Midwifery Today Community

I need some information about cesareans.I have had two girls by c-section and I'm pregnant with my third. I am considered a high risk because I am so small (I only weigh 101lbs at 5 months). I am unable to have a vaginal birth because my hips won't spread enough.  My doctor told me to talk to my partner about getting my tubes tied after this baby because this will be my third c-section. I have mixed feelings about this but I need to get any information that will help me determine what the risks really are. Does this have to be my last baby? Any information would really help me. Thank you

*hug*

that sounds like a difficult situation.

How do you know you can't birth vaginally?

Have you looked into the possibility of a VBA2C?

The risks of repeat cesareans grows with every one, but unless you have some other factors to consider than just the sections, that shouldn't be a reason to absolutely stop having children, should you want more. There is a lot of research available that indicates vaginal birth is still safer than repeat cesareans.

I would suggest talking more about it with your OB, and really exploring the risks and options, and perhaps getting a second opinion or two.

 Thank you for replying. When I got pregnant with my first daughter I had complications the whole pregnancy. I had a emergency c-section after trying to have a vaginal birth. I got pregnant again and the doctor I was seeing said that I had to have another c-section because of the first one. So he scheduled me for one. And now I'm pregnant again and the doctor is saying i have to have another one and that the risks are too high for me to have anymore. But i haven't seen this doctor more than 5-10 minutes every visit. So I think I need to go ahead and find another doctor since I've been having my doubts about him from day one.

Just wanted to add my support as you follow your instinct to seek out another provider's opinion.

Could be, that your mother's intuition is guiding you wisely to explore the possibilties for good reason. 

(Maybe in addition to checking out another doc, you might consider finding a midwife to talk to about this too?)

Best wishes as the path unfolds before you!

Definitely see if you can meet with a good homebirth MW as well. Just because you had one c/section is no reason for a repeat one, without other factors.

I think that getting a second opinion would be valuable.  I would be interested in knowing the particulars of what happened during your vaginal birth that led to a c-section.  CPD (baby not able to fit through pelvis) is definitely possible but it is rare.  Women *usually* grow babies that they can push out.  

Depending on your cesarean history you may be able to attempt a vaginal birth.  What about talking to some CNM's or CPM's?

 
I was in labor for 10 hours.  Finally when I was dilated enough I would try to
push but I just couldn't get her out. Everytime I had a contraction the baby
flat lined so finally they decided to do an emergency c-section and come to find
out the cord was wrapped around her neck 3 times and thats why she flat lined.
And then she had scrapes on top of her head from where she was hitting my pelvic
bone everytime I pushed. So they said my hips didn't spread enough. With my
second child they never even had me attempt to have a vaginal birth. But with
her the cord was wrapped around her neck once. And with this pregnancy they
automatically said i would have another c-section.

This is all new to me really I just always trusted that the doctors new what
they were doing but with this doctor i'm seeing now he hasn't taken the time to
discuss anything with me and I don't really know how to go about getting other
medical advice other than to find a different doctor all together. I just don't
want to make a decision now that I will regret later if I dont have too.

Greetings!

Sounds like you feel like you are between a rock and a hard place.  The best thing for you to do is continue to seek out a second and third and maybe even fourth opinion. 

10 hours of labor is great for  a first baby.  That baby sounds like she could have been "misaligned:" and just needed someone to help guide you in repositioning...and the like, in order to have your baby reconsider her position.  The cord around the neck three times is  not unheard of. Seems like possibly there were some other factors that contributed to the cesarean birth.   The fact that the cord was around your second baby's neck is nothing to be shocked about, it is not an unusual occurrence.

Mind you, I don't have gobs and gobs of experience, but the little I do have...I was with  a woman who had had two previous c-births and went on to have a fantastic third vaginal homebirth.  I am certain there are others out there that have a similar story...it is not out of the realm of possibility.

And unless you have an xray of your pelvic structure...there is no way for anyone to stand there and tell you you are too small!!!  You have been specially designed to have your joints and ligaments soften and stretch.  There are more parts involved than your hips in the process of labor and delivery...

When are you due?

Keep us posted.

Press on

  I want to thank everyone for there input. My due date is June 4, 09.

Every risk goes up with each additional c-birth.

It's really up to you when the risks outweigh the benefit of having a additional surgical birth.

I would definetely get a second opinion. Every dr/midwife has their own comfort levels with how many c-births they are comfortable with.

Mary

Kudos to you for seeking out additional information!

I agree with the many replies that have been posted.  If your "mommy gut" says that this provider may not be for you, never be afraid to seek out someone else's opinion.  Do what feels right for you and your family!

No matter what you decide to do, the choice is ultimately yours.  No one should "pursuade" you into medical sterilization if it isn't a choice you stand behind completely, 110%.

Good luck on your journey!

The size of the woman does NOT reflect how she will birth.

NO NO NO NO NO

I've had women your size in my practice deliver 8 to 10lb babies.  Vaginally.  It definitely sounds like there was something up with your baby's position, your position (likely on your back or sitting on your tailbone) or the time frame given to push your baby out.  

FWIW, babies don't "flatline" because of cord wraps around the neck.  Their heart rate may decrease with every push, and typically will resolve after the contraction.  Any stress on the cord that shows up in the heart rate is revealed DURING the  contraction, but then babies typically return to a nice baseline.

I'm appalled that any doctor is recommending a tubal ligation for you.  Appalled, but not entirely surprised.

I'd consider reading the following books:

Pushed by Jennifer Block

Ina May's Guide to Childbirth by Ina May Gaskin

And also consider signing up online for the ICAN email list - Intl Cesarean Awarenss Network - the women are wise and educated.  They could offer some evidence-based research and lots of personal experience.  They also have a great forum there, too.,

Hi JLangley

I would like to encourage you to plan a physiologically normal birth, and only accept surgery if there is a valid reason at the time.  The main issue to check prior to making that decision is that the baby's placenta is clear of the scars in your womb's lower segment.

It sounds to me as though you have a very good chance of giving birth vaginally (Plan A) this time, if given a chance.  You have come to a midwives chat forum, so I don't suppose you will be surprised when a midwife says you need a good midwife who is skilled in normal birth.  You won't need an obstetrician unless referred on by your midwife.   Even if you do find that you need another caesarean, your baby will be better prepared for her/his transition from the womb to this world if you come into spontaneous labour and are unmedicated until a decision is made to move to Plan B.

You said you were in labour 10 hours, and progressed to fully dilated.  That's excellent progress.  The problems you experienced after that with the reduced beat to beat variability on the monitor mean that for some reason there wasn't as much oxygen getting through to her during contractions.  This could have been related to the cord around the neck, but that in itself would not usually obstruct progress. The big obstruction to progress at this point would have been fear.  From your story we don't know if you might have been able to give birth vaginally, because once the decision is made to operate, that's what's done.

The scrapes on the top of her head would not have been caused by hitting a bone in your pelvis.  They were probably caused by a doctor placing a scalp electrode, or by obstetric forceps used in the operating theatre.  Your hips and pelvis are probably beautifully proportioned for childbearing.  The loss of ability with normal birth is a problem with the care providers, not with the women.

My best wishes from Melbourne Australia

NICE post Joy, thanks!

Mary

 For a look at women who weren't too small to birth their babies you might want to go here.  There are graphic photo's of birth (fairly obvious, but don't want to offend anyone!).

Bec