Evaluating My Suitability for a VBAC
In November 2022, I underwent a cesarean section for the birth of my first child. My labor began with the rupture of my amniotic sac at 38 weeks, followed by an induction using Cytotec and Pitocin. The labor progressed relatively well, with manageable contractions, but my baby was in a left occiput posterior (LOP) position. After enduring about ten hours of labor, I opted for an epidural when I was already at 9 cm dilated. I was denied alternative pain relief options due to concerns about the baby’s well-being, as there were some concerning heart rate decelerations. Once the epidural was administered, I felt the urge to push, and the obstetrician arrived to inform me that I was fully dilated, ready to proceed. However, despite my efforts, the baby did not descend, prompting the decision to allow for "laboring down.” Given that it was a smaller birth center and both obstetricians were engaged in cesarean deliveries, midwives frequently came to reposition me and encourage me to labor down while waiting for an OB to assist. After approximately seven hours of intermittent pushing, the obstetrician attempted to rotate the baby and alleviate cervical swelling using forceps. Unfortunately, this did not yield the desired results. I was presented with the option of using a vacuum for assistance, but I chose to proceed with a cesarean section instead. The procedure involved a low transverse incision and resulted in some bleeding, necessitating a blood transfusion. In the postpartum period, I developed an infection—both pelvic and at the incision site—that went undiagnosed and untreated for about six months. This situation raises concerns about the quality of my healing, particularly since the incision was still slightly open and bleeding six months later. I wonder if this places me at an elevated risk for uterine rupture in future pregnancies. If this next baby is positioned correctly and I experience spontaneous labor, would I qualify as a suitable candidate for a Trial of Labor After Cesarean (TOLAC)? I have come across information indicating that a prolonged descent can often warrant an elective cesarean, but could my previous labor issues be attributed to the baby’s sunny-side-up presentation? Could malpositioning be more related to the dimensions of my pelvis or the size of the baby? My first was quite large, weighing 9 pounds and measuring 22 inches, and with my husband being 6’5”, it’s likely that this child may also be sizeable. Thank you for any advice you can provide! I find that much of the literature on VBACs seems disproportionately optimistic, often encouraging women to pursue that option regardless of their circumstances. Just as a note, I plan to deliver in a larger hospital network this time, rather than at a birth center. As a woman who aspires to have multiple children, I’m aware of the potential risks associated with successive cesarean sections over numerous pregnancies. I'm a 5'2", 120 lbs pregnant female in the USA, and I am not on any medications currently.
Answers (1)
4/1/2025, 7:01:09 AM
OpenHealth AI
You have a complex history regarding your previous cesarean section and labor challenges, and it's understandable that you're seeking clarity on your suitability for a vaginal birth after cesarean (VBAC). Let's break this down to address your concerns.
Main Points:
- Your eligibility for a VBAC (Trial of Labor After Cesarean, TOLAC) depends on multiple factors, including your healing, the specifics of your previous labor, and your baby's positioning.
- The complications you experienced may affect your risk level, but there are encouraging signs that may make you a candidate for TOLAC.
Explanation:
- VBAC Candidates: Generally, many women can safely attempt a VBAC if they have had a low-transverse incision from a previous cesarean, have no contraindications (like certain uterine surgeries), and are in good health. Your history of an infection and prolonged labor may raise some considerations, but they do not automatically disqualify you.
- Positioning and Labor: Your experience with the labor may have been influenced by the baby’s position (sunny-side-up), which can complicate vaginal delivery due to labor dynamics. Factors like your pelvic dimensions and the baby's size also play a role, and larger babies can increase the risk of labor issues; however, it’s not entirely determinative.
- Uterine Rupture Risk: Although there is a risk of uterine rupture during TOLAC, the overall risk remains low for those who have had only one previous cesarean. Your provider will assess your specific risks based on your healing and medical history.
Next Steps:
- Consult Your Healthcare Provider: Schedule a discussion with your obstetrician or a maternal-fetal medicine specialist. Present your previous delivery history in detail, discuss your healing process, and any ongoing concerns. This professional will help assess your suitability for TOLAC.
- Monitor Healing: Ensure that your incision site is well-healed and free from infection. Regular check-ups can help ascertain this before deciding on TOLAC.
- Discuss Birth Plans: If your healthcare provider determines that you are a suitable candidate for TOLAC, discuss a detailed birth plan, including the monitoring procedures in a larger hospital during labor.
- Educate Yourself: Collect evidence-based information on VBAC and TOLAC from reliable sources like the American College of Obstetricians and Gynecologists (ACOG) to prepare for discussions with your provider.
Your proactive approach to discussing these concerns is commendable, and seeking a larger hospital network for your upcoming delivery is a wise choice, given your previous challenges. Remember, the goal is to work collaboratively with your healthcare team to make an informed decision that prioritizes your and your baby's safety. Please feel free to ask if you have further questions or need more clarification!
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