Failed VBAC - I think maybe I can't deliver vaginally. What would you think if you were me?

[MrsHappy]

I have just had my second emergency CS and am trying to get my head around things in advance of my follow up appointment with my consultant.

My sections were for different reasons. DD1 was stuck and could not be turned and pulled out with forceps. DD2 was showing signs of distress and needed to come out quickly. It looked like it would be another attempt at rotational forceps delivery and when the epidural could not be inserted we went for a section. Given the urgency of the situation and how high up she was a section was my preference. But in the 30 minutes while they tried to insert the epidural my body was pushing and the baby did not shift at all.

So neither of my babies has rotated out of the LOT position and I think that both were above my ischial spines when the sections took place. Both times I was fully dilated.

My first labour was very medicalised and unpleasant (stuck on my back, CFM, ARM, synto etc etc). I thought those circumstances had led to my section. But my second labour could not have been more different. I didn't even get to the hospital until I was ready to push.

So now I am wondering whether there is something about my pelvis that stops my babies from doing what they need to get out. I've read about mid-pelvic disproportion and my labours seem to fit the bill. Or maybe whether, had DD2 had more time, she might have been able to come out. I have giant childbearing hips so the idea that I can't birth a baby seems ridiculous, but the gap in my pelvis from one side to the other feels extremely small to me.

Does anyone know what causes babies to not descend in the second stage? Is there any way to find out whether I really do have a physical problem which will prevent vaginal delivery? Has anyone attempted a V2BAC after having these sorts of problems or should I just accept that I will never give birth vaginally?

Sorry, lots of questions, but I don't really know where to start! And any thoughts are welcome.

Thanks

I also had 2 cs but in slightly different circumstances - I never went into labour with either despite inducitons and going very overdue. It also occurred to me that there was somehting structurally amiss that was causing the problem. I asked the Consultants for an assessment of my pelvi structure prior to my second birht but they said it wouldn't mena anything.

Are you planning on more?

Definitely want more, yes. I just hate sections (or rather the recovery period) so much and in the back of my mind I am a bit sad at the thought that I might only be able to have babies that way, even though I know that mode of birth is not the main thing.

I don't know anything about your particular circumstances but about the recovery period - I had an emergency cs and then a planned cs, and the recovery for the planned cs was much much easier than the emergency one. OK, not as easy as a straightforward vaginal birth, but not the nightmare I had after the emergency cs. Felt like a walk in the park compared to the first one.

Interesting post, exactly the same as me! 2nd time i went for elective section and they still needed to use forceps as too high and OP.Recovery from planned CS is much quicker, i felt great after 7 days, 6 weeks with first.
Anyway this doesnt answer any of your questions, but will keep an eye on the thread, as kind of in the same position...

i had two sections then i had 2 vbacs

go on the ukvbachbac yahoo chat room, they can really help/support/advice.

don't dispair lots of people have had vbacs after multiple sections

also look at the vbac handbook by helen savage and someone else, can't remember who sorry

I feel very similar, my first CS was a crash section under GA after PROM, 'fetal compromise', brow baby and turned out I was strep B positive as well. Hideous experience.

Tried for VBAC, had repeat section for failure to progress. Well I insisted on repeat section rather than allow other intervention because I would never have had another baby if I thought the first birth situation could recur. Borderline distress on the cord bloods so I was v happy I went for the CS before it became a crash situation this time.

I personally feel I have a duff pelvis, both babies were malpositioned despite me having active labours(both were planned homebirths), plus am small framed/narrow hips - I know that is not diagnostic BTW

I will be choosing an elective if I have another baby, I have lost faith in my body frankly. Am quite good at being pregnant but the labour bit just doesn't seem to suit me. So I don't know whether you are right or wrong but I understand why.

I'd be interested to follow your thread if you don't mind.

My dd was stuck in LOT, above the ischial spines. I was fully dilated and pushed for 6hrs. She did not descend one iota. I was told at the time it was 'one of those things'. Too high for forceps, ventouse made no difference and a manual rotation wouldn't work. Was an em cs in the end.

I am terrified to have another as I just cannot understand how she was so stuck, especially when I read online that pelvis rocking and changing position can help shift a LOT baby. I rocked, danced and pushed in every position there is. Nada. I think there's something wrong with my pelvis and have ended up with PTSD over the whole thing.

Sorry, I'm not meaning to hijack, just thinking out loud. I think I want an answer nobody can give to me.

Congratulations on the birth.

Don't mind at all showofhands.

It looks as though there are quite a lot of us who have the same questions. I do wonder whether, had this baby not been distressed and I had continued to push properly (and not had the efficiency of my contractions compromised by the doctors' interventions) she might have come out by herself, but I suspect not. And anyway the hospital would not have let me have a marathon pushing session in case of rupture.

I find it hard to believe that I might fall into the small category of women who genuinely can't give birth. My granny had 5 homebirths, FGS, and most of the women I am related to pop babies out without thinking. I was really good at labouring too - it hurt and I swore but I found it quite empowering. So it seems ridiculous to me.

