VBACs, TOLACs, & ERCs

VBAC: Vaginal Birth After Cesarean
TOLAC: Trial Of Labor After Cesarean
ERC: Elective Repeat Cesarean

My next birth is something that I have thought about every day since Quinn was born. When I went in for my six week check up, the doctor who performed my c-section said I had a small pelvis and guessed that if I were to attempt a VBAC, I would have a 13% chance of succeeding. Those aren't good odds. At the time, Kelly and I just accepted it and decided that I would just deliver the rest of our children via cesarean. I never thought that I wouldn't be able to deliver babies normally, but at least I could have babies, right? I'm still one of the lucky ones. I kind of went back and forth, maybe I would attempt it, maybe I wouldn't. I think that at that time, the only reason I was considering attempting another normal birth was based on how much I hated recovering from a c-section. It seriously sucks.  The first few days of Quinn's life, I couldn't get up when she cried without someone helping me. I'm her mom, I'm supposed to be able to get to her when she needs me.

Well, Quinn got older and we had always said that once she was a year old, we were going to start trying for baby #2. She turned six months old, and I realized that I was getting so close to her turning a year old and I was starting to freak out. I was going to have to get pregnant again so soon! I finally confessed my fears to Kelly and he was like "Uhhh.. we don't have to have another baby until you want to." So then I felt relieved and kind of dumb, haha. Nobody is making me have more children right this minute. I also realized that I needed to find out as much as I could about all of these birthing options.

I had to have a wellness check up or whatever those appointments are called where they do a pelvic exam every year. I questioned the doctor at the time on his opinions about VBACs. He told me he generally didn't have a problem with them, but then when I told him that I was told that I have a small pelvis, he made it sound like I wouldn't be a good candidate. He said good candidates are usually those who had to have a c-section because of a breech baby, or a cord prolapse. After that appointment I decided I needed to find out all that I could about my chances of birthing normally.

Why is the VBAC rate so low? It's only around 8% of women who have had prior c-sections that choose to do VBACs. ERCs are basically considered benign by the general public and some doctors and they really aren't. I'll get into that later. The American Congress of Obstetricians and Gynecologists (ACOG) says: "Attempting a VBAC is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans." If it's safe, why is nobody doing it? There are some guidelines in place from ACOG that say that facilities had to be completely prepared in case of an obstetrical emergency. Not all hospitals have an anesthesiologist on the floor 24/7, so they don't allow VBACs. I'm not sure whether the interpretation of the hospitals just varies on this one.

60-80% of women who attempt to VBAC will be successful. I don't think that this means the other 20-40% of failed attempts die or lose their baby, because uterine ruptures occur .5-1% of the time. I'm guessing this means that their labor stalls or something happens where the doctors decide that it's no longer save to continue laboring, and they perform a c-section. TOLACs have a maternal mortality rate of 3.8/100,000 births.

First of all, the biggest risk people talk about with TOLACs is uterine rupture. You could have a uterine rupture, and your baby will suffer severe brain damage or die. How is uterine rupture detected? Signs include: fetal bradycardia, increased contractions, new onset of uterine pain. The most common sign is the fetal heart rate abnormality. Once the uterine rupture occurs, I found two different statistics on this, you either have 16-17 minutes or 10-37 minutes to get that baby out before it gets serious brain damage or dies. I'm guessing that they don't take the time to give moms a spinal before that emergency c-section. Knowing how bad the incision hurts the day after getting it, I can't imagine getting one without being numbed. My friend had to have one and she said they strapped her to the table. Awful. I found these statistics from the 2010 NIH VBAC Conference: of women who have uterine ruptures, 6.2% (1 in 16) result in infant deaths. Mothers who deliver at term, 2.8% (1 in 36) result in infant deaths. So I'm not sure what the difference is, maybe in the first statistic, mothers were induced? In the second one, the moms were maybe allowed to go into labor on their own? I don't know.

Like I said earlier, ERCs are generally considered to be harmless by most people. They aren't. ERCs have a maternal mortality rate of 13.4/100,000. There are quite a few risks involved, but perhaps the biggest one is the risk of placenta accreta. I had never heard of this until a few months ago. This condition occurs when the placenta attaches to the uterus right where the scar tissue is. The placenta can't get proper oxygen from the scar tissue, so it burrows deeper into the uterine wall until it finds oxygen. In some cases, if even goes through the uterine wall. Once baby is born, the placenta fails to detach properly, part or all of it remains attached after delivery and severe hemmorhaging occurs. 90% of patients with this condition require blood transfusion. 40% require more than 10 units of packed red blood cells. This condition is generally detected during pregnancy. This condition has a 7% maternal mortality rate or 1 in 533, (I found two statistics for this one too). It has a 71% hysterectomy rate. I was surprised when I read the hysterectomy statistic though because from what I read on ACOG's website, almost every time they have to do a cesarean hysterectomy in order to save the mom's life. In some cases, if the mother wants more children they may attempt to remove the placenta surgically, but that comes with a lot more risks. ACOG says that the occurrence of placenta accreta has been rising with the higher c-section rate. Of 39,244 women who had c-sections, 186 of them had cesarean hysterectomies. I found two statistics for the chances of this occurring: after 2 ERCs it's either .57% or 5.77% I found those on two different websites so I'm not sure. The first one definitely sounds better though. This risk goes up with each ERC, so family size is definitely something to take into consideration.

