I wrote earlier in the homebirth section about the length between pregnancies and vbac. I opted to go for a homebirth because with my first pregnancy I ended up going until almost 43 weeks and the CNM practice would have induced me as a vbac at 42 weeks and I was afraid of rupturing. My second pregnancy I did go into labor at exactly 42 weeks but without my doula and midwife supporting me (my contractions were not regular enough for them to come down, they were 2-4 minutes apart lasting only 30-40 seconds) my husband and I went to a nearby teaching/womens hospital where we were allowed to continue laboring and try for our vbac...I was 8 cm but stalled out and got an epidural where they then broke my waters and I was complete within 20 minutes... after 1.5 hours of pushing my sons heartrate was 220 and it was determined we had an infection (probably from exams) he was also still 0 station so cesarean was rec. again. My question is the ob who did my delivery said my sons head was floating above my pubic bone . I am confused by this since the ob who I pushed with said he was 0- plus 1 station... Also my son was 10 lbs . The ob who performed my surgery said he must have been too large for my pelvis size. However with my first son who was 9 5 oz the midwife said I had a very nice roomy pelvis. Is it unreasonable for me to attempt a vba2c with this type of history? I was on my back pushing so I do not know if other positions would help. I have read in the NIH analysis that women with a taller stature are more likely to vbac. I am only 5'3 and very short waisted. could this be a reason it is hard for me to birth such large babies? I did not have gestational diabetes I might add so I do now know why the babies are so large. Thankyou
As you yourself point out in your story, there are reasons why you may have ended up with a cesarean that could go differently with another labor. I wouldn't worry overmuch about the OB who said the head was above the pubic bone. That may have been the case during the surgery but not the case while you were pushing. I'd be more inclined to trust the midwife who said you had a roomy pelvis. Certainly pushing for only 1 1/2 hrs on your back with an epidural on board and a big baby says nothing about your ability to birth a big baby under more favorable circumstances with more time. The research supports the safety of planning a VBA2C as well. A systematic review (a study of studies) pooling data from 16 studies of VBA2C comprising 5666 women in all found similar maternal and neonatal morbidity rates between women planning VBA2C compared with women planning their third cesarean.
Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 2010;117(1):5-19.
Thankyou. I am glad you pointed that out about pushing. Perhaps the babies head did move back up during the surgery. Is there anything I can do to prevent such a large baby or is that mostly out of my control since I didn't have gestational diabetes? I see in one of the other posts that one study showed only a 48 percent chance of success with a baby that large . I am not overweight either my bmi was only 22.8 and I gained 38 lbs during the pregnancy. Thanks!
Jana Stump[Organization Members] @ Apr 05, 2013 - 02:35 PM (America/Eastern)
If you had a high BMI, I would advise losing weight sensibly before the next pregnancy because maternal prepregnant weight has the strongest correlation with with baby's birth weight, but your BMI is great. You didn't have gestational diabetes, which would be better termed "carbohydrate intolerance of pregnancy" as it rarely involves sugar levels that would be diagnostic of diabetes in a woman who isn't pregnant. Still, it wouldn't hurt to keep to a diet in pregnancy that is high in fruits and vegetables and whole grains and moderate in fat and to minimize junk food as well as to get moderate, regular exercise. That diet and regular exercise help metabolize blood sugar and can only do you good even if you aren't prone to higher than average blood sugar levels. It seems likely, though, that you just grow big babies, in which case, the best that can be done is to maximize your chances of birthing a big baby vaginally. Along those lines, I recommend these strategies:
- Choose a care provider who puts no preset time limits on length of labor or pushing. It often takes longer to birth a big baby.
- Hire a doula. This is for two reasons: first, she will have ideas that can help promote labor progress and descent in pushing, and second, she can offer support and reassurance should you or your partner become discouraged or frustrated, something you can't count on receiving from hospital staff.
- Begin labor spontaneously. Inducing labor isn't a great idea with a uterine scar under any circumstances because it can increase the risk of scar rupture, but it also decreases likelihood of vaginal birth.
- Refuse membrane rupture. It doesn't increase likelihood of vaginal birth. In fact, the opposite is probably true. One potential problem is that early release of the forewaters can drop the head prematurely into the pelvis in the occiput posterior position (facing your belly instead of your spine). OP babies don't fit well in this position, and persistent OP leads to high risk of cesarean for this reason. (You can find out more about OP babies here.)
- Have patience with a longer labor. You and your partner should remind yourselves that it is normal for labor or pushing to take longer than average.
- Push in positions other than on your back or semi-reclining. An epidural shouldn't rule out alternative positions. Today's "light" epidurals offer adequate pain relief while still giving you enough muscle control for hands and knees or squatting during contractions, although you may need assistance or "spotters."
- Preplan to give birth on hands and knees or to be able to turn quickly to hands and knees if the head is born, but the shoulders hang up (shoulder dystocia). This is occasionally a problem with big babies, and the best way of releasing them is all fours.
As for the 48% VBAC rate with a big baby and no prior vaginal birth, keep in mind that we don't know how the labors were managed, which can make a huge difference in VBAC rates, and if you schedule a cesarean, the chance of surgical delivery is 100%.