Posted: Tue Aug 13, 2013 8:22 pm
Post subject: Are things against me going for a VBAC???
I shall dive straight in with my quandry... My daughter was born by emergency c-section after 36 hours in labour, I started on my own (water were leaking but baby not engaged) they popped my waters then hooked me up on a drip, I went in at 3cm dilated, progressed (if you can call it that) to 4-5 after 36 hours and ALOT of oxytocin and finally they decided baby was in distress and it was a 'sunroof' jobbie!
This time they have given me growth scans, I had what I thought would be my final scan today at 34 weeks, however, they discovered that my placenta is only 32mm away from my cervix (posterior) and if its less than 30mm away, they suggest an elective section to prevent placenta praevia.
They also discovered that baby has leapt up on the growth chart and is now just under the top line, so 75-98th percentile. I'm 5ft tall, baby didnt engage at all during first labour which I putting down to not being able to fit through my pelvis as she was born with s swelling on her head.
I was so fixed on a VBAC before, but now I have been faced with a potential big baby and complications with my placenta... I don't know what to do, has anyone every been in this situation...?
I desperately wanted a 'natural' delivery and the thought of an elective section seems to take the magic out of the baby arriving (eg the uncertainty and excitement of contractions/is it starting, not knowing when baby will be born etc). The consultant said that the placenta wouldnt move any closer to my cervix but also wouldnt be moving much further away if at all, but if I wanted to go for a VBAC, baby would HAVE to be engaged when labour starts as if baby isnt engaged, then it would mean that baby cant get past the placenta...
To those who have finished reading my essay, thank you, I hope you can offer any advice/experiences, I'm feeling a bit of a failure...xxx
Posted: Tue Aug 13, 2013 10:05 pm
I have a bicornuate uterus (heart shaped womb) and have had one section due to this plus my placenta being 0.2mm closer than they would have liked plus bleeding throughout, etc et
As someone who is facing never being able to give birth naturally i understand where you're coming from completely. My section really affected me and im still unable to get my head around it and believe it was necessary and that there also part of my future. If i was in your position, personally i would see how i went during the last few weeks and placenta permitting i would go for a natural birth. Growth scans are more often than not incorrect, also if you were saying this about your 3rd then i feel its a different story but as its your second i feel like your first could have just been a one off. I would thoroughly discuss with your doctor (if you were to opt for a natural) at which point they would intervene and the implications and so on in case though. Good luck xx
Posted: Tue Aug 13, 2013 10:17 pm
Thank you Hayley, I will wait and see what my next scan says before making a final decision, I know if I decide to go for a VBAC, I can change my mind at any time, I need to weigh up the risks etc of both major surgery and potential complications with a large baby & low lying placenta. I so desperately wanted a 'normal' delivery, I want that experience of giving birth, I'm sure you feel that same, but I guess I need to consider both 'modes' of delivery and what is best given the information I have.
I was a complete wreck following the birth of my daughter after being left for so long and the effects the drugs had on me, the epidural only worked partially so one side was numb, the other not and I really don't want that again, I'm sure it will come good in the end, just feeling quite disheartened after hoping I could go 'au natural' xxx
Posted: Wed Aug 14, 2013 7:50 am
The placenta can still move, I had full placenta praevia were my placenta completely covered and overlapped the cervix and they were still scanning me weekly from 32 weeks to see if it would move enough for a natural delivery as I was desperate to not have a section, my consultant said if it's just close then it almost always moves enough for a natural delivery
As far as being engaged goes not sure what he's on about there as my son was engaged for weeks He insisted on being head down and engaging even though he wasn't my first and my placenta was right there which is probably why I had so many bleeds so I don't think whether baby is engaged or not before labour is a good test of whether they can get past the placenta As my son certainly couldn't have done and he was engaged
So you've still got plenty of time yet and yours is already outside the limit anyway
I do think sometimes docs are just looking for any reason they can to put you off a VBAC, for me if it wouldn't put me off a natural birth if I'd never had a section then I don't think it would for a VBAC either
I don't think your first birth experience should affect this time , to be honest I think from what you've said it was all their interference that caused the problem, if they'd left things alone when your waters were leaking or just broken them fully and then let your body get on with it the section might never have happened, as often its the oxytocin that causes problems, especially when they either stick you on your back on a bed as well or insist you should have an epidural with it it interferes with your body's natural contractions and because they insist on turning it up every time they decide your progress isn't quick enough then it's very common for babies to not tolerate it and become distressed Then instead of doing what they should do and turning it down or off to give baby a chance to recover they whip you off to theatre for a section
I don't know how you laboured but being upright really helps baby engage and sometimes babies don't engage until you're in full blown labour, often they'll turn into the optimum position at some point during labour and then their head will come right down and settle on the cervix and get things moving, if they had you on oxytocin forcing contractions and they also had you lying down which makes it harder for baby to turn then she may not have been able to get into a good position to engage and if baby isn't in a good position then it can take longer for your cervix to dilate .
