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06/01/2008
OH MY GOD THERE'S A SIX-INCH GASH IN THIS POST
It is a truth universally acknowledged, that a ridiculously bulbous woman in possession of a third-trimester fetus must be in want of some way to get that sucker out.
I am at that point myself. At almost 31 weeks, I am being made aware, gently but insistently, by my care providers that sooner or later this baby is going to have to come out.
Improbably, in this respect my last pregnancy was easier. Before 14 weeks or so, I hadn't been truly convinced I'd actually deliver a baby. Between then and 20 weeks, I had no reason, when I was so bold as to consider it at all, to assume anything but a vaginal delivery. After 20 weeks, at which time I was diagnosed with complete placenta previa, I knew I'd have no choice but a C-section. No decisions. Easy. This time, not only do I seem to have the luxury of choice, I have the burden of it.
Off the top of my head, I've made a quick list of the pros and cons of each of the options available to me as far as delivery goes. I am aware that it is not an exhaustive list, and, indeed, that it is a heavily biased one. It is also, as it happens, a largely unsubstantiated list, since I'm on vacation and unable to add supporting links as I'd normally try to do. Trust me...if you dare...especially when I tell you that I've based it on my own medical situation, my own personal neuroses, and my own highly specific areas of intelligence and ignorance.
Planned C-section
Pros: Predictable. Overall risk to the baby, across the spectrum of all outcomes given my history, is minimal. Risk to me ditto is minimal, except for the whole troubling OH MY GOD THERE'S A SIX-INCH GASH IN MY ABDOMEN thing.
Cons: Recovery would be more difficult and protracted than from an uncomplicated vaginal delivery. Evidence that establishing breastfeeding can be more difficult after a C-section. Possible respiratory problems due to gestational diabetes could be exacerbated in babies born without the healthful lung-squeezing benefits of a vaginal birth.
Spontaneous labor, vaginal delivery (VBAC)
Pros: I would be given a once-in-a-lifetime chance to reestablish my faith in my body's natural reproductive abilities. Hahahahaha, ohhh. How I do love to laugh. No, it's this: My lifelong dream of an unattended home birth could be realized at last. No, wait, that wasn't it. I've got it now: OH MY GOD THERE'S NO SIX-INCH GASH IN MY ABDOMEN. Healthiest, most desirable possible option for the baby and me...if possible.
Cons: Unpredictable. Some risk of uterine rupture. Some risk of injury to the baby, who is currently measuring in the 90th percentile for size, a risk that increases as he gets bigger. Also, the possibility always exists that the so-called trial of labor -- which always reminds me of trial by fire, trial by ordeal, and trial by tying-a-giant-boulder-to-a-suspected-witch-to-see-if-she-can-float -- could fail, landing me with a C-section regardless. And this is truly, truly a minor consideration in the grand scheme of things, but I would be remiss if I did not mention that OH MY GOD THERE COULD BE A SIX-INCH GASH IN MY NOT-ABDOMEN IF YOU KNOW WHAT I MEAN AND I THINK YOU DO.
Induced labor, vaginal delivery (VBAC)
Pros: Predictable, within certain parameters -- at the very least, they tell you what time to show up at the hospital.
Cons: Significantly greater risk of uterine rupture than with spontaneous labor, and the attendant risk to the baby that that entails. There is also the risk of losing my uterus entirely; when I asked about an induced VBAC, my OB paused and judiciously asked, "Well, what are your plans for future childbearing?" Like, Are you looking to use your uterus for anything baby-related after this, or would it be okay for us to take it out, give it a quick once-over with a damp sponge, and give it to you to use as a stylish change purse? Additionally, I have heard tell that induced labor isn't quite as much fun as you might think it is when you hear words like "excruciating pain" and "cervix no riper than a January melon" and "holy Jesus fucking Christ I asked you to do this!?" The induction could fail, and/or the trial of labor could fail, meaning I could end up with a C-section on top of it all, exhausted, grouchy, and HEY WOULDJA LOOK AT THAT GASH.
Now, should I become ill — Feelin' fine! How 'bout you? — and need to deliver swiftly, a neat and tidy C-section is obviously the way to go. Under those circumstances I'm not at all apprehensive about surgery; getting the baby out quickly and restoring my own body to pre-pre-eclamptic equilibrium will be of far greater consequence than any missish reservations about a couple of weeks of postpartum inconvenience. And given the fact that I've already had a C-section, and have gestational diabetes, my chances of needing a C-section this time around are greater than they'd be without these factors. So in those respects, my options aren't boundless. All things being equal, my very first, fondest choice would be for a VBAC after spontaneous labor. But "all things being equal," or in this case, "easing seamlessly from a healthy pregnancy into a full-term but not-overdue labor with the baby in no distress, in the correct position, and juuust big enough but not too big" seems like asking an awful lot.
