32 week apt ... and looks like no VBAC for me

I had my 32 week checkup yesterday. Measuring 35 weeks, everything is looking great. This was the first time, though, that we discussed how I would deliver this baby ... he said that because with the twins, I had a C-section due to "failure to progress", a C-section would be the safer route. With the boys, my water broke at 830AM on Sunday, and after several rounds of pitocin and an epi put in at midnight, by 11AM the next day I was only dialated to a 6 and pretty much stalled out. I then spiked a fever so they got the babies out. He feels that since i didn't dialate very much that time, that it would probably happen again since bone structure doesn't change ... and that there would be a risk of uterine rupture and other things. He made a VBAC sound pretty scary. He said if the C was for other reasons, like a breech baby or fetal distress, that would be a different story and he would say to go for it. But he really wants me to consider a C-section again.

I was pretty sad about it ... part of me wants the vaginal birth experience, and part of me is scared of the recovery. I'm a SAHM to the boys, and the thought of taking care of two 2-year olds and a newborn with no help while recovering from a C is soooo scary to me. All it would take is for one of my crazy boys to pounce on my stomach ...

Whatever it takes to get the baby out safely, I guess, right???

 

I could see how it would be safety first but I understand your concern at the same time. GL to you!

 

Oh Kendra, I'm sorry. Will you have no help at all? For me, by week 2 I was in pretty good shape, so if you have help for the first 10 days, maybe that will be enough to get you on your feet?

Do keep us posted

 

I'm so sorry about the bad news! My c-section was also due to failure to progress along with HELLP but I was induced so the likelihood of a c-section for me was already quite high. I wouldn't be a fan of your doc but I hope you're okay with his choice. :hug: Dilating 6 cm in 14 hours isn't a little bit. The average first time labor is 12 hours so you're just a little bit on the high side of the average. There has to be people on the high side of the average to even make an average.

 

QUOTE(Ali M @ Oct 18 2008, 05:03 AM) [snapback]1031188[/snapback]
I'm so sorry about the bad news! My c-section was also due to failure to progress along with HELLP but I was induced so the likelihood of a c-section for me was already quite high. I wouldn't be a fan of your doc but I hope you're okay with his choice. :hug: Dilating 6 cm in 14 hours isn't a little bit. The average first time labor is 12 hours so you're just a little bit on the high side of the average. There has to be people on the high side of the average to even make an average.



Thank you :hug: Although it was 27 hours, not 14 ... my water broke at home at 830AM on Sunday and they were born at 11:47 and 11:49 on Monday. And if I recall right, I was stuck at 6 for about 8 hours without moving.

But the more I look online, it seems like it's really a doctor and hospital choice to perform or not perform a VBAC ... shouldn't it be the mother's choice? Some docs are totally fine with it, seems like mine isn't. So do I want to push (haha, get it?) for a VBAC or just go along? I don't know.

 

Kendra,

I have not written on twinstuff forums in eons, since the birth of my twins in 2005! but your email inspired me to write as i recently had a baby girl, VBAC. i think your doctor is flat out wrong, and you are absolutely right - it is a doctor/hospital choice. if it doesn't feel right to you, i think you should insist - and possibly even find another doctor/midwife/support system. if you are ok with csx - obviously that is fine too (there is absolutely nothing wrong with it!!)

i had my twins in pennsylvania - and afterwards i asked my OB if there was a chance i could have natural delivery int he future. he said that because i had 'failure to progress' that i would not be a good candidate. i knew right then to switch doctors...with twins, i think all bets are off - things can be so different. my were born at 36 weeks and 2 days, and i had actually gone into labor on my own - was 4cm when i arrived. this disappointed my doctor who had *his* heart set on a cesarean for me...so they put me on magnesium sulfate for borderline high bp (150/90), then pitocin to induce (since mag sulfate can slow labor) and an epidural which sent my bp crashing (i kept passing out). i went to 5 cm and then had csx. i think with your water breaking and not having contractions on your own, pitocin made sense. but your water may have broken from the factor of 2 babies - not because this will necessarily happen to you again.

turns out our twins were fine - healthy, and my recovery was ok. fastforward, and i was now pregnant with a singleton. no complications (normal bp; preeclampsia is often a risk for first time mothers, and mothers of twins...but again, with my frist pregnancy i simply had high bp, with no protein in urine, elevated liver enzymes, swelling, dizziness, etc. - just an extremely conservative doctor).

