Repeat C-sections and deaths? - Mothering Forums

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#1 of 52 Old 04-10-2011, 02:21 PM - Thread Starter
 
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I am trying to decide whether or not to attempt a VBAC. I have to admit that I am now leaning towards the repeat c-section, though, which surprises me.  I've been posting my concern on a some message boards in hope of more information, but I just don't know if it is out there.

 

I have one child and he was born by c-section. It started as natural labor, but then he became stuck in my pelvis, apparently. 

 

At first I was really considering a VBAC, but now I am leaning more towards the elective, repeat c-section because I have read so many terrible stories about VBAC ruptures. And it is so strange...maybe I am doing something wrong...but I cannot find one story on a repeat c-section where the healthy baby died. 

 

It's strange because I know that the given statistics are that repeat c-section are more dangerous than a vaginal birth for both mom and baby. But I haven't even found one person saying 'their friend's baby' or 'their sister's baby' , etc. I know it doesn't necessarily mean anything because there must be some, but it kind of alarms me and makes me think the statistics for repeat c-section are also including unhealthy mothers and babies.

 

Now granted, I have found posts about the mother's dying during repeat c-sections, but I am particulary looking for information for the babies. I only ever see people giving the statistics that have been reported. 

 

Does anyone have any ideas about this? 

 

I am truly kind of puzzled. 

 

PS-

 

Oh, I should mention while I'm thinking about it, that while I am having a hard time find any personal stories about RCS death of a healthy baby, I have read all the statistics and I do still think that VBAC is an excellent choice for some people. I don't think it's crazy at all for some people to try it.  I'm really just questioning it for me because of my last labor. I know that even with my history, I still could succeed, but I just don't know that I'm willing to take that chance.- especially because of the stories that I have read- I feel I might be in more danger of that happening than some other people.

 

My last labor, I got to 10cm and was at the pushing stage, but felt no urge- only a terrible, unrelenting feeling in my back that was inescapable. The doctor said it was because my son was stuck in my pelvis. She is supportive of either VBAC or c-section, but says that it is probably more likely to repeat with me than with someone who didn't have that problem or who has had a previous vaginal birth. 

 

Someone mentioned to me that if you are looking for horror stories, you will find them. And that is just it. I have been looking and looking on both sides and I haven't come across any horror story deaths from RECS for a healthy baby- you would think someone would be talking about. But I have run across the VBAC horror stories and sometimes it upsets me even more because some of the mothers do not regret their choice and even go on to say they had a successful VBAC because the baby eventually emerged- though not alive. I guess I am just disturbed right now...the more I read, the more disturbed I get. But, I should also add that I have never felt a desire to need a vaginal birth- I know some do feel that strong urge.

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#2 of 52 Old 04-10-2011, 05:50 PM
 
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Comprehensive risk comparison: NIH VBAC risk white paper from March 2010

 


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#3 of 52 Old 04-10-2011, 06:29 PM
 
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Your story is CLASSIC. Dilating to 10 with no urge to push and severe back pain that just doesn't go away indicates a baby who was probably malpositioned. Since my c-section in 2007 and being involved in ICAN and hearing loads of women's stories.. it seems to be one of the more common ones. Of course, everyone's details are different, but dilating, trying to push, and not being able to move a stuck, malpositioned baby is one of the more common c-section stories I hear. Thats what happened in mine as well. There's no reason that your history would increase your rupture risk (I'm assuming you had a low transverse incision?) and, regardless of vaginal vs c-section, 2nd time moms are less likely to have problems with a malpositioned baby simply because after pregnancy, our uterus is more "apple" than "pear" and its a little easier for baby to rotate around to an ideal position. There are also things you can do to help encourage your baby into an ideal position, such as exercises recommended on spinningbabies.com, or seeing a chiropractor who specialized in pregnancy. 

 

As for "horror stories".. there are a lot of rupture horror stories online in which the mother was induced. Induction is well known to significantly increase the risk of rupture. Rupture also occurs without induction, and even without labor! Even if you're the unlucky 1 in 250 non-induced vbac women who ruptures, rupture does not always, or even most of the time, mean a dead or damaged baby. 

 

 

quoting from http://vbacfacts.com/vbac/ (removed some text to shorten the quote, see link for full text)

 

 

 

Quote:

...the rate of uterine rupture in a spontaneous labor with one prior cesarean is approximately 1 in 250 (0.4%), 1 in 2000 (0.05%) VBAC babies will have a bad outcome.

However this rate is inflated as Landon (2004) included women who had pre-labor stillbirths in this statistic.  In other words, women whose babies passed away before labor, had VBACs rather than repeat cesareans, and so those deaths were counted towards the 0.05% statistic. 

Landon (2004) stated that from 114 ruptures at term, 7 (6.2%) babies had...(oxygen deprivation), 2 (1.8%) died

 

 

I do have a friend who, while she had a live baby from her ERCS at 39 weeks, he had to spend 10 days in the nicu because his lungs just weren't developed enough. He was a 39 week "preemie", and spent much of the first 2 years of his life regularly needing hospitalization for breathing treatments and such. 


