Want to try VBAC but scared of perineal tears

[AdiMom]

First an introduction. I just started posting here after lurking for a few months. I find this board a great place to hang out. I am a WOHM mom with a 4 year old who was born by c-section. Its a long story, lots of interventions during labor starting with an induction, then going to epidural and lying in bed for the rest of labor with an internal fetal monitor stuck to me. I always thought I was a well-informed person, but I still feel guilty about my first labor and how I let things slide.

Back to the present, I am due again in November. I did lots of reading and decided I wanted to give VBAC a try. I found an OB who was open to a VBAC (and it isn't easy around here to find OBs ready to try VBACs). But now I am having second thoughts . I have heard of so many women having post-pregnancy issues with episiotomies and 3rd and 4rth degree tears. These are people from my circle of friends. I wonder why I am opening myself up to that whole can of worms when I could just as easily opt for a repeat C.

The way I look at it, I have this c-section scar already. I'll never be normal there and nothing I can do about it now. But at least my perineum is whole. By attempting a VBAC, I am opening another part of my body to significant damage. If I do attempt VBAC, I am hoping to find a doula to help me through labor though.

I am hoping all of you on this board will help me make a decision one way or another.

Thanks so much.

[JacksMommy]

HI there! Do a search on VBACs (if you haven't already), you will find TONS of previous threads.

I had a cc and a vbac and would never voluntarily choose a cc! Even though my cc experience was relatively good, it was a week before I could walk a mile. With my VBAC, I was at work the next day (just to clean things up since DD came early) and I felt great! I did have a medium episiotomy but really didn't have much in the way of difficulties with pain, etc. And while I never felt gypped by having a c the way that some women have, I really enjoyed the experience of having a vaginal birth. Ok, enjoyed is maybe the wrong word :) but I thought it was really awesome after it was over!

Bottom line, both a cc and vaginal birth have risks. My understanding (I'm no expert) is that cc's have as many if not greater risks than vaginal (even VBAC). There is always some risk involved and you have to do what you feel comfortable with.

That being said, my dr (Kaiser, I'm in CA) would have allowed me to change my mind at any time, which was a source of comfort to me.

Best of luck with your decision!

Laurel
Mama to Jack 6/02 and Maddy 12/04

Babywearing education in Napa, CA

[lizajane]

ok, i am trying to recover from hearing that laurel could walk a MILE one week after a CS and went to WORK the day after delivering her second...

i could not walk up STAIRS after having my first (vaginal delivery) for about a week and most certainly didn't walk a mile that week! maybe it was because i had a giant baby? i dunno...

ok, i have never had a CS. but i did have two episiotomys and i did have a 3rd degree and a 2nd degree tear in addition. the 2nd degree tear was NUTHIN'. i felt much better after my 2nd DS- didn't even need the pain meds after the first day. (until i walked back and forth to the NICU a billion times, and then it hurt again...) the first DS did cause me a lot of pain, but not life altering pain. it went away.

i will admit, though, sometimes i can feel the scar and it hurts a little (DS2 is 20 months.) but it gets better and better as time goes on, so i don't fear for the future.

[emilyf]

Well, I haven't had a c, but delivered two 9+ lb babies and had some tearing with both-after my 1st I had some discomfort, after my 2nd my midwife did such an amazing stitch up job I could hardly even tell after just a few weeks. I think you should go for the vbac if you want-complications can arise either way, but hopefully won't.
Emily mom of Charlie born 11/02 and Zoe born 9/05

[nfowife]

I had a vag. delivery with a 4th degree epis. w/DD and have had no complications. It took about 8 weeks before I didn't feel the scar at times (like if I sat for a really long time at the computer), but I would say that I definitely went back to "normal" and sex feels the same as before.

[LucyG]

Hi!

