vbac w/ GD after failure to progress Csec

laurenmae1228

Hi ladies. I'm not currently pregnant, but DH and I are planning to try in ~9 months, and I'm just the type of person who needs to research every option, etc to feel at peace. 

This may be a stupid question, but am I able to make an appt with a MFM/perinatologist for a preconception visit? Because I have so many questions related to complications with my first pregnancy. I'm really trying to figure out if a doc would support my feelings of wanting a Vbac, or if it's truly not a good idea for the baby (or me, I guess). 

First pregnancy was complicated. I had hyperemesis g (vomited 24/7 until 27 weeks; had to receive iv fluids in the hospital a few times, and only stopped vomiting due to the miracle drug of Zofran and multiple acid-reducers, etc), so lost weight at first. Then diagnosed with GD at 28 weeks. (Family history of Type II Diabetes is crazy, and I was (and am still) overweight). Morning sugar levels refused to be controlled, despite me following an extremely strict diet to the letter. Had to go on insulin overnight. I was able to control baby's weight really well; he was 8 pounds even at birth, and I only gained 18 pounds total.

I had a Foley bulb induction at 39 w 2 d. I was not dilated, effaced, etc at all in any way. My doc would not allow me to go to 40 weeks because of the GD, but was still willing to try a vaginal delivery, because the baby had performed well on all NST and BPPs, fluids looked good, and size looked good. Well...my labor failed to progress. The Foley bulb was supposed to get me to 3 cm, but when it fell out and they checked, I was only around 1cm! So they started pitocin, and I was having fantastic contractions, but I just would NOT dilate, and the baby's head was so high, they couldn't even break my water until a few hours later when I FINALLY got to 2- 3cm. They broke my water, and continued to pump pitocin. First epidural failed, so got a 2nd, which finally worked. 24 hours later, I was still barely 2-3cm diated and the doc told me I was "failure to progress", and since I had GD, they were concerned for the baby's sugar levels and recommended a C. So I did. DS seemed to be stuck (they actually bruised his shoulder/chest pulling him out; he wound up with really bad [dangerous] jaundice because of this), and his head was definitely coneshaped. However, none of the docs ever said anything to me about me being too small, or him being in a weird position (his BPP a few days before had him in perfect position), or anything. He was only 8 pounds even, and his head only measured in the 39th percentile, so he wasn't a huge GD baby either; I can't imagine how he would've been stuck. 

Labor/delivery aside though, my CS recovery is what truly scares me about having a RCS. I had a hellacious recovery. My CS incision opened up and would not heal. I wound up with a raging staph and strep infection, had to go to hospital wound care center weekly. My husband had to pack/unpack my wound twice daily. Because of the staph infection (which took 3 rounds of antibiotics!), I also got mastitis, and despite antibiotics/lactation consultations,(although I did also have latch/flat nipple issues too), my milk dried up at 6 weeks. 14 weeks after delivery, I had to have a 2nd surgery to remove a forming seroma and finally stitch me closed. It took another 8 weeks to heal. (And still hurts/feels weird now @ almost 9 months). My DS was 5 months old before I was allowed to even take a bath, do more than pick him up (as in, carry him more than a few feet before having to sit down/put him down), etc. Since my GD disappeared right away after the pregnancy, and I was eating healthily, forcing lots of water (particularly to try to keep my milk production up), still took vitamins, took probiotics, pumped up my protein intake, etc- nobody knows why I wouldn't heal!

So basically, I have NO idea why my labor didn't progress last time, I'm assuming I'll have GD again this time (the likelihood is extremely high b/c of family history), and I'm terrified of a horrible RCS recovery with no idea how I'd take care of a newborn and my then-toddler DS at that point. So I'd REALLY like to go for a Vbac. However, both my doc (and his entire practice) AND the hospital I delivered at refuse to do vbacs for anyone (let alone anyone with some complications, like me). I'm obviously looking into a new hospital & new practice, but I really want to just chat with a MFM/perinatologist ahead of time to see if a VBAC is even a possibility for me. Because if it isn't, I will need to take these next few months to get myself used to the idea of a RCS and make peace with it. 

I guess I don't really have many questions, so much as I needed to vent, but...does anyone have a similar story and had a successful Vbac with GD, after a failure to progress C? Or had a non-healing incision, then had a successful Vbac? I really just need some hope, I guess. (And if you got this far, thank you so much for reading this!)

acaudill75

Ok, I won't answer all your questions, but I will try to give some insight where I can. Your Hyperemesis has nothing to do with your ability to have a successful VBAC, although I do feel terrible for you, since I was taking 8 mg, 3X a day for BOTH pregnancies. Was your OB monitoring the size of your son? Because 8 lbs at 39 weeks is not that big that they needed to induce you. DD1 was 8.5 lbs at 39 weeks, and I had a CS because of failure to progress, but not because of size. I went with a VBAC because I lost almost 1000 ccs of blood during the section and was very weak afterwards, and we wanted to minimize bleeding. I ended up with a cervical tear and lost 2.5X that with DD2, but that's because her head came out 14 cm and ROUND, not cone shaped, like they are supposed to be. She also had her cord wrapped around her neck twice, and her HR was decelerating with each contraction. I spiked a fever, which may have indicated an infection, and my OB NEVER does VBACs. Still, she didn't push a section, and I was able to push DD2 out. I don't know where I got the strength, but I did it. Without your healing issues, I would say you could totally do a VBAC. But, you do have those complications, so, I don't know how that effects your risk of uterine rupture. I wouldn't want to go through what you went through either, so I would try to find someone who will work with you until the very end to give you a "cut free" birth. GL!

Jena503

With my first, I was failure to progress and had a c/s. I was induced early for a high(ish) BP. With my 2nd, I had GD, though it was diet controlled, no meds. My OB allowed me to go to 41.5 weeks and I had a vbac. GD alone isn't that big of a problem if it's well controlled, but being on insulin tends to put you on a tighter timeline.  For my 3rd, I actually ended up NOT having GD again. I was completely and totally shocked as I am overweight, have a family history of diabetes, and had GD previously. But I passed the 3hr glucose test with flying colors. Apparently it's the placenta itself which is messing with you.

Are you the best candidate in the world? Probably not, because you didn't dilate that far. But an induction when your body gives no sign of being ready isn't really indicative that your body can't do it at all... the catch is that you need to be able to wait long enough for your body to be ready. And if you're on insulin again, you will most likely be required to go into labor before 40wk to get a trial of labor.

laurenmae1228

Thank you both so much. I know my post was a lot to take in (mostly venting, really); I appreciate you taking the time to read it! You did give me some hope! I know I'm probably not the best candidate, and I'll accept that if I have to for the safety of the baby. But for my peace of mind, I have to explore the option of a Vbac first! I'll definitely start looking around for a MFM/perinatologist.