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#4 of 52 Old 04-10-2011, 10:07 PM
 
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I'm sorry you're feeling so much fear.  I think too much focus on the horror stories (either way) is not going to help you prepare for another birth.  Planned ERCS can be a great experience for some mamas.  However, there are risks to consider for sure and then even other factors that aren't scientific.  Like in my case . . . if I end up with another c/s, how will I keep 2 22-month-old twins off of me while I'm healing from major abdominal surgery?  Rupture risks are fairly low esp. w/o induction, augmentation, or epidurals, and it's my understanding that there are often 'signs' that it's happening.  Of course, not everyone can discern those signs.

 

The NIH held a VBAC consensus-building session in 2010.  You can read the entire report . . . you should read the report, actually.  I think it'll make you feel better about at least considering the risks and benefits of VBAC.  And a GREAT source of information is Childbirth Connection.  I'd also recommend getting involved with ICAN.

 

Good luck on your journey!!


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#5 of 52 Old 04-11-2011, 07:46 PM
 
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This is definitely a personal decision and many factors will go into it, including your own previous experience.  Some things to consider:

*  family size.  If there is even a remote possibility that you may want a third child, you may want to attempt VBAC, since the risks of RCS go up quite a bit with each subsequent repeat surgery

*  your own liklihood of success.  You seem quite convinced that you are unlikely to succeed, and I understand your hesitation, based on prev. experience.  However remember that regardless of what the reason was for your first c/s, about 3/4 of all women who attempt VBAC will succeed.  As others have said, baby getting "stuck" was probably just poor positioning (a chiropractor and a look at www.spinningbabies.com during this pregnancy can help with that).  Or it could be some goofy pelvis thing.  You will probably never know unless you try. 

* your fears.  You should try to work through these before your next birth, regardless of what you decide as a mode of delivery.  Telling your birth story can help.  Going to some local ICAN meetings can help (really).  Speaking with a councellor who works with birth trauma, PTSD, etc, can help.  Speaking with other women who have been there can help.  Sometimes you can find emotional healing workshops that can be very helpful in identifying your fears and helping you move past them.  Remember, this is a new pregnancy and a new birth.  It has nothing to do with your last one.

 

If you are a facts and figures person, (and we all are to some extent) here are some brief facts:

* about 3 of every 4 women who attempt VBAC will be successful

* around 1 of every 200 women will experience some form of uterine rupture.  About 20% of these result in the baby dying.  This is 1/5.  Multiplying these numbers out, roughly 1/1000 VBAC attempts will end in the baby dying.  To put this in perspective, the risk of losing your baby due to amniocentisis is around 11/1000.  The risk of losing your baby for CVS is 15/1000. 

*  The risk of a mother dying during childbirth during a VBAC is 4/100,000.  The risk of mother dying during a repeat CS is 13/100,000. 

*  Another perspective:  around 1/200 women will experience a placental abruption.  Or a complete previa.   

*  While rupture is an obstetric emergency, it is about as likely to happen as any other obstetric emergency.

 

I know these numbers are difficult to wrap your brain around (anything with lots of 0s is), but hopefully it puts some things into perspective.  I also think the resources at www.childbirthconnection.org are excellent.  The links on the left will lead you straight to a page that has a comparison of risks to mom and baby for VBAC vs RCS, and it is very helpful. 

 

Another good decision-making resource is:http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/weighing-the-pros-and-cons/

 

The facts and figures in the above-mentioned guide are straight from the NIH Consensus statement that was drafted and finalized in 2010. 

 

If you decide to have a RCS, there are many excellent resources you can find on planning a family-friendly cesarean section, and this is also something that your local ICAN chapter can assist with.  Best of luck with your decision and your pregnancy!


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#6 of 52 Old 04-11-2011, 10:48 PM
 
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You have some great replies.

The statistics deal with fractions of %'s the number are so small.

C-sections are more risky for the MOM then the baby which is probably why you have not heard of any tragic baby death stories with c-sections.

 

I'd still try for a VBAC. It is the safest way to birth.

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#7 of 52 Old 04-12-2011, 02:23 PM - Thread Starter
 
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Thank you all for replying.

 

I checked ICAN and I think all of the other sites mentioned and I lots of books, too. I think it's a hard decision. Right now, I still am thinking that basically:

 

VBAC is best for most people, but more dangerous for the baby if it goes wrong,

ERCS is more dangerous for mom and future pregnancies.

 

It's just still weighing the possibilities in those two choices.

 

I know this is the best time to decide, though, because if I have another c-section and then want a VBAC later, that is possible, but not as easy to find a provider and may up the risks.

 

I have a low transverse incision on my ueterus, so the doctor says I am a candidate for VBAC, if I would like to go that route.