However, even taking the last option — induction — off the table completely, because I'm not comfortable with the elevated risk of rupture, it is strange and exciting to believe I have even a modicum of choice. I know plenty of second-time mothers plan immediately for this or that depending on their previous experience, but I've enjoyed the unaccustomed freedom to turn these matters over in my mind for the last few months. Even now — I was tempted to write "at this late date" because, damn, I've never been this pregnant before, but really it's not that late — I don't need to make a decision. Overall, that's good, because I know perfectly well that this feeling of control is an illusion, given how quickly the game can change, and I don't intend to get too deeply entrenched in any one position. But at the moment it's thrilling to imagine I still have options, that my preferences might actually matter, and to mull over them happily, and to revel in each day I can put off exercising any of them.
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In the end, you may have no choice at all, as you mentioned in your post, but all things being equal, a vaginal delivery is the way to go. My sister has had 3 c-sections, I have had 4 vaginal births. The difference in recovery is astounding. Shortly after giving birth, I am able to pick up my baby, roll over in bed, breastfeed, eat, etc. My sister has to have someone help her (handing her the baby, getting out of bed, etc) although after her first c-section the recovery time was quicker. She also told me about the pain meds she took which led to constipation which led to not being able to "push" a bm because she was in pain, which led to a self given enema and well, you get the picture. All I'm saying is, if you have to go with a c-section I'm sure all will be fine, but if you have any choice at all, I'd go with the vaginal (but you are right about not wanting the induced vaginal...shudder).
Where I live (Ontario, Canada) they will not do an induction after you've had a c-section ("too risky" I've been told), so door number three was out for me from the beginning.
I know how you feel about having to make the choice between planned c-section or VBAC; for me it was easier earlier in the pregnancy, when I couldn't see anything but doom and gloom if I opted for that "trial of labour". This was largely because it was hard to picture anything different from my previous experience, which was pre-eclampsia, followed by induced labour, ending with an emergency c-section, and I didn't want to repeat that particular sequence. Now that I'm almost 38 1/2 weeks along and have "pristine" blood pressure (my OB's word), I'm second-guessing the planned c-section I have scheduled for Tuesday.
I don't think I'll change it at this point though, since all the arrangements for care of my toddler have been made, the hospital bag (well, large storage tote, actually) is packed, and we're pretty much at the "Thundercats are go!" stage.
I think you have a good attitude, and that you accept what may be may have to be.
Having said that, if you can have a VBAC, it's a better experience. I know that, for me, giving birth to my son vaginally was the only "normal" part of my pregnancy.
I wonder, you absolutely can't deliver with a midwife (far too risky, and they wouldn't take you) but if you're in a place that allows them, could you hire one to work as a doula/labour coach? My midwife was a tremendous advocate for us, and her gentle and compassionate presence made such a difference to us.
Just my 0.02 cents, wishing you a happy, healthy baby, whoever it gets here!
Since I had major uterine surgery already, I had no choice when I was delivering my twins, and I have no choice now. I asked about the possibility of a vaginal birth...what the heck...and was given an incredulous "WHAT? Are you out of your MIND?!" which I gather was a NO. Now my C section date is scheduled for July 31.
I did get a gash in my uterus, but then again, I already had one. I was up and out of bed within hours, feeding both of my babies, and pooping just fine. What really hurt was the myomectomy, which allowed me to have children in the first place. That took a week in the hospital, months of recovery, and no bundle of joy to show for it. I would like to have the choice of a vaginal birth, but when its all said and done, I'm glad just to have the chance to give birth at all. I do envy your choice, a little, and secretly I wish that I could go into labor early just so I could experience it...up until they put me on the operating table, anyway. I know it may sound crazy....but going from walking around pregnant to BAM here it is, is a little bit surreal, and anti climatic.
I have missed feelings here. I have been induced and the pitocin induced pushing can be pretty intense. I have also had spontaneous labour and it meant a long tired night before my baby was safely delivered. Despite all the natural childbirth hype, the most important result is the healthy baby and mother. Yes, I did natural childbirth both times and am glad that I did.
I have to tell you that my fondness for you makes me wish that you would have a c-section. I know that you wouldn't get the special motherhood club discount for a vaginal birth, but it is not that important in the long run.
I've been thinking about this too. Vaginal is my preference for all the obvious medical reasons, especially with all the stairs in our townhouse.
But it's twins, which complicates everything anyway. AND both babies' heads still (at 30 weeks and change) measure 10 days ahead of the rest of their bodies. If they go full-term, the gashing in my not-abdomen could be dramatic.
Did I mention I have had six csections? Oh? I didn't? Oh - okay, I've had six csections. You'd think I'd be a great advocate of that 6 inch gash given I've had one 6 times now - and no, no not so much. Though - I really didn't have any choice. The first one - no way that baby coming out. The second a complete placenta previa - sound familiar? After that - another preemie with cord compression emergant section and it just got easier to say "book me an OR!" That and an Android pelvis (sounds very robotic doesn't it?) kind of puts a damper on the vaginal exit thing. (Android pelvis is a pelvis that narrows anteriorly - think triangle, and since most babies' heads are not three sided, well - complicates matters a bit - square peg, round hole kind of thing)
You know what to expect with the section having had one before. It is easier to recover from a section where you didn't labor and try to deliver the other way first. The wear and tear is harder the surgical route though - short and long term. I'm 40 this year and I gotta tell you, the only reason why I can't see the six scars is because of the lovely large spare tire overhanging them - no matter how skinny I get. Not withstanding I have a rare complication of multiple sections and d&cs and endometriosis that means my uterine muscle wall has endo all in it thanks to being cut open and scraped so much and is roughly the size of an 18 week pg despite being sans baby. So, I will have now have to have my 7th 6 inch gash to remove said endo ridden ute. Now - unless you are planning another 4 babies/sections - you may not end up heading down that endo ridden primrose path. I never regretted it before - but now, sometimes I wish I had tried it the non-surgical route at least once more just to make sure.
