Some Questions....

Ok, before I even think about TTC again, I need to ask some questions about labour.

I was induced and DD was born via emergency c-sect because she was in fetal distress and I have been told she was obstructed - too big for my pelvis. My Mum lost a baby due to the cord being wrapped around baby's neck during labour and it not being picked up on in time (about 28 years ago) so am really scared now about monitoring etc. I hated being on the CTG because it meant I couldn't move and (I believe) grossly contributed towards my c-sect.

If I am able to find an Ob who will let me VBAC, how much monitoring would I need?
How can they tell if baby is obstructing without CTG?
How can they tell if bubs is in fetal distress without monitoring?

I feel robbed for not getting my natural delivery but am so scared something will happen if I birth naturally because my Ob told me I am unlikely to ever be able to deliver naturally due to pelvic size etc. Being able to overcome some of the issues I have will depend on if and when we have another baby.

TIA

MG

Oh MG, I'm so sorry you had such a tough time with the birth :(

All I know is that with my OB, and I am having a VBAC, I don't have to be monitored constantly. they will monitor me intermittently, so that I can still shower, move around etc. So I am very happy about that.

As for your pelvis size, have you heard of the pink kit? It is a great resource & covers things that can help you prepare & find the best positions for your particular body.

And don't forget to shop around for your OB ;) Find one that is on your wavelength. :hug:

MG I agree with everything Linda said. I haven't had a C/S so can't offer any advice, however I wanted to wish you luck and hope that you get your vbac that you want. I hope you find peace in knowing that it can and is done averyday. Good luck
Dee

When i had DD (homebirth) they listened in with a doppler every 20 minutes through a few contractions to make sure her heartrate was ok. They also asked me if she was still moving in between each doppler check (which she was).

You are right that being able to move makes a MASSIVE difference to how much room there is through the pelvis. Squatting/all-fours can apparently give as much as 20% more room! That's a massive amount! I've not seen the Pink Kit but i've only heard good things so it's probably worth getting one.

Induction often leads to foetal distress, babies begin the labour when they're ready - if they're not in quite the right position they'll try to shift but induction contractions can be quite aggressive and because baby isn't in control distress isn't uncommon.

True cephalo-pelvic disproportion (pelvis too small/baby too big) is very very rare. It's something associated more often with women who've had illnesses such as polio, which can distort and twist the pubic arch. In the western innoculated world it's usually found in women labouring on their backs, who cannot move due to monitoring/epidural.

I feel a bit GRRR at your Ob as he shouldn't be telling you your pelvis is too small arbitrarily, and it's something obs say a lot after c-sections! An experienced midwife can measure you with a pelvic exam and will be able to tell you how much room you have (most likely lots!).

You shouldn't have to think about if they'll "let" you VBAC - this is YOUR birth. You have to live with the consequences however it all turns out, thus it's up to you how to do it all. You are learning already about all the considerations, you are empowering yourself right NOW. You can FIND an ob who will support your VBAC. Janet even birthed VBAC unassisted - your body can do it. You're doing such a great thing researching before you ttc. Well done hon, and best of luck with it all.

Bec

MG, I understand some of what you are going through. I went through severe shoulder dystocia with my first deliver (shoulders got stuck) I've been told by some Dr's that I should not try a natural birth again and another say that it is possible with the right care. I'm so confused!It's been nearly 2 years and I still haven't come to a decision on the matter.
I think for me a lot will depend on being able to find a Ob that I can trust completely. I plan to start looking before TTC. Have you thought about talking with your Dr about what did happen and ask some of the questions that are bothering you. My MCHN suggested this to me when I wasn't dealing well with what happended and I think it really help.
Sorry, I haven't heard of the pink kit, is it a book?

All the best

MG - I also ended up with an emergency c-section however I had the benefit of a supportive OB who supported my attempt at a breech vaginal delivery. The emergency c-section was the risk I was prepared to take to try for the natural vaginal birth.

Because I was attempting a vaginal breech I required constant CTG monitoring BUT this was done via a telemetry system. I was hooked up but able to move around and I did most of my labouring to 6cm (when we ended up with foetal distress and thus c-section) in the shower.

You can be monitored AND mobile (and in the shower if you want - just not sure about the bath though :dunno:) for your next labour. VBAC is possible (and what I will be aiming for) but you need to find an OB who will support your choices. I was blessed with a fabulous OB who allowed me every opportunity for a vaginal birth despite my risks (breech, GD, previous stillbirth).

