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VBAC questions


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#1 Lucygoosey1

Posted 28 January 2013 - 08:54 AM

I had an emergency c-section for my DD2.  

After only an hour of labouring at home,  I went to hospital at 6cm dilated.  Another 2 hours and I hadn't progressed so I think they broke my waters and put me on a drip.  I think I then had an epidural and stalled at around 8cm.  My DD then was distressed so they did a c-section.  She was born only 7hours after I went into labour at home.  She was perfectly healthy at birth with apgars 8 or 9 straight away.
I asked my ob (not the one who was on call during my labour),  and he said the reason for my c-section is my cervix had started to swell and she was too large at 7lb14.

I actually birthed my DD1 vaginally after a 12 hr labour.  I was put on the drip and had an epi.  She was 6lb12.

I am now TTC #3 and a VBAC is very important to me.  I have been analysing the labour of DD2 and have come to my own conclusion that perhaps I should have waited longer at home,  allowed my body to 'warm up' naturally,  rather than being rushed onto the drip,  and perhaps avoided the epi so I could get into better positions for her?
My ob said I could most certainly have a VBAC but he is not confident I could birth an 8lb + baby (I am petite). I also asked him if it was the epi that stalled it and he didn't think so as I was already 8cm and in established labour.

Sorry for the essay,  but what advice could you offer me?  
I was happy with my ob,  but do worry that perhaps the ob on call rushed into a c-section?
Is it safe to labour at home for a while after a c-section?
What should I be asking my ob or insisting on at the hospital?
Should I consider going to a different hospital - this is North West Private in Brisbane?



#2 Melissam12

Posted 28 January 2013 - 09:00 AM

Consider a different care provider ... go with a midwife.  There are some great private midwifery practices in QLD.

#3 Soontobegrinch

Posted 28 January 2013 - 09:18 AM

OP, you have an Obstetrician you are happy with and he said you can attempt a VBAC then I would say go with that.
It seems he is on your side so I would continue to discuss this every visit you have that this is your intention.
You have successfully delivered vaginally which is something that bodes well for you, remember every pregnancy and labour is different from the other so it is hard to predict the outcome. Your swollen cervix may have been from the position of the baby's head and may not factor into your next labour.
Lots of good luck with your TTC. original.gif

#4 nicknick

Posted 28 January 2013 - 06:45 PM

Do you know I did the same thing with my DD's birth, I wanted to know exactly why I had to have a emergency c/s with my 1st that it almost drove me nuts - and yes you guessed it I never did find the answer why!!  rolleyes.gif Around 20 weeks I let the why's go and it was the best thing I could have done, I had a schedule elective c/s booked which I had agreed with Ob that if I hadn't gone into labour I would have but agreed with him that we would keep the plan open and see how the pregnancy progressed. I actually went into labour the week before and had my DD via Vbac.

As for large babies v's your size don't be too worried, both mine have been over 8lb and I am petite so it can be done. I think my biggest advice would be keep an open mind and make sure you have an Ob/midwife/hospital you are comfortable with -  at the end of the day a healthy mum & bub is the most important thing. Goodluck.

#5 tick

Posted 28 January 2013 - 07:07 PM

So you were 6cm after 3 hours of labour and that wasn't fast enough for them? I'd be at least exploring other options in terms of care providers after that! The big baby clause would worry me too. You won't find out how big the next baby is until after s/he is born afterall.

I have had a caesarean in similar circumstances to yours (much longer labour but same deal with drip at 6cm, epi and 'distress' at 8cm). DD2 was a VBAC, born at home with two private midwives in attendance. I had a backup plan for hospital if either midwife thought it necessary (or if I wanted drugs etc) but it all panned out fairly textbook at home. If I was planning a hospital VBAC I'd definitely bring a private midwife or experienced doula with me to keep it real, so to speak.

#6 fairymagic

Posted 28 January 2013 - 07:17 PM

Tick, it doesn't sound like lack of progress that lead to the C/S. It sounds like an edematous/swollen cervix which as STBG pointed out, could have been caused by the way the baby's head was positioned. It may be that this particular baby was too big too and this can cause a cervix to swell causing an obstructed labour. This will also cause fetal distress.