 

I do wonder if part of me will always wonder if it was possible, but I don't know if I wonder enough to take the chance, if that makes sense. But then also, I think I already said it, but I really don't feel sad or a loss from c-sections, I just think anything done the most natural way, when possible, is always best. (And I hate needles, etc!)

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#8 of 52 Old 04-13-2011, 08:43 AM
 
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"VBAC is best for most people, but more dangerous for the baby if it goes wrong,

ERCS is more dangerous for mom and future pregnancies."

 

You know, I thought this too, but I've found some research that doesn't support this.  Most ruptures are not catastrophic, so even if the dreaded uterine rupture occurs, it does not mean death, or even harm, to the baby.  There is also evidence that babies are more likely to die in the first year of life if they were born by elective repeat c-section.http://www.news-medical.net/news/2006/09/05/19919.aspx?page=2  The chance that something will go wrong in a VBAC or a RCS is small, so the good news is that whatever you decide, the odds are overwhelmingly in your favor for a healthy mom and babe. 

 

I am struggling with this decision as well, but we aren't TTC until this summer.  I truly believe I can give birth, and I do want to experience natural birth.  I was in a car accident in '93, so there is the slight posibilty that I have true CPD.  I really don't believe I do.  I think my pelvis healed just fine.  But there are medically necessary c-sections, and with my luck, I'd prepare for a VBA2C, and end up with placenta previa or something that schedules me for a section.  So, I am trying to have absolute faith in my body and "know" I can VBAC, and also prepare for a c-section.  Because, really, there is only so much I can control. 

 

Right now, I am planning to have a homeirth, HBA2C.  I've tried to labor in the hospital twice now, and my long start-and-stop labors are not tolerated in a hospital.  I am not any more concerned with uterine rupture than I am about cord prolapse or any other unlikely complication with any pregnancy.  I have an experienced midwife that I trust, and I know that she is quite capable of detecting problems and transferring to the hosptal in a timely manner.  That is how I feel today, anyway.  I am usually a total science geek, looking at the studies and stats, trying to find the absolute safest choice, but the truth is, there are risks no matter what I decide.  So, I am following my gut on this one.  The frustrating aspect of following your gut, though, is that there is never a deadline to decision making.  I could be in early labor, decide that something is not right, and opt for a 3rd section.  I don't see myself doing that, especially after my last TOL, but if I have learned anything in this journey of pregnancy, birth and motherhood, it's that:  I am stronger than I give myself credit for and although the only thing I can control is my attitude, that's sometimes all it takes.   

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#9 of 52 Old 04-13-2011, 08:58 AM
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Elective, scheduled c-sections have the best outcomes for babies. Better than standard vaginal birth.

However, risk for mother is increased. So I think that's the balance you have to consider.

If you are interested in a VBAC, what does your OB say? Some women are better candidates than others. If the OB thinks you are a good candidate, and you have a hospital birth (in case of rupture) then the risk is somewhat managed.

Either way, congrats on the baby!
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#10 of 52 Old 04-13-2011, 01:08 PM
 
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Quote:
Originally Posted by MsFortune View Post

Elective, scheduled c-sections have the best outcomes for babies. Better than standard vaginal birth.

However, risk for mother is increased. So I think that's the balance you have to consider.

If you are interested in a VBAC, what does your OB say? Some women are better candidates than others. If the OB thinks you are a good candidate, and you have a hospital birth (in case of rupture) then the risk is somewhat managed.

Either way, congrats on the baby!


If the only goal is a breathing baby right out of the womb, then sure, elective, scheduled c-sections have the best outcomes, but when looking at the first year of life, and maybe beyond, not so much.  The study excluded women with complications in pregnancy, so they tried to limit to the method of delivery.  And what about the issue of prematurity.  Scheduled c-sections are based on an ESTIMATED due date.  There is evidence that even the last few days of pregnancy are important to the developing fetus.  My doc scheduled my c-section for 6-10-10, and my due date was 6-19-10.  I went into labor and had my son 6-23-10.  If I had continued with the section, my son would have been born almost 2 weeks early.  I would be interested in my OBs opinion, but it wouldn't be a deciding factor.  At least half of women, and upwards of 70% in some studies, with diagnoses of CPD and FTP go on to have healthy vaginal births when OBs told them they could never do it.  OBs are immersed in a medical model that teaches them to be on the offensive for something to go wrong, which is wonderful when something does go wrong, but the excessive use of unnecessary interventions on healthy moms and babies is contributing to unnecessary c-sections.  They also have insurance and legal considerations that sway their decisions.   

 

This is not an easy decision, and very personal.  No one solution is the safest because it depends on so many factors, physical, emotional, and spirtual.  That is why I disagree with blanketed statements like, "Elective, scheduled c-sections have the best outcomes for babies. Better than standard vaginal birth."  It's not that it's a wrong statement, it just simplifies a complicated issue a little too much.