I haven't read the other replies, but will share my story. My first DD was born by c-section in 2003. She was breech. My recovery from my c-section was very easy, but I knew that I wanted to go for a VBAC when I had another child. I did a lot of research, which further encouraged me to pursue a VBAC. With the help of supportive midwives and a great doula, I had a VBAC six months ago. My VBAC labor was very fast, and I didn't have any medications for pain relief. I had a very short pushing stage (10 minutes), and primarily as a result of the fast delivery, I did have a 4th degree tear. My daughter was only 6 pounds, but she was in a big hurry to get here! Really, in all of my VBAC worries, a bad tear did not enter my mind. My midwife caught my daughter, but the OB had to come in to do repairs on me after she was born. I'll be honest and tell you that the first couple of weeks were very painful. I took prescription paid meds (something I never needed to do after my c-section), sat on an inflated donut, and wondered if I would ever use the bathroom, sit, or have sex again without pain. More than once, I wondered why I ever wanted to try for a VBAC.

Six months later, I can tell you that, despite the pain of the tear, I am more than thrilled with my VBAC birth experience, and I don't regret it for a moment. It was, without a doubt, the most amazing experience of my life. I have never felt more proud and accomplished than I did after giving birth to my daughter. Two weeks post-delivery, I could tell a huge difference in how I felt. A month after her birth, I was SO much better. Now, I feel basically like I always have "in that region." :)

I have not done a lot of research on 3rd and 4th degree tears, but my hunch is that they are somewhat rare. I know that if I have another baby, I will use alternate pushing positions (side-lying, on all fours) to help avoid another tear. There are things that you can do to lessen the likelihood of tearing badly. I think you are on the right track in wanting to find a doula. Mine was invaluable to me. She gave me a lot of confidence and reassurance, and gave my husband and I someone to look to when we were unsure. I would also suggest hooking up with an ICAN (International Cesarean Awareness Network) group in your area. Check out their website, and read about them online if nothing else: www.ican-online.org. The website www.vbac.com was also a great source of info. for me.

You have to go with your gut, but if you really want to VBAC, I would not let the fear of tearing deter you. There are many risks associated with c-sections, as well, and you just have to weigh it all out and decide what is right for you. Feel free to PM me if you have any questions!

[Alice523]

I delivered a 10.5 lb baby with only a minor tear and no need for an episiotomy. (My doctor deserves a lot of the credit. She was great.) I do remember discomfort for about a week afterward, but nothing major. Sex is still uncomfortable if it's rushed (DS is 10 months), but I am breastfeeding and I've heard that can have an effect. I have no experience with c-sections, but just want to tell you that your body may amaze you. Good luck with whatever you decide.

[Scsigrl]

While I have not given birth by either method, I have been there for them.

There a a few different things you can do to reduce the risks of having to have an epi. If you are worried baout this (I know it is one of my greatest fears about a vag. delivery) look into perineal stretching and squatting exercises. They suggest you start these at 32 weeks, so I would look into it ASAP if you are interested in reducing your chances of needing one.

Also, if you make your wishes known to your Dr. abour NOT wanting one (some Dr.'s do it as a routine thing) let them know ahead of time, if they KNOW you are really apprehensive about it they are more willing to help you get through it with out one.

HTH

[ajmom]

Forgive my ignorance, but are tears more common with VBAC? It sounds like tears/episiotomies are something that go along with delivery, VBAC or not...

Personally, I had an episiptomy with my first and I was in quite a bit of pain for about a week or so afterwards. With my second, no episiotomy and no tearing. I felt a million times better without the episiotomy. HOWEVER (having never had a CS, so take with a grain of salt), I would think that recovering from an episiotomy or tear would be a million times easier than recovering from major abdominal surgery.

Since giving birth the 1st time, I've had no lingering problems. I think it's a lot less common than you think overall.

[BaileyBea]

So here's an example of an episiotomy vs tearing. When you get an Episiotomy sometimes the cut is along sensitive areas or areas with a lot of nerves and because Drs don't know exactly where your nerve endings are sometimes they tear them and these nerve endings never really repair themselves. This results in some women having to have extra surgeries to fix it so they can enjoy sex again etc...

Now Take a bed sheet, or cloth and tear it or pull it apart really fast. You will see that it tears along fiber lines. Well your body is made up of these types of fiber lines and tissue as well. This results in you healing better and faster.

