment and joy about attempt this VBAC is being sucked out of me and I can't help but feel sad and anxious now. Any words from other "failure to descend" mamas out there? I need some inspiration quickly!
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Old 02-14-2009, 03:57 AM
 
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AIUI, your chances (speaking in the aggregate) are lowER than if your CS was considered "nonrepeating" (breech, multiples, etc). They are not "very low". I can't remember the statistics but IIRC over half of women who attempt VBAC with a repeating reason still succeed. Also, the distress part of the section is considered nonrepeating--that normally doesn't happen again.

However, the aggregate doesn't tell the whole story. It lumps together women who do have a problem, and women who had a fluke. That former group is going to drag down the average, and until you try, you don't know which you were. The chances that you are one of the "problems" (and that's pretty loosely defined since they prefer to be cautious) are fairly low.

There's also a problem--and your OBs sound like they MAY have this--where you anticipate a problem, and therefore create it. If you come at it with the attitude that TOLAC is going to fail, your entire attitude towards the birth is going to be different. The provider will be more discouraging, start suggesting section earlier, tolerate less pushing. I really hate this attitude from OBs--maybe they think they're injecting realism, but there's being realistic, and there's coming off as if you've pulled a bait-and-switch. Let's face it--you need to be able to trust your OB, so you know that if s/he says there's a problem he means it and isn't just trying to scare you. He shouldn't be undermining that trust.

At this point, it's too late to switch, so I would strongly recommend talking to your OB if you see him/her again, and tell him/her that their attitude is undermining the trust that both of you need to have. If you think s/he's trying to scare you into an unnecessary section, it won't be productive for either of you. And remember, that while we always have to be prepared for the possibility of surgery, the future isn't written in stone.

DD 01/2007, DS 09/2011

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Old 02-14-2009, 04:57 AM
 
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I think you and I are right on in similar situations...except, my doctor is very supportive. But, I'm in your shoes, I was a c/s due to "failure to progress"...I was 10cm, started pushing, yet my DS's head never decended, therefore, what was I pushing for??? I'm not really sure...I didn't know better then...I do now!

Also things I didn't know then, but I do now..I was induced...mistake 1! He wasn't ready and the biggest sign was his head was still high and basically floating...so when they broke my water (mistake 2) my feeling is that his head sort of came down as is..even though it wasn't ideal. I just recently found in my labor notes that he was facing my right hip in a posterior/side laying position (sorry, I don't know all of the fancy terms for it). But as I progressed to 10cm, he was never in an ideal position...sure, this can very much work for some, but giving my 2 hour time limit that was apparently placed on me...2 hours later, his head still hadn't decended.

Is any of this similar to your story?

Anyway, over the course of my 36 weeks so far, I went from wanting to try a VBAC to wanting to succeed at a VBAC, to "I WILL do this VBAC!!!!!" I've gone from wanting an epidural, to realizing that maybe mobility could be key that if I were in a repeat situation of last time, my freedom to move could rotate him or help lower my baby's head to come down! Now I too am planning a natural birth, I've hired my doula and I'm super excited and confident!

BUT, in this time I've had ups and downs. I would find could 9 where I thought I was 110% going to have my perfect delivery...this was usually after reading success stories, talking to women on here and having positive encounters. Then, I'd maybe take a break from things (like maybe no reading my wonderful books) and I'd start to have fears, doubts, and think I can't do this, I'm not going to succeed! I needed to snap out of it and get my confidence back. Have you read Ina May's Guide to Childbirth? I swear, every time I picked up her book I was back on Cloud 9 thinking I can do anything!!!! Those stories and her writing is so positive that it would bring me back to my positive place, where I feel I need to be to succeed!

Wow, I'm really really rambling on, but I think the best thing is to stay positive! I can't help but be upset for you that your OB is bringing you down. Like the previous person said, it sounds like she's trying to discourage and scare you now so when things aren't just PERFECT during labor, you won't fight for what you want. What about your doula...I would hope your doula is very supportive of your VBAC and natural birth...can you talk with her to get a little pep talk?

I personally am very very encouraged by doing everything different this time. I will go into labor on my own, I will let my water break on it's own, and I am planning to go natural so I have mobility and I'm not flat on my back useless! I'm not sure if you were induced, if your water was broken or anything like that, but you did mention the epi and being on your back...like me, I feel that was a major downfall with pushing a baby that had not decended! Mobility!!!!!