our family moved to switzerland in 2007, which is a much more vbac friendly place - doctors here assume women will try for a vbac if there is no reason not to (otherwise healthy). this time i had no bp issues, and obviously a single baby is much easier to carry! the hard part for me was going past my due date - 11 days?! doctors started talking about induction a couple days before that, but induction is contraindicated for vbac (increased chance in uterine rupture). luckily i went into labor spontaneously - (although i have heard many stories of successful vbac induction)...i arrived at hospital dialated to 8cm, baby born 2 hours after that. it was one of the sweetest moments in my life - getting to hold baby paola immediately after delivery, and lie with her for an hour on my chest - and then walk to the bathroom to take a shower while my husband and a nurse cleaned her, weighed her, etc. we left the hospital the following day (i was strep+ and they wanted to monitor baby since there was no time for antibiotics) - and received at home care by a midwife for 7 days. this is a much more birth friendly place!!

anyway - i know in pennsylvania i would have had a hard time having a vbac -without a lot of unecessary intervention/monitoring. so depending on where you live or what doctor/hospitals your insurance allows you to go to, it may be an issue for you as well. but i urge you to get informed about vbac - and how it might be a real option for you. i think 'failure to progress' is a standard doctor line used for reasons of malpractice and scheduling convenience. the thing is - if you have vbac at the hospital, you do have, potentially, the best of both worlds. you can have a place well equipped to handle emergencies should anything go wrong, as well as the opportunity to birth vaginally. by the way, vbac risk of uterine rupture is around 1/1000 compared to 1/2000 for woman without prior cesarean. so yes, chance doubles, but it is still very low.

 

QUOTE(kendraplus2 @ Oct 18 2008, 12:22 PM) [snapback]1031260[/snapback]
Thank you :hug: Although it was 27 hours, not 14 ... my water broke at home at 830AM on Sunday and they were born at 11:47 and 11:49 on Monday. And if I recall right, I was stuck at 6 for about 8 hours without moving.

But the more I look online, it seems like it's really a doctor and hospital choice to perform or not perform a VBAC ... shouldn't it be the mother's choice? Some docs are totally fine with it, seems like mine isn't. So do I want to push (haha, get it?) for a VBAC or just go along? I don't know.


I don't mean to go against your doctor's advice, but it really is your choice. I have met tons of women who have FTP or your pelvis is too small diagnoses and went on and had beautiful vbacs. I switched my care at 36 weeks because I wanted to ensure as much as possible to have a successful vbac. I see you are from milwaukee. There is a great OB there named Wasserman who is very supportive of natural birth and vbacs. I heard of his name from www.mothering.com. I'm not from Wisconsin but remember someone mentioning him being supportive of a vbac with a history similar to yours. His number is (414) 291-1530


I'm sorry this sounds very direct but I would switch doctors. I switched at 20 weeks and then again at 36 weeks to find people who would be supportive of me having a vbac. Once you have the csection there is no turning back. You still have time to make changes and decide differently. I say go for the vbac and find someone more supportive. Just my 2 cents. Again, I apologize for sounding so forward, I'm just tired of OBs making decisions about OUR bodies and OUR babies. They are there to offer the options. You ultimately make the decision. I hope it works out for you!

Just to add, if I had FTP in my initial birth, I would personally fight as much as possible to have a vaginal birth. The women I have met with similar diagnoses were overjoyed with their vbacs. They were incredible women. Their bodies work just fine and are able to birth vaginally just like everyone else. You certainly can do it too!

 

Wanted to also add a thread in which wasserman was mentioned a few times.

http://www.mothering.com/discussions/showthread.php?t=389861

 

If you are okay with a c-section, then that is great. BUT your doc is full of beans, and biased on top of it. . . . I've had 3 sections, 3 vaginal births. One section was for breech presentation, one for the twins, and then one for "failure to progress". One of my VBAC labors was well over 24 hrs. Another of the VBACS was a 9 1/2 lb baby. The FTP baby? not even 7 lbs.

 

QUOTE(Christel @ Oct 18 2008, 08:51 PM) [snapback]1031751[/snapback]
If you are okay with a c-section, then that is great. BUT your doc is full of beans, and biased on top of it. . . . I've had 3 sections, 3 vaginal births. One section was for breech presentation, one for the twins, and then one for "failure to progress". One of my VBAC labors was well over 24 hrs. Another of the VBACS was a 9 1/2 lb baby. The FTP baby? not even 7 lbs.

