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  1. #1
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    Default VBAC despite suspected CPD? Considering it and would love to hear others views.

    I am contemplating a VBAC despite a CPD diagnosis, if anyone has a similar story or anything they can offer. I would love to hear your thoughts. (Long but hopefully not too boring story)


    With my first I was at a country hospital with a local OB who i saw throughout my pregnancy. I had been in and out of hospital since 20 weeks due to a bleed. Although the bleed resolved itself it made me (and I suspect my OB) nervous so I was calling the hospital at the first sign of anything wrong and being asked to come in. At around 35 weeks I had a brief high BP episode and while attending hospital for tests showed that I had trace proteins in my urine. So technically threatened pre-eclampsia but it never went further than that and I was back home. At 38 weeks during a routine OB visit he offered to induce me early the next week on a day only 4 days before my due date. I said yes it was a hot summer; I was over it all and excited to finally meet my baby. In hindsight it was the wrong choice but I was young and keen and it never occurred to me that there would be a problem.

    On the morning of my induction I arrived at hospital, an internal by midwife showed no signs of cervix being ready and I was told it would be a long day. I was never given any gels; it was straight onto the drip at 8.30am and by midday I had dilated just enough to have my waters broken and a probe. I was having frequent contractions 3 minutes apart and being constantly monitored meant I couldn’t move much, by mid-afternoon the midwife said I was only about 4 cms and I had some pethidine. By dinner time I was in serious pain, feeling like I was being drilled from the inside, I was on gas but it wasn’t helping much, the only thing that offered any relief was stretching out on my side, bowing my back. In the aftermath I realise that this gave some relief because it was lifting my baby’s head off my pelvis. By 8pm the midwife thought I had dilated 6cms but the OB rechecked and said 5 at the most. They were about to give me an epidural and leave me for the night when the OB noticed that baby’s heart rate had started to drop with every contraction. An emergency c-section was ordered due to foetal distress. At the time I was scared for her safety and I was happy for them to do what they needed to do, I was hastily catheterised and rushed to theatre. They even kicked out an appendectomy to make way for me so I do believe it was a genuine emergency. I had a spinal block.

    After they lifted Emily out of me the OB said that I would need a Cesar every time that there was no way she was going to fit through. Recovery was awful, as my baby was taken away and after only 5 minutes of feeding and greeting my family I was given two sleeping tablets and told to go to sleep. I didn’t see my baby again until 11am the next morning.

    I asked the OB during rounds more about his comments, he explained that my baby had done her very best and her head had attempted to fit. (And this is true as her head did have a very severe cone shape when she came out, but it settled into a lovely round head within 24 hours) He said she was never engaged properly and said that he had only ever seen a pelvis like in someone who had been in a car accident.

    At the 6 week check and we asked him again about my situation, he hadn’t written any notes so he didn’t have anything to refer to. However, he did say that he thinks that if I was to go into labour again around 36 weeks then I could trial labour. My official reason for induction was pre-eclampsia and the official reason for section was foetal distress and this is what my current hospital found when they requested the file.

    Fast forward 15 years later, I’m pregnant again, I have GD but my baby is normal sized although set to be bigger than my first, but still average. With all my research I know that my first labour must have been severely compromised by the induction. I’m not a small woman; I have big hips so it’s just the issue of the pelvic inlet if there is an issue at all. I am now wondering if I am allowed to go into labour naturally could the hormones work on my ligaments to help expand my pelvis to accommodate a baby. I also think it would be wonderful to at least experience natural labour onset and to allow my baby to choose his own birthday. This time I will be at the Royal Women’s in Melbourne and my OB is fine with me having a trial of labour, especially when the notes she got form the country hospital didn’t mention CPD. However, she has also said that she doesn’t think the OB would have made the comment he made in the theatre if there wasn’t an obvious problem.

    My concerns are that a trial of labour could damage my baby; as much as I really want to try I want to put his safety first. Right now I am researching into the risks to him of having a trial and I know that at the first sign of distress I’ll be screaming for a section but then I’m also hoping that I will turn up to hospital with lots of dilation already and if given time and nature my pelvis can shift and fit.

  2. #2
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    Orlyon I'm sorry you had such an ordeal with your first child. I can't comment on the CPD too much. It seems very strange that your ob would make that kind of comment when you had really only just gone into established labour (and making that kind of call during the section) but I understand that while it's very rare, some women do honestly have CPD and you are understandably nervous. My ob made a comment about my baby having shoulder dystocia during my emergency c, which by all accounts is total bollocks as its not something you can gauge until the shoulders are being born. Also, was your bub in an awkward position? I had an emergency c at 9cms and due to dds posterior position, she had quite a misshapen head.

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    orlyon  (28-08-2013)

  4. #3
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    I had to go back and read your post again as I was getting off track! I can't see that you would be harming your baby by letting your body go into labour naturally. An induction performed before baby is really ready can cause so many problems and its quite common for baby to go into distress (as I'm sure you're aware now!). If you're really set on a vbac and you have a supportive care provider I would prepare as much as possible for that.