 

 

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#11 of 52 Old 04-13-2011, 05:09 PM
 
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There is a rupture birth story on here somewhere that I found to be pretty typical, mom and baby are just fine. 


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#12 of 52 Old 04-13-2011, 05:33 PM
 
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Quote:
Originally Posted by jenniro View Post

And what about the issue of prematurity.  Scheduled c-sections are based on an ESTIMATED due date.  There is evidence that even the last few days of pregnancy are important to the developing fetus.  My doc scheduled my c-section for 6-10-10, and my due date was 6-19-10.  I went into labor and had my son 6-23-10.  If I had continued with the section, my son would have been born almost 2 weeks early.
 


This.

 

I can't remember exactly what ds2's EDD was, but I do remember my family doctor and OB wanting to schedule a c-section for July 4th (I'm in Canada, so that's not as far out as it probably sounds to American posters!). I was pushing for a VBAC and put them off until an ultimatum from the OB. (FWIW, I've regretted giving in every day since it happened, and the nerve damage from the surgery still affects my daily life, to some extent - ds2 is almost six.) I went into labour the night before the surgery and was just starting to dilate when I got to the hospital, so ds2 did end up choosing his own birthday (to within a day or so, anyway - don't know how long I'd have laboured). That birthday? July 26th. The doctors wanted to take him three weeks before he was ready to be born. That scares me.

 

Oh - and the OB said he was "overdue" and there could have been trouble...but he had the highest initial apgar of any of my babies, including the first two, both of whom were taken through my abdomen, because they were breech - no concerns about their health, only about their ability to be pushed out without injury.

 


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#13 of 52 Old 04-15-2011, 02:18 PM
 
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To the OP:  i understand your aversion to risk and wish for a healthy baby.  Of course, this is everyone's wish.  I think the question you need to ask yourself is, what lengths are you willing to go to reduce your risk by a fraction of a percent? 

 

To flip things around and instead talk about success rates, take the following perinatal death statistics, which are from the NIH VBAC consensus statement:

 

For planned VBAC:  130/100,000

For ERCS:  50/100,000

 

To reword this, 0.13% of all babies will die after planned VBAC, versus 0.05% after ERCS.  Or to flip it around, the odds of your baby NOT dying are:

99.87% with planned VBAC versus

99.95% with ERCS. 

 

When you look at it this way, I think this particular difference is rather trivial.

 

Now let's flip around the statistics for mom:

Risk of deep vein thrombosis (throwing a clot - can be bad)

the risk of NOT having this is:

99.96% with VBAC

99.90% with ERCS

 

Hospital Stay length for mom is HALF the length of time for attempted VBAC versus ERCS (2.55 days versus 4.5 days, and this does include unsuccessful VBACs)

 

Anyway, my point is, the risks to the baby are present for both scenarios, but they are so very very small that you should think seriously about whether the reduction in risk is worth having major surgery for YOU.

 

It's a very personal decision, and only you can say what is important for you.  Best of luck.

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#14 of 52 Old 04-15-2011, 07:56 PM
 
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Forgive my intrusion, I'm not a VBACer (by some miracle) but I am a VBAC supporter.

 

seili, the horror stories that you are looking for from ERCS are few and far between. I'm sure they do happen (freak accidents where the cord is cut accidentally by the scalpel and such) but they are rare because the main issues that arise from ERCS happen later. They are not birth stories so much as they are neonatal stories. There can be problems (and even death) due to prematurity and other lung issues, but the baby is whisked away and is cared for in the NICU so it does not happen, catastrophically, at the time of birth. There are also the "first year" morbidity and mortality statistics that are often quite removed from the birth (and likely most people would never even make the connection). There are also stories of the hazards (maternal and fetal) of pregnancies that happen after c/sections - risks increase with each c/section. These too are not ERCS horror stories. because they happen before the birth.

Please also consider the much greater risks to yourself - after a second c/section (or VBAC) you will have two children depending on your wellbeing.


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#15 of 52 Old 04-16-2011, 06:27 PM - Thread Starter
 
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Yeah, I definitely have concerns with both choices. Still the immediate dangers of VBAC still weigh on me, but my next step is to research if many of those cases were induced.

 

I'm sure no matter what I ultimately decide, I will still have concerns because that is just the nature of living and definitely can be more apparent when you are pregnant. And I do tend to over-analye.

 

I am sure if I choose the repeat c-section, that I will be a nervous wreck! Sometimes I get nervous just walking into a doctor's office. ha! My c-section with my first-born was so different because I was in so much pain that I could not wait for them to get the epi started again and get the c-section. It was almost heavenly.

 

I do wonder if any of the interventions caused me to stall, but I am really scared of what might happen if I try again. I do wonder if breaking my waters and the pitocin caused him to not position correctly. He was posterior the whole time, but he did try to turn. But for some reason, I am just rather scared of trying, even though I will be beyond nervous for surgery, I think I am more worried about what could go wrong during a VBAC. For me.