As for growth scans or midwives weight estimates I've never known one to be right yet, they either say its a big baby and then it turns out to be tiny or they say average and it's big So I wouldn't let that put you off, a friends daughter had a baby the other day and she'd been told 8 1/2 to 9lbs based on a growth scan a couple of weeks ago and her baby was 5lb 10oz
As far as my VBAC goes after my section for PP (unfortunately my placenta didn't move enough but it was always a long shot with how much it overlapped) I really wanted a VBAC next time round to the point that when the hospital weren't supportive I decided on a home birth
I was adamant there was no way I was having an elective section for the same reasons you said I found it very unnatural and nothing like my natural births and also the recovery time with other children to look after .
Unfortunately my DD had other ideas and turned out to be breech so it was off to hospital for a 'scan' in labour and ultimately bullied into another section, third time I had support for a VBAC after 2 sections but unfortunately my son was prem and I got an infection and he became distressed, BUT I don't regret trying with either of them , my only regret is letting them talk me into the second section, my labour was going brilliantly I had no issues from the previous section Even in my second labour I had no issues from the previous sections and what ultimately happened with them both could have happened to anyone previous section or not, and was not related to them being VBAC attempts and if I ever got pregnant again I would go for a VBAC again as I'd still rather try and see what happens then just go straight in for a repeat section
You could start labour with contractions this time and things might progress quickly you just don't know until it happens Every labour is different .
Totally personal choice of course and I know docs can be very negative but overall you have as good a chance of a natural delivery as any other woman, in fact your chances are better than the average first time mum of avoiding a c section especially if there's minimum interference in your labour this time and of course the statistical risks of giving birth vaginally are compared to c section are also lower The NCT have some good info on VBAC and I think it's now coming to be generally accepted as the safer and better option to repeat section for almost all women xx
Posted: Wed Aug 14, 2013 9:33 am
Thanks for sharing your stories DL05, you certainly have put a positive spin on it for me. You are right, they popped my waters and stuck me on a drip almost immediately, the drip wasnt hooked up correctly and after 'fixing' the problem they caused, they upped and upped the dose to a ridiculous amount as I was only having 3 contractions in 10 mins and they weren't strong enough. The midwife was extremely defiant and uncooperative and moaned about unplugging me from the monitors when I needed the loo etc, I felt so awkward and as if I was a burden that I ended up staying in one position so as not to 'annoy' the midwife and ended up with an epidural as she said if I went for it sooner rather than later it would work better. Well it didnt, it only worked on my left side I have opted to go to a different hospital this time as they have been so uncooperative at the closest one so I'm going elsewhere.
The consultants I have had this time have been very supportive of a VBAC rather than a section, it was the sonographer that made me panicky about the plancenta praevia. I will wait and see what the outcome of the next scan is, if the placenta is in the same place and baby is still on the growth scale as opposed to 'off the scale', I will deffo try for a VBAC, I am hoping for a labour where I have no interference at all, I don't like being messed with and aside from examinations to check progress, I would prefer to be left to my own devices unless I felt I needed assistance. They have already told me I would be hooked up to the monitors which doesnt thrill me I can tell you!