Now.... I had two tears a 3rd degree that should have been a 4th degree and a 1st degree. That 3rd degree tear took about 6 weeks to heal but the Dr did a great job sewing me up. After the birth the Dr. had a whole team of people sewing me up as fast as possible. They gave me a shot and I didn't feel a thing while they were sewing. Healing went well and sex after was painful but that was mostly due to breastfeeding and vaginal dryness.

Now the 2nd birth I had a 1st degree. The Dr. quickly sewed me up and it took about 2.5 weeks to heal. I can't really feel the scar at all. I feel so much better.

The thing that made the most difference for me was having a controlled birth experience. DS shot out of me and the Drs and Nurses were running to the table to catch him. DD came out gradually and I had hot compresses with olive oil. DD was a much more controlled experience and therefore I tore less.

I would take tearing over a C/S anyday. And I would take it over an episiotomy too.

[brittone2]

No vbac experience, but I'd also recommend looking into a doula (greatly enhances the success rate of VBACs) and talking w/ your doc about episiotomies. They are no longer recommended on a routine basis, but many docs still do them very very routinely. It can be hard to find out in advance who does them routinely, because a lot of OBs will tell you they only do them when necessary, but have like a 90% episiotomy rate.

Episiotomies can also lead to more extensive tearing. It is like starting to unzip a zipper...starting it can make it more likely the rest of the tissue will tear.

I'm not sure if midwives are an option (I know in a lot of areas women can find midwives that will do vbacs) but often they have very very low episiotomy rates. Even if you can't work w/ a midwife in your area, a doula may be able to tell you about how common episiotomies are with your particular doc, etc.

Look for someone that will apply counter pressure, do oil compresses, allow you to use alternative birthing positions. (I believe sidelying can help reduce tears). Write a birth plan, and get your doc to sign it in advance. Talk with him/her and make sure he/she is supportive of all of these things. They make a huge, huge difference.

I didn't have a big baby, but I guess a fairly average one. He was 8lbs 4 oz. I'm very much on the petite side when not pregnant, and only had a minor tear and pushed for 15-20 mins total. DS had a big head too. I think I had 2 or 3 stitches and I healed very well. I did have a midwife and doula, and they did do the oil compresses, etc. to help me. There's just no predicting who will tear, but with a good supportive team, IMO you can help swing the odds in your favor and hopefully avoid an episiotomy and/or tearing.

I think a lot of pregnant women are scared of tearing, but really, you can do some things that might help swing things more in your favor.

[writermama]

nak. i've had 2 babies. with dd1 I had an episiotomy that tore -- ended up a 3rd degree tear. with dd2 I was worried about the scar increasing the likelyhood of a bad tear again. instead, with dd2, I had NO tears. not even a skid mark.

the big difference was with dd1 i pushed really, really hard. for 3 and a half hours. and i was pushing hard at the end. like i was trying to shoot the baby across the room.

with dd2, i used hypnobirthing and "breathed" the baby out. yes, there was still pushing, but mostly i would stat as relaxed as possible and let my body's involuntary reflexes do the work -- I just added a brief extra "umph" with the peak of each push. and then I was patient while the baby was crowning - letting it take what seemed like forever.

if you decide to go the slow push route, talk it over with your doula and your OB to make sure they're on board.

perineal massage also helps (midwife had us start at 36 weeks) and warm compresses during birth.

even the 3rd degree tear wasn't terrible -- just a few days of ice, midol and lidocane. it all fades into the background when I think about the power of the birth experience.

[SnuggleBuggles]

It is very rare to have a 4th degree laceration without an episiotomy. Luckily the word is out that routine episiotomies are no good. I would hope that a progressive Dr. that is supportive of VBAC would be up on the May 2005 release by the ACOG against episiotomies.

For a few years I moderated a labor board for another popular baby website. I wrote up all sorts of FAQ replies and here is what I have on how to minize/ avoid lacerations:

Something I hear is that mom needed a big episiotomy or tore a bunch because baby was so big. That might be a bit of a leap. More likely it had to do with how the perineum was managed as well as the delivery.