I apologize for going off topic but... just curious-what are you planning for your current baby? Will you be having a csection or vbac? You don't have to answer, I was just curious.

 

I really don't like that your dr said that a vbac is so dangerous. Sections are obviously NEEDED sometimes and you can't avoid it but repeat sections are a TON more dangerous and risky then a vbac. FTP is not necessarily a one size fits all type thing. It won't mean that you can't go on to have a great labor and vag birth.
To go vbac or section is up to you but please don't let a dr who is probably worried about his schedule too tell you you can't do this. You can do this. There is no reason you can't try.
Pitocin and epi's are known for sometimes not the best for a good labor.
I would do some reading and asking about this before you just give into the drs opinions. Unless you are ok with just having a section.

 

QUOTE(kendraplus2 @ Oct 18 2008, 12:22 PM) [snapback]1031260[/snapback]
Thank you :hug: Although it was 27 hours, not 14 ... my water broke at home at 830AM on Sunday and they were born at 11:47 and 11:49 on Monday. And if I recall right, I was stuck at 6 for about 8 hours without moving.

But the more I look online, it seems like it's really a doctor and hospital choice to perform or not perform a VBAC ... shouldn't it be the mother's choice? Some docs are totally fine with it, seems like mine isn't. So do I want to push (haha, get it?) for a VBAC or just go along? I don't know.


LOL, sorry my math was totally off. FWIW, my son was born my VBAC. I was actually induced at 41.4 weeks, in labor for 48 hours, and he ended up being 9 lbs 9 oz (after pooping ). I spent about 6 hours at 7 cm and then suddenly went from 7 to 10. My midwives knew that I was 100% committed to a VBAC though and that I wasn't going to agree to a c-section unless there was actually something wrong with me or the baby. Theoretical possibilities were not a good argument. Some of the nurses at the hospital were grumbling for a c-section but Paul and the midwives set them straight. 48 hours in labor was hard (especially after my water broke and my scar started getting irritated by the contractions) but it was all so totally worth it. I was at at least 85% within 30 minutes of the birth and at 100% within the week. That was not the case with my c-section.

It was actually my main midwife that called for the induction with my singleton, I didn't want to do it. She was concerned about the rise in stillbirth rate after 42 weeks (it goes from about 1 in 2000 to 1 in 1000) and thought the increased risk of uterine rupture was worth it compared to the increased rate of stillbirth. I didn't agree but I allowed myself to be talked into it. This time I told the midwife up front that we aren't even going to discuss the possibility of induction until I am already 42 weeks. Dax's placenta looked fantastic at 41.6 weeks and he was at no risk of stillbirth due to decreasing placental function. My family history of going postdates and still having perfectly healthy babies also works in my favor. Hopefully, I go before 42 weeks this time and it won't even be an issue though.

I've been blessed with good doctors who have been as committed to my birth plans as I am. Even though I was at 2-2.5 cm for nearly 12 hours with my first birth, my OB was perfectly fine with proceeding with induction until I came down with HELLP. Then we had to act quickly with a c-section before I got worse. She actually almost cried when she gave me the news. With Dax, I had a very specific birth plan and midwives who knew that c-section was not an option until it was actually required and they supported me through that for 48 hours. This time I'm using the same midwives so, hopefully, we'll get a successful VBAC once again.

Like it was said in a pp, a singleton birth and a twins birth are two totally different things. I had lots of complications with the twins and haven't had any with these two pregnancies. Your OB should at least let you try for the VBAC if that is what you want to do. Good luck!

 

Thank you so much, ladies, for all your help and advice. I looked and Dr. Wasserman is in my insurance! So is Columbia St. Mary's. However, I delivered at West Allis Memorial and loved it, and one of the main reasons was my friend is a L&D nurse there and she is studying to be a midwife. She was there from the beginning of my labor all the way to the C-section and she was such an amazing support for me, I'd hate to lose her.

In fact, I e-mailed her today about what my doc said, wanting her input since she was there for the labor and the delivery. She basically said that some docs prefer C-sections since they can be scheduled, don't take as much time/effort, and generate more money. They like to use the "uterine rupture" as a means to persuade moms for a C-section. How freakin' terrible is that. She told me she didn't see any reason I couldn't at least try for a VBAC, especially since my only other pregnancy was a multiple one and there could have been many reasons why I didn't progress.

She suggested striking a deal with him, maybe, where we don't talk induction until after my due date, and where I can at least try for a VBAC and if I don't progress within 16 hours or so, discuss a C. I'm really wondering if I should just switch doctors.

