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Normal Birth Forum Featuring Henci Goer
Subject: vbac after uterine trauma

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06/25/2006 12:37 PM Quote Reply
Hi! I'm so glad to have found this site. I have so many fears about getting pregnant again but I'm ready, finally. My daughter is 6 and when she was born I took the advice of my doctor and was induced a few days prior to 42 weeks. I also had an epidural at 2 cm, I knew little then about how these interventions could screw up my chance of a normal birth.
So when it was time to push and deliver, I was stuck on my back, legs in stirrups, trying to deliver my baby. Not feeling much I could have gone all night. But then my doctor asked if I had broken my tailbone as a child, I said yes. He said because of the way it had healed the baby was getting stuck and couldn't come out. My husband could see her hair but she couldn 't come out without possibly hurting her. I was willing to try and break my tailbone but it was stronger than normal because of the way it recalcified. So needless to say, 30 minutes later my baby was born via C section. It was scarry, not the birth I had intended.

I recovered and checked out well at my 2 week postop with my OB. But then at 3 weeks something terrible happened. I woke up just pouring blood. A hemorage? a bleed-out? I was bleeding straight from a uterine artery. A ambulance ride, an emergency vaginal entry surgery to block the artery, 2 days in ICU and a week at the hospital I finally recovered and was able to go home. I had lost 75% of my blood during what my doctor described as a medical mystery. He explained it as a scab on my uterine artery slofted off and I just bleed until he could manually stop the bleeding. It was scarry nedless to say but I still have a uterus and he said then I could still carry a baby. He also said he would only consider doing a c-section. Well I don't want a section but I have the issue of the tailbone and the stress my uterus endured. Is it even possible for me to consider having natural childbirth? Have you ever heard of such bleeding problems at 3 weeks postpar? What about a vaginal birth with a tailbone shaped like a hockey stick blocking the baby?
Thanks for reading my long story.
By: mamamama
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06/27/2006 1:48 PM Quote Reply
I leave for Australia today and won't be back until July 10, however, I know I'll have internet access for at least part of the trip. I have downloaded your post and will work on it off line.

-- Henci By: Henci Goer
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07/02/2006 7:09 AM Quote Reply
Let me start by saying I am so sorry you have had this difficult experience. Your issue is a clinical question, not one about research. Your best bet is to find an ob whose judgment you can trust and consult with that person. A good benchmark is the ob’s cesarean surgery rate. According to the World Health Organization and any number of studies, a c/sec rate over 15% cannot be justified. With c/sec rates what they are in this country, an ob with a cesarean rate this low will be hard to find, but persevere. Likely if you tap into the doula network or the midwives in your community, they will know who to go to.

Since your tailbone was the problem at this last birth, one thing you might ask is if anything can be done before you get pregnant again. Perhaps it could be re-broken and moved out of the way. It certainly sounds like that was the obstacle if you pushed the baby down far enough for your husband to see the hair on your baby’s head.

This brings me to the next problem: assuming the tailbone issue gets resolved, you are likely to have difficulty finding an ob willing to attend a vaginal birth after a cesarean. This, of course, is an outrage as it forces women to agree to major surgery in order to obtain medical care, but there it is. Still, if you can find an ob with a c/sec rate in a reasonable range, that doctor is also likely to attend VBACs.

The other advice I have for you is to consider how you are feeling. An experience like yours can be traumatizing, and you may still be experiencing symptoms of that. Even if you aren’t they are likely to resurface as you go through another pregnancy and anticipate your next birth. Trauma survivors tend to experience extreme anxiety, nightmares, flashbacks, and to be hypervigilant. Over time, posttraumatic stress can shift into depression. If this is happening (or happens) to you, you may wish to consult a counselor. There are treatments. If you want specifics, I have a friend who is a marriage and family counselor who specializes in perinatal mood disorders. I’ll get her to give me more details on this, and I’ll pass them on.

In any case, I recommend that you hire a doula. I think both you and your partner would benefit by having continuous labor support from a trained and experienced woman because you are both likely to be more anxious during the next birth. I would also recommend a doula because I think you would be wise to avoid an epidural, and she can help you with comfort measures and other strategies for coping with labor pain. It is just possible, though by no means certain, that you might have been able to push the baby out if you could have gotten into a more physiologic position and had the full power of your muscles.

As for postpartum hemorrhage 3 wks later, I believe it is very rare. I had a doula client years ago to whom this happened. Different cause, though. She had some kind of odd and highly unusual healing problem of the uterine wound.

-- Henci

By: Henci Goer
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