Conference moira::parenting

    Hi,
    
    I had a c-section for my first one (after 29 hours labor).
    During my second pregnancy, my doctor said it was my choice of
    which kind of delivery I wanted.  I leaned heavily toward c-section
    again for two reasons:  the first reason was that I had already
    experienced labor, and didn't like it much (understatement), the second
    reason was that I knew the second pregnancy was going to yield a
    larger baby (I just "knew" this kid was going to be BIG, he was 9lb
    2 1/2 ounces) and I didn't want to go through another round of exhaustion 
    and fetal distress that occured the first time.  I have a tipped uterus, 
    and during contractions the doctor tried to "right" the wrong direction 
    of the uterus.  OUCH!  Actually the doctor's procedure during labor was 
    more painful than labor itself!   And that would have had to occur again
    during the second labor.
    
    I'm glad I went with another c-section.  It also turned out to be
    a blessing that I did, my uterus was stretched to a dangerously thinned
    membrane that in all probability would have ruptured during labor,
    putting the baby in danger.
    
    I understand that many, many women have successful vbac's.  I
    personally know of three, they have no regrets.  They really wanted
    to experience natural birth and were thrilled that they were able to.
    I didn't have a good situation during labor and chose not to repeat
    the experience.
    
    Happy deciding!
    
    NF
    

    I've had two successful VBAC's.  My first daughter was a c-section
    due to her being breach.  My son, two years later, was a VBAC with
    an episiotomy.  My next daughter, 19 months later, was a VBAC with
    NO episiotomy.  I would DEFINATELY take the VBAC opposed to a c-section
    any day.  The recovery period is so much easier.  If you don't
    anticipate problems (like baby being too big for you) I would
    definately give it a try!!!
    
    		- janice
    

    Our first (now 4-year-old daughter) was a C-section, so when it came
    time for us to discuss our options for our second (now 14-month-old
    son), the doctor "encouraged" us to consider a planned C-section. I had
    remembered that when our daughter was born, the doctor told my husband
    that I had a small pelvis and that if we were planning to have more
    children, we should consider having a planned C-section (she said she
    didn't think I could have any children naturally. When I questioned her
    about that comment prior to our son's birth, she said I could try VBAC
    but that she doubted that it would be successful (based on our
    daughter's birth and her professional experiences). So, we opted for a
    planned C-section.
    
    Unlike many women, I didn't have much difficulty recovering from either
    C-section. I did have some minor incision problems with the second
    C-section, but I (and my husband) attribute that to my overdoing it
    trying to get ready for our son's bris (a Jewish circumcision held
    eight days after the baby is born at home).
    
    In my case, both my husband and I had a lot of faith in the doctor and
    her abilities, so following her advice felt right. My son is no worse
    for wear because of it.
    
    Your mileage may vary...
    
    Nancy- 
    
    

What is VBAC?

    
    	Vaginal Birth After Cesarian
    
    			Wendy

    Thank You, Thank you,
    
    Every thing you wanted to ask but were afraid to.

Thanks for the comments.

	My situation is similar to that of .1
	
	I also had to labor (induced) for a long time with my now
	4-year-old son.  I also have a tipped uterus and he was 
	in the posterior position which made things a little more
	difficult.  My section was not a direct result of any of
	these things, rather it was due to fetal distress brought
	on by a strep infection.  My son was taken c-section and
	immediately sent to New England Medical center for 2 weeks.
	I never saw him until he returned because I was also
	sick and unable to leave the hospital I was in.

	I know that this is probably not going to happen again, but
	the fact that I was 3 weeks late and spent many hours in
	induced labor with little progression frightens me.  My
	doctor has left the decision up to me but is *STRONGLY*	
	encouraging me to VBAC.
	
	My husband and I had decided to try to 'go natural', I just
	have this feeling that I'll end up being sectioned anyway.
	At the same time I somehow feel like I would be copping out 
	by opting for a section, though I think it would put my mind
	at ease.

	Any more comments and experiences are more than welcome.
	
	--------MM

    MM --
    
    Don;t look on a section as "copping out."  My experience (those
    familiear with Parenting may skip the next 2 or 3 paragraphs :-))
    with my son was that he was 8 lbs. and footling breech.  I'm 5'2"
    -- when I started that pregnancy I weighed 106 lbs.  James also
    had a big head and big shoulders; the nurse told me I might well
    have ended up with a section anyway, even if I had dilated normally.
    In short, he was just too big for me to birth "naturally."  Someone
    told me that if he'd been born 100 years ago, we both would have
    died.  Gee, thanks.
    
