Posted by My OB said WHAT?!?.
Jan
4
Posted by My OB said WHAT?!?.
“We Don’t Discuss Vaginal Birth After Two Sections.”
“We don’t discuss vaginal birth after two sections.” – Immunologist at an prenatal clinic.
There are 23 comments to this post.
I’m actually looking for info about doing a VBAC but everything I’ve found is kind of confusing to me. My daughter was 9lbs 12oz when she was born via C-section (no GD) and it is assumed any other kiddos will also be considered LGA. Everything I’ve researched is divided, mostly leaning towards continued C-sections for LGA babies, yet many others say it is considered perfectly safe to VBAC regardless. Help, where to look?
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Mama Wrench Reply:
January 4th, 2012 at 12:58 pm (Quote)
According to the ACOG, suspected LGA is not sufficient reason for scheduled c-section without other medical indications — and one previous c-section is not sufficient indication for routine repeat c-sections. ACOG’s revised VBAC guidelines “Women with a twin pregnancy, an anticipated big baby, with two prior cesareans, and women who do not go into labor at term can still plan a VBAC.”
I don’t want to freak you out, and please understand that this is anecdotal, but a friend of mine had a routine repeat c/s for suspected LGA baby (her first was a c/s for a 9lb 15oz baby); despite being large, he was still premature and ended up in the NICU with neonatal pneumonia from fluid in his lungs. Even if you do choose to have a repeat c-section, please consider waiting for the initiation of labor on the baby’s terms, or even TOL; it’s the only way to ensure that the baby is born when he or she is ready.
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Details Reply:
January 4th, 2012 at 1:00 pm (Quote)
Nothing is perfectly safe. I’m sure if you go back through these posts you will find some links that will help you. First though get rid of the concept of perfect safety. There is a risk to VBAC, there is a risk to C-section, there is a risk to amnio (which happens to be higher than VBAC), there is a risk to carrying to term and there is a risk to aborting. You have to learn the numbers. There are no zeros and no 100%. You could start your serch at ICAN, I believe it is .org
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Melissa Reply:
January 4th, 2012 at 2:40 pm (Quote)
First of all, I would be careful not to conflate the slightly increased risks of certain problems with a potentially larger than average baby with the risks of VBAC vs CBAC.
So, looking at the numbers for a larger than average baby, the cutoff for any actual improvement in outcomes for prophylactic induction or c-section is a baby of 11+ lbs. Not nine-ish. Any rules about all babies over nine lbs as “diagnosed” by late untrasound are just bad medicine. That’s not to say that it couldn’t be a good choice for an individual mom…just that the odds are, in general, better with vaginal birth. Though still, I would encourage you to look into which risks are more of a concern for you, because neither choice is risk-free.
Second, it seems pretty clear to me (lots of research, given that I’m in a similar situation) that a VBAC, all things being equal, is the healthier option for both mom and baby. But…that’s all things being equal. I happen to be healthy with a healthy pregnancy…and with my particular history, my odds of uterine rupture or dehiscence are astronomically low. And I want more children…so getting off the “repeat C” train is really, really important to me.
I’m not aware of any particular way in which a moderately LGA baby (like yours or like my son, at 9lbs5oz, sectioned as a surprise breech at 41 weeks) could increase the risks of a VBAC as such. Bottom line, even ACOG recognized recently that suspected macrosomia is NOT a good reason to induce or section (unless baby is projected to be off-the charts HUGE–which prediction itself is often in error) AND that a suspected macrosomic baby is not a contraindication for a trial of labor after C-section (TOLAC). By the way…the assumption that the next baby WILL be macrosomic is, well, quite an assumption. And it’s not an identification of a problem that you *will* actually have…just something to watch out for, and more reason, if you go the VBAC route, to stay upright, push according to your body’s signals, etc. Waterbirth would be an excellent choice…lowers the risk of shoulder dystocia, tearing, etc.
Here are a few links to get you started. Check out Kmom’s site: http://wellroundedmama.blogspot.com/
and http://www.aafp.org/afp/2001/0701/p169.html
(be sure to read the last line in their summary of ACOG’s practice bulletin: “Suspected fetal macrosomia is not a contraindication to attempted vaginal birth after a previous cesarean delivery.”)
and http://www.pregnancybirthandbabies.com/Big_baby.htm
and
http://www.aafp.org/afp/2001/0115/p302.html
Also: your daughter actually doesn’t even meet one of the two standard definitions of fetal macrosomia! Some like to use the cutoff of 8lbs13oz, others 9.15. Frankly, they’re both arbitrary. That said…TEN percent of babies are above 8.13…hardly seems abnormal, eh? So I’m more inclined to be less than impressed with the idea that she was somehow horrifyingly huge. Less than 2% of babies are 10+lbs…that sounds slightly more useful, but still does not in itself indicate a worrisome situation.