Delivering on your back is one of the worst delivery positions. It applies uneven pressure to the perineum and stretches the skin more taut than in many other positions. Simply avoiding this position could save your perineum. This is a wonderful article about the lithotomy position and what it's drawbacks are for birth and recovery (it's quite an eye opening discussion about how this position even became popular- since it isn't very biologically sound!):

http://www.storknet.com/cubbies/childbirth/pushingpositions.htm

This link explains the advantages of other positions as well as illustrations:
http://transitiontoparenthood.com/ttp/parented/pain/positions.htm



Pretty much any position is better than lying down for birth from a biological standpoint!!! But, probably 90+% of moms birth that way. Why? There are so many better options. You can birth standing up (though more effective is probably squatting). Not to be gross but pushing out a baby is an awful lot like having a bowel movement and for that there are toilets. They are at a good height and help moms really use good leverage and the muscles that they have been building for years. Since most moms wouldn't want to push over a toilet there are birthing chairs- same principal of a toilet but no water or bowl, just a place for the Dr. or midwife to be able to help.

There really are many better positions. Most any good birth book will tell you them and explain why they are good. I'll post a link that has that info. But, 2 good books are "The Birth Book" by Dr. Sears and "Pregnancy, Childbirth and the Newborn" by Penny Simkin.

Good link:
http://www.obgyn.net/displayarticle.asp?page=/women/articles/reviews/review007



Choosing a careprovider that doesn't put time limits on the delivery is another thing mom can do. I can't even count the # of moms who come back with their birth stories and say that they pushed for an hour or less and weren't making progress so the cp did an episiotomy or used an instrument to deliver baby. That just bothers me a lot. Given plenty of time- and opprotunity to try different things- many moms could be spared these invasive proceedures.

If the perineum is respected by your care provider then you should feel good that they will do their best to minimize damage. There are questions you can, and should, ask at your next appointment.
Find out how often your Dr. performs episiotomies.
-The answer should be less than 25% and ideally less than 15%.
-The answer should be "I try to avoid an episiotomy unless the baby has to come out immediately. I prefer to do perineal massage and a controlled pushing phase." The American College of OB/Gyns does not recommend episiotomies as a matter of routine or to prevent tearing (it is widely known that an episiotomy can cause you to tear more than if you just tore. The analogy is that a pair of jeans that already has a hole in them is easier to tear than a pair of jeans that is still intact).

What reasons do they perform episiotomies?

What preventative measures do they do to help avoid an episiotomy or tearing?

Will they pressure you to an episiotomy if it looks like you are going to tear.
-Discuss this before you are in labor and pushing b/c when you are pushing you will be too preoccupied to make rational, well thought out decisions that can have a profound effective on your future births, your urinary and fecal continence and your sex life.
-You hear of Dr.s and nurses recommending cuts in labor so it is very good to be clear ahead of time what your preferences are. You are the one who will have to recover, not them.

Their attitude towards episiotomies can tell you a lot about their birth attitude.
-Will they rush you throughout your birth? If pushing is "taking too long" but you and baby are well, will they still recommend an episiotomy? How often do they augment labor with pitocin or breaking the water? Are they willing to let nature take its course if you and the baby are well?
-How much do they respect you? Do they want to help you have an easier recovery?
-Are they cool with letting you labor and deliver in positions that are best for you even if they are less than ideal for them? Squatting and all 4s are so much better than being on your back and they know that. It is a lot easier for them though if you are on your back and legs in stirrups.

Are they patient, laid back in a low risk healthy birth, respectful and up to date with current ACOG recommendations?

The ACOG does not believe in setting time limits on the delivery of baby if all is well. They acknowledge that a first time mom can easily take 3+ hours to push baby out, especially if she has an epidural.

There are some myths that it is dangerous to push for a long time. If mom and baby are doing well then that is not true. There are also options to pushing as soon as you hit 10cm anyway. I'll discuss that in a second.

Setting time limits sets up a lot of pressure on mom to perform and that can make things even harder.