    The experience with my daughter (baby #2) was totaly different
    (including the fact that I felt like garbage for 9 whole months!).
    I spent a day in bed a month before she was born, because I was
    having contractions all day while she was moving head down into the
    pelvis.  I went into labor with Hollis at 8 p.m. one Sunday night
    a month (almost to the day) later, and managed at home without anything
    till almost 6 a.m.  Off we went to the hospital and my dear daughter
    was born at 8:20 a.m., with only a half-hour of pushing.  She was
    7 lbs. 9 oz., 20 inches long, not that much smaller than her brother.
    
    My doctor would not give me any satisfaction about whether or not he
    thought I should have a C-section.  (Readers of V.3 in April-May of
    1991 will remember my complaining about that!!)  Now that I look
    back on it, I wonder if he was half-expecting to do one anyway.  When
    I saw him the Friday before Hollis was born, I was already five
    days late and had not dilated one bit!  I couldn't be induced becasue
    the cervix had not "ripened" enough (if at all).  What he did, then,
    was to strip the membranes (move the amniotic sac away from the
    cervix, a very UNcomfortable procedure), and even with all that, it
    still took another 48-plus hours for labor to start.  
    
    MM, I'll be glad to answer any and all questions offline if you wish.
    
    Best of luck in whatever you decide,
    Kate

    Curiosity question (at this point, anyway)...
    
    Does the position/direction of the incision have a bearing on repeat
    C-sections vs. VBAC?
    
    We had been told that a vertical inicison (like my wife's) meant a
    certain repeat C. Has anyone VBAC'd after a *vertical* incision
    C-section? Or only after a horizontal ("bikini cut") section?
    
    --dave--

    We were told (my wife had 3 c/s) that the vertical incision is
    easier to make because they just slice through anything in the way,
    muscles most importantly ... it is fast.  The horizontal incision
    tends to be much more carefully done so as not to cut muscles ...
    since the general direction of the muscles is in the same direction
    as the incision this is much easier.  This incision is therefore
    slower and tends not to be used in emergencies.
    
    Because the vertical incision does cut muscles, Doctors are generally
    afraid with a VBAC with a vertical incision that the repaired muscles
    will split apart.
    
    Stuart

    Stuart,
    
    That's interesting. Wendy had a vertical incision, but they had loads
    of time. For her (at least this is what she was told), they did the
    vertical because of where Jacob was positioned, and where the placenta
    had implanted (low and anterior... right where they do a horizontal
    cut).
    
    She was also told by nurses, that verticals heal faster, which makes no
    sense, given what you said. Maybe they were just trying to make her
    feel better. She did heal *very* fast, and recovered extremely quickly.
    Every one is different, though, obviously.
    
    --dave-

    
    
       I have  a tipped uterus also. My first daughter was a unplanned 
    c-section. 13 months later I had a successful vbac and Kimberly 
    weighed 8lbs 14oz. 2 years later I had another successful vbac and 
    14 months after that I had a vbac again.  I had no problems with the
    3 vbac's and I did not push longer than 15-20 minutes with any of 
    them. I "enjoyed" the vbac's more than the c-section because it was
    a much more relaxed atmosphere.
    
    
                           Jill
    

    
    I spent 2 years as an L&D nurse and our C-section rate was about 30%.
    Of all the sections I was involved with (about 3 a week) I never saw a
    verticle incision.  A low lying anterior placenta is the only reason I
    can think of for doing a vertical incision on the uterus. (And you 
    would have to know about it ahead of time)
    
    I don't think vertical is necessarily faster. We did plenty of emergency 
    sections.  The fastest one I ever saw was 30 min from skin back out to 
    skin for a mother who *insisted* on a general anesthetic. It was less
    than 5 minutes from the first incision to the birth of the baby. (And 
    the kid was *still* sleepy and not keen on breathing)
    
    A verticle incistion on a uterus is definitely less stable that a
    horizontal incision.  Another thing I think I should mention is that
    the incision on the skin is not necessarily made in the same direction as
    the incision on the uterus. You would have to ask the Dr. who did
    your surgery to know for sure which way the incision on the uterus
    went.
    
    LaDonna

    Maybe LaDonna can answer these questions:
    
    When they do the incisions for a repeat C-section, do they cut into the
    scar tissue or do they work above or below it?
    
    Is it harder to recover from a second C-section?
    
    L
    

    I can answer the second question on behalf of my wife who had
    3 c/s ... each one got easier and the recovery was better
    each time.
    
    Stuart

    
    My experience has been that they cut right on the previous incision.
    And I recovered very quickly both times. 
    
    I went shopping (mostly to just to get out and about) the day after I 
    came out of the hospital with my first child/c.section, but it's not 
    recommended) and the second time I was out and about the same week I 
    came home.  I wasn't rushing around, I took it easy but I certainly 
    wasn't bed ridden.
    