So my words are, get your confidence back...you CAN and WILL do this! Read some positive stories, they don't have to be VBAC, just positive stories! Go into this labor with the "I WILL succeed" and all of the success stories that you've read fresh on your mind!

Me (30), DH (31), DS (3.5 yrs - 5/07), DD (1.5 yr - 2/09) via VBAC!!! DS (newborn - 11/10) via natural VBAC! 2 angel babies - 06/06 & 04/08
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Old 02-14-2009, 06:52 AM
 
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My c/s was for "arrest of descent". I did have a VBAC a couple of years ago with a baby over a lb bigger. I stayed home until I was 8 cm and when I got to the hospital refused to get in the bed. They still monitored the baby but it was while I was upright.

Best wishes to you.
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Old 02-14-2009, 09:59 AM
 
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My first baby was a failure to decend baby, she also got distressed so had a c/s. At 32wks pregnant with my second i went to a chiropractor and found out that i had a twisted pelvis, he realigned me and clicked me and a week later my daughter had decended into my pelvis and i got my VBAC 13mths after my c/s and she was 1lb bigger than my first. So YES it can be done! Have faith and try and avoid going to the hospital until the last minute.

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Old 02-14-2009, 12:16 PM
 
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I was also going to suggest going for a Chiro session before you go into labor. Even if there isn't something going on with your pelvic area, it's best to check and get yourself in tip-top condition.

Also, someone else mentioned being induced. Were you induced with your first child? If so....that might explain some of the "failure to descend". The baby simply might not have been ready.

My suggestions...Say positive affirmations to yourself because you're obviously getting a lot of negative energy around you. Imagine your baby descending and moving through the vaginal canal. Also, wait until your body goes into labor naturally and try to keep yourself upright during labor.
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Old 02-14-2009, 08:36 PM - Thread Starter
 
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thank you for the feedback ladies, here is the story of my 1st...I was 38 weeks and my water broke at home..went to the hosptial right away
( because I didn't know any better then ) and the hooked me up to Pitocin and Fetal Monitor....I was constantly asked when I wanted my Epidural and thought "well I'm uncomfortable, guess I have it now" so I took it around 6 or 7cm... when I got to 10cm they had me "labor down" or rest for an hour then they came back and said time to push...I had no feeling, pressure, pain, urge to push or anything..so I was a bit confused, I pushed on my back for maybe an hour..and couldn't feel a darn thing, they just told me to watch the monitor and push when the contractions showed up...it was very frustrating not to be able to feel an urge or anything...then suddenly the OB came in and said the baby's heart rate is too high and he/she is not coming down at all..we have to give you a C-section..and that was that. I was really confused and overwhelmed and didn't know a thing about C-sections since I never even thought it was a possibility for me.

This time around I'm using the same OB practice and same hospital but am working with a doula who is indeed very supportive, it's just hard to go to the Doc and hear all the negative talk against my VBAC wishes and stay positive, but I have been reading the success stories on these boards as well as Ina May Gaskin & Dr. Sears books trying to stay focused and positive is proving harder for me than I thought.

I appreciate hearing your stories ladies and your supportive messages as well.
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Old 02-15-2009, 01:45 AM
 
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I had to push my vbac baby down. She just didn't want to descent! Same thing happened with my c-section baby (which is why she was a c-s). My first medwife told me that my pelvis was too narrow for vaginal birth. For my vbac, my MIDwife told me my pelvis was probably too roomy. It gave my babies a lot of room to float around up there before locking into place and descending. Since she actually helped me achieve a vaginal birth, I believe the 2nd midwife.

Anyway, my labor was stalling big time during my VBAC so I finally consented to having my water broken around 2pm (I was probably around 5-6cm at that point and 36 hours into labor!). At 3pm, my midwife had be take contractions in the squatting position so that i could push my dd. I would up pushing through transition and pushing while they guided my cervix around my baby's head. DD was finally born at 7pm.

You had an advantage though - during my 1st labor, I only got to about 5cm. You dilated all the way! If you can do that without an epidural and push when you have the urge, I see no reason why you won't have a wonderful VBAC!

