A few questions

[Shari]

After reading a few birth stories here and quite a few articles on VBAC, I already have questions. I know its normal for me to go over my son's birth and question why didn't we do this or that. I just want to be fully informed and prepared this time!

With my son I had 2 due dates...the first one was by my LMP and the second was by ultrasound. They were 6 days different and my doctor went with the ultrasound date. Meaning, when my son was born he was 16 days late according to the u/s. According to my LMP he was only 10 days late! I'm fully expecting that I'll be overdue again w/ this one but here's my question. I waited it out for induction as long as I could, and in the end gave in. If I had used the LMP date, my mind keeps wondering if things would have been different. If I'm in the same situation again, is there anything wrong with waiting a little longer??? i.e. 12-14 days late by LMP? ~ I've also read that your ancestry/decent has alot to do with gestation, I'm German/Scottish/English decent...if I remember from one of the articles I've read European women average 42 weeks. My mom also went 2 1/2 weeks late with all 3 of her children.

Second question: How much of an effect does pitocin have in causing fetal distress? What about position?? I feel as tho my doctor pushed me into decisions at the time and I wasn't as informed as I should have been. The only reason I had a c-section was fetal distress during contraction. The cord was NOT around his neck and there seemed to be no explanation of why. BUT they never tried changing my position (I had a walking epidural at the time and was mobile) they never decreased the pitocin rate...there were so many things they didn't do that I wonder... My doctor pushed me into the decision of C-section and I never had time to consider what could be done.

Third question: is a vbac possible with an induction? I know its not recommended but knowing my history of being late...what are my options at that point?

I know I have TONS of time for answers to these questions but I can't stop them from coming ;) I want to learn as much as I can from my own experience and how I'd do things differently as well as from other experiences.

TIA!

Shari

[miche]

VBAC is definitely possible with an induction! I had a gentle induction with low dose prostin gel and had no problems. Induction does increase your risks of uterine rupture and other complications. Pitocin or any form of induction can increase the chance of fetal distress because the contractions are often stronger than what would occur naturally. Also even without the cord around the neck the cord could be compressed during a contraction, especially with previous rupture of membranes.

As far as due dates and ultrasounds go, early ultrasounds are much more accurate than later ones. But even early ultrasounds can be off by 5 days or so. My first son's due date was determined by LMP, but I know his conception date and it was a little later than the LMP due date. He was induced 2 days before my due date (doctor scared me into it) and was 10lbs, but he was also covered in vernix and had a poor sucking reflex which are both indicators that he wasn't cooked long enough. My second child would have been almost 4 weeks late by LMP. I ovulated extremely late that month! We based my due date on an early HCG level that said I was 12-14 days pregnant, an ultrasound at 7 weeks which agreed exactly with the HCG level estimate (HCG levels are extremely poor due date markers, but early on they can give a bit of a clue), and my 20 week ultrasound agreed to the exact same day as the 7 week one so we felt confident with the due date. He was born 10 days "late" and was definitely a post-due date baby. He had no vernix, had a lot of meconium and was otherwise definitely a late and a very healthy baby (all of 8lb 6.5oz - so much for second babies always being larger!) I believe that I'm just meant to go past my due date.

With my third pregnancy I was prepared to fudge my LMP a little bit to buy myself some time in the end. I believe that the risk of another unnecessary c-section is greater than the risk of fudging a date a little bit. Of course if things seemed amiss I would agree to BPP's at the end, but I don't want to be induced or sliced open again simply because I'm a little later!

[hedra]

It is indeed normal to go over everything (even with a vaginal birth that went mostly well) and wish you'd known more. Even the second time around, having learned everything that could have helped with the first one, you may still wish you'd known something else. Sigh.

From what I recall, the average for northern european women is 41 weeks 1 day. With a two week spread on either side, as usual.

You can refuse to be induced, you know. I refused to be induced before my 14-day-post-due date, and I suspect that you could refuse to be induced until the later due date. What my care providers and I agreed on was that since my 14-days-post-due date was a weekend, and I refused to be induced early, they'd do a biophysical profile on Friday, then if things were fine I'd do another one each day on the weekend, and if things were still fine, they'd induce on Monday - 16 days post due. If at any point the bpp was not good, or was definitely deteriorating, then they'd induce then, even on the weekend. I went into labor on Thursday, so that was bypassed, but he still wasn't born until Sunday (15 days post due). He was definitely overcooked, though - almost no vernix, and his footprints had fully developed (look at the soles of their feet to tell the real due date - they start crinkling at the toes end. If they are crinkled just to the arch (fully on the pads of the ball of the feet), they are right around their due date. The further down the foot toward the heel the crinkling goes, the more post-due they are.). Oh, and his skin dried up, went all shiny, and peeled off like a sunburn. Poor boo.

I agree about ultrasound dating - it can be really off, expecially the longer you go into the preg. Size can be really off, too (They estimated Bren at 10 lbs 10 oz on his due date, and he was born that day - 9 lbs 6 oz...)

Can you get your records? Heart decelerations DURING contractions are normal. It is when the decel stays after a contraction that they should worry. That is, there's a lag in the heart-rate coming back up when the contraction does. The only time they worry when a decel happens during a contraction is if it goes WAY down, or if it starts decelerating in random intensities (sometimes severe, other times not). Gabe's did that, but massaging my legs brought it back up and stabilized it - my circulation was not doing well after the epidural had been in for a while, and needed help. Some leg massage (even though I couldn't feel it) did the trick. But even with the decels, they weren't jumping to c-section (midwifery care). Not even when he had one decel so steep the readout went to zero - they just massaged his head (through the cervix) and he bounced right back. Then he stayed stable again after that. They did talk about c-section risk, but did loads of other things first. Hopefully your next experience will have staff more willing to try other options?

