WWYD? repeat c or vbac question

[c&j04]

With DS I was induced and made it to what the Dr called a 9.75 before things started adding up and he recommended a c/s.

I saw a different Dr reccently and his opinion was to schedule a c/s at my first appt. His reasoning was that being in labor forever then ending up in OR anyway is emotionally and physically draining. Also, he thought there would be a huge possibility that I "couldn't" hit 10.

FTR, we will be moving again so I will not see either of these drs in the future.

Also, breastfeeding was a disaster so that added to feelings of failure all around....

[amldaley]

Same conversation currently in progress over here if it helps you to see what some other responses have been........

http://windsorpeak.com/vbulletin/showthread.php?t=425882

My answer to you would be the same as my answer there - discuss in depth with Doctor and wait until closer to your due date to see where your growth scans and NST's lead you.

ETA: interestingly....you and the OP of the other post I linked to have DC #1's the same age!

[mikala]

Re: C-sections, you may want to check for a local chapter of ICAN for more info and support in your area. There is definitely a spectrum of VBAC friendliness among OBs and it might help to find one that is known to be positive or at least neutral towards it so you can make sure you're getting an unbiased opinion instead of just a "I really don't like to do that" opinion. (This isn't to say that's your current doctor but I'm a bit skeptical when doctors are negative about it without mentioning any positives.)

Re: breastfeeding, if you want to try with the next child I highly encourage you to make contact with your local LLL chapter before you give birth to start developing a support system there. They can also help you find out the names of great lactation consultants in your area. A great LC and related support can make all the difference in the world. FWIW I know several women who struggled to nurse their first child and either ended up exclusively pumping or using formula and have now gone on to have successful breastfeeding relationships with subsequent children. One of these friends just commented a few days ago that breastfeeding was like night and day the second time around. If it turns out it's not meant to be for your next child you'll at least know you did what you could and can move on from there.

[AngB]

I had a repeat c-section with DS, a little bit of labor (water broke, real contractions started, but that wasn't supposed to happen), it was a lot lot easier than my first c-section. We haven't had any problems bf'ing, either (9 months and going.) I don't actually have a choice since my first c-section was a vertical uterine incision since it was so early and the risk of rupture is much higher, but personally, I'd do repeat c/s even if I had the choice. I wasn't even taking tylenol by the time I left the hospital.

[american_mama]

First, you don't say what your preferences are. If you don't know, hold off on scheduling the C section and take some time to find out.

Second, I don't trust an OB who wants to schedule you for a repeat c section at the very first visit. It's a very un-VBAC friendly attitude, and VBACs are much more likely to succeed with a provider who supports them. It's way too soon to say if you need a repeat c section, especially if that wasn't the ob that was there with you during labor.

Third, just anecdotally, it seems unusual for an ob to claim in advance that a woman is incapable of dilating to a 10 cm. I don't believe it, especially since you got so close before. It would be one thing if you never dilated past a 5 cm or something (although even that would be just one birth, not a huge sample), but that's not the case. I mean, if a marathoner "lost" a marathon by a minute, would you believe they were incapable of going any faster? Or would you assume that, given another chance or a different set of circumstances, they might easily make up that small difference? I think you are that marathoner.

I wouldn't base your decision solely on what your current doctor says, since his statements are so VBAC un-friendly. I would present your situation to your new doctor and get his or her take on it. Plus, factor in your own preferences. Doctors are generally very comfortable with VBACs and may favor them, but only you can determine and speak up for what you prefer.

As for breastfeeding, I would prepare as best you can and try not to worry. If you think it would help, take a breastfeeding class if you didn't before, get in touch with La Leche League and/or have a lactation consultant lined up. Other than that, trust that a second attempt at breastfeeding may go easier than the first.

[citymama]

I agree with the PP - you should switch doctors. You want to have someone who has a lot of experience with vbacs (and a hospital that does too), if you are considering both options. I wasn't 100% sure but I had a strong preference for a vbac. I at least wanted someone who could talk me through the considerations rather than someone who was discouraging, as my previous practice was. I went on to have a successful, unmedicated vbac and it was a terrific experience. This was after "failure to progress" with my first (after being 2 weeks post term and stalling out at 6 cm for a 12 hr period). At many points in time, I didn't have faith in myself that I could do it, but I set myself up for success - vbac friendly (and experienced) docs and hospital, I spoke to the OB who had performed my C and found out that she had given me the double layer of stitches and made the kind of incision favorable to vbacs, and I got a great doula. All of that really helped. Good luck to you!