Sorry - that comment got away from me. Wishes for the ability to make the best decision for you and live with it happily. Congrats on getting to this point where you get to think about delivering your new son!
I did "enjoy" my vaginal delivery more, in that I wasn't flat on my back puking afterwards, while visiting my baby in the NICU. Instead, we were snuggled up in bed, nursing. However, I completely disagree about the recovery - for weeks after my vaginal delivery, I couldn't sit, pee, or poop without pain or fear I was re-tearing something; with my C-section, I could do all of these things. I was also spared the sprained rotator cuff I gave myself during the vaginal labor (pulling on the bedrails trying to push that baby out and completely not feeling it because of all the adrenalin), which meant I couldn't comfortably lie down for weeks, either. I really had no trouble holding the baby or doing anything else I needed to do following the C-section - it helps, I suppose, that I didn't mind not driving for 2 weeks - kind of enjoyed it (why DO we all need to drive so many places so much of the time?!) - and was even OK with not picking up my 4-year-old - she could still snuggle up to me, sit in my lap, etc., and, frankly, I was kind of tired of her constant demands to be picked up, but found it hard to say no, and welcomed the imposed break on it. Anything else I couldn't do, I was HAPPY about - and milked it for all it was worth. Nope, no cooking or cleaning for me - or anything else I didn't want to do.
My vaginal was an induction, btw, and, you're right, they do hurt. But unless you're one of those crazy people who wants a drug-free delivery, I wouldn't worry about it. Just crank up that epidural.
WIth all that said, my opinion is, it doesn't matter. The delivery is like the wedding - the important part is the marriage.
I'M SO EXCITED YOU'RE AT 31 WEEKS!
I've had two vaginal births so I can't comment on the c-section recovery aspect, but I can say I tore less with my second (8lb12oz) son than with my (8lb2oz) first. If you still have the use of your legs during labor, you can change position to ease the pressure on your parts.
Oh, and you know estimating weight by ultrasound is unreliable, so I'd just discount that altogether as a factor. Unless they tell you it has two heads or something.
Oooo, choices. Lovely things. So very very glad that all is going well and that you can savour your, um, burden.
I became exponentially alarmed as my baby got bigger. Neither exit seemed hopeful... baby departure via the sunroof? Hmmm. The gash does mentally loom a little, doesn't it? Vacation of quarters down the conventional route? Umm. Let us consider how to pull a size 18 rabbit out of size 10 hat... Even though the poor little guy was IUGR, I still didn't fancy his head scan measurements much. When sarcastic and long-suffering friends eventually started muttering about Hobson's choice and offered to start desultory research into a small teleport device, I knew I'd deliberated too long.
Fingers crossed that when Lil Boy Blue decides it's time to head for the exit, he does so in an orderly and calm manner. Very best of luck and warm wishes to you.
I wouldn't worry too much about the size of the baby. From what I've read it's the size of the head and not the weight that matters.
To put it in perspective, my MIL delivered 6 kids vaginally, 5 at home, and 2 of them (my husband and his younger brother) were over 10 pounds.
Yes, I who was born at 5 and a half pounds, is trying to have kids with a 10 pounder. I'm not too scared....
Can I tell you how tickled I am that you are at 31 weeks and in the very next room is my perfectly normal and healthy 7.5 year old who was born at that gestation?! It's all good from here. You SO deserve this. :)
I've experienced all 3 of your options (none were really a "choice" for me). Of all of them, the planned induction (with an epidural as soon as I felt the first uncomfortable pain) was by far the easiest. I dilated painlessly and he was out in 4 pushes. After they brought me back to my room I took a shower, did my hair and put on makeup. I am not trying to brag, but I'm dead serious. I was ready to go downstairs for lunch with my cousin but the damn nurse caught me and told me it wasn't allowed. WTF? Anyway, it was far different from spontaneous labor that lasted for 39 EFFING HOURS with vaginal delivery and lots of stitches. I wasn't functional for like two weeks after that (thank God he was a good baby). The last was an emergency c-section at 31 weeks. Me thinks that those are worse than planned sections because I bruised and scarred much worse than anyone I have ever seen. I couldn't stand upright for what seemed like forever. I was literally bruised from my boobs to me knees.
I thought I had a point here but I seem to have forgotten what it was....