Why don't doctors talk about this? All they ever tell you is that you shouldn't VBAC, because your uterus could rupture. I think that doctors like to be in control. If they can go in, get that baby out and sew you back up nice and tight, then they have done their job. Healthy mom, healthy baby for the time being. If they have to sit back and let your body do it's thing, it's hard for them to know exactly what's going on.

A successful VBAC has fewer complications than an ERC, but a failed TOLAC that ends in an emergency c-section has more complications than an ERC.

Fun stuff.

They told me I have a small pelvis. Quinn's head was stuck in me and the doctor had a hard time getting her out. So what is the deal with cephalopelvic disproportion? Basically that means that the baby's head is too big for the mom's pelvis. At first I had a hard time finding out much about this subject. What I did find is that this is actually pretty rare in the US these days. It usually happens because of malnutrition in the mothers that leads to bone structure abnormalities. The only thing I could find that made sense to me, is that the baby being positioned incorrectly can lead to the pelvis failing to make room for baby's head to pass through. During labor, the body releases hormones to relax the ligaments of the pelvis allowing it to expand. There is no way to know whether my pelvis would have expanded more if I had been allowed to go into labor on my own. But I do know that Quinn was posterior, or sunny side up. I definitely think it is possible that this is why my pelvis didn't spread far enough. She was correctly positioned before my labor started, but at some point she got stuck the wrong way.

ACOG says: "The chance of having a cesarean delivery is greatly increased for first-time mothers who have labor induction, especially if the cervix is not ready for labor." Well, my cervix certainly was not ready for labor. I was at a 0 and very hard. I had high blood pressure at the end of my pregnancy, and after refusing to take the prescribed beta-blockers, they wanted to induce me. I understand why they wanted to, I had really bad anxiety with each doctor visit during the last weeks of my pregnancy. I had never had a baby before, so I was kind of freaking out! Plus, since my blood pressure was rising, I felt like I had to stay calm or else I would get a bad reading!! So of course I couldn't stay calm. They got two really high readings on two different days, so they worried and induced me. They said I might have a seizure. A few hours after I had settled into my hospital room, my blood pressure went back down to a safer range. I really believe there was no medical need for me to be induced. Baby was fine, I was fine. So right now, my I strongly feel that I have a good chance of being able to birth babies normally. I think that I will probably have high blood pressure again towards the end of my next pregnancy (my mom always had this happen, and she delivered four healthy babies normally), and I will have to just either learn to calm down or put my foot down and tell my doctor that I don't need medication for it, and I don't need to be induced. I think that when my body starts to go into labor, we will check and see that the baby is positioned properly, and if he/she is, then we will go ahead and let me labor. I plan on hiring a doula for my next birth, statistically, births that are coached by a doula are much shorter. I would definitely need time to be on my side.

Something else that bothers me, a lot of doctors tend to scoff at things that midwives do. There are seriously so many things that can be done when a baby is turned the wrong way. Why don't doctors do that?! They want you to be lying on the bed when you push your baby out, because it's easier for them to catch the baby. Squatting can increase pelvis size by up to 30%. That's significant. Somewhere along the way, a lot of invaluable birthing knowledge has been forgotten, and now some women are paying for it with their lives. The US is now ranked 50th in the world for their maternal mortality rate. For every 100,000 births, 21 women die here in the US. We should be better than that.

I know that interventions save moms and babies. I am very thankful for modern medicine. I also know that interventions occur unnecessarily all too often, causing problems that could have been avoided.

I know that I am one of the lucky ones. My baby is here, I get to hold and nurse her. I thank God every day for that blessing.

Most of the information for this post comes from ACOG's website. I initially began researching on www.vbacfacts.com and then I checked ACOG to back up most of the stats I found.

Pants

It's been 7 months since I had my baby. That's a long time. Especially when I consider the fact that those jeans that I got into three months post partum are still the only pair of pre-pregnancy jeans that I can get on. I never wash them. Unless I spill something on them. They shrink when I wash them and then I have to stretch them out again until they are finally comfortable. This isn't as gross as it sounds because I only wear them when I leave the house which is usually only for 1-2 hours at a time, to grocery shop or for the occasional outing. As soon as I get back home, it's back into my yoga pants. 

