VBAC - advice needed from all you midwives out there

[Roskva]

Sorry if this question has already been asked before, but here goes.

I've just found out I'm pg , so it may be a little early to think about this, but that's how my brain works.

Dd turned up by emergency cs, because she was stuck for no apparent reason, I was pushing for several hours, and my blood pressure went through the ceiling. My midwife who went through things with me afterwards, said words to the effect that there might be a "kink in my plumbing", and I should keep that in mind for future births. What are the pros and cons of trying for VBAC? The only person I know in RL who tried ended up with a ruptured scar and crash cs, which is rather scary...

I'm not a midwife - but I'm planning a VBAC following an Em-CS in 2006.

You might find this site helpful: ican-online.org

Also this one www.vbac.com/

And finally www.childbirth.org/section/VBACFAQ.html

The risk of a scar rupture is around 0.5% (like wmmc I'm not a midwife but am going for a VBA2C in April).

First thing you need to do is get an appointment with a consultant and ask them the risks based on your personal experiences, they can read your notes and advise you better than anyone on ehre can, but bear in mind some cons don't like VBAC's particularly so they may not say 'Oh, you'll be fine, sure push it out', make sure you ask them for detailed, calculated risks in your situation and then ocne you have that info you can try and make informed choices rather than a wild stab in the dark at what may have gone wrong.

However I would say that 'kink in the plumbing' is a fairly unlikely thing, UNLESS you have:

(a) broken your pelvis
(b) suffered from polio
(c) suffered congenital hip problems.

Wild stabs in the dark....now that's what I'm trying to avoid VS

I Doula'd a Vbac, it was awesome!

What is a kink in your plumbing? I wonder if you should ask your GP for clarification?

Me too!

I'm still waiting for that 'now, VS, when shall we bbok your CS for?' convo, only 8 weeks left

congratulations on your pregnancy!

kink in the plumbing?? eh? that is not terribly helpful

if you were pushing for several hours then there are some possible causes

baby cannot fit through the pelvis as the head is too big - CPD

baby is presenting in a way that it cannot come through the pelvis easily.. e.g a brow presentation, or head is on a tilt ( asynclitic )

you were tired and unable to push as effectively due to being too tired

so until you have a proper explanation of what happened and why, it is hard to say !!

I had a VBAC , was very straightforward and a positive experience, but there was no medical or physiological or physical reason why i could not.

if there is genuinely an issue with your pelvis or something like that, you need to know, and make an informed choice on whether VBAC is possible for you

You need to get a proper explanantion for the kink in your plumbing before you can make a rational decision about what to do.

My neighboiur had a section after she went backwards in dilation and was told she had a too small a pelvis. She had a VBAC less than 2 years later.

I have had 2VBACs after an emergency section.

'Kink in your plumbing'

Highly unlikely unless you have had pelvic injury/surgery. Far more likely to have happened because of malposition of baby, exhaustion etc. Genuine CPD is very rare and loads of women who have been told they have it go on to have successful VBACs with the right support and advice.

Could you get hold of your notes? Might give you more of an idea about what actually went on?

I managed a VBAC and it was well worth all the risks. I was told that if baby was late then I would NOT be induced. I would be allowed to go 14 days over, then straight C section. Once in labour, would only be allowed to be in labour 8 hours (unless progressing nicely). Had C section 2 years before falling pregnant again so like to think internal scars were pretty much healed. SO many midwives ect just assumed I would opt for another section but the first was emergency like you, so no real reason not to go for it. My VBAC baby had same problems during labour (low heartrate) but this time forceps were used so voila, VBAC. Honestly, go for it, such a different experience than C Section.

The midwife should no way have said that. It is far more likely that your first baby got stuck due the presentation of the baby than any problems with you. I take it you got to 10cm if you were pushing?

The risk of scar rupture is low as others have already said. The hospital will want to put you on continuous monitoring with this labour though if you go for a vbac.

No 'technical' advice (though 'kink in the plumbing' doesn't sound all that technical either, come to think of it ), but I had a wonderful, amazing VBAC with dd2 and it was worth every minute of the not-inconsiderable time I spent planning it! You do not need to be continuously monitored in labour if you are having a VBAC, and I strongly recomend that you ask for intermittent monitoring (unless there is reason to suspect a problem) to enable you to stay as mobile as possible, to use water (I did almost all first stage in the bath), etc. You will probably have to have a cannula in (though I escaped that too as by the time they found a doctor to put it in I was pushing and they decided there was no need) and they might take bloods to cross-match and save 'just in case'. I would not allow myself to be induced for a VBAC labour (the chances of scar rupture are massively higher with induced labours) and nor would I have an epidural (which can mask 'unusual' pain coming from the scar rather than from contractions). Otherwise, there's no reason why your VBAC labour should be any different from any other experience of labour. Good luck. I hope your experience is as good as mine was.

Hospital may want to put you on cfm(continuous fetal monitoring) but you do not have to agree to that.
Before you start deciding what shots you want to call at the birth though, find out the reason you didn't get baby out and come back and let us know.
We do love a good VBAC story

Thanks for your thoughts, everyone. I've been offline for a couple of days due to non-stop morning sickness , but hopefully the acupuncture I've booked will sort that out...

I know there were no presentation problems with dd: the midwife with me at the time called the obstetrician when my blood pressure went up, and the obstetrician scanned me with a mobile scanner, and I distinctly remember her saying that dd was fully engaged, the right way round and with her chin tucked in. The got me pushing some more, and scanned me again, but dd hadn't moved. That's when the obstetrician called her consultant in. When I had had the epidural and was in theatre, the consultant made 2 attempts with forceps, and that didn't work so then it was section.

It is the same midwife who will be looking after me this time round, so hopefully she will be able to give me some constructive answerws.

Have you heard of the Pink Kit method www.birthingbetter.com

The kit has wonderful suggestions to help you to find the best postion suitable to your pelvis (guides you to measure you own pelvic floor and ideas to improve measurments)this will encourage your baby to move through your pelvis (as baby will choose the path of least resistance). They also cover VBAC. Its all abit long winded but well worth trying.