Previous birth injury...future children? - Mothering Forums

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#1 of 11 Old 05-27-2011, 12:22 PM - Thread Starter
 
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My DD suffered a severe brain injury during our otherwise normal homebirth (her HR never dropped so we don't know what, why, or when it happened). Nothing was wrong with me, her, or the placenta/cord.  It was just one of those crazy fluke things.

 

Anyway, I'm not pregnant now, but I worry about this often.  How would I be treated if I wanted to do the whole hospital birth thing next time?  Would I be labeled high-risk automatically?  Would they be reluctant to let me even HAVE a vaginal birth?  I live in central ohio, so not the most progressive area when it comes to birth.

 

I know my options pretty much.  I know a couple of midwives that would *probably* attend if I asked (I say probably because I haven't actually asked yet, but they understand that it isn't something likely to happen again).  I know that any doctor would never refuse me an elective c-section if I asked, given my history.

 

I just don't know what would happen if I tried to do a natural, vaginal birth in the hospital.  I worry that they'll want to do pitocin (and after researching birth injuries excessively I know pitocin often CAUSES brain injuries during birth), that they'll have a bad attitude toward me since I had a poor outcome for my homebirth.  I had a bad experience with my son, which is WHY I had a homebirth in the first place.  And they were crappy to me just because I declined the eye goop, vit K, and circumcision.  It was ridiculous.  I can only imagine how much worse it could get.

 

Any thoughts?  Personal experiences to share?

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#2 of 11 Old 05-29-2011, 07:59 AM
 
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I think in the hospital system you would be labeled as high risk.  I think that you would be pushed to endure lots of interventions during your entire pregnancy as well as your labor.  

 

I say trust your instincts, if you feel that the homebirth had nothing to do with it, then it probably didn't and the brain injury could have been in utero.  If YOU feel comfortable with another homebirth, then I would encourage you to follow that path.  The hospital is not always the answer to prevention of injury.  

 

I am sorry you have/had to deal with this and I wish you the best of luck.


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#3 of 11 Old 05-29-2011, 08:26 AM
 
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What a hard place to be!  I can only share my own experience and decisions, hope it helps!

 

With dd1 I had a very long labor that ended in the hospital with a c/s.  Turns out she was posterior, became seriously asynclitic while she was trying to wiggle into a good exit position, and despite tidal wave contractions I stayed at 7cm until my eventual c/s (about 19 hours at 7cm).  She was fine, I recovered well physically, but I developed PPD and PTSD and it took a long time to find my new balance.

 

With dd2 I wanted a vbac more than anything and found an amazing birth team that specialized (in part) in helping women with birth or sexual trauma achieve natural vaginal births.  I had a wonderful hospital birth ended with a severe shoulder dystocia after nearly 4 hours of pushing (unmedicated, all sorts of positions).  I was squatting when it happened, the Gaskin didn't relieve the dystocia, and eventually my provider had to reach in and twist dd2 out... dd2 required resuscitation and I had a 4th degree tear that required around 200 sutures to close.  I also had pph and developed bladder and uterine prolapse afterwards.  DD2 has some minor neurological quirks that could be related to the oxygen deprivation and a droopy eyelid/sensory problems that might be the result of a braxial nerve injury (common during a sd).

 

With ds I again wanted a vbac, but I was now considered "doubly" or even "triply" high risk... I was a VBAC mom, I had a history of SD, and I had pelvic organ prolapse.  I did a lot of soul searching, a lot of research, a lot of role-playing of different scenarios to try and figure out what I could do to make ds's birth a "no regrets" event.  The birth team I used with dd2 was no longer an option (they moved out of state) and the local hospital no longer supported vbacs with any consistancy.  I planned a homebirth but just never meshed with the midwife and felt like she wasn't taking my concerns seriously.  Eventually I found a hospital midwife practice that was willing to work with me at a hospital about an hour away.  I wasn't considered any more "high risk" than any other VBAC mama (the hospital has a 41 week limit on VBAC, and requires a heplock, but that was "it") and they never batted an eye at my hands off birth plan.  I also decided that while I wanted a vbac I wasn't willing to make it an all or nothing affair and spent a lot of time with DH, my doula, and midwives discussing at what point I wanted to move from a vbac to a rc/s.

