VBAC and Tearing obs advice!

[Ali Jayne]

Hi everyone,

re..(uterine tearing)

Sorry I am still going on with this but I still have not come to a dec on a vbac or c-sec.
I thought I would give an update on my trip to the ob.
I went in actually wanting a vbac and the ob also said he would like a vbac, trial of labor!
Not sure where everyone else is but here they never push for a c-sec. (they are the opposite actually, the midwives here just let you go and go and go, my sister had two over 30hr labors that still resulted in emergency c-sec, not happy poor girl).
Anyways, I asked my ob about tearing and he went on to say that he has seen tearing quite a bit, that they must work very quickly as it is highly dangerous for both mother and baby if tearing accurs, that I would have to go straight for a c-sec with out much warning, and if there is noone available at my hospital would have to transported 40min away to the next hospital.
I then asked, how do you know when you are tearing whilst you are having pain already with the contractions. He said that the babies heart rate drops and baby goes into distress and/or labor stops. Both are so SCARY!!!!
You see stats being stated as rare 1 in 150 women or something, given the number of women giving birth each week that is quite high really.
Sometimes I thinks you are better off going with a c-sec for peace of mind, coz if something happened to bub as a result of labor I would never forgive myself.
As much as I would like a natural labor and as much as the ob would too he talked me out of it at the same time I think!!!
:banghead:

[nats]

By 'tearing' I assume you mean uterine rupture :confused:

[AM]

Yup, I thought it was about vaginal tearing at first too..

[Ali Jayne]

Sorry loveys yes I mean a scar rupturing. Better change it!! Thanks

[kas_chat]

Hi Ali
I had my son by VBAC on 14 May 2007.
When I was planning my pregnancy I started looking into VBAC and decided to go for it and trust my body.
The first two GPs that I saw were cautious and raised the issue of the scar breaking. I decided to find another doctor. I ended up going to a dr that I had read about on the CARESA website. Dr David Simon. I travelled past the two local hospitals to see him 1 hour away from home.
I also joined a midwife progrom called KYM Know Your Midwife. I think this was privotal in my successful VBAC. The midwife was present at my babies birth not the doctor! He wasn't on duty that weekend.

I did tear in my perineum and had a epistiotomy, however my baby was 4440grams and he was 14 days overdue and I am a small girl... but he and I recovered and the recovery spiritually, mentally and physically has been much better and faster than with my first baby which was a caesar after 36 hours of labour and a epidural... both babies were roughly the same length and weight and head size... the second was tiny bit bigger.

PLEASE PLEASE get a second or third opinion from a midwife who is experienced with VBAC and possibly another doctor, one who is not likely to financially benefit from having you elect to have a caesarean!!!
If your Ob has told you he has seen a lot of scar tears, then ask what is his delivery rate in the last 12 months, how many planned cs how many emergency how many vaginal and how many vbac.... he may think he sees "a lot", but in comparison this figure is minute. I would be running fast in another direction if there was a Ob who saw a lot of failure of trail of the scar because it could indicate poor maternal care in labour and lack of midwife care.

Have a good read of the CARESA website. Lots of good info on planning a VBAC, getting support, asking questions and making the decision to plan a cs or plan a vbac.

good luck :hugs:

kas_chat

[Ali Jayne]

Kas-chat,

Thanks for your story. How long was your labor if you dont mind me asking?