    I was sort of surprised that the incision was made on the first 
    incision.  But I healed up just fine and still only have 1 scar.
    
    NF
      

    I can't be sure without asking my OB specific questions, but I am
    fairly certain that what I have is a bikini cut, on the surface, and a
    verticle cut under that.  I can only base this upon knowing for sure
    the outside was definitely a left to right, and in the middle of my
    abdomen is a mild depression which goes from naval to pubic bone, which
    makes me believe that is the incision.  
    
    Mine was not a "life and death" type of delivery, just a case of "we
    need to deliver this child as soon as we can gain access to the
    C-secton room".
    
    (and I swore I was going to stay out of this note  :-) !!
    
    Lyn

    Just as an FYI, I have had two back surgeries, which used the same
    point for incision.  I asked the surgeon what he planned on doing the
    second time. (it was a semi-emergency surgery)
    
    What he actually did, inlight of the fact it would be the same route,
    it to cut slightly to one side of the incision, and remove the original
    scaring, leaving the second surgeon two clean sides to suture together. 
    From what I can see it's a fairly smooth even scar.  Possible this is
    what is done with repeat c-sections.
    
    Lyn

    
    Re: subsequent incisions
    
    I think it depends a lot on the state of the existing scar and the
    surgeons personal preference.  If the old scar is pencil thin then they
    usually cut through it.  I have seen them go slightly to one side as 
    Lyn described and then clip the edges together.  If there is a lot of
    scaring (ie the scar is wide) or there are keloids then they will
    usually excise the old scar and make a new one.  In my experience,
    surgeons do not like to leave ugly scars if they can possibly help it.
    Apparantly, neatness counts.
    
    I can't help you with complete recovery time.  I only saw them for an 
    hour or two after the surgery in our recovery room.  Personally, I have
    only had one C-section and it seemed to take a very long time for me to
    get over it.  I seem to remember it was 6 weeks before I was completely
    recovered.  I had painful abdominal muscle spasms for a long time
    after even though I was fairly fit before the birth (swimming twice a 
    week for the last 4 months).  But everyone is different.
    
    
    LaDonna
    

    I've had one birth, via C-section and might have a second child. 
    That's why I asked.
    
    Just so we don't scare all those pregnant Moms-to-be anxiously reading
    this note (don't I know you're there ;-) here's my experience.  The
    C-section went smoothly.  I wasn't comfortable walking much for about 4
    days but the incision healed up well and I had no abdominal pain.  The
    scar was itchy for about a year but now I don't feel it anymore.
    
    I'm ambivalent about VBAC vs. another C-section.  I'd like to
    experience vaginal birth (and hopefully heal quickly) but the thought
    of a long, rigorous labor doesn't thrill me.  
    
    L
    

    Another comment to the 'mom's-in-waiting'....I actually am
    scared to death to have a vaginal birth now....my c-section
    was no big deal....in 3 weeks I was driving a car, vacuuming
    (slowly) and going up and down the stairs since I got home.
    In the hospital after they took out my epidural, they had
    percocet prescribed every 2 hours...I took it every 5-7 because
    it wasn't that bad....I was 31 years old, and didn't do too
    much exercise either....I am still amazed at the comments I
    hear about it taking so long to recover from a c-section...guess
    I was lucky.
    
    I thought it felt more like I did too many sit-ups....really
    no big deal...I thought the 8 week thing was a little long
    to recover but hey, I'm flexible, I'll take it.
    
    I dread hemorroids more than a c-section ! 
    
    hang in there....you'll laugh at all your worry when it's over... 
    
    Kristen

    My wife says she'll take the C-section, thank you, any day over our
    third child's delivery! Children 1 and 2, were born vaginally, with no
    episiotomy and extremely minimal tears (2 stiches each child). Number
    three was another matter. Daniel, already weighing 8 lbs. 15 oz. came
    flying into the world with his hand over his head (born hand/arm
    first), making the total circumference around head and arm (at the
    elbow), the same as if delivering a 12 - 13 lb. baby! She had severe
    tearing, into the rectum, despite an episiotomy. Took her a very long
    time to be anywhere approaching comfortable, either sitting or walking. 
    
