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Monday, December 10, 2007

The debate settled unfavorably

On whether this delivery should be a ceasarian or normal. The repository online seems to suggest that it is possible to have a normal delivery if it is after 18 months of a previous c-section (called VBAC, Vaginal Birth After C-section), and that the risk of uterine rupture(the previous C-section scar tearing) is very small (around 8 in 1000). But, the doctor I consult is totally against VBAC, says there is a high possibility of uterine tear and she cites a case wherein she was operating on a patient and another patient with a uterine tear was waiting for an OT. None was available and an emergency c-section had to be performed in the minor OT. Cases like these, I am sure are not common, but, they do occur.
On one hand, I do believe what she says when she mentions how traumatic it is for the surgeon, an emergency operation and a risk to the mother and baby. On the other, is this worth forgoing a normal pregnancy and going in for a major operation without even giving it a trial, just because there is a .0something% risk of complications? Left to me, I would like to go the normal way, but the doc here is even refusing to consider it since my delivery is within 3 years of the previous one. What are the options left to me now? With an understanding doctor who would stand by me through the labour, closely monitoring signs of any complications, I could I believe go through a normal delivery. But I would go in for it only if I have complete belief that the doctor feels as strongly as me the need to have it all normal this time. For me, it is more of a challenge..after the severe complications of the previous delivery, it was my challenge to my self to have everything normal (though nothing is in my hands except my attitude...and my attitude was one of complete normalcy. When the last time I spent almost the entire day in bed, this time, I spent it in office, cooking, taking care of kachi and kautu and the house, when the last time I traveled just once a month for the check ups, this time I made 5 inter state trips two of which were road trips). Of course, if there is substantial risk of complications, I am not the one to shrug it aside and be stubborn about the normal delivery just to prove a point to my self, but then, if it is possible, I would have loved to have it my way.
As of now, it is kind of too late to search another Gynec, and I do not want to get into an argument with her when she might be the one ending up holding the knife over my stomach. So, the date is being fixed, and the players are getting prepared for an operation anytime after Jan 5. Hands crossed, everyone?

Edited to add: A question raised by gettingtherenow was what was the complications that brought on the first C-section. Actually, there was nothing other than that a bacterial infection caused the OS to open, after which I had an OS stitching done (this was in the 28th week). I was bedridden in the hospital for a month after which labour pains started (33rd week) and they performed the C-section cause the babies were breech. Considering all that, this time, its just a single, and so far, touch wood, I have had no problems, shouldn't it be possible to get it all normal? If so, we need to either convince the doc. or search another one. I shall keep you all informed!

11 comments:

Cee Kay said...

I understand where you are coming from. I had asked my doctor if he would be willing to let me try for a VBAC this time (June 2007) and he cited the same reason - uterine ruptures. He said that recently there has been more research and it has been found that there is a greater risk of uterine ruptures with VBACs than earlier believed. Also, while making a decision for VBAC, the doctor also takes into account the previous deliveries and if they had any complications etc. I don't know the problems you faced during your first pregnancy, but that could be one of the reasons your doctor isn't allowing VBAC. Anyway, don't feel bad about the C-section. It doesn't matter how you get there. What's important is that you do (get there).

Kara said...

I just want to say, it is never too late to look for another doctor or midwife, though it may be hard, just explain your situation and usually someone will help you. I have had a vbac, the risk of rupture is so small that even my dr said not to worry about it, she was so supportive of vbac. It is ultimately your decision about what is right for you, and if you do go for another c/s I hope it all goes well. :)

Krishnapriya said...

Hi gettingtherenow,
I actually did not have any complications other than that it was a twin pregnancy. No BP, Sugar etc. it was more of an infection plus the combined weight of the babies that brought on the C-sec. So, as you mentioned, this doctor too says that there is more chance of a rupture, but does not seem to be giving me good enough reasons why VBAC is impossible. You agree?

Hi Kara,
Your comment is very encouraging. What was the time gap between your deliveries? The doc here is refusing me for the only reason that mine is under 3 years.

AA_Mom said...

Hi Krishnapriya,
Although I do not have an answer for you. I thought I should congratulate you for keeping a positive and cheery attitude through the pregnancy, I believe it really helps.

I am sure you will get over this little hurdle too :)

heather@it'stwinsanity said...

I just wanted to say that the generally accepted interval is 18 months between deliveries for a successful VBAC. That means you would have 9 months between pregnancies, not 18 months between pregnancies as some providers seem to think. There are women who have shoter intervals and still have successful VBACs of course. If you want to see the studies, just let me know.

I had a VBAC last year (with twins) and my c-section baby was 13 months old when I got pregnant so there was about 22 months between deliveries.

mnamma said...

Hi KP,
Finding another doctor after almost 33 weeks of preganancy would be really difficult. If you dcotor isn't keen on going for VBAC then he/she must have a pretty good reason for that. Try reasoning with her/him more. My best wishes for a smooth delivery either way.

Timepass said...

Best wishes for a safe Delivery.

Kara said...

My boys were born 20 months apart. I've heard that most agree that 18 months apart is good, some say 24 months, I've never heard 3 years is best. Have you checked out www.ican-online.org to see if you can find information on a support group and vbac supportive doctors near you?

Anonymous said...

hats off for even contemplating VBAC when most women would just go right into C-sec. I hear this often everywhere, the doctors seem to be more hesitant even though (based on prev delivery) the risk of rupture is low and patient has high confidence level. maybe the doctor does not want to be held liable? I don't like doing anything because it causes 'trauma for the surgeon' - but faced with little other choice at this point (obviously you cant change docs with 40 days to go) and the comfort of having a scheduled delivery, c-sec does seem like a better choice. do what you think is best, and you're 100% right - if a doc is not fully supportive, it is not easy to have a natural labor. as gtn said, it doesnt matter how you get ther, just as long as you and the kid get there safely.

Krishnapriya said...

aa_mom, thanks a lot. I really hope everything's fine too.
Heather...you are amazing. My husband and I got a real booster knowing that you had a twin vbac..thanks for taking the trouble to help!
mnamma, timepass, thank you. As the term approaches, I seem to loose the calmness and confidence I had. Your comments are really helping to bring it back!
kara..you are very right. Even we haven't read about 3 years being the ideal time, though the doc was saying it. But again, arguing with her seems to be a risky process, so I am planning to use all the diplomacy I have!!
k's mom..you've got the point. its more of the doctor trauma that she wants to avoid, but as you mentioned, there is a certain comfortness in having everything planned to the last stage!

Hari said...

Ok.. Btw.. I just found out today morning.. That they'll let you have only 2 C-secs in life.. Apparently something about how it can't be cut more than 4 times and they leave the other 2 times for emergency purposes.. And after twice, it's either risky or takes too long to have a VBAC.. Check up on this..