And yes, pit can increase the decelerations during contractions, because it can make the contractions harder and longer than normal, which stops bloodflow to the placenta, which means baby is getting less oxygen, so the heart slows down to match. Position can also affect that - if it didn't they wouldn't be so quick to roll women over on their left sides when the baby's heart rate plummets - lying on your back puts pressure on the anterior vena cava (blood vessel), which supplies the uterus. Same reason you aren't supposed to sleep on your back during late pregnancy - if you already have one thing slowing oxygen to baby, positional pressure on that blood vessel is not going to help.

My best friend was induced with a VBAC. Her first labor was 57 hours, followed by her developing strep throat (from the stress) and it turned out that he was a forehead presentation and was so stuck that his skull plates overlapped and he had a huge ridge on the top of his head (plus two major black eyes). The OB hadn't even palpated to check presentation. And it was a nurse who finally discovered that the reason it was taking so long was that her contractions were misfiring and working 'backwards' - the sequence of the conractions was wrong (around first, then down, instead of down then around, I think). UGH. So she got a midwife, and did a hospital-with-midwife VBAC. 41 hours, 4 hours of pushing. Or was that 5? Something huge - her daughter kept slipping back through the cervix (very unusual, but her uterus is malformed so labor is very inefficient for her, though theseond labor the contractions at least fired in the right order). Anyway, she was induced, post due, with the gel I think, plus low pit because her uterus doesn't work real well on its own. No meds, either.

And just because your first was overdue and your mothers were overdue, does not mean all yours will be overdue. My half-sister's pattern doesn't match her mother at all. My pattern matches my paternal grandmothers more than my mom's (one two weeks late, one on the due date exactly, both big but born fairly easily).

HTH!

[hedra]

BTW, do you have "The Birth Partner"? There are a lot of tips in there on how to affect things like heart decels with position changes, and why you might want to get out of the birth tub at some point, etc. Good info. :)

[born2birth]

#1 - could you fudge your LMP date? We did that, not for our midwife, but for our family so they wouldn't start bothering me about being late.

#2 - Pitocin causes some horrendous contractions that sure can have a negative effect on a fetus. But the epidural might have been the actual culprit. Hard to say...

#3 - Well, it isn't recommended, but I was induced for my second VBAC and it went well. It was my choice though, not a doctor's.

You are smart to discuss this stuff with your doc NOW and if you have to, find someone else who won't be so worried about you going over.

[Shari]

Wow incredible info!! THANKS so much!! To answer some of the "questions"

1. I had my first U/S at 15 weeks (severe gastritis ruling out gallbladder). Then another at 18 weeks (routine) both U/S put me 6 days ahead so doc (although I wasn't sure if I was happy with that but that's another story) changed my due date because both showed the 6 day difference. I had another U/S at 28 weeks (gastritus again, turned out to be foot lodged just at pyloric sphincter ~ out tube of stomach) and another at 37 weeks (to make sure the movement I'd felt that week actually WAS baby flipping out of breech position (and it was!). All u/s showed me 6-7 days ahead according to growth development etc. When Gregory was born, I didn't see him for about 10 mins (they had him all wiped down when I did) and DH thinks that he saw blood not vernix. He did have a problem nursing ~ not a poor suck reflex but poor sucking co-ordination? IOW not a productive suck w/ nursing but could latch to my finger like mad...they called him a lazy nurser or a poor co-ordinated nurser. He did not have typical dry/flaky/peeling skin.

2. I had NO drugs meds or anything until 27 hours of labor when I lost control because contrax were SO intense that I could not breathe...they were 1 min long and 1 min 15 secs apart...so I had a 15 sec pause. I remember the nurse saying to my DH that my contractions were as intense as most women have during transition phase. If I'd been a little more alert I would have asked for the pitocin to be turned down. After I got my epi I went dozy (hadn't slept in 36 hours) and fell asleep on my back (NOT GOOD I KNOW). I woke up after about 30 mins and my water was leaking..doc broke it the rest of the way and then the decels started. SO I feel I could have done SOMETHING to help...since I was 1. on my back, 2 on a high dose of pitocin, and 3 just woke up w/ epidural and circulation probably wasn't good.

Thanks again for the amazing info!! I am going a different route this time (hospital birth w/ Midwife) so hopefully things go better ;)

Shari

[metta4]

i am finding the resonses to your posting very helpful..hope you don't mind.

we are going to ttc in the early spring and i recently talked to my midwife about a vbac as ds was an unplanned csection after 4 hrs of pushing and no meds!

anyhow, what they told me was that they could not (or maybe i'tsmore like would not)induce me but the could augment labor. for instance if i was not dialted at all at 42 weeks they would csection. if i was dialated they could probably augment the labor process (ie: strip membranes, etc). she said they can't (again..or maybe is more like won't) use cervical gel due to increase potential for rupture. she also said they would want to monitor continuously more or less but thats not a big issue b/c they have a mobile use (telemetry unit) that is noninvasive.


i hope all goes well for you.

i had a doula when my ds was born and plan to hire her again with the next child. if you haven't considered one i would definetely recommend one.