VBAC after "Failure to Progress"

Archived User

VBAC after "Failure to Progress"

Hi there,

I was so glad to see on Twitter that you are taking VBAC questions - thank you for your time!

 

I had a planned-the-day-before C-section at 41.5 weeks due to "large" baby who had not dropped/engaged while I had not dilated. If I had to do it over, I would likely not have made this decision, but I was led to believe at the time that this was the best choice for my baby.

 

Fast forward 3 years, and I am obviously with a different practice. Finally met with the OB who has privileges at the hospital that allows VBACs yesterday. He mentioned among the other risks that if I didn't engage last time, I am even less likely to this time due to being 3 years older (I am 36). Is there any truth to this? It's something I'm having a hard time finding stats on.

 

Right now I'm taking a wait and see approach, but I would love your insight - it's been hard to find information that doesn't lean one way or the other.

 

Thanks!
Danielle

Henci Goer

RE: VBAC after "Failure to Progress"
(in response to Archived User)

I am not a clinician, and the question you pose isn't one on which I'm aware of any research. That being said, I don't think engagement before labor means much one way or the other. Even lack of engagement well into active labor, while not what you want to see, doesn't mean vaginal birth is unlikely. Case in point: my daughter-in-law, just yesterday, gave birth to her first child, my beautiful 8 lb 15 oz grandson. When labor began, he was at -1 station, i.e. 1 cm above the ischial spines ("engaged" is 0 station, i.e. at the level of the ischial spines). At one point in the labor, he had retreated to -2 station. I won't say her labor wasn't long and difficult, but, nonetheless, he was a spontaneous vaginal birth. If she had had your doctor, she would probably now be recovering from her cesarean.

I find it concerning that this ob seems to be discouraging VBAC. Unfortunately, it is not uncommon for obs to agree early in pregnancy to VBAC, but then, as the pregnancy progresses to become more and more negative on the idea in hopes of persuading the woman out of it, and eventually to come up with some reason to refuse if she doesn't cave in. Your best chance for a VBAC is having a practitioner who is enthusiastic and encouraging and who believes you can do it until proven otherwise. The questions I would have for your doctor are: "What percentage of your patients with prior cesareans choose VBAC?" and "What percentage of women who opt for VBAC have vaginal births?" Ideally, the answer to the first question should be "most of them" and, based on VBAC rates in the research, the answer to the second question should be "3/4 of them." Beyond that, I would inquire about any restrictions or limitations your ob has. You want to find out if your ob practices what I call "the Cinderella VBAC": "You can have a VBAC if the baby isn't too big, and if you go into labor by your due date, and if you make at least 1 cm progress and hour, and if . . ." You get the picture. If it turns out this ob isn't what you hoped, I would check out the other practitioners.

-- Henci  

Archived User

RE: VBAC after "Failure to Progress"
(in response to Archived User)

Thank you for your reply, and congrats on your grandbaby!

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