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VBAC
Candidate for VBAC?
What kinds of things can make you a candidate for VBAC? I had a c-section with my son after pushing and them telling me he was stuck and heart rate stopped whenever I pushed. At that time the dr who delivered said I'd have to have c-sections b/c I am too small to deliver. But the dr I saw for my first visit said I don't have to. What kinds of things do they look at/for to determine if you can or cannot have a VBAC?
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Re: Candidate for VBAC?
There's no way to determine ahead of time if you are too small to deliver, assuming you don't have any obvious pelvic deformities. It can depend on a lot of things like the size of your baby, how much the baby's head molds, what the baby's position is, how much your pelvic ligaments stretch, and what position you are in when you push. Do you know if your baby was in a weird position like sunny side up (occiput posterior)? That can make it seem like your pelvis is too small when it was actually the baby's position that was causing the issue.
Studies looking at women who tried for a VBAC after a primary c/s for being "too small" aka cephalopelvic disproportion or CPD, show that 60% or more were able to deliver vaginally. Keep in mind that the overall vaginal birth rate in the US for everyone is only 68%. So one c/s for CPD certainly does not mean you can never have a vaginal birth.
You can try different pushing positions. Lying on your back is not the best position for many women. Pushing in a squatting position or on your hands and knees can open your pelvis up wider and give your baby more room.
My OB told me that my pelvis was too small too. I have gotten some second opinions who told me I am a great candidate for VBAC and that the problem was more likely the baby's position than my pelvis. So I'm giving it a shot. I will let you know in about 20 weeks how it went
Ditto Iris. The primary thing that would exclude you from a VBAC is if you don't have a low transverse uterine incision. You almost certainly do! Women with vertical incisions are usually excluded from VBACs because the occurrence of uterine rupture is higher. Most doctors will not allow you to deliver twins or a breech baby vaginally, especially if you are a VBAC.
The following things should not exclude a VBAC:
1) Gestational diabetes
2) Two previous c-sections (many docs will exclude you anyway)
3) Having an epidural
Sunny side up can make a HUGE difference! I also understand being upset after your c/s. Totally normal feelings I would say.
I know what you mean. I was so excited when I started pushing and the thought of still needing a c/s never even entered my mind. When my doctor said I needed one, it seemed to come out of nowhere and I was so close that it just seemed like a cruel joke. I was pretty upset about it too.
I found out later that there are other ways to try and address an OP baby besides a cesarean. If the OB can manually rotate the baby with forceps, it significantly reduces the c/s rate. And pushing in different positions can help get an OP baby out vaginally, it just might take longer. You can also try getting on your hands and knees to flip the baby, but this works better before the baby is engaged in your pelvis. We didn't try any of those things, so I still wonder if I could have gotten her out vaginally with a more supportive doctor. So when I got pregnant again, this was one of the first things I asked my new OB about.
Hopefully we will both have anterior babies and VBACs the second time around.
Check out spinningbabies.com for info on how to prevent malpositioning (which posterior is MOST definitely).
If they were losing fetal heart tones with pushing there was probably some cord in the way as well.