Posts Tagged ‘VBA2C’

January 26th, 2011

Venting about My Pending C-Section

If you have been following my journey of this pregnancy, you would know one of my initial plans was to talk to our local home birth midwife, and plan a HBA2C (Home Birth after 2 C-sections) because of the lack of access to a real trial of labor with two previous surgical births. With my oldest son, while he never dropped into my pelvis, I was sure that my OB/GYN’s interest in going home for the day was the reason the induction was called off, and the OR was the place my son came into the world.  He was born at 4:37pm, around the peak c-section time of the day… 5pm.

When it came to my VBAC attempt with Benjamin, I labored forever. 26 hours, and was always under the impression that he got stuck because he came down in a face presentation, but after reading over my records, and learning more about m surgery not only from the surgical report, but also talking with the resident who was in the OR since the OB/GYN who was on call that day had since retired.  Benjamin was just OP… sunny side up… hence the back labor I had… Nothing special… And when he tried to make it down into my pelvis, he got stuck. Poor little guy had a nice bruise when he finally made it out. And apparently, there were some dense adhesions from my first surgery. Bang up job by my first OB.

Needless to say, learning all that made my decision making process much more difficult than I thought it would be. And had I not truly researched and learned all of that, I probably would be well on my way to a home birth as we speak. Which would most likely end in a hospital transfer because of the true CPD I have in my pelvis. Something I have not talked about until now because I know how many in the natural childbirth community (which I am an active part of) do not believe in CPD, and I didn’t feel like defending why I think, and my midwife thinks I have a true CPD.

It has been hard for me to come to terms with the fact that I will have a third c-section. I have heard so many beautiful VBAC stories of mothers who have had two or three c-sections, and I always had envy of their experiences, and I know that it is not something in the cards for me. It is hurtful.

I wrote earlier in the week on the Babble Being Pregnant blog I participate in about it too… The post was called I Don’t Want Your Pity… I Want Your Support…

I don’t want people saying they feel sorry for me anymore. This is a choice I made, and was not forced into by providers, or bad information. Nor am I a hypocrite for being a VBAC activist, and not trying for a VBAC this time around, like some idiotic and uneducated internet trolls have accused. Being an activist, especially for VBAC is about being educated, and making informed decisions. It would be one thing if this was my second child, and I was opting for an elective c-section, not a medically necessary surgical procedure.  I am sure there are some out there who simply do not respect that at all, and would rather I put myself, and my child in danger to please them… unfortunately for them, they don’t mean much to me.  They can run their mouth all they want, but they will continue to look like the uneducated assholes that they are!

I interviewed four providers. One OB/GYN who is famous in my area for supporting VBA2C (vaginal birth after 2 cesareans), one home birth midwife, one hospital birth midwife practice, and a high risk Perinatologist I was referred to. None of who I felt comfortable with. Comfort was a big factor.

I continued to tote my medical records, surgical reports and my emotions all over the state, and ultimately, I went back to my midwife I trusted with my care during my last pregnancy and delivery. After hours of discussion, questions on her professional opinion, which I take very seriously as she has been doing this for 30 years in various settings including home birth, and birth centers, I knew that the best option for myself, and our third child would not be a trial of labor, or an attempt at a VBA2C.

It sucks, but one thing I am sick of hearing is how sorry people are about this birth. I don’t want your pity!!  I want your support and resources that can help make this the best experience I can possibly have given the circumstances!

I think sometimes people really fail to see when they are being negative or pessimistic, and today I just really wanted people to see how it comes off sometimes. Leave your judgment at the door, and provide your amazing resources for helping someone who needs a medically necessary c-section.

I want to have an empowered delivery, a delivery I know that I made the choice to have, and can be in control of. I am going to be empowered by this birth, and I am going to show women everywhere that you CAN be empowered by a c-section on your own terms!

October 19th, 2010

No, I am NOT a Hypocrite…

I found out we were expecting our third child almost two full months ago. During this time I have put an insane amount of thought into our options for birth. I searched high and low for a provider who would even accept me as a patient for a VBA2C… I dug through surgical reports, research, had awesome ladies like Amy Romano, and Kristen from Birthing Beautiful Ideas help me write letters to the backup OB/GYN’s of the midwives I love so much.

