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MarilynW
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How long does it usually take you to push your babies out? I usually have to push for 1-2 hours and have ended up with a vacuum for all 3 regular deliveries including my two VBACs. My OB has mentioned that I should consider a c-section - because this would be my 3rd pushing labor with vacuum in 5 years - and he is worried that I may end up with bladder/rectal problems. My uterus is fine and I have never had any problems (ok except for this hacking cough during pregnancy which is not ahem great on the bladder!) Of course the ideal would be to have a 5 minute labor with the baby just sliding out - but given my past history not likely! So I am trying to figure out what to do - I am such a strong fighter for VBAC - but I do trust my OB and want to make the right decisions. Any opinions would be appreciated.
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Donna Marie
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Have you tried different pushing positions? I delivered my last child (first vbac) on my side and he was out in 4 pushes...that was the fastest I EVER delivered...I was sooo surprised! FWIW my midwife said that the standard delivery posture (on back in stirrups) is the worst position. Geometrically speaking, the baby's head doesnt fit well in that position because of what the baby's body has to do to get out.
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JodieLyn
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I think it would all depend on the reason you're pushing so long.. for myself.. I've pushed an hour a couple times.. big headed babies.. but it was definately doable and no intervention (homebirth with midwife).. and I had one I pushed for 2 hours.. but that was because she was carried so high.. no one realized that the squatting or semi-squatting position they were strongly suggesting was holding her in instead of helping.. if baby is not at least at 0 station that can happen.. and she was still above that by a couple inches.
But basically there's no real problem.. just takes some time..
If there was something else going on.. something about the pelvic girdle that was making it a struggle when it shouldn't be.. that type of thing.. then perhaps rethinking it is a good idea.
Why is the vacuum being used at all? impatience on someone's part? an arbitrary limit set by the hospital? or is there something that is preventing baby from decending normally and this helps them maneuver through safely.
Or is your OB just trying to find a nice way to get you to go c-section because insurance/hospital policy or such is trying to do away with VBAC?
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Mackfam
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Marilyn -
Each labor is unique...but I suspect that your next labor will be similar to your others because I see patterns in all of my labors.
I've VBAC'ed 3 times now and they have all moved swiftly. Labor is 2-3 hours...5 minute pushing. However, each of my labors has been artificially induced for other medical reasons...thus, I'm not sure what my body would do on its own.
My OB is very attentive, slowly ramping the pitocin. I respond quickly with good contractions.
I think I would pursue if there were any way to move labor/pushing along sans vacuum. Do you have an epidural? I'm not a fan of them in general (and I'm not looking to engage the pros/cons of epidurals...I know there are both and truthfully I wish I could avoid it  ), but again, because of some risk issues associated with my C-section (3 pregnancies ago) I consent to the epidural (low dose). I can still feel my contractions and I am very active in talking with the anesthesiologist about ensuring that I am able to feel both contractions and the instinct to push. I have found this to be very helpful in assisting my labor along. Also, I'm sitting more forward and upright for actual delivery, not laying down. I think that helps as Donna Marie points out.
In the end, you must work with your OB and your dh to discern the safest way for this baby to enter the world. If that is via C-section, well then thanks be to God that you have that opportunity, my friend. The goal is a healthy delivery. I used to have very lofty ideas of what that looked like...now, the only image I have in my mind is a baby in my arms at the end of it.
I can't offer you any experience from the perspective of having long pushing sessions...I'm praying you will hear from others that can offer you some insight there. And, as always, I am praying for you and this baby every single day, my friend!!!
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JodieLyn
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oh yes and ditto Donna Marie, investigate different positions and see if there is one that seems likely to work better for you.. hands and knees, full squat, birthing chair, semi-squat, side lying.. I've even umm accidently (as in not on purpose) had one leg kneeling and one leg squatting and the rest of me leaning on the bed.. not really on my hands 
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Tami
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Marilyn, I'm wondering why you push so long (esp. being a multip) - does the baby take a while to move into the pelvis? Does the urge to push hit early? Can you hold off longer (I hate to even write those words, I know how excruciating that can be). 
One thing that comes to mind is getting with a doula (I've trained as one, tho I haven't done a delivery in many years), to see if she can help you with various positions during labor to help accelerate the baby's descent.
I'm a big believer in squatting - opens the pelvis by 30%, I believe.
I'm not a good example, personally: pushed twice with my first baby. Pushed 45 minutes with #2, because he was posterior - dr. had me squat holding onto the back of the bed while I pushed, he turned right around while in my pelvis (yeowww, I felt that for sure!  ) then I flipped over and out he came. All the others after him were only 2 or 3 pushes.
