Reply With QuoteNo just coming in to say something similar Lulu. Thanks
Lucy in the sky with diamonds.
I think you are the one with the generalized view jessica. It's pretty obvious that you havent read the rest of this (and Trillians other posts) thread. This is a gentle birth/parenting forum built and supported by many, many women who have come to the same conclusions, most often through their own (interrupted, overly sanitized, helpless) experiences with their Obs.
As a mod here, I'd say Trillian has seen countless posts, birth debriefs and questions regarding Obs and is in a pretty knowledgeable position...
Now lets get back on topic before said Mod yells at me in purple for staying OTT.
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No just coming in to say something similar Lulu. Thanks
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Nai, good for you. I used hypnobirthing and it was wonderful, as did Christy who inspired me to go down that path
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Oh my, what happened here???
i was under the impression that my post was very carefully worded and wouldn't offend anyone. But it seems that I did in fact offend you, Jessica. This was not my intention and I do apologise.
Tempers have really flared up in here... sorry for stating the obvious. For what it's worth, Nikki, I think anyone who has read the whole thread can tell that you weren't out to discourage anybody from pursuing a VBaC. As I have said before, I am glad you had the courage to share your story. It is a very tragic, sad story and I can't even begin to imagine what you and your family have been through. I wish nobody would have to endure that.
Jessica, in fact, I did mention that some studies state the risk of uterine rupture as being 1 in 100. But I then proceeded to criticise those studies for not giving enough information. Those studies included women with highly medicalised and augmented labours. No conscientious OB would these days induce a VBaC labour. But it has been done a lot in the past.
In fact, continual fetal monitoring is not necessary. Monitoring can be achieved via a mobile unit or via a fetoscope.
The article you have quoted in your post is very interesting. And you know what? I do whole heartedly agree with pretty much everything in it. It is important for OBs assisting a VBaC to be educated about them and the possible risks involved. That is just common sense, isn't it? But, when I read the article, I can't find anywhere a statement where he says that VBaCs should be discouraged or that the risks involved are higher than a repeat c/s. To me it seems that he encourages VBaCs, but calls for better education of the health professionals who are on standby in case of an emergency.
I do like the fact that he makes a difference between true ruptures and dehiscences. A discrimination not made in the earlier studies on uterine rupture as a result of VBaCs.
You have also made a comment about an increased risk of infection if a trial of labour fails to progress and an emergency c/s is needed. Here I think it is important to note that there is an "emergency c/s" and an EMERGENCY C/S. A true emergency c/s is when something goes horribly wrong, fetal heartbeat drops for example, and hastily, a c/s is performed. In this case, the risk of infection is indeed increased. But, any c/s that wasn't planned is labelled an "emergency c/s". Failure to progress does not have the urgency as a true emergency c/s has however. And usually doesn't lead to a higher infection risk.
And to address your statement abut trusting health professionals: My father is a highly accomplished and well regarded surgeon in Germany. He and his anaesthetist both support the notion that the only person who shouldn't be in the delivery room during an uncomplicated birth is the doctor. Doctors are there for when things go wrong. I think that is what Trillian was trying to say.
I also don't understand your OB discouraging a VBaC because of the expected size of your baby (do you know how inaccurate these estimates often are?) but supports a trial of labour. To me that is a contradiction.
You also mentioned in a pretty inflammatory way that if I wanted to run the risks associted with a VBaC, then that is my problem, but you would rather be on the safe side. Or something to that effect. My point was merely that a repeat c/s is by no means the "safe side". There is no safe side in birth (or in life for that matter). No matter what you do, there are risks invloved. And most professionals, including the World Health Organisation judge the risks of a repeat elective c/s to be higher than the risks involved with a VBaC.
Nai, all the best with your VBaC. I hope it is everything you imagine and so much more.
Lastly, Nikki, I want to apologise for hi-jacking your thread and making it a discussion of the pros and cons of VBaC. I'm sure you never intended for this to happen. I also feel like we are somehow insulting the memory of your prescious daughter by doing this. I apologise for that. I just hate for somebody else to come along and make up their mind on VBaC by reading this thread and not getting both sides of the argument. I hope you understand. I just couldn't let Jessica's comments stand unrebutted (is that even a word???)
