Hi there,
I had an appointment with my ob yesterday and we had a lengthy discussion about my VBAC birthplan. The only thing that is bothering me after our talk is what he said about a realistic time to get an emergency c/s.
I have read in VBAC studies that 20 minutes is the ideal time for a c/s if a uterine rupture occurs. My ob says that it would be unrealistic to claim that you could achieve this with any kind of regularity in any hospital in Australia, and that if it was an actual requirement then noone would be able to offer VBAC. He said that it would be safe to say that you could be in surgery inside an hour. I don't think he was trying to put me off, just being honest.
I don't want to focus too much on this as it is the worst case scenario but it is playing on my mind. Is an hour an ok length of time if my uterus ruptures?
I had an emerg c section but only due to getting to 8 cms and not being able to prgress so not the same as you - but from the time we decided on the c sec from the time Bella was born was 46 mins all up so fairly fast - that included signing of forms and getting me dressed and getting DH dressed as well... I guess if it was a huge emergency like a rupture then it would be faster than that!?!
Its quicker with a uterine rupture. Hopefully Nai will pop in here cos she just went through it.
With a normal c-section in "normal" emergency situations (eg failure to progress) they do have a bit of time up their sleeve - with uterine rupture - they don't. I'm pretty sure that most of them knock you out too, to save time with worrying about the epidural and stuff.
I have just had that experience with a uterine rupture and I was in theatre and the baby was out within 20-30min BUT I was already in the hospital and it was the Royal Women's in Melbourne. Also I identified to the OB that I had a pain across the front of my uterus that was not subsiding with the contractions and she correctly identified a uterus that was about to rupture. When I was cut open she just touched my scar and it burst open so she thinks we probably only had 5 more minuted before I ruptured in labour.
However - the hospital does about 600 VBACs a year and has about 2-3 ruptures a year so it is very rare - unfortunately I was one of them, fortunately I was in the right place at the right time for a good outcome.
I'm due in 5 weeks and I'd planned to have a VBAC too but yesterday when I had my normal appointment I asked me OB what happened if the worst happened and I ruptured. She said that the hospital would have to call her and she would come in and assemble a team. My thoughts where the same as yours. Surely it's not safe to wait that long for her to arrive!?!? I'll be a the Wesley. Now I'm thinking that a c-s is the way to go....I've no idea what to do
I think it's important to understand that when it comes to caesareans, there are emergency caesareans....and there are true emergency caesareans.
An emergency c/s is classed as one that is unplanned and occurs after some labour. This includes "failure to progress", fetal distress etc. Most times in hospital it can be up to an hour before you will get into theatre because although it is considered an "emergency" c/s as per the definition above the situation is not immediately life threatening.
In a true emergency - for example a total placental abruption or a serious rupture - you would be in theatre much quicker than that. Sometimes in under 10 minutes depending on the seriousness of it.
It's also important to recognise that there are varying degrees of uterine rupture - yes there is the catastrophic kind but some ruptures are also small, or the uterus doesn't rupture the whole way through. So there are lots of variables.
But if it were a serious rupture you will be into theatre pronto. I think that this is a scare tactic. Ask your obstetrician what the hospital does when someone comes in to the hospital on short/no notice with life threatening injuries. They get their act together and get them into theatre immediately. This is a daily occurence in most hospitals.
KellH - the Wesley is notorious for poor support of vbac and has an extremely low rate of successful ones, not surprising for a hospital that has an excessive primary caesarean rate.
Watch out for the "bait and switch" - yes yes yes we are supportive of you having a vbac. You get to your last month and suddenly there's a multitude of reasons why you can't have it and you feel too trapped by being so far along to do anything about it.
I too think that it's a bit of a scare tactic but it's worked. I just couldn't bear it if something went wrong. It's so strange because until yesterday I was 100% sure that a VBAC was the way to go but after speaking to my OB and visiting a friend at the Wesley who had her baby on friday made me realise that there is a little person inside me and they are depending on me making the right decision and there is a little boy (2) at home needing his mummy to come home safely. I'm sorry but I'm starting to get a bit emotional about it all...
Tobily - I asked her how many the Wesley sees and she said maybe 1 per fortnight. I didn't think to ask how may where successful. I was really surprised by this low rate too. I then started to worry about how much experience they have....in this day and age I would have thought that VBAC's would be supported and encouraged more than that!! Thank you for talking to me about it. All my friends had natural deliveries (or haven't gone for #2 yet) so there isn't really anyone to talk to about it.
Good luck berrme with whatever the outcome!!Exciting although nerve wracking time so all the very best to you hun and I hope you are able to achieve your VBAC, will look out for posts to find out...