Basically, as long as a real live take home baby comes out of the process, how it got there is pretty much a blur once they start teething. :)
This is an incredibly personal quetion to write on a website, but then, I guess infertility websites are inevitably personal, so, uh, here goes: I seem to remember that you had HPV at some point. My understanding is that once you have it, you may always have it. Even if you're never symptomatic and have normal Pap smears for decades, you can't be sure that your body has cleared the infection. Which leads me to my incredibly personal question: VBAC, induced or not, presents some risk of infecting the newborn with HPV, no? And while it's no big deal for an adult to have HPV, could it be a different story for a newborn?
Yes, the very idea of a birth plan does sound luxurious!
I had pre-e and HELLP and was induced at 37 weeks. I couldn't have an epidural because of the HELLP and really, even with the odd combination of mag sulfate and Pitocin, it wasn't bad. 10 hours, total, and only half an hour of pushing, although I did start at 3cm/100% effaced. Maybe I'm the exception that proves the rule, but not all inductions suck.
I'm curious if anyone has given you any stats on repeat pre-e/HELLP. My MFM-ist said that there's no significant chance of a repeat, but other sources have told a different story.
On a completely other note: I was the winner of the quilt you made way back in the day (spring 2006) and the only person I know, other than you, to develop HELLP. My husband makes a lot of jokes that your quilt had some HELLP germs on it and that's why I got sick.
Might I suggest interviewing a midwife or doula? I know you'll have to deliver in a hospital with a doc around, but a trained midwife (one who has a masters and ob training) might be a wonderful ally. If you go with slower natural (I don't mean necessarily without painkillers, just without pit and epidural) childbirth, you're more likely not to tear. It might be slower but our midwife practice here has a much better track record for getting their patients through "intact" and they even make several housecalls in the following week to help with breastfeeding, etc. If you're less stressed, or not flat on your back, you might labor faster. Even if one has to have an emergency c-section, they never leave your side and are an advocate for you during your stay.
Best wishes for an easy and joyful experience however it happens!
Being in a position to make choices is amazing. Even if the choices are limited by previous events at least there is some element of how you might like best to get to the meeting with your new son. I hope things remain stable enough to allow you the real choice.
Just a quick note to say, whatever you choose will be fine and dandy in the end, I'm sure. And for what it's worth, I've had 2 c-sections and I really think the second was a much easier recovery. Not a walk in the roses, but not too bad.
I had an induction first time (pre-eclampsia) and spontaneous vaginal delivery 2nd time. 2nd was easier and quicker definitely and anyway no time for the induction which was booked as he came a bit early. I would favour door 2 for as long as possible but if any factor starts looking iffy book door 1. I wouldn't rely on ultrasound measurements particularly at this stage they can be 20% out depending on the machine/sonographer. I've noticed lots of people suggesting a midwife. This looks odd from a UK perspective - do you not have these in hospitals as well as doctors?
and after your unassisted home birth, when Charlie cuts the cord and prepares a little placenta omelette, and the cat helps your uterus contract by licking your toes [reflexology, dude], and Paul goes outside to hold your newborn son up to the awakening sun, and you supply him with your mothers milk that has 66.6% more complete nutrition than the cans of crap at costco...
I blatently stole your line when my doctor asked about a birth plan.
"Live baby."
Just have him. Doesn't matter how. Just get him here safely.
My MFM team does not do inductions as a vbac. Being that I also had an emergency c section with my previous one, provided that this kid is not breech I'm definitely aiming for a spontaneous vbac. I cant imagine caring for my 3 y.o. immediately post c section, at all.
I had a scheduled c-section for my first since she was breech. The c-section for my second is scheduled for Tuesday. It wasn't my choice - I wanted to do a spontaneous VBAC, but after the baby measured in the 90th percentile at 37 weeks, my docs told me that a VBAC was no longer an option. Too much risk of uterine rupture. I also have gestational diabetes, so that was another factor.
I'm actually really upset about it. My first c-section felt too impersonal - like I was just having surgery, not giving birth. I also wanted to experience labor (despite my friends saying I was crazy). I chose a different OB from my practice to do the surgery this time around and will talk to her to see if there's anyway to make the experience better. But all of that are just my own personal issues with having a c-section - your mileage may vary.
One option is to schedule a c-section for 40 weeks and if you go into labor before that, then go for the VBAC. I know my docs wouldn't let me go past 40 weeks due to GD.
Good luck with the rest of your pregnancy and with whatever decision you make.
Long time reader first time poster here.
My first was a c/s after 28 hours of pitocin-augmented labour and I had a natural VBAC in October so I've experienced most of your options. By far, the best experience was the natural VBAC. There was no comparison in recovery. I went trick or treating with my 2 year old 3 days post partum and carrying him up and down stairs at 2 days postpartum. I should mention I also had a 3rd degree tear and episiotomy so I can tell you for sure that the cut in my you know where was much easier than the cut in my uterus.
