More VBAC questions (sorry if tmi)

[Roskva]

Sorry if these questions have been asked before, but I'm trying to get my pg brain round my options and arguments before my next round of ante-natal appointments...

Dd was delivered by emergency caesarean in Aug 06. My labour was induced at 38+4 because the consultant thought dd had stopped growing. I was given prostglandins to induce labour. Labour progressed normally, except I couldn't keep any food or water down, I got to fully dilated, but then my contractions slowed down. I was given oxytocin, but several hours later dd was still no closer to being born, so the obstetricians took over from the
MWs and I had an emergency section after one failed attempt with forceps.

Although externally my scar is low and horizontal, I'm fairly sure that internally I was cut vertically (I had some sensation of pressure during the section and I'm fairly sure they sewed my back up to my diaphragm, but I wasn't going to say anything because I didn't want a general anaesthetic).

I would prefer not to have a section this time (no 2 due in Oct). Some of the information I've been reading suggest that if there was a vertical incision, or the labour was induced with prostglandins, or oxytocin was given, then these are factors that increase the risk of the scar rupturing. The consultant I'm seeing is the same one who decided dd should be induced, and I have the feeling he is very interventionist, but my MW is supportive of my preference for VBAC. Does anyone have any advice, or can point me in the direction of good advice?

first thing you need to do is get a look at your notes (PALS at your hospital should point you in the right direction)Its very unlikely you had a vertical incision , the usual circumstances they are done is when the baby is very prem, so the lower segment of your uterus won't have formed yet,or if the baby has a neural tube defect, or it's conjoined twins. the pressure you felt higer up was probably the retractors or the junior holing thngs out of the way. I wouldn't go near the consultant unless you have a specific medical problem, if this is too hardcore for you (it worked for me!) and you feel he's too interventionist -you can ask your midwife to refer you to someone supportive of VBAC (you do have the right to choose your consultant). The next step after that is to start doing your research and printing out stuff - turning up to an appointment with a bunch of research papers covered in highlighter and pencilled notes does seem to get you taken rather more seriously lol! you also need to think about your birth plan, and get something drafted up by the time you are about 7 months - if you like I can email you a copy of my homebirth/incase of transfer one or theres some online, just google VBAC birthplan
Good Luck!
L

Hi Rovska I'm due Oct too and planning a VBAC, I haven't had it yet, so can't offer any "this is how I did it" advice. There is another VBAC thread which has lots of info/experiences on it here
Is this your 1st consultant visit?, mine was fine I just said I wanted a VBAC this time and she seemed quite supportive. I have another appointment in August @ 32 week to look at things again, for which I will be taking lots of bits of paper with highlighter and post it (thanks Jamilia)

are you sure the scar rupture/oxytocin link refered to the last birth rather than the vbac attempt? only cos I've read papers showing increased risk of scar rupture in vbac attempt if vbac involves induction but never read anything with link to previous birth (if that makes sense?)
most hosps nowadays have to encourage vbac so you prob won't have any probs with that but might want to read up a lot more on issues surrounding the vbac labour eg continuous monitoring or not, fluids in labour, active birth, water birth etc

forgot my top tip
to get your own way in any situation, if they are being obstructive just mention that you have been considering hbac. watch them blanche lol
(nothing wrong with hbac btw, I've had one, but the threat of it is v v effective)

You would probably have been told if they had done a vertical incision, especially with a horizontal skin wound. As far as I know the risks of rupture with induction are to do with the current pregnancy, not what happened before.
Maybe your current midwife can talk you through what happened last time, so you can be sure?

Well said morocco - yes HBAC does concentrate their minds wonderfully - I did my first because the protocol at my local hospital was continuous monitoring ,venflon in,limits to pushing,epidural recommended blah blah, good ob i was already a nurse and knew where to go for answers and pointers to specialist info. I'd recommend reading this article and joining UKVBACHBAC at yahoo groups
I've had 3 vbac's (2 at home and my last one in hospital after an APH ) so got the whole thing down to an art by the end - yes , they try it on whether it's your first VBAC or your umpteenth , it's once a CS always an unexploded bomb as far as docs are concerned lol! Dunno where lulu and Klaw are right now, but they've been there too.

