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

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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!!

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Old 06-12-2012, 06:48 PM   #22
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Re: VBAC questions - several

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I've seen c-sections for uterine ruptures happen in less than 5 minutes from "decision to incision".
My emergency c-section (for complete placental abruption rather than a rupture) happened in three minutes. Three minutes from decision to BIRTH, not just decision to incision. I had no idea they could do stuff that fast. No epidural. They put me completely under with an inhaled anesthetic.
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Old 06-12-2012, 07:48 PM   #23
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Re: VBAC questions - several

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My emergency c-section (for complete placental abruption rather than a rupture) happened in three minutes. Three minutes from decision to BIRTH, not just decision to incision. I had no idea they could do stuff that fast. No epidural. They put me completely under with an inhaled anesthetic.
Sorry, that's what I meant. Decision to baby out. It's really amazing to watch, if you ever get the chance, but of course it's really scary. I'm surprised the OBs don't cut themselves, but I guess that's why residency is so rigorous!
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Old 06-12-2012, 08:14 PM   #24
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Re: VBAC questions - several

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Sorry, that's what I meant. Decision to baby out. It's really amazing to watch, if you ever get the chance, but of course it's really scary. I'm surprised the OBs don't cut themselves, but I guess that's why residency is so rigorous!
Yeah it wasn't a resident who cut me, lol. They have to learn but they can do the cutting on the non-emergency sections. A resident dictated my op report though.

I "watched" what I could for the minute or so before I went under. Felt like there were 20 people in the operating room. I felt myself being "trimmed" lol, felt the catheter, took the mask off briefly to tell them that baby was head-down and I wanted a low incision (which they did) and a double-layer closure (which they did not do). But it was weird to have so much stuff done to me, by so many different people, so fast. Didn't seem like there would be enough room for all those people.

I wasn't even in any condition to help transfer myself from the hospital bed to the OR table. I'd lost too much blood and was super weak.

But anyway. I'm hoping that if I have to have another c-section in the future (and I'm hoping to NOT have one) that it's not an emergency. But having been through one before, I feel like I know what to ask for, for next time. It's a bigger picture than just the type of incision.

/hijack
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Old 06-13-2012, 07:27 PM   #25
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Re: VBAC questions - several

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Yeah it wasn't a resident who cut me, lol. They have to learn but they can do the cutting on the non-emergency sections. A resident dictated my op report though.

I "watched" what I could for the minute or so before I went under. Felt like there were 20 people in the operating room. I felt myself being "trimmed" lol, felt the catheter, took the mask off briefly to tell them that baby was head-down and I wanted a low incision (which they did) and a double-layer closure (which they did not do). But it was weird to have so much stuff done to me, by so many different people, so fast. Didn't seem like there would be enough room for all those people.

I wasn't even in any condition to help transfer myself from the hospital bed to the OR table. I'd lost too much blood and was super weak.

But anyway. I'm hoping that if I have to have another c-section in the future (and I'm hoping to NOT have one) that it's not an emergency. But having been through one before, I feel like I know what to ask for, for next time. It's a bigger picture than just the type of incision.

/hijack
No, residents shouldn't be cutting in emergency c's. If it's a true life or death situation like that, the attending should be the one doing the c. My point was that residency is so rigorous so that when residents are attendings they can do c-sections in 3 minutes. A lot of people think residents work too hard, work too many hours, etc. but there's a method to the madness. You need to work that hard, do all of those hours, etc. so that when it's you who is responsible, you can make it happen.

ETA: Lots of women VBAC successfully with single layer closures. My closure was actually single layer (well, there was "one layer of running, interlocking sutures with interrupted sutures as needed for hemostasis"- which I took to meant single layer or 1.5 layer closure). I wouldn't be worried about your layer closure, personally. I"m sure you'll VBAC fine.
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Old 06-13-2012, 08:54 PM   #26
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Re: VBAC questions - several

Thanks, Holly.
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Old 06-14-2012, 12:25 PM   #27
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Quote:
Originally Posted by Harmony96

Yeah it wasn't a resident who cut me, lol. They have to learn but they can do the cutting on the non-emergency sections. A resident dictated my op report though.

I "watched" what I could for the minute or so before I went under. Felt like there were 20 people in the operating room. I felt myself being "trimmed" lol, felt the catheter, took the mask off briefly to tell them that baby was head-down and I wanted a low incision (which they did) and a double-layer closure (which they did not do). But it was weird to have so much stuff done to me, by so many different people, so fast. Didn't seem like there would be enough room for all those people.

I wasn't even in any condition to help transfer myself from the hospital bed to the OR table. I'd lost too much blood and was super weak.

But anyway. I'm hoping that if I have to have another c-section in the future (and I'm hoping to NOT have one) that it's not an emergency. But having been through one before, I feel like I know what to ask for, for next time. It's a bigger picture than just the type of incision.

/hijack
This is all I remember too. I woke up as they were wheeling me back to my L&D room. And I woke up asking where my baby and DH were and if I still had my uterus. After that the morphine kicked in and I have a fuzzy period of time. I remember reassuring DH it was ok to go get himself some In n Out a couple hours later at about midnight. lol Poor guy hadn't eaten since noon.

I'm typing on my iPhone, sorry.
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Old 06-14-2012, 07:58 PM   #28
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Re: VBAC questions - several

My emergency C for cord prolapse happened in less than 10 minutes. Probably less, I had an epi but i could "feel" them cutting me(or so I thought, it was very traumatic and i screamed so they knocked me out)

Holly, I had the same 1.5 closure lol...single layer with an added figure 8 for hemostasis!

While I don't agree with constant monitoring, i do agree with PP about a heplock. IMO, something very minor that can be very useful in case of emergency.
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Old 06-26-2012, 06:02 PM   #29
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Re: VBAC questions - several

from my personal experience, I had an unneceserean with my first for suspected "big baby" (urgh for being an uninformed first time parent) and just had my wonderful HBAC 4 months ago. My first was 8lbs 12ounces and about 10-12 days early and my second was only 8lbs even and was 13 days "late"...every baby is differnt and I believe under most circumstances (barring gestational diabetes or something like that) your baby will not get to big for you to deliver and in regards to rupture, the possible increase is so so small.

in regards to fetal monitoring, if you do some looking into studies done on the subject, it is proven that it does not save the life of ANY babies and actually leads to countless unnecessary c-sections. And the reason the require IVs is because they have the pointless policy against eating or drinking when research has proven that eating and drinking during labor reduces the overall labor time.

Good Luck and remember your body is not broken, God made the woman's body to have babies vaginally!
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