 

I don't mind not ever having a vaginal birth because even though I love the idea of a natural birth, when possible, I think that death is also natural, so in some situations, it is better to abandon natural and reach for life. It saddens me that so many women that have had c-sections feel so despondent, though...so despondent that they have a hard time celebrating their child's birth. I know not everyone is like that, but of course, through all of my reading, you see a lot of that utter depression over it, that I usually don't understand.

 

 

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#16 of 52 Old 04-17-2011, 09:03 PM
 
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but the Dangers of a VBAC are the same dangers you face with ANY vaginal birth.

Any women that is pregnant can experience a Uterine Rupture. In fact UR's can happen even before labor starts so even those women planning an Elective C-section are not without risk.

 

Besides the risks, what kind of Birth Experience would you want?

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#17 of 52 Old 04-17-2011, 09:05 PM
 
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And for what it's worth, I have no hard feelings about my first birth which ended in c-section.  I still choose to have a VBAC. :)

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#18 of 52 Old 04-22-2011, 01:00 PM - Thread Starter
 
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Isn't uterine rupture more common in women who have had abdominal surgery, though?

 

It seems that most uterine ruptures during VBAC's were often because of induction, though, so that is something to ponder. But I am still leaning towards the c-section, which kind of still surprises me. Oh, how I hate needles and procedures! I will be a nervous wreck!

 

It's strikes me funny to realize I am almost equally naturally-minded and surgically minded. I was thinking about other women in my family before me and I realized that I think they probably should have had c-sections. My mom had a terrible birth with me. She had a partial placenta previa that they didn't know about, she had to have x-rays, she was in labor 36 hours or so. But we both ended up okay, but I am surprised to find myself thinking that she still should have had the section. Both of my grandmothers had terrible births, too. One of my grandmothers had 4 boys in 4 years (one set of twins) and the doctors have no idea why she didn't die with the last boy....they did have to do a hysterectomy, though.

 

At this point, it is still just a feeling I have.....that even if it doesn't end up terribly, it will end up bad again or I will be able to birth him, but barely, with lots of tearing and lots of fear for a baby that is stuck and barely coming out. Or that I will be exhausted and then end up with another section. But I do know that are feelings can steer us the wrong direction, so while I have time, I am still pondering!

 

I'm glad that you do not have lots of emotional trauma from your surgery! There are lots of people like that, too, thankfully, but I was just suprised at how many seem deeply disturbed and traumatized by their lack of vaginal births.

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#19 of 52 Old 06-15-2011, 07:08 PM
 
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Originally Posted by seili View Post

... I definitely have concerns with both choices.

 

 


Thank you for the great thread. I seem to have alot of the same concerns as you. I have issues with both options. We are still TTC, right now I am just trying to do research and have a thought of what I want to do, IF we have another.

 


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#20 of 52 Old 06-15-2011, 07:37 PM
 
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I think it's really wonderful that you are pondering both decisions so carefully.  I will say that if you do decide to VBAC, I think it takes very real commitment on your part.  I think you will find this post on The Unnecesarean very helpful.  I really loved reading it:

 

http://www.theunnecesarean.com/blog/2011/6/5/vbac-vs-repeat-cesarean-try-on-both-choices.html#comment13118899

 

For me, personally, I am one of those people for whom having a vaginal birth is very important.  I have no negative feelings about my cesareans, but it is very much a goal of mine to have a vaginal birth.  Additionally, (and I am not sure how to word this without it sounding terrible), VBAC is statistically safer for me, while slightly more risky (and I mean, very, very slightly) for the baby.  I do have two other children to consider as well, who need a mother.  I do believe that I can safely (safely for me and the baby) VBAC our next baby, which is why I am making that choice--I trust my midwives, literally, with my and my baby's life, so this makes the decision a little easier for me (although it is a difficult one no matter what choice I would make).

 

Anyway, best of luck to you! I am sure you will make the right decision for your family. 


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#21 of 52 Old 06-15-2011, 08:05 PM
 
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I somehow fell behind on this thread.  Glad a few peeps re-invigorated the discussion!!  How you doin', seili!!??
 

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Originally Posted by jenniro View Post
Right now, I am planning to have a homeirth, HBA2C.  I've tried to labor in the hospital twice now, and my long start-and-stop labors are not tolerated in a hospital.  I am not any more concerned with uterine rupture than I am about cord prolapse or any other unlikely complication with any pregnancy.  I have an experienced midwife that I trust, and I know that she is quite capable of detecting problems and transferring to the hosptal in a timely manner.  That is how I feel today, anyway.  I am usually a total science geek, looking at the studies and stats, trying to find the absolute safest choice, but the truth is, there are risks no matter what I decide.  So, I am following my gut on this one.  The frustrating aspect of following your gut, though, is that there is never a deadline to decision making.  I could be in early labor, decide that something is not right, and opt for a 3rd section.  I don't see myself doing that, especially after my last TOL, but if I have learned anything in this journey of pregnancy, birth and motherhood, it's that:  I am stronger than I give myself credit for and although the only thing I can control is my attitude, that's sometimes all it takes.   