THank you for your help, I'm always grateful of advice and other people sharing their experiences xxx
Posted: Wed Aug 14, 2013 10:21 am
Sadly I've seen it a few times with labours that are induced Poppytops, it was heading that way with my sister in law and my middle daughter but luckily they were both fully dilated when their babies heart rates started to drop and managed to deliver with the help of ventouse but even when my grandsons heart rate was dropping they wouldn't turn my daughters drip down and I was furious because when they put it up they said they would if he didn't tolerate it, instead they turned it up to get the contractions stronger and then ended up using ventouse to drag him out, my daughter now has an umbilical hernia that she got because of muscle damage from those contractions and trying to push with an epidural that was topped up too much
It's a well known fact that the cascade of interventions as they call it increases c section rates and hospitals with high induction rates that often lead to high epidural rates also have the highest c section rates, some at 28%
With VBAC's they often set 'rules' or conditions or tell you how they think it should be there's no evidence that continuous monitoring is necessary or even helpful for a VBAC in fact the best way to get a VBAC is for them to treat you exactly the same as anyone else only going into hospital in established labour etc. also helps as then they won't be tempted to try and speed things up, and remember everything is always your choice , if you don't want continuous monitoring you don't have to have it, I didn't with my first VBAC attempt, it wasn't even suggested as when I was at home and still wasn't done at the hospital, with my second it was different as the doc who had been looking after me wasn't there and the one who was, was a b*tch, they knew I had an infection and he was prem, but they also stuck me on a bed, wouldn't ring my OH and had me tied up to drips and left me on my own and I'm sure that's why I wasn't progressing fast enough to have a natural delivery so your story of your first labour struck a chord with me, sadly it happens too much
But VBAC is definitely do-able for most women and I've read of women having their first VBAC after 2,3 or even one I saw had 5 sections then a VBAC and some of those were home births, water births, multiples and breech babies as well
Posted: Wed Aug 14, 2013 12:45 pm
Thank you You really have been such a help and so positive, I remember you offering positive words when I posted about VBAC early in my pregnancy. Its also reassuring to know how much control the mother to be has during her labour. I felt pushed around during my first labour, but feeling more assertive this time and your words have made me even more determined that I won't be forced into something unless its absolutely necessary.
I didn't understand why I would be continuously monitored either, seems daft to me and those pads they strap to your tummy become soooo sore, it was extremely distracting and uncomfortable!
Your wealth of knowledge is commendable, thank you for sharing it xxxx
Posted: Fri Aug 16, 2013 9:24 am
The last growth scan that I had with George was just before 40 weeks and suggested that he weighed around 9lb 9ozs! He was born 7 days later and was 8lb 10ozs so growth scans can be quite inaccurate. I'm only 5ft 3 but George's birth was super-speedy, he arrived an hour after we got to the hospital and we shocked the midwife as she had assessed me to be 3cm dilated when we first got there! I hadn't been properly admitted or even have a wristband on! My consultant told me that it doesn't matter how tall you are, it's the size of the pelvic inlet inside. A short woman could have a big pelvic inlet as much as a tall woman could have a small pelvic inlet. I'd go with it and see how it goes, good luck! x x
Posted: Fri Aug 16, 2013 9:50 am
With my daughter I was induced, she wasn't engaged and being in labour for 65 hours before I was rushed for a c section but last minute forceps relived me of it, for so e women it runs smoothly and a material birth can be enjoyable but if you've got a history of bad labour it's really not worth putting you or your baby through distress at the end of the day the best part is being handed your baby it was for me, if I'm aloud I'm opting for a c section, as I don't want to relive my first experience. I'm more excited to have my baby handed to me after it all than go through the painful and scary process xxx
Posted: Sat Aug 17, 2013 6:53 am
Can I just say on this point that the first labour is often the longest and most difficult for a woman and doesn't set a 'pattern' for future labours,in your case Poppytops you didn't actually have physical problems as such more interference issues, if it had been a natural labour, not induced and despite everything being tried you'd got to 10cms and baby still wasn't descending or showing any signs of wanting to get in the right position then that might make a difference second time round but as it was issues with things not progressing in an induction it should make absolutely no difference this time
