Planned c-section vs. vbac - what would you do?
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Pepita
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OP, I would have another conversation with your OB. Since you like and trust him, I actually don't know that you should necessarily dump him, though don't rule it out after you've given it a ton of thought and conclude that he can't give you a fair shake at VBAC given his own limited experience or the hospital environment. I had a posterior baby and I know that I spent at least two hours on my hands and knees wiggling my butt back and forth like a dog slowly wagging its tail. It brought me so much relief, and in hindsight, I think that's what caused baby to turn partially for an easier birth. I didn't have an epidural, but if I had (I wasn't opposed) I really would have wanted to make sure I could still change positions. I think it's nearly universally accepted that different positions open up the pelvis more, as PP said. This is a little bit gross but in SE Asian countries where people squat to toilet, they have fewer issues of constipation, etc. There's a reason for that. So, what I'd ask specifically is if the hospital's anaesthesiologist is able to "right size" your epidural (if you want one) to make sure you can change positions - even if just a little bit - while pushing and get off your hips and at least onto your side, or preferably hands and knees or ideally, squatting with a squat bar. A question I'd have for your OB? Is he willing to be personally invested in your VBAC, really champion you in it as opposed to just "allow" it, and what can he (and you) do to bring that 10 percent figure higher.
Do some research, have another talk, and maybe just for kicks, consult another provider. There are midwives that deliver in hospitals that may present a best of both worlds for you - medical attention if you need it, including pain relief, but also the kind of support that might get you further without it. GOOD LUCK! |
Anonymous
| I'd choose csection recovery over the pelvic floor issues I currently have any day.... |
Anonymous
| I think whatever choice women make is fine. People are different. But, op, if you WANT a vbac, take action. Research it and interview providers and do all you can to give yourself the best shot. Don' t just take the path of least resistance, which would be to stay with a provider who has essentially told you that it very likely won't happen with him. |
Anonymous
| I just had a c section Monday night for the same reason after pushing for three hours. I even let the epidural wear off almost completely for the last 45 minutes (ouch). I am a medium sized (medium hipped person) who had a 7 pound baby. On my way out of the OR, I was told that this would be the first and last attempt at a vaginal delivery. It made me feel better that hidden measurements of my pelvic opening caused the failure to descend, not any lack of effort or effective pushing. I am continuing to follow your responses to the OP. A c section after a failed vaginal delivery is rough. I wonder if a planned c section is much better. |
Anonymous
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With already having a little one to look after along with a newborn, I'd choose the option with the easiest recovery. And if your first c-section recovery went well, it is still major surgery.
If you really want to try a VBAC. And I mean really want to and are willing to commit to it, find a practitioner with more VBAC experience. 2 hours of pushing really isn't that long for a first birth. At a minimum, get a 2nd opinion. Karen Kane delivered by 2nd VBAC at VHC and she was awesome. |
Anonymous
Congratulations on your baby. That is too bad that the doctors told you that you'd be incapable of having a vaginal birth. I've had doula clients who were told this after their first cesarean, and then they switched providers for subsequent babies (to providers who had high VBAC rates and were skilled at VBACs) and had VBACs after all. I know it's tempting to trust a doctor's assessment of your pelvis during a cesarean, but I think it's important to know that there are women have been told that they'd never be able to have a vaginal birth who then go on to do so. There are so many factors that go into whether a baby comes out vaginally -- size of baby, position of baby, how pelvis is positioned and moves during labor and pushing, patience of provider, etc. And if providers are telling women after a first cesarean that they will never be able to have a baby vaginally, and then those women just schedule cesareans for their next baby, no one will ever have the chance to find out that that second baby may have been able to come out after all, so everyone just continues to believe that the pelvis was the issue.
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Anonymous
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OP here! Thank you for all your thoughts and inputs! I think I would be able to move forward with decisions once I talk to my OB next week. He is an OB with stellar reviews all around but when I checked NIH record his cs rate was fairly high and VBAC rate was low. I think that data was based on 2005 which is a while back but still.
