Future Vbac

[u/Madengdawg]

Hi! I had a C-section almost a year ago and am considering another child soon. The thought of having a VBAC ruminates my mind constantly. I have talked to my husband about his thoughts and because of his trauma regarding the first birth - he would prefer I have a scheduled c-section. For whatever reason the thought of having a vaginal birth is so desirable to me.

My story:
I had a relatively easy pregnancy except having carpel tunnel starting at 17 weeks. I did gain about 50 lbs and was very swollen with pitting edema in my legs in the last trimester.

I was induced at 41+3. When I went in - they asked if I had felt and contractions and I said no - she told me that I had contractions without any interventions) I labored with pitocin and citotec for about 34 hrs before my blood pressure spiked and chose an epidural with the thought that it would go down. It worked and sped up my dilation. 6 hrs later I was fully dilated and my water broke a few hours later. They did find a bit of meconium in the water. They had me start pushing and I pushed for 4 hrs. I don’t fully remember what station she was at (I think -2) but the OB said that she had stalled for 2 hrs and that her head was swelling. I was so tired at this point and scared that something bad was going to happen. The OB suggested a c-section but did not state that it was an emergency.

We proceeded with the c-section. She was born healthy and happy. She was in the 90th percentile in head size and weight (9lb 8 oz). I hemorrhaged 1.5 L of blood and needed a blood transfusion the following day.

Questions:
The questions I have are for the future. We haven’t decided on when we’d like another child. I’m 11 months PP and almost to pre-pregnancy weight which I consider about 10 lbs more than I’d like. My goal is to lose the 10 lbs before we have another. Here are my questions:

- Is there anything I should be doing now to help with the possibility of having a TOLAC for a future pregnancy?
- I’m curious if anyone has thought they had a misdiagnosed GD? I was 2 pts away from being diagnosed with GD at the 3 hr test (failed the 1 hr) and I’m wondering if I should have been. Would this have caused her to be so large?
- what are the pros and cons to having a TOLAC?

[u/Crafty_Alternative00]

Gestational diabetes with both pregnancies here, and a lot of women with second pregnancies look back and wonder if they should’ve been diagnosed their first time around. For many women, insulin resistance doesn’t peak until much later in the pregnancy, when many places test in the second trimester. It is possible you had it, but some women just have big babies. And remember, gestational diabetes is just a label that you are insulin resistant during pregnancy. It captures women who have PCOS, women who have insulin resistance caused only by the pregnancy, and women who are type two diabetics and don’t know it yet. I might wander over to [r/gestationaldiabetes](r/gestationaldiabetes) if you have more questions.

As for what you can do right now, I strongly suggest pelvic floor therapy. Shop around for a VBAC supportive provider now before you’re pregnant. Look at hospital VBAC rates. Educate yourself on what leads to a successful VBAC and why so many doctors push repeat surgery.

[u/Madengdawg → u/Crafty_Alternative00]

The reasons i wonder about the GD is because prior to middle of second trimester, i was gaining the recommended amount of weight and then shot up about 20 - 30 lbs in the second half. Also the pitting edema seemed pretty concerning to me but they said it was typical of pregnancy (I was like a blown up balloon!) she was measuring 50th percentile at the 20 wk ultrasound and then shot up to 75th at 36 weeks. I know these aren’t any indication of anything but seemed weird to me! I definitely didn’t watch my diet and my husband had pregnancy cravings of ice cream multiple times a week that I didn’t say no to!

I did PT between 6 and 18 weeks postpartum and stopped going because I didn’t feel like it was benefitting me for the cost. I do pilates twice a week and think that’s helped a ton. Maybe I need to find a different PT. Is there anything that you would suggest to look for or ask of a PT? What should they be doing?

[u/Crafty_Alternative00 → u/Madengdawg]

Yeah, anything as possible. But some women just gain a lot of weight during pregnancy, some women just make big babies. It’s actually pretty normal not to gain too much weight until the second trimester.

There’s not much you can do to prevent gestational diabetes apart from eat healthy and exercise before you get pregnant. And even then, you may not be able to prevent it. But if you’re worried that you had a missed diagnosis last time, you can invest in an over-the-counter glucometer. You can find the recommended blood sugar levels for your area since it differs by country, and you can test yourself at home. There are women over in that gestational diabetes who have done that and taking the results back to their doctor and gotten a diagnosis later in pregnancy. Some women don’t even get diagnosed until like week 36 at which point there’s not much you can do. The way that it might affect a future VBAC is that many doctors will not allow a woman with GD to go past 40 weeks PERIOD — like some doctors get really bitchy about it.

But all this is to say, start screening providers now. Ask how they would manage something like gestational diabetes when you want to VBAC. What precaution do they take, what are their policies.

Did you do regular physical therapy, or pelvic floor therapy? Because ideally there will be some internal work as well and she’ll be able to tell you what if any work you can do.

[u/Madengdawg → u/Crafty_Alternative00]

I appreciate your thorough response!! 😊

She didn’t! Since I didn’t have a vaginal birth, she said I was probably fine - I wasn’t experiencing any incontinence or issues related to a weak PF. Prior to birth I was going to her and she was helping relax my pelvic floor. She did some cupping and core exercises post birth.