VBAC & Epi Question

[Claudia83]

Hello

My DH and I will be TTC for #2 in the next few months.
Our DS will be 2 years old tomorrow! Where did the time go?!

Anywho, for DS (#1) I ended up with a c-section after 26 hours of labor (stuck at 7cm for 4 hours) - failure to progress plus baby had pooped (fear of infection), I was off to the OR. I hated it. I resented the long recovery, all the meds... you name it. It was NOT my cup of tea. For #2 I am REALLY hoping for a VBAC. I have read a ton about it but still can't find information on a successful VBAC using an epidural.

Here's my concern: If I get an epidural, will I still be able to feel if something goes wrong? I'm worried about Uterine Rupture. While I know the risks are very low, I am still worried that I could be in that 1% and if I get an epidural, would I be able to feel if something goes wrong?

Also, for #1 after being stuck at 7cm for 4 hours, I got an epi and shortly after, started closing up (was at 5cm when doctor decided that I would get a c-section); is there a magic number as to when to avoid getting an epi? I have heard that too early could slow down progress, but I guess too late could do the same? Is 5cm the magic number?

Stories welcomed.

TIA

 

[Claudia83]

Anyone here with experience with VBAC using epi?

 

[Darlin65]

Just going off of talking to my midwives and others...

Being that you didn't progress there is a higher chance you will end up with another section. I made n appt specifically to speak about vbac and what the chances are etc. she said since my only reason for a section was a breech baby I was a perfect candidate however, if I had narrow hips or had gone into labor but didn't progress the chances of a successful vbac drop significantly. This does NOT mean it won't work and isn't right for you.

As for uterine rupture....

In the us vbac requires constant monitoring. Even if you do have an epidural you will be closely monitored so if there are issues they will know. I do suggest finding a midwife practice in your area. They are much more patient and more willing to let you have more time to progress. My midwives (3 in the practice plus 1 doctor for emergencies and sections) will even let you have an epi whenever you want it. I asked and they told me just the other day they had a woman who had already began pushing. They will encourage your original plan if you don't want one but be able to realize when you've hit your breaking point.

Sil had to have an epi because she was so stressed she wasn't dilating. Epidural will actually help the cervix and things relax and let your body do what it needs to

 

[capegirl7]

I am pg with number two and hoping for a vbac but also fear I won't know if something is wrong id I get epi.... So stalking!!

 

[Darlin65]

The risks of something going wrong are really small. It's like an additional 5% less than the normal risks with a vaginal delivery

 

[Claudia83]

Just going off of talking to my midwives and others...

Being that you didn't progress there is a higher chance you will end up with another section. I made n appt specifically to speak about vbac and what the chances are etc. she said since my only reason for a section was a breech baby I was a perfect candidate however, if I had narrow hips or had gone into labor but didn't progress the chances of a successful vbac drop significantly. This does NOT mean it won't work and isn't right for you.

As for uterine rupture....

In the us vbac requires constant monitoring. Even if you do have an epidural you will be closely monitored so if there are issues they will know. I do suggest finding a midwife practice in your area. They are much more patient and more willing to let you have more time to progress. My midwives (3 in the practice plus 1 doctor for emergencies and sections) will even let you have an epi whenever you want it. I asked and they told me just the other day they had a woman who had already began pushing. They will encourage your original plan if you don't want one but be able to realize when you've hit your breaking point.

Sil had to have an epi because she was so stressed she wasn't dilating. Epidural will actually help the cervix and things relax and let your body do what it needs to

Thank you tons for your input!! This gives me lots of questions to ask. We're currently now TTC so I will start looking for a good midwife/doctor. I had midwives with my last pregnancy (first pregnancy) that ended up in c-section; the Kaiser where he was delivered only has midwives to deliver babies and doctors are called in for complications. They told me that I would be a perfect candidate for VBAC since I went in for a csection because of failure to progress after induction (and baby poop lol).... but you said you were told by your doctor that it wasn't? I'm so scared to hear that

 

[Darlin65]

Just going off of talking to my midwives and others...

