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    Questions? Ask Henci!


    Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

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    Archived User
    Hello,

    I am 5 weeks pregnant with my 3rd child & would like to attempt a VBAC. My first son was born vaginally 7 yrs ago (although not without difficulty) and my second son, who is 9 months old, was failed forceps - emergency cesarean due to brow presentation.
    at some stage during my last labor i suffered a cervical tear - the whole experience was very traumatic - i lost 2 litres of blood and was considerably sick for some time. I don't want to have to go through such an emotionally and physically difficult labor again and while worried about risks, I would like to attempt a VBAC.
    I would like to know if anyone has attempted a VBAC having suffered a cervical tear in a previous labor? Does anyone know what the implications of having had a cervical tear on a future pregnancy would be? Can the tear open again during dilation? Also, is it too soon to attempt a VBAC considering my son is only 9 months old? Baby 3 will be due in April 2007.


    I would appreciate any ideas

    Thanks! By: Tamlin
    Archived User
    I'm sorry, but your question is outside of my sphere of expertise as it is a clinical question specific to your obstetric history, not one that would be addressed in a study. I think your best bet would be to consult an obstetrician who encourages VBACs and see what he or she says about it. That way, if the ob recommends a planned c/sec, you will know it isn't because the ob would rather just do repeat c/secs. The trick these days is finding such a person. The local home birth midwives, doulas, and childbirth educators are likely to know if such a person exists in your community. If there is no one who fits this bill close by, it might be well worth while to travel for this consultation, seeing as your situation is complex, and a major decision is riding on it.

    If you can find someone satisfactory, here is what you need to know in order to make an informed choice:

    * What this practitioner recommends and why.
    * The pros and cons of planned cesarean delivery vs. planned vaginal birth, including how likely problems are to occur.

    You also aren't looking at an "all or nothing" issue. There are choices within choices you may wish to discuss. For example, it is likely that the torn cervix happened during the failed forceps attempt. You might decide to plan a vaginal birth, but if it comes to a vaginal instrumental delivery or a c/sec, you will take the c/sec. Or you might decide to plan a c/sec, but you want to wait until labor starts before having it to ensure that your baby is ready to be born.

    I suggest you go with your partner to the consultation appointment because your partner is also likely to have questions and concerns. In any case, go with someone who can debrief with you afterward. Write down a list of questions ahead of time and take notes on the answers. That way you won't forget to ask something important, and you won't have to count on your memory to recall what was said.

    A good source of general information on the planned VBAC vs. planned c/sec decision is VBAC or repeat c-section? on the Childbirth Connection website.

    Of course, there is more to this decision than information. Your personal values and feelings enter into it as well. Along those lines, it is not uncommon for women who have had a birth as difficult and frightening as yours must have been to have symptoms of post traumatic stress. These include flashbacks, nighmares, high anxiety, hypervigilance (feelings of being on "high alert" all the time), strong avoidance of anything that reminds you of the experience (ex.: inability to walk into a hospital). If you are nodding your head at any of these, getting some help at working through the trauma will help you make a clearer decision freer of subconscious pressures. Working with the right mental health professional can be of great value. Again, the locals may know who is knowledgeable about birth trauma.

    If you decide to plan a vaginal birth, I strongly recommend hiring a doula. Both you and your partner will benefit from having continuous support from a skilled and experienced labor companion. If you want to know more about this option, Who can give me support during labor and birth? on the Childbirth Connection site is a good place to start, and here is some additional information on the research supporting doula care on the DONA website.

    -- Henci By: Henci Goer
    Archived User
    Let me just add my personal experience.  I had a cervical tear in my c/s birth----I don't know when I actually "got" it, but it was in my surgical report that the doc sewed me up.  He had used the vacuum, so maybe there?  Also, I pushed for 2 1/2 hours, so I don't know. 

    Two doctors risked me out of vbac for the cervical tear and my big baby (9lbs 10 oz--not huge).  They said the cervical tear would cause scar tissue and that my cervix would have trouble dilating. 

    The doc I went w/, told me my chances of having a stenotic cervix were about 1 in 200.  IF it did happen, he indicated he would massage the scar tissue and then the cervix would return to normal working order.  He said it might hurt, and a friend actually had this happen to her after a LEEP procedure (not a vbac).  The doc gave her an epidural and then massaged it out and vb no problem.  My doc said it was no big deal and highly unlikely as well. 

    I vbac'd just fine! 
    Archived User

    Thought I would mention that as a doula I have seen cervical tearing and after suturing Doc assured the woman that it would heal fine and all would be fine in the future.  A midwife friend seconded that although it probably did not have to happen (a good internal exam would have determined that she was not ready to push-- esp. since the woman was birthing with an epidural you cannot go solely on the "urge to push") that it was not a long-term issue.

    I think you should consider getting a few more opinions.

    Best,

    Shayna


    All Times America/New_York

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