Highly probable for another c/s really want VBAC

[nickers]

Some of you already know my story but for someone who may be able to help here's a run down.

• I had a c/s with DS after labouring for approx 15hours and Not dilating to even 1cm.

• DS was born at 33weeks due to PROM. his Heart rate also started going down and for his and my health and safety an emerg c/s was performed. I was extremley upset that i could not birth my baby naturally.

• I am currently 27weeks with baby 2 and very keen to have a VBAC

• current OB is all for letting me have a go although:

The reason i did not dilate was due to tough scar tissue around my cervix from a procedure to burn abnormal cells off 5yrs prior.
The likelyhood of this scar tissue going away from April 06 to when bub is due Oct 07 is minimal.
If i make it to 38weeks OB will do an internal and give me his take on my cervix and the scar tissue around it, whether he thinks there is any possibility a VBAC can be done.

He also made me aware of a worrying statistic (if i heard him correctly) that 1 in 1000 babies that mum tries for VBAC baby doesn't make it??? This scares the crap out of me and then i think should i swallow my pride and have a c/s for bubs safety. (my DH thinks i should) considering it was only 5% chance a pg woman has PROM which leads to a premmie baby and i made it into that small percentage, whats to say i wouldnt fall into the 1 person in the 1000.......

anyway Has anyone out there had a succesful VBAC from the same condition as myself?
I've read stories of the scar tissue being broken by the OB/Midwife whilst in labour.

[{sarah}]

Oh hun 1 in 1000 sounds scary doesn't. I'm pretty sure that the stats are way better than that honestly. I do know though that a repeat c/s carries far more risk than a VBAC. I'll scour my books & find out what the stats are, but I'm sure it's not as bad as 1 in 1000.

[BellyBelly]

The rupture rate in VBAC is 0.7% after one c/s and 0.9% after two. There is also a risk of rupture from inductions but lots of people have them these days!

Your scar is strong; the risk of miscarriage from an amnio is higher than rupture!

I would find a Doula to help give you strength and try to beg, borrow or buy some C/S books like Silent Knife etc...

If your Ob can't help you with the birth you want, you can always try a second opinion or changing Obs. Even some labour is better for your baby. If you labour and there is the same outcome, no dilation, then your baby will be benefiting from the labour, preparing them for birth and of course allowing baby to be born when he/she is ready.

I'll speak to some midwives for some more feedback.

[BellyBelly]

From a very experienced and sensible midwife, she was the national midwife of the year last year, (or the year before!):

"I have never manually "broken down" the scar tissue myself, but my observation is that the first stage can sometimes be drawn out e.g. long latent phase and then all of a sudden labour sets in and goes very well. It appears to me that left alone, the body does the work. I don't know the figures for VBAC survival of mothers and babies, but I do know that the outcomes of elective C/S should be pointed out."

[BellyBelly]

Some more, have PM'd you two more stories:

I've had a few women with scarred cervixes (cervices?) due to abnormal pap outcomes. One was told she'd never be able to carry babies to term let alone birth them vaginally - lost about 1/3rd of her cervix from memory.. She carried baby number 2 to term and had a very long latent stage of labour. I could feel scarred tissue and the cervix was irregular in shape. She persevered and birthed at home vaginally - a 36 hour labour all up. Some trickle bleeding afterwards but no major problem.

Same women birthed again at home with me a few years later. No sign of scarring on her cervix this time and a straightforward labour and birth.

Another woman's story: Primip, SROM at 40 weeks followed by nothing. 5 days of her team trying all sorts of things but no contractions. Bub in good position. Vaginal swab done at day 3 ... Her cervix was pulled to one side - ie felt irregular. She'd had a TOP in India a few years prior to the birth which she'd had problems recovering from - ongoing bleeding, infection etc. Off to hospital - doctor could feel same with the cervix - synto put up for 8 hours, cervix the same. Rested overnight with aim to try synto again in the morning. She spiked a fever early morning - off for c/section. Everyone fine. The surgeon commented on severe scar tissue across the cervix which he cleared away.
Same woman was pregnant a few years later and birthed at home with me. I had asked her to use a homeopathic for scar tissue at about 36 weeks after a conversation with the late Joan Donley - Conium 200 taken once may assist with scar tissue. (Joan, a midwife and homeopath, told an amazing story of a woman with breast reduction - nipples replaced etc - heaps of suture scars around the breast and areola - no sign of milk for days then after some doses of this homeopathic milk flow was established). Lovely HBAC with no sign of any hiccup with her cervix - difficulty with placenta I remember - must have been sitting across the scar tissue but we managed well.

Another more recent one - primip with twins. Only previous sugical history was cervical ablation therapy for CIN 2(?). This woman went in to premature labour and birthed her twins at 26 weeks - first vaginally and second by c/section. Twins came home after 3 months in SCU. She was offered a cervical suture at the time to try to gain a few more weeks but the couple declined this.

