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Helen White 06-29-2005 10:50 PM

Hi! I'm a doula still getting my certifying births. I've been to 3 births (and had 2 myself) but was only the "primary" doula at 1 birth so far. I have a friend having her second baby in September, and she wants me to be her doula. She's wanting to try for a VBAC but just found out that written on her charts from her previous birth was "Bandl's ring," which was apparently the reason for her first Cesarean.

We've both been doing reading and research but aren't finding much conclusive information. I'd very much appreciate feedback and answers to any/all of the following questions from as many of you as possible.

*How is a Bandl's or pathologic retraction ring distinguished from a physiologic ring? (Is it possible she did not actually have a Bandl's ring the first time and that her Dr. was just being overcautious?)

*How likely is a Bandl's ring to recur in a subsequent birth?

*Where can we find more information on this topic?

*What can she do to maximize her chances of a successful VBAC?

*What can I do to best support her?

At this point, I have suggested that she get a 2nd opinion with another, more open-minded, doctor, as her current OB is fairly old-school and not that supportive of VBAC. (He'll "let her try" but isn't that optimistic.) She has remained with him for this pregnancy because she feels grateful for his assistance with her infertility problems, but I have told her a caregiver supportive of VBAC is very important.

I've also previously given her some Mothering magazines on VBAC, Ina May's Guide to Childbirth, and The Birth Partner, which she had been reading over the last couple months. She was initially excited and optimistic about her VBAC after reading these, but finding out about the Bandl's ring really has her depressed and discouraged. She's had two miscarraiges and the one cesarean birth, and I think she's really doubting her body's abilities now. I'm not that experienced as a doula and could really use some help here! I don't want to let her down. Thanks so much!

Artisan 06-29-2005 10:53 PM

Have you seen this?

Helen White 06-29-2005 11:18 PM

Originally Posted by reader
Yes, that's one of the sites I've come across in my research, and it was one of the more helpful things I found. But I have read some conflicting things on this and am just looking for as much information as possible. (I'd have liked it better if that source included some citation so I could research it further. That's the trouble with a lot of internet research.) Thanks so much for your reply!

Zoo Loo Naturals 06-30-2005 01:48 AM

Visit Lots of good info there and maybe you have a chapter near you.

pamamidwife 06-30-2005 02:34 AM

A Bandls ring is formed when the lower uterine segment gets really thin - usually because of an obstructed labor. This could be because baby is in a bad position, mostly. You'd see it if baby wasn't well applied to the cervix, or malpositioned in some way (shoulder presentation) after a VERY long time of contractions.

It isn't likely to occur again - and good thing! A Bandls ring with a VBAC is dangerous - the next step is full blown catastrophic rupture (even in an unscarred uterus!!).

mwherbs 07-01-2005 11:04 AM

the info will be in OB textbooks

it is as Pam said. Another reason for a Bandl's ring would be from a cervix that has adhesions and is not dilating if contractions continue and the cervix can't open on its own a Bandl's ring can occur
other causes in the old days when the pelvis hadn't grown properly from malnutrition or a previously broken pelvis that is pinned or mis-shapen so the baby cannot come through all occur after the uterus has been working hard for a period of time not just at the beginning of labor.

Helen White 07-02-2005 03:58 PM

Thank you for the replies so far, everyone. Also thanks for the obstetric textbook recommendation. I'd done more specific searches in my library's system, but none for textbooks.

Any book recommendations for reading about VBAC specifically?

I'd also welcome any other recommendations on what I could do to be most helpful to her.

pamamidwife 07-02-2005 04:12 PM

I think you are being really helpful already! Perhaps joining the ICAN email list will also give you some insight into what women face with traiditonal medical care in regards to VBACs.

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