OP as STBG pointed out, you have an OB who is keen to support your VBAC so go with that. You stayed home last time and got to 6 cm - well done!! The fact that you were in established labour when you had the epidural inserted may not have made any difference to the outcome. Being a petite person, there is a possibility that the baby may have been too big for you - by attempting a VBAC you are giving it another go so that if it was a malpresentation of the baby's head, this time that may not happen.

Discuss this with your OB. Discuss what his plan of action is to help you achieve a successful VBAC. Discuss what he will do if you get to your due date with no signs of labour. Discuss with him how long he will recommend this pregnancy go being a VBAC. Some OBs don't like women going past their due date - others will have a day in mind ie  7 days/5 days etc. Get all the information now so you know what to expect and how this pregnancy will be managed by this particular OB. That way, if you are not happy with his proposed management, you can source another OB whose plan may be different.

Good luck.

#7 naturalgoodness

Posted 28 January 2013 - 07:18 PM

After DS1 and DD1 being natural birthing centre deliveries I was very shocked when DS2 ended up being an emergency c/s when apparently his head was not presenting in the correct position and causing inflammation.

Naturally (for the hospital), it was assumed when pregnant with DD2 that I would want a c/s. I advised early on that I wanted to have a VBAC. They threw everything at me - that I couldn't go over date, that I couldn't be induced, that I would have to have close monitoring etc etc etc. I smiled and nodded each time. All previous 3 births had been 40 + 10 so I had no expectation that I would get a VBAC.

When the time came, 1 day before due date, I laboured naturally at home for as long as I could, when I got to labour ward I was 9cm dialated, my waters broke on their own and within 30 minutes DD2 was born. It was not until they were updating my records later that staff realised I was a VBAC!

As for size, I was a large baby and I am plus sized (big boned too), all of my kids have been under 8 pounds. They cannot tell you the exact size of your baby until after birth!

This time I am taking it as it comes. I firmly believe that my body knows what to do, and given that 3 out of 4 births have been vaginally delivered I know that its possible for me to do it. However, I would never compromise my health or that of the baby to meet my own objectives. If a valid and reasonable explanation is given to me as to why a c/s would be required, I would certainly listen and consider.

I hope that you get what you want this time and you are able to have a successful VBAC original.gif



#8 tick

Posted 28 January 2013 - 07:33 PM

QUOTE (fairymagic @ 28/01/2013, 08:17 PM) <{POST_SNAPBACK}>
Tick, it doesn't sound like lack of progress that lead to the C/S. It sounds like an edematous/swollen cervix which as STBG pointed out, could have been caused by the way the baby's head was positioned. It may be that this particular baby was too big too and this can cause a cervix to swell causing an obstructed labour. This will also cause fetal distress.


No but lack of progress did lead to the drip, which probably lead to the epidural, both of which may have affected the progression to c-section..... And that's why I'd be interested in interviewing other care providers.  No harm in assessing all the options before proceeding!  Speaking of that, it can help to get a copy of your hospital records from the previous births and go over them with an independent midwife or similar, just to get another perspective.

#9 Soontobegrinch

Posted 28 January 2013 - 07:41 PM

QUOTE (tick @ 28/01/2013, 08:33 PM) <{POST_SNAPBACK}>
No but lack of progress did lead to the drip, which probably lead to the epidural, both of which may have affected the progression to c-section..... And that's why I'd be interested in interviewing other care providers.  No harm in assessing all the options before proceeding!  Speaking of that, it can help to get a copy of your hospital records from the previous births and go over them with an independent midwife or similar, just to get another perspective.



Why can't she discuss this with the trusted and supportive caregiver she has already unsure.gif  It doesn't sound like her Ob has any intention to keep her in the dark.

To be fair you are making quite some assumptions in your post unless you are privvy to more history than the OP has provided us with.

