I've received several requests for information and resources about VBAC, VBAMC, twins, Bandl's Ring, and shoulder dystocia. I can't personally respond to all of these requests but I didn't want to just let them go unanswered. So I'm asking for your help! Several of the questions are fairly brief and it's hard to answer them without more specifics and background information. Nevertheless, let's see what we can do when we all put our heads together.
Request #1:
I have a friend that I'm trying to help. She is due in December with her third child. She's had 2 prior c-sections and is coming to find out that she does not want a third. I have some questions about what resources I should help her with and what she should look for in hospital policy.
Request #2:
My best friend is having twins. She is currently 33 1/2 wks. Both babies are breech. Dr's of course want to section her bc of it. She is wanting true info on the safety of section versus breech birth. (I don't think there are any good studies on CS vs vaginal birth for breech twins. I mean, the Hannah Term Breech Trial was the biggest of its kind and that was only applicable for term, singleton breech babies.)
Request #3:
I have been curious about VBAMC for obvious reasons...Also, Rixa. Do you know where I might find info about Bandl's Ring? (if she is who I think she is, she's had 2 c-sections, and during the last one they discovered a Bandl's ring)
Request #4:
I have a question for you regarding shoulder dystocia. I have had 2 natural births, and both of them my daughters shoulders got stuck, it seemed they never rotated properly. The second time it happened I was in a hands and knees position though slightly upright leaning into an inclined bed. I was wondering if you could give me any information as to the best way to deal with this if it happens again (I'm pregnant with my 4th baby and a little worried about it happening again). Could it be that I am pushing to urgently and not giving the baby enough time to rotate before the shoulders pass? Thank you so much for your time!
Request #5:
I am interested in what the recent research shows about Pitocin administration and risk of uterine rupture in patients attempting a VBAC. For some reason, I thought that Pitocin was contraindicated for VBAC moms, but my OB tells me that she is comfortable administering Pitocin to augment (but not induce) labor. I'm not sure how I feel about this. I've done some of my own research, but find mostly mixed reviews. So, I thought I'd ask you since you are very familiar and up to date with obstetric research.
In case you were wondering about my background, I am expecting my 2nd child, in about 3 weeks. And I'm preparing and hoping for a VBAC. I had a c-section with my first for "failure to progress". It's a long story, so I'll try be concise: my water broke spontaneously 8 days before my due date; I waited for 12 hours for labor to start and had no contractions; was started on Pitocin-- labored on Pitocin for 12 hours and dilated to 1/2 centimeter; turned down the offer to do a c-section (since it had been 24 hours and they worry about infection risk), but I wanted to give labor a real chance; had Cervidil placed on my cervix and waited for 12 more hours-- no contractions; after 12 hours of Cervidil, I was dilated to 2.5 centimeters and "soft"; labored on Pitocin for 12 more hours and got to 5 centimeters when I stopped dilating. I never got an epidural and was up and moving during all the laboring; and by the time I got to that point, I was exhausted and it had been over 48 hours since my water broke, so I opted for a c-section. It was a tremendous disappointment and I felt like I never really got to do what I was preparing for. I still have no idea why my water broke, why my body didn't labor on its own, or why it didn't respond favorably to Pitocin. But, my doctor is very supportive of a VBAC. And I feel very lucky to be delivering at a hospital that does support VBACs.
Anyway, I guess the reason why I'm so worried about Pitocin is because I can't help but wonder what I'll do this time around if that situation happens again-- it's the only frame of reference that I have, you know? I've heard other doctors and other CNMs say that Pitocin can help VBAC moms, but I'm not necessarily interested in an opinion, I'd like to know what the research says. I am still just hoping and praying that I will go into labor on my own and that my water won't break until I'm far along, but I want to be prepared in case labor does slow down and/or stall. In fact, I just checked out some books on Acupressure because I've been told that it can help during labor. Do you have any other suggestions, I'd like to have more cards to play than just the Pitocin card.
I spoke with this last woman on the phone and gave several things to look into if this same situation arises, including nipple stimulation/breast pump, waiting a bit longer for labor to start on its own, asking her doctor about the possibility of low-dose pitocin, etc. We also talked about things that are theorized to make the amniotic sac stronger or prevent PROM. I wasn't able to find my files on UR rates and Pitocin administration during a VBAC, although I know that information is out there.
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