This baby was 10 days late and I didn't want to take the chance of induction (with the higher risk of uterine rupture) so I opted for careful monitoring and then self-induced with castor oil. It worked and I was in full blown active labour within 4 hours and delivered within 4.5 hours of my first contraction. I know that doesn't have any bearing on what your experience will be but I wanted to give you the perspective of someone who has had very different labour experiences. At the end of the day, a healthy baby is most important and you'll make the right choice for you.
Ah. Here's the thing. You're only at 31 weeks, and, while you're contemplating how you're going to deliver, you haven't yet reached there point where you don't freakin' care if they yank that baby out of your left nostril while you're naked on the pitcher's mound at Fenway Park -- you just want it out. Healthy, thriving, chubby and pink, sure. But OUTOUTOUT!!! That usually hits around week 35.
I'm pretty sure there's a "naked on the pitcher's mound of (insert your local Major League Baseball stadium here)" hormone that kicks that off. Doctors just haven't isolated it yet. It's so you won't have such anxiety about delivery once the time comes.
Nature is a beautiful thing. Except when it isn't. And then we just mock it and figure out a work-around.
Good luck with your decision-making process.
~C~
Very interested to read this, as if I get my wildest hope (another healthy pregnancy) I'll get to make a similar decision. Hey, a girl can dream...
So. Thanks for sharing your thoughts on this, even without sources. I suspect that a scheduled c at the local hospital of your choosing, and recovery from same (even with Charlie to care for in addition to Baby Boy Natalie) is quite different from the earlier one you experienced or even, say, the c that I had after 36 hours of labor -- a combination that, in retrospect, I cannot recommend as optimal (though clearly better than an assortment of alternatives). Around the time my son was born, Chris (of accidental housewife blog) gave birth to her twins via scheduled c-section and her advice was, if you know there's a 50% chance you're going to need a c-section anyway, just schedule it. That made sense to me. Is there a X% you can identify that would serve as the cutoff for you between VBAC and scheduled c, and can you get your doctors to provide timely estimates so that you can make the decision? Or perhaps a trial of labor with some rule of thumb concerning rate of progress? I mean, I'm sure such things exist for medical reasons anyway, but I was thinking of "Julie's rule," tailored to your own preferences and, of course, medical history.
Even after the combination of long labor and c, I, you know, survived and coped, albeit with some difficulties in those first few weeks. I had good help from family and would strongly advocate hiring same if you and Paul don't have great, plentiful help (from friends or family) available.
Look forward to reading about your progress, which I hope will be smooth no matter the route you choose.
For me, my biggest stress about delivery (past my oldest kid anyhow) as what the heck I was going to do with the kids for those couple days. I'm hoping that you have family / support nearby so that isn't an issue for you for Charlie.
Everything else will happen the way it will. You have a great attitude about it all, and I'm hoping for the easiest, least complicated possible outcome for your family.
Hey! Something I can comment on helpfully!
I went for the scheduled C the second time around (my daughter is like 5 days younger than Charlie) for a lot of good reasons, with the benefit of hindsight I would have gone for spontaneous labor and a VBAC. Although, no one ever shared with me the stat about rupture being more likely with an induction. I would likely have had to be induced -- Will was removed on his due date and I was showing no real signs of going into labor at that point. Recovery was harder, until strangely enough one day I just felt more or less fine, and it was hard to not be as snuggly with my daughter as I typically am. And the four days in the hospital just KILLED me with missing her.
So, that's my experience. And YAY for the luxury of choice, as much as we ever can have such a thing.
Dunno. My gut says that VBAC is the best option, but you in the end will just do what's safest for you and batboy*2 (can't find my hash key).
Btw what evidence have you found that breastfeeding is harder to establish after a caesar? Because my OB swore that wasn't true, while all the midwives told me it was, and I've never seen the hard evidence.
Well, not that you asked, but here goes: My first baby was a mercy c-section because even with pitocin, nothing happened the way it should. So, like you, I started getting the pressure with my second baby to come up with a plan. I went into labor on my own, tried for a VBAC and had an emergency c-section. The pre-eclampsia and fetal distress worked against me. My third baby - I had partial placenta previa and it was recommended I schedule I c-section. I just laughed! I had a scheduled, lovely c-section in a party like atmosphere. It was everything my other births were not. And I never had trouble establishing breastfeeding with any of my babies. One more pro for the scheduled c-section - since you have another child at home, it makes it easier to plan for his care while you are in the hospital. In the end, you have to go with your gut. You (as you are well aware) just can't control this entirely.
De-lurking for a second... No time to read other comments so I hope I'm not repeating anything anyone else has said!
I think waiting for labor to happen naturally is the best plan (barring any medical emergencies, of course!). But if you do choose to induce and try for a VBAC, please, please, PLEASE don't let them use Cytotec. Be responsible and ask what they're cramming into your hoo-ha!
A lot of doctors have been using the drug Cytotec (an ULCER medication, can ya dig it?) for inducing labor. The makers of Cytotec and the FDA BOTH have told doctors not to use it for induction but they still do. It's cheap and "effective". So effective it can rupture your uterus!
Linkety link:
http://parenting.ivillage.com/pregnancy/plabor/0,,6xr4,00.html
And I suggest having a doula to help advocate for you. A lot of doctors brush off what a woman wants because it's not convenient or they think it's unlikely to happen. They don't even give VBAC a chance!
