How Many sucessful VBAC's.. - page 3

How often does your hospital have sucessful VBAC'S? Does your hospital even allow them? Have you had any really bad outcomes? If you had had a prior c-section would you consider VBAC for... Read More

  1. by   debi538
    Quote from PegRNBSN
    At our hospital we have telemetry monitors without cords that can even go in the shower. My second son would have died if I had not used a fetal monitor. He wasn't moving and I did a strip in the morning. It was flat and because of that I repeated it in the afternoon (I was working) even though he was moving more. I was having huge spontaneous variables to the 40s. They tried to induce, I had huge variables, lates and no variability. He was on his way out. I ended up with a c-section. His cord was around his neck three times and then around his body. As they delivered him his cord tore because it was so taut. If I would have just auscultated it would have sounded fine in the morning.
    Using the telemetry monitors allows you to move around and be monitored. Sometimes the first thing you see with a uterine rupture are small variables, which cause you to be extra vigilant.
    I understand where you are coming from. I am sure it was very scary for you. Sounds like your C/S was very necessary. An experienced labor and delivery nurse could have picked up those variables if she had listened in the manner prescribed by ACOG. Then it would have been appropriate to apply an electronic monitor for additional information. If you read the AWHONN literature, ascultation is the gold standard and should always be done before applying EFM (along with Ritgens manuver to determine fetal position). Unfortunately you rarely see nurses do it that way because, especially newer nurses, are not taught auscultation and fetal palpation and depend way too much on technology.

    The false positive rate with fetal monitor interpretation is extremely high. Many babies who were fine are cut out of their mother's bodies because of an "abnormal" fetal heart pattern.

    I still trust my eyes, ears and gut more than any machine.
  2. by   breastfeedingRN
    Quote from debi538
    I guess what I am trying to say is that a repeat cesarean has its risks as well, which seem to be whitewashed by doctors trying to convince mothers to just have a c/s for their convenience. It is not that VBAC is unsafe...... it is all of the non-evidensed based procedures (inductions, fetal monitoring, enforced bedrest....) that make it unsafe. Give mothers the truth and then let them decide.
    Exactly. I had only seen one VBAC in the year I have worked postpartum. I read the VBAC consent form and it actually said several times how the risks of VBAC were less than the risks of C/S and that was surprising to me how honest they were. I wonder how honest they are when it comes to just a C/S?? We have so many that are cut happy. You can even tell when certain docs are on-call because we have soo many sections that night. Argh...

    I do think that it is our sue happy world though that has a lot to do with it since I don't think that actual safety has the biggest part in the reason docs don't want to do VBACs, though I am sure the new restrictions hinder their schedules, a lot is probably to do with fear of being sued. That is our country, things don't go right, sue.
  3. by   PegRNBSN
    I am sure the variables could have been picked up, I am not sure that the lack of variability in the morning would have been. The lack of variability was the ONLY reason that I monitored in the afternoon. That was my point, not the big variables.

    Quote from debi538
    I understand where you are coming from. I am sure it was
    very scary for you. Sounds like your C/S was very necessary. An experienced labor and delivery nurse could have picked up those variables if she had listened in the manner prescribed by ACOG. Then it would have been appropriate to apply an electronic monitor for additional information. If you read the AWHONN literature, ascultation is the gold standard and should always be done before applying EFM (along with Ritgens manuver to determine fetal position). Unfortunately you rarely see nurses do it that way because, especially newer nurses, are not taught auscultation and fetal palpation and depend way too much on technology.

    The false positive rate with fetal monitor interpretation is extremely high. Many babies who were fine are cut out of their mother's bodies because of an "abnormal" fetal heart pattern.

    I still trust my eyes, ears and gut more than any machine.
  4. by   MS Kathy
    First I was induced at 42 weeks- classic cascade of interventions to C-sec.
    17 months later I was induced at 42 wks and a few days with Cytotec- I consider myself VERY lucky to not have a bad outcome now- but I had my VBAC and it wasn't a horrible birth. I decided after reading more, that I would never be induced again - if me or my baby';s life were in immediate danger, I'd consent to an emergency C-sec.
    3rd born at 43 weeks- no induction, no drugs, no surgery. 4th born at 42 weeks and some days -homebirth, labored in water, I didn't even tear.