My ob actually wants me to try a vbac and obviously the midwives. It would be very unusual here for the staff to push for a c'sec.
One of the prob's is that neither the ob or GP attend any birth really unless it gets complicated and it is the midwives that I hate here. I know hate is a harsh word but they are so rude and not very helpfull even after you have your baby, the after care is bad.
No one can even pay a doctor or ob of your choice to attend the birth here even if you are a private patient. If I could get my doc of choice who would be there I would be more inclined to try.
My ob is a lovely man but there seems to be some sort of communication problem between all the docs, obs and the midwives. I have been told I will only labor for max of 6hrs but I dont trust the midwives to act promtly enough.
With my twins I was induced at 39 weeks, I found out after I had left the hospital that they induce twins early as the placenta dies earlier in multiples than in single babies and my blood pressure was up. I was told I had to have an epidural due to the high chance of ceasar in twin births all of which I was happy with. But the midwives were not impressed with any of it. They were rude asking me why why why are you haveing all this, all I could say is that all the specialist I had spoken to say that it was the usual for twin labors. That if I gave birth to the first baby and the second twin turns in the wrong way I have to have a ceasar etc...
We bascically just get whoever happens to be on duty at the time and last labor being so long a had a string of them. And the funny thing is that the really bad midwives were the ones that hadnt even had a baby.
Maybe I am carrying on too much, I dont know.
But I have considered going to Sydney for the birth???
But I am interested in how your labor actually went and did the same midwife through your program stay with you the whole time??
:)

[becca74]

I'd definately seek out some definitive stats from this Ob, as his stats seem outrageously high compared to the studies I've seen. Even for a vba-multi-c, the latest studies show a UR rate of only 0.9% - which means a 99.1% chance that you will NOT rupture......

Other factors to remember to avoid rupture are: avoid induction, avoid intervention, keep active during labour, keep healthy during pregnancy....to name a few

definately check out www.birthrites.org (http://www.birthrites.org) - there are some excellent links.....and do a history search of the VBAC section of Bubhub. Tonnes of links to research which will fill you with bubbling confidence.

Do you know you are 6 times more likely to have a Doctor that is a phony than to have a uterine rupture during a VBAC...... ;)

[PunkyDiva]

Because it is very difficult to be certain that a particular middie/ob can be with you through the entire labour I beleive this is where an experienced VBAC Doula comes into their own.
Contact Doula's through Birthrites or do a google search.
Good luck.

[Frangimimi]

Hi. I dont know if you have made up your mind on what to do birth wise or not, but i wanted to let you know im in the same situation. my bub is due in october and i too have a choice of vbac or elective caesar and honestly cant decide, so many stats around but none of it helps. contact me if you want to share stories:)

[Collie]

Hi. I'm also in the same position...

I'm due in December but I'm booked in for a c-section at the end of November (just to secure the theatre slot while I make up my mind). I haven't decided which way I'd like to go yet but the thought of doing anything to put my baby or me in danger makes me really nervous. I'd like to go VBAC and my ob will support this so I don't have that issue... just don't know what to do!

Feel free to PM me if you want... same goes for Frangimimi.

[becca74]

Frangimimi and Collie, what are the conflicting stats you are reading?

This link might be extremely helpful - let me know how you interpret what it says: http://www.childbirthconnection.org/article.asp?ClickedLink=293&ck=10212&area=27

It uses all the latest research and compares it in a non-biased fashion. :thumbsup:

Also, here is a link to the latest study on uterine rupture: http://www.greenjournal.org/cgi/reprint/108/1/12

Essentially, for a first time vbac'er, you have a 99.3% chance of not having a uterine rupture. So if you were in an auditorium with 1000 women, what makes you think that you would be one of the 7 women for whom the spotlight would shine upon to have an UR? Essentially, 993 unnecessary and risky surgeries have to take place to prevent 7 uterine ruptures.

and from: http://www.childbirthconnection.org/article.asp?ck=10210#die



What is the added likelihood that the baby will die as a result of the scar giving way (uterine rupture) during a VBAC labor?

Best research suggests that about 1.4 extra babies die due to problems with the scar in every 10,000 VBAC labors, compared with planned c-section deliveries. Thus, over 7,000 women would need to experience risks of surgical birth to prevent the death of 1 baby from scar problems during VBAC.
Added likelihood for a woman with a known low-transverse (horizontal) scar: LOW (http://www.childbirthconnection.org/pop.asp?ck=10082) for death of the baby around the time of birth compared with repeat c-section.


