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Hi,<br><br>
I'm excited to say, that I am now 1/2 thru my pregnancy.. And will be attempting to VBAC...<br><br>
So excuse me, if I sound really stupid, as this pregnancy has been quite a surprise and I'm now trying to cram my head w/ VBAC knowledge.<br><br>
My sister told me, that the further you progress in your previous birth, the better your chances of a VBAC? Is this true?<br><br>
With my ds. I labored for 23hrs, naturally, and pushed for 3hrs, before it was determined that his head for OP. Apparently every time I pushed, his head wasn't distending.? Obviously, I still have some research to do, but will I fair better this time around?<br><br>
(I did go to the chiropractor, and it was found that my ds was OP. We think he turned, but I was stupid and asked for my water to be broken at 7cm, and I think this is what caused his head to be OP, and not his body.) I was also on 9wks of bed rest, with a large baby, so I'm not sure if this added to my c/s.)
 

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Hi Mighty-Mama!<br><br>
It's sooooo good to see you! (and happy belated birthday to the tiny one <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> )<br><br>
There is a scale that has become popular in the last year or two (I'm totally forgetting the name right now, but I'll look it up) that tries to score how good a VBAC "candidate" you might be. Keep in mind though that this scale is just a prediction...it's not black/white and my current care providers (two amazingly VBAC supportive OBs) were happy to tell me about all the successful VBACs they've attended who didn't fall on the "right" side of this scale but still had their beautiful vaginal births.<br><br>
Anyway, one of the things on the scale is "why" the c/s was done. If the c/s was for positioning or another "not likely to repeat" issue on the part of the babe then you have a better chance of a successful VBAC. So a c/s for a breech or OP baby is seen as less of a problem (in terms of a VBAC) than a c/s for a babe who was in a "good" birth position.<br><br>
I made the optimal fetal positioning exercises and advice from spinning babies into a lifestyle this pregnancy and hope to avoid the positioning problems that led to my first c/s. So that might be something to look into...<br><br>
And another element on the scale is "when" the c/s was done. A mama who dilated to 10 and then had a c/s after problems during pushing is seen as a better VBAC candidate than a mama who never dilated. Of course, there are so many reasons a mama may have failed to dilate that it's hard to say what the underlying cause might have been but...<br><br>
Long story short, yes...at least according to this specific VBAC success scale, you have a better chance of a VBAC if you dilated and your c/s was due to positioning problems on the part of the babe.<br><br>
Ack, gotta run...it was good seeing you again and I'll see if I can find a link to that scale/set of studies!<br><br><img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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That is interesting because I actually heard the oposite. I heard that the more you dilated (past 6cm), the less chance of VBAC in a later birth. I wish I had the link to the article I was reading, but this was RIGHT after I had my daughter and wasn't really thinking about getting pregnant again at the time. I honestly don't know what the reasoning was because now that I am reading it, it sounds crazy. however, I know I am remembering the article correctly.
 