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Old 02-15-2009, 02:20 AM
 
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My first DD was a c-section due to "failure to descend". She was positioned incorrectly and I labored entirely on my back (like others have said... didn't know better then). My second DD was nearly a pound bigger than my first and I had a successful (incredible!) VBAC. You CAN do it! Wait a long as possible before going to the hospital. Make a birth plan! Can't wait to read about your VBAC!

mama to two sweet girls love.gif 8/05, fairy.gif 11/08, a handsome little guy babyboy.gif 4/11, and expecting another 5/13
always missing our angel1.gif (11/04, 4/07, 8/07, 5/10)
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Old 02-15-2009, 02:21 AM
 
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Originally Posted by AlexisT View Post


At this point, it's too late to switch, so I would strongly recommend talking to your OB if you see him/her again, and tell him/her that their attitude is undermining the trust that both of you need to have. If you think s/he's trying to scare you into an unnecessary section, it won't be productive for either of you. And remember, that while we always have to be prepared for the possibility of surgery, the future isn't written in stone.
I politely disagree, it is only too late to switch when the baby is OUT! Otherwise, there are always options that may be more VBAC friendly. Your local ICAN chapter can be a big help in identifying providers and facilities that are VBAC supportive. I have had clients who felt the need to switch providers 12 days before the baby was born!

As a vbac mom, and as a doula of many, many VBAC women, I think it is critical to have your entire team believe in you, trust in your ability and power, and allow you to trust in yourself.

You can birth a baby out your vagina! I just attended a VBAC today, of a tiny, petite woman, who had a c/s for failure to progress (FTP) and cephalopelvic disproportion (CPD) and the surgeons told her she could not get a baby out her vagina ever! She birthed her VBAC baby unmedicated in less than 7 hours! And he was a pound heavier than her "too big" first baby. Her hospital midwife, her nurse, her husband and myself never doubted for a minute that she could do it! And she believed in herself!

You are strong and powerful and you can succeed. Build your team, and fill it with those who will walk with you proudly in this journey!

Best wishes for a rocking great birth!
Sharon

Birth doula, doula trainer, ican leader, lamaze childbirth educator, and most importantly, mom of 2 great girls!
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Old 02-15-2009, 10:15 AM
 
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Yes, 1st baby induced, epidural, water broken at 2cm, stuck high and posterior with a deflexed head...failure to progress and C section.

2nd baby, went into labour naturally (took EPO and did accupressure the night before I went into labour. Coincidence? Probably not), moved around more in labour, hospital at 7cm, did have water broken at 7cm (long story, but turned out ok), had internal monitor put on, but was still mobile, baby posterior again ...baby came out in 1 conscious push!

Both my babies were pretty big and exactly the same size as each other.

Even if you have monitors and IVs, you can still normally move around near the bed, sit on birth ball/stool. Ask about telemetered monitoring at your hospital. REally try to wait to go into labour on your own. The docs will probably try to talk you into being induced (hopefully NOT with prostaglandins) or have repeat C section if baby is at all "overdue", but I'd avoid it at all costs. More painful, more likely to have epidural, more likely baby will be malpositioned, more likely it will not descend. Not a definite of course, but more likely.

I always told myself when I saw a statistic that I thought was "bad", like one about chances of success being low, like 40% or something (don't know what it is, I'm just plucking a number out of thin air), I'd remind myself that the chance of a baby coming out of my vagina with a repeat C was 0%!!! So I'd still take the 40% chance and see what happened.
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Old 02-15-2009, 07:24 PM
 
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Originally Posted by Emily's Mama View Post
I always told myself when I saw a statistic that I thought was "bad", like one about chances of success being low, like 40% or something (don't know what it is, I'm just plucking a number out of thin air), I'd remind myself that the chance of a baby coming out of my vagina with a repeat C was 0%!!! So I'd still take the 40% chance and see what happened.
I LOVE IT!!!!! So so so true...i'd take any % of a baby coming out my vagina than just going in for a c/s...which like you said is a 0% chance!

I LOVE IT!!!! : : :

Me (30), DH (31), DS (3.5 yrs - 5/07), DD (1.5 yr - 2/09) via VBAC!!! DS (newborn - 11/10) via natural VBAC! 2 angel babies - 06/06 & 04/08
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Old 02-16-2009, 03:35 AM
 