These jeans don't even fit that well, which is probably obvious considering I try not to wash them, if I sit down I better be wearing a long shirt or else my post baby butt will be coming out the top. A few months ago, I was really excited that it wouldn't be too long before more jeans and my old pencil skirts fit again. I have 3 or 4 skirts that still don't fit so I usually wear stretchy clothes to church. That was a few months ago and my pants still don't fit. So now I'm thinking, should I just go buy new pants? If it's going to take this long, every time I have a baby, to get into my old jeans then I should probably just get some bigger pants, and skirts, right? Especially when I look at those jeans that fit and notice that they are wearing really thin in some places and are about to rip.

 Ugh. I mean, what are people even wearing these days? Last year, I was in college and I felt like I knew what was going on in the world. Now, my days consist of outings to the gym, walmart, winco, and Costco. One of my fears is that I'll be like one of those people who never moves on from the styles they wore in high school and college. I'm 23 but I feel so old. Right now, my wardrobe consists of v-necks from target and those one pair of jeans. Is that embarrassing? When I get dressed to leave the house I catch myself thinking things like, maybe I can find a shirt that I could just wear a sports bra with... Or, if I find a long t-shirt then I can wear leggings as pants. And then I realize that no, you need to wear a real bra with a real shirt and real pants. Have I let myself go?!  I still wear make up when I leave my house, so that's a good sign. There are days when I leave with my hair wet though, which I never used to do.

Anyways, I've gotten down to about 8-10 pounds above my pre-pregnancy weight. It doesn't seem like that much weight but it does at the same time. I'm sure that by the time I get it off it'll be time for my next baby though. So I really should just buy some bigger jeans. 

Also, I know I wrote about some trivial things like clothes and make up in this post and they really aren't that important in the grand scheme of things. I still want to look nice though. 

7 Months

My baby is 7 months old!! Can she please just stay this way forever? I feel like I wanna have 20 babies so that I always have a sweet baby. Most likely that won't happen, but she just makes me so happy! I don't want her to grow up! I had to buy her some clothes the other day, which I always love doing, but I was buying her some 12 month sized jammies because she doesn't have any, and I almost started crying in the store when I held up those huge pajamas! I don't want her to get that big! She's still wearing 9 month size but I know it won't be long before she fits into those. 

Anyways, she has become much more vocal in the last week or two, she chats all the time! I love it. In the morning, I lay her down on the changing table and sometimes she just looks right at me and jibber jabbers and it is the sweetest thing. I think she is telling me about her dreams. She also likes to make high pitched squeaky noises. And she has learned to make popping sounds with her lips, so she does that all the time too. She laughs more than she uses to. I took her to the park the other day and I have a video of her giggling while I pushed her in the swing. I wish the blogger ap would let me add video. 

Here she is playing with her friend, Lily! They are only a week apart I think. They took turns stealing toys out of each other's hands. They are too young to he mad about it and I love that. It is the most wonderful thing to watch my baby take in and try to make sense of the world around her. 

In my last post, I mentioned that Quinn is sneaky and likes to practice new tricks while she alone in her crib. Sure enough, the first few times I caught her pushing up onto her knees she was in her crib! She did it for about a week in her crib before I snapped this picture of her doing it in the living room this morning. 

I think she knows it's faster and easier to just yell for me so I'll help her, maybe that's why she only did it while she was alone. 

There she is at church a few weeks ago. Man, church is difficult with this baby. She refuses to nap while we are there and she usually wakes up around 7:00 and church starts at 9:00, right when she needs a nap. I see other moms holding their sleeping babies and I just think how nice that would be. She never just sits to be held. Another reason I am thankful I am able to breastfeed her because that's one of the only times she will relax in my arms. She will get sleepy while I'm holding her afterwards but she doesn't usually like to fall asleep with me, she would rather be in her crib. Which is good, I am glad she likes her crib. 

I like this picture because I feel like she kind of looks like me in it. She loves to play with her bath toys! She hates when I lay her down to wash her hair, she just tries to sit up. I finally got a bath mat in there just today because last night I had a little heart attack after she slipped sideways while I wasn't looking! She choked on some water and I freaked out because I read about secondary drowning this summer and I was scared that she was gonna die in her sleep. I called Kelly and he told me she would be fine. Then I called my mom and she said the same thing. So I relaxed and she is still alive today, so that's good. I still have to watch her like a hawk though, she almost fell a bunch of times tonight in her bath because she was trying to get things out of her reach. Like the wall of the bathtub, which she was trying to bite. I think her fourth tooth is about to come in, because she is biting everything again. 

Here she is laying down watching the baby channel on tv. She likes to keep one or both feet in the air while laying down. This picture shows how out of proportion babies are, her feet are so tiny and her head is so big! I love it. And I love baby skinny jeans.

Something sweet that she does it she will touch my face so that I look at her. She does this every time I pick her up from the kids klub at the gym, and it is so sweet. I am glad that she misses me :) 

She loves to be out and about. She gets bored at home. I take her for walks in the evening before dinner time and she refuses to sit back in her stroller. She just holds on to the tray and leans forward and looks all around. She doesn't want to miss anything! I love my curious baby girl, she brings me so much joy! I am so thankful for a happy, healthy baby!