Saša
Last edited by sunshine_sieben; August 3rd, 2008 at 09:02 PM.
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All I can say to Sasa is I agree. Thank you for that post.
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Sasa, I'm sorry hun, but I've gotta spread the love. Well said
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Thanks Cass, I also used it first time around and I got to 7cm dilated before requiring an unplanned c/s due to foetal distress. I found it to be wonderful and DP is a great partner to keep me on track so I am hoping that this time around we will get the whole wayNai, good for you. I used hypnobirthing and it was wonderful, as did Christy who inspired me to go down that path
And well said Sasa.
This message has been deleted
Last edited by jessica; August 7th, 2008 at 08:35 AM. : I've been told my findings are inappropriate
♥ BellyBelly's Creator ♥
There are so many factors in this - did you know that induction runs a risk of rupture too, prior caesarean or not? You never know how these women laboured, if they were induced etc - CPD is a very rare ocurrance, and labouring on the bed will reduce the space in the pelvis. We have to look at how we can reduce c/s in the first place, to prevent the whole VBAC rat race. We all know that our c/s rate is horiffic, higher than the USA - over 1/3 of babies are born this way.
Many of these could have been prevented but they end up necessary due to the way they are cared for and treated, including our sky high induction rate, fear of litigation and all the rest. Its not as simple as big babies, I have seen many big babies born and no ruptures. Even my teacher who has been doing this for 30 years - over 1,000 births - has only ever seen 1 which was repaired and both mother and baby were fine. You also have to consider risks of caesarean surgery and all that comes with it. Not so easy, a very complex issue.
https://www.bellybelly.com.au/birth/...nown-and-loved
https://www.bellybelly.com.au/birth/...s-big-baby-cpd
Some Studies On Pelvimetry and CPD
1. Impey L. and O’Herlihy C. First delivery after caesarean delivery for strictly defined cephalopelvic disproportion. Obstet Gynecol 1998;92:799-803.
68% delivered vaginally in the next pregnancy, 47% with a larger baby. Of 15 women previously delivered by caesarean at full dilatation 11 (73%) delivered vaginally. In 19 patients pelvimetry had been performed. In 11 (63%) dimensions were judged to be abnormal. All underwent trial of labour and 6 (55% – including two with larger babies) delivered vaginally.
2. Phelan et al. Vaginal birth after cesarean. AMJOG 1987;157:1510-5.
“Previous indication for cesarean birth bears only little relationship to the subsequent successful vaginal delivery”.
75% of women with previous cesarean for CPD/failure to progress delivered vaginally.
3. Jongen VHWM et al. “Vaginal delivery after previous caesarean section for failure of the second stage of labour”. BJOG 1998;105:1079-81.
82 (80%) of 103 women with previous delay in descent in second stage delivered vaginally, including 41 (75%) of 55 who had a history of failed instrumental delivery.
4. Flamm BL and Goings JR. “Vaginal birth after caesarean section: Is suspected fetal macrosomia (large for dates baby) a contra-indication.”
4000-4499g range, 139 of 240 patients (58%) delivered vaginally. Greater than 4500g, 43% delivered vaginally. Comparison with control group of 301 women with no previous uterine surgery and macrosomia, showed no significant difference in perinatal or maternal morbidity.
Kelly xx
Creator of BellyBelly.com.au, doula, writer and mother of three amazing children
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Lies, damned lies, and statistics rear their ugly head again...
There is certainly risk involved in a vaginal birth after a previous caesarean. However, risk is relative - you can't simply examine it in isolation. For instance, in the study you quote, we see an incidence of uterine scar rupture of 0.7% The acknowledged rate of "severe morbidity" - in other words, life threatening complications directly relating - to caesarean section surgery, is 2.73%. That is nearly 4 times as high as the risk of a uterine rupture relating to a vaginal birth. And that is also considering that the study you posted limits its analysis to women whose babies were over 4kg at birth - in words, it was a retrospective study.