Ok done ranting!
xoxo
katrina
About breastfeeding after a section - personal bit first two sections (one emergency & one planned) and no problems breastfeeding blah - and this is from a UK perspective things seem very different in the US. I had immediate skin to skin contact once the baby was delivered - i.e. while I was being sewn up the baby was put under my gown & we were both covered with a blanket and the baby was never taken away from me. They were both tucked up in bed with me in recovery where they got their first long feeds, then when we went up to the postnatal ward they stayed at my bedside & were demand fed. I had excellent pain relief (non opioid) and was mobile within 6 hours which is really helpful.
Early skin to skin, frequent/demand feeding & good pain control if required are really important in establishing feeding. A c-section needn't be an obstacle to that.
I'm so glad you're at 31 weeks and have so many options!!! I personally don't have options if I decide to grow another human. My emergency classical c-section at 28 weeks took away any choices I may have had.
I have my fingers crossed you have that spontaneous labor and VBAC.
I am not sure whether to post this - forgive me for what is, if not assvice, then certainly a negative thing to say - but I have a very close friend who had a fairly straightforward Caesarian with her first child, decided on VBAC for the second, had a uterine rupture; the baby was brain dead by the time they got him out, and was switched off life support the next day; meanwhile, the friend had to have an emergency hysterectomy. There were various issues with suboptimal handling of everything by the hospital, but it was never clear whether things would have been different if they'd been more on the ball. It was the worst tragedy I've ever been close to. I just wanted to say - uterine rupture can be more than "just" a ruptured uterus, and I so hope everything goes smoothly for you with this baby.
Sorry again for the negative comment.
I was very curious about this post since if NBH I will be in a similar boat--my group doesn't induce VBACs so I am scheduled for a 39 week C Section, but sometimes mull over the possiblity of what if I go into labor before hand--mostly because of the faster recovery and the 35 lb boy at home asking for "uppy first" every other minute. BUT--Alison's comment pretty much makes me want to shread that idea. I sort of worry about the other bad things with C Sections--PE, etc. but I don't know what the odds are of the bad stuff happening to me. Since I never went into labor last time and my blood pressure started to climb, well, I think I am going to end up in the risk to mother, less risk to baby category in any event. Still, it's nice to think a person has options...even if only on paper....
I know this is your blog but please - remember that your words are powerful and not doing any research before posting what looks like a "c-section is ok and I'm also looking at induction" post is just plain wrong in the face of gads and gads of research to the contrary.
I appreciate as well that you have lots of experts advising you but perhaps do some looking (yes I did see the disclaimer!) into the risk of these *for your average person*.
For you, sounding anxious and distressed about it now and possibly not having any more babies in your future, booking a c-section may be the kindest way to go - but it's not the safest in terms of risk to bub and to yourself.
The very tragic uterine rupture story is probably not that helpful. Childbirth can be dangerous for anyone. There was a story a while back about a woman who died from an epidural. The risk of UR is just extremely low. The safest thing based on research is planning for a VBAC, with a doula (found to reduce the risk of all interventions including CS). I totally love Julie too, that's why I am posting my opinion even though I know they are like assholes. :-)
$0.02 on induction.
I was really against getting induced with - thinking that getting induced meant being chained to the bed/monitor, awful pitocin, etc.
But, as I found out with kiddo #2 - none of that was necessary. I had a week of false labor with kiddo #2 and was 2 days over (that and polyhydramnos or however you spell that) so I decided enough was enough.
Anyhow, all they had to do was break my water and we were off to the races. It was a great L&D, just like my first go round.
So, anyhow, something to consider as you mull your options.
Since my planned c-section was the easiest c-section in the history of mankind, I probably can't offer very good advice here. I will say that the key word is "planned." Because I didn't go through labor the second time, I didn't have to go through recovering through labor in addition to a c-section like I didn't with kid number one. I was off the pain meds on day 3 and driving 2 days later.
If you do the c-section remember this: Walking is your friend. As soon as they pull that catheter out, get on your feet.
I've had 3 vaginal deliveries. All 3 were induced, so I have no idea what it's like to go into labor naturally. My first was 9lb 3oz. born on the day I turned 38 weeks. I had a small labial tear that needed 2 stitches. My 2nd baby was 9lb 6 oz., delivered when I was 38 weeks 1 day. No tearing, not even a skid mark with her. My 3rd (was a surprise, we needed assistance (bad endo) getting pg with 1 and 2) baby was born at 38 weeks 2 days. He was 9lb. 14 oz., and his head circumference was 39 centimeters (15.5 inches). Yes, his head was well off the top of the charts (ped's comment at his 2 year appt. recently - "Oh, his head size has come down nicely." lol). I had to have dh bring in size 1 diapers, he crapped out the sides of the newborn ones. I had no tearing, at all. Recovery was a breeze. I was up, showering, eating chinese food about an hour after his birth.
