VBAC after Bandls ring?

[Diege]

Have been advised by the mw that I will need a c-section with this baby (no.5) after a bandls ring was discovered during my EMCS with dc 4. I had previously had 3 normal vaginal deliveries (dc 1-3) but dc4 was an obstructed labour, due to size and position, resulting in a EMCS under general.
Having had 3 'normal' births I would have expected I would be a prime candidate for a vbac, but apparently not (mw says bandls ring will reoccur, I'm not convinced)...Am seeing consultant on Thursday to discuss further, but wondered if any mumsneters had found themseleves in a similar situation? Many thanks x

diege

A Bandls ring is formed when the lower uterine segment gets really thin - usually because of an obstructed labor. This could be because baby is in a bad position, mostly. You'd see it if baby wasn't well applied to the cervix, or malpositioned in some way (shoulder presentation) after a VERY long time of contractions.

was dc 4 induced or augmented at all as this can contribute. I think you could contact aims and they can support your choice to vbac. I am awaiting a response from a mw friend, I will post it when she gets back to me

Thank you Lia (bit wave from the snug ). No, not induced with dc 4. Head never engaged, or even seemed close to which was different from the dds but I wasn't concerned as I know esp with subsequent births that heads can be 'free' for a while. My waters did break at 38 + weeks though, a first for me, and there were decelerations from the start which prevented my water birth. I was active throughout (had a doula with me much to the horror of the hospital staff ), got to 10cms in about 8 hrs (long for me - dd3's labout 5 hrs start to finish) then got very feverish, high temp, pushing felt very odd etc. After syntocin drip and epidural head still declared too high for instrumental delivery, taken to theatre for section. The surgeon said she saw a clear bandls ring and that she estimated I was 20 mins away from uterine rupture. I suppose my question is that I was told the obstructed labour was due to size and position (he was diagonal) and as such presume this would be specific to the last labour and not necessarily the next one? My mw has also put on my notes that he was macrosomatic (sp?) but he was 'only' 9ib 8ozs, so not quite? Sorry for the essay, it's my pet subject

9lbs 8 is not exactly mahoosive is it these days? Were your others large? I will add the extre info you have given and ask my friend.Don't know if she's art work tonight so might be tomorrow.

Apart from this worry, how the devil are you? Are you having doula this time too?

Hi again! Others pretty average. Dd1 7.6, dd2 8.1, dd3 7.11. I'm very petite so don't know if ds's size in itself was the problem - more likely his 'unstable lie' as they called it.
No not having the doula again. Tbh, it wasn't really for me (I felt quite uncomfortable with her ideas which she quite forcefully promoted (electric candles round the bed, insisting on not cutting cord etc) but was so wimpy I ended up agreeing (though dh found her a great support when he was waiting for me during section, so glad for that). Anyway, that's another thread and more my problem with 'conflict avoiding' and not being clear abut my intentions than the doula herself

Am pretty good thanks - very thankful to be in this position at all, and hyperemesis passing now so a lot to be grateful for. How are things with your newest addition?

we are very well thank you. Little P is adorable, 6 wks already. i want another one,

Glad your sickness is subsiding, A doula is not for everyone but the right one can really make a huge difference, I think yours wasn't the right one for you.

Have spoken to my friend, this is what she replied so far

Reading this Lia, I see this birth as having something not right about it from the outset.

It might be worth lady getting hold of her old notes to see if anything else that might have prevented her baby's descent was documented.

Having a fever and not feeling right also suggest something was very wrong although I do wonder if those were very,very early signs of impending rupture and not just a possibility of infection.

I'd be interested to know the timings - how long the synto was up, what rate it was given and how long mum pushed for.

I'm also wondering why her baby's diagonal lie wasn't picked up sooner.

I also don't understand how anyone can estimate how much time is left before a rupture will occur. I've never seen any research to indicate that it's even possible to predict when a rupture will occur. Is more info available on that?

There's no eivdence to suggest that the same thing would ever happen again other than once you've had something like Bandl's Ring, the risk of it ocurring again are higher compared to someone who hasn't. Not helpful I know.

at the idea of a 9lb 8oz baby being macrosomatic.

Of course, I'm just going on what you've posted here and I'm no expert so these are just my ponderings.

Hope some of this can be of some help to you, even if it's just for research

Thanks LIa; I',m touched that you went to the effort of doing this for me. Certainly gives me some issues/questions to raise with the consultant tomorrow. I know that they do see these quite rarely, and as such may react in a way that doesn't always fit with the actual evidence. My mw is known in the community as a bit of a drama queen, so fingers crossed my consultant may adopt a more measured approach.
Great to hear that dd is doing so well; she sounds adorable. You know I thought you might not be finished yet
Will update after tomorrow's appointment x

how did you get on today diege

Hi! Appointment tomorrow, 3pm, so will report back then

ah ok, sorry. Hope it goes ok. x

Back from appointment and all good. Before I'd even opened my mouth my consultant declared 'No reason not to do a vbac then?', explaining that bandl's rings rarely reoccured, and that the one I had was specific to ds's size and position. He said he would have actually argued the case if I had wanted an elective, as after 3 vaginal deliveries my chance of a successful vbac is 90% . Also, he said ds was NOT macrosomic. So have decided mw is a bit of a drama queen and will have great satisfaction in regaling the consultant's version of events.
Oh and Lia, you being a bit of an expert on all things pregnancy, can you confirm that placenta position (ie, from front to back) can't change? MY 10 week scan said anterior, today quick scan revealed posterior. I'm presuming 10 week sonographer made a mistake?
Anyway, good news that I can have my vbac - I'm over the moon

am so so pleased for you diege have replied on t'other fred. xx