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revisiting the c-section question
I chatted with a friend on Sunday and it's brought a lot of worries back
to the surface. I think she feels a that I'm a bit too relaxed about just seeing how things go and really fears that I may injure myself during birth. I've basically been working on the principle that I'll get warning and can take appropriate action, but I realise this may be partially flawed. After my first birth, my pelvis and hips were very unstable for a few days, which nearly resulted in some interesting falls and whilst I was in hospital I was basically confined to bed as I couldn't safely get anyway. This will be a third birth, not a first birth, my ligaments and muscles will be in a different state to how they were then. Also that birth was not of a physically normal baby, IUGR meant his fontanelles were significantly enlarged, which probably meant an awful lot more head molding than average occurred. All of which means I'm back in the groove of worrying that perhaps 3rd baby, plus the injuries of 2nd time around, plus a normal baby (hopefully), could turn out to be too much, even if I am feeling tip top in the run up to the birth! But unfortunately it seems like that is an unanswerable question and I've really no idea how to approach resolving that. Cheers Anne |
#2
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revisiting the c-section question
Anne Rogers wrote:
I chatted with a friend on Sunday and it's brought a lot of worries back to the surface. I think she feels a that I'm a bit too relaxed about just seeing how things go and really fears that I may injure myself during birth. I've basically been working on the principle that I'll get warning and can take appropriate action, but I realise this may be partially flawed. After my first birth, my pelvis and hips were very unstable for a few days, which nearly resulted in some interesting falls and whilst I was in hospital I was basically confined to bed as I couldn't safely get anyway. This will be a third birth, not a first birth, my ligaments and muscles will be in a different state to how they were then. Also that birth was not of a physically normal baby, IUGR meant his fontanelles were significantly enlarged, which probably meant an awful lot more head molding than average occurred. All of which means I'm back in the groove of worrying that perhaps 3rd baby, plus the injuries of 2nd time around, plus a normal baby (hopefully), could turn out to be too much, even if I am feeling tip top in the run up to the birth! But unfortunately it seems like that is an unanswerable question and I've really no idea how to approach resolving that. Well, you've got a few different choices available: 1) Prioritize a non-emergent c-section (in other words, ideally decide before labor if you'll need a c-section). If this is your priority, then you have the least chance of a homebirth or a vaginal birth. On the other hand, you maximize the chance that if you do have a c-section, you'll be able to plan it how you want it, and planned c-sections are slightly less risky than unplanned c-sections. 2) Prioritize a vaginal birth (and/or homebirth). In this case, you go ahead with the homebirth until and unless something materializes to suggest that it's not the best option. This maximizes your chance of a vaginal birth or homebirth, but also maximizes the chance that a c-section, if needed, will be an emergent c-section. It also leaves you wondering and worrying about how things might go. 3) Try to balance the two. This might mean something like attempting a vaginal birth, but with a very well planned out c-section option. It might mean giving up the homebirth, which might result in lowering the chances of a successful vaginal birth or increasing the chances of a vaginal birth with injuries, depending on the care providers and their skill with potentially tricky vaginal births. On the other hand, your backup plan is somewhat more robust. Do you have a good idea what the worst case scenario is with a vaginal birth? Is it likely that trouble will announce itself in advance (i.e., if you are about to do damage, will you know in time to switch to plan B, or do you only know after the damage has been done)? If you can't know with relative certainty that damage is about to happen, can you know that if all indicators stay within certain limits that damage is *unlikely*? What are the relevant indicators? I think what you need to think through with your care providers is what the indicators and thresholds might be, and what their predictive power is. Personally, I would never go lightly into a c-section. I think the downsides are more numerous than many will admit. I have a friend right now whose grandson is going through some medical difficulties that may have long term consequences that I highly suspect to have been related to birth injuries due to a possibly unnecessary c-section, though no one comes close to admitting that. (Of course, I don't know for sure, but I do believe I smell a fish....) So, my natural inclination is to work hard to give a chance at a low intervention vaginal birth. That said, there are definitely times when the planned c-section is, on balance, the lower risk choice. I think the key discriminating factors a 1) Worst case scenarios (on either side) 2) Quality of information available on which to make decisions 3) Availability of information on which to make decisions (before labor, during labor) You'll never have all the information you'd like, and the information you have will never be as accurate or predictive as you'd like, but you take what you can get, evaluate it as critically as you can, and then go with your informed gut instinct. Best wishes, Ericka |
#3
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revisiting the c-section question
Do you have a good idea what the worst case scenario is with a vaginal birth? Is it likely that trouble will announce itself in advance (i.e., if you are about to do damage, will you know in time to switch to plan B, or do you only know after the damage has been done)? If you can't know with relative certainty that damage is about to happen, can you know that if all indicators stay within certain limits that damage is *unlikely*? What are the relevant indicators? I think this is where the problem lies, worse case scenario would be something along the lines of needing pelvic stabilisation surgically, which because of lowish success rates, noone does for at least 2 years after the birth, the thought of the pain is worse than the thought of the disability this brings. I suppose I could injure the other hip, it appears I have the same bone abnormality that side and obviously still have the same connective tissue issues. So the worst is pretty bad - but not life threatening, only quality of life threatening. I very much doubt that the worst could happen with no warning, but somewhere well onto the scale potentially could and we really have no idea what are the chances of significant pelvic damage, simply by a normal birth and nor does it appear that anyone else does either! 1% risk and I'd go for a normal birth, 50% risk and I'd be planning a section. I suspect the risk is down at the low end, but 10% would probably still be enough for me to plan a section. 1) Prioritize a non-emergent c-section (in other words, ideally decide before labor if you'll need a c-section). If this is your priority, then you have the least chance of a homebirth or a vaginal birth. On the other hand, you maximize the chance that if you do have a c-section, you'll be able to plan it how you want it, and planned c-sections are slightly less risky than unplanned c-sections. That is kind of what we are hoping to do, but it's tricky with caregivers, we've talked to our midwives and they do seem to understand where we are coming from and feel that we'd actually have a better chance of a good c-section if we use the OB group the midwives work with because of a good working relationship with them, so one thing that is important to me is a short delay before cutting the cord - it's been shown to be safe for c-section mums, with much better outcomes for babies, but it's slow to filter through, the midwife feels I'd have a better chance of getting something like that by planning to have a normal birth and a lateish transfer to a particular doctor within the group. To be honest I haven't actually gone and discussed it with an ob whilst actually pregnant, but in many ways I don't really want to as I have a huge fear of a vaginal birth in hospital and also the management of the run up to that. My midwives have said that in a situation where it became obvious in 2nd stage that injuries were a significant possibility, it wouldn't be deemed an emergency, so there would be a real chance of delivering vaginally before I was fitted in for a section - which would then kind of defeat the object of switching to birthing in hospital. I think my hope is that pregnancy will make it clear to me how my body is and I'm too early to be really getting those kind of clues. Good news is, I'm feeling movement. Feeling movement later was an early sign of an anterior placenta which then baby stayed facing. I felt the first wiggles on Sunday at 16 weeks, so I'm fairly confident that the placenta is not at the front. Cheers Anne |
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