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Okay...here's one of the studies from the American Journal of Obstetics & Gynecology. It's not the one with the nice, user friendly, everything tabulated into a readable scale however so I'm going to keep looking...talk about pregnancy brain! My memory has gone to mush...:<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">The MFMU Cesarean Registry: factors affecting the success of trial of labor after previous cesarean delivery.<br><br>
OBJECTIVE: The purpose of this study was to determine which factors influence the likelihood of successful trial of labor (TOL) after 1 previous cesarean delivery (CD). STUDY DESIGN: We performed a multicenter 4-year prospective observational study (1999-2002) of all women with previous CD undergoing TOL. Women with term singleton pregnancies with 1 previous low transverse CD or unknown incision were included for analysis. RESULTS: Fourteen thousand five hundred twenty-nine women underwent TOL, with 10,690 (73.6%) achieving successful VBAC. Women with previous vaginal birth had an 86.6% success rate compared with 60.9% in women without such a history (odds ratio [OR] 4.2; 95% CI 3.8-4.5; P < .001). <b>TOL success rates were affected by previous indication for CD, need for induction or augmentation, cervical dilation on admission, birth weight, race, and maternal body mass index.</b> CONCLUSION: Previous vaginal delivery including previous VBAC is the greatest predictor for successful TOL. Previous indication as dystocia, need for labor induction, or a maternal BMI > or = 30 significantly lowers success rates.</td>
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The bolding is mine, and if you read the actual article you find that "dystocia" as used in the paper doesn't refer to diagnosed positioning problems like breech but instead applies to women who were sectioned due to generic "failure to progress/cpd".<br><br>
Okay...off to find that scale! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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And here's a more "readable" analysis of the above study by one of the researchers involved:<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">From 1999 to 2002, there were 29,661 women who had a singleton gestation at term with a history of one prior cesarean delivery. The 14,529 (49%) of those women who underwent trial of labour composed the study population. There were 10,690 successful VBACs (74% of the study population), and 3,839 failed VBACs requiring a repeat C-section. In just more than half of failed VBACs, the indication for repeat cesarean was cephalo-pelvic disproportion or failure to progress.<br><br>
Dr. Landon's demographic analysis indicated that women who achieved VBAC were more likely to be Caucasian, married and privately insured. Maternal age did not affect VBAC success.<br><br>
Analysis of obstetrical factors showed women who had successful VBACs were also more likely to have entered spontaneous labour, to have had greater cervical dilatation at the time of admission to labour and delivery, and to have a lower mean birth weight. They were also less likely to have a body mass index (BMI) ≥ 30.<br><br>
"The trial of labour success rate in obese women was 58%, compared with 80% in non-obese women," Dr. Landon said.<br><br>
An interval of less than two years from prior cesarean section also significantly reduced the chance of successful trial of labour. In terms of medical history, women whose prior C-section was due to cephalo-pelvic disproportion or failure to progress tended to have lower incidence of VBAC success. Only 54% of these women went on to have a successful trial of labour. <b>Among prior indications for C-section, malpresentation was associated with a high VBAC success rate (84%).</b><br></td>
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Again, bolding is mine...<br><br>
And I swear someone has put all this in a "pretty" chart with a scale of percentages/risks! But I have to head home from work now (I'll keep checking tomorrow though). <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile">
 

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Okay, here's another spin on the dilation debate. The more you dilated with your other births, the less like a "first" labor you're likely to have.<br><br>
So Mama's who are induced, fail to dilate adaquately (sarcasm here), and are then sectioned, will probably go on to have a long labor in their second pregnancy (as in, more like a first time mama).<br><br>
In other words, if you dilated to 10 cm and pushed, you should dilate just fine with this labor.<br><br>
And, as far as I know, the further you dilated in a previous pregnancy, the better your odds for a VBAC (although personally, I think a lot of that is due to impatience on MW/OBs parts who get frustrated when the labor doesn't follow a typical 2nd/3rd/4th labor pattern).<br><br>
Sorry if none of that makes sense. I should really stop posting when I'm tired.
 

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I've read that the farther you dilated in your first birth the more likely you'll get to THAT POINT in dilation as if it were a second (or subsequent) birth but once you get past the point in dilation you got to before it will be like a first labor. Your body "remembers" how to dilate as far as you got the last time. So, for instance, if you were given a c/s after dilating completely (10 cm) and pushing, then you'll likely progress as a second labor normally would... but if you only got to, say, 5 cm before having the c/s you'll dilate like a second labor until you hit 5cm and then your labor may progress more slowly (they say an hour a cm as for a first time labor)
 

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Discussion Starter #9
thanks mama's.<br><br>
**Wombat give Laia a big belated kiss from me and Noah... Can you link me to some info on turning and spinning..<br><br>
Great... I tried doing the turning and the RN's at the hospital saw he turned, (as they tried inducing me the week before, and I ended up leaving the hospital <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol"> )<br><br>
My hospital was really great, especially for an upstate NY one.. I didn't have a fetal monitor, or IV, they left me alone and were actually very encouraging.. I really think since I asked them to break my water, that just suctioned his head into a bad position.. Once I did that, things just didn't feel right. Even with my pushing, I didn't feel like I had that great "sensation" to bear down.<br><br>
In my op report it does say "failure to progress" but in the summary, it goes into detail about his head being a "OP brow presentation". Apparently once my ob cut into me, she told me, the first thing she felt was her finger in his mouth. So that really showed how twisted his head was<br><br>
I just ordered the VBAC companion, so I'll see how that is.. But I'm really confident that I'll be able to do this..<br><br>
Thanks mama's!!
 