    After C-section, she came home on day 4. Days 5-7 we had to take Jacob
    back to the hospital at least once per day (some days twice), for blood
    work, which meant that much more stair climbing in our home to get to
    the garage and car. Lots of walking int he hospital. When Jake was 2
    weeks old we drove to New Hampshire and stayed in a friend's condo for
    4 days. During that time, Wendy had to drive all the way back to
    Worcester with Jake for another blood test (2.5 hrs each way). She
    swam, we took walks and went sightseeing... all with 4 kids along!
    Other than making her more tired than usual, she felt great. She was
    constantly astonished at how well she *did* feel, and how quickly the
    recovery was. Our family practitioner (who is her regular doctor and
    our kid's doctor) told her she shouldn't be surprised. If you are in
    good health, young (she was 32 at the time) and in good condition, you 
    should come through it quickly. We would have no problem with a repeat
    C-section, if we should be blessed with more children.
    
    --dave--
    and easily.

    Laura, your note about "long and rigorous labor" mde me think a
    little....Labor with your second child need not be any worse
    than with your first!  I've heard of dozens of women who had
    long, tiring labors with the first child, but who (relatively)
    breezed through the second labor/delivery.  
    
    I think a lot depends on how well you and the baby tolerated the
    first labor, how the baby is lying, your own physical condition
    throughout the pregnancy, and a lot of other things.  I managed
    my labor without any painkillers at all.  This is not because I'm
    brave or didn't have any pain, it was because I went into labor
    at 8 p.m. and stayed home until nearly 6 a.m. the next morning!
    If I had gone to hospital at 4 a.m., as I thought I might, I would
    have asked for something for pain.  But as it was, by the time I
    got there, things were too far gone for any pain medication to work.
    
    Frankly, if my first labor had been really bad and ended in a section,
    Hollis likely would have been a repeat C.  There are limits.  
    
    Other reasons I decided to try a VBAC:  
    
    	-I already had a fairly demanding 3-year-old at home, and little
    	 if any help available.  James liked (and still likes) to be
         picked up and cuddled, at the time he was still in diapers, 
    	 and frankly, I didn't think I could cope with his demands, the
    	 demands of a new baby, and recover adequately from a C-section.
    
    	-I wanted to give Hollis as long as reasonably possible in the
    	 womb because no one was sure when she was conceived.  I'd ovulated
    	 very irregularly for six months before she was conceived, and the
    	 original due date I had been given was June 6 -- almost 3 weeks
    	 before she ended up being born!  Even after the ultrasound
    	 revealed that she was supposed to be born June 17, I thought
    	 even that was off by 7 to 10 days.  I was right.
    
    	-I just had this gut feeling that I could do it.
    
    This is not to say that the post-partum period was easy.  My after-
    baby blues snuck up on me when Hollis was about 6 months old, and I'm
    just now starting to shake them.  I was sore for a long time, and it
    seemed to take a while to get our romance life back on track.  So there
    is definitely a downside to a VBAC.
    
    I'll be glad to talk to anyone off-line if they want more information/
    support.  The only position I advocate is doing what is best for
    mother, baby -- and the rest of the family, father included!

    RE:  7
    
    When I was preparing for a VBAC for my second baby I took a course on
    VBACS at our hospital and the nurse mentioned that the majority of
    VBAC women she had talked with had the same feeling that they were
    going to "cop out" and have another C section. I really wanted the
    labor/delivery experience that I missed with my first (she went into
    fetal distress very early in my induced labor) but I felt in my heart I
    would have to have another C.  (I didn't).  I delivered Jessie after 16
    hours of hard labor and would chose a vaginal delivery over a C-section
    anyday.
    
    RE:  21 being scared of a vaginal delivery.  I remember very vividly
    leaving LAMAZE class after watching a movie on C-sections with my first
    pregnancy being terriorified of having a C-section.  After watching a
    vaginal deliverly during my second pregnancy I had the same terrorized
    feeling.   
    
    I am really glad I got to have a VBAC with my second.  If anyone wants
    to talk to me off line please give me a call.  DTN 422-7265.
    
    Angie

    For those of you who mentioned being afraid of labor --  there
    might be some trends about how subsequent labor goes, but you 
    really can't predict what one labor is going to be like based on a
    previous one.  Mine were, in order:  hard, ridiculously easy, and
    brutal.  I didn't need medication for any of them, though for the
    last one I think that reflects the total derangement of my mind
    during labor, not any toleration of pain!
    
    --bonnie

    
    I would definately prefer a vaginal delivery over a C-section.  I had
    my daughter by C-section 7 months ago and it was not a joy ride.  I had
    a spinal (would have preferred an epiderual but the doctor would only
    do spinals) and the last 15 minutes of the C-section I felt tremendous
    pain.  I asked to be put to sleep but the doctor said he could not put
    me to sleep.  I grasped his hand the last 15 minutes of the surgery and
    tried to gain strength and not complain.  
    
    When I have my second child I will also have to have a C-section so I
    am already terrified.  I would prefer to be put to sleep so I won't
    have to have a repeat like the 1st C-section.
    
