Dear Henci Goer,

I am currently opting for a VBAC as my first was an emergency caesarian.

After some research and talk with my yoga instructor from Concord Yoga Studio – I feel the caesarian was unnecessary and was robbed from having my natural birth. 

My doctor had given me a CT scan at around 37 weeks and stated that I had a tight pelvis and would not be able to birth. I told him I still wanted to try.

So we never booked a date in but after 2 days being overdue I had what they called a membrane rupture and was told to go to the hospital to get checked. The nurse checked me and as was doing so my waters broke.

After 1 ½ hrs of no contractions I was given the drip and then increased the volume only to find I could not keep up with contractions at all. It also caused my bub to become distressed and poo 2 times, so then after about 9 hrs we had the caesarian.

This time I have another doctor. He is ok to give VBAC a go but still wants me to have CT scan at 37 weeks to see if the baby is too big. Is this a new trend???? My mother had 6 babies and never had this done.

I am feeling that he will tell me that I must have a c section due to my pelvis again. I do not want this. I understand that there is a risk of rupture but this is the same risk any mother takes in birth. 

So the reason for my email is to ask for some pointers. How I can approach the doctor and what I should be doing during labour.

Also do you recommend any book for me to read on VBAC? I have completed a workshop course with Tara from Concord yoga and her information was great but I just want to keep reading so I can be mentally ready too. 

I am due in approximately 6 weeks.

I hope you can help me. Many thanks in advance.

Vana, I can't see the point of a CT scan. The baby either fits or it doesn't. A scan doesn't allow for the way upright positions and movement open your pelvis to let your baby down.

Your best chance to have a vaginal birth is to birth as undisturbed as possible. A known and trusted birth professional (preferably a midwife who has done your antenatal care), homelike surroundings with no bright lights and machines that go ping! Just your trusted and supportive birth support people. Use movement and upright positions for labour etc, etc.

Cheers

Judy

First, the good news: Congratulations! You have found a doctor who attends VBACs. They are getting to be rarer than hen's teeth, although not for good reasons.

Now the bad news: I agree with Judy that having an evaluation to judge the baby's size and your pelvis will do you no good and has the potential to do harm. Your ability to birth the baby vaginally has much less to do with the baby's estimated weight or the size of your pelvis and much more to do with (1) what care you receive in labor; and (2) whether your doctor believes that you can birth the baby. This is because, first, as Lamaze's recommended Healthy Birth Practices make clear, staying upright and active in labor can help your baby get into the best position for passing through the pelvis and can help your pelvis flex open to accomodate your baby. If you're looking for a good resource, you can't do better than Mother's Advocate, a new website with videos developed in partnership with Injoy Videos. Second, your ob's belief about whether you can birth the baby is crucial because this affects judgment--just ask the numerous women who birthed a baby as big or bigger in the VBAC labor than the baby they supposedly couldn't birth the first time. I have several studies finding that many more women have cesareans when the ob suspects the baby to be big (over 8 lb 13 oz or 4000 g) than when the baby is actually this size but the ob didn't suspect it. Here's one.

Your best odds for an uneventful vaginal birth, especially with a good-sized baby, are to:

• begin labor spontaneously: Inducing labor both increases your odds of having scar problems and decreases likelihood of vaginal birth, a "batting 0 for 2" proposition,
• use pain coping techniques and comfort measures other than an epidural: Epidurals cut down on mobility, your ability to push effectively, and increase your need for I.V. oxytocin, which, again, can increase your risk of scar problems,
• push and give birth in a position other than on your back,
• hire a competent, experienced doula: She can not only be your on-site "idea" lady, but she can also provide emotional support and encouragement, which may be especially important in VBAC labors, even more so should you experience negative medical staff attitudes.

As for a test to evaluate your pelvis and baby, the rule is not to have a test if you don't plan to change your course of action based on the results.

You may also find useful information on the International Cesarean Awareness Network website and on VBAC.com.

Let us know how everything goes.

-- Henci