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| 06/26/2006 10:33 PM |
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Hi, I am desprate to find some information. I will try to be brief. I had my first child in '98 I was induced for preeclampsia and I was also past 42 weeks by a few days. I ended up with a c/s. Five years later during my preg. I tested positive for group B strep. I went to the hospital leaking fluid and they decided to keep me. I was a week or so past due. I was given time to see how things went and after a few hours the doctors wanted to do a "soft induction" with a prostaglandin gel. I continued to labor for about 15-20 hours. I was having a lot of pain in my hips and felt like I wanted to maybe push, well I was still only 4cm. Now here, I think, was my mistake, I asked for an epidural. I'd been in labor almost 30hours and I just was so let down that I'd not really made any progress. After having the epidural I fell asleep for a few hours and woke up with pain in my abdomen. Only with contractions. I was feeling it along my old scar and a popping feeling. Baby was doing well still and no heavy bleeding. At this point they took me in for another c/s. What I was told was I had ruptured, and not to become preg. again. Also they thought the reason I was not dilating and the hip pain was because my son was "star gazing" like with his head tipped back I think. This was in a German hospital so I'm not sure of the correct term. When I asked for more info they said my scar was open all the way across and I'd torn into my cervix. They also said my son was still in my uterus. I've since seen a high risk OB here and he said that was dehiscence and I wold need another c/s around 38wks but could become preg. again and be followed by a regular OB.
Now my question is, is it totally out of the question to have a VBAC? I live in FL which is one of the worst states for VBAC right now but I am willing to fight for it, I just need more information. I can't find any studies that relate to my case. I also need to "prove" it to my husband, who is very worried for me. He was told I could have died after my son was born. Please Help me find something. It is hard for a lay person to search when I don't know where to even look.
Thank you,
Heather By: Heather |
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| 06/27/2006 1:43 PM |
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I leave for Australia today and won't be back until July 10, but I know I'll have internet access during at least part of the trip. I will download your post so I can work on it off line.
-- Henci By: Henci Goer |
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| 06/27/2006 4:03 PM |
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Thank you so much for taking the time.
Warmly,
Heather By: Heather |
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| 07/02/2006 7:06 AM |
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It sounds from your story like the scar gave way entirely even though it didn’t do any harm to you or the baby. In such cases, it is recommended that the woman plan a repeat cesarean. I am not aware of any research on this point. I doubt that there would be enough cases where women with scar rupture in a previous labor after c/sec would be allowed to labor again to produce any. Even so, it does seem just common sense that if the scar gave way in one labor, it is likely to do so again. It should be your right to refuse surgery under any circumstances, although that right is being flouted in this country when it comes to women and repeat cesarean surgery, but would it be wise for you to do so?
If you want to learn more about VBAC vs repeat c/sec, you cannot do better than VBAC or repeat cesarean?. Among other things, you will find information on planning for a safer cesarean and a positive cesarean birth experience.
Speaking of safer cesareans, scheduling a c/sec at 38 weeks increases the chance of the baby having respiratory problems severe enough to require admission to intensive care. At the very least, you should wait until 39 wks, although even then, there is still an increase in the rate of respiratory complications. But were I you, I would want some evidence of increased risk of scar problems in the final weeks of pregnancy before scheduling surgery at all before your due date. Not every baby is “done” according to the calendar. The onset of labor is still the best way of determining this. It is possible, of course, to have the scar open during pregnancy, but it is extremely rare and I don’t know if there is any association with week of pregnancy. If the concern is labor starting in the middle of the night, I suggest you plan to have your baby in a hospital where there is no problem setting up for a c/sec any time of the day or night. In fact, if your ob calls ahead, they can be set up for you when you get there.
As a side note, you are correct in your understanding of “stargazing.” It means the baby’s head is tipped back so that the baby is looking up. The problem can occur in breech babies—babies who are head up instead of head down—in which case they would be looking at the sky.