It is very normal to feel pressure and sensation near the top of your bump during cs, but I think very unusual to have a vertical incision - would have thought you would have been told if this was the case. Your midwife or consultant if you are seeing him anyway should be able to tell you exactly what happened last time.

Good luck!

Thanks for your all your suggestions, ladies. I have to say, I've been wondering how artificial hormones given to me 2 years can possibly affect a later pregnancy (and if they do, then surely they should come with a health warning?), but my brain is feeling a bit mushy at the mo. Jamila, do you know where I can get my hospital's statistics on VABCs? I'd be interested to know how they feature.

Hedgepig, do you mind if I gatecrash your other thread? Looks like lots of useful info and support.

I've got my 20 week scan next week, and I'm seeing the consultant week later.

hi roskva - I'd be amazed if you manage to get any meaningful statistics from your hospital on their VBAC ratios! But if you do I'll be very interested to see them
TBH it's irrelevant whether your consultant is keen on intervention or not - ultimately every procedure that they want to carry out has to be done with your consent. It's obviously much easier if everyone knows your wishes beforehand, and much easier if your consultant agrees with those wishes, but don't forget that all the choices are YOURS.
Do what everyone has suggested and write yourself a good birth plan, tailored to VBAC and get those statistics and info printed out to go in with it. The highlighter pen is a great aid too!
If your consultant pisses you off enough but you don't want to homebirth, did you know that you can do away with the consultant altogether and just have MW only care? When I was having my VBA3C it took me 3 consultant changes before it sank in that I didn't really need one at all! Should I be mad lucky enough to ever get pregnant again, I won't be bothering with a consultant unless a problem comes up.
It's highly unlikely that you had a vertical incision but make an appointment via PALS to either get a copy of your notes (you have to pay up to £50) or just to go through them with someone (that would be free), just so that you're sure.
Having had drugs to induce you previously such as syntocinon, oxytocin etc makes no difference to your VBAC - it only increases your chance of rupture if you have them during your VBAC labour.
For lots of info on VBAC go here
Hope that helps!

Dr foster have the most up to date stats for births here
what hedgepig said Ican is good, but american, so not always the most relevant and can be a bit alarming(man, their system is scary)

Thanks for the links. I can't open ICAN - I'll try again tomorrow. LOL at a statistic about my hospital: it apparently has 46.8 MWs - that conjured an image of some poor person chopped off at the knees (or worse still, headless)

I watched some of those TV childbirth programmes; the US ones were really scary - each birth, however uncomplicated, looked like something out of ER. And the one woman who didn't want intervention was made to feel like an alien from outer space.

If the consultant turns out to be unhelpful, I might think about hiring a doula to help me fight my corner - dh and my Mum are both a bit wimpy when confronted by people in white coats giving orders, and one of them will be looking after dd, anyway.

Hi Jamila (sorry to hijack the thread btw) but I'd really welcome your thoughts on what we can do to make ICAN more user friendly for UK women. I'm in the process of putting some stuff together for them for this very purpose so feedback from real live women would be fantastic!
you can email me at [email protected]
We're also looking to get some UK Chapters off the ground so if you'd be interested, let me know. I remember when I was planning my VBA3C, as useful as websites are, what I really wanted above all else was to be able to meet other women who were in the same/similar situations and there is just nothing like that in the UK. It always struck me that ICAN would be great if it wasn't tailored solely for the US market, so eventually I decided to do something about it

I'd love to get involved in some way VBQ, I'll mention it to Klaw and Lulu as well! will Email you later (feeding E at the mo!)