The AAFP and the ACOG also make one, very large, and very mistaken assumption in their statement relating this study - that it is possible, with any degree of accuracy, to predict the birth weight of a baby. 4kg is a very large baby. There are no ultrasounds, no scans, or any other esoteric formulas based on shoe size or the size of the parents, that can predict how large the baby will be with any accuracy. Only 15% of babies are 4kg or more at birth. This means that the study you have posted above applies to only 15% of births worldwide, and can only really be applied in hindsight, as there is simply no way to know how big your baby will be.
Also consider that the decision to have a caesarean for one pregnancy has a direct influence on subsequent pregnancies. The risk of placenta accreta, a condition which can lead to severe haemorrhage during and after birth, is just 0.13% after one or two caesarean sections, but after the third, jumps to 2.13% - a signficant increase. Women planning larger families need to consider this statistic, too, when they are weighing up the relative risks and benefits in a VBAC.
My opinion - based on examining the research - is that VBAC should be encouraged, but for it to be succesful, women need to be educated regarding the risks, ways to minimise those risks, and the benefits of having a VBAC. I honestly believe it is a safer option than a repeat caesarean section.
Sources:
Last edited by Schmickers; August 4th, 2008 at 10:37 AM.
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Hi everyone,
I would just like to say that I wish anyone who is going for a vbac the very best and I am sure things will go well. I guess I just want people to take things from my story with them to there vbac so that if you do have to have an "emergency C-section" vital minutes are not lost. Be prepared, things that added waisted time for us was not having a IV already in, having to shave me. One major thing was the fact that the midwife thought the monitor was faulty, so the minutes spent putting on another thing(not sure what it is called, goes to babies head via cervix) and then getting another machine. All the while it was our babies heart that really was fading away, the other huge thing of course do not go for the epidural as you have no way of feeling what is going on.
The fact that you are looking this up in the first place means you will be far more aware than we were. Thanks for listening and good luck..
Nikki
Hi Jessica,
In light of what you posted in the c/s support section, maybe it would be appropriate for you to edit out some of your comments in this thread. They are really inappropriate especially when considering this threads very sad original topic. Whilst you are maintaining you have 'a right to share information' , you have to then afford other posters the very same right don't you think?
I will be deleting all my previous messages.
Last edited by jessica; August 7th, 2008 at 08:33 AM. : pressure from another user
I don't find your other post upsetting nor confronting, Jessica. It's ok to have different opinions - really
Moderator
At this point I want to remind you all that this thread was started by a real woman who lost a real baby. Making it a VBAC v's C/S thread is hardly sensitive or appropriate. Nor is dragging a debate from one thread to the next. Anymore posts along these lines will be deleted immediately and the posters will be barred from the threads and issued with infractions.
You're not children and you should not need to be asked to behave yourselves more than once. Other forums may allow such disrespect - we don't.
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Nikki - Just want to send you another hugeI hope you are doing well. Also want to say thankyou for sharing your story and for your strength for doing so.
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Dear Nikki,
Thank you, Thank you Thank you, Thank you Thank you, Thank you Thank you, Thank you Thank you, Thank you Thank you, Thank you Thank you, Thank you Thank you
I always find it amazing how hearing of someones tragic VBAC can really open the eyes of others.
I am so very sorry for the loss of little Lilli, you have amazing strength to share your experiences and even though yours was not a positive outcome, your loss has become the gain for so many women.
My Ob, (whom I still have appointments with post losing my daughter) is very Pro VBAC and I mentioned some of my concerns to him after reading your post. He is a very caring ob and respects the way I feel and knows that when it comes time again we will have a very set game plan to try for a VBAC but knows that nothing to us is more important than having a beautiful "bring home" baby.
He has given me some websites to do some research into successful VBAC's and I think that thats wonderful however I feel that perhaps your story should also go onto these websites as it emphasizes that things CAN and DO go wrong.
Women need to be aware of this and have a story like yours so they are aware, you always hear the good and never the bad but the bad is just as important.
I am blabbing here, but if you are interested (please do not feel pressured) PM me and I will give you the website.
If the moderators choose not to allow your story that is there decision but people need to be aware.
Much love to you and I feel so lucky that you had the strength to share your story AND am amazed and inspired by your strength to have a third baby.
Nae x x x
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