risks for C risks for VBA2C's

[joralyd]

Hi guys,
This is more of a debriefing I really don't think there's much I can change but your opinions are greatly appreciated.
I'm currently pregnant with my 3rd baby, my first was born via emergency C after 24hrs of labour, no progression, didn't dilate past half a cm, had my waters brocken muconium was found, babies heart rate dropped and I went into shock. I later found out that ds was stuck in my pelvis and ALSO had the cord around his neck. It was traumatic, I was so not prepared and to top it off had so much trouble bfing him we just didn't bond well at all. He has also been diagnosed with Aspergus (part of the autism spectrum) recently after 8 years.
Second baby was going to be a VBAC trial of labour anyway as my ob would only let me labour for 5hrs however at 39wks she was still breech! so I ended up with an elective. I must say it was so much better, recovery was quicker, I was awake the whole time, everything was perfect. My ob discussed tubal ligation which I refused he also didn't recommend any more children because of the risks of complications with subsequent C's.
3rd time (6 years later) although it was a surprise I am so excited and happy thank god I didn't have the tubal.
Ok here's the distressing part...
As I've had 2 C's of course I am told by my ob I will need a 3rd, at first I was ok with this even though I knew it was possible to VBA2C's if you can find an ob and a hospital willing to attempt it but I really didn't feel strong enough to fight this issue. I mean what if I did VBA2C and ended up having another traumatic emergency C anyway or what if my baby had to go through the same complications as my first I would never forgive myself if something happened just because I chose to trial labour kwim?
My last ob appointment the usual tubal ligation discussion came up and again I refused not because I want another baby (this most likely is my last) but because I don't want my choice taken away. He then informed me of the risks of subsequent C's- bladder tear, ruptures, hysterectomy, placenta on the scar. Trouble is the risks for VBA2C's is just as bleek!! so dammed if I do dammed if don't?? I'm stressing now because all I hear is the risks. I would like to broach the subject of possible trial labour with him but I really don't want to go in there un prepared but how do you argue with a specialist ob who obviously knows more than me!!?? Don't get me wrong he is a wonderful dr and knowing I would most likely have another C he is the most capable and thorough ob and surgeon, I feel safe knowing he'll perform the op. Anyone got any advise?
sorry it's soo long!

[joralyd]

Oh I forgot to ad I could get hit by a bus on my way to the hospital is that concidered a risk to?? lol

[BellyBelly]

The risk of rupture for a VBAC is 0.7%. The risk for VBA2C is 0.9%. Hardly a heavily increased risk! There are more risks going for your third c/s than a vaginal birth, but you will have trouble finding an Ob who will support you, as ridiculous as it all is with 0.2% in it... so I would hire a private midwife and possibly a doula too - you need a team cheering you on and supporting you. Read VBAC books, its not hard work in that once you have info, you have power and confidence so fighting isnt that hard.

[joralyd]

But wouldn't I need to convince an ob and the hospital of a trial labour first? this is my problem I can't get my foot in the door. I'm not comfortable with a home birth BUT a monitored trial labour in hospital would be great however I think my chances of that are very slim. I can't understand why an ob is happy to put you through the risks of subsequent c's but not or VBAC's?

A "monitored trial labour" is just going to keep you in the same boat anyway, Tiff. You hold the power, not the obstetrician. If you want a vaginal birth, go and get it elsewhere. You don't need to convince anyone of anything. Become knowledgable, if your Ob is threatened by that - go elsewhere. VBAC's aren't for the faint-hearted at the best of times but a VBA2C will be even harder especially within the private system.

[becmc]

I agree totally with the other posters. Have you considered a homebirth?? I don't think the risk of vba2c is comparable to the risks of an elective c/s without medical reason, and personally I don't think previous c/s is a medical reason to have another one. I just had a vbac, which was a planned homebirth though we ended up transferring to hospital due to a long posterior labour (it was not an emergency transfer).
You are more at risk of ending up with another c/s if you labour in hospital, and by the sounds of it you don't have much chance of a vaginal birth with your ob.
I really dislike the term obs use that a vbac is a trial of labour. It is no different to a woman having a first labour, but we don't call those trial of labour. And I believe becoming informed and knowledgeable about your previous labours and what happened, and knowing everything about vbacs, gives you more chance of a vaginal birth that a woman having her first that doesn't know anything about birth and believes her ob will do the best thing by her. I was like that for my ds's birth and never again will I give responsibility for my baby and my body to someone else without knowing what is going on myself.
Good Luck with whatever you decide.
Bec

Congratulations on your pregnancy!
To be quite honest.. I don't fancy your chances of a vaginal delivery with an obstetrician who says he will "let" you labour, monitored, for a certain length of time. Do you really think that kind of pressure will be conducive to your chances of a spontaneous, physiological birth?
A VBAC is just a birth.. it's really no more risky than any other birth. Your obstetrician should be able to give you stastical information about the likelihood of rupture, which is extremely low, instead of using scaremongering tactics which will only serve to convince you that your body is faulty.
Honestly.. if I were you I would hire a private midwife, and never go back to the obstetrician again. Your best chance of having this baby vaginally is in an environment where you are comfortable, where you have the complete support of your care providers, and where you will be respected as the birthing godess that you are.