It has been stressful, and I have had up after down, after down, and then up again. I have been confused, worried about judgment, felt attacked and unsupported, and loved all at the same time. I took my thoughts about having a VBA2C vs. a repeat cesarean out of the public spotlight and started to discuss it with two people that I trust the most.

1. My husband
2. My midwife who attended my VBAC attempt in May 2009.

The two people I knew would ….

1. Not pull any punches with me
2. Tell me like it is
3. Support me in my choice.

They did when I was in labor with Benjamin, they did during the surgery, and they did in my postpartum period.

After looking at surgical reports, taking my last labor and birth into consideration, and all the factors in between, I have made the very educated and hard decision to opt for a scheduled cesarean this time around. I think one of the biggest statements, and ideas that has remained in my head through all of this was my midwifes speculation on my pelvis. And the more I think about Camden, and Ben’s births, the more I think that there very well may be a malformation that doesn’t allow my babies to get down into the pelvis. Neither ever made it, and there is little hope this one would either.

With the damage done by the two surgeries, one NICU stay, two emotional recoveries, and serious lack of support after my first son, I know that I can make things different this time around. Do I want to have another cesarean?  No. Not at all, I never wanted to have one, or even two… it was just the cards that I was dealt. Do I want to plan to have a scheduled delivery after bitching about other people doing it for years?  No. But the difference at this point is… and this is also where the title of this post comes from… the vast majority of scheduled cesareans in this country taking place have no medical reason.  This situation I am facing has a number of medical reasons.  And if I felt like there wasn’t going to be hundreds of people picking the reasons apart, I would certainly share them more openly. Unfortunately in recent weeks, it seems like internet harassment over medical choices that peaked, and it is something I am not going to deal with.

Especially over a choice that hurts me to come to terms with myself.

I have opted to go to the backup OB/GYN’s that my personal midwives I used last time around have. And my midwife from Benjamin has signed on to be with me for my surgery, and postpartum time in the hospital as my doula, which means the world to me since I lost Karen (My doula) a year ago unexpectedly.  It makes me know my experience will be more comfortable, and I will have not only my husband, but her with me, two people I trust very much to help my experience.

I will be writing a positive cesarean birth plan over the next couple months in a real attempt to make this not only a Family Centered Cesarean, but a positive experience for all of us.

Am I dreading the recovery?  Yes, I am scared to death.

After my first c-section, I had a newborn I was able to lay and rest with all day. Breastfeed in my bed, and change his diaper right there also.

With my second c-section, my husband was home and able to help me through my recovery. I laid in bed for weeks, not only in pain, but an emotional wreck from a failed VBAC.

This time around, I will have a 3 year old, a 2 year old, and a newborn to take care of after the surgery with little help. It is scary!

September 16th, 2010

Update on the VBA2C Front…

I am going to write this post, then unplug for a couple hours, because I have too much on my mind. I have two beautiful son’s I am going to enjoy the day with, and a mother to share this time with. I am only sitting down to write this out in my confused state because I know so many here have been asking in the last couple days about this consult.

I had a great consult this morning with a warm, friendly, and informative provider. He, is a perinatologist, and even though I was speaking to someone with so much education, he was able to talk to me one-on-one like an educated mother. We discussed the new ACOG recommendations, the likelihood of a successful vaginal delivery with my history, and what they found during my second cesarean, which is what brings me the most confusion.

The positive is obviously that this Doctor will give me the green light as a patient, and even allow me to see the Midwives that everyone loves if they will take me as a patient, but the downside is, I am not sure of which choice to make at this point.

What was found during my second c-section, I was never told in full. From serious adhesions and damage, to issues with my bladder, and despite requesting a double layer closure, I was only given a single layer closer. I know this sounds Greek to most, but more and more evidence says that double layer closures for c-sections are really the safest option.  I know this, which is why I requested the closure I did, but apparently did not get.

Now here is the tough decision. I can opt to go into labor on my own, and have a trial of labor, and if something does go wrong, the time for them not only to get the baby delivered, but not seriously injure me, may cause damage in the event of an emergency. Unlike in a first time mother, opening them up, with no bladder damage, adhesions, bowel damage or adhesions, and deliver the baby is a piece of cake. With someone who has a history of dense adhesions, and the above problems, it could be a longer process, and more dangerous for myself especially.

