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-   -   VBAC questions - several (http://www.diaperswappers.com/forum/showthread.php?t=1396553)

Riverdavidsmama 05-20-2012 10:00 PM

VBAC questions - several
 
I had my first son (9 lbs., 14.5 inch head) normal vaginal delivery in hospital. He's 5.5.

Second son was planned home birth but was breech despite doing everything you can think of (chiro, spinning babies, version) and did a scheduled c-section at 39 weeks with a double-layer closure. He was 8 lbs. 13 oz. at 39 weeks 0 days. He just turned 3.

Third baby (girl) due in late July. Hoping for a VBAC. Here are my questions:
1) I keep reading that "big" babies increase risk of rupture. I've had two 9 lbers. Does that qualify? How much does it increase my risk?

2) I have a very ugly overgrown (and itchy, painful) scar from my c-section. How do I know it's not placenta acreta or whatever? I requested a double-layer closure - but I know they didn't let the cord stop pulsing. How do I know they did what I asked? Could I request the medical records?

3) I am planning a natural labor and delivery and have a doula hired who is a labor/delivery RN at the hospital I'm delivering at (also will be a certified midwife in August). But an anesthesiologist at my church today said they will have to knock me out if I rupture or need a c-section. Is that true? I was thinking that in the case that I needed one, it would be a discussion and there would be time to get the epidural/spinal for the c-section.
If that isn't the case, shouldn't I get the epidural just to make sure I can be awake when baby is born?

4) Will they make me have a line for fluids, be hooked up to monitors, etc., even if I DON'T get the epidural? That would serisouly suck. And make it way harder to get through labor naturally.

meldo 05-20-2012 10:51 PM

Re: VBAC questions - several
 
I'm going to preface my response with this disclaimer: I am going solely on my history and what just happened with my VBAC 3 weeks ago.

Dd1 was a normal, easy vaginal delivery, came out in just a couple of pushes, 7 lbs 15 oz

Dd2 was Frank breech and, like your son, wouldn't budge. C section at 39 weeks, 8 lbs 7 oz

Went into labor on my own at 39 weeks 4 days with DS. Labor was ridiculously easy and I only got the epidural because I didn't want to actually push him out without it. I could have labored without it even at 8 cm. Waaay easier than with DD1.

DS came out quickly. 2 contractions and there was my 9 lb 12 oz baby boy!

1. I don't know if the following events happened because he was big or fast or what but I was bleeding a lot and the dr kept saying "I don't like what I'm feeling" while fishing around trying to get the bleeding under control.

2. I have no idea about this one, sorry.

3. You will not have time to get an epidural or make decisions if there is a rupture. I had time to sign consents. If baby is still inside you the doctors need to move quickly or you or your baby could be at risk. In my case, baby was already out and fine but the speed at which you lose blood from the uterus leaves no time for decisions on your part. I trusted my doctor when I asked "how much time do we have?" and she said "none". I had had the epidural but when they ran be back to the OR I received general anesthesia.

4. Monitoring the baby is important for a VBAC since her heartbeat can indicate distress and a possible rupture. My hospital had telemetry so I could be up and walking around. I don't think the IV would be necessary but I had one and it was kind of a pain walking around with the thing.

So basically I had my VBAC but it was followed by a bonus csection. Talk about sucky. But I would do it again (technically I can't, according to my dr. Any future babies will have to be early csections). I have my beautiful son and my uterus and everybody is healthy so I can't complain.

Hopefully that helped with your questions a bit and didn't totally terrify you. :hugs: does the hospital you're delivering at offer classes? We attended a VBAC class to learn about risks, benefits, etc. if you have any other questions, feel free to PM me. I'm lurking a bunch since I have the DS app on my iPhone and am usually trapped under a sleeping nursling these days. :giggle:

MelDM 05-20-2012 11:08 PM

1) I keep reading that "big" babies increase risk of rupture. I've had two 9 lbers. Does that qualify? How much does it increase my risk?