ETA: I flipped over (i.e, turned around in the bed) - not the baby. It was late last night when I posted. 
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insegnante
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Wow, I have had 1 VBAC after 2 c/s and I pushed almost 2 hours. My doula and OB never hinted at it being a long time at the time (at least that I noticed.) I think she was at zero station when I started and I know she was posterior at one point, not sure whether she turned before any pushing began. I did push in the generally "worst" position (which I had made such a big deal about not using, well I hardly cared when the time came) but my very educated, experienced, natural-minded, friendly with the doctor and not shy doula said nothing that I heard to suggest otherwise so I just went along with it.
Recovery was longer and harder than I expected but I would not trade it for a c-section -- you have had one though so I am not a voice of experience you lack. I guess some of it has to do with how many babies you expect to have the potential to have in the future; I suppose at 30 another c-section would have had a lot more ramifications for me than for a woman later in her childbearing years.
Since you asked for "opinions," personally I am sure I would not have a c-section for what it sounds like are the reasons you were given. Holding and nursing my baby right away and not being separated from her for about two hours was just so amazing, going home with her the next day so wonderful, and I am more aware of the serious risks of surgery than I once was.
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Fuzzy
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Marilyn, you are soo tiny - I'm sure you are smaller than me - and you have such tiny babies, it amazes me that they don't just come out with a few pushes. I had a vacuum with #1 (my smallest - at 8 lb 14 oz!) but I don't remember how long I pushed, and we did a c-section with this baby (9 lb 13 oz) and I have to say, I am very grateful to my OB (we go to the same one, I know). Both my babies had shoulder distocia and I had tearing (I never asked how bad ), and we were nervous about this baby's safety, as well as mommy's. As big as he was, I am very glad the drs decided to do a c-section for me. I appreciated that they were concerned with MY health, as well as the baby's.
My DH and I talked so much about this issue, and the drs gave us the option in the beginning, but as things progressed (i.e. my belly) the drs finally made the decision for me. I feel the same as you, that it would be great to have a vaginal birth, but you want to trust your drs in this area too. I trust the office we go to, and I know they do so much praying for and with the patients that it makes me at peace. (Dr. A was in the room as I was getting my spinal, holding my hand and saying prayers with me. I can't tell you how calm that made me!)
Of all the births, I think my best recovery was this last baby. When you had your c-section with your twins, was it an emergency? I know we talked about this before, but I can't remember. I think when it is planned and not rushed, you can prepare better and you have BTDT.
I know you will do the best for you and the baby, and I will keep praying for you!
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monique
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Marilyn,
Your initial question was how long do you push? I have pushed a variety of lengths for all my children but for most of them I pushed for a very long time. Yes, things are not where they should be anymore but it's probably because of the large babies-9lbs for the boys! The one thing that helped with 3 of the births is having someone push down on my perineum. Then the babies were out in just a few pushes. Maybe that would be something that could help you push as well.
A trial of labor and vacuum births are still safer then having major surgery. Babies that are born by Caesarean section are more likely to have problems as well as are more likely to die. I think your dr. is thinking along the lines of Caesarean sections are safer for the pelvic floor than regular vaginal births. I've heard that argument for Caesarean's recently. I'm sorry, I don't buy it. God made women to have babies vaginally.
Good luck with your decision. I know these are hard decisions when you want to trust the doctor.
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Martha
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I've had anywhere from no pushing at all (just whoa someone catch!) to 6 hard hours.
no vacuum ever used on any of them.
and no ill affects on my bladder or other areas at all.
I would hesitate to have a c/s because it's getting nearly impossible to get a VBAC these days. So if you have a c/s, you need to be prepared to accept that every delivery there after might be a c/s too. Which is fine if that's what you need and feel is best, just an fyi to keep in mind.
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Lisbet
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The longest I've ever pushed was 2 hours, with my first. I had an epidural and couldn't feel a thing. The rest (some nearly 10lbs.) I pushed for an average of about 10 minutes. My 7th I pushed his entire little (9lb. 4oz.) body out in one big gusto of a push. (I pushed after the urge, as I felt I didn't have any more in me at that point.)
All that said, I have been in transition for up to 4 hours before. That was a posterior baby. As soon as I felt her turn, I also felt her drop down in the the birth canal - from there I pushed about 10 minutes. (she was 9lbs. 14oz.)
I am ready to push again now! LOL!
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Elizabeth
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I might be supersensitive here. I've done it all: 6 unmedicated deliveries; emergency c-section for a footling breech; unmedicated, induced, vbac; and planned (though ultimately emergency) c section after a vbac.