As has been said, you almost certainly would have not had a vertical incision, occasionally they do them for very pre term babies (ie 25 - 28 weeks type of size) also occasionally if someone has had lots of previous uterine surgery or fibroids or something. If they had for any reason done that they would have made certain that you were aware of it. Was your baby large or in an awkward position? its just that women whose first cs are in the second stage of labour, especially after a failed forceps delivery have a lower chance of a successful vbac than many other women. Of course plenty of them do still manage it, just something to think about, hope I'm not being too gloomy.

The prostaglandins and syntocinon link to scar rupture is if they are used in your VBAC attempt. There is no link to their being used in your first, c-section, labour.

It's very unlikely that you had a vertical incision internally. That is normally only done under very exceptional circumstances. You get pressure all over the place but most of it isn't them making the actual incision. Your MW and consultant can check your notes from last time quite easily to see, if you are concerned -- just ask your midwife to review them.

If they tried forceps, then presumably you got to fully dilated last time? If so, that makes you more likely to have a successful VBAC, and should mean that the first stage (getting to fully dilated) will go much faster.

(I know my information above contradicts maxbear's. It is my understanding that some US studies have shown a lower rate of success if the c-section was in the second stage, but more recent Dutch studies have shown quite the reverse (much higher rate of success if the c-section was in the second stage). What I read on the subject suggested that this was might be down to the much more medicalised, anti-VBAC attitude in the US hospitals where their studies were done; the UK is closer to the Dutch model, really, so I think their studies are more applicable)

(that is, assuming that there wasn't an identified factor causing the c-section last time (say, pelvic deformity) that is likely to recur. In my case the c-section was because DS was in an asynclitic presentation and they didn't realise that until I'd been pushing for a good while and he'd got well and truly wedged -- that wasn't particularly likely to recur)

I got to fully dilated, and a portable scanner showed that dd was in the right position (facing my back, chin tucked in and fully engaged). My MW thinks that the problem was largely exhaustion - I hadn't been able to keep any food and very little drink down since about 5am, and by 11pm apparently my muscles were giving up (even with IV fluids going in). She has said to me that muscles need glucose to contract, and if they don't get it, they eventually stop contracting.

That's quite promising in terms of VBACing, then. As you got to fully dilated last time your first stage should go far quicker and you won't be nearly so tired when it comes time to push. I had 40-hour labour with DS (also not able to keep anything down for any length of time throughout) followed by c-section. With DD I had first contraction 0210 and she was born at 0727 after 20-25 minutes of pushing. Again I couldn't keep anything down, but that's not such a problem when it's just a few hours.

I have had 3 children.

1st was emergency section.
2nd was a VABC with retained placenta.
3rd was VBAC with close to rupture.

I would get as much advice as you can so you can make a relelvant decision to your situation. Good luck.

Hi NotaBanana
Hope you don't mind me asking but I'm intrigued by your "close to rupture" phrase. Can I ask what happened? And how do you know you were close to rupture? Forgive my nosiness but women often ask me about rupture so it's always good to know real life stuff rather than just quoting statistics.

Usually it follows that if baby is fine then mum is fine, therefore no rupture risk.

The pain in my scar was horrendous. Much more than the contractions coming close together. Baby wasn't coping at all. his heartbeat was lost several times and he wasn't coping well when I was having contractions. Blue at delivery. Fine now. I was prepped for a section but I pushed him out in 7 minutes. The doc had given me until 10 to get him out and he was born at 10.15. They started prepping at 10 but I got him out quick. I can't risk anymore children now.

Regarding the scar issue - you can't have had an internal vertical cut and a horizontal cut without having an external show of it post surgery - the pressure you will have felt will have been from the spreaders - but metal curved bars which hold the incision open so they can minimise the amount of cutting to get in. Once they are in, they do stretch the uterus vertically in order to get access to the baby but that doesn't mean they have cut you - just that they have stretch the uterus that way - it's not an issue though - labour stretches it every which way in any case.