Henci
By: Henci Goer |
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| 08/03/2006 6:39 PM |
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Thank you for the input. I did look at the site you recommended. One section said if there was seperation of the scar that may not be a reason to have a repeat c/section. Is my case somewhat different since mine opened all the way along? I was also thinking the use of a prostagiandin gel and pitocin really effected the outcome of my labor. I have heard of a midwife in my area who does homebirth VBAC. Would that be too risky?
Heather By: Heather |
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| 08/08/2006 12:26 AM |
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The recommendation differs for symptomatic scar separation, usually called scar or uterine "rupture" and "dehiscence," meaning a window opens in the scar. Since different caregivers described what happened to you using both terms, and, in fact, you didn't experience any alarming symptoms, it isn't clear which category you fit into. You are also correct that prostaglandin gel and Pitocin could have affected your uterine scar.
At this point, I think your best bet is to discuss your individual case with a practitioner who encourages VBAC, although unfortunately such a person is hard to find these days. Then if a repeat cesarean is recommended, you will have a basis for trusting the practitioner's judgment because you will know it isn't just because he or she prefers repeat c/secs. If you connect with this midwife, she should frankly discuss the potential harms as well as benefits of planning a home VBAC if she is willing to attend you. You need both sides in order to make an informed decision.
Please keep us posted on what you decide and how everything goes for you.
-- Henci By: Henci Goer |
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Heather (guest)
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| 02/20/2007 7:08 PM |
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Henci,
We are still TTC at this point, but, I have a question. You mentioned in your post that the recomendation differs for rupture and dehiscence. Can you point me to where I can read what they say? I have been doing a lot of reading and joined an ican group online, these things have helped me clear my mind so much. I have will try to HBAC if I can find a provider. I felt so much stress just thinking about going in to another hospital. However, if it is recomened by a provider I trust(someone who supports VBAC and normal birth) that I should plan another c/s I will give it serious thought. I am also wondering if mulitple induction drugs are given do the risks that go along with them go up accordingly. What I mean is say a prostaglandin gel increases rupture risk by 4%- don't have numbers in front of me- and pit also by 4%, would that give an 8% increased chance of rupture? Hope I'm making sense.
Thank you,
Heather |
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Henci Goer
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| 02/21/2007 10:25 PM |
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Posted By n/a on 02/20/2007 7:08 PM
Henci,
We are still TTC at this point, but, I have a question. You mentioned in your post that the recomendation differs for rupture and dehiscence. Can you point me to where I can read what they say? I have been doing a lot of reading and joined an ican group online, these things have helped me clear my mind so much. I have will try to HBAC if I can find a provider. I felt so much stress just thinking about going in to another hospital. However, if it is recomened by a provider I trust(someone who supports VBAC and normal birth) that I should plan another c/s I will give it serious thought. I am also wondering if mulitple induction drugs are given do the risks that go along with them go up accordingly. What I mean is say a prostaglandin gel increases rupture risk by 4%- don't have numbers in front of me- and pit also by 4%, would that give an 8% increased chance of rupture? Hope I'm making sense.
Thank you,
Heather I can't think of a specific reference on the dehiscence vs. scar rupture recommendation. I just know that it is pretty much universally recommended that if the scar has come completely unzipped in a prior VBAC labor, a planned repeat c/sec is recommended. I also know that I have read that a dehiscence, a small, harmless "window" in the scar, is not believed to pose excess risk in subsequent labors.
As for the use of cervical ripening/induction agents, several studies have found increases in scar rupture with various agents and combinations of agents, but it isn't as straightforward as adding the increased risk of individual agents together. The degree of increased risk--and some studies do not find any--depends on the characteristics of the women in the study, what agents were used, in what combinations, and at what dosages. No two studies are alike on that score.
I still think your best bet is to review your medical records with an obstetrician who encourages VBAC. Now that you are in contact with ICAN, hopefully you can find someone through their network. Considering how important this decision is, it may be worthwhile to travel if such a person is not available in your community.
-- Henci
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