Same for you really Cleggy, an induced labour bears no resemblance at all to what a woman might experience if her body is allowed to do what it needs to do when it needs to do it, part of the process that triggers labour normally and speeds it up is from the baby's head being low onto the cervix so inductions should not be done with babies who aren't in an optimum position in the first place, it's just asking for problems. Most hospitals now are encouraging VBACs Cleggy so it's unlikely they would offer a section if you didn't end up needing to have one last time , but the chances are you would have a much more positive birth experience this time anyway as second labours tend to be much shorter and elective sections are also scary and more than a bit painful afterwards which is the worst time to be in pain as then you have a new baby to look after as well xx
Posted: Sat Aug 17, 2013 6:10 pm
They monitor you to check your section scar is coping well with the pressure, its not necessarily the baby although the baby can show signs to help work out if your scar tissue is coping. I know its a pain but its all for a reason. I volunteer on a maternity ward and although it may not be explained to you fully and you may have rude carers they're doing it to be cautious. As for the drip and other pain control this infuriates me haha!
Posted: Sun Aug 18, 2013 12:35 pm
I can't remember much from my daughter, she was breech but had been in perfect position throughout my pregnancy, but as she decided to come out she stretched her arm I split and ended up being cut further to get her out, they got me ready to have the c section and literally before they decided to make a cut the doctor asked me to push for the final time and I was lucky enough to get away without a c section by the skin on my nose lol, I was a big girl though but had no underlayer health problems or issues, I'm large this time round but trying hard to control my weight so I don't have complications. My midwife said that if any future pregnancies arise I may have the option to select a c section so if I'm still alowd I will xxxx
Posted: Sun Aug 18, 2013 1:17 pm
I wanted a natural hands off labour with my first but it really didn't turn out that way. I was in labour for 31 hours, I was hardly dilating at all despite being on the move and in optimum position. I did most of it at home as well. They eventually broke my waters which sent me into constant unbearable contractions. I really couldn't cope as I had no break between them. I really didn't want an epidural but I opted for one at 8cm. As I wasn't dilating they agreed, I had a syntocin drip after another four hours as I'd only dilated another 1/2 cm by then. So I do t think they really had a choice with me I wasn't progressing at all. Slight panic at the end getting him put and ended up being cut and ventous. Then had a massive harmorrhage after delivering the placenta. I had three blood transfusions after that as my HB was only 6. I have never felt so ill as I did then, it took me months to fully recover. I still want a natural labour this time though and I'm really hoping being my second time it's quicker and easier. Good luck with whatever you decide, I think you just can't predict the outcome and just have to go with the flo xx
Posted: Sun Aug 18, 2013 3:28 pm
I think you have to unfortunately wait it out and see what happens. I've read that the placenta normally moves up as your belly grows and you have a few weeks yet so try not to worry and besides your over the minimum measurement now and it will only move up and not down.
I don't think they can that accurately predict how big your baby will be, I was told mine would be over 10lbs and he was 9lbs 3. I had a c-sec because I didn't progress quickly enough for my OBGYN but I live in a country where they love to slice you open. I got right to 10cms down in theatre but couldn't feel to push because I'd had my epidural topped up so much on the way down I was literally dead from the waist down. I felt robbed of a natural birth and can tell you that this time there is no way on earth I a letting anyone push me about when I deliver my new baby!!!
I think you have to try and relax and put it out of your mind and see what happens but I would always aim for a natural birth just because in most situations it is an easier recovery. I developed an infection after my c-sec and was in hospital 2 weeks and then caught dysentery from there and was ill for 7 weeks after the birth. I felt miserable and really let down by my body. However, basically I had every intervention going, waters burst, induction, epidural at 3cm because they told me the epidural guy might not come back that day so it was now or never!!