It appears the cervix can/might recover a bit after being stretched up to give birth, and possibly the homeopathic was effective too

[nickers]

Thank you very much for all the info Kelly.

I have changed OB's from my DS to this pregnancy as i moved states.
I am a lot more happy with my current OB then the one who cared for me with DS.
So i have only based my information that the reason i could not dilate was because of the scar tissue from CIN3 from my Melbourne OB.

My Sydney OB was not there first pregnancy to know this was the reason and only given my information from my records and what i have told him with my previous pregnancy.

I have been quiet impressed with this OB so far that he is willing to let me try for a VBAC. He is very thougher with me considering my previous pregnancy ending early.

Im definatley going to get some books to read up on and have been thinking about a doula. i was just unsure if a Doula is worth it if my likely hood of c/s is high?

OB has avdised me that he wont induce me because of the risk of a rupture but i have heard of other ladies being induced after a previous c/s?

[{sarah}]

I would highly recommend "Silent Knife" for you to read, it's a fantastic book that talks about VBACs.

I think doulas reduce c/s rates, so would assume that would be the case with VBACs as well as first timers. How did you cope in labour last time? Do you think a doula might be helpful for you? Even if you do have a c/s I'm sure a doula would be helpful for those circumstances, for example when DH goes off with bubba you'd still have someone to hold your hand

As for inductions, I'm pretty sure that it was standard practice to not induce VBAC mums. I think because of the full on contractions straight away putting too much pressure on the scar rather than building up IYKWIM. At least I think that's it!

[becmc]

1 in a 1000! No way!
I have read quite a few articles that state it is more like 1 in 10,000 babies die due to rupture of the scar during a vbac. Which is not a huge number. And probably comparable to other reasons that could occur during labour or c/s.
What was he referring to?? Uterine rupture specifically or something else?? I would be interested to know. That would mean that of 1 in 200/250 that do rupture, 1 in 4 babies die??? Not from everything I have read. And apart from UR other conditions can happen to women that are having a labour that is not after a c/s.

I don't know anything about your condition nickers but I hope that you can find lots of info so you can make your decision confidently! Good Luck.

[BellyBelly]

Yup 50% less c/s with a Doula. Especially where you have a VBAC I highly recommend them. As per the PM's I sent you, those rupture rates are not just for VBAC, it's inductions and everything else, so its innacurate anyway, as would the deaths be. You could also look into an independent midwife to accompany you to hospital. They cant do anything medical but are an advocate for you and a second opinion.

Email me your suburb/location and I can get some Doulas in your area to contact you for a no obligation chat if you like

Definitely read Silent Knife, The Thinking Woman's Guide to a Better Birth is also great and Sarah has a few other VBAC books which are great too.

All the best - surround yourself with those who are passionate about you acheiving the birth you want - it's very possible!

[BellyBelly]

More for you:

I have often cared for women with scarred cervixes from cone biopsy or laser ablation and have noticed the same - they usually get there quickly once labour has truly established. Often a slow latent phase where progress may seem to be stalled, the oft quoted 'failure to progress' scenario, failure to wait is more like it!

I can't see that a VE at 38 weeks, unless she has already started to pre labour, will do anything to help predict whether she will labour successfully. If anything it may make her doubt the likelihood of success even more because she will probably have a closed and unripe cervix at that stage (not knowing the full story of her previous birth) I have known docs who manually 'open' the scar tissue (shudder) but it is best left alone IMO. One was telling me about this recently and said that 'it just opens up with manual dilation' This tells me that it would 'just open up' anyway!

I also agree that if she is going to be quoted worrying statistics then she needs to see the whole picture and include statistics from c/s outcomes as well.

[Trish]

Nickers, just thought that I would add that the use of EPO vaginally is also recommended to break down old scar tissue.

Evening Primrose Oil acts as a prostaglandin, which ripens or softens the cervix. It's also useful for softening scar tissue from abortions or IUD damage. This will soften/ripen the cervical tissues and increase the flexibility of the pelvic ligaments. This will help the baby to deeply engage in the pelvis. This early application of the baby's head will assist with dilation and should result in a relatively easy birth, even after multiple C-sections for "stalled" labor. Evening Primrose Oil may be helpful for women with borderline pelvises as well. The utilization of Evening Primrose Oil seems to enhance the complex set of biochemical messages that initiate labor. You can take evening primrose oil, orally, in the last four weeks of your pregnancy. You should take three evening primrose oil capsules daily for the first week (36th week of gestation) and then one to two capsules a day for the last three weeks of pregnancy.

