Failed VBAC attempt

Hi, Henci! 

I saw your response to a couple of ladies about their delivery experiences, and thought it might be helpful to get your opinion on my own situation.  I have previously had 2 cesareans and hope to have more children.  With my daughter, I labored at home for about 36 hours.  It was not a painful labor, but after arriving at the hospital, I still progressed slowly.  I held off on an epidural for probably another 12 hours (and until after they broke my water), but finally got one, mostly because of exhaustion (the pain had increased by that point, of course, as well).  I did dilate and efface completely at around 50 hours, and pushed for over two hours.  At that point my doctor brought up the c-section option, but allowed me to choose if I wished to continue trying.  She said that I was pushing really well, she could see the baby's head trying to come down, but as soon as the contraction ended, she would pop right back up to where we started.  She hadn't come down at all in 2 hours.  She said that my pelvic opening was small.  My husband and I decided to try for 15 more minutes (which turned into 30).  Again, my dr said I pushed perfectly, but there was no progress.  At that point we decided on a c-section. 

At my 6 wk follow up, I talked to my doctor about future pregnancies, and she actually encouraged me to try a VBAC the next pregnancy.  We have always wanted at least four children, and she said that while it was possible to do that many cesareans, it was also possible that the pressure of the next pregnancy could help my opening become larger, allowing a vaginal birth.  She warned me that we could very likely end up in the same scenario, but thought it was worth trying.

We moved cross-country and I found a new OB when I became pregnant with our son.  She was supportive of trying a VBAC, but again warned me I might have another long labor, ending in a c-section.  This time my labor was much shorter (can't remember exactly, but maybe 18 hrs), but MUCH harder.  I was in an extreme amount of pain by the time we arrived at the hospital (only 5-6 hours in this time).  Other than the time and pain, the same basic scenario progressed.  After my son was born, I talked with the doctor again about future pregnancies.  She said that my uterus' scar had healed beautifully and she saw no reason why I couldn't have many more.  She recommended that any future pregnancies be scheduled c-sections.  She had discovered one further problem.  My uterus was curved (almost C shaped), and so the contractions weren't being effective at pushing the baby down.

I trust my doctors and do not feel like either of them pressured me.  It really seemed like this was just the way things worked for my body, but I've had a lot of people tell me there's no reason I shouldn't be able to deliver.  I do believe that c-sections are done too often, but I was just curious to hear your opinion on my situation.  While I would have preferred to be able to deliver vaginally, what's most important to me is my babies arriving with both of us healthy and safe.  If I proceed with planned c-sections in the future, I at least look forward to the recoveries being easier than my previous labor plus surgery experiences. 

Your thoughts are appreciated!

Sincerely,
Amanda

I think it is important to distinguish the common scenario that all too often leads to cesarean surgery from your individual experience, which doesn't fit that mold. It also sounds as if you are well aware that both planned VBAC and planned repeat surgery have risks, and only you can decide what seems safest and best for you. In other words, my advice is to make the decision that feels right to you.

I do have one intermediate suggestion, which itself has pros and cons. I offer it strictly as an idea to mull over, not a recommendation. if you decide on a planned cesarean, you may want to wait until labor begins as the best indicator that the baby is ready to be born--that's the "pro." And you might want to see how it goes for a bit just to see if for some reason, the pattern is different this time. The main "con" is that your cesarean wouldn't be scheduled, which allows for preplanning for the OR team.

~ Henci 

Thanks, Henci!  Just curious, how would you say my experience differs from the common scenario leading to c-section?  I have considered letting labor start rather than being scheduled.  From conversations with my doctor, I don't think she will consider scheduling a cesarean until I am 40 weeks anyway (and I went into labor with my first two before that point...both were born at 39 weeks, 4 days), but that is definitely a conversation I would like to have with her.  She seems to be an advocate for waiting until the baby says he or she is ready, which I appreciate!

Thank you again for taking the time to answer my question!

Amanda

Oh, my, where to begin on that one. Let's start with the emotional scenario:

• It sounds like no one tried to talk you into an epidural.  
• Despite your unusually long labor, your first ob didn't pressure you into agreeing to a cesarean.
• Even when she felt that was your best option, she did not, as the Aussies call it, "wave the shroud"--tell you that you were putting your baby at risk by holding out--to persuade you into it.
• She actually "encouraged" you to consider VBAC in your next pregnancy.
• You found a second ob who also encouraged VBAC. And if finding a second ob wasn't unusual enough--at least, in the United States-- this one was encouraging you despite your first cesarean being for a potential recurring indication (as opposed to a breech baby or cesarean for fetal distress the first time around).

As for care aspects, an all too typical scenario is, unfortunately, the exact opposite of Lamaze's "Healthy Birth Practices."

-- Henci

P.S. I notice that you entitled your post "Failed VBAC attempt." If I may suggest a reframing, you didn't "fail" at anything. You planned a VBAC that ended in a repeat cesarean.