JeMenFous it's nice to hear that someone has managed a V2BAC (and thanks for the book recommendation - I have a copy and did everything it recommends before this VBAC, so not sure where I go from here!). The thing is that often when I read birth stories they are by women who had an emcs, then an elective and then tried for a VBAC. I've not yet heard of anyone who had two failed vaginal deliveries because of stuck babies and then a V2BAC and that makes me think it is unlikely that I ever will.

how do you ladies know so much about what happened after your births?

my ds got stuck and couldn't be budged with forceps so i had an emcs. and that's all i know!

did you see consultants or something afterwards who explained stuff to you and if so, why didn't i!?!

bamboobutton the first time the consultant sent a letter to my GP confirming the position the baby was stuck in, the type of forceps used and that my pelvis "seemed adequate". I spent quite a lot of time researching all that might mean and drew some of my own conclusions from it too.

The second time was only a few weeks ago but I will have my 6 week check with a consultant this time (different PCT). I also had an independent midwife with me who stayed when I was put under and watched my section, so she reported back on what she saw.

hmm, i don't think any letter was sent my GP, i certainly wasn't told about it at my 6wk check

i will ask my midwife when i go in a few weeks time, don't want a repeat performance of last time if it can be avoided.

I was told nothing at the time. The surgeon who performed the cs popped into the postnatal ward to ask if I had any questions and I was on day 3, hormones had hit and I couldn't open my mouth without sobbing so just shook my head. God I wish I'd asked what he thought of my pelvis!

The reason I know anything about the birth is that I requested to have a copy of my notes when dd was about a year old as I was still struggling to get over the birth. They're fairly comprehensive. They also say on them that there's no contraindications for a vbac next time but I don't know if that's a standard comment for a delivery like mine or an actual comment on my pelvis and whether it looked adequate.

You can ask for a midwife or consultant to go through your notes with you if you need to. Your hospital PALS or the records department will point you in the right direction.

MrsHappy I know of another MNer and somebody in rl (the mw who attended dd's birth) who had a stuck baby with deliveries one and two and were both advised to have an el cs on the third birth, perhaps assuming that once is luck, twice is indicative of something.

I don't know how you come to terms with the possibility of never delivering the way nature intended. Especially knowing you can labour and dilate fully but just can't do the last bit. If I had the answer I'd tell you in a heartbeat.

Can I ask if you had an urge to push? I had no urge at all in the 6hrs of pushing and pushed as directed. I knew something wasn't right. Contractions were odd too, 2 and a half minutes long and I knew they were that long because they weren't managing what they were supposed to do. But as a first timer, my wails of something isn't right sounded like nerves and inexperience when really I knew something was the matter.

Yes, a massive urge to push. I really liked that bit. Well, until I had to try to sit still while they tried to give me an epidural...

I know that my local hospital advises an ecls after 2 sections, but sod policy. I think what I need to know is whether it would be unwise for me to try again.

I think that some of us do just have duff pelvises. I'm pretty certain I do anyway. When I went into labour with DD1 within about 4 hours I had progressed to contractions every 1.5 to 2mins and they continued like that unabating for the next 24 hrs. No sign of DD coming out though, even though it turned out she was a teeny little thing. Eventually once she was in distress, heart stopping, blood gasses low, passed merconium etc I was whisked off for a section. The consultant who had examined me and then operated came to see me the next day, to discuss it. He was of the opinion that I had a very unfavourable pelvis. His prognosis was that if I tried for a VBAC next time i had 'a greater than 95% chance of having another section' so not exactly something I was keen on attempting so I went for electives the next two times.

Someone suggested to me having my pelvis X-rayed (when not pregnant obviously) to check it out, but then I was told that this was an irrelevant thing to do as some pelvises that look v unfavourable will soften and adjust to allow an easy birth and some that look just fine will not do what they are meant to. So you can't tell just by looking, although it can be a guide - e.g. apparently I have an android shaped pelvis which is the least favourable type, but then so do about 30% of the UK population and most of them can still manage to give birth naturally even though they are more prone to problems.

That's my story though - not sure what to say for you except that don't let the recovery time be an influence on your decision, after both my electives I was up and showered and positively skipping around after about 6 hours. It couldn't have been more different from the emergency section. Joking apart - recovery really was amazing after the electives in comparison to the long labour / emergency.

I had a very long labour and em cs. Was up and about and back to normal, no painkillers, no pain within hours too. I was very fortunate and would have no qualms about having another cs if I knew that I couldn't deliver otherwise.

The surgeon who delivered dd said that there was no reason for her being stuck and that I should try for a normal delivery next time. I guess that means somebody who has seen my pelvis doesn't believe it to be oddly shaped. So why was she stuck?

Thanks Nelly. I had heard that about x-rays/scans etc not being all that reliable which is why I didn't try to get one after the first emcs. I had an accident and banged my coccyx years ago so maybe there is some way of checking whether that has healed normally and isn't fused - I shall investigate that further.

It's interesting what you all say about recovery time from elcs. The thing is that I got up and about within hours of both my emcs, and the second time I felt fine. But a bit over 2 weeks on I still can't walk more than half a mile or stand up for long without my scar feeling like it is pulling on one side (where I have grown a lump of scar tissue), I can't walk fast, I have be careful lifting my DD1, if I am out of bed to get DD2 a lot in the night I start to ache etc. What I wanted to do was to walk out of the hospital the same day as the birth and get on with my life. Instead I feel like an invalid. [self-pitying emoticon]. I guess if I do have more babies and have to have an elcs than that is the trade off I will make, though.