Being that you didn't progress there is a higher chance you will end up with another section. I made n appt specifically to speak about vbac and what the chances are etc. she said since my only reason for a section was a breech baby I was a perfect candidate however, if I had narrow hips or had gone into labor but didn't progress the chances of a successful vbac drop significantly. This does NOT mean it won't work and isn't right for you.

As for uterine rupture....

In the us vbac requires constant monitoring. Even if you do have an epidural you will be closely monitored so if there are issues they will know. I do suggest finding a midwife practice in your area. They are much more patient and more willing to let you have more time to progress. My midwives (3 in the practice plus 1 doctor for emergencies and sections) will even let you have an epi whenever you want it. I asked and they told me just the other day they had a woman who had already began pushing. They will encourage your original plan if you don't want one but be able to realize when you've hit your breaking point.

Sil had to have an epi because she was so stressed she wasn't dilating. Epidural will actually help the cervix and things relax and let your body do what it needs to

Thank you tons for your input!! This gives me lots of questions to ask. We're currently now TTC so I will start looking for a good midwife/doctor. I had midwives with my last pregnancy (first pregnancy) that ended up in c-section; the Kaiser where he was delivered only has midwives to deliver babies and doctors are called in for complications. They told me that I would be a perfect candidate for VBAC since I went in for a csection because of failure to progress after induction (and baby poop lol).... but you said you were told by your doctor that it wasn't? I'm so scared to hear that

We're you induced?

 

[tristansmum]

They say that it's fine to get an epi with vbac as the pain of a uterine rupture is not the first sign. You will be closely monitored so they would pick it up anyway. Also if you get an epi and then end up needing a emcs you can just get it topped up..... Not that there is any reason why you won't be successful in a vbac.
I had a vbac with my second although had no epidural. My Labour was only a few hours. You might find its quicker this time and you can cope without one.
Remember the risk of uterine rupture is very low... Like 0.3% in a spontaneous labour. Avoid induction at all costs as this rises the risk to almost 2%. Good luck. My vbac was an amazing experience and I'm so glad I did it x

 

[JessPape]

Just going off of talking to my midwives and others...

Being that you didn't progress there is a higher chance you will end up with another section. I made n appt specifically to speak about vbac and what the chances are etc. she said since my only reason for a section was a breech baby I was a perfect candidate however, if I had narrow hips or had gone into labor but didn't progress the chances of a successful vbac drop significantly. This does NOT mean it won't work and isn't right for you.
:

I have to disagree with this, FTP, could essentially be failure to wait. The problem with failure to progress is there is so many unknown factors that can play a role in it. True failure to progress may cause an issue, as your body may also do the same thing twice.

But things that can cause you to not progress are:

-Not being relaxed, stressed, uncomfortable.
-Lack of food/drinks
-Lack of moment
-Induction
-Interventions
-AROM
and the list goes on...

A lot of women that have FTP do go on to VBAC. There is a lot of mixed information on the failure to progress piece, but I really think it comes down to why didn't you progress. The problem with this, is it may not be an easy question to answer.

 

[Darlin65]

While it isn't something that will stop you from having a vbac it is something that can be very likely to happen again. Not only was I told that by my mw I have a few friends who have had this happen. Again, didn't say it was a for sure thing but just being honest with what I've been told.

 

[Claudia83]

We're you induced?

Yes, I was induced at 40w+2d because my pressure was going up and they found small traces of protein in my urine. I was basically admitted and wasn't given much of a choice after that. They also wouldn't offer any other form of induction besides pit, so I was on the drip 9pm on 8/28 and he was born via c-section 8/29 @11:15pm.

I do feel this was a case of failure to wait, I wish I had been more informed the first go around, I knew I wasn't ready (and I told them) but they said I was favorable so on I went.

