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Author
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Topic: Advice on for VBAC with head high
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<katie30>
unregistered
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posted 08 February 2006 09:15 PM
Hi Everyone,
I justed wanted to get some advice for trial VBAC. My previous baby was born c/s because they thought it was pelvic disproportion. I now don't know if I believe this. I would like to try the most active labour possible. My only problem is the drs seem to believe if the head is high (which it is - not even decended) then it not possible. I natually went into labour with DS as my waters broke. But the OB said give it a go which meant I was on the bed, with an epidural in and they induced the baby. The baby went into stress almost immediately and I had a c/s. I don't think this is a true attempt.
Can someone please tell me what should be some steps to take and miss if you go into labour and the head is still high and Drs want to say your pelvis is too small. Do we not allow inducements, how long should we expect to labour (I hear drs want to c/s due to a prolonged labour). Last time they stuck me on a bed and monitored. How do you know you are NOT risking the baby in labour if the dr is telling you to c/s ?.
Please any advice would be appreciated.
Katie.
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<Penny Hardy>
unregistered
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posted 11 February 2006 09:48 AM
Just to let you know that I had a VBAC 11 weeks ago at Woodside Hospital in Fremantle.
It is vital that you insist on an active labour in order to give the head a chance to move down into the pelvis and along the birth canal. No baby will move very quickly if you are lying on a bed and strapped to a monitor. Requesting that the baby is monitored using a doppler is a good compromise in this situation as the midwife can normally check the heart rate at any position that you are in.
There is a great book by Janet Balaskas called Active Birth. I found this very beneficial and proved sucessful in my case.
Good luck, and dont forget to trust your body to do what it is capable of doing!!
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<Redlyn>
unregistered
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posted 12 February 2006 05:29 PM
Hi Katie
I also am going to try for a VBAC in a couple of months, I have hired myself a Doula (highly recommended) who will mediate my wishes to the Hospital staff so I don't have to feel bullied she recently sent me some info on optimum foetal positioning which I have included for you, hope it helps and Best of luck in having the birth you want.Redlyn
Optimum Foetal Positioning
'Optimal Foetal Positioning' is a theory developed by a midwife, Jean Sutton, and Pauline Scott, an antenatal teacher, who found that the mother's position and movement could influence the way her baby lay in the womb in the final weeks of pregnancy. Many difficult labours result from 'malpresentation', where the baby's position makes it hard for the head to move through the pelvis, so changing the way the baby lies could make birth easier for mother and child.
The 'occiput anterior' position is ideal for birth - it means that the baby is lined up so as to fit through your pelvis as easily as possible. The baby is head down, facing your back, with his back on one side of the front of your tummy. In this position, the baby's head is easily 'flexed', i.e. his chin tucked onto his chest, so that the smallest part of his head will be applied to the cervix first. The diameter of his head which has to fit through the pelvis is approximately 9.5 cm, and the circumference approximately 27.5cm. The position is usually 'Left Occiput Anterior' or LOA - occasionally the baby may be Right Occiput Anterior or ROA.
The 'occiput posterior' (OP) position is not so good. This means the baby is still head down, but facing your tummy. Mothers of babies in the 'posterior' position are more likely to have long and painful labours as the baby usually has to turn all the way round to facing the back in order to be born. He cannot fully flex his head in this position, and diameter of his head, which has to enter the pelvis, is approximately 11.5cm, circumference 35.5cm.
This means that often posterior babies do not engage (descend into the pelvis) before labour starts. The fact that they don't engage means that it's harder for labour to start naturally, so they are more likely to be 'late'. Braxton-Hicks contractions before labour starts may be especially painful, with lots of pressure on the bladder, as the baby tries to rotate while it is entering the pelvis.
Posterior presentation is more of a problem for first babies and their mothers than it is for subsequent births; when a mother has given birth before, there is generally much more room for maneouvre, so it is easier for the baby to rotate during labour. Sutton and Scott note that the rate of posterior presentation has increased drastically in the last few decades, apparently in line with changes in the way women use their bodies. Sitting in car seats and leaning back on comfortable lounges, together with less physical work, have combined to produce an increase in posterior presentations. Paying attention to your posture in the last few weeks of pregnancy can help to reverse this trend. Since keeping reasonably active in pregnancy, and practicing good posture, isn't going to do anyone any harm, this theory at least deserves to be considered.
When do you need to start doing something about this?
Pay attention to your posture at the time when your baby may be starting to 'engage', which means its head will be descending into the pelvis. This means for the last six weeks of your first pregnancy, and the last two or three weeks of subsequent pregnancies. In your second and later pregnancies, the uterus is roomier and the baby will not normally start to descend into the pelvis until later, and often not until labour starts.