Great stuff.  Totally resonates with me, and the whole 'risks no matter what I decide' is something my awesome hubby keeps reminding me.  I can find stuff to back up or dispute just about every cotton pickin' aspect of my upcoming birth.
 

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Originally Posted by MsFortune View Post

Elective, scheduled c-sections have the best outcomes for babies. Better than standard vaginal birth.
 

If only it were that simple then we women wouldn't have to deal with those pesky vaginal births at all.  Actually, you might be onto something . . . 'standard' vaginal birth does pose quite a problem these days in the hospital setting.  This is why I'm doing my job here at home - I don't want a 'standard' vaginal birth; I want a (what should be) 'normal' one.

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Originally Posted by seili View Post

Yeah, I definitely have concerns with both choices. Still the immediate dangers of VBAC still weigh on me, but my next step is to research if many of those cases were induced.

 

I'm sure no matter what I ultimately decide, I will still have concerns because that is just the nature of living and definitely can be more apparent when you are pregnant. And I do tend to over-analye.

 

I am sure if I choose the repeat c-section, that I will be a nervous wreck! Sometimes I get nervous just walking into a doctor's office. ha! My c-section with my first-born was so different because I was in so much pain that I could not wait for them to get the epi started again and get the c-section. It was almost heavenly.

 

I do wonder if any of the interventions caused me to stall, but I am really scared of what might happen if I try again. I do wonder if breaking my waters and the pitocin caused him to not position correctly. He was posterior the whole time, but he did try to turn. But for some reason, I am just rather scared of trying, even though I will be beyond nervous for surgery, I think I am more worried about what could go wrong during a VBAC. For me.

 

I don't mind not ever having a vaginal birth because even though I love the idea of a natural birth, when possible, I think that death is also natural, so in some situations, it is better to abandon natural and reach for life. It saddens me that so many women that have had c-sections feel so despondent, though...so despondent that they have a hard time celebrating their child's birth. I know not everyone is like that, but of course, through all of my reading, you see a lot of that utter depression over it, that I usually don't understand.

 

 


This is pretty typical 'fear' stuff I'm reading.  It's not anything you can't work through if you so desire.  (I just *hate* to see mamas making fear-based decisions!!  And I don't at all mean that as a criticism of you.)  But if you decide on RCS, you'll be able to plan/prepare for a good experience there.  No reason to feel guilty, IMO, about your decision.  And you can always change your mind - at 20w, at 30w, even at 39+6w and beyond!!!

 

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Originally Posted by roadfamily6now View Post

And for what it's worth, I have no hard feelings about my first birth which ended in c-section.  I still choose to have a VBAC. :)


Ditto.  I was fine - felt like a friggin' awesome powerful mama.  But then when I went to the post partum appt and heard "rupture" and "small pelvis" and stuff, I felt betrayed to a certain extent.  Then I found ICAN in 2007 and the learning began . . . and I'm still learning!  Seriously, one of the best things for me was joining their yahoo group list.

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Originally Posted by lawmama1984 View Post

I think it's really wonderful that you are pondering both decisions so carefully.  I will say that if you do decide to VBAC, I think it takes very real commitment on your part.  I think you will find this post on The Unnecesarean very helpful.  I really loved reading it:

 

http://www.theunnecesarean.com/blog/2011/6/5/vbac-vs-repeat-cesarean-try-on-both-choices.html#comment13118899

Totes agree, lawmama!  kmom is the best.

 

Speaking of kmom, she has fantastic resources for plus-sized mamas AND for all mamas - http://www.plus-size-pregnancy.org/firstindex.html.  I've been over there a lot this pregnancy, especially mulling over the VBAmC stuff she has posted there.
 

 


Kimberly, mom & wife - blogging.jpg about pregnancy and birth
DD 2004; 3 angel1.gif babies 2007-08; rainbow1284.gif twin DDs 2009; DD 7/12/11 hospital uhoh3.gif VBAC bouncy.gifafter 2 cesareans!

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#22 of 52 Old 06-15-2011, 08:19 PM
 
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Uterine rupture is more likely by the tiniest of percentages: http://vbacfacts.com/vbac/  Something like .5% vs .7%.  And, as pp pointed out, uterine rupture could occur at any time during pregnancy, not just during labor.

