Gutted - been denied a VBA2C

[RoyaUK]

Hi,

I'm doing shared care and went for my first hospital appt yesterday. I'm looked after a team of people in the hospital.

The ob i saw said that due to the type of incision they made last time (i've had 2 emergency c-sections) that she says the risk is too high for me to try VBAC and i'll have to have a c-section.

I feel completely gutted and disappointed as this wasn't made clear 18mths ago and i've been looking forward to trying VBAC. DH and my mum have said 'oh, well the end result will be the same' but it won't be because i'll be cut open again and I really don't want that.

It feels like after the last 2 times of medical intervention this time i'll have absolutely nothing to do with the birth of my child and it just feels wrong at the moment.

Thanks for reading.

[Kazmar]

Im sorry you're feeling this way Im sure someone here can give you some advice

[HotI]

Hi

I don't know that much about VBAC, but do know that you can always ask for a second opinion.

take care,

Kate

[Carrie]

Hi RoyaUK,
I'd definately be getting a second opinion on that. Find out about the type of incision that you had and do some research into it yourself also. I really don't know about the medical side of things, but perhaps you could get some advice from someone like Alan - who is a midwife who is often on BB.
Goodluck, I really hope that you can get to have a birth that you are happy with.

[julie_ann_jules]

I just wanted to send u a big :huh:
I'd also be getting a second opinion. Do you have a copy of your hospital notes from your last two births? You can get a copy of them from the hospital just ask to speak to the "freedom of information officer" they will be able to organise it for you. One u have your notes you'll have all the info u need to research and speak to other professionals about your options. I have also had 2 c-sections and I found it very difficult to cope with them. I was told that I needed a c-section the third time so I changes ob, changed hospitals, hired an independant midwife and did everything in my power to avoid another one. Is your scar low on your tummy?? I know that a scar that runs up and down (instead of from hip to hip) isn't reccomended for a c-section. But I don't know the difference in the rupture rates. You really do need more info so u can get somemore accurate info. Big hugs to you. Have a look at Birthrites - Healing After Caesarean there is lots of info on healing after a c-section and Plus-Size Pregnancy Website Cover Page there is lots of info there on everything to do with pregnancy, labor and birth, VBAC.... This includes lots of recearch and statistics (great to arm yourself with when speaking to your dr's)
Jules

[gardeningkate]

I had a natural birth after 2 CS, and blew a few myths out of the water, a Lower Uterine Transverse Scar sewn up properly is NOT a medical indicator, even if you have had 2 or 3, is the doctor suggesting that it wasn't sewn up properly, may be throw that at him/her, always ask why and for sources that back up the "facts" that doctors give you, most of it is only their opinion and not medical fact, medical facts are that a LUTS is NOT a medical indicator, and you do not require repeat surgery. Read my post about my VBA2C if you like, I overcame just about every obstacle with information and supportive carers. The psychological battle and the battle with the entrenched medical opinions that you MUST have surgery are going to be your greatest challenges!!
Good luck!

[gardeningkate]

oh, the Mercy are fairly friendly to VBACs, unofficially I know that they have recently done one after 3 CS, not sure of the circumstances of the first 3, but worth looking into a doctor there, I went to the Sunshine and had caseload, which is one midwife assigned to each patient, so you get consistency with your care giver, you both know what you want and expect, I might not have been able to follow through otherwise!!

[RoyaUK]

Thanks so much for all your replies.

gardeningkate - the first c-section was a LUTS with double layer repair. the second was LUTS but extended upwards (upside down t-shape) as DD2's shoulder was stuck and they needed to pull her out. Double layer repair again.

I guess i don't know where to go to get a second opinion - i'm in the public system at the RWH in Melbourne and doing shared care. Where did you find good sources of information?

I just seem to be crying at the moment about the loss of control and feel i need to arm myself with facts and stats and really understand the risks so i can have an informed process whichever way it goes.