I say these things only to encourage those who have their heart set on VBAC. I understand that sometimes women have an instinct about not wanting one, and I respect that.

At the end of the day, VBAC is so safe, it shouldnt even need an anacronym to differentiate it from any other vaginal birth.

It really comes down to what you really want in your heart.

I think the biggest obstacle with VBAC is the mental war, the faith you have to build in yourself, and the stubborness you have to maintain against those around you who are fearful (tho generally speaking they have never shown any research to back up their fears). It is a hard slog, I can understand why some women dont want to go through that, as to be honest, when we get pregnant, we just want to have a baby, we dont want to have to become some pawn in a care-providers agenda about birth. We just want to be safe during the birth, and have the opportunity to experience an intimate meeting with our new baby when they first enter the world.

I think you have to really analyse your fears and their basis. What are the research papers you have read that have increased your fear and doubts? Sometimes lack of support can make us fearful....sometimes it is merely the unknown that frightens us....

much love to you on this journey that shouldnt have to be made so treacherous....I wish for you all a beautiful and straightforward birth :hugs:

[Frangimimi]

Thanks for the link becca, I will read it later today, i thought i should clear something up though. All along with this pregnancy i had assummed it would be a vaginal birth i didnt know about any risks, then when i started having my ob visits drs kept handing out brochures on vbac and its safety blah blah. So i started to wonder wow i didnt realise all this, and started to talk with friends about it, and then the stories come out of course.
I have seveeral issues with the whole thing. first my safety for my baby, and if that means surgery then i wont fight that. second i DONT TRUST our hospital, or the drs, and some of the midwives are less than to be desired. Im scared of doing a vbac, something going wrong and no one is around to help( not exxagerating, i have assisted in 3 births and they have been left alone for hours before being checked on).
Lastly, we suffered a misscarriage last year, it was more devastating then i could ever describe, the thought of losing a baby terrifies me no matter how small the stats.

You say with such statistics why would we think we would be one of those people, well i am a healthy woman always have been but when i had my 15 week down syndrome test( i wasnt told it was optiional, here you just get sent for it), my results came back real low, about 1/150 chance, the hell my family went thru, what do we do? what are our choices?? etc. I NEVER believed i would be in that catergory. LUcky though i paid attention at the test and spoke up, they had the wrong dates on my test(unbelievable hey, thats the system here), I asked for a re test, it came back at 1/7000. A huge difference and relief.
So as you see numbers on a paper, can mean it will be me it happens to.
I appreciate your help and advice and will certainly read the article(got to get kids to school) and let you know how i find it.
thanks becca:hugs:
DH 35
Me 33
DD 9
DS 6
An angel 14 weeks:angel:
New arrival 18th Oct o7

[SAMum]

Hi becca74, I am not pg yet but hoping to be soon and I had a CS last time. I am already looking at whether to go for VBAC or CS next time, my obs said no reason I can't go for VBAC. My only priority is the safety of my baby, I am not one of those who has to have a certain type of birth for my own reasons or anything, though i certainly understand those who do, it's just not that important to me, all I care about is making the choice that it most likely to result in a healthy baby. Anyway I have read some of the documentation you and others have suggested and I am finding it impossible to find the basic statistics that I want which is what is the percentage of babies or mothers to have serious complications in Australia during a C-section compared to the percentage of babies or mothers to have serious complications during a VBAC. Most articles seem to concentrate on the so-called "low" risks of uterine rupture like the 7 in 1000 but never give an actual figure for serious complications to mother or baby during C-section. can you point me in the right direction to help me find the info I need? Sorry to hijack the thread but you seem to be very helpful and knowledgable about this subject! Thank you!!

[Frangimimi]

thats a great question SAmum. I havent come across any statisics myself either and would also be interested to know that.:thumbsup:

I had a look at those articles becca and i see your point with how low the risks are with vbac,i had a think about it all day. Its not so much the statistics, its what you believe you are doing and making the right decision for your body and mind. Thats how i will make my decision in the end:)
You have been very helpful, thank you:hugs:

[flib]

I think you'll find that c-sections are generally more risky than vaginal deliveries - especially for Mums. It is abdominal surgery - any surgery is risky. It could affect your ability to carry and deliver future babies too. There are risks for babies too.

