cpd c-sec/vbac questions (long sorry) — The Bump
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cpd c-sec/vbac questions (long sorry)

Hey everyone

I had a c-sec for cpd 2.5 yrs ago and we're planning to start trying for #2 soon. I've just started exploring my options re:repeat c-sec or vbac but still have loads of questions.

With DS I ended up being induced at 40 weeks due to sudden pre-e (on the day I came in for routine exam for GD). They decide to induce me right then and there. I ended up laboring for 30 hrs, I fully dialated and pushed for almost 3 hrs. The doctor (not my OB we switched hospitals in the last two weeks b/c they found that DS had a heart defect so we wanted a hospital w/ a great pediatric cardiology dep) then announced that DS was not progressing through the pelvis and that they don't let women push for more than 3 hrs and that I'd need a c-sec. I ended up getting general anesthesia and not seeing DS until he was 2 days old (which made breasfeeding a huge challange for us). Long story short I did not have a good experiance and in the case of another c-sec may end up w/ general anesthesia again (they couldn't get the spinal in for some reason and told me to get an MRI before TTC again).

So my questions are

1.If you had a c-sec due to cpd, are u planning (or did you successfully) a VBAC? why/why not?

2.Is there a way to find out for sure if something's wrong w/ my pelvis before I get preg again?

3.If I hire a doula for a VBAC, would my ob still be there? could I still have an epidural?

I read that laboring standing up or walking around may help w/ cpd (if that was the reason) births. Is there a way to do that AND get an epidural? (I'm a huge chicken when it comes to pain).

TIA

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Re: cpd c-sec/vbac questions (long sorry)

  • my c/s was not for CPD, but there is a girl in my VBAC Support Group whose first c/s was for CPD.  Her story is very similar to yours (got to a 10 and pushed for 3 hours when they told her 3 hours was the pushing limit).  She went on to have a VBA2C with a baby only 2 oz smaller than her first baby Smile.

    I don't know about your 2nd question for sure, but I don't really put a whole lot of credibility in anything like that, especially since your bones move so much when you are pregnant and in labor

    a doula is just there to support your as the laboring mama.  you still have an ob or midwife and you can still get an epidural.

    being able to move when you are in labor helps lots of things.  It helps the baby get into a good position, eases the pain of labor, speeds up labor, etc.  I have heard of "walking epidurals" but I don't know much about them.  I do want to say though, that if you go into labor naturally and are able to move your body the way you want to, you may find that labor isn't really painful.

    I am a big sissy when it comes to pain too, but I was never really in pain when I was in labor.  It was really intense, but not painful.

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  • Well, slightly different circumstances than yours, but I'm attempting a VBAC after my doctor believed DS wouldn't fit (never got to the pushing stage, but he wouldn't descend). 

    It's SO hard to correctly diagnose CPD from everything I've read.  Baby positioning can have a lot to do with it.  Epidurals don't help, as lying flat on your back is one of the worst ways to push, and makes your pelvic opening much smaller than if you're squatting or sitting upright.  There are walking epis out there, or so I've been told, but haven't really heard about anyone who has gotten one.  They should be able to turn down your epi (I'd discuss this beforehand) so you can feel the pushing urge better (which will often help you to make your pushing more effective anyway), and get you to a point where you can probably at least sit up with some additional support. 

    I, personally, am going to try and go without so I have as much freedom of movement as possible to deal with any baby malpositioning, as it's one of my biggest concerns for not getting a VBAC.  I'd discuss your options with your provider - see if turning down the epi is a possibility, and what movement that may allow you. 

    Ditto pp - your body and pelvis undergo a lot of changes when your pg, and the female pelvis is made to expand so baby can fit.  Most true cases of CPD (from my research) are due to illnesses or malnutrition in the mom that has prevented correct growth.  A lot of CPD is misdiagnosed, or caused from problems with baby positioning and sometimes cord issues rather than size of baby or mom's pelvis. 

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  • 1.  I had my c/s for CPD, but I don't think that is an accurate diagnosis for me.  My daughter was persistent occiput posterior, so she was malpositioned.  CPD cases are often misdiagnosed malpositions.  Malpositioned babies have trouble fitting through the pelvis because of their position, and it may have nothing to do with the mother's pelvic dimensions.  Also, if you pushed lying flat on your back, that position actually makes your pelvis smaller.  There are positions like squatting and hands and knees that open your pelvis up more and actually make it larger.  68% of women who had a c/s for CPD are able to have a VBAC.  When you consider that the overall vaginal delivery rate is also right around 68%, your odds seem pretty good!  

    So I am planning a VBAC.  I have talked to my doctor a lot about what happened with my last labor and what we could do differently.  We talked about manually rotating the baby, pushing in different positions, etc. I am also planning to hire a doula.

    2. There is no way to tell for sure if your pelvis is large enough.  Unless you have an actual pelvic deformity, there is no way that they can tell you if you can have a VBAC or not.  The only way to know is to try and push out a baby again.

    3. A doula does not replace a midwife or doctor, so you would still need one of those at your birth.  But I think hiring a doula would be a great idea for you.  And yes, you can still get an epidural if you are trying for a VBAC.  You can have them turn it down lower before you start pushing and you can even try pushing in different positions--ask for a squat bar and have your husband and doula help support your legs.  You can't walk around with an epidural but you can wait until you are later in labor to get one, and that way you can walk around a lot before that, which will hopefully help your baby get into a good position.  You can also have them check the baby's position (anterior, posterior, etc.) before you get the epidural).

    HTH! 

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  • I had a c-section with DS1 - he was 8lb, and never came out after 4+ hours of pushing. It was discovered that he was posterior (sunny-side up), which like everyone said above, can be a reason instead of CPD. I had a VBAC with D2, and he was 2+ lbs bigger. No question, for me it was 100% positioning that led to my c-section.

    Talk to your provider about your concerns about your pelvis, but be aware that if they aren't truly supportive of VBAC, they may try to tell you something's wrong with your pelvis when it's actually fine. hthand good luck deciding what to do.

    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

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