Possibly, but to be honest it's not a huge amount. The bigger the uterus is stretched the thinner the area is where the incision is. The muscle in the uterus is strongest and thickest near the fundus. But because you were a scheduled section and weren't dilated that's a point in your favor :) the muscle is even thinner at the incision when it's done when your cervix is fully dilated.

2) I have a very ugly overgrown (and itchy, painful) scar from my c-section. How do I know it's not placenta acreta or whatever? I requested a double-layer closure - but I know they didn't let the cord stop pulsing. How do I know they did what I asked? Could I request the medical records?

I'm confused by this??? You had the scar (probably a keloid) after your section? Or did it change when you got pregnant? You can't see placenta accreta from the outside. Yes you can request medical records. However your skin was sutured has no bearing on what they did to your uterus. The incision on your uterus is all that matters.

3) I am planning a natural labor and delivery and have a doula hired who is a labor/delivery RN at the hospital I'm delivering at (also will be a certified midwife in August). But an anesthesiologist at my church today said they will have to knock me out if I rupture or need a c-section. Is that true? I was thinking that in the case that I needed one, it would be a discussion and there would be time to get the epidural/spinal for the c-section.
If that isn't the case, shouldn't I get the epidural just to make sure I can be awake when baby is born?

If you rupture yes you will be put under general. No time to fool around with the epidural, baby would need out ASAP. And even if you have an epidural chances are they would still put you out. Uterine rupture is an obstetrical emergency.

4) Will they make me have a line for fluids, be hooked up to monitors, etc., even if I DON'T get the epidural? That would serisouly suck. And make it way harder to get through labor naturally.

Yes, you will need a line and continuous monitoring. I suppose you could refuse both, but they are recommended for a reason. If you rupture and need a section do you really want them struggling to get an IV in while you are bleeding and baby is getting no oxygen? Probably not! They don't necessarily need any fluids running, but it will need to be placed.

All that being said I'm sure I sound like an L&D nurse who hates VBACs. I'm actually hugely pro (safe) VBACs! I had 2 myself. I would recommend having a good talk with your OB and see what he has to say about your questions. The chance of uterine rupture actually occurring is very low! Because you have vaginally delivered a baby before, bar any other complications, I think you will have no problem having a successful VBAC!

Mrs_B2009 05-21-2012 10:56 AM

Re: VBAC questions - several
 
I haven't had a VBAC (yet!), but I can answer at least one of your questions! You can definitely request a copy of your surgical report. I'm considering doing this as well, so I can know exactly what was done. I don't have any reason to believe that my doctor did anything "wrong" or anything that could harm my chances at a VBAC, but I guess I like to know everything!

Good luck and I hope you get your VBAC!!

Riverdavidsmama 05-21-2012 11:22 AM

Re: VBAC questions - several
 
Quote:

Originally Posted by meldo (Post 15125730)
I'm going to preface my response with this disclaimer: I am going solely on my history and what just happened with my VBAC 3 weeks ago.

Dd1 was a normal, easy vaginal delivery, came out in just a couple of pushes, 7 lbs 15 oz

Dd2 was Frank breech and, like your son, wouldn't budge. C section at 39 weeks, 8 lbs 7 oz

Went into labor on my own at 39 weeks 4 days with DS. Labor was ridiculously easy and I only got the epidural because I didn't want to actually push him out without it. I could have labored without it even at 8 cm. Waaay easier than with DD1.

DS came out quickly. 2 contractions and there was my 9 lb 12 oz baby boy!

1. I don't know if the following events happened because he was big or fast or what but I was bleeding a lot and the dr kept saying "I don't like what I'm feeling" while fishing around trying to get the bleeding under control.

2. I have no idea about this one, sorry.

3. You will not have time to get an epidural or make decisions if there is a rupture. I had time to sign consents. If baby is still inside you the doctors need to move quickly or you or your baby could be at risk. In my case, baby was already out and fine but the speed at which you lose blood from the uterus leaves no time for decisions on your part. I trusted my doctor when I asked "how much time do we have?" and she said "none". I had had the epidural but when they ran be back to the OR I received general anesthesia.

4. Monitoring the baby is important for a VBAC since her heartbeat can indicate distress and a possible rupture. My hospital had telemetry so I could be up and walking around. I don't think the IV would be necessary but I had one and it was kind of a pain walking around with the thing.