There should be no timer that goes off after X time telling them to do an episiotomy to speed things up (BTW- this has been found to, at most statistically, speed up delivery by 5 contractions!) nor should they reach for the vacuum or forceps. Barring fetal distress, the ACOG does not recommend any of those practices. I know that some moms just get tired and don't care anymore- they just want the baby out. However, there could be long term consequences for that impatience.



What else can you to to help keep your perineum in tact?
-Kegels!! At least 5 sets of 10 per day!! These will help you to know how to control those muscles so that you can effectively relax them when you push. They will also help speed up recovery since when you use muscles you send more blood to the area.

-Stay upright during the pushing phase (squatting) b/c that will help the baby descend. You can deliver like that or change to another position for your last pushes. Other positions like sidelying can be beneficial. Actually for the actual crowning squatting isn't great because your perineum isn't as relaxed in that position since so much weight is bearing down on it. But it is a great position for moving baby down.

-Try a variety of pushing positions if your progress slows. Hands and knees, side lying, use a birthing bar...More advice:
http://askdrsears.com/html/1/T010900.asp#T010911

-Start doing perineal massage before your edd. Insist that warm compresses be applied during delivery to help stretch the skin.

-If you have an epidural, ask them to turn it down/ off so that you can feel what you are doing if you are having trouble.

-Push only when you have the urge. Sometimes a woman dilates to 10cm and could start pushing but doesn't actually have the urge. Some call this the "rest and be grateful" stage. Don't feel pressured to push.
"The importance of waiting
It is important to wait for the natural urge to bear down before starting active pushing. You are often encouraged to push by "holding your breath and push as hard and as long as you can." Research has suggested that a woman's spontaneous urge to push occurs three-to-five times during a contraction while the woman is exhaling and bearing down." http://babies.sutterhealth.org/laboranddelivery/ld_ftm.html


-Along the lines of the last tip...If you do have an epidural (it could work if you don't but it'll be harder) consider the newest trend, "Laboring Down" or "Passive Pushing." Your contractions will naturally work to push the baby out. Some care providers are now encouraging moms to let their bodies do almost all the work and allowing mom to rest. Mom then just gives the final few pushes. This gives the perineum more time to stretch naturally and it conseves strength.
"Pushing with an epidural
If you use an epidural, you may be encouraged to rest until you have the sensation to push. Women who receive epidural anesthesia for labor may have difficulty pushing, especially if the strength of the anesthetic numbs the sensation to bear down. The practice of "delayed pushing" is currently being studied in women using epidurals as an alternative to routine pushing at 10 centimeters."
http://babies.sutterhealth.org/laboranddelivery/ld_ftm.html
And:
http://articles.findarticles.com/p/articles/mi_m0CYD/is_6_38/ai_99376501


-Also, when you do push, push when it feels right. There is no scientific reason to hold each push for 10 seconds. 6-7 seconds is actually more beneficial and scientific. Ask that no one count or shout commands at you unless you need them to. YOu may strain too much and push too hard with the traditional method and that could put unnecessary pressure on the perineum.

-Don't pull your legs back into your chest. Some nurses ad Dr.s are really fond of this position b/c it is convenient for them. Not so kind to your though and that is what matters! It makes your perineum really taut and any additional strain and pressure could be too much. A relaxed perineum is better.

The askdrsears.com website has some additional tips on pushing that might be worth a read.

Perineal Massage
Here is an article that explains the technique:
http://www.babycenter.com/expert/1955.html

Remember to do those Kegels!!http://www.babycenter.com/refcap/baby/physrecovery/1154885.html http://www.babycenter.com/refcap/baby/physrecovery/1154885.html



I would really take the time to ask your friends more about their births. Maybe there is something they or their care provider did that increased their risk of those big tears? How was their birth managed? What did they know about the perineum, tearing and episiotomies before hand? As a whole many US moms don't know a lot about their birthing options- or the possible risks of common interventions and routine things (like laboring with legs in stirrups and pushing for 10 seconds). There really things you can do to help yourself have a safe, uncomplicated vaginal birth.