I did a lot of research before my first VBAC and talked to my Ob about uterine rupture. I made sure I was in good hands if it did happen. But I thought that considering the odds I had a much better chance of a vaginal birth than a rupture.

I was 38 and had a miscarriage and knew I was having a girl. My first born is a boy and I was desperate for a girl so I didn't want to take any chances either. I understand the urge to not take any unnecessary risks. I just thought I'd give it a try...

Birth #1 - 36 hour labour, 10cm dilation, stuck posterior baby, emergency c-section.
Birth #2 - 16 hour labour, vaginal delivery, no stitches, tears, not even a graze!
Birth #3 - 4.5 hour labour, vaginal delivery, no stitches, tears, not even a graze!

I could hardly believe it the first time and now I know after number 3 that I really can do it. My body is totally capable and that the first time it was just position. I am tall but only a size 10 with small hips. My babies were average size and I had no trouble pushing them out.

My son and I were not well after my c-section. He ended up in special care and I had side effects from the epidural and needed to go back to surgery for a blood patch. It was a minor procedure but meant I spent the first 10 days of my son's life lying down. I could hardly sit up in the car going home after a week in hospital. After my VBACs I was in the shower about an hour after, enjoying my family and then able to walk to my room.

It was also a wonderful experience and I realised what normal birth was like.

Anyway I'm pretty enthusiastic about VBACs now so forgive me for rabbiting on. I hope my experience helps you a little.

Best wishes for a wonderful and healthy birth whatever you decide!

[Frangimimi]

Hi flib, hope you dont mind if i ask a few questions.
When you were in labour with your last two, were you on a monitor?? or were you allowed to move around, to the shower etc?
And can i ask where you gave birth? a big town or country?? Did you have the same dr throughout your preg??
sorry i dont mean to be nosy, but it would help to know. you can PM me if it private:)

[flib]

Hi Frangimimi

I don't mind answering any questions at all.

I live in Melbourne about 15min (outside of peak hour) from the Royal Women's hospital so I'm close which makes it easier and less of a worry. I had a private Ob for my VBACs who delivered both the girls and who I saw at each appointment.

My Ob wasn't concerned at what stage of labour I went to hospital in so although I laboured for 16 hours second time around, I was only at the hospital for 2 hours before DD1 was born. At my first examination I was 9 cm. I was scared and worried that it would end up like the first time so that was great. I had a monitor that was wireless so I could move around. I was happy to have it on. I found it reassuring and it didn't get in the way too much. I'd also found the shower didn't help much the first time so I wasn't planning on getting wet.

With my DD2 I got to hospital 45min before she was born. I needed my Ob to break my waters and she was out in a matter of minutes. I'd been in the shower at home and it was great. I wished I'd insisted on it at the hospital. I was monitored on the bed and everything happened so fast that I didn't get the chance to get off. It was ok because it helped to slow her delivery which was probably better for both of us.

If you're worried, the monitor can be reassuring. I just wanted both my babies to be ok so I agreed to it. It does limit your movement somewhat. I didn't have an epidural either which was difficult but I read that it's easier to detect a rupture without it as you will feel the pain and it's different to contractions. It means it's detected earlier if it happens and is better for everyone. I also really didn't want an epidural after my previous problems. It's really worth avoiding if you can because you feel so great afterwards and almost normal.

I went to the hospital only when I was certain I was in active labour - cut it a bit fine with #3. Once I was having long contractions at least 5 minutes apart I rang the hospital and both times they said come in. I wanted to labour at home as long as possible so I wouldn't have to worry about time limits etc.

If there's anything else I can tell you just ask!