 

Since you are on the fence about it and your ob is supportive, you could always plan to go ahead w/ a vbac & schedule last minute if you freak out and change your mind :)  Is there a reason that you need to be set in stone right this minute?  Also, and I know doctors probably hate this, but you could allow yourself to go into labor & if you feel too panicked about it, ask for a c/s then.  Will they tell you no?  Maybe, maybe not.  I had a scheduled breech c/s for dd1 and a natural vbac for dd2.  Both births went v smoothly and I will absolutely go for vaginal again in the future.  I had no doubts that I could birth vaginally & I also had no fear of the c/s, I just didn't want (another) one!  Another thing, try and schedule your c/s for a date past your due date & you may go into labor before then.  That may give you some calmness b/c you did schedule, but baby had other plans :)  Every baby and every pregnancy is different.  Just b/c you could not push out the first one does not mean that you are destined to be in that same exact situation again.  Good luck, I know it can be a v difficult decision.


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#23 of 52 Old 06-15-2011, 11:19 PM
 
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I do wonder if breaking my waters and the pitocin caused him to not position correctly. He was posterior the whole time, but he did try to turn

 

 

Yes, this had everything to do with your inability to birth your son.  If he was posterior and the cushion around him (amniotic fluid) was removed there is no way he could get himself rotated.  You mentioned epidural being turned back on, does this mean you labored with the epi?  If so were you in a hands and knees position to help him turn?  Were you out of bed in a staggered squat?  What did you do to help him turn?  With my daughter's birth I was told at 6 p.m. that she was posterior, 20 minutes on hand and knees in the bed and she was born at 6:25.  I went from 6 cm to pushing in 20 minutes.  If she had stayed posterior that wouldn't have been the case.  She turned because she had room.

 

Rupturing membranes cements babies in bad positions.  Have you ever tried to take off a latex glove that is soaked?  It is really difficult.  A baby trying to turn in the birth canal without the cushion of the fluids is about the same.

 

My last birth ended in stillbirth.  He was 24 weeks, so it had nothing to do with the birthing process.  BUt I can tell you truthfully, I have other children and they need a mother, even a broken one.  This can come across as callous, but if my choices led to MY death and left my children without a mother that would be the worst case scenario.  Dealing with the death of a baby is difficult for sure, but I am an adult and have better coping mechanism than my children do for grief.  They would have a sad life without me.

 

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.


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#24 of 52 Old 06-16-2011, 04:16 PM
 
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Wonderful information on this thread.


hippie.gif Hi, I'm Amber

Ava {12.20.08}  Levi {8.19.10}  Aspen  {EDD 7.21.13}

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#25 of 52 Old 06-17-2011, 12:11 PM - Thread Starter
 
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Lawmama, that was a good link; thanks!

 

I am now nearly 35 weeks pregnant! I did so much research and I could...not...make up my mind! They both sounded good; they both sounded potentially bad.

 

RCS worries me because of danger to me, in particular; VBAC scares me because of danger to the baby and because of increased likelihood of lots of tearing and/or shoulder dystocia if I do indeed have a small pelvis/pubic bone. I know tearing probably shouldn't scare me so much.....that it is better than the worse outcome of RCS, but I feel like it is statistically a higher likelihood, so I definitely have kept it in mind.

 

So, right now, the plan is to RCS at 40 weeks 2 days, but if I go into labor before that....VBAC! But the doctors have said I can change my mind in either direction if I definitely decide! ha ha! I do feel kind of silly that I just cannot completely commit to either one! I am very nervous about heading into surgery, but at the same time, I am almost more afraid of VBAC...all the unknowns.

 

I tried to ask the doctors if I could just wait till labor and then decide and they said...that is basically just a VBAC! That if I don't schedule a RCS (or if I schedule one past 39 weeks, like I choose to do), then if I have to come in otherwise, they need to have the doctor and anesthesiologist already prepared. Basically, it is hospital policy, but I feel pretty comfortable with my doctors....I have asked if I can get an ultrasound later on to see if this baby boy is in the correct position and to check head size and potentially weight and they said they could try that, but that ultrasounds are not very accurate at predicting weight and head size. So, I don't really feel like they are trying to push me in either direction.

 

Ablepearl, I got an epi around 8cm and apparently, pitocin, too. I think they broke my waters around 6cm, though. They had me push with the epi on and they didn't think it was doing much, so ..they turned it off. That was terrible. I had horrible back labor the whole time and eventually it got so bad that I got the epi, so when they turned it off...it all came back! Before the epi, I labored by walking, birthing ball, showering, on hands and knees, etc, but they did keep putting me up to the external montior every half hour.....very uncomfortable! And they did seem to do lots of internals...and those hurt so much for some reason! (Later, during c-section, they realized that I did have an infection...maybe from all those checks and breaking the water?) With the epi on, they had me try to push on my back, that didn't work, so we tried hands and knees and  birthing ball. Nothing. Then they turned it off and we tried all of that again....but.....I was in so much continual pain again that it wasn't very productive. And...I still had no urge to push. (Apparently, he was stuck in there, by this time, with his head sideways...but he hadn't really descended.)

 

I'm very sorry for the loss of your little one.