I had a 2.5 degree tear. I blame that a lot on myself. The 2 things I did "wrong" were I wound up in the semi siting position (bed broken down, legs in stirrups) for the final few pushes and I didn't stop pushing when the baby was crowning (I tried but I still gave some small pushes). But, recovery was very easy for most things. It only bothered me when it came to bowel movements but I think a lot of that was psychological (in hindsight I should have asked for a stool softener just so I would have passed that milestone and found that it wasn't so bad). Eveything else was fine and I was not in pain at all.

I would take a tear over a c-section any day. If you are planning more kids it is important to consider the risks c-sections pose to future pregnancies and births. I know they say that placental complications like accreta are more common in RCS cases. http://www.pregnancy-info.net/csections_future.html

I find this website to be pretty neutral and helpful. This article is all about helping you choose between a VBAC and RCS:
http://www.childbirthconnection.org/article.asp?ck=10212

Both options have risks. I know some moms feel more comfortable taking the set of risks they already know. I would personally lean VBAC if I were a good candidate.

GL,
Beth

[AdiMom]

This board is so amazing. Thank you everyone for all the great advice and your personal anecdotes. I will go through every one of the links in here.

Beth, thank you for all wonderful advice on preventing tears. I will have a chat with my OB at my next appointment regarding episiotomies/birth positions. I will also find a doula. I'v read books like "The thinking women's guide to birth" by Henci Goer. But the information is overwhelming and I feel when I really need the info during labor, I am going to be too stressed to recollect most of it.

A lot of my doubts started after I heard one particularly tragic story from a friend. This friend has a co-worker who had a particularly bad episiotomy and tear. The poor women had her uterus starting to descend into her perineal area. She has had multiple surgeries to fix the problem. And now they want her to have a hysterectomy because they don't know what else to do. I don't know all the details of her exact problem. All I know is she has already had multiple surgeries and the accompanying physical and mental stress for years and now may need a hysterectomy.

I guess anyone could end up with a bad OB. I think women spend more time thinking about their grocery purchases than they do picking an OB. It is so difficult to objectively compare doctors. You usually go with someone recommended by a friend or acquintance.

Thanks again for everything.

[writermama]

I think your friend's friend may be describing a uterine prolapse -- a condition that might be made worse by pregnancy and/or birth, but there's more to it than just a rough delivery. More information here: http://www.webmd.com/content/article/85/98752.htm
(note the bit about it being associated with having 10 or more births, plus nutritional factors, fibroids, etc)

One big key to preventing it is doing kegels -- many and often.

[marchmommy]

I just want to add my 2 cents. My first child was a CS b/c he was breech, so it was a scheduled one: I had no complications, and very little pain (that I can remember). I remember running up the stairs with him in a carseat to bring him home after my hospital stay.

I did VBAC 20 months later--my CS was scheduled the next day as I was 10 days past my due date but I went into labor. My labor was fast, but the pain is much greater delivering vaginally (until epidural). I had some tearing and it took a long time to heal--many times I regretted VBAC. Meanwhile, a neighbor of mine who did 2 VBACS said with her second one she had a uterine rupture and can't have any more children (she has had three children). There is a woman on these boards who had a uterine rupture with an attempted VBAC and tragically lost her baby. I just want you to know this to make an informed decision. I was so stressed during my VBAC knowing about the slim chances of rupture--the chances are very slim, but if it happens, it's horrible. So I'm leaning towards saying do the scheduled C/S--very low risks with a scheduled C/S.
Also, in response to a previous poster, b/c you've had a C-section already, you will be monitored closely in case you rupture--so you can't birth out of the bed, and I think they want you on your back--I'm not sure you can birth on your side (there are fetal monitors attached at all times). I couldn't even walk while I was in labor--I had to be in bed attached to the monitors.

[SnuggleBuggles]

Not to beat the VBAC drum too loudly, and I know that a uterine rupture and losing the baby is extremely tragic, but the true odds of VBAC complications are not very high for a low risk mom. Whose labor is managed correctly, btw.