Best wishes

Flib

[Frangimimi]

:wave: youre so lucky, those sound like real postive birth stories, that would have helped.
We not so lucky in the country, with the closest city hospital being 4 hours away, and there is only one private ob here that you have to book yourself in before you are even pregnant.LOL
We have a public and private hosp, here but you have to have your bub in the public one then you can be moved to the preivate one after(weird hey).
When you have your antenatal check ups, you see a diff Dr or midwife with each one, and that can get tiring, introducing yourself over and over.
When you go into labour, you get whoever is on duty, and you rarely see a Dr unless a midwife thinks its urgent enough to call one in.
So apart from deciding safety factors of vbac etc, all this weighs on me too, I just dont know if i feel confident enough to my our lives in their hands??:confused:
Thanks for your help, I can see why you chose to try a vbac, with the level of care you were getting.:thumbsup:

[flib]

Being further away from the hospital does make it more stressful. I had my first baby in the public system and saw someone different every time and it was tiring. I must say however that while my Ob was supportive of my wishes, he didn't really do much. As I mentioned, i went to hospital quite late both times. What really helped me was the low level of intervention. A lot of c-section are caused by interventions like inductions when babies aren't really ready to be born and become distressed.

I do understand the worry and the urge to control as much of the process as possible. You still have to be able to trust the Dr doing the c-section and there'e actually a lot more that could go wrong really.

It is a tricky situation but just keep in mind that you might have a vaginal birth that is straightforward and not need much hands on doctoring. All my Ob did in the end was ease the baby out but really anyone could have done that.

Do you have a support person who could be with you? Either a friend or relative who has had a positive birth experience or an independent midwife or doula or other kind of paid birth attendant. This kind of support is invaluable. I had a friend who was really much more positive than us. Later my DP said he thought I'd probably need another c-section. After what he saw the first time, I don't blame him but he was wrong!

Good luck. I know it's hard. You need to be fairly sure either way. The good thing about trying for a VBAC is that a c-section is still an option but if you choose the c-section there's no going back once it starts.

Best wishes:hugs:

Flib

[Frangimimi]

:wave: Thanks flib for your input:thumbsup: i have my next antenatal visit on the 2nd august, i will trying to discuss alot of my concerns, and advice that ive picked from here and see if any more light can be shed into my situation, to help make a decision. As my son was born at 9pound, (my DD was only 6p) i have asked for a scan they can do later in the preg to see if bub is too big to fit thru my pelvis, and then my decision will pretty much be made from that as well.
My husband would be my supprt person(they rarely let you have more than one with you), he is supportive but also has a temper, and when things look like they not progressing well he will tell the staff off which doesnt make it easy for me, I have told him not to lose it as it stressing, he agrees for now, but i wonder:confused: , Unfortunately we dont have the kind of funds to access a private midwife or doula( if there was even one here), so that rules that out
Anyway, i;ll keep battling with my mind.:banghead:

[SAMum]

Hi flib thanks for your posts. I am really leaning towards VBAC for my next birth, especially since the only reason for my previous c-section was foetal distress due to uterine hyperstimulation caused by the gels used during induction and I would never have another induction! I really liked your point about how if you try for VBAC you can always have c-section later but you can't do it the other way around. I guess I am just so worried about putting my bubba at risk. It's such a hard decision isn't it?!:yes: It's always good to hear positive stories such as yours.

[becca74]

Hi becca74, I am not pg yet but hoping to be soon and I had a CS last time. I am already looking at whether to go for VBAC or CS next time, my obs said no reason I can't go for VBAC. My only priority is the safety of my baby, I am not one of those who has to have a certain type of birth for my own reasons or anything, though i certainly understand those who do, it's just not that important to me, all I care about is making the choice that it most likely to result in a healthy baby. Anyway I have read some of the documentation you and others have suggested and I am finding it impossible to find the basic statistics that I want which is what is the percentage of babies or mothers to have serious complications in Australia during a C-section compared to the percentage of babies or mothers to have serious complications during a VBAC. Most articles seem to concentrate on the so-called "low" risks of uterine rupture like the 7 in 1000 but never give an actual figure for serious complications to mother or baby during C-section. can you point me in the right direction to help me find the info I need? Sorry to hijack the thread but you seem to be very helpful and knowledgable about this subject! Thank you!!