#10 tick

Posted 28 January 2013 - 07:45 PM

QUOTE (soontobegran @ 28/01/2013, 08:41 PM) <{POST_SNAPBACK}>
Why can't she discuss this with the trusted and supportive caregiver she has already unsure.gif  It doesn't sound like her Ob has any intention to keep her in the dark.


She already is discussing wither her trusted care provider!  What on earth is wrong with getting a second opinion though?!

#11 fairymagic

Posted 28 January 2013 - 07:47 PM

I agree it is worth going over things with your OB or an Independent Midwife.

I am often disappointed though when reading stories of births on here how quick people are in assuming that an OB (it is usually an OB) is condemned for making a decision re a birth which may not go the way a woman had wished it to, so the OB must have jumped in/intervened too quickly etc.

In this case, labour was established. The OP did very well staying home till she was 6 cm dilated. She came into hospital where Im assuming that she continued to labour with regular contractions. After a further two hours, there was no progress. (This could be an indication that for whatever reason the baby was not well applied to the cervix or in an optimal position on the cervix to assist with dilatation). Perhaps by then the contractions were becoming more irregular hence the decision was made to start a drip. This is not unusual practice. Two hours with no progress - this indicates inadequate contractions or perhaps an obstructed labour or something else is going on.

The drip was started and soon(?) afterwards, there was fetal distress. Again, this may be because the labour was obstructed ie baby too big or malpositioned. A " side effect" of an obstructed labour is an edematous or swollen cervix. A cervix that is swollen does not usually dilate to 10 cm therefore preventing the baby being born. At 8 cm instead of waiting to see if the swelling got worse, that baby was in distress. Some Drs when there is little progress over a period of time will start a hormone drip - this will often get the labour to "show" where it is headed (hope this makes sense). If the labour is obstructed or there is malpresentation of the head, fetal distress is not uncommon when the hormone drip is started. Hope this makes sense??

Regardless, not all labours go to plan and it is not always the Dr deciding to "pull the plug" on a labouring woman earlier than what they should that leads to a C/S. Contrary to "popular" belief, not all OBs intervene unnecessarily, not all OBs want their women to birth in daylight hours nor do all OBs intervene so that they can go to previously planned "events". I think its a shame that the trust a lot of women have in their OBs is questioned when a labour does not progress to plan.

Sorry to the OP. Slightly off track.  blush.gif

#12 Madnesscraves

Posted 28 January 2013 - 07:53 PM

OP, your OB know what he's doing. If you're not happy with the care he's giving, get a second opinion from another OB.

But STBG seems right in what she's saying. When my DD was born (for different reasons to yours) I spent a good year being angry I had a c/s. it wasn't until recently I realised my OB knew what she was doing. She even was willing to let me try induction before c/s but DD was too weak to do it.

Point being OP, I'd discuss this with a professional, not EB original.gif

#13 Mianta

Posted 28 January 2013 - 08:01 PM

I agree with everything fairy magic said, my midwife mind is imagining that this was probably a asynclitic OP baby, in other words a position that can indeed lead to an obstructed labour.

Unfortunately, once you go into hospital, you are "on the clock", particularly if you have had a vaginal birth before. Not to forget that prolonged first and second stage can come with their own risk factors, which is why they do need to intervene at times. We don't always just start synto or recommend epidurals for the fun of it.

OP, the fact is, this may a completely different labour, particularly if the baby is in an optimal position. There is every chance you can do it again. Your ob sounds supportive and it doesn't sound like your c section was performed to suit the ob's timre restrictions. I would start researching how to get the baby in a good position for birth. The spinning babies website is one I always recommend to  antenatal women with OP babies on board.

Best of luck with it all.

#14 Lucygoosey1

Posted 28 January 2013 - 08:36 PM

Thanks for all the detailed replies.  I don't blame the ob or hospital,  but of course you do wonder if you could have prevented the outcome,  and we'll never know!
I was happy with my ob,  so I will discuss all the above q's.  And look into better positioning etc for the next time around.  I will definitely 'shop' around if he doesn't provide suitable answers.
And I think I should be able to attempt a VBAC,  so we'll see how it goes!






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