[joralyd]

Thanks guys I have taken everything you've said onboard and I'll do some more thinking. I have some time and as I've been very happy up till now with my OB (he's been through threatened m/c with me) I do feel I should give him the benifit of the doubt and a second chance. I think it's mostly my fault because I should have bought all this up at the first appt, I feel a little bit stupid for not taking control as it is MY responsability kwim? so I think I'll research and write down all the questions I want to ask and points I want to make and take it from there. thanks again guys I think you gave me some backbone

[BellyBelly]

Good to hear - and even if you choose to stick with him, please consider hiring a private midwife who is as passionate as you are about giving it your best shot. It is hard when you feel like you owe it to your doctor, but honestly, you'll remember the birth forever, he'll soon forget you. At the end of the day, you will labour with the midwives around, who all have their own opinions and comfort levels, so if you bring your own who knows what you want and knows its not risk, then you'll have a much better birth experience. Good luck!

[katkins]

can I jump in here with a question? I'm 18wks pg with my number 3. Had pretty similar expiriences as Tiff. I have been adamant I want a VBAC2. However, Ob I saw yesterday kept going on about risks and that bubs is transverse (reason for my 2nd c/s, first was emerg due to fetal distress after fully dialating and pushing and failed vac). She seemed to think the worst would happen, yet the ob who did my last c/s said everything was in topcondition down there and you'd hardly know I'd had a c/s at all. I fully dialated with Kat and I was pushing well. They told me if I'd had another hr or so I'd have had a normal vaginal delivery, but Kat was too distressed. I am stuck now. I keep thinking what if. We def have number 4 on the cards (not for a few yrs now, but we do want more) and I don't know which would be better. I am also scared of going thru a labour again as last labour was hell. I was induced and synto was on full and I was in agony with a posterior bub, stuck in a bed unable to move due to monitors, unable to use shower or bath and it was just such a hard labour, so idfferent to what I wanted and so terribly painful due to all the above. I'm not so scared of the pain. I'm scared of not being free to move or use the bath or fitball again. Being stuck on a bed made the whole thing harder for me and I was scared for Kat. My support team also let me down a little because they were shocked at the pain levels I was going thru. I know I faught the labour. I am so used to trying to ignore pain and fighting it, I'm scared I'll do that again. I asked trish to be my doula, but I am un sure she can make it yet as she's due only 2 months before I am. I know another c/s would be easier. I'd know when bub is coming and I know I can deal with that pain very well. I'd have no risk of tearing really etc, but I feel like suck a failure for not being able to give birth vaginally and it's something I want very much. But everyone else's doubts are making me doubt and rethink. I am so confused. Even Dh has said he'd rather I have another c/s. He also enjoys telling me "See, I told u u couldn't cope with another yet" because Dr keeps thinking I am developing PE (BP seems to go up briefly then back down). I feel so unsupported and unsure now.
Please feel free to move this if you need to Kelly. I would just like some advice and some support from someone would be really nice. Feeling very emotional and unsupported.

[BellyBelly]

Katkins, I think when you are having a vba2c its worth getting a private midwife for the birth, I have a spreadsheet of NSW midwives. Even if you chat / meet no strings attached to see how supported you will feel with them.

I think its definitely worth finding some support, makes a huge difference to your experience, and even if it does go down the path of c/s, you feel more resolved as you know you had good support and did all you could. That said, having a doula means 50% less c/s - thats a huge rate - so worth looking into. You CAN have a great experience and feel nurtured... just find the right people to surround yourself with right now xx

[katkins]

That's the hard thing right now. Pretty much all my family and friends think that I should have another c/s. Even my Dh. They don't get why I feel so bad about having had c/s's why I want a VB so badly. I guess I'm just feeling so alone right now. *sigh*

[BellyBelly]

Your hubby and/or family could also come to the midwife appt and fire their questions at her

[katkins]

my other prob is my hubby won't want to pay for a midwife and even if I save my allowance for the rest of my pgcy, I'd not have enough to cover a midwife. So frustrating. Guess I'll just be quiet now. No-one can solve these problems but me. I'll try having another talk with DH about VBAC as soon as he's in a good mood

Hi Katkins,

Did I read right that you were induced with syntocinon (the drip) during a VBAC labour?

[katkins]

no, that was my first Labour. They can't use syntocin in VBAC's as contractions are brought on too strong too quickly. Sorry. My post wasn't veyr clear. Too emotional etc right now. Sorry

[BellyBelly]

Once he has met with a midwife who he feels comfortable with and is armed with some facts, he might lighten up to it... fear and uncertainty is what drives it, so if he has some clarity, information and facts, then he might feel more comfortable about it, and more willing to part with dollars

[katkins]

he might, but my hubby is very controlling and he'll only spend money on his stuff really so I'm not too sure.