VBAC
So sick of being told "because you pushed"
I have a lesser chance of a successful VBAC. How many people who are told that by their doctor then actually attempt a VBAC?
"Little seahorse/Floating on a primal tide/Quickening like a/Spark in a haystack side/I already love you/And I don't even know who you are" -Bruce Cockburn
BOOKWORMS and BUTTERFLIES
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Re: So sick of being told "because you pushed"
I havent attempted a VBAC yet, but this is the reason why I am switching providers. My doctor told me "because you got as far as you did, you will have a 1-3% sucess rate."
I havent looked at my medical records, but I had my section due to "Fetal Distress." My daughter's heartrate did drop and I was rushed away. However I bet to believe that my medical records give me a diagnosis of Failure to Progress and CPD. I pushed for 2 hours with out making progress (I also have a feeling that my daughter was not in position, I never felt the pressure that some woman feel at the end of pregnancy when the baby drops) and as far as CPD my doctor told me "they really had to pull to get your daughter out. She was stuck in there pretty good." A Nurse later told me I had a small pelvis.
So with that I have found a doctor that is a "legend" in the VBACing community here in Wisconsin so I am going to go to him and see what he says before I get pregnant again.
TTC #1 Cycle 14 - IUI#1=BFN, IUI#2=BFP | TTC #2 Cycle 8=BFP!!
Yeah.
There are some studies finding that women who had a c/s after full dilation have very low VBAC rates. The thinking behind this is that if you dilated all the way and couldn't get the baby out, there must be something wrong with your pelvis, and that therefore the same thing would happen in any future deliveries. This is what my old OB told me. She pretty much told me not to even bother trying for a VBAC "unless it was a preemie."
But I think those studies looked only at dilation and didn't account for the reason for the c/s. There are many different reasons that you could have a c/s at full dilation that has nothing to do with your pelvis. If you look at studies that break down VBAC rates by the reason for your primary c/s, they still show that "CPD" moms have VBAC rates over 60%. So obviously a lot of CPD cases are either misdiagnosed (perhaps due to a fetal malposition) or was a case of relative, not absolute, CPD.
I found one study that looked at VBAC rates in conjunction with your dilation at the primary c/s AND whether the c/s was for a recurrent or non-recurrent reason. It found that if you had your c/s for a non-recurrent reason (e.g. breech position, fetal distress, etc.) and you dilated 8 cm or more, you had the highest chances of having a VBAC. If you had a c/s for a recurrent reason (e.g. CPD), it didn't matter how dilated you were.
However, sometimes it can be hard to know if your c/s was truly for a recurrent reason or not. Going back to CPD, that is obviously a recurrent reason, but we still see that more than a majority of women who had a primary c/s for CPD are able to VBAC, so it's really not that recurrent, is it? And many CPD cases are misdiagnosed. My old doctor told me that my c/s was for CPD, recurrent. But I also know that my daughter was OP and OP babies have high c/s rates. So it could be that my c/s was actually because of a fetal malposition, a non-recurrent reason, rather than CPD, a recurrent reason. In that case I go from having the lowest VBAC odds to the highest (had a c/s at 10 cm for a non-recurrent reason). In the end my odds don't really matter because I'm going to try for a VBAC either way and stats can't tell you what will happen for sure.
Here's that study:
https://informahealthcare.com/doi/abs/10.3109/14767050902874089
I wonder the same thing. Do a provider's preconceived notions about your ability to have a vaginal birth affect the kind of care they give and when they might decide a c/s is necessary? Even if it's not the same doctor, if they know you had a c/s for CPD, are they going to jump at the first blip on the HR monitor and do another section? Or if you have slow progress pushing, are they going to think it's obviously your pelvis and not be as patient as they would with another woman?
That study is extremely interesting. Until today I had never heard that pushing = future c-section. I go today for my postpartum check-up and am interested to see what the "official" reason for my c-section was. I dilated to just under 10 cm (took ~60 hours, but that is a story for another day) and pushed for 2.5 hours, however LO never descended all of the way. He was OP as well.
I think so. I have 2 girlfriends who used the same provider (acutally the same one I did, but I think I was just lucky to get to the hospital pushing) and she was talking c/s to them WAY early. One girl she didn't even see, just spoke to on the phone and said it was "looking like a c/s". It's really said I think. One ended up with a c/s and the other fired the midwife and pushed her baby out after something like 2 days with ruptured membranes.
Argh, I swear I just read somewhere that there's studies that show women (and their providers, I think?) who have no idea what size their babies are have higher rates of vaginal deliveries, which is along the same lines as what you guys are talking about...I can't remember where it was, though! Damn new baby/lack of sleep memory loss!
To the OP: I was constantly told by my midwife that I "got credit" for what my body did during my first son's labor (in my case, I fully dilated on my own, and then pushed for 4+ hours - he was OP, also), which always made sense to me...if your body got to a certain point once, it stands to reason it can do it again. And I really, really think that malpositioned babies are a very common reason for c-sections, but it doesn't seem like it's talked about/studied very often...
DS2 - Oct 2010 (my VBAC baby!)
I've read those studies you are talking about too. Henci Goer also talks about studies on c/s rates that show one of the largest indicators of whether a woman will deliver by c/s is not her medical history but who her care provider is.
Yeah, I agree completely that fetal malpositions are not being addressed enough as a cause of cesareans. I read somewhere that OP position accounts for 12% of cesareans for dystocia. Even in vaginal births, a fetal malposition significantly increases maternal morbidity, yet it doesn't seem like many OBs take the time to look for and address a malposition during labor. I had obvious signs of one and no one did anything about it--so I ended up in the OR.
Ok, so this is the one time I'm going to listen to a bunch of internet strangers rather than my doctors!
I agree that I have a better chance because I have been through it before.
I've never gotten my records, but I do know that CPD is listed as the reason. DD never went into distress, but after 3 hours of pushing, she made no progress after the 1st half hour. I do not know if anything is mentioned about her position, but the bruise she had on her head after she was born was very much to the side - which makes DH and me think she was not in the right position to come down.
Unfortunately, this practice is the only one in my area to offer VBAC. And they are a mixed bunch when it comes to support. But I'm going to be positive that I can do it.