 

And I guess that's my advice... role play every scenario you can think of.  If you have a homebirth and you or the child suffers a birth injury, will you blame yourself for not being in a hospital "this time"?  If you're in the hospital and you or the babe suffer an injury, will being in the hospital make you feel like you "did all you could" or will you feel guilty thinking that maybe if this or that intervention hadn't happened neither would the injury?  If you're in a hospital and nothing happens but you end up with a bunch of interventions will you blame yourself for "putting yourself through that for nothing"?  It's such a complex and personal decision, and so many things go into finding that personal balance...

 

I'd also suggest researching your local (and mostly local) options... perhaps a local ICAN group can point you towards the most hands off hospital providers, or suggest homebirth midwives who would work with you?  I didn't find the hospital midwife program I ended up using until nearlly my third trimester so I know how nerve wracking it can be doing this sort of research with a "deadline".  The more info you can get before getting pregnant the better!  And it might help you feel more relaxed in that whole "getting pregnant" phase too.

 

Good luck!


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#4 of 11 Old 06-02-2011, 10:21 AM
 
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How do you know the injury happened during birth? I ask because my son had a brain injury from birth, but we were told they cannot tell for sure if it happened during birth or inutero prior to birth. In our case, it was obvious it happened in birth because of 4.5 hrs of pushing, passing meconium that entire time, and deccelerated heart rate. But they won't even put in the records that it happened at birth, because they say there is no way to tell if it happened at birth or before.

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#5 of 11 Old 06-02-2011, 10:23 AM
 
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Honestly, I would not bring up the birth injury to future doctors if you do not feel something in the birth caused it. See what I am saying? If it really does not have any bearing on the next child, then I would not offer the information. Not like they will ask you straight out if your child has a birth injury. That would be info you would have to offer up.

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#6 of 11 Old 06-02-2011, 05:53 PM
 
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Hey OP! Who was your midwife in central ohio? We are in north central ohio and are having to use a MW from up wayyyyy North....just asking. Thanks!


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#7 of 11 Old 06-04-2011, 04:41 PM - Thread Starter
 
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Quote:
Originally Posted by Lisa1970 View Post

How do you know the injury happened during birth? I ask because my son had a brain injury from birth, but we were told they cannot tell for sure if it happened during birth or inutero prior to birth. In our case, it was obvious it happened in birth because of 4.5 hrs of pushing, passing meconium that entire time, and deccelerated heart rate. But they won't even put in the records that it happened at birth, because they say there is no way to tell if it happened at birth or before.


Well we AREN'T sure when it happened.  But I had a non-stress test hours before I went into labor and everything seemed fine then.  My guess is it just happened at the very last second and she didn't decel because she was in the beginning stages of oxygen loss.  Why her brain injury was so severe I don't know.

 

My midwife and I had been over it a billion times and we agreed I'm not high risk and would be fine for another homebirth.  Getting an OB to agree to that would be near impossible I think.  Maybe only the most open-minded OB's would look into it instead of seeing a previous birth injury and just automatically assuming that something is wrong with ME.

 

I don't think I could just NOT tell.  I mean, they ask your straight out about your previous births and if they were normal or not.  I can't lie to save my life.  Plus, I would likely need to bring my DD with me on occasion.  It's just not something I could get around.

 

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#8 of 11 Old 06-05-2011, 10:48 AM
 
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But the birth was normal....right? You can just tell them your child has some brain damage and it might have happened in the birth, but, you do not know for sure because the actual birth was normal.

 

Honestly, if the birth had no issues, no meconium or anything, it was probably not caused by the birth. I have done sooo much research on this and been to various neurologists and such. The psychologists say they think it is birth injury for us as I was pushing 4.5 hrs, he was passing meconium the whole thing, he had to be resuscitated, the whole thing. But, despite that history, we get told over and over again that they cannot tell for sure. Babies can have perfect births and they had a stroke or something during the pregnancy. Every neuro we have seen refuses to even speculate when this happened. 

 

The history asks if there was anything about the birth that was an issue. You already said nothing in the birth, it is just she has damage so it is being assumed it was the birth. But there are sooo many possible causes of damage that if nothing went wrong in the birth, then it should not really be considered a birth injury. I would most definitely not put it down as a birth injury on your records. I would put down normal birth. But then under the family history when it asks about the children, you put down specifics on what is wrong with her. 

 

Quote:
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Well we AREN'T sure when it happened.  But I had a non-stress test hours before I went into labor and everything seemed fine then.  My guess is it just happened at the very last second and she didn't decel because she was in the beginning stages of oxygen loss.  Why her brain injury was so severe I don't know.