So basically I had my VBAC but it was followed by a bonus csection. Talk about sucky. But I would do it again (technically I can't, according to my dr. Any future babies will have to be early csections). I have my beautiful son and my uterus and everybody is healthy so I can't complain.

Hopefully that helped with your questions a bit and didn't totally terrify you. :hugs: does the hospital you're delivering at offer classes? We attended a VBAC class to learn about risks, benefits, etc. if you have any other questions, feel free to PM me. I'm lurking a bunch since I have the DS app on my iPhone and am usually trapped under a sleeping nursling these days. :giggle:

Hey mama, thanks for posting. Here are my questions...

1. so once they went in, had you ACTUALLY ruptured? Or what did they see?
2. when they put you out, how long were you out? Why did they put you out if you had the epidural already? How long was it after birth until you got to/were able to sit up, nurse, hold baby, etc.
3. Do you know if your prior c-section was closed with a single or double layer closure?

I'll PM you too. THanks!

Riverdavidsmama 05-21-2012 11:27 AM

Re: VBAC questions - several
 
Quote:

Originally Posted by MelDM (Post 15125770)
1) I keep reading that "big" babies increase risk of rupture. I've had two 9 lbers.

I'm confused by this??? You had the scar (probably a keloid) after your section? Or did it change when you got pregnant? You can't see placenta accreta from the outside. Yes you can request medical records. However your skin was sutured has no bearing on what they did to your uterus. The incision on your uterus is all that matters.

Yes, it's a keloid scar - just ugly and pulls and feels yucky and itchy. Glad to know that's not indicative of placenta acreta. I had an ultrasound at 20 weeks, and I think that's how you know if you have that (is it even possible if I had a double layer closure? I'm thinking not). My doc is doing another U/S (for position - she was breech at 28.5 weeks) on Wed. Can I have him check for placenta acreta then?

All that being said I'm sure I sound like an L&D nurse who hates VBACs. I'm actually hugely pro (safe) VBACs! I had 2 myself. I would recommend having a good talk with your OB and see what he has to say about your questions. The chance of uterine rupture actually occurring is very low! Because you have vaginally delivered a baby before, bar any other complications, I think you will have no problem having a successful VBAC!

That's what they say - my doc says I'm best possible candidate - but size of my babies concerns me. It's also a small (though VBAC friendly) hospital. Just trying to decide how to go about it to make sure I give myself the best chance to succeed and if I fail, how I can still have the most normal c-section/time with baby after birth as possible.

sunyflwr 05-21-2012 11:38 AM

Quote:

Originally Posted by Riverdavidsmama

That's what they say - my doc says I'm best possible candidate - but size of my babies concerns me. It's also a small (though VBAC friendly) hospital. Just trying to decide how to go about it to make sure I give myself the best chance to succeed and if I fail, how I can still have the most normal c-section/time with baby after birth as possible.

I have a unicornuate uterus (1/2 the size of a normal one) and just delivered my 7 lb 10 oz son via VBAC two weeks ago. My perinatologist cleared me for a VBAC. So if you have a normal uterus, the size of your babies wouldn't concern me at all. :) JMO. Hope you get your VBAC!!!

Riverdavidsmama 05-21-2012 02:31 PM

Re: VBAC questions - several
 
Quote:

Originally Posted by sunyflwr (Post 15127723)
I have a unicornuate uterus (1/2 the size of a normal one) and just delivered my 7 lb 10 oz son via VBAC two weeks ago. My perinatologist cleared me for a VBAC. So if you have a normal uterus, the size of your babies wouldn't concern me at all. :) JMO. Hope you get your VBAC!!!

Congrats, mama. And thanks!

Sally's Red Meadow 05-23-2012 07:39 AM

Re: VBAC questions - several
 
I cna't medically answer your questions but my VBAC went great for me.

Riverdavidsmama 05-23-2012 07:42 AM

Re: VBAC questions - several
 
Great to hear, mama! Thanks for sharing! I need more of those stories in my life.


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