While we truly aren’t planning anymore children, I am not comfortable with the idea of a hysterectomy, or any other major surgery as the result of these complications.

Downside? To avoid all that, I would have to opt for an elective c-section. I don’t see it as truly elective because of the nature of the surgical report from my second son, and the condition my uterus, bladder, and bowel were in at that point. They most certainly will be worse off this time around after going through two prior uterine surgeries.

I am scared, and I have a lot of thinking to do over the next 7-8ish months. I do not know what I am going to do at this point, but I know I am going to explore the option of the midwives for my prenatal care at the least, and then go from there.

I appreciate respect, and kind supportive words during this period of time. As usual all comments will be screened, and if I don’t like that you have to say, or it is negative, I will be throwing it into the trash can.  This is a very difficult time for myself, and my husband as we talk about our options.

September 7th, 2010

OB’s Aren’t Listening to ACOG

OB’s aren’t listening to ACOG. While this is a huge shock for some people, it is not surprising for others. But how did I come to this conclusion?  Well, becoming pregnant put me in a position I was not comfortable being in yet. Being a woman looking for a trial of labor after two previous cesarean sections.   One that was not medically necessary at all, and one that saved my youngest son. While I believe if things had been done slightly differently the second could have been avoidable, but it was a catch 22.

In July of this year, ACOG released new VBAC recommendations in response to the growing cesarean rate, complications that are a direct result of that, the falling VBAC numbers, and the lack of access for VBAC that was all brought out in the National Health Institute’s VBAC Consensus back in March.  I was lucky enough to be able to watch the entire conference from home, and take a ton of great information from it. But it also hit ACOG hard because their representatives knew that their guideline changes essentially caused the decline in VBAC access for women Nationally.

On July 21st, ACOG made a new press release detailing some of their new VBAC guidelines, which included a statement on women with two previous cesarean deliveries.

In keeping with past recommendations, most women with one previous cesarean delivery with a low-transverse incision are candidates for and should be counseled about VBAC and offered a TOLAC. In addition, “The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,” said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago.

Ok, so what is the big deal right?  It says right there that ACOG supports and finds a trial of labor acceptable and essentially a safe option for women with two prior cesarean sections.

So what is the hang up? Apparently all the same OB/GYN’s out there that were quick to jump ship on VBAC when the guidelines changed years ago with new guidelines on the readiness of Anesthesia in the hospital, are NOT as quick to jump back ON the VBAC bus despite the clinical information showing it to be a safe choice.

Where does that leave me right now?

Screwed!  I have a hand full of options I am looking into at this point, but I can’t go see the midwives I was with because their backup OB practice won’t take me on… I have an appointment with a high risk Perinatology group who seems to be open to my request, but the two words high risk scare me because I know it is going to limit the availability of a natural birth. Although the positive of it all is a friend of mine, who had two home births, and came down with a horrible blood disorder during her third pregnancy had a 100% natural hands off birth with this same practice. So… I have hope…

We’ll see!

August 30th, 2010

Goodbye Sanity!

If you recall, I made a post a couple weeks ago about my toddler pooping like my mothers chihuahua in her backyard as an answer to all those people who asked when we plan on having our third child. Well apparently someone else had different plans for our family. For the past week or so I haven’t been feeling too hot. Not sick, but just really tired. I was freaking out slightly, but I assumed because we have been careful (besides a minor accident we had) it as another issue like anemia, or maybe something being off with my thyroid.

Goodbye Sanity! Hello Third Elwood Child!

Well I guess I was wrong. And after a week of sitting on the edge of my seat, and a full 24 hours of disbelief and shock, and lots of questions flying through my head about VBA2C, providers, money, a new car that can fit 3 car seats safely, money, money, and money again, and heck, where are we going to PUT another kid?  I have come to terms and now I am in Momma Bear mode. Get shit done and take no prisoners….

I have a laundry list of things to do in the next 9ish months.

I think my husband took it the best out of the two of us. As I cried like a baby spouting off question after question, he kept it together and just said we need to do X, Y, and Z and we will be fine… Calm down, relax, and everything will be ok.  Thank god for him and his calm reaction, even if it was only a show in front of me to keep me from running down to the Housatonic River Bridge and hurling myself off the side.

So, sit back, and relax, and watch the loss of my sanity over the next 9 months.  It should be a fun ride.