 

My midwife and I had been over it a billion times and we agreed I'm not high risk and would be fine for another homebirth.  Getting an OB to agree to that would be near impossible I think.  Maybe only the most open-minded OB's would look into it instead of seeing a previous birth injury and just automatically assuming that something is wrong with ME.

 

I don't think I could just NOT tell.  I mean, they ask your straight out about your previous births and if they were normal or not.  I can't lie to save my life.  Plus, I would likely need to bring my DD with me on occasion.  It's just not something I could get around.

 



 

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#9 of 11 Old 06-06-2011, 03:06 AM - Thread Starter
 
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Originally Posted by Lisa1970 View Post

But the birth was normal....right? You can just tell them your child has some brain damage and it might have happened in the birth, but, you do not know for sure because the actual birth was normal.

 

Honestly, if the birth had no issues, no meconium or anything, it was probably not caused by the birth. I have done sooo much research on this and been to various neurologists and such. The psychologists say they think it is birth injury for us as I was pushing 4.5 hrs, he was passing meconium the whole thing, he had to be resuscitated, the whole thing. But, despite that history, we get told over and over again that they cannot tell for sure. Babies can have perfect births and they had a stroke or something during the pregnancy. Every neuro we have seen refuses to even speculate when this happened. 

 

The history asks if there was anything about the birth that was an issue. You already said nothing in the birth, it is just she has damage so it is being assumed it was the birth. But there are sooo many possible causes of damage that if nothing went wrong in the birth, then it should not really be considered a birth injury. I would most definitely not put it down as a birth injury on your records. I would put down normal birth. But then under the family history when it asks about the children, you put down specifics on what is wrong with her. 

 



 



Unfortunately, it is in her file that there was meconium...there was NOT.  But we cannot get it off her file.  I've tried.  So that doesn't help matters.  Of course, I wouldn't have to go to the same hospital as the 2 she's been to, I suppose, that have her file.  It'll probably be several years before I even have more kids, if I have any more at all.  My partner says he wants maybe 1 more. He is the one who is extremely uncomfortable with me having another homebirth.  I'm looking into this NOW before I get pregnant so I can decide whether I even want to do this again if we butt heads on the very first big decision we'd have to make as parents.  Oy.

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#10 of 11 Old 06-06-2011, 06:03 PM
 
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My last child also had a birth injury, though unlike you, it was definitely related to the birth. I am also not pregnant again, and wonder how it will affect my next pregnancy.

 

My son, who is now 3.5, had a shoulder dystocia when he was born. (well, guess I had it, whatever). Could it have been b/c I was laying on my back when I pushed? Don't know. there were signs that it was possible during the labor, as I was 9.5cm for about 4-5 hours. Wasn't diabetic, was 41.2 weeks, but have always gone to 41 weeks or slightly more. Anyways, the SD happened, and he ended up with a fractured clavicle. (He was 10 pounds 7 ounces, BTW)

 

So, I have no idea what will happen next time, and I wonder just like you, how it will be managed. Have you considered doing some pre-conceptual appointments with MW or OB to discuss this?

 


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#11 of 11 Old 06-30-2011, 10:17 PM
 
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Originally Posted by 4C-mom View Post

My last child also had a birth injury, though unlike you, it was definitely related to the birth. I am also not pregnant again, and wonder how it will affect my next pregnancy.

 

My son, who is now 3.5, had a shoulder dystocia when he was born. (well, guess I had it, whatever). Could it have been b/c I was laying on my back when I pushed? Don't know. there were signs that it was possible during the labor, as I was 9.5cm for about 4-5 hours. Wasn't diabetic, was 41.2 weeks, but have always gone to 41 weeks or slightly more. Anyways, the SD happened, and he ended up with a fractured clavicle. (He was 10 pounds 7 ounces, BTW)

 

So, I have no idea what will happen next time, and I wonder just like you, how it will be managed. Have you considered doing some pre-conceptual appointments with MW or OB to discuss this?

 

My DS also had shoulder dystocia and I was on my back to push (that is my favorite position to push, feels right after trying numerous ones) ds was only 8.1 but had broad shoulders. With my next baby I pushed her out (again on my back) in 3 minutes and she flew right out. She was 7.11. 

 

I know back pushing is not ideal and if you are concerned about it happening again you could push on all fours. 
 

 


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