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Old 06-12-2012, 06:27 PM   #21
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Re: VBAC questions - several

Originally Posted by Riverdavidsmama View Post
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?

There are studies that show an increased risk of rupture with kids over like 8 lbs 8 oz. I don't think it increases your risk by much, but if you're worried about it, your dr/cnm should have some advice. Just because a couple of studies show a slightly increased rupture risk, that doesn't mean a baby over 9 lbs isn't a candidate for a TOL.

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've never heard that letting the cord stop pulsating decreases rupture risk. I have heard that double-layer closure does, however, so that's good that you have double layer closure. You can request your medical records, but it probably won't say anything on there about whether or not they delayed clamp or not. It really doesn't matter, though, because delayed clamping doesn't really have anything to do with your rupture risk. I wouldn't spend another second thinking about that. About the scar, did you have an infection postpartum? If so, that might increase your rupture risk, but if the scar is just "ugly", without a history of infection or delayed wound healing, I wouldn't worry about it.

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?

No. If you rupture, that is an emergency. If you don't have an epidural, they will (and should!) knock you out and cut asap. I'm talking you should be in the back being cut on within minutes- literally, minutes- of diagnosis. I've seen c-sections for uterine ruptures happen in less than 5 minutes from "decision to incision". If you don't have an epidural, they aren't going to have time to wait to put one in. They are just going to what we call "splash and dash". Hopefully there will be an anesthesiologist there on the floor who can knock you out, otherwise they might just use lidocaine (not pretty, I've known of several lidocaine only c-sections and the screams that you hear from the woman out on the floor pretty much traumatized my RN friends who were on the floor at the time).

Now, if you need a c-section for a non-emergent reason- like if you are progressing super slow or there are minor, but not severe, decelerations, they *should* have time to put in an epidural. But if it's a true emergency, do not pass go, do not collect 200 dollars, go to OR now.

It's up to you if you want the epidural. It's a gamble. Know that if you rupture without an epidural, you wont' be awake when your baby is born. BUT, you likely are not going to rupture, so if you choose to not receive an epidural, most likely you will have a happy ending- successful VBAC and a mom who was awake.

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.
You should always have a medlock with a VBAC. This is in the event of rupture. If there is a rupture, there wont' be any time to put in an IV- or at least you'll waste time getting one. You want a large bore medlock at the very least. You should always have continuous monitoring with a VBAC. One of the first signs of rupture is abnormalities in the fetal heart rate tracing, so it's very important that you have continuous monitoring. Now, that doesn't mean you have to be tied down to the bed. You can be up and moving around the room. You can be on the ball. Your hospital might even have telemetry units so you can walk around. I've even known hospitals to have telemetry units where you can be in the shower with it on. But it's really not safe to have intermittent monitoring with a VBAC. A VBAC is not a low risk birth and the only peopel who are candidates for intermittent monitoring are low risk women.

I didn't read all of the other replies, but I HTH. I'm a VBAC mom myself, had 2 VBACs and with this pregnancy am going for VBAC #3. I hope you get your VBAC and I hope you get a wonderfully healthy baby!!
Holly, Mom to 5 boys.
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