    Not that it makes a difference, but I sometimes I hear people bring in baby weight issues (everyone know their body the best) but for me I always knew my babies would be large - I was a 9 pound baby and everyone in my family had large babies so it was just a fact of life. mine were 9lb 9 oz, 9lb 2 oz, 10 lb 6 oz, and 9 lb 4 oz.
    Kathy
  5. by   TweetiePieRN
    I had my first baby in July of 2005 via C-section due to CPD, large baby and baby under stress as well. Cord was wrapped around the neck 3x. I would not want a VBAC for myself. I had a very pleasant c-sect experience. I healed up nicely and they had me up walking around 8 hrs after baby came. Even when I went home, I felt pretty good. I was surprised at how good I felt. Yeah, so no VBAC for this mama!
  6. by   debi538
    Quote from TweetiePieRN
    I had my first baby in July of 2005 via C-section due to CPD, large baby and baby under stress as well. Cord was wrapped around the neck 3x. I would not want a VBAC for myself. I had a very pleasant c-sect experience. I healed up nicely and they had me up walking around 8 hrs after baby came. Even when I went home, I felt pretty good. I was surprised at how good I felt. Yeah, so no VBAC for this mama!
    I certainly wouldn't argue that most cesareans turn out fine but the risk of surgical complications are there and the risk of any kind of complications are greater than in a vaginal birth....even a VBAC. I am not sure you could call abdominal surgery pleasant....at best maybe tolerable? But even if it was pleasant for you it was certainly more risky for for both you and your baby. You just roled the dice and came out fine. I see women and babies all of the time that don't turn out fine......maybe not MAJOR complications but infections, excess bleeding, respiratory problems requiring separation from mom (thus delaying breastfeeding), more frequent trips to the OB after birth because of minor incision problems...... There was even a study that came out of the dental world recently that C/S babies have greater risk of cavities because they didn't come through the vaginal canal and get colonized with "good" bacteria.

    We have raised a generation of women who don't trust their bodies and think someone else has to start their labor (to be convenient for everyone)and get their baby out for them (even woman having vaginal births with inductions, epidurals, vacuum, forceps.....). Look at Brittaney Spears.......what a role model for women! One study I read said the induction of labor in a first time mom increases her chance of C/S by 40%! How many moms are told that?

    Again, I am not saying all C/S are unnecessary or bad but I am saying that it should not be a first choice because of fear and ignorance. It should be a procedure for emergency circumstances to save mother and/or baby, like yours was. In that way, the benefits out weigh the risks.

    Best wishes in your future pregnancies.
  7. by   TweetiePieRN
    i certainly wouldn't argue that most cesareans turn out fine ut the risk of surgical complications are there and the risk of any kind of complications are greater than in a vaginal birth....even a vbac. i am not sure you could call abdominal surgery pleasant....at best maybe tolerable?
    may sound crazy, but it actually was a pleasant experience. i had great pain control, even when i was at home.


    but even if it was pleasant for you it was certainly more risky for for both you and your baby.
    having a vag birth would have been more risky in my situation. baby was already 2 weeks late. i was not dilating. amniotic fluid level was low, baby under stress, cord around neck 3x, my pelvis outlet is unusually small.

    you just roled the dice and came out fine. i see women and babies all of the time that don't turn out fine......maybe not major complications but infections, excess bleeding, respiratory problems requiring separation from mom (thus delaying breastfeeding), more frequent trips to the ob after birth because of minor incision problems......
    yes, of course there is a risk to any surgery. but, for me having this c-section was safer than a vag birth. i didn't have great luck with the breastfeeding anyway, but that had nothing to do with the c-section. flat nips and gigantic breasts, baby with high roof of mouth. tried everything even lac consultants. stopped bf at 2 weeks of age. i also suffered with severe pp depression, incision did dehisce thanks to my doggy jumping on my lap!! but, the extra trip to the ob (initially for the dehisce) saved my life and the baby's....i was able to get help for that horrifyingly debilitating depression.


    there was even a study that came out of the dental world recently that c/s babies have greater risk of cavities because they didn't come through the vaginal canal and get colonized with "good" bacteria.
    all my siblings were born vaginally and have the worst teeth. my brother, by the time he was a teenager had 12 cavities! other brother ended up having some disorder with his teeth that weakened them and he had to get false teeth at 17. i saw a study similar to what you are referring to. it appeared in the september issue of journal of dental research. at the end of the article it states "the take-home message for mothers, li said, is this: 'if the mother has very poor oral health, she really needs to pay attention to her [baby's oral health] if she delivers c-section.'
    'don't share spoons with your baby,' hewlett tells mothers, especially those who have cavities." dr. li was the lead researcher of this case. this study was done on predominantly poor afro american women living in inner city birmingham alabama who had cavities themselves. maybe the cavities have to do with genetically weaker teeth. most likely, because these kids are growing up in poverty, they cannot afford dental care, toothpaste or toothbrushes, therefore they have more cavities.

    we have raised a generation of women who don't trust their bodies and think someone else has to start their labor (to be convenient for everyone)and get their baby out for them (even woman having vaginal births with inductions, epidurals, vacuum, forceps.....).
    i never had any doubts to my ability to birth vaginally, but with all the issues stacked against me...what was i to do?