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verukablue,
I'm really upset for you. You deserve a provider who supports you. It also makes me angry for you, since hearing you brings me back to my first c/s and dealing with those doctors and then my 1st VBAC attempt 2 c/s and having the hardest time finding someone supportive. I felt like since they agreed to let me "try", then that was all I could really expect. I now know way better now and realize that I can have what is due any pregnant woman: support, respect that this is sacred, and for all members on my team to give 100% to my goal. So much of me feels that I would have successfully birthed my second child, if I had had someone even more committed to my successful VBAC than my doctor. It just seems that they have too many patients to give me the care that I needed to birth vaginally. This time I have hired a midwife to provide labor support alongside my OB (who is VBAC supportive, but again does not have time to address all of my needs.) A lot of me wants to say to you- RUN!!! Find a homebirth midwife, or stay home and have your child by yourself, or change your doctor! But only you know the answer for yourself, I'm just being reactionary. The real message I want to say is that you deserve better, than to be treated the way that you are being treated, and it angers me to see the injustice and inhumanity (if that is a word). Who do they think they are?!! You should be surrounded by love and support right now and in your delivery. Feel free to change providers, if you feel that that would be the best.
Having had two c/s, which to me represents two failed birth attempts, I am now going for the gusto because it is so important to me. I don't want to have any regrets.

I'm rambling too, because this just stikes a cord in my heart. Good luck with your birth. I know you can do it! You were created to do it.
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Old 02-16-2009, 05:16 AM
 
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I was a "failure to descend" too. Why didn't DS1 descend? He was posterior, I have a narrow pelvis, and I was stuck in bed with Pitocin (which glued him in place) and an epidural (which kept me from moving about to help him manuever his way out). I birthed my second son at home, and although it helped that he was LOT and had a smaller head, I also birthed squatting, which let the force of his head snap my tailbone back out of the way so he could come out. On my back that never would have happened!

You did not fail. The system failed you. Hospitals shove all women, regardless of their individuality, through the same cookie-cutter assembly line, and when they don't come out the right shape at the end, they have "failed." It's effed up. That is what I love about home midwifery care. They tailor everything to fit you personally, not some mass-produced model designed for maximum efficiency! Have you thought about birthing at home, or in a FSBC?
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Old 02-18-2009, 01:50 AM
 
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My first c/s was because baby wouldn't move down, found out his head was asynclitic (though they labelled it CPD and suspected macrosomia). Had a great vbac for #2, and #3 ended up with another c/s for arrest of descent (his arm was in front of his head, he couldn't tuck his chin like he needed to) and non-reassuring heart tones. I will be trying for a vba2c next time because I know that just because my baby didn't come down last time it doesn't mean it will happen again.

Kara mommy to Jason 9/27/04 ribboncesarean.gif, Jacob 6/1/06 vbac.gif, Nathan 11/13/08 ribboncesarean.gif, and twin boys Isaac and Caleb born 1/10/11 vbac.gif
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Old 02-18-2009, 12:28 PM
 
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I didn't read all the other posts but just wanted to say my DS never descended past -3 (which is when I was sectioned) and I just VBAC'd! You can do this!

Also, would they consent to a heplock instead of the whole IV so you can stay mobile easier? My MWs and their back-up OB were ok with that.

Taryn-31 Crunchy Conservative Catholic SAHM with DH-32
DS 7.5, DD 5 (vbac), DD 2.5 (vbac), and DD 12/30/13 (vbac)

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Old 02-18-2009, 06:43 PM
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hi mama, I haven't read through all the posts, but looks like there's a lot of great info here.

In my experiences, failure to descend was caused by not truly being ready to birth. Positioning inside the womb was critical - and if the water breaks and baby is not in the right position, it can get stuck in an awkward position. And being on your back is the worst thing for anyone - let a lone a vbac. Keep upright, side lying, hips straight until you're past +1. Then bend the hips to open the lower portion of the pelvis when pushing. Try a bath or other means of relaxing to help you open up and let the baby move around.

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Old 02-19-2009, 02:12 AM
 
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My c/s was for "arrest of descent". I did have a VBAC a couple of years ago with a baby over a lb bigger. I stayed home until I was 8 cm and when I got to the hospital refused to get in the bed. They still monitored the baby but it was while I was upright.

Best wishes to you.
: I am wondering if being kept in the bed isn't what's causing the "failure to descend"! Of course the baby isn't going to move down that much if his mother is semi horizontal, and the pelvis is flattened front to back by being in the bed(read Henci Goer's Obstetric Myths vs. Research Realities, and The thinking woman's Guide to a Better Birth= also anything by Nancy Wainer Cohen(Silent knife, etc)). The best chances for a VBAC might be to stay home til the ctx are 2-3 min apart, 60-90 sec long(as long as you aren't 30 or more miles from the hospital(then I would rent a motel room near it) and then go in and stay upright! It takes longer to birth a first baby, cuz the head has to mold, and some practitioners don't like to wait, so they try to force the baby out, and that might create decels and other side effects that they feel warrant a surgical birth. Pushing a first baby for more than a couple hours isn't necessarily a bad thing as long as the baby/mom are tolerating it well. And it isn't unusual for the fhr to drop a little as his bony head is going under the pubic bone. And it does get molded(sometimes looks sorta like a banana, temporarily).As long as it goes back up. PS, good job Lisa2005!
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Old 02-20-2009, 06:55 PM
 