Good luck, whatever you choose. But I certainly hope you get better info than they are currently offering you!
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Michelle Potter Reply:
January 4th, 2012 at 3:53 pm (Quote)
I agree with everything said here. Especially the part where NOTHING is risk free — it’s all about deciding which risks you can live with.
Also, “By the way…the assumption that the next baby WILL be macrosomic is, well, quite an assumption.”
My first baby was 8lbs 15oz. (Which I don’t even consider large, but whatever.) My next THREE babies were all around 7lbs each.
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Julie Reply:
January 5th, 2012 at 4:04 am (Quote)
I was going to say the exact same thing about the assumption. My daughter, born just one day past her EDD was 9 lbs. 5.5 oz, over half a pound larger than her big brother. So I naturally assumed that my next baby, at a week late, was going to be close to 10 lbs.
Imagine my shock when he was 8 lbs. 8 oz. The smallest of all three of my children.
And my own younger brother was exactly a pound smaller than I was. So it does happen that mothers who’ve had large babies go on to have babies who are not as large.
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Michelle Potter Reply:
January 5th, 2012 at 6:13 am (Quote)
Speaking of due dates, my first baby was both my largest and my earliest, coming only 1 week past his due date.
My middle daughter was my smallest baby, at only 7lbs 1oz, and also my latest, coming at 42w3d (17 days past her due date).
Wouldn’t it have been FUN if I’d been induced or scheduled a c-section at 38 weeks to make sure my daughter wasn’t “huge” like her older brother? She could have been a whole MONTH early! Yay!
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vbacqueen Reply:
January 4th, 2012 at 2:47 pm (Quote)
I had a 9lbs 10oz baby vaginally after 3 previous caesareans………..and a client had an 11lb baby at home after 2 previous caesareans (she’s 4’11)
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BigBaby Reply:
January 4th, 2012 at 3:38 pm (Quote)
My first was 11lbs5oz, born vaginally after an 8 hour labor and 2 hours of pushing. My second was 8lbs15oz born with 4 pushes after 4 hours of labor. Don’t assume that the old wives tale that they get bigger each time is true.
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Joan Reply:
January 4th, 2012 at 5:34 pm (Quote)
My first baby was a 9 lb 14 oz cesarean baby-but I did have a successful VBAC the second time around (1 hr pushing no tears!!). She was a bit smaller at 8 1/2 lbs, but her head was the same size (almost 15 cm). I went into labor (naturally) at 39 weeks. They were cautious about her size, however never pressured me into scheduling-and all my midwives felt it was worth laboring and trying for a VBAC rather than scheduling for “suspected” large baby. Also no GD-gained 20# first pregnancy, 25# second, so all that just means I have bigger babies normally.
Good luck with your search! http://www.vbac.com/ is another good site for information.
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Me again lol
As soon as I knew I was pregnant I got my Doula booked in as I knew exactly who I wanted as she specialises in VBAC. If I have another section it will have to be a crash with GA and I’d prefer not to go there. One of the first things she told me was not to discuss or mention VBAC to them at antenatal, we’ll do this later.
At my booking in appointment I saw the immunologist (I’m on the joint immunology/ FMT team as I am a thrombophiliac due to an autoimmune disease) to discuss my usual pregnancy medication. As I take Clexane (Lovenox to most of you 
) during pregnancy it would have to be stopped before the baby was born because of the risk of bleeding, so he reminded me of that and said that I knew I had to have another section. I said “Well obviously I’d prefer to have a natural birth but…” cuts me off with a patronising laugh “Well, we don’t discuss vaginal birth after two sections, it’s just automatically another section”.
My partner’s head dropped, I could hear his thoughts “Oh no, you’ve done it now, she’s having this VBAC” he’s always been convinced by my doctors that a VBAC with full classical inverse T is so dangerous we are just going to go straight for a repeat section and I think he was hoping that they would talk me out of it. He knows me too well to know that when someone says I can’t, I say “well actually yes I can!” and this doctor had just sealed the deal.
I booked an appointment a little later on with a Supervisor of Midwives (it’s a MW with extra training to represent the views of both midwives and mothers, if you’re having a problem they’re the best person to get in with) and we met together with my consultant obstetrician. My cons was shocked and apologetic because yes we do discuss VBA2C, even with special scars and it’s most definitely not in his remit to make comments like that.
As you may remember, despite a difficult registrar at my birth I did go on to deliver my little girl by VBA2C.
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Of course we don’t discuss it, we expect you to VBAC unless YOU tell us otherwise. There, I love it when they let you fill in the blanks 
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Better than false hope I suppose. Now mom can find a provider who hopefully will help her! Now if only ACOG, doctors and hospitals would follow the findings of the studies showing that there is not a significant difference between VBA1C, VBA2C, and VBA3+C outcomes, and that they are all still lower risk than scheduling a c-section!
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