    

    RE:  .26
    
    I'm sorry you had great pain during your C-section.  I had no pain at
    all after my epidural.  I recommend that you discuss this with your
    obstetrician and if necessary, change doctors.
    
    L
    

    
    My wife had a whopping headache after the epidural wore off, but that
    only lasted a few hours. 
    
    Chris
    

    
    re. 26.
    
    A similar thing happened to my friend.  She was terrified to have it 
    done again as you are.  She did a VBAC the second time around and
    didn't have to deal with that again.
    
    My first thought was, you should set up an appt. with the
    anethesiologist (who ever will be scheduled on the day of your
    c-section) and tell that person of your previous experience and make
    it know that you want every precaution taken to avoid that scenario 
    this time around.  I met with mine 3 days before my c-section, just
    to voice my concerns, It only took about 5 minutes, but he put me at ease.
    My spinal (mine wouldn't use epidurals either) was a breeze, I didn't 
    feel a thing.  If the same anethes. is scheduled this time around again, 
    you may want to meet with your ob. first to voice your concerns, and 
    then meet with your anethes.
    
    Let them know your expectations, you're the only one who can voice this
    and take some control.
    
    NF

    Re: Pain even with an epidural
    
    My sister had this too on her 3rd C-section, but not with the first
    two. If I remember my childbirth class info. on this correctly, isn't
    it very possible to have a 'window' in which the epidural doesn't/can't
    block pain. I have heard of this with vaginal/epidural births too.

    re the pain in c-sections...
    
    This is the very reason I had general anesthesia for AJ.  My (I
    believe, but have some doubts) epidural was termed "spotty", meaning
    not all of my abdomen was fully numb.  My feet were numb, my naval area
    was numb, my pubic area was numb, but between pubic bone and naval
    there was a "I sort of feel it" area.  I begged him to do anything but
    put me out, even begged him to use a local on that part of the skin,
    but I lost that battle.  Fortunately I was put out relatively lightly,
    and remember hearing his first cries, and even part of the stapling
    process, and conversations between my OB and my husband.
    
    As for post op recovery, he was born at 4:45p.m., and because I was
    stubborn and refused to allow the nurse to catherize me for urine, I
    walked to the bathroom, to the staff's amazement I might add, less than
    6 hours after the section.
    
    As for fear of a repeat C, yes I was terrified.  I became pregnant when
    AJ was not quite a year old, and that was one of the first thoughts to
    cross my mind.  I guess the pain and recovery were still too fresh in
    my mind.  Fortunate or unfortunate as you see it, that one became a
    very early miscarriage, so the issue never was dealt with.
    
    I was doing a lot of "normal" activities within two weeks of delivery,
    despite the doctors' admonishment not to.  I drove my car (a standard
    shift) on day 8, because AJ was still in NICU and wanted to go see him
    early the morning after my discharge no one was around to drive me.  Of
    course with a newborn there's tons of laundry, especially with a baby
    with colostomy and the things in the learning process of that.  So I
    was doing at least a load of laundry a day.  Our suite was on the
    second floor or a cape style home, Mother inlaws's washer is in the
    basement.  Fortunate though, we wer living with them at the time, so we
    had her to rely on when I needed to rest, and of course she's a
    wonderful cook, and terific housekeeper.  A few things that made
    recovery very easy.
    
    Sorry to ramble, just felt I needed to add some thoughts.
    
    Lyn

I wouldn't mind having another *unplanned* C-sec  %^}   Why?  My roommate
had a planned one, and the make-work procedures the hospital staff was doing
to her just boggled my mind.  I can't remember it all, but I know they shaved
her (practically everywhere!) and restricted her diet (severely!), and there 
was the ever-popular catheter.  It all reminded me of Ed Norton on "The
Honeymooners," when he would get ready to sign a piece of paper--all that arm-
flailing and rolling up the sleeves and adjusting the pen, etc.  Jeez, just get
ON with it!

.31> I was stubborn and refused to allow the nurse to catheterize me for urine

Good for you!  My C-sec was not emergency, exactly ("failure to progress" from 8cm)
but the prep involved a catheter, and I was not in any position  :-) to protest; 
it was done before I really knew it.  The insertion was uncomfortable, but not 
horrendous. THEN when they took it out, they *showed it to me*--Aaarrgghh!  It was
not the delicate threadlike device I had imagined.

So if there's another pregnancy (doubtful), I'd try for VBAC and not mind a last-
minute section.  Just don't book me for the preamble, introduction, foreword... etc.
Glad to hear of someone who fought the "law" and won!