[castle]

Nic, I've had many of the same feelings as you. Although my story is not the same, with every baby something that was supposed to be highly improbably, has happened. Yes, you do get the feeling that you are someone who is singled out to have trouble! I felt very resentful...all I wanted to do was have a family, why did these things have to happen? So HUGS to you because I know how that feels.
I cannot speak to the cervical issue, but I can share some other experiences.
With my first baby I went into labour and laboured about 9 hours. Like you, I made almost no progress (this was not the reason for the c/sec, however). Subsequently I had 2 VBACs. With both of those, I had long labours. In each case the baby's presentation was not absolutely ideal, but with my 3rd birth especially, we all expected things to move much faster. I now think that for some women, this is just their pattern. We require some extra time. It is important to find a doctor who does not have rigid ideas about how much progress should be made per hour. It sounds like you have found a good OB, so that is a great start.
My doctor at the John Hunter here in Newcastle is renowned for supporting VBACs. He has an additional degree in medical statistics, so when he said that risk of rupture with a VBAC was minimal, I strongly respected his opinion. A biostatistician is the best person to address the meaning of risk! The thing is, almost anything carries some risk, but how important is it? A c/sec itself is a risk, especially to the mother, but we perceive the risk to be almost nothing. Part of the reason for that is because they have become so common.
Induction is not advised with a c/sec scar, but I believe augmentation once in labour is OK, as long as it's carefully watched. BTW I had auscultation alone with my first VBAC, intermittent electronic monitoring with my 2nd.
I haven't used a doula, but my brother & his wife have for all 3 of their births. They swear that it was the best money ever spent. With the 3rd, they almost didn't engage her services, but in the end there were complications during labour and they said her support was essential.

[BellyBelly]

A couple of midwives have metioned that upture rate is actually 0.3% so I must have old data.

Rupture seems to be the big bad risk factor of vbac. The risk of babe dying because of the rupture is different to the actual rupture. Important for women to know that. Some women actually think that if vbac success is only 70% - and how I wish it was that high! - that the rate of rupture is the other 30% WRONG! The same misunderstanding with vbac rupture rates being 1% (and that is a very high percentage rate. Normally it is 0.3%) doesn’t mean that that’s how many babies die from a vbac resulting in rupture.

The rate of uterine rupture is about 0.3%. About 1 in 20 uterine ruptures result in the death of the baby.
so the rate is more like 1.4 in 10,000.

These rates are similar to the odds of losing a baby in any unexpected circumstance such as a prolapsed cord.

There is also a small chance of losing a baby due to interference by a midwife or doctor (but we never hear of those!). For example, in the rare cases of vasa praevia, where the sac has blood vessels running through it, artificial rupture of membranes (routine in many environments) can cause the death of the baby within minutes. Rare, yes, but it does happen adn I have NEVER heard a care provider describe this as a risk of ARM.

Did you know that an unscarred uterus can rupture due to syntocinin (used for induction of labour or to "speed things up")? Rare, yes, but it is a small risk and one that i have NEVER heard a care provider describe.

I find it interesting that some risks are exagerated while others are ignored.

[nickers]

I am currently in contact with a doula, thanks BB (Kelly) found her on here!
Umm having some troubles though with my DH wanting me to get one as he beleive's i SHOULD have a c/s.

Thanks for the continued information it is empowering me more so to go with the doula and do as much as i can to try to acheive a VBAC.
I also havent discussed with my family because i am sure they will not understand. my mum and sister both had quick, complication free vaginal deliveries and i know if i go for this labour is probably going to be long, probably going to be tough and i really need the support of someone who wants me to acheive vabc as much as i do to keep me going. DH, Mum, Sister i dont beleive will give me that side of the support i need.

[{sarah}]

Go for it Nic!! You can do it

[Claire]

Definitely go for it Nic!!

[jaspen]

i know my DH was the same Nic - he read the line in the c/section info brochure about chance of uterine rupture in future vaginal birth attempts and he said "well c/section for you from here on out". As you might remember I ended up having one but not for that reason - I eventually talked him round with stats - cause he's a numbers man. I didn't have the added issues you have though - best of luck.

I have been checking up on you here and there to see how you are going and I'm glad to see PowPow and you are doing well and that the move and everything now seem to be settling into place - all the best and I have everything crossed that your little one holds on and is not as anxious to meet you as Nixon was.

[nickers]

Thanks so much girls!
I am having a meeting with a lovely sounding doula Michelle Galilee soon.
I seem to have talked dh around to the idea. and cost wise i told him my next 4-5 tupperware parties will pay for it!
i dont know what my sister and mum are going to think about it but its my body, my baby and my birth so i am very happy with my decision!
If i end up with another c/s i will know i did everything in my power to acheive a vbac and it wasn't meant to be.
i have dreams of my bub being lifted onto my chest i hope i can make the dream come true!
Thanks Jaspen! its good to hear from you!