[daisymommy]

Not being able to go to a 10 ? Craziest, dumbest thing I've ever heard!
Being off your back, no feet in stirrups when pushing opens up your pelvic outlet by another 30% and allows gravity to work in your favor to help fully dilate you. I'm betting that didn't happen the first time around?

I would chose a doctor that starts you out on a level playing field, that is open to giving you real choices in what goes on with your body and birth.


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[JBaxter]

Not being able to go to a 10 ? Craziest, dumbest thing I've ever heard!
Being off your back, no feet in stirrups when pushing opens up your pelvic outlet by another 30% and allows gravity to work in your favor to help fully dilate you. I'm betting that didn't happen the first time around?

I would chose a doctor that starts you out on a level playing field, that is open to giving you real choices in what goes on with your body and birth.


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I agree. Both of my friends who have had vbacs had to have csections because the baby's head was mispositioned. They both scheduled a csection for 42 weeks but delivered on their own prior to those dates

[TxCat]

I think there's a rush to judgment on this thread by many previous posters, without having all the information available about your previous labor. It's clearly not for any of us to say what is crazy or impossible vs. possible, based on such little information at hand.

To the OP - you've already stated that you need to find a new OB provider since you are moving. Since you are interested in a possible VBAC, obviously one of the first questions you want to ask when you are looking for a new OB is if they provide coverage to VBAC patients. Hopefully you know some people in your new location that you can ask for recommendations of doctors, but if not, when you call various practices, the reception desk should know if their physicians will or won't do VBACs. Second, make sure you have all of the hospital records from your first delivery and bring those to your appointment, to help your new OB see what factors were at play with determining the need for cesarean the first time around, and exactly what type of cesarean incision was made (I'm assuming a low-transverse uterine incision, since you're even having the VBAC discussion, but you want to have some proof of that to show your new OB). If your new OB is "good", hopefully he/she can thoroughly explain the pros and cons to you for the mode of your second delivery, and also the likelihood of a successful vaginal delivery based on your previous labor course (taking into account your final dilation and fetal station before c-section was called, fetal positioning, etc.). It's also important to consider your desire for future children as repeat c-sections can become slightly more risky with each subsequent section.

Hopefully you can find a doctor that you feel comfortable with and make a decision based on sound medical information and advice, a decision that you feel comfortable with and can embrace without any feelings of shortcoming or failure. I find it so frustrating that women still fall prey to feelings of "failure" based on how they deliver their baby, success with breastfeeding, etc. Hopefully you have a healthy and uneventful pregnancy and a healthy baby once all is said and done.

As for BTDT advice, as you can see on that thread linked to above, there is a wide variety of opinion and threshold for different risks. I had a c-section for breech, and I will probably opt for a scheduled repeat c-section if we have a second child. My reasons for this are as follows: 1) I'm not sure we would have more than 2 child and definitely not more than 3, so I'm less concerned about risks of multiple c-sections, 2) Personally, I'm not comfortable with the risk of uterine rupture, 3) I've already been exposed to the risks and long-term sequelae of abdominal surgery - for future deliveries, I'd rather continue in that line, and not add the possible complications of vaginal delivery to that as well (ie, history of a c-section and now I have abdominal adhesions, and then add to that a possibly complicated vaginal delivery maybe with a 4th degree laceration and future pelvic organ prolapse - I'll try to limit my complications/risks to one area). So, a very personal decision weighing the risks and benefits for me. Everyone has to make their own decision that makes sense for them. Good luck with your decision, and whatever it is, it is the right one for you.

[smilequeen]

I have had 2 VBACs so that's where my personal choice would lie.

Yours has to be what YOU want though. If you think you may want the VBAC, then you need to find a doctor who truly follows the ACOG recommendations and is VBAC friendly. The best ways to find that are through friends who have had VBACs or through the local ICAN chapter. Then take your time to decide what feels right for you. Personally I'd plan for the VBAC but know that you have until delivery to change your mind. But if you plan the VBAC and know you have support, you'll be in better hands if that's your ultimate choice.

Good luck.