Failure to progress : why risk for repeat c/s?

StaceFace09

Hey ladies!

 

Does anyone understand WHY, if you had "failure to progress" (in my case, never dilated past 3 cm in 40 hrs of labor) in your previous labor, it decreases your chances of a successful VBAC? I don't get it and I don't want it to be true! Any thoughts on this? Thanks!

 

 

lorryfach

There are three ways a lot of doctors will categorize VBAC candidates:

1) women who have delivered vaginally before - in this case, you KNOW it's possible, so the chances are the highest

2) women who had c/s for fetal distress (or really, any reason you KNOW is because of the baby and NOT YOU) - in this case, there is no reason to think it will happen again, so your chances are still pretty good

3) women who had c/s for FTP

In the third case, it MIGHT be something that will happen again. For example, if your pelvis really, actually is too small to deliver a baby, that's going to be a problem every single time.

The thing is, you can fail to progress for many, many reasons, and all of them are lumped into this one category. The women who definitely cannot deliver a baby vaginally will be in this category and bring down the % for everyone else. If you know the details of your particular situation, your chances can go up or down. For example, a cord wrapped around the baby such that it can't descend (thus it's not putting proper pressure on the cervix to help you dilate) is not likely to happen again, so your chances would go up.

That's why it helps to talk to a care provider to access YOUR personal risk, potentially getting a second opinion if you don't think they've considered everything. 

Brownie_222

I would be curious to hear more of your birth story if you're willing to share. I was "ftp" but it was an induction at 41 weeks and I had a cesarean less than 12 hours after they induced. I was at 4 cm and my surgery was at 6 p.m. I've since been told by a different OB that it appears I had a convenience section (doctor's convenience, not mine).

Sam78

Perhaps in your case it would be something along the lines of your body not knowing how to dilate?  That being said, there are a lot of different factors and perhaps your body just takes a long time to dilate (i.e. more than 40 hours).  I can say that I had a repeat c/s after a TOL and I wouldn't go any other way (birth story in my siggy)

Brownie_222

Based on those details, I would think that same situation is unlikely to repeat and you'd have a solid chance at VBAC success. I'm not a doctor but I think your odds are very good. Sorry you had to go through that!

StaceFace09

Brownie_222:

I would be curious to hear more of your birth story if you're willing to share. I was "ftp" but it was an induction at 41 weeks and I had a cesarean less than 12 hours after they induced. I was at 4 cm and my surgery was at 6 p.m. I've since been told by a different OB that it appears I had a convenience section (doctor's convenience, not mine).

 

MY experience was that my water broke first and then contractions never came. Eventually they started me on Pitocin, which they had to majorly max out to get me to go into active labor. In the next 12 hours I only dilated 4 cm and they were concerned that I needed to get the baby out because it had been 40 hrs since my water had broken. Also, my baby was facing up, so his head may not have been properly engaged and not stimulating my cervix to dialate at an appropriate rate. What do you think? 

 

THANK YOU so much for all your wisdom and help, ladies! I carefully read and studied each response and they're all very helpful!

StaceFace09

lorryfach:

There are three ways a lot of doctors will categorize VBAC candidates:

1) women who have delivered vaginally before - in this case, you KNOW it's possible, so the chances are the highest

2) women who had c/s for fetal distress (or really, any reason you KNOW is because of the baby and NOT YOU) - in this case, there is no reason to think it will happen again, so your chances are still pretty good

3) women who had c/s for FTP

In the third case, it MIGHT be something that will happen again. For example, if your pelvis really, actually is too small to deliver a baby, that's going to be a problem every single time.

The thing is, you can fail to progress for many, many reasons, and all of them are lumped into this one category. The women who definitely cannot deliver a baby vaginally will be in this category and bring down the % for everyone else. If you know the details of your particular situation, your chances can go up or down. For example, a cord wrapped around the baby such that it can't descend (thus it's not putting proper pressure on the cervix to help you dilate) is not likely to happen again, so your chances would go up.

That's why it helps to talk to a care provider to access YOUR personal risk, potentially getting a second opinion if you don't think they've considered everything. 

 

HUGELY helpful - thank you!!!