What position is your baby in?
This is important because you need to know when your baby moves into a good position, so that you can encourage it to stay there! You can learn to tell what position your baby is in, by asking midwives to show you what to look out for, and by practicing feeling for the baby yourself.
When the baby is anterior, the back feels hard and smooth and rounded on one side of your tummy, and you will normally feel kicks under your ribs. Your belly button (umbilicus) will normally poke out, and the area around it will feel firm. When the baby is posterior, your tummy may look flatter and feel squashier, and you may feel arms and legs towards the front, and kicks on the front towards the middle of your tummy. The area around your belly button may dip in to a concave, saucer-like shape.
If you feel the baby move, try work out what body part was moving. Remember that heads feel hard and round, while bottoms feel soft and round! It may take a lot of concentration and trying to work things out at first, but you soon get the hang of it. You may find it easier to feel your baby's position if you lie on your back with your legs stretched flat out.
If your baby is posterior, you may find that you suffer backache during late pregnancy (of course, many women suffer backache then anyway). You may also experience long and painful 'practice contractions' as your baby tries to turn around in order to engage in the pelvis.
Practical steps to avoid posterior positions
The baby's back is the heaviest side of its body. This means that the back will naturally gravitate towards the lowest side of the mother's abdomen. So if your tummy is lower than your back, eg you are sitting on a chair leaning forward, then the baby's back will tend to swing towards your tummy. If your back is lower than your tummy, e.g. you are lying on your back or leaning back in an armchair, then the baby's back may swing towards your back.
Avoid positions, which encourage your baby to face your tummy. The main culprits are said to be lolling back in armchairs, sitting in car seats where you are leaning back, or anything where your knees are higher than your pelvis.
The best way to do this is to spend lots of time kneeling upright, or sitting upright, or on hands and knees. When you sit on a chair, make sure your knees are lower than your pelvis, and your trunk should be tilted slightly forwards.
• Watch TV while kneeling on the floor, over a beanbag or cushions, or sit on a dining chair. Try sitting on a dining chair facing (leaning on) the back as well.
• Use yoga positions while resting, reading or watching TV - for example, tailor pose (sitting with your back upright and soles of the feet together, knees out to the sides)
• Sit on a wedge cushion in the car, so that your pelvis is tilted forwards. Keep the seat back upright.
• Don't cross your legs! This reduces the space at the front of the pelvis, and opens it up at the back. For good positioning, the baby needs to have lots of space at the front
• Don't put your feet up! Lying back with your feet up encourages posterior presentation.
• Sleep on your side, not on your back.
• Avoid deep squatting, which opens up the pelvis and encourages the baby to move down, until you know he/she is the right way round. Jean Sutton recommends squatting on a low stool instead, and keeping your spine upright, not leaning forwards.
• Swimming with your belly downwards is said to be very good for positioning babies - not backstroke, but lots of breaststroke and front crawl. Breaststroke in particular is thought to help with good positioning, because all those leg movements help open your pelvis and settle the baby downwards.
• A Birth Ball can encourage good positioning, both before and during labour.
• Various exercises done on all fours can help, e.g. wiggling your hips from side to side, or arching your back like a cat, followed by dropping the spine down.
If your baby is already posterior...
When your baby is in a posterior position, you can try to stop him/her from descending lower. You want to avoid the baby engaging in the pelvis in this position, while you work on encouraging him to turn around. Jean Sutton says that most babies take a couple of days to turn around when the mother is working hard on positioning.
• Avoid deep squatting
• Use the 'knee to chest' position. When on hands and knees, stick your bottom (butt) in the air, to tip the baby back up out of your pelvis so that there is more room for him to turn around.
• Sway your hips while on hands and knees
• Crawl around on hands and knees. A token 5 minutes on hands and knees is unlikely to do the trick - you need to keep working at this until your baby turns. Try crawling around the carpet for half an hour - while watching TV or listening to music. It is good exercise as well as good for the baby's position!
• Don't put your feet up! Lying back with your feet up encourages posterior presentation.
• Swim belly-down, but avoid kicking with breaststroke legs as this movement is said to encourage the baby to descend in the pelvis. You can still swim breaststroke, but simply kick with straight legs instead of "frogs' legs".
• Try sleeping on your tummy, using lots of pillows and cushions for support.
References:
Understanding and Teaching Optimal Foetal Positioning' by Jean Sutton and Pauline Scott, in New Zealand: Birth Concepts, 1995.