This time for me, as long as my baby is ok, I am not having any interventions or drugs other than gas and air (which I love), I am going to stay at home for as long as possible in the bath and only come out when I can't take the pain any more. I have a 3 year old and really don't want another C-section as I won't be able to carry him or play rough and tumble games or anything and that would break my heart. I am also realistic though and if it comes to having another C-section then so be it and at least this time I won't be scared to death of having one.
Only you can make the right decision for yourself, good luck hun, I am sure it will be fine and try to remember, it doesn't matter how your baby came into the world as long as it is healthy (I told myself this for weeks and weeks after the birth and it has helped me come to terms with it). hugs x
Posted: Mon Aug 19, 2013 7:10 am
Hayley the docs use the scar as an excuse to continuously monitor VBAC women but there's no real evidence it helps, the monitors don't always pick up changes in the uterus and not all babies would show signs of distress either, how a woman feels can be the best way to pick up any warning signs of a potential problem, so any abnormal pain that continues between contractions etc. in which case labouring without an epidural is best (and yet they're often recommended for VBACs 'in case' they have to whip the baby out and ironically they can make that outcome more likely )and after all uterine rupture is such a tiny risk even after a section its barely any different than for none section women so is it really a good justification for telling VBAC women they will be confined to bed during their labours I know you want to be a midwife and you're working in a hospital but unfortunately not everything that you'll be told is necessarily backed up by facts and studies its more a case of policies written by someone in an office with the aim of covering their backs in case something goes wrong It's one of the reasons I decided against midwifery as a career in the end as a lot of research I did after I was pushed into my section with a breech baby made me realise I could never work in an NHS hospital where midwives aren't allowed personal opinions and just basically have to stick to 'policy' Sorry had a rant there But it really gets me that women are basically lied to in labour just to get them to comply with what the doctors want you to do
Alowicious I think that's a great attitude to have and it sounds like you have a brilliant chance of a natural birth this time I really feel for you, with my breech baby I was getting the urge to push in theatre just as the spinal kicked in, if I could have jumped off the table at that point I would have, I also felt robbed of a natural birth and it can as you said take quite a while to reconcile with that xx
Although personally that particular phrase drives me nuts (coming form doctors) as it's one that doctors often seem to use as if to say women shouldn't complain if they didn't get their natural birth even if it was the docs fault but yes at the end of the day a healthy baby is a happy outcome but I don't think it's wrong to feel sad that you didn't get to deliver naturally or to be upset that you have a longer recovery and all that goes with that (although some docs will imply it is wrong to feel like that ),as I know from doing both that it is such a special experience which a c section planned or otherwise just can't compare with and for me personally in terms of recovery within literally a day with my natural births I felt human again but with the sections it was weeks because every time I did anything I would normally do I would end up in pain and I just found that very restrictive and depressing
I'd just like to see the overall section rate come down especially for first time Mums, as statistically you're more likely to have a section with your first and often from stories you hear its down to interference and mismanagement and it really can put women off the whole experience of labour and delivery
I'll admit to anyone I was scared of labour even after I'd done it and my first was what most people would consider an easy labour and birth, but I was still terrified next time and the time after and it was never as bad as I'd imagined it to be beforehand I just knew it was something I had to do though But the way I felt after my first section was awful and in no way do I see a section as an 'easier' option compared to birth, but I can see why a woman who's been traumatised by a bad experience might see a section as a better way,especially when sometimes you have docs practically expecting you to want an elective, or like in my case trying to book a date for one at a 12 week appointment I'd love to see dedicated midwives to work with women with birth fears though to help them through it. I know a lot of hospitals have VBAC clincs etc. but some only send women to them if they've already expressed an interest in a VBAC maybe they should work more with women who do ask for an elective to try and find out why they made that choice and if there's anything they can do to help that women overcome her fears and avoid what is after all a major operation