Having read your birth story, I can understand why you are feeling as you are. If at all possible, try to find an OB now (before considering TTC) who you can talk to and feel comfortable with in advance. It is hard to develop a rapport with someone when you are pregnant because the time goes so fast. It also makes it difficult to change doctors mid pregnancy if you discover you are not comfortable with their practice or they don't support the choices you make.

Good luck. I hope you can get the answers you need to make your next pregnancy and labour a pleasure to experience.

If your baby's wellbeing is of serious concern to you then constant monitoring will give you the peace of mind you need even though it's restricting. You can negotiate break times though, to have a shower or walk around etc. I have stated I will be doing this on my birthplan. They might also have some monitoring machines with battery packs so you are still hooked up and the info is still sent to the machine, but you can move around? If your waters have broken they will be able to tell if bubs is distressed if there is meconium present too.

Gee that sounds like my story.
After much consideration and even booking into hospital I am going the homebirth option.
You could have intermittent monitoring with the handheld thingo, I think it is called a doppler. And yes I also believe being able to move freely will help the baby move down and avoid being distressed.
When you find an ob you will probably have to negotiate on what sort of monitoring you want, at the end of the day is up to you of course, but I personally didn't want to have to deal with getting to hospital to have them tell me what I should be doing, and risk failure to progress due to stress.

Have you organised to get your hospital records at all?? I did and it was an eyeopener, my supposedly distressed baby who was 'stuck',(at the time that is what they said), really had 'descended well' and had a heart rate that didn't go below 120 (according to the notes). Hmmm...

Hi MG,

Make sure you choose your careprovider very carefully if you would like a VBAC. You can increase your chances of a successful VBAC by making a simple choice about the model of care you will be in.

And I don't just mean choosing between Ob's ;)
Sam.

Hi MG,

I don't think you need to worry about the prediction that future labours will also result in CPD. There are so many variables that change things. As you've said, just being unhindered and being able to move, re-position your pelvis and work with gravity and your instinct could make a difference. You only need such a "little difference" to make the difference between an "obstructed labour" and a "progressing labour".

After your mother's sad experience and a difficult experience for you last time, your fears are real and important, they need to be faced and heard - not minimized or glossed over. But I do want to encourage you that every labour is different and although last time you faced an obstructed labour, *take heart MG*, it's not a given that you'll have CPD with the next labour at all.

Your pelvis moves and it's diameter can increase by up to 3 cubic centrimetres in some positions. It's hard to find that extra pelvic capacity if you are confined to bed or have to stay still for the CTG monitor. The size of the baby, the position of the baby's body and head, the tilt of your torso and the tilt of your pelvis, the relaxation of tissues and tendons deep inside your pelvis, and your state of mind and the atmosphere around you are all factors that potentially *could* be different with future births.

I once read an article called, "Pelvises I Have Known And Loved" by a midwife who had a number of clients who had all been told quite negative things about their pelvises. You know, it's not an exact science and your pelvic capacity/ability is not a fixed quantity, and no-one can say with a reasonable degree of accuracy, "you are unlikely to ever be able to deliver naturally due to pelvic size".

You're well on the way to arming yourself with new information for new choices. All the very best MG, big hug to you, you're a brave woman.

:

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I feel robbed for not getting my natural delivery but am so scared something will happen if I birth naturally because my Ob told me I am unlikely to ever be able to deliver naturally due to pelvic size etc.

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MG what you`ve written is exactly how I felt after having Matthew via c/s, so many people couldn`t understand why I wanted a VBAC so much and off course I was worried that I may have had true CPD and not be able to birth Adrian but I did it even if he was born with the help of forceps due to exhaustion on my part (MIL tells me that I didn`t birth him, the Dr did pffft)

By the time I was pregnant with Adrian I was aware of how wrongly CPD can be diagnosed hence my VBAC with him and I got him out and he was the same size as Matthew.

It will all depend on your OB as to how much monitoring you`d be having, my OB was fine with me to have very little monitoring as I wanted an active labour and not hooked up to the machine but as it turned out when I did go into labour the midwife was just beautiful and would let me stay in the bath and use the doppler to monitor me BUT then I had a change over of MW`s and this one wanted the monitor continuously on :( I was not impressed especially since being in the bath really helped things move along

Oh Deejoy. It sounds like you were doing so well in the bath, I am so sorry about the mid who wanted the continuous monitoring (proven to not improve safety for babies but only to improve intervention for mothers).

I just wanted to say, re. your MIL's comment:

YOU BIRTHED YOUR BABY. Not the doctor.

We nearly all have help of some kind or another when we give birth - it might be emotional, physical or sometimes technical help. So you had some help - BUT YOU GAVE BIRTH TO YOUR BABY and I would just like to say ...

CONGRATULATIONS!