The inductions weren't so bad. I can tell you from much reading that it's my understanding an induction with pitocin only slightly increases the risk of rupture. Prostaglandin induction is MUCH riskier. I know this b/c my best friend is in labor, having her VBAC, as I type. She went into labor naturally at 40w 4days (today). I have been through this decision with her in the last few months, and she wanted this very badly. She told her midwife that if her friend (me) could give birth to a nearly 10 pound baby with a giant head, she could do it, too. Her first was a c-section at 39 weeks and baby was just an ounce shy of 9 pounds.
I didn't have gestational diabetes (supposedly). I do wonder if my test was on the high end of normal, given the gargantuan babies I had. My mom is type 2, also. All 3 had no blood sugar issues after delivery, though.
My point is that a vaginal birth, even an induced one, doesn't have to end with giant gashes (mine didn't anyway). All my inductions went fine, though I was ready to go with all 3 (a couple centimeters dilated at least, I was 4 with the last one). For me, it would be the easier recovery that would make the difference. That's the primary reason my friend went VBAC, also.
I am just happy you get to weigh your options this time. :)
yeesh, I cannot BELIEVE your moxie. First you talk about your boobs, and now about your uterus and hoo-hah and six inch gash, like they BELONG to you and YOU should be able to choose what to do with them. To the internets. Yeesh. You're a braver woman than I.
May you be blessed with a beautiful birth experience that looks exactly as it should. I would wish you the opposite of the last one, but hey, look what you got there. I just hope it's an easier journey for everyone this time.
I went for a planned c-section with my daughter last December. After a very, VERY traumatic miscarriage in 2005 and 39 weeks of sheer terror that something could go wrong again (even though the pregnancy was pretty much uneventful, GD aside), I simply couldn't handle the unpredictable facets of a vaginal birth. For me, this was more than enough good reasons.
My recovery was much easier than I'd anticipated. I was in fairly tolerable pain for five days or so. I could shower, get in and out of bed etc. all by myself and never needed help picking up the baby. It didn't affect my milk production either.
I feel I'm pandering to your neuroses here when I tell you I gave in to my own, but regardless of anything anyone could say the only thing that mattered to me was to get her out *healthy*. And healthy she came.
*
Oh, and you may want to kick my ass for this, but Julie... I can't wait for your 35 week+ misery posts. :D
I'm thrilled for you!
What a dilemma. Would you consider it mean for me to wish that you remain stuck with it for, oh, I don't know, at least 6 more weeks? Because that would mean there is no red light in your pregnancy, and you get to keep thinking about the mode of delivery, is all...
I myself am probably staring squarely at your one reject. Because my set of risk factors is completely exclusive of yours so far (but I am betting we will overlap at GD once I drink the vile stuff on Tuesday), my risk factors are pointing at induction. Which is all good with me. 'Cause the name of the game is, of course, live baby, baby.
Anyway, if I do get that far, I will in fact likely be stimulated first (or only) with cytotec. I know it is not an option for you, since induction is not an option. So inforamtion below is really for your readers for whom it may be an option and who are now scared shitless by Katrina's comment above.
I generally try not to argue with a source as authoritative as ivillage, but what the hell. Since my tertiary care (handling highest risk patients) facility uses cytotec (misoprostol), and since that is how I was induced last time (granted, the baby was dead last time, but I ascertained that the protocol they use is the same), I figured I'd better ask PubMed, seeing as it tends to have things like peer-reviewed articles rather than OMG, horror stories listed. They have a couple of thousand articles on cytotec for labor induction, but this one seems nice and fresh (December 07) and most on point: http://www.ncbi.nlm.nih.gov/pubmed/17961564
So, to recap: when people were first using cytotec, they sometimes used risky uncalibrated protocols, using too many pills in too short a time or with too little monitoring. Some bad things happened. Since then the dosing, timing, and monitoring questions have been worked out, and many large scale studies have been done that confirm the safety of the newer protocols. The reason that drug is used is that IV pitocin induction sometimes fails due to cervix not being nice and soft. For most patients, cytotec used responsibly can soften the cervix enough to allow for smoother and more successful labor induction. For some patients, using cytotec allows for induction without the use of pitocin altogether.
Hey there!
I love that you have options!
email me if you want the nitty gritty on VBACs. I've done two.
kisses.
(You didn't ask for advice and I'm not giving it--just sharing my experience.)
My OB wouldn't eve consider induction in a VBAC. No pitocin. No cervadil. No nada.
I went with a repeat c-section because I found the possibility of an emergency c-section just too terrifying. The OB had warned me that I wouldn't be able to lift my 30 lb+ toddler for 6 weeks after the c-section and that gave me pause, but parenting being what it is (at least in my house and/or hospital room), I was lifting him almost right away and it was basically fine.
It's nice to have options.
Oh goodie! We are in the same boat (except for the GD)!!!
Yeah, I've scheduled the 39-week planned C-section, never figuring I'd make it to 32. Still may not make it to 39. But how interesting to have new options.