Thanks again for all your advice.

 

I apologize for going off topic but... just curious-what are you planning for your current baby? Will you be having a csection or vbac? You don't have to answer, I was just curious.


we were planning a VBAC until yesterday (Friday). His placenta still on my scar, so we've scheduled a csection for next week.

 

My only other comment is that induction will increase your chance of uterine rupture and the likelihood of needing another section. If it were me, I would switch drs. Mainly because I need to be able to trust that my dr will be honest with me. If he says I NEED another csection I want to be able to trust that and not be wondering if hes just trying to pressure me into doing things his way.

 

QUOTE(Christel @ Oct 19 2008, 03:27 AM) [snapback]1032144[/snapback]
My only other comment is that induction will increase your chance of uterine rupture and the likelihood of needing another section. If it were me, I would switch drs. Mainly because I need to be able to trust that my dr will be honest with me. If he says I NEED another csection I want to be able to trust that and not be wondering if hes just trying to pressure me into doing things his way.


Good point.

 

just a quick addition to the thread: i completely agree that it is worth switching doctors if you really want to go for a VBAC. i know it is difficult to make such a decision after being with the same person for the whole pregnancy. with my first pregnancy, i think i knew deep down that the doc was not supportive of natural birth with twins, but it had been so hard to find a doc int he first place that i didn't want to switch (we found out about twins over halfway thru pregnacy)

i think that making a deal about waiting until your due date might still land you in murky water. my twins were born a month early but my singleton arrived 11 days late. i looked up the scientific literature on going past due after having cesarean and there is absolutely NO INCREASED RISK of uterine rupture for women attempting VBAC who are past their due dates, compared to women attempting VBAC who are on time. so basically having a prior csx is no reason to induce. in fact, induction is what increases uterine rupture risk....other real reasons to induce would be low amniotic fluid (deteriorating placenta), fetal distress, etc. after 14 days you probably won't have much choice...and that being said, i have heard plenty of stories about successful VBAC after induction, so there is no reason to think that it won't work. i think the best thing is to have a positive attitude about it - and fight for what you want. you deserve it!!

 

QUOTE(babies@2 @ Oct 18 2008, 04:52 PM) [snapback]1031551[/snapback]
Wanted to also add a thread in which wasserman was mentioned a few times.

http://www.mothering.com/discussions/showthread.php?t=389861


Just had to say that I didn't connect the name when you said it, but Sheldon Wasserman is running for State Legislature this term and I keep seeing his ad on TV!!!

 

Wow...lots of responses and I just wanted to add that I'm glad that you have talked with someone else.

I had failure to progress with the boys but only after 13 hours because the boys were showing distress. My water broke on its own, did dilated, needed some pitocin but got to 8 cm.

I have the same doc this time, and we're trying for the VBAC in hopes that I'll labor on my own or at least be very favorable to an induction. If my cervix hasn't done anything by 39 weeks indicating it's favorable to an induction, he has prepared me for the alternative of the scheduled section...which I don't want but will do if the other options don't pan out.

Definitely go with what you feel is best for you and your family!

 

QUOTE(Christel @ Oct 19 2008, 03:25 AM) [snapback]1032140[/snapback]
I apologize for going off topic but... just curious-what are you planning for your current baby? Will you be having a csection or vbac? You don't have to answer, I was just curious.
we were planning a VBAC until yesterday (Friday). His placenta still on my scar, so we've scheduled a csection for next week.

I'm sorry to hear the placenta didn't move. I hope you have a great birth and quick recovery!

 

QUOTE(snoopytwins @ Oct 20 2008, 01:52 PM) [snapback]1033401[/snapback]
If my cervix hasn't done anything by 39 weeks indicating it's favorable to an induction, he has prepared me for the alternative of the scheduled section...which I don't want but will do if the other options don't pan out.


I wanted to respond to this b/c I was NOT dilated NOT effaced and the baby was NOT engaged at 39 weeks. She was super high at a -3 station. Heck, even at 40 weeks there was no sign of labor in sight. I was only 4 days past my due date when I had our little girl. As soon as I went into labor I began to dilate, efface, etc... AND the baby didn't engage to a 0 station until 7 cm! I had a very beautiful birth. I knew all along that this was my birth, not the nurse's, the doctor's, etc.., only mine. This is why I switched health care providers twice in my pregnancy. I needed to find someone I could trust and NOT touch me with any induction agents unless medically necessary. My body knows how to birth as in almost ALL women.