I had a "emergency" CS 12 months ago my OB has stated in DS file that is was Failure to progress due to an abnormal shaped pelvis.???
From the time that my OB said to pull the pin on a NB it was roughly 40 minutesish. And they had to call in an anesthetist and pediatrician before they started.
Northwest Private in Brissy also has a 50% CS rate also. I was advised if I wanted to go VBAC for my next bubby to try at the RBWH but after reading Nai's post I think I move to Melbourne...LOL!!
Wow, thanks for all your fast responses.
Nai: It is good to hear from someone who had a rupture and it turned out ok!
My c/s was an emergency c/s due to preeclampsia. I was induced at 38 weeks but my blood pressure went nuts during labour so off to theatre we went. I think it was about an hour that time, but I was waiting in theatre for quite a while as they were waiting for my platelet count so they didn't have to give me a general. It is all rather blurry though.
My ob has told me that the only difference between me and a first time labouring mum is the small risk of rupture. I am at North West, but he has told me that while only about 10% of his patients attempt VBAC, around 2/3 are successful, and I have as good a chance as any. As long as the preeclampsia doesn't return. He has said that going to 42 weeks is ok and hasn't asked me to schedule an in case c/s date either which I have taken as a good sign.
He did also point out that not all emergency c/s were real emergencies and all that could be done to get me in there quickly would be done in a true emergency. Delays are generally due to getting an anaesthetist during the day as they are so busy. Apparently not all anaesthetists will work on obstetric patients as we are 'higher risk'. It seems that if I am going to have a rupture I should do it after hours as there is always an on call obstetric anaesthetist and empty theatres.
I had an emergency c/s due to pre eclampsia.i was 37 weeks 4 days high b/p,protein in urine, swollen ankles u name it i had it. a couple hrs later my baby born was born
My ob is Martin D'Arcy-Evans. I really hope you aren't going to tell me he is full of crap now! That would be very disappointing. He said that the other obs on his rotation roster had the same general view; there are risks involved but they aren't high enough to say that the patient can't have VBAC as an option, they just watch you closely.
KellH: I feel the same way about not knowing enough people who understand the decision we are making. Noone close to me has questioned that I should be able to do it, but I find myself explaining risks and benefits etc when it shouldn't be such a big issue. There just isn't enough knowledge in the general community! Most people look surprised when you say that there is an option other than another caesar. Not very helpful when you just need someone to reassure you that you are making a good decision.
Berrme - I think in the last day I've talked myself into another c-s. My partner is completely open to either option which is frustrating cause it would be nice if he made the decision for us!! I'll probably change my mind 100 times between now and my due date 9/4/09. I just keep coming back to what I've read on other forums that it doesn't really matter how bub comes into the world as long as they came safely. I just had such a rough time recovering from my c-s with my DS (he was breech) that I couldn't imagine looking after a toddler and a new born in the pain I was in. But having said that I'd take whatever pain was needed to ensure bub was safe and healthy. Sorry not being much help to you. It's just nice to vent to someone in the exact same position.
berrme, I saw Dr John Howland, No the only reason I ask is that a girlfriend of mine is seeing Dr Bob Watson and is quite supportive also. As is Dr Tuicolo.
I agree with what you said about lack of information but as someone said to me the odds are stacked against us (us as in women who want to attempt a VBAC....Including me!!) when to me that is just a joke, We need support, guidance and a whole bunch of "YOU CAN DO IT"attitude to get us through even when we think we can't.
I think contemplating the thought of a VBAC is an achievement in itself, But I think you have made a very brave and very empowering decision, I hope that you get the birth experience you are looking for. I'm sure we could rally up a little "YOU CAN DO IT" Have faith in yourself and your body squad if need be too..LOL. Ultimately it's your decision but I think...YOU GO GIRL!!!
My GP has told me that you have as much chance as a VB as a first time mum about 70% but yes there are risks. Pretty good stats if you ask me!!
Have you thought about a doula? there was a post about a week ago... I'll see if I can find it for you.
My DH keeps telling me he supports whetever I want to do. I would love him to make the decision for me too! I am in the process of printing out some info on VBAC for him to read himself instead of everything coming from me. Then he can tell me what he thinks for himself. It is his baby too, afterall.
I don't think I would be able to ask for an elective c/s unless there is something else wrong besides a scarred uterus. I also can't imagine not being able to pick up my 2 year old, or play like his mummy is supposed to. So many reasons not to have surgery! I just get a bit scared at the prospect sometimes. I am already feeling better about it than I was this morning. Having people point out how quickly hospitals can act when they need to has helped. They don't want my baby or me to die either. In the end we can only do what we are comfortable with, it would just help if everyone else was comfortable with it too!
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Time taken for emergancy c/s
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