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okay, here's the study with the "scale":<br><br><b>Variables associated with successful vaginal birth after one cesarean section: a proposed vaginal birth after cesarean section score.<br></b> American Journal of Perinatology Nov 2004<br><br>
and the highlights (taken from an article discussing the study since the format is a lot more readable):<br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Gonen and associates reported, "Of the variables that can be obtained at the onset of labor, five were significantly associated with successful VBAC: abnormal presentation as the indication for the primary CS (OR, 7.4; 95% CI 2.8 to 19.2), a previous VBAC (OR, 7.2; 95% Cl, 2.1 to 24.8), cervical dilation (OR, 2.5; 95% CI, 1.3 to 4.9), gestational age less than or equal to41 weeks (OR, 2.8; 95% CI, 1.1 to 7.1), and lower gestational age at the primary CS (OR, 1.2; 95% CI, 1.02 to 1.4)."<br><br>
They explained that "in the proposed VBAC score, each of the four most significant variables was assigned a score ranging between 0 and 3 based on the probability for VBAC. A score less than or equal to 2 was associated with a success rate of 42%, a score between 3 and 6 was associated with a rate of 81%, and a score between 7 and 10 was associated with a 98% successful VBAC rate (p<.0001)."</td>
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You may be able to find the complete study at your local library (or request it through interlibrary loan).<br><br>
Their final score system/scale is:<br><br><div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">Indication for first CS<br>
Abnormal presentation = 3<br>
Other = 2<br>
Nonreassuring fetal heart rate = 1<br>
Failure to progress = 0<br>
Previous VBAC<br>
Yes = 3<br>
No = 0<br>
Dilation (cm)<br>
≥ 2 = 2<br>
0-1 = 0<br>
Gestation (wk)<br>
≤ 41 = 2<br>
> 41 = 0</td>
</tr></table></div>
But as my care providers pointed out...it's JUST a potential and they have seen plenty of VBAC mamas deliver even with a "low" score!
 

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<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"> Mighty-mama<br><br>
The two sites I like at Spinning Babies (<a href="http://www.spinningbabies.com" target="_blank">www.spinningbabies.com</a>) and Optimal Fetal Positioning (<a href="http://www.homebirth.org.uk/ofp.htm" target="_blank">www.homebirth.org.uk/ofp.htm</a> ). Both have the same basic information...but the OFP site has more birth stories and is a bit easier to navigate, while the Spinning Babies page has more detailed information, including pictures and belly mapping ideas.
 

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Discussion Starter #12
Great...<br><br>
I feel even more confident...<br><br>
I haven't checked out the site yet, as my computer won't allow me to go onto the link, but I'm totally going to get this started, as how things are looking already, I'm sure I'm going to have another 9lb+, little boy...<img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/lol.gif" style="border:0px solid;" title="lol">
 

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wombat, if you have time, can you summarize the techniques you're using from those 2 sites? both of them have me lost. The only one I've incorporated is sitting backwards on a chair - I've been doing it once a day for 1/2 hour, maybe I should do it all day but I don't know!
 

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dara00 - I'll PM you....
 

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Thanks for the studies -<br>
now, not to be a downer, but "malpresentation" means breech/transverse, so usually a cesarean with*out* labor.<br>
Posterior, asynclitic, brow would be referred to as malposition.<br>
Usually a previous 'cpd/ftp' cesarean is associated with lower vbac rates (like see the 0 score assigned for a "failure to progress" cesarean above). BUT, still better odds on a vbac than not - and especially so if you avoid some of the "causes" of cpd the second time around, like impatient caregivers, malpositioning, etc.
 

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<div style="margin:20px;margin-top:5px;">
<div class="smallfont" style="margin-bottom:2px;">Quote:</div>
<table border="0" cellpadding="6" cellspacing="0" width="99%"><tr><td class="alt2" style="border:1px inset;">now, not to be a downer, but "malpresentation" means breech/transverse, so usually a cesarean with*out* labor.<br>
Posterior, asynclitic, brow would be referred to as malposition.</td>
</tr></table></div>
Not a downer at all! <img alt="" class="inlineimg" src="http://www.mothering.com/discussions/images/smilies/smile.gif" style="border:0px solid;" title="smile"><br><br>
The second study (the one with the scale) lumped everything together into "abnormal presentation" since so many care providers use the two phrases interchangably, and some providers never even try to differentiate.
 
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