from: http://www.childbirthsolutions.com/articles/birth/vbacinfo/index.php



Effect of caesarean section
A caesarean section is major surgery with all the attendant risks. It is not safe. The maternal death rate associated with (but not necessarily attributable to) caesarean section is 4 times greater than in relation to all types of vaginal birth. Mother and baby morbidity is significantly higher. There are risks of anaesthetic accident, operative injury, infection, effects on subsequent fertility and psychological morbidity. The rate of respiratory distress syndrome in babies after caesareans is about 4-6 times higher than for vaginal births. This could be due to the caesarean birth itself or prematurity caused by miscalculation of dates. A woman's psychological well being is often seriously affected after a caesarean, causing, in particular, higher incidence of post natal depression (up to 6 times) and lower breastfeeding rates. Anger, disappointment, grief over lost experiences and feelings of failure and violation are common reactions. Family and sexual relationships can be seriously affected. The post-operative pain and the high incidence of wound infections means a longer recovery period with physical mobility affected for months afterwards. And in addition to all that, caesareans cost the community significantly more than vaginal births. Caesarean section is not a preferable way to have a baby for most women. For some, the desire to give birth vaginally is so strong that a caesarean section causes grief that may take years to resolve. The possibility of a vaginal birth in the future may be a lifeline at a time of deep emotional turmoil.


this link will show the above info in more depth with links to research studies....

http://www.childbirthconnection.org/article.asp?ClickedLink=274&ck=10168&area=27

sorry my post is brief, but my 3 year old currently thinks it is funny to press buttons on the keyboard.....me-thinks he needs mummy time now :laughing:

[flib]

SaMum - I'm really glad it helps to hear a positive story. There's many more of them than negative ones too!

Uterine rupture is so rare. Ask your Dr or hospital if they've actually seen it happen. Remember that it's safer if you have a bikini line scar. Also some of the ruptures quoted in stats aren't life threatening to Mum and baby. Becca can probably help us out with stats for this.

If you try for a VBAC then probably the worst thing that could happen is another c-section. You should write what you'd like if you need one into your birth plan. If you end up having an elective c-section you'll be doing this too. Find out if the baby can come to recovery too, make sure you get skin on skin contact when your bub is born. Go to www.birthrites.org for more ideas for a positive c-section.

It's worth considering how you might feel psychologically if you do/don't try a VBAC or have an elective c-section. I don't think that it's understood how complex the issues are for women trying to make these decisions.

Good luck and best wishes to all for a good birth whatever you decide!

Flib

[SAMum]

Thanks flib and becca74. For the record I actually had a very positive cs experience last time, DS was given to me straight after paedeatrician checks, so about 30 secs after birth and I held him on my chest while they sewed me up until I got too weak in the arms so I reluctantly gave him to DH! Then he was given to me in recovery where he was breastfed for ages and eventually given again to DH to have his bath etc while I finished in recovery. I guess this is another reason why I am having trouble deciding what to do as from my previous experience my cs was actually great! If I am like this before I am even pregnant, imagine what I will be like when I actually have to make the decision :banghead:

[Frangimimi]

:wave: I want to thank flib and becca too for all your help and encouraging stories, I havent made a decision yet, but I am certainly wiser to both sides, and have learnt things i didnt know before, i will be taking this knowledge to my next appointment and trying to get some more from the drs.:hugs:

[becca74]

No worries SAmum and Frangimimi! It is my hope and prayer that all women have beautiful births and that trauma becomes a thing of the past.

SAmum, my first c/sec was similar to as you describe - very positive - very beautiful - very romantic :D. So I know that a c/sec doesnt have to be a traumatic experience....

but I still wouldnt swap both my vaginal birth experiences to have it again....but that is just me ;)