 

[Claudia83]

They say that it's fine to get an epi with vbac as the pain of a uterine rupture is not the first sign. You will be closely monitored so they would pick it up anyway. Also if you get an epi and then end up needing a emcs you can just get it topped up..... Not that there is any reason why you won't be successful in a vbac.
I had a vbac with my second although had no epidural. My Labour was only a few hours. You might find its quicker this time and you can cope without one.
Remember the risk of uterine rupture is very low... Like 0.3% in a spontaneous labour. Avoid induction at all costs as this rises the risk to almost 2%. Good luck. My vbac was an amazing experience and I'm so glad I did it x

Thank you
That's my plan, to try to go into labor naturally and hopefully have a VBAC but in case something goes wrong, I can go into the OR easier if necessary, I'm just worried about WHEN to get one (Last time I got one at 7cm and I got stuck there) but I guess this is all just 'what ifs' right now.

Congrats on your VBAC that sounds like such a lovely process

 

[Darlin65]

We're you induced?

Yes, I was induced at 40w+2d because my pressure was going up and they found small traces of protein in my urine. I was basically admitted and wasn't given much of a choice after that. They also wouldn't offer any other form of induction besides pit, so I was on the drip 9pm on 8/28 and he was born via c-section 8/29 @11:15pm.

I do feel this was a case of failure to wait, I wish I had been more informed the first go around, I knew I wasn't ready (and I told them) but they said I was favorable so on I went.

Do you know what a foley bulb is? (not sure if I spelled it right) It's like a balloon they put in your cervix to help stretch it open. They slowly increase the size to help you dilate. If I were induced this would have been how they started me. They used this on SIL in May plus the Pitocin. I just wanted to let you know there are other options that don't require drugs. I had never heard of this until the mw told me

 

[Claudia83]

Do you know what a foley bulb is? (not sure if I spelled it right) It's like a balloon they put in your cervix to help stretch it open. They slowly increase the size to help you dilate. If I were induced this would have been how they started me. They used this on SIL in May plus the Pitocin. I just wanted to let you know there are other options that don't require drugs. I had never heard of this until the mw told me

Yes, we have that here too It's what I asked for immediately when I was told I would be induced but I was 2-2.5cm dilated already so the OB said I was not a candidate for the bulb and my only option was pit. They didn't even have the ripening gel available to me either; it was very frustrating to be told 'you only have pit as your option' - not a fun experience.

 

[Darlin65]

Do you know what a foley bulb is? (not sure if I spelled it right) It's like a balloon they put in your cervix to help stretch it open. They slowly increase the size to help you dilate. If I were induced this would have been how they started me. They used this on SIL in May plus the Pitocin. I just wanted to let you know there are other options that don't require drugs. I had never heard of this until the mw told me

Yes, we have that here too It's what I asked for immediately when I was told I would be induced but I was 2-2.5cm dilated already so the OB said I was not a candidate for the bulb and my only option was pit. They didn't even have the ripening gel available to me either; it was very frustrating to be told 'you only have pit as your option' - not a fun experience.

Hmm that doesn't sound right to me. I'm sorry things didn't go as planned.

 

[Claudia83]

Hmm that doesn't sound right to me. I'm sorry things didn't go as planned.

Right? I was so caught off guard because my MW had signed off on my birth plan and I had requested all of these before going on Pit and she said they had it available and would be available to me before Pit and when the OB read my chart and I handed her my signed birth plan from my MW she said that my MW was misinformed because they no longer carried ripening gel and that I wasn't a candidate for the bulb. The more I talk to other moms, the more I feel I wasn't really being heard.

 

[Darlin65]

I find it shocking your mw wasn't there! We have three in our practice and at least one is always there. If you have a natural labour/birth they stay with you basically the whole time. The ob is only for emergencies and sections. I only had one appt with the ob at the office and that's because the mw were away at a seminar.

 

[OmiOmen]

Here's my concern: If I get an epidural, will I still be able to feel if something goes wrong? I'm worried about Uterine Rupture. While I know the risks are very low, I am still worried that I could be in that 1% and if I get an epidural, would I be able to feel if something goes wrong

Yes, it is called a breakthrough pain. I had an epidural due to the agonising pain of complete rupture (although did not know that was what was wrong when I had the epidural) and in my experience it doesn't mask the pain. I have also read that studies support this. If it isn't complete rupture it may not be as straight forward but trust me when I say your organs tearing open is a very obvious pain.