I think Monique is referring to elective c-sections before term or at 38-39 weeks. That's not what's being considered, if I'm reading Marilyn correctly. Her physician is concerned about the chance of rupturing an existing scar during an extended pushing stage and pelvic floor prolapse. Two hours is a long time to push for a vbac--it's not unheard of, but it is exceptional. I have had extremely short pushing stages (never more than three pushes) all 7 times and I have still had extensive prolapse.I think it's hard to know what your doctor is seeing specifically that is giving him pause. I'd ask him if it's advice being tailored specifically to you. A short pushing stage is no guarantee you won't do damage to your pelvic floor. On the other hand, neither is a c-section. My mom had two sections and no vaginal deliveries and no trials of labor. She has the same pelvic floor I do; a lot of it is genetics
You need to trust your doctor to help you make the wisest decision for mom and baby. If you can get to that kind of trust and come to a decision that gives you both peace, you will be all set for a positive outcome, no matter how you deliver. Remember, the goal here is a healthy mom and a healthy baby. There are many ways to get to the goal.
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Elizabeth Foss is no longer a member of this forum. Discussions now reflect the current management & are not necessarily expressions of her book, *Real Learning*, her current work, or her philosophy. (posted by E. Foss, Jan 2011)
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Barbara C.
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On my first, I think it was two hours. And I think a lot of it was mental as well as physical: disorientation coming off of IV pain meds, doctor yelling at me, bad position, first time fear of the unknown.
Second one, two hours. I know that it was mental. I had a panic attack during transition. And I think I had residual fears from my first time.
Third one, I'm not really sure. Maybe 30 minutes.
Is it possible that part of your problems could have been a mental issue? The child birth book I found most helpful was Ina Mae's Guide to a Better Birth....the mind/body connection can make the biggest difference. Fear can really make your body do weird things...and then impatient or fearful doctors/midwives can make the problem worse with their desire to intervene.
Positioning can make a big difference, too. I pushed for about 20 minutes on all fours and it felt good (even if it was kind of gross for everyone else). Then when I flipped over onto my back it didn't take long.
I think I would find out if the doctor thinks there's a physical reason that you keep having vacuum extraction--is there something they can trace that's keeping the babies from coming out on their own? If not, I think I would talk to a doula or midwife as well.
I'm sure your doctor is very nice and looking out for you. But in general, doctors are trained to treat childbirth like a series of problems to be avoided rather than a natural process that sometimes needs a little assistance. And we have to remember that any professional (doctor or midwife), they are people who could have incomplete knowledge or be influenced by their own preferences, prejudices, and desires.
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Elizabeth
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One more thought and then I totally need to vacuum for about an hour or so...
Very few people would elect to have major abdominal surgery. Most women who have c-sections give heroic assent to it in order to provide the very best care for their babies in whatever situation they find themselves. It is major surgery, despite the "movie star phenomena." What I think marilyn's doctor is posing is the possibility that if she has this surgery now, she can avoid pelvic prolapse. Very few doctors discuss pelvic prolapse with pregnant women.For women who have one or two babies, it's not very common. This doctor sees lots of women who are grand multips. There, it's much more common. And prolapse can be debilitating. We're not talking cosmetics here. We're talking pain and we're talking an interference with normal activity, depending on the degree. And sometimes, to repair a prolapse, a woman needs...major surgery. That surgery can have a longer recovery period than a c-section. Perhaps the doctor is taking a longterm view of the situation and trying to pose possibilities from every angle in order to be the best advocate for good care for all involved.
Marilyn, I think you need to have a frank conversation with him and probably with other doctors in the practice in order to weigh all the possibilities and come to the best decision. If you trust your doctor, go about the discernment prayerfully, knowing that God is in control and you are *all* working to do His will and to bring your precious Anna Grace into the world, while still ensuring that you are healthy and well and able to care for her.
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Lisbet
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Elizabeth - I know you are vaccuming - sorry. But I have a question about how simply carrying another baby plays into prolapse, rather than pushing, kwim?
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Elizabeth
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Lisbet wrote:
| Elizabeth - I know you are vaccuming - sorry. But I have a question about how simply carrying another baby plays into prolapse, rather than pushing, kwim? |
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Pressure on the pelvis can contribute to prolapse, even if you kegel like crazy. The fascia stretches and it can tear (imagine the mesh of panty hose). Once the stretch and tear starts, it can stretch and tear more easily. So, last time's pushing can make the fascia more vulnerable as you carry this time. When you add coughing (as in asthma or bronchitis--something more chronic than a quick cold), or a lot of lifting or even a one-shot lift of something too heavy while pregnant, you can end up with noticeable prolapse. Hormones play a part, too. And really, genetics, have a role. Some women get varicose veins and others don't and there's little one can do. In the case of prolapse, too, a woman is limited in how much she can prevent it. Personally, I think every OB should offer a pessary to a woman who is going to have more than one baby . A pessary can tuck it all back up so that's it's not painful, can prevent some of the coughing/sneezing damage while pregnant, and can make those kegels way more effective because gravity works with you.
