Aggghhh! VBAC or maternal-assisted c-section

If you asked me yesterday I would have told you that I WILL BE going public next time and I WILL BE having a VBAC - no ifs, ands or buts about it!

However I'm starting to think about EVERYTHING again.
With DD last september I had an elective CS at 38 weeks due to PE and her head not being engaged. The anaesthetist could not get the EPI in so I had to have a general. (the first 4 attempts he kept hitting bone - on the 5th attempt he got it in but i only started to go numb down one side)
I felt completely robbed of a birth experience - no labour, didn't see her being born, didn't hear her first cry, didn't meet her til she was 1.5 hours old.
This started to affect me really badly in the weeks following the birth so I decided to embark on a mission to try to ensure I have a more positive empowering birth experience next time.

I spoke to my OB about my feelings and she told me that she was open to the idea of me having a VBAC but she said she feels I'll probably need another caesar. But she agreed that if I DO need another caesar she will allow me to have a maternal-assisted caesarean (where I can reach down and pull bub onto my chest after she makes the incision and delivers the head and shoulders) and she will allow skin to skin contact with bub whilst I'm still in theatre and whilst I'm in recovery.

I really want a vaginal birth though and I feel that I'd have a much greater chance at having a VBAC if I went through the public system and our local VBAC friendly public hospital. I know the proof is in the statistics.

But what happens if I go public and I DO end up needing another caesar? I will miss out on the Maternal-assisted CS option.
In saying that though, there is always the chance that the Epi wont work properly again and I'll need another general. Has anyone else had an experience where the epi/spinal didn't work properly but then they were able to get it to work properly in subsequent births?

I'm soooo confused, I don't know what to do! I'd love to hear any comments suggestions or idea's. I feel that if I can have a positive birth experience next time it will help me heal.

What are the reasons for the Ob saying you'll have another c/s?

I was told the same thing, and changed ob's and my next one told me that I had been misinformed and there was no reason I couldn't have a successful VBAC. I got my VBAC and I look back and shudder at the thought if I had listened to my original Ob I would have been robbed of that experience altogether.

firstly she 'feels' that you will need another c/s

what is this based on, your previous birth? if so yes you have a risk of developing PE again but with correct management you can still have a vaginal birth

and she will 'allow' you to have skin to skin with your baby

this is your right not something you need to get permission for, with any type of birth

regardless of whether you have a VBAC that results in c/s or elective c/s you still have rights in regards to your birthing, and yes you can still have a birth plan for a c/s or a VBAC

sorry charli'smumma for the rant, it just makes me so mad when I hear doctors kindly allowing their patients to do things, that is every birthing womans right

x

Hi Niliac,

Well, early in my pregnancy my Ob had said that an internal and also ultrasounds showed that I have a deep pelvis and that sometimes when this is the case it can be difficult for bubs head to be able to engage properly. I didn't really take any notice of this comment at the time.
However at 38 weeks DD's head wasn't engaged. So with a combination of these factors, my OB suspects that I may have a problem with bub being able to engage again next time.
I've done some research on CPD and I'm of the opinion that it is a load of crapola in most cases so I would definately fight my OB about her "baby not being able to engage" theory unless of course I got to 42 weeks and bub still hadn't assumed the position.

My other concern though is, I have a 10-20% chance of PE with my next pregnancy so what if I get that or if I have another condition such as placenta praevia or accreta and I really do need another caesar. If I have cancelled my health insurance and gone public I won't have the same opportunities and I will most probably have an Ob operating on me who I have never met before and who is unaware of my personal situation.

Hi Natalie, no need to apologise. I totally agree it should be every womans right to have skin to skin following a birth no matter how bub was born. I spoke to the public hospital about the possibiliy of this if I had a caesar there and the midwife said that they love to be able to allow this but it depends on whether they have enough staff on that day as the recovery nurses won't allow a bub in recovery with the mother unless there is a midwife present. So there would be no guarantees that I would be able to have skin to skin with bub in recovery.

PS: Natalie, have you ever heard of the "deep pelvis can mean problems engaging" theory? or have you ever had a patient have an experinece where the epi didn't numb them properly on one occasion but it did on another?
perhaps I'm just having a freak out today wondering if I'm better off going back to what I know. I probably should just go public midwifery care, control what I can control and leave what I can't control up to fate.

the female pelvis is unique in that it has a pelvic cavity that allows for a baby to manouvre through :)

a deep pelvis is not something I have heard of before, and I would therefore be a little wary of this discription. True CPD is quite uncommon, and simply as your baby had not engaged at 38 weeks is not really an indication that she would not have been able to fit through. A VE is not really a good measure of pelvic depth and width either. The only way is to have your pelvis mapped radiologically to know the diameters, which for the average women is 10cm at its widest diameter at any particular point in the pelvic cavity (just the diameter of the baby's head ;))

regarding the epidural...I have looked after many women (and myself experienced this with my first labor and epidural :cry:) who have experienced this, it is known as a patchy or incomplete block and is dependent on many factors such as: your position when insertion is performed, anaethetists skill, your individual anatomy (we are all unique :))

it is normal to feel overwhelmed charli'smumma :) growing, birthing and nurturing a baby is the biggest job in life :)

if you couldnt have skin to skin in recovery why not in the theatre as you are being sewn back up...they will argue theatres are cold, but the best way to warm a baby is skin to skin. If not you, then your partner can wear a jacket or shirt that he can undo and place his baby to his chest and enjoy the skin to skin while you watch on :)

listen to your heart, trust your inner self and be guided by what feels right for you and your baby

I am more than happy to answer any Q's you ever have :)

I hope this helps

x

Hi Natalie,

Thanks so much for your reply :)

My biggest wish is for a vaginal birth so I think I should just stop being worried about the unknown and embrace the different mode of care that will help me achieve what I want. I will definately be writing a birth plan this time around, and you are right ,they shouldn't be able to deny me of skin to skin in theatre. I will also be stipulating that I want the screen lowered so I can see bub being born. But anyway, I shouldn't be worrying about that too much because when the time comes, I'm really going to be putting all of my positive energy into achieving a VBAC.

hugs to you charli'smumma

you do know what you want ;)

x

you need to get the information yourself! don't rely on anyone else telling you what you *should* do.

a VBAC is totally do-able, the risks are low but the benefits to yourself and your baby are high!

Put the power back into your own birth experience... ;)

+ search out some support... particularly if you want to birth under hospital conditions. an advocate for you, such as a doula is an option. you can always search out a student doula, whose services are free if cost is a consideration. Treat this birth differently to your first. My SIL had a VBA2C, so anything's possible if you want it to be.

I could ramble forever... best wishes in your journey :)

Thanks Danielle, yes I will definately be having a doula for extra support.