I have spent a lot of time on VBAC and C-section boards and have heard thought processes and good/ bad otcomes from both sides. They both carry risks and it can be a trade off on to which is actually riskier.

On the RCS side you have risks like infection, too much blood loss, adhesions, greater risk of future still birth (the links above talk about that one, it was newly uncovered through recent research), bad reactions to anesthesia, difficulty with future pregancies because of that placental accreta...all not very likely but RCS risks do pretty much even out to the VBAC risks depending on how you look at it.

On the VBAC side there are all the same risks with any vaginal birth and there is the uterine rupture risk. That risk is .5%. It goes up as high as 2.5% if they use cervical ripening agents. Goes up to 1% if they use pitocin. Many VBAC moms birth safely- especially if they avoid having their labors induced chemically (AROM and foley catheter don't increase the rupture rate). And of the uterine ruptures it is not a forgone conclusion that it would end tragically.

They can use telemtry monitors to allow you freedom of movement in labor so be sure and talk to your care provider about that.

By having had a c-section you do have to choose between 2 not perfect options. It's all about your personal comfort zone.

SOrry if I am breaking a rule here on recommending other boardds but the VBAC and c0section boards over on Baby Center are great places to learn more about theses 2 and hear many 1st hand accounts. The boards are very active. The Childbirth Choices' board is extremely informative and will present things more cut and dried than emotionally than the other 2. Just something to consider. (off to go read the terms of use on this board now...)

Good luck with your decision!!

Beth

[o_mom]

Fetal monitors have nothing to do with birthing on your side, it is the OB. Some just don't know how to deliver any way but on your back in stirrups.

The monitoring also depends on the hospital. If they have telemetry, you can walk around. Even if not, you can get out of bed and change position as far as the cord will reach. Yes it will be a pain for the nurses as they will have to spend more time with you, so you will have to be ready to advocate for it or have someone to support you.

A Doula can be a great help in reminding you of your options and giving you and your DH the encouragement to speak up. Your DH will be instrumental in remembering all the stuff you read about, so he should be prepared.

[LucyG]

>Not to beat the VBAC drum too loudly, and I know that a
>uterine rupture and losing the baby is extremely tragic, but
>the true odds of VBAC complications are not very high for a
>low risk mom. Whose labor is managed correctly, btw.


ITA. I believe the risk of uterine rupture is about 1 in 200 for a VBAC that is not induced with prostaglandins (Cytotec or Cervadil) and in which Pitocin is not used. Some OB's do use pit. conservatively in VBACs. Ultimately, you have to make your own decision, but please look into all of the research before you shy away from attempting a VBAC, if that's what you really want. FWIW, I think a repeat c-section is a fine choice. It is just not what I wanted for my birth.

[brittone2]

ITA. I didn't have continuous monitoring, but had intermittent monitoring (not a vbac) with DS. The nurse did NOT want to figure out how to hook me up so I could still sit on the birth ball, kneel on the bed, etc. while I was being monitored but it was the ONLY time I was having discomfort. My doula gently but firmly pressed her to figure it out, and miraculously she did...it just took more time and wasn't as convenient as what they are "used to doing". I think a lot of birth works like that...things (like pushing in lithotomy position) get repeated, repeated, repeated because that's the way they've always been done by that particular professional, even if it isn't scientifically/anatomically the "best" way to do it.

[brittone2]

Beth-
What an absolutely awesome post!!!!!!! Thank you for taking the time to compile all of that...I'm a big believer in everything you said. You rock for putting that all together and sharing it here :)

I also wanted to post this link to a the results of a study that came out early this year saying that coached pushing shortens the pushing phase by only a few minutes. It *increases* the risk of having meconium in the amniotic fluid.

The article also discusses a related study that talks about a higher risk of urinary incontinence in women that were coached in the 2nd stage of labor.

http://www.medpagetoday.com/OBGYN/Pregnancy/tb/2408

[MissyAg94]

FYI for the OP, the Childbirth Choices board at BC is heavily weighted in one direction and is NOT a source for unbiased info. I have been appalled at some of the fear-mongering I have read over there.

[lizajane]

two words... personal lubricant!