I had epidural and had it twice (actually not because he said I should buy I requested the second one out of panic). I wasn't informed or did much research. So yes I was in semi reclined position when during labor and when I pushed with almost no sensation durin the push. I can almost confidently say I did not feel like I knew what I was doing. I know it couldn't have been my 100%. I progressed quickly - it was just the push that didn't work for me. I feel that maybe if i pushed longer or had better sense of control over pushing it might had a different result. Once I talk to my ob, if I confirm that he still sees my chance as 10%, I think I am going to get a second opinion from a few different providers. Hubby is not comfortable in going to a non hospital setting in case c section is needed though. Can someone recommend practices that are VBAC friendly that i could possibly counsel with? We live very close to Fair oaks hospital. I know there are threads about them, but they are mostly outdated. For those who used birthing center, were you comfortable being in non hospital setting? This might be a stupid question but then do you have OB for your regular checks and go to birthing center for delivery only?? Or can midwives do regular check ups as well? As much as I love my OB I am not married to him. What I want is the best thing for me and the baby. |
Anonymous
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Tepeyac delivers at Fair Oaks and has a 85% vbac success rate. I really like them. NOVA Birth Center offers montrisse packages where you could labor with them til you're
close to pushing and then transfer, or you could just get a doula. Tepeyac keeps a list of recommended doulas. |
Anonymous
| Best thing for the baby is a c-section (fastest and safest way to get the baby out,might?). Best thing for you is a separate yet related issue, right? If you opt for a second opinion, you'll need to have your records from your last delivery with you so the second OB is informed (as opposed to relying on your recollection of things). |
Pepita
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What? Can you back any of this up? I don't mean to be rude, but the best thing for a baby is not ALWAYS a c section, though thank god we have them, because sometimes it is. But it's not the default best option. |
Anonymous
| I happily had 2 csections and never really considered a vbac, and based on my experiences your OB's 10% seems really low. Honestly, maybe its because i never progressed past 4 cm even though i went into labor naturally and waited a really long time before starting an epidural, but i am shocked that your OB got you as far as you did but you ended up with a csection. It sounds to me like he's trying to talk you out of considering a vbac, even if he claims not to be. What patient is going to voluntarily pursue a 10% option? |
Anonymous
| 23:09 - I'm talking about the best thing for OP's baby, not making a sweeping generalization for all babies. Her OB has told her that she has a slim chance of a successful VBAC. Thus, laboring until there's a medical need for an emergency C is obviously more risky for HER baby as opposed to a scheduled C (no stress to the baby in a scheduled C). That's all. Weighing the odds of VBAC vs repeat C for the OP is obviously centered on what's best for the OP (not the baby), perhaps THAT is the next question OP should ask her OB (which route is best for the baby). |
Anonymous
Yes, but you're assuming that the doctor's estimate of 10% is accurate. It's very possible that other providers would give the OP a much higher chance of success, and would have policies and protocols that would bring that percentage chance of success much higher. And there is a lot of evidence out there to indicate that a successful VBAC is in many cases safer for both babies and mothers than a repeat cesarean. (See http://consensus.nih.gov/2010/vbacstatement.htm for evidence). You are incorrect that there is no stress to a baby in a scheduled cesarean -- there is documented evidence that babies can sometimes have more trouble breathing or clearing fluid after a cesarean because they haven't been squeezed through the birth canal. There's also evidence that babies born by c-section can have more allergies and asthma for years into the future. Whether a c-section or vaginal birth is safest for mother and baby depends on many circumstances.
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Anonymous
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Agreed, but if we are talking about the OPs small pelvis and the odds of a baby getting stuck and need an emergency c, then a repeat is very likely safest per her OBs suggestion. I'm sure I have a bias here bc my first vaginal delivery was scary since my baby got stuck too far down for an emergency c and required vacuum extraction. He was positioned beautifully, but my structure was just too small....and I'm not a physically small woman (5'8"). Needless to say, my next three were scheduled sections.
Again, I suggest the OP asks an OB what the best plan is for her BABY....and please report back... Ps - no hearing issues, no asthma, no allergies |
Anonymous
2309 here - still havent' gotten the hang of using my newly minted username. This conversation always gets barbed so I appreciate us talking nicely  . But I still don't agree that anything you're putting out there resembles evidence that this is best for the baby in OP's situation. ACOG has determined that a VBAC is very safe. Unless OP had some specific condition that contra-indicated a VBAC, there's no reason to conclude what you are concluding. Just because one provider, who by his own account does not do a lot of VBACs, gave OP his opinion that she has a low success rate, doesn't mean that it's inherently risky for her child.
I think there are so many people who seem anti-C at all costs that when you come on these boards saying "don't rule out a VBAC" that gets lumped in with the former. There's a reasonable middle ground being overlooked, which is that c-sections are necessary and life-saving, but overused. And I think it's absolutely true that some doctors are so conservative with when they offer them and when they "allow" a VBAC that it has swung too far in the opposite direction. OP, have you visited the I can website? Lots of help for you there. http://www.ican-online.org/vbac/home |