VBAC

This will probably be rambly, but I need some advice.

I'm going to try to keep this as short as possible:

First pregnancy:  (Pit-) Induced at 41 weeks with no dilation and not much effacement.  36 hours of labor, pushed for 1 1/2 hours, his head would come down while pushing, but go right back up after stopping.  We're not sure he ever really engaged.  Anyway, I pretty much gave up and we did a section.  After birth and for weeks later, he had internal bruising on both shoulders from, what docs think, being stuck in birth canal.  He was 9 lbs. 12 oz. and over 22" long. 

This pregnancy:  I'm 32 weeks and baby is measuring, via u/s, large.  Head, belly and femur, measuring multiple times/ways are all measuring 3-5 weeks "ahead" and weight is estimated at 5 lbs. 3 oz.  And again, I should have 8 weeks to go.

My care providers (midwife, supervising OB and PA) seem to be truly supportive of having a VBAC and right now, my plan is to go for the VBAC if labor happens spontaneously.  If I end up like first pregnancy (closed up tight at 41+ weeks), I'll do a RCS.

Last appointment (a few days ago), PA suggests that, because of this baby's (estimated) size, I may not be able to push him out, either, since I wasn't able to with my first.   There was a term she used for this and it had an acronym with it, but of course now I can't remember it.  CPM?  CMP?

Anyway, I'm afraid she could be right but I also feel that there are many women out there that push out ten-pound babies, too.  

She thinks we'll have a better grasp on size and can better determine what to do in a few more weeks, or closer to full-term, and can make a better plan of action then, but I can't stop thinking about what I should do.

Any advice?  Anyone have a similar "set-up?" 

Re: This will probably be rambly, but I need some advice.

  • I guess I have a few questions first, if that's OK?  Was your bag of waters artificially ruptured?  Did you have an epi?  Which position(s) did you push in?  Were you pushing when they told you to push or when your body was? Were you induced for any other reason besides being 41w? 

    More often than not there are other factors at play and the baby can be in a bad position.  True CPD is kind of rare.  Here's a blog post on the topic:

    https://birthingbeautifulideas.com/?p=560
    DS born via c/s 11/08 and med-free GD VBAC DD 3/11! Baby Birthday Ticker Ticker Baby Birthday Ticker Ticker
  • imagechicsub:

    I guess I have a few questions first, if that's OK?  Was your bag of waters artificially ruptured?  Did you have an epi?  Which position(s) did you push in?  Were you pushing when they told you to push or when your body was? Were you induced for any other reason besides being 41w? 

    More often than not there are other factors at play and the baby can be in a bad position.  True CPD is kind of rare.  Here's a blog post on the topic:

    https://birthingbeautifulideas.com/?p=560

    Totally OK.  Yes, water artifically broken same morning as pitocin was started.  I got an epi after 24 hours of labor (and finding out I was only at 3 cm).  I pushed in bed (because of the epi, obvs), sitting, using bar and on my side.  I pushed during contractions.  Nope, was induced because I was 41 weeks (and they were expecting quite a big baby - and he was).  

    Hindsight's 20/20 on that induction.  I feel like I was pretty well-informed during pregnancy, but at the end, I was done and so ready for the induction.  Silly me thought it was going to be a pretty easy process!  Had I known what I do now, I would've either held off the induction (which my CNMs would've been OK with) or started the induction with some cervix-ripening drugs first.

    ::off to read blog post::

    Thank you in advance for any advice.  :)

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  • I had a similar story.  2 weeks late. 59 hours of induction.  I had 2 rounds of cervadil and 1 cytotech (sp?), then lots and lots of pit.  I eventually did get to 10 and tried to push for an hour or so, but I was exhausted, my pushing was weak, and the doctor was encouraging me to get the c-section.  So, I gave up.  DD was 9lbs 1oz and 22 inches. My diagnosis was either CPD or FTP or a timing issue, because my water had broken 24 hours before.  I don't remember the actual diagnosis.

    I understand your concern and your PA's.  Shoulder dystocia is very serious.  I would follow your PA's advise and continue to monitor your progress.

    For me, I still believe I could have gotten DD out vaginally.  I needed a better support team in place and I needed to work through the pushing phase better.  I didn't move around enough and the nurse kept laying me flat.  So, I personally would like the opportunity to try again with someone there who is on my side. 

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  • I'm just going to be blunt and say that your PA does not sound supportive.  They are already scaring you to think that you are not capable of birthing a "large" baby.  Honestly, do you think that in a few weeks after they do more growth ultrasounds they will say that he or she is not big and that they are willing to let you go into labor spontaneously?  I doubt it.

    My opinion is that you would have had a different outcome with your first had you not been induced.  After having a successful VBAC, I know now that if I had not been induced at 42 weeks and had been given a few more days, that I could have and would have birthed by 9 lb 10 oz first child instead of a c/s after a failed induction.  I was told by everyone that I would probably have a c/s because my mom did and my aunt did because we are all small, but I proved them wrong.

    You can do it.

    Baby Birthday Ticker Ticker Baby Birthday Ticker Ticker
  • I agree that the PA doesn't sound supportive.

    My VBAC baby was significantly bigger than my first - he was 10 lb 10 oz. For me, it was all about positioning - he was in a good position, and I was able to labor mainly at home and upright.  I'm sure being induced, etc didn't help anything with your first birth. Lots of women on this board have gone on to birth VBAC babies that were the same size (or larger) than their c-section births.

    I dunno, it's obviously a decision only you can make, but you have a reasonable chance of success if you attempt VBAC, especially if your providers are willing to wait for you to go into labor on your own (which is the recommend course of action for suspected macrosomia, anyway).

    Another thing to think about scheduling a RCS at 41 weeks is that you might also just have babies late - I didn't go into labor with either of my sons until 41 or 42 weeks. hth

    DS1 - Feb 2008

    DS2 - Oct 2010 (my VBAC baby!)

  • I have not had a vbac but just to give you hope on size...my first was 9.13 and I basically had the exact same problem with you. For the second(and third), I was uneducated and listened to what everybody said about big babies and that they were measuring "large" and I had 2 more c-secions. My second was 7.13 and my third was 7.11. So, if you want my advice, I say to educate yourself and find a provider who is in line with your views and go for the vbac!!
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