Need VBA2C research - Mothering Forums

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#1 of 12 Old 01-28-2007, 05:16 PM - Thread Starter
 
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I am needing info about VBA2C. I have looked at several websites, but they all seem to have anecdotal info and not real research. My doc is willing to talk about it, but nervous. I've had 2 c/s and 2 vag del. I had low transverse incisions both times. I really don't get him. He was willing to to an induced VBAC last time with pit, but it skittish about a VBA2C (I will not consent to pitocin with my c/s being so recent.)

Tamara: hs'ing Christian mom of five here and five in Heaven. Joyfully awaiting Punkin, coming mid-Sept!
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#2 of 12 Old 01-28-2007, 07:24 PM
 
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I'd be very wary of hiring a surgeon for a normal physiological process but highly distubred by one who thinks chemical induction is ok for a woman who's had surgery. That just chills me to the core! Interesting that he's ok with that which is proven to be really dangerous but nervous about what is actually the safest way to birth - through your vagina without his skillset.

Quote:
"Vaginal Birth following 2 caesarean sections" V.K.Garg, E.N. Ekuma-Nkama. International journal of Gynaecology and Obstetrics (Jan.2005) 88, 53-54.

"205 women with 2 previous sections, delivered vaginally between 1997 & 2002 . 66 Vaginally (32.2%), 71 had elective C/S (34.6%), 68 had emergency C/S....Induction or augmentation of labour was not offered due to increased incidence of uterine rupture. . The complication rate was higher in the C/S group than in the VBAC2 group(19.5% v 7.4%) mean blood loss was higher in the C/S group than the vaginal group. There was no scar dehiscence or hysterectomy in either group. ......Thus, VBAC2 is reasonable and is sucessful with minimal complications if patient selection and labour management is judicious."
Summary of studies on VBA2C, VBA3C, women’s birth stories, an Ob’s report on a client having VBA5C.
http://www.homebirth.org.uk/vba2c.htm

Quote:
"The available data show that among [women who have had more than one previous caesarean] the overall vaginal birth rate is little different from that seen in women who have had only one previous cesarean section. Successful trials of labor have been carried out on women who have had three or more previous caesarean sections."
"The rate of uterine dehiscence in women who have had more than one previous cesarean section is slightly higher than the dehiscence rate in women with only one previous cesarean, but dehiscences in the reported series tend to be asymptomatic and without serious sequelae. No data have been reported on other maternal or infant morbidity specifically associated with multiple previous cesarean sections."
"While the number of cases reported is still small, the available evidence does not suggest that a woman who has had more than one previous cesarean section should be treated any differently from the woman who has had only one cesarean section."
- From 'A Guide to Effective Care in Pregnancy and Childbirth' 3rd edition, by Enkin, Keirse et al, Oxford University Press, 2000 (p363-4)

http://www.plus-size-pregnancy.org/C...after_2_cs.htm
VBA2C information – very extensively referenced and analysed.
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#3 of 12 Old 01-29-2007, 01:07 AM - Thread Starter
 
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Thank you! I will be printing those out!

I, unfortunately, do need his skill set for the pregnancy. Specifically, his prescription pad. I have to take blood pressure medicine and the P17 shots for preterm labor. I have PROM'ed twice at 33 wks and have chronic hypertension.

And, yes, he did wig me out last time suggesting induction. I was absolutely not comfortable with pitocin after having a section 19 mo earlier.

Tamara: hs'ing Christian mom of five here and five in Heaven. Joyfully awaiting Punkin, coming mid-Sept!
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#4 of 12 Old 01-29-2007, 06:50 PM
 
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This is the study you need: current, large cohort, etc:
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

It looked at uterine rupture in women who had 1 CS vs 2+ CS and found no statistically significant increase in uterine rupture between the two groups.
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#5 of 12 Old 01-29-2007, 07:14 PM
 
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Quote:
Originally Posted by pfamilygal View Post
I, unfortunately, do need his skill set for the pregnancy. Specifically, his prescription pad.
Well that's wise use of technology although I assume you've also looked deeply into other ways of dealing with those issues. Needing his prescription pad when pregnant however is a long way from needing his surgical skills. I hope you can keep well away from those in labour
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#6 of 12 Old 01-29-2007, 07:35 PM
 
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plussizepregnancy.com was about the only place i'd seen online for vba2c information.

i just had my 2nd hb after 2c/s. and the information is hard to come by.
my 1st hba2c was 23 mo after the 2nd c/s

there is a suggestion "rule" to have 24 months between and then debates about where the 24 mo period begins...

i hope you find the answers you need
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#7 of 12 Old 01-29-2007, 09:16 PM
 
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Dr. Mark Langdon (I think that's the correct name) from Ohio State Unv College of Medicine completed a study recently showing no significant increase in risk between vbac and vbamc (vbac after multiple sections). He is speaking at the next ICAN conference so I am sure his study can be referenced at the ICAN website: www.ican-online.org.
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#8 of 12 Old 01-29-2007, 09:30 PM
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I only have anecdotal evidence right now, but I just a VBA2C last week with a family practitioner in attendance. It was supposed to be a UC waterbirth, but I transferred for various reasons. I had the FP as a back-up anyway because of PIH that I needed to be medicated for.

I had low transverse incisions with both c-sections like you, but I'd never had a vaginal birth before. There were slightly less than 2 years between my second c-section and my VBAC. I had a 9lb 13oz baby 2 days before my EDD with no interventions at all except an epidural. My doctor wouldn't even consider using any type of medical induction with a VBA2C and only used Pitocin under strictly controlled circumstances with a regular VBAC.
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#9 of 12 Old 01-31-2007, 12:01 AM - Thread Starter
 
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Thank you! You guys rock! I've also contacted a doula from ICAN and will be meeting with her in the next few months.

Tamara: hs'ing Christian mom of five here and five in Heaven. Joyfully awaiting Punkin, coming mid-Sept!
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#10 of 12 Old 01-31-2007, 03:23 PM
 
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Great info! I'm bookmarking this page to show dh whenever we get pregnant with #3. I've had two c/s (my second was supposed to be a homebirth, long story) and while I have no qualms about plannning a homebirth next time, dh is wary. And I can't blame him, dd2's birth was very scary and traumatic for both us- emergency c/s, stroke, seizures, severe brain damage, 2 week NICU stay...he just wants us to be safe. It's hard to get him to read the information though that shows that a homebirth, or even a hospital VBAC is safer for baby and me than a repeat c/s.
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#11 of 12 Old 01-31-2007, 03:24 PM
 
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Oh, and I wanted to add some anecdotal evidence- my midwives had one client who had 4 c/s and then 11 homebirths!
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#12 of 12 Old 01-31-2007, 07:42 PM
 
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Quote:
Originally Posted by CherryBomb View Post
Great info! I'm bookmarking this page to show dh whenever we get pregnant with #3. I've had two c/s (my second was supposed to be a homebirth, long story) and while I have no qualms about plannning a homebirth next time, dh is wary. And I can't blame him, dd2's birth was very scary and traumatic for both us- emergency c/s, stroke, seizures, severe brain damage, 2 week NICU stay...he just wants us to be safe. It's hard to get him to read the information though that shows that a homebirth, or even a hospital VBAC is safer for baby and me than a repeat c/s.
My local ICAN chapter leader had a homebirth after 2 c-sections. She did not have the experience you had with your babe but I found her bravery to be very inspiring. I did not think homebirth was an option until I met her. Now after one c-section I am preparing for a homebirth in the next few weeks. Sometimes it just takes knowing the possibility is there!
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