    look at brittaney spears.......what a role model for women! one study i read said the induction of labor in a first time mom increases her chance of c/s by 40%! how many moms are told that?
    hopefully you are being facetious about britney spears being a role model!! lol!

    again, i am not saying all c/s are unnecessary or bad but i am saying that it should not be a first choice because of fear and ignorance. it should be a procedure for emergency circumstances to save mother and/or baby, like yours was. in that way, the benefits out weigh the risks.
    i agree with you totally!!!

    best wishes in your future pregnancies.
    thank you!!
    Last edit by TweetiePieRN on Sep 18, '05
  8. by   NurseNora
    Quote from Shea OB RN
    that would mean getting anesthesia to stay in house 24/7, and they're just not on board... yet.But


    I am confused, if you don't have anesthesia on all the time, what so you so in emergency situations? or for epidurals? so the patients wait?

    ~Shea

    Yes, the patient waits for anesthesia to come in from home to get an epidural. And in emergencies. That's why smaller hospitals without 24hr anesthesia will section for fetal distress much earlier. If you have anesthesia available and the ability to do a C/S quickly, you can sit on a baby that's looking not so great, but not awful. If it goes awful, you can get it out in 5 or 10 min. If you have to wait for 30min or more for OR and anesthesia to get in from home, you don't just keep watching an "ifffy" strip for very long. You do your intrauterine resuscitation and get the team in.

    This was the biggest adjustment I had to make when I moved from 30 years in large teaching hospitals with all kinds of 24hr in house staff to a small rural hospital without 24 hr in house anything.
  9. by   vampireslayer
    I tried for a VBAC twice, but ended up with c/s every time! My first was c/s due to breech. Then my 2nd was intended to be VBAC but ended up c/s because of distress (cord wrapped around his neck...after 17 hours of labor!).

    Finally, my 3rd and I knew LAST baby, I really wanted VBAC. Read up on it, had images of laboring in the bathtub at home etc. My doc insisted on inducing...yeah, I know NOW, that was a bad idea. However, at the time, a good friend of mine had gone to term, then a week or so beyond...no intention of inducing because she wanted the baby to be ready...baby ended up dying in utero...I still don't really know what happened...but I do know that genetically the baby was fine, and if it had been induced on the due date...things would have been different. So I was afraid to go beyond my due date and accepted the idea of being induced.

    Anyway, the worst happened, uterine rupture. I'm lucky, though, we both survived, although it was pretty hairy & scary at the time...my doc still says pts like me are why he has gray hair! Luckily we were in the hospital (not at home the way I'd wanted to be) and on monitors (not in a natural birthing room with no "invasive monitoring"...the way I'd wanted). So all in all, I'm happy with m c/s's! And truthfully, hearing all the stories about tearing and episiotomies, I'll take a nice controlled c/s incision any day!

    VS
  10. by   TweetiePieRN
    Quote from vampireslayer
    I tried for a VBAC twice, but ended up with c/s every time! My first was c/s due to breech. Then my 2nd was intended to be VBAC but ended up c/s because of distress (cord wrapped around his neck...after 17 hours of labor!).

    Finally, my 3rd and I knew LAST baby, I really wanted VBAC. Read up on it, had images of laboring in the bathtub at home etc. My doc insisted on inducing...yeah, I know NOW, that was a bad idea. However, at the time, a good friend of mine had gone to term, then a week or so beyond...no intention of inducing because she wanted the baby to be ready...baby ended up dying in utero...I still don't really know what happened...but I do know that genetically the baby was fine, and if it had been induced on the due date...things would have been different. So I was afraid to go beyond my due date and accepted the idea of being induced.

    Anyway, the worst happened, uterine rupture. I'm lucky, though, we both survived, although it was pretty hairy & scary at the time...my doc still says pts like me are why he has gray hair! Luckily we were in the hospital (not at home the way I'd wanted to be) and on monitors (not in a natural birthing room with no "invasive monitoring"...the way I'd wanted). So all in all, I'm happy with m c/s's! And truthfully, hearing all the stories about tearing and episiotomies, I'll take a nice controlled c/s incision any day!

    VS
    WOW! You just reaffirmed my intention on never having a VBAC. I am one of those people that if something is going to go wrong...it'll happen to me!!
  11. by   rn4babies63
    We just had a uterine abruption last week after a VBAC. Mom and baby OK. We really don't do many at our hospital.
  12. by   HomeofLove4Him
    I had a c-section with my first pregnancy (twins). I have gone on to have *two* succesful VBACs, and wouldn't have had it any other way. Of course the last one I was in a different city, different Dr, and had to fight (hard) for my VBAC (fighting against two c-section happy MD's in the practice)...but had three wonderful CNM's on my side, of course My dh and midwife delivered my last baby (baby #4). Part of why my passion lies with obstetrics, and why I'm 99.999999% sure I want to become a CNM!

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