Ask the Birth Guru

PLEASE have you ever heard these stats and I need a recent reliable source as to how safe it really is after 2 c-sections to try vbac.He then says since I never went into labor on my own with either,that he doubts I would and that since 12 hours of pitocin did not decend first baby into pelvis that my pelvis is to narrow and claims he could see this on ultrasound.(I never heard of this either)I am a large boned women,5ft.8" and as a teen was told by my x-rays when I had broke my tailbone that I had a wide pelvis.

My background:I had two previous c-sections.Both at 37 weeks.FIRST BABY was 17 years ago with a DIFFERENT doctor for Toxemia -labored 12 hrs. with pitocin.No progress at all.SECOND BABY was 4 years ago for baby in distress.Other than some contractions for a few hours that started after amnio which was to check her lung readiness....no labor as the baby needed to be out right then.She would not move or respond to stimula.Very scary as this continued even after birth for 3 more days(could hardly get her to wake up)and she was all swollen up.No known reason.Both babies had NO breathing problems and ironically they both weighed the same.8lbs.7oz.

So please......I need to be prepared before my next conversation with him and before he puts c-section in stone as I had no comebacks for him.If I should not try a vbac then I guess I need to hear that too.I just need some CURRENT information so I can make an informed decision and not feel regrets later for not trying a vbac.

Thanks !!!!
Chris due 10/9

Trial of labour after two or three previous caesarean sections:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=12932864

Planned vaginal delivery after two previous caesarean sections:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=8018637

These studies do not support your doctor's claims at all. Although I didn't spend long enough on Medline to be really thorough, I didn't find any study that claims such a high rupture rate. If you want to research more, try clicking "Related Articles" at the top right of either article at Medline. That will bring up a list of more studies about VBAC.

Liz.

ONe other thing you could try is to put the burden of proof onto your doctor--have him point you to the reading he has done that gives a 50% rupture rate.

Liz.

I agree with Liz that these studies are plenty current.  Actually, the 1995 ACOG policy on VBAC was that women with 1 or 2 cesareans should be encouraged to try VBAC.  The policy changed in 1998 and 1999 with no supporting research--it was all about liability.

Liz is correct that you should put the burden of proof on your Dr.

But frankly, even if you do coerce him into "agreeing" to allow you to try for VBAC, I doubt you will get one with him.  It is ridiculous to tell a woman who had to birth her babies at 37 weeks for good medical cause, that the fact that she did not go into labor with those babies is a sign that her body just does not work.  It doesn't matter how much medication you pump into a woman, if she isn't ready to give birth, she isn't going to go into labor...and your being stressed certainly did not help you to go into labor!

Being induced will increase your chance of rupture--particularly with prostaglandins, which were used in the second of the studies that Liz sited.  Considering the size of your first two babies, I would expect that you will be pressured to induce for "suspected large baby."  You should no that NO research supports inducing labor for this reason--the research actually shows that inducing for suspected large baby increases the risk of having a difficult birth over just waiting for labor.  One major reason is that your pelvis relaxes in preparation for birth, allowing it to spread open further.  If you induce labor before this relaxing is done, the space for the baby to exit is smaller.

Which brings me to another point.  Ultrasound is not accurate for assessing pelvic diameter as you suspected.  Your pelvis is not rigid, it moves during birth.  The only way to assess the adequacy of the pelvis is to push the baby out--using a variety of positions.  Large babies are often best pushed out when you are in a hands & knees position or squatting--not the standard semi-sitting position that most American women birth in.  To find out how open your care provider is to use of "non-standard" birthing positions, it is best to ask a question like "how many of your patients deliver in positions other than semi-reclined?"  Don't ask "will you allow me freedom to choose my own position during delivery?" because to some care providers they think that means a difference between flat on your back or semi-reclined.

I very MUCH encourage you to get a copy of Ina May Gaskin's latest book, Ina May's Guide to Childbirth and Henci Goer's book A Thinking Woman's Guide to a Better Birth.  I find Henci's book to be a good guide to the research about birth, while Ina May's is an excellent coverage of the social/emotional/sexual aspects of birth.

Hugs!

Jenn