BTW, my spinal was heaven (though curling up during a contraction to receive it
was... well, comical) and I had no headache or "windows of pain".

Leslie 

    More on my planned C-section.
    
    They didn't shave me at all.  No enema.  I think I wasn't supposed to
    eat for a few hours ahead of time, but I don't remember anymore.
    
    I had pre-registered at the hospital so I didn't need to do any
    paperwork or preliminary bloodwork.
    
    I walked into the ward, flagged the nurse, and was placed in a pre-op
    room in the maternity ward.
    
    The ob listened to the baby's heartbeat, and then the anesthesiologist
    came in, gave me a local anesthesia on my back and a pill to relax me, 
    and inserted the epidural.  The nurse inserted the urinary catheter,
    which surprisingly didn't bother me.  Slight discomfort.  
    
    I really appreciated the catheter because I was able to lay in bed
    longer after the delivery.
    
    Overall, I'd rate the whole C-section very well.  I had a horrible
    toothache (later got a root canal) so it's just as well I didn't do
    labor.  The toothache was the worst part of my birth experience! -;)
    
    I did have a severe case of hysterical post-partum 48 hours after
    birth, but I think that was partly due to the toothache.  I'd be
    interested in knowing if anybody else had a sudden, severe post-partum
    reaction after a planned C-section.  I wonder if they are related at
    all.
    
    BTW, Most hospitals don't shave or do enemas anymore.  I would
    certainly ask about that when selected a hospital.
    
    L
    

    
    Re: .28  headache after epidural
    
    I just thought I would make a couple of comments about epidurals,
    spinals and headaches.  
    
    For a spinal anesthetic the drug must be injected around the spinal 
    column into the spinal fluid.  In order to do this, the tough casing 
    around the spinal cord (called the dura) must be punctured with a needle.
    In order to avoid a "spinal headache" the patient must lie flat for 
    (usually) 12 hours after the surgery.  This is because it is possible
    for spinal fluid to leak out of the hole caused by the needle which
    puts a negative pressure on the spinal fluid system. (like a suction) 
    The body can replace lost spinal fluid but not as fast as it can leak. 
    Sitting or standing can increase the already negative pressure on the 
    spinal fluid system which causes what the trade calls a traction headache. 
    Lying flat allows time for the hole in the dura to heal and for any lost 
    fluid to be replaced.
    
    With epidural anestesia, the drug is injected into the small space
    between the dura and another layer outside the dura called (wait for
    it)  the epidura.  This space is called the epidural space.  After an
    epidural, the patient is only required to stay in bed until the use of
    the lower limbs returns.  This is usually about 4 hours.  Because the
    dura is not punctured, there is no leakage of spinal fluid and no
    reason to have a spinal headache.
    
    The problem is that it is a bit tricky getting into the epidural space.  
    It is not an actual space but is a "potential" space.  The two layers fit 
    right next to each other.  This means that it is possible to puncture the
    dura (since everyone is different, the dura is of varying toughness) when 
    attempting to do epidural anesthesia which turns it into a spinal 
    anesthesia.  It is also within the realms of possibility for the anesthes- 
    iologist not to know that the dura has been punctured so everyone treats 
    it as an epidural.  So when the patient gets up 4 hours after their 
    epidural anesthetic they can have one of these horrendous spinal headaches.
    (they are very painful)  I would recommend anyone who gets a headache like 
    this to get back into bed and lie flat or nearly so for another 10-12 
    hours. (Of course, this should always be discussed with your Dr.)  Being 
    horizontal reduces the effects of gravity on the spinal fluid. (instead of 
    being pulled down to the bottom of the spinal cord, the pull is even across
    the whole of the central nervous system.  The headache probably won't go 
    away until the body has manufactured enough spinal fluid to make up for 
    the loss. 
    
    Sorry this went on for a bit.  I hope it explains a few things.
    
    LaDonna 
             

    
    On my C-section the epidural was a very strange experience.  It
    was an emergency c-section.  I remember the anesth. inserting the
    needle (no prior medication for pain) and feeling a burning and
    then he said you'll feel a jolt in your legs now....and no kidding,
    I jumped about 3 times....very strange....but if it wasn't for
    Mitch's heart rate picking up...I was going to get a general...they
    said there was no time for an epidural...
    
    It wasn't until they came later when I was in my room that I
    realized I even had a catheter in me...I never knew they put it
    in.
    
    One of the things that bugged me the most about the epidural and
    I think it was another drug that was given with the epidural was
    that I was so itchy....it was constant...they finally gave me
    some benedryl.  Also, I had my baby in my room with me and I
    kept getting up to feed him and kept pulling out the epidural.
    I'd feel the liquid dripping down my back and have to call the
    nurse all the time to come put it back...what a pain.  I pulled
    it out from where it inserts in a plastic thing that is taped to
    your back.  They told me I needed to stop moving around so much.
    
