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VBAC
XP Uterine Windows/Rupture?
I guess I've gotten to the point where I'm talking to my OB about plans, and I wanted to compare notes. Anyway, here's what mine says!
She's totally supportive of the choice and just gave me an info sheet about the risks of repeat CS or VBAC to read over and sign.
She also said that I was welcome to try going med-free, but if I needed a CS, they'd have to do general anesthesia instead of a spinal block, and that can have extra risks for me and baby. Alternatively, I can try to wait until I'm 4-5 cm dilated to get an epi, and then they can use that to do a spinal in case I need it. I definitely don't want a general for a CS like I had last time, though, so I may just go along with the epi. I guess I'll decide later.
The success rate for VBAC is around 60-80%, which is great news considering that the CS rate in general is about 30%.
I asked about "uterine windows" or thinning of the uterus around the CS scar. Some women I know have been denied a VBAC or trial of labor because their OB sees thinning on an ultrasound. My OB said that the research on it isn't really good enough to use uterine thickness as a predictor of rupture or success during a VBAC, so they just use fetal monitoring to detect the first signs of a rupture, since apparently fetal distress is the first clue.
That's where I'm really concerned, because it seems like other OBs take the uterine window thing really seriously, and mine doesn't take it into consideration at all. I also worry about getting a repeat CS I don't need because a tiny bit of fetal distress would make them worry about rupture and stop the VBAC.
VBAC ladies, what are your OBs saying?
BTW I got pregnant 7 months from my CS delivery, so the labor should be about 16 months after my CS. Reasons for CS were breech baby in distress because of labor they couldn't stop with meds at 25 weeks. It's a long story, but there was infection inside the uterus causing labor.
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Re: XP Uterine Windows/Rupture?
There really isn't a lot of research on it and logistically, your uterus thins some as it stretches (think like when you blow up a balloon). Many OBs use it as an "excuse" to push a CS, the same as "the baby is too big", "you can't go past your due date", etc.
If your OB is good, they won't push a CS just beause of "a little fetal distress". I VBACed with a midwife. Other than my 20 week ultrasound, we did no monitoring of the scar, the size of the baby, etc. Had there been any scientific research that suggested this was in any way a factor in a VBAC, obviously we would have done these things.
FWIW, I had continuous fetal monitoring during my VBAC as well as pit. the entire time. All was well and baby girl arrived safely!
I have never heard of general anesthesia for a VBAC turned c-section. Or that you only have a window to get an epidural until 4-5 cms. And I agree that "any sign of fetal distress is a RCS" is sort of questionable, too. Did she give details of examples of how long or what sort of fetal distress she was talking about?
I do agree with your OB on the uterine window thing, though, I don't think it's a huge predictor of anything.
It might be worth your time to interview a different provider and see how they handle VBAC moms, bc I yours doesn't sound especially supportive. I had a midwife also, and even though I planned on going med-free, she never said I would be put under with an unplanned section. hth and good luck!
DS2 - Oct 2010 (my VBAC baby!)
I think the reason she said I'd need to be put under is because I had to last time. My spine is a bit wonky I guess and I had to have my first epidural redone, and the spinal for my CS had a window on my left side as well, and since it was done on an emergency basis they had to put me out so they could get baby out and revive him.
I didn't think she meant I couldn't get it after 4-5 cm, just that it would be a better place to get it than right at the beginning. Of course I realize an epi can seriously slow things down, so I'd want to wait at least until then if I can!
I really have no idea what level of fetal distress they look for, I'll have to ask more about that. I have read that fetal monitoring isn't really helpful in preventing fetal/neonatal deaths, but only increases the CS rate, so I just wonder what the research is supporting watching for rupture this way and for fetal monitoring helping maternal mortality rates during a VBAC. I'm not a huge fan of fetal monitoring in general, since it's very uncomfortable and confining!
Ah, that makes a lot more sense about the general anesthesia! And yeah, I agree with the epidural - if you can hold off getting it as long as possible, that would be ideal.
Ask about telemetry units! They are wireless monitors, so you can labor up and about. And you can also ask if monitoring for x minutes at a time, and then being able to stand and move around without it. It might also be worth it to talk to some doulas, also, bc they have tons of tricks for laboring comfortably in a hospital with various limitations (and most will still be happy to be your doula even if you plan on an epidural). hth
DS2 - Oct 2010 (my VBAC baby!)