And now, I really have more vacuuming to do.
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Elizabeth Foss is no longer a member of this forum. Discussions now reflect the current management & are not necessarily expressions of her book, *Real Learning*, her current work, or her philosophy. (posted by E. Foss, Jan 2011)
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doris
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I pushed for over 2 hrs with my 1st (epidural, couldn't feel a thing); 30 mins with my 2nd; 5 mins with my 3rd; 5 mins with my 4th.
I was on my back for my 1st; upright (kneeling on the bed hanging on to dh's shoulders) for my 2nd; upright, but in the birthing pool for 3rd and 4th.
I had a mild prolapse after my 3rd. Interestingly, I asked the OB (in the 5 minutes I saw him during my pregnancy!) if I should have a c-section for my 4th because of the prolapse. His view was that it was not helpful, because by then the further damage (if any) would have been done, by the weight of the pregnancy itself.
UK OBs are less interventionist I think (well, for a start you don't even see them unless you're in a higher-risk category) and this one was possibly less clued-up than yours about multips, and of course yours knows your precise history -- but I think it's worth just asking yours the question.
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Martha
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I really think this is a personal decision.
I don't know how previous pregnancies went and I don't know her dr.
I do know that c/s are performed way, way too often.
I do know that having a c/s for any reason can set one up to forever have to have more c/s in future pregnancies. My having had 1 c/s (3rd baby) nearly 11 years ago made it nearly impossible for me to VBAC this last baby, even though I'd already had good VBACs 5 previous times.
I agree that a prolapse surgery can be far more invasive and painful than a c/s. But most women only have a prolapse correction done once. Where as the medical establishment is quickly moving to once a c/s always a c/s stance again. So having a c/s might mean several more surgeries. Discuss this with your dr too. If he knows you might want to continue having children, he might have the attitude that you should wait until done having children and deal with any prolapse issues as they arrive. (This is the main reason OBs don't discuss it for this reason. It's considered an "after child bearing years" discussion.)
I recommend you consider your own opinion on your physical health too. Do you feel you are starting to have a prolapse or bladder issues? If so, a c/s might be less about avoiding a problem and more about reducing it.
If that's not the case, then ask the dr to clearly illustrate to you why he feels another vag del would clearly lead YOU to have a prolapse, not case studies, but YOU in YOUR situation. There's always a chance of these things, even with a first pregnancy, what you want to know is YOUR chances.
I do not want to discourage anyone from having a c/s if they feel they need it. C/S can be the healthier choice at times.
Just be informed.
And only you can be truely informed about your health situation.
If it encourages anyone to know, I've had 1 c/s and 8 vag deliveries and have zero bladder prolapse issues.
Instead I have dislocated pelvis and hips to mend.
no pain no gain takes on a whole new meaning with motherhood doesn't it?
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MarilynW
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Thanks everyone for all the comments and advice. I really do have a good pro-life OB-GYN practice and will feel comfortable with their eventual advice. I was initially a bit dismayed - as I just assumed another vbac would be textbook after 2 in a row. I have always feared another c-section - because the one I had with my preemie twins was so tough - they were 31 weeks, I never got to see or hold them, and the recovery seemed long and painful. But ultimately they were mono mono and the c-section saved their lives. And from what I hear repeat c's are not as bad as the first one.
I would love to do the Vbac - but I am going to see how things progress and what the other doctors say. I see the most conservative pro-c doctor next , and then the one who did my last 2 VBACs - by then I will have 3 opinions and be over 28 weeks.
I think I am mellowing as I age - I just feel so lucky to be having another baby that really I will accept whatever I have to do to have a safe delivery, and be able to look after all my children after.
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Elizabeth
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MarilynW wrote:
. And from what I hear repeat c's are not as bad as the first one....
I think I am mellowing as I age - I just feel so lucky to be having another baby that really I will accept whatever I have to do to have a safe delivery, and be able to look after all my children after.
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I so hear you on both counts. My second c-section, though a much scarier scenario, was a breeze recovery-wise. God knew how much grace and strength I needed and gave me so much more.And the age thing does play in. If I were thirty, the prospect of always having a c-section because I'd already had two would make me sad and worried. But after forty, you kind of think you'd be so very blessed to be able to have two or three more c-sections if only you can have that *wonderful-beautiful-baby* reason to need them!
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4Real Forums : Mothering and Family Life
Topic: Pushing, Vbacs and C-sections?!