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My baby was an arrest of descent c-section. I labored at home, arrived at the hospital at 9cm, got to fully, pushed for a couple of hours, still no descent (no epidural). I did get an epidural after the couple of hours of pushing, pushed for another couple of hours ( I had a midwife) and had a c-section for my 7Ib 12oz baby. She was wedged in my pelvis through the pushing and needed help getting her out through my abdomen!

My vbac 2years later was a 8Ib 2oz baby, I arrive at the hospital 10cm dilated and I wait for the urge to push I push for 30 mins and he is born. I also read "sit up and take notice" about trying to keep the baby in a good position during pregnancy and labor.

I'm now 24 weeks pregnant and keeping the same ideas in mind.
I did have a battle with my vbac md's and was told "I'm just attempting VBAC" many times. I did hire a doula and did my best to educate my ob's!

Best of luck! You can do it!
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Old 02-23-2009, 06:31 PM
 
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Thanks to everyone for posting--my first was 'failure to descend' also. This post is a tremendous encouragement.
I'm preg with #2, and per my MW, first baby FTD has to do mostly with some idiosyncracy of the first baby's position *together with* the hospital intervention stuff. (even thought I labored 70 hours before I got any epi or pit)
Mine had his arm tucked up, too, and I labored about 3 days. I think if I had been able to relax & done my research, during a 'slow down' of labor he could have repositioned.
But that's water under the bridge. This time--you and I--we KNOW, and we're ready to fight to be allowed to listen to our bodies, and so we're going to do it!! I believe in us!!!!
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Old 02-23-2009, 08:43 PM
 
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I had ftd w/ my c/s---my first baby. I had no pitocin and heart tones were fine. I pushed for 2 1/2 hours and she never changed stations.

You have every reason to vbac successfully. I cannot imagine why you wouldn't. THe c/s was for the non-reassuring heart tones, not bc you pushed and pushed and pushed and couldn't get baby out.

Moms like me, who pushed for a longer time do have a lower rate of vbac'ing, but that could be a variety of factors----are the doctors not giving the mom a chance? Does the mom doubt herself too much etc. etc. Studies show moms who pursue a vbac have a 65-80% chance. And I'm sure it's higher if you do a few things:

get a doula
avoid that epi. I've had 2 vbac's since that were a bear to push out. There is no way I could have down it w/ an epidural. Both were posterior and came out that way. I did chiro faithfully, but my babies just like the posterior position.

You will be fine. Where do you live? Can you find a more supportive cp? My doc was awesome. He totally encouraged me and was behind me 100%.
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Old 03-08-2009, 08:31 PM
 
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The official reason for my c-section according to my medical record was "Arrest of Desent"....so, yeah, another failure to descend mama here. But the reason my baby didn't descend is because she was straight up OP and her forehead got caught on my pubic bone.

However, I went on to have my 2nd baby via VBAC and it went perfect!!
Lots of luck to you.
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Old 03-08-2009, 08:38 PM
 
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My son was an emergency c-section- failure to descend, never got past -3 station, and then when they broke my water to try to "move things along," he went into distress and they called the section.

When I looked into VBAC options, a midwife told me they "don't like" failure to descend, and that there "may have been something with my pelvis that made the baby not fit through."

I had an HBAC in November. My baby descended beautifully and came flying out.

I did see a chiro for webster during pregnancy. Baby was vertex, LOA, but I wanted to make sure my pelvis was optimally aligned. I don't know for sure what difference it made, but I did get these achy pelvis feelings after every session, like it was really moving things around and making the baby drop. If you can find someone certified in webster, hopefully who specializes in working with pregnant women, I'd recommend it. It cured my sciatica, too!

Best of luck. You can do it!

SAHM to 6.5yo DS and 4yo DD. PCOS with two early m/cs. Married 8 yrs. Certified birth doula, writer, editor.

Some stuff I like: hbac.gifteapot2.GIFeat.gifnocirc.gifbftoddler.giffemalesling.GIFcrochetsmilie.gif read.gifcat.gif

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