 

You do bring up a good point about stats on c-sections being lower because it may extend further than just a few weeks. I have wondered that. That's why I wanted to wait until at least a bit past my due date....till labor, preferably. I think 39 weeks can be okay, but I just didn't feel quite comfortable with that. My first son was 9 to 11 days overdue, so he either was legitimately late or they were a little off on his due date. (He was 8.2- so not really big or small.)

 

 

 

 

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#26 of 52 Old 06-17-2011, 12:47 PM
 
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My first VBAC had his head tilted, which almost resulted in a c-section.  I pushed for about 2.5 hours and then they used forceps to re-position his head ( a midwife would have doen this with her hands).  After that he was out in about 4-6 pushes.  He was almost 10 pounds and had a 15.75 inch head!  Had they not fixed his head position he would have never moved.

 

Pushing without on urge to push is really never a good thing.  You can be complete and wait a few hours before your body is ready to birth the baby.  It sounds to me that you had a c-section for malposition and a failure to wait.


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#27 of 52 Old 06-17-2011, 01:58 PM
 
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Quote:
Originally Posted by ablepearl View Post

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.

What condition exactly that would take the life of an infant months aft birth can be directly tied to the mom's birthing method. Unless you have some concrete information this just sounds like another case of blame everything on the mom because she consented to a c section.
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#28 of 52 Old 06-17-2011, 05:20 PM
 
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Quote:
Originally Posted by ablepearl View Post

LIke others have said the research doesn't count any c-section babies that die later on.  I think they normally cut off at 2 weeks, which is not appropriate.  If they went out a year and included the deaths that were a result of the birth method, the c-section group would have more impact.

 




What condition exactly that would take the life of an infant months aft birth can be directly tied to the mom's birthing method. Unless you have some concrete information this just sounds like another case of blame everything on the mom because she consented to a c section.


One would be Bronchopulmonary Dysplasia as a result of RSD.  In the U.S. they do not count it as a result of birth if it happens 2-4 weeks after delivery, but if a baby dies at 6 weeks as a complication of respiratory distress and the only risk factor that baby had for developing it was the mode of delivery (c-section is a risk factor for RSD) then the mode of delivery caused the death.  But, we don't see that or hear that.  In actuality it is very likely that the parent was never informed that their baby developed RSD as a result of the delivery method.
 

 


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#29 of 52 Old 06-18-2011, 10:17 AM - Thread Starter
 
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Originally Posted by ablepearl View Post

My first VBAC had his head tilted, which almost resulted in a c-section.  I pushed for about 2.5 hours and then they used forceps to re-position his head ( a midwife would have doen this with her hands).  After that he was out in about 4-6 pushes.  He was almost 10 pounds and had a 15.75 inch head!  Had they not fixed his head position he would have never moved.

 

Pushing without on urge to push is really never a good thing.  You can be complete and wait a few hours before your body is ready to birth the baby.  It sounds to me that you had a c-section for malposition and a failure to wait.


First off....15.75? That does sound big! My son's head was 13.78 and I know that was kind of big, too. Did they label you as having a small pelvis, too?

 

And I definitely had malposition problems. And ...a failure to wait....I think so. But that is where I think both I and the doctors will be similar again. I realized during my last birth that I really must believe in preemptive c-sections! Now, I do think there are too many, but I can see why we do have more now that years ago, especially since they can do low-cut scars now. I do think that my mom should have had a c-section with me and I even think that at least one of my grandmothers should have had one.

 

My mom had a partial previa with me- very bad labor, lots of blood. My grandmother had 4 boys in about 3 years. (One set of twins) With her last, they nearly lost her, she had to have an emergency hysterctomy.

 

For me, once they turned off the epi and my severe pain returned and they weren't permitted to turn the epi back on until they got the anesthesiologist again, I knew that I was then considering a c-section. Could they have been manipulating me into one? Maybe, but I think it was just life. I remember asking how the baby was and they said he didn't appear to be in distress. I asked if they could pull him out another way and they said that he wasn't far enough down to reach. No one actually suggested a c-section to me; I requested it. Or screamed it. I'm not sure! I figured that with the way I was feeling, it could turn very bad. I didn't want it to turn into an emergency. To me, I wanted him out before it was an emergency for him. Then after surgery, they told me he was stuck in there and probably woudn't have budged much.

 

-----------------------

 

TCMoulton, I think they are still trying to determine if c-section babies do have more problems later on. It's kind of hard to tell. Well, with anything with statistics, there can be so many variables, that it seems to me things can easily be skewed. But, a c-section before 39 weeks, is definitely more likely to end up with problems. The thing about 39 weeks, though, is that they could still be off by a week or so, so I tried to remember that when scheduling my RCS.

 

This reports on the first 28 days following birth: http://www.medicineonline.com/news/12/6008/High-infant-mortality-seen-with-elective-c-section.html

 

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#30 of 52 Old 06-18-2011, 10:57 AM
 
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There is much higher risk with repeat csects than vbacs. You should join ICAN and they have lots of statistics. I almost died from my repeat csect and will be having a vbac this next time.

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