Modern Midwife , January 1997 Vol 7 No 1, article by Mary Nolan
Hofmeyr GJ, Kulier R. Hands/knees posture in late pregnancy or labour for fetal malposition (lateral or posterior) (Cochrane Review). In: The Cochrane Library, Issue 2, 2000
Recommendations from other sources, which are not specified in Jean Sutton's 'Optimum Foetal Positioning'.
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<tcleighton>
unregistered
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posted 13 March 2006 10:54 PM
Thats situation sounds soooo common, I had my son 2 years ago and didn't even go into labour. My Obst got a second opinion from a surgeon and everything went downhill from there. I was told that I would be putting my baby at risk of cord prolapse because his head was still so high. I was 40.5 weeks and decided to go for a check up at 10:30am, by 5:30pm my beautiful baby boy was surgically removed. I really do feel for you, it is totally unfair to take one of the most special and important days of your life and turn it into a nightmare. Good luck to you.
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<babybrains>
unregistered
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posted 16 March 2006 01:24 PM
I completely agree with Redlyn on this one. Make sure you do not get bullied into things. This is your body and your birth. Jean Sutton is amazing in what she has given to women in labour, optimal postioning is never pushed enough ( if at all) in hospitals. Every pregnant woman should be striving to achieve a baby ready for delivery in the ROA position.
If you feel you are not being told the whole truth, make sure you ask every question possible to know ALL your options, not just the ones that make things easier and quicker for the medical staff. You can always get second opinion and having a strong support person (Doula or otherwise) is a great help.
Good luck with YOUR birth. Trust in your body, women were made to do it... just not lying down!
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<carolyn>
unregistered
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posted 21 March 2006 09:15 AM
I have had 3 babies all with high heads and never engaged. They were also all big over 4kg and I'm only 151cm tall (5ft)
With my first she never descended and got stuck in a posterior position after my ob ruptured my membranes. I stayed dilated at 6cms for 8 hours with no progress. Also I was 2 weeks overdue.
My 2nd didn't engage, with a high mobile head and positon. Went into labour day after due date and he finally descended when I was 8cms dilated, and my membranes naturally ruptured of their own accord. A 20 hour very satisfying labour with ventouse rotation for stubborn posterior positioned boy!
My 3rd never engaged and remained high and at 4.3 kg he was my biggest. All with heads over 37cms. I had a challenging 7.5 hour labour and he also engaged at about 8cms, remained high and mobile for the first part of labour but when he did engage it was very quick and full on.
My birth story for the first 2 are at www.cares-sa.org.au an organisation that I am involved in Adelaide which offers the same sort of support birthrites do. Have a read if you are interested in knowing more.
Just have faith in your body and baby, that they will know what to do. My 2nd obstetrician wasn't worried about my unengaged babies, when lying down for palpatation they would pop out of my pelvis. He got me to sit in reclined position and baby moved down into pelvis, He then got me to stand up leaning over onto the exam bed and the baby showed him that it knew which way to go and could fit in the pelvis.
It really is crystal ball gazing to say an unengaged baby wont engage in labour of you might have a prolapsed cord. Most prolapse cords are due to induced labours where membranes have been ruptured artificially - this is based on research. An unengaged baby may elevate your risk of not having a vaginal birth, but it would raise your risk much more than any other birthing woman.
good luck
Carolyn
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<Carolyn>
unregistered
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posted 21 March 2006 09:18 AM
It WOULDN'T increase your risk greatly!!!
Sorry typo and then I couldn't correct it. ![[Eek!]](eek.gif)
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<Debby M>
unregistered
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posted 24 March 2006 05:41 PM
Hi Katie,
The old "high head" thing is one of my pet hates with obstetricians. My personal belief is it is just another excuse to cause us to doubt our bodies and thus submit to a csec. If you want a csec then that is fine but if you want to try natural it is not nice to be going into labour with these doubts eating away at the back of your mind.
I can speak from first hand experience and tell you that a high head it not necessarily an impediment to vaginal birth and is MOST CERTAINLY NOT a reason for automatically assigning a woman to the csec category.
My first was born by emergency csec. The ob told me that he hadn't descended properly (despite the fact he was a bit of a cone head) and the same ob later sent me off for a pelvimetry which indicated my pelvis was slightly inadequate (2 of 4 smaller than ave measurements). He told me I would be unlikely to be able to birth a baby normally as my sons head was only 33cm.
Later found out that pelvimetries are not an accurate means of predicting birth and yet despite numerous research which shows this so many obs still use these as a means of judging ability to birth.