The reason I'm telling you this is because, in my own opinion, I feel your doctor is trying to come across as vbac supportive and he really isn't. Most women don't go into natural labor at 39 weeks. The average length of pregnancy is 41 weeks and 1 day. This relates to only women who go into spontaneous labor (i.e. no involvement of artificial rupture of membranes, pitocin, etc...). Also, even if your body does shows signs of impending labor, why induce at 39 weeks. You haven't even hit your due date. I'm sorry I sound so irritated, I'm just getting tired of doctors saying they are one thing and many times have a hidden agenda. I obviously don't know your doctor, but it sounds like he's setting you up for a csection. I personally have come across many OBs, ALL of which said they were vbac supportive. I asked about the number of woman who attempt a trial of labor and the number of successful vbacs and they couldn't respond with specific numbers. I interviewed 7 midwife practices, ALL of whom reported exact numbers to me.

There's a reason why only 9%, yes only 9% of women have vbacs, because most OBs are truly not vbac supportive. They would prefer a woman to schedule a repeat csection then wait until she goes into labor on her own. Whatever you decide, I hope you have a beautiful birth. We all deserve to have a beautiful and memorable birth.

 

QUOTE(babies@2 @ Oct 20 2008, 01:43 PM) [snapback]1033852[/snapback]
I wanted to respond to this b/c I was NOT dilated NOT effaced and the baby was NOT engaged at 39 weeks. She was super high at a -3 station. Heck, even at 40 weeks there was no sign of labor in sight. I was only 4 days past my due date when I had our little girl. As soon as I went into labor I began to dilate, efface, etc... AND the baby didn't engage to a 0 station until 7 cm! I had a very beautiful birth. I knew all along that this was my birth, not the nurse's, the doctor's, etc.., only mine. This is why I switched health care providers twice in my pregnancy. I needed to find someone I could trust and NOT touch me with any induction agents unless medically necessary. My body knows how to birth as in almost ALL women.

The reason I'm telling you this is because, in my own opinion, I feel your doctor is trying to come across as vbac supportive and he really isn't. Most women don't go into natural labor at 39 weeks. The average length of pregnancy is 41 weeks and 1 day. This relates to only women who go into spontaneous labor (i.e. no involvement of artificial rupture of membranes, pitocin, etc...). Also, even if your body does shows signs of impending labor, why induce at 39 weeks. You haven't even hit your due date. I'm sorry I sound so irritated, I'm just getting tired of doctors saying they are one thing and many times have a hidden agenda. I obviously don't know your doctor, but it sounds like he's setting you up for a csection. I personally have come across many OBs, ALL of which said they were vbac supportive. I asked about the number of woman who attempt a trial of labor and the number of successful vbacs and they couldn't respond with specific numbers. I interviewed 7 midwife practices, ALL of whom reported exact numbers to me.

There's a reason why only 9%, yes only 9% of women have vbacs, because most OBs are truly not vbac supportive. They would prefer a woman to schedule a repeat csection then wait until she goes into labor on her own. Whatever you decide, I hope you have a beautiful birth. We all deserve to have a beautiful and memorable birth.

Oh I totally agree with you. My doc knows that I have a big say in this (he knows I'm a bit assertive and I do my research) but there other things to think about too (I have gestational diabetes, edema, and my bp is starting to rise...so I'm cautiously optimistic). But I absolutely appreciate your response and you are right...I think too many docs "scare" us into repeat sections because they don't want to deal with it themselves.

We'll just have to see what I can work out with my body, baby, and doctor. I hope that I can have as wonderful a birth experience as you did...cross your fingers!

 

QUOTE(snoopytwins @ Oct 21 2008, 01:20 PM) [snapback]1034979[/snapback]
Oh I totally agree with you. My doc knows that I have a big say in this (he knows I'm a bit assertive and I do my research) but there other things to think about too (I have gestational diabetes, edema, and my bp is starting to rise...so I'm cautiously optimistic). But I absolutely appreciate your response and you are right...I think too many docs "scare" us into repeat sections because they don't want to deal with it themselves.

We'll just have to see what I can work out with my body, baby, and doctor. I hope that I can have as wonderful a birth experience as you did...cross your fingers!

Way to stay positive! You have other variables to worry about which makes the situation a little more challenging, but you sound like you are handling it all beautifully. I most certainly hope you have a great birth. You deserve it!