You can steal my thoughts any time.
another two cents for you:
regarding the HPV thing, i hope you already know that it is a total nonissue--if everyone who'd ever been infected had to have a c-section, then vaginal births would be the exception to the rule, considering that something like 70% of the population has been exposed.
my pregnancy experiences so far have not borne much in common with yours, but after two vaginal deliveries i can offer a couple of insights that might be helpful. regarding the terror of the 6-inch gash in your NOT ABDOMEN: i also had a third degree tear with my first baby, a 7 1/2 pounder. i am happy to say that the recovery from that was far easier than i anticipated. my midwife recommended warm compresses of comfrey leaf tea, which i sat on while i nursed, and honestly, healing from that tear was not a big deal; ibuprofen was fine for the pain, and the "resumption of relations" occurred on schedule and without trauma (at least not from the tear.... :-) ). even the dreaded postpartum BM--which i feared almost as much as labor--was a pleasant surprise (though i dosed myself with cholase for about two weeks just to be on the safe side!).
i had an induction with my second baby; while i can say that it worked like a charm for me (baby in two hours) and i survived without an epidural, tho not because i didn't scream my fucking head off for one, i support you in rejecting that option. just given your own personal history and risk factors, it's not worth it.
whatever gets both you and baby natalie through the big day is the right choice. i too look forward to reading of your misery at 38 weeks in late july...i will be right there with you. :-)
So happy and excited for you.
You really can't do it wrong, and I'm sure you'll make the right choice, but since you asked...
I vote for the scheduled C. I had a scary emergency C with my first (heart rate = 0; she's fine now thanks to my great midwife and attending docs) and when it came time to decide what to do with the second I knew I wanted NOT to have emergency surgery more than I wanted to experience vaginal birth. Labor *and* an emergency C? No thanks. I think attempting a VBAC is great if you know you won't beat yourself up if it doesn't work, but I knew I'd just feel like I'd failed all over again. And there's something to be said for predictability when there's an older child involved.
My second birth was so calm and beautiful with lots of great play-by-play by my lovely OB. The pain and recovery was much less than the first time. I had no problem breastfeeding either time (so while, for some, it might be a hindrance it's certainly not a dealbreaker). Yeah, rolling over in bed was hard for a few weeks, and I took a couple percocet those first few days, but by 6 weeks I was good as new.
Good luck to you! You'll make the right choice, hope my perspective helps.
Mazel Tov Julie on 31 weeks!!! My first was a 31weeker (IVF, incompetant cervix,vaginal birth, 5.5 NICU weeks) and is now 2. My second was a 36weeker (pregnant on our own, first month we tried - crazy, he's 10weeks, as of Friday) because the doctors in trying to get out my "elective cerclage" put me into labor. And, how charming, they couldn't get the cerclage out so had to do an emergency c-section.
THAT ALL being said, my 2 cents on the c-section:
1. You're right about the lung issues - my guy had to spend a few days on c-pap because his lungs didn't get cleared out. But, since then, he's been breathing like a champ.
2. He also has been nursing like a champ. No breastfeeding issues, even though he didn't get sight of my boobs until 3 days after he was born. In ten weeks, he's almost doubled his birth weight.
3. Before I had this one, I kept saying "what's so wrong with the way they used to do it in 1950s. You go to sleep and wake up and have a baby". Well, I fished my wish. After 1.5 hours with a spinal and the doctors trying to get the damned cerclage out - when they told me I had to have the c-section I insisted on being knocked out. Refused all rational arguements for another spinal. And finally they relented. So, I went to sleep and woke up with a perfect baby. For me, it was the way to go.
4. Maybe it was my prize for the terrifying pregnancies and NICU experience first time around, but I had NO issues with the c-section. Hardly any pain. Recovery was a piece of cake.Walking around that night. After night one, only took Tylenol. For a week it hurt when I laughed, but other than that, I was just fine.
Best of luck Julie. I've been lurking for a long time now, since Fall of 05 when preggers with my first. You're an amazing woman. Charlie and his new sib are pretty lucky to have you.
Isn't it interesting how varied the outcomes are of EVERY SINGLE OPTION...yet there are still some people who INSIST that there is only one best way? I mean, if I had known that the six inch gash in my not-abdomen would still be causing me frustration nearly three years later, I'd probably have labelled it more than a just a minor consideration! But clearly, there are plenty of folks who can squirt out massive babies with nary a scrape, so it doesn't mean that I'm going to insist that natural childbirth is flatly horrifying and to be avoided by everyone.
Childbirth is like a box a' chocolates...you never know what yer gonna get.
I agree with Chris. I had a planned c-section with #2 after having a C after being induced for close to 4 days. The recoveries where totally different. I, like you, wanted to VBAC w#2. I scheduled a C-section for three days before my due day, and said IF I go into labor, I will try for 12 hours. Having the double plan was great. Fruitless, but great. Furthermore, setting a date for a C-section allowed me to pick the doctor in my practice that I wanted, not the doc who just happens to be on call, who I referred to with my first child as Dr. Asshat.
Also, Halloween was the date I picked. I figured that if I had to have ANOTHER C-section, I was going to throw some dang skippy birthday parties in the future.