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    orlyon  (28-08-2013)

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    subbing as I am in the exact same boat so am very interested too, will come back tomorrow to reply

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    orlyon  (28-08-2013)

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    I have heard that you can have a ?ct scan in third trimester that looks at your pelvis size to diagnose cpd.

    When I had my emergency c sect this was a specific question I asked if cpd was a problem and was told no. It will be interesting to see in the future if my notes indicate anything different

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    orlyon  (28-08-2013)

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    You make a very good point when you talk about hormones and your ligaments loosening. If your cervix wasn't very favourable chances are your pelvis wasn't either. I would give it a go, there are lots of exercises you can use to open your pelvis and hopefully someone else can give you some details of these.

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    orlyon  (28-08-2013)

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    Ok Im back! Im currently 30 weeks and hoping to get my VBAC with the birth of this little one.

    I went in to labour naturally at 39 1/2 weeks (after a S&S) with DD and laboured happily until I felt pressured by the midwife to have an epidural, which subsequently confined me to bed. It all went pear shaped from there. Even though I got pretty much to fully dialated, there was an anterior lip of my cervix stuck which they wouldnt remove manually. They kept waiting for it to move but of course it didnt DDs heartrate became erratic, so I was wheeled off for a c-section.

    The c-section itself was fine, I got to see her while in theatre but then I was wheeled in to recovery. DD was whisked upstairs with DH, and by the time I got there she had already been bathed by the midwife. I hadnt even held her yet I got to try to breastfeed (only quickly) then DD was wheeled away to the nursery for the night as I would be "unable to look after her as I had a c-section". Not the birth or first day of DDs life I had envisaged

    At my 6 week check up appointment the OB said she thinks I may have CPD. I am only little, but it was quite sad to hear her say that after she had said many times during my pregnancy that she had seen smaller framed ladies like me birth much bigger babies than my DD - naturally!! But she said as I went in to labour naturally and laboured well, she was willing to support a VBAC for #2

    Im going through the same OB and hospital again this time. She has recommended a pelvimitry scan at 34 weeks to measure my pelvis compared to babys head. I have heard these are inaccurate as there is no way before labour, to tell how your pelvis is going to act during labour. Im planning on refusing it. She hasnt mentioned it for a while so fx it doesnt come up again!

    I went through my notes quickly with her the other week and the midwife I had has since retired (thank GOODNESS.) Although she was lovely, I felt she was pushy - she pushed me in to having an epidural (therefore confined to bed) and took bubs away, bathed her etc without my consent. Ive since found out from other staff that she was very "epidural-happy" and like to try to keep everything as "controlled" as possible.

    So, where I am at now.....
    - Im doing as much reading as possible about natural birth, labour, positioning, VBACs etc
    - Theres a FB page VBAC Australia Support Group which has had great info and support (I posted only just recently on there asking about CPD and VBACs)
    - Im attending prenatal yoga classes to help to improve my flexibility (I have none!) as well as try to get bubs in an optimal position for birth and learn positions for labour etc
    - Im writing LOTS of questions down that I ask the OB and Midwives each time I go to appointments about VBACs and my previous labour, to try to find out what I can/cant do, I want to go in as informed as possible so I cant be pushed around again.
    - Im writing a birth plan to take with me. I know this can all go out the window at a moments notice, but I figure it will be good to have if I am unable to answer questions, and DH is so quiet and shy, he will naturally just go along with what the midwives want, even if its not what i want. So hopefully a birthplan might help everyone to know what is wanted and consented to etc.

    Sorry that was long, hope that helps!

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    orlyon  (28-08-2013)

  14. #8
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    Thanks everyone for such considered responses.

    I saw my OB today and we have come up with something of a plan. Im having a section scheduled for 39 weeks, otherwise he is just going to get too big. In the mean time if i go into labour i can have a trial and my OB assures me that i can request a section at any time if I feel that same internal intensity as last time (that terrifying grinding and pressure against my pelvis that told me something was seriously wrong). So i guess this means i need to do everything to try and make natural labour successful.

    I got an epi-no, im walking, swimming and practising squatting for extended periods of time and once my DP finishes up with the election (it's a busy time for him work wise) we are going to do everything we can to get things started. Tips most definitely welcome!

    As much as i want to avoid a section (hell, id be graetful just to get forceps this time) i am absolutely terrified of hurting my baby. I asked about gretting some sort of assesment done, a CT or ultrasound but he didn't think it would be that useful. It probably didn't help that this was a new OB (my 4th one this pregnancy) but he seems confident enough (albeit very young) and he assures me he should be the only one i'll see from now on.

  15. #9
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    Orlyon - great idea to prepare your body as much as possible. Whether you have a vbac or c section the preparation will help recovery. I would seriously decide on what you would like to do. Chances are you aren't going to go into labour naturally before 39 weeks. If you're really set on a vbac then you tell the ob what's going down, or change care provider. If you're worried and think a repeat c is the way to go, I'd write a really detailed birth plan and include things that are important to you - I.e baby not to leave your side unless absolutely necessary (health concerns). Good luck with it all!


 

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