Anyway
Pregnant with No 2, done heaps of reasearch and decided to go for a VBAC. Great supportive OB luckily this time. When I went into labour my son was still floating well above the pelvis. He was still like this when my labour was well advanced 20hrs later however once I started to push he was out within 20mins.
My daughter was exactly the same. In my case they sit up high until I start to push them and then they push down quite easily.
Incidentally my 2nd son had a 38cm head - 5cm bigger than my first, and my daughters head was 36cm and she was 9lb.
Not bad for a 5ft2in woman with an inadequate pelvis and high floating babies!!
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<babyboy>
unregistered
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posted 18 April 2006 06:58 PM
good luck and relax. My 9lb babyboy was born vbac and was high until labour started.He came out painfully and sideways but it was amazing! Find yourself a midwife who knows how to help women give birth- it will make all the difference.use suttons positions to help move bub but most of all believe in yourself.
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<j.a.a.Smum>
unregistered
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posted 13 May 2006 11:24 AM
hello everyone
how i have loved reading this sight!
it is very interesting to see how many women have had the c-sect for first ( second or third) then want the next by vbac. i have two daughters, 9 and 7. the first was 10 days over and induced- born after a 3 hour labour. my second was 5.5 weeks prem after three pre-term labours being stopped i arrived at the hospital 6 cm and my waters were broken 18 minutes later second daughter was out! my third child, now 4, was born at 32.5 weeks by c-sect after my waters broke. he was breech with one foot through my cirvix. i now want to have a vbac for my next baby. the reason for this post is to hear from others who have had natural birth(s) and then c-sect then wish to have a vbac. i am wondering how many brickwalls i will come up against at the hospital ect. i would be intersted to hear from others who have been in this situation.
thanks j.a.a.Smum
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<Ekki>
unregistered
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posted 18 May 2006 06:25 AM
Hi Debby M,
I read ur reply to the "high head" subject.
I am just interested to know where about u had ur vbac? and also u said u had a supportive Ob, did it take much to concvince him? and if you are able to tell me which OB this is?
Sorry for allt he questions but i am planning a pregnancy this year and a VBAC for it, as my first was an emergency c-sec after they declared "failure to progress", i got to 8cm though.
Would love to hear you story, first birth & VBAC.
Thanks
Ekki
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<Debby M>
unregistered
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posted 18 May 2006 06:38 AM
Hi Ekki,
My birth stories are in the birth stories section here on Birthrites. They are quite long.
My first VBAC was in Townsville QLD. The doctor I had was newly graduated and very liberal thinking at the time. I had tried every other OB in town before I went with him - all the others were very conservative in their approaches and I know I would have ended up with a csec with them as my labour was 27hrs.
This was 7 years ago, I have heard from other sources that he has since been pressured / swayed or whatever into having practices that conform more closely to the other OBs now.
I am very pig headed once I get an idea and have a background where I am used to being the boss, so it is not that easy to bully me into something I do not want. From what I have read of many other women tho this is not that common and many women who do their utmost to try for a VBAC end up being brow beaten by the "God" syndrome that is associated with doctors.
With my 2nd VBAC are RBH in Brisbane I gave the OBs away totally and went with midwives - heaps better!! We are not planning any more children but if I had another one I would not let an OB near me with a 10 foot barge pole unless are real emergency happened.
Even at RBH I had to stand up for myself to get what I wanted, and eventually resorted to a "tantrum" after "logical" discussion failed to sway a couple of twits there.
I also had an experience as a doula with another lady who had VBA2C and acted as her advocate at RBH when they were trying to bully her into a repeat csec. I had a senior OB and a legal officer there absolutely fuming because every "barrier" they tried to raise I was able to counter with a medical study or statements like the legal one in "Hospital Policy" on this site. They finally acknowledged that it was the woman's right to choose and that there was not a bloody thing they could do about it (its was very gratifying actually :-P) As it was she ended up having her successful VBA2C at Redcliffe hosptial - it was a beautiful birth.
Debby
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<Heather>
unregistered
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posted 18 May 2006 01:02 PM
Hello Katie,
I am 4ft 10in - 147.6cm.
Neither of my first three babies engaged which I was told was due to pelvic disproportion - big babies, little lady. (plus not wanting to let me try for a VBAc with 2 and 3)
My fourth baby also never engaged during two weeks of pre-labour, I only dilated 1.5cm. Then three hours after my waters broke I had my fourth and biggest baby vaginally 7lb 11oz.
I strongly agree with the other ladies about positioning. In the last weeks I practised so much and was always aware of how I sat - always sitting forward - NEVER leaning back. My baby came out in the perfect postion - says my terrific midwife.
Also try and stay mobile while in labour.
Good luck
Heather
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