[sas85]

Oh hun, I'm sorry it's caught you off guard like that. I don't have experience but when I was in the SCU with DD one of the nurses was saying she couldn't have a VBAC because she had the T-shaped cut in her uterus due to bub being stuck during CS and when asked why that was she said that she knew at the time when the OB said he'd have to cut up she wouldn't be able to VBAC after because with the upwards cut the risk of uterine rupture increases too much in subsequent labours. I'm not sure of percentages but maybe you could ask your OB what the risk of rupture actually is with this kind of cut so you know if it's just a preference or if no ob will agree to it. HTH

[Carrie]

I got my best information through my Doula who had heaps of resources that I borrowed and researched. Also the VBAC booklet (from birth rites) was great.

[gardeningkate]

I would firstly give you this information, 30 years of information has shown that the rate of uterine rupture for women with a LUTS is 0.7- 0.9%. This is whether you have had one or many, that appears to be the range. This is also based on US statistics were it is still routine to give inducing and augmenting drugs during labour, which is not commonplace in Australia, so to break that statistic down further, 1.1% of women who had augmentation during labour experienced rupture, 0.9 who were induced, and only 0.2% of women who had neither of these ruptured. Not all ruptures are symptomatic, which means that some, for example dehiniences (I can never remember that word) or those that only go in some places on the scar, or not through all layers of muscle and uturus are not a problem for mother or baby, which makes the danger factor even less. Put in perspective, nearly 400 women have to undergo CS to prevent 1 case of UR, which may or may not be a problem anyway, and even if it is a problem and you are in a good hospital you should be fine.
Read anything by Henci Goer, Silent Knife, and google like mad, I read heaps of info from natural birthing sites in other countries, where previous CS is not deemed to be an medical issue, let me know and I can try to hunt them down again if you like....
Having said that, I went in armed with all that and still came out of a couple of "sessions" at the first hossie I went to losing confidence, and I had 2 perfectly normal LUTS. I would ask for specific information, pertaining specifically to your scar, not based on their opinion but on confirmed actual medical facts. You should ask them to back up their statements with facts, and treat them as though you are interviewing them to see if they are up to the job of having the priveledge of attending YOUR birth. It is sad that you have to go this far to even get a hearing. If you can try to discuss things with the Sunshine Caseload Program. They don't have the same risk model as other hossies, so I had a midwife for my VBA2C, the same one the whole time, we discussed everything, trusted each other, she stood up for me and supported me both medically and emotionally and batted for me when things got tough. You would get a fair hearing there, I also found this, it seems to be backed up by lots of resources and actual medical outcomes, and mentions the names of some authors that I have come to believe are trustworthy, and it seems sensible in encouraging us to manage the risks, have a read, and go armed with it!!
Anne Frye on VBAC and Uterine Rupture - FROM RONNIE Falc?o's MIDWIFE ARCHIVES
The general consensus seems to be that inverted t shape scars are a higher UR risk, having said that put in the persepctive of all the things that can go wrong, and the risks to you and baby during this and future pregancies of a third CS, I would say go for it!! The hardest battle is not the physical one, but the one you may have to wage against the institutionalised bias against non surgical birth, and the psychological one. Even if you choose a CS, it can be an empowered birth, as long as it was your choice, and on your terms, don't let them book you in just because they want to!
Ask me any questions if you like, and for the record the Mercy is probably a good place to go to, not that I can personally vouch,
Good luck, and I know about the grief you feel, I felt it for years!!
Kate

[gardeningkate]

Oh yeah, and if DH and others don't get it, suggest they go and have major surgery on something just in case, it is harder when close people don't get it, point out that the overall maternal mortality for Cesarean section has been reported to be at least four times higher (Petitti, 1982) to as much as 26 times higher (Evrard and Gold, 1977) than for vaginal birth, the relatively small risk of uterine scar separation is put into perspective." Does he really want his children to be left motherless, that was the clincher with my hubbie!!
Good luck!
PS I am not really a fanatic, it shouldn't be a battle, ......