    But, your not suppose to sleep in bed with the baby and you're nursing
    and the baby wants to eat all the time because your milk isn't 
    fully in....what are you suppose to do?  Get up and down.  
    
    One thing that really pissed me off was when the nurse asked me if
    I was going to keep the baby in the room with me (it was the 2nd
    night) and I said yes.  I had a semi-private room.  She said
    why don't you put him in the nursery so you can get some rest.  I
    said I wanted him with me and she said, "well do it for your roommate"
    Well, you can imagine...I'm full of drugs, tired, bloated and on the
    verge of post-partum blues....let me tell you, I gave her a piece of 
    my mind and said I really didn't care about my roommate (she was 16
    and wore red negliges that were cut to her navel and walked up
    and down the halls with her baby, exposing her enormous chest..couldn't 
    believe it)...I told that nurse that's the disadvantages of a 
    semi-private room and I am not going to send my baby away for anyone....
    and how dare she suggest that I do....well you get the jist...really
    pissed me off.
    
    I also went through some major baby-blues about the 3rd day...cried forever.
    The nurses stayed away from me....very strange feeling not being able
    to control your emotions like that.
    
    enough rambling....Kristen

    C-sections are major surgery. There is greater danger than during
    normal childbirth, and recovery is recovery from major surgery.
    
    C-sections have saved many lives, but there's plenty of evidence that
    they are being overused in this country  -- because of mistaken  medical
    ideas, for the convenience of doctors, even because of the way labor
    is managed in hospitals.
    
    Our eldest was born via Caesarian after 48 hours of labor. Labor was
    horrible (home birth was the plan) , recovery even worse, if possible.
    The next was an attempted VBAC, a 10 pounder who ended up being born by
    C-section.  For the third, my wife gave up and scheduled a C-section. As
    for the others, recovery was horrible, and the baby had lung problems
    -- a result, we believe of premature birth due to the scheduling (not
    that the doctors would confirm this).  
    
    Only the ending is happy -- three great, healthy kids 8, 5 and 3. But 
    while C-sections were essential for my wife, I would be vary wary of 
    them.
    
    Kit

    Just thought of something....if the dr wants to schedule a c-section
    can you refuse and wait for natural labor to start?  I had mine
    because the baby was in distress from long labor and he was too 
    big for my pelvis...he never even got below +2 station...but
    other than that, everything was normal.
    
    I would rather have a big baby, full-term, and by c-section if
    necessary, than be induced early or schedule a c-section early to
    'get him out' before he gets too big...
    
    Kristen

It's astounding how you get nurses who will do that ...  My wife suffered
with "well meaninged" but otherwise "know it all" nurses in all three
hospital trips.  The hitch comes when you get one nurse say one thing, and
no less than 5 minutes later when a different nurse pops in for soemthing
and proceeds to give you a blast for something you were told to do!  Talk
about the perfect ways to induce post-partum depression!  All you are
trying to do is cope with the way you feel (aawful) and a new life whose
only interests are sleeping, eating and crying.

Of course, then you add the Doctor ....

Stuart

    
    Re: .36
    
>    -- a result, we believe of premature birth due to the scheduling (not
>    that the doctors would confirm this).  
    
    Another reason (or contributing factor) might be that statistically 
    C-section babies just have more lung problems that vaginally delivered 
    babies.  Part of the reason is that C-section babies have more fluid in 
    their lungs when they are born than do vaginally delivered babies.  They 
    haven't benefitted (?) from being squished through the birth canal.  A 
    process which wrings most of the fluid out of the lungs prior to that 
    first breath.
    
    I remember thinking when my son was born (C-section) "God, he looks 
    terrible!"  I reached out and touched his feet when they brought him by
    to show him to me before putting him on the "hot dog stand".  He was
    blue and floppy. (He looked pretty pissed-off as well :-))  The C-section 
    was done for an undiagnosed breech position and failure to progress.  No 
    one was in any distress.  Even so, his 2 min. apgar was 4 out of 10. He 
    perked up pretty quickly though and has been healthy as a horse ever since!
    
    LaDonna
    
    

As I understand it, unless it is an emergency, you can refuse *anything*.  And,
even if it is an emergency, I think you have the right to express an opinion.
(I am of course assuming you are conscious and coherent).

I was advised (by my midwives) that there are very, very few *emergency* 
c-sections.  The rest are thought about and talked about before a decision
is made, and the laboring woman and her partner *must* be included in the
discussion.

Even after the decision to have a c-section is made, it takes 15-30 minutes 
to prepare for it.  (In an emergency, they skip a lot of prep, but it still
takes 5-10 minutes).  So, you can change your mind, should labor start again, 
etc.

A c-section is just one more procedure that you have a right to discuss, and
accept or reject.  So is induction.

In my experience, medical professionals will respect and accept your decisions, 
whether they agree or not, if you take responsibility for your medical care, 
actively listen to their expert advice, and make informed decisions.  Some of
them don't like it very much, but they will accept it.

Pat

>>>    Just thought of something....if the dr wants to schedule a c-section
>>>    can you refuse and wait for natural labor to start?

You can try.  I did this for my second child - we knew he was going to have to
be a c-section, but I said I wanted to wait for labor to start rather than
have it scheduled based on the calculated due date.  The doctor kept trying to
schedule it, but I just ignored him.  :)  I did agree to a date that we would
do a scheduled C if I hadn't started labor yet.  It turned out my labor started
at 3 the afternoon before that date.

The other thing is that they may want you to have ultrasounds, etc. when you
get close to your due date if you don't go for the scheduled C.  I think a lot
of this comes from the fact that you've got a surgeon in the picture and they
like to control everything (broad generalization there, I know!).  I found that
it worked out better for me to do most of my discussions with our family
practitioner and let him argue with the surgeon if I didn't like the way the
surgeon wanted to do things.  The surgeon was excellent, and I'm very glad
he did the actual procedure - I just didn't like his attitude of "I'm in
charge here and you just go along with whatever I decide".

							cheryl

    
    For those of you who did have a C the 1st time and had
    vaginal 2nd time - was it like having a baby for the
    1st time? To clarify... Usually with vaginal births the
    2nd baby is easier, quicker to come out - so if you had
    a C you wouldn't have this advantage..??
    
    My 1st was a c.....
    

I am expecting in January and plan on a VBAC. I wouldn't
want to go through a C-section again if I can help it.

Pain wasn't really an issue, I had a spinal and felt
relatively little except some muscle pain afterwards and
I think that was more from the doctor pounding on my
belly to "put me back together" than anything else.
But I really hated being strapped down by my arms and
feeling totally helpless and out of control of my own body.

My C-Section was required due to distress and my husband
and I didn't argue as the baby was 2 months premature and
we wanted to give him every chance possible.  (He is now
2 1/2 and just incredibly energetic).

Actually the most dishearten event was shortly after my
son was pulled out, they increased the anesthesia to start
the closing procedure, and then brought the baby over for
me to see.  I don't remember 1 second of that and I still
well up with tears when I think about it.

    My sister just had her second boy, first was C-section.  She is a 
    riot to talk to---says natural childbirth is the most horrible 
    disgusting thing she could ever go through and she would prefer a 
    C-section.  She said C-section is the easy way out.  2 Weeks later 
    she is not sure which she prefers.  Natural enabled her to get out 
    after 1 1/2 days and get back home to her first born---very important
    to her at this time.
    
    Natural - Labor was bad - Delivery was bad - Recovery was pretty good
                        
    C-Section - No labor - No Delivery - Recovery was bad and longer

    I was told by my doctor that second labor/deliveries via VBAC are
    generally similar to first vaginal births.  
    
    Baby #1, C-Sec, Early Labor, Fetal Distress, 3wk recovery
    
    Baby #2, VBAC, 16 hour HARD labor, shorter recovery.
    
    The advantages I found to having a VBAC are:
    
     I could immediately hold the baby, -- Could not with C
     I was calling friends 1 hour after the birth. -- After the C I was
        in the recovery room for 1 1/2 hours then I was finally returned
        to my room where I was only allow to sit up a small bit.
     I was given a tray of food about half an hour after the birth (With
    	the C I was not given food intil the next day.. That meal consisted
    	of dry toast and tea) AFter 24 hours of not eating I was starving.
     
    The disadvantages>
    
      With the C section I could sit. -- With the VBAC it
      took me three weeks before I could sit without the "donut".
    
      With the C section I did not have any pain..
    
    As I stated before I would definately have another VBAC.  

    .42  When I had my VBAC, the staff treated me as if it was my first
         pregnancy. Several times I corrected the nurses when they said it
         was a first pregnancy. They told me that they new it was a second
         pregnancy, but since I had not had a vaginal delivery they
         considered me "new to the game", if you will. They also said that
         my labor would be as if I were having my first child. It wasn't
         too bad as the whole ordeal lasted about 10 hours.
    
         I'm still not sure which was better/easier. Both methods of
         delivery had their pros and cons. I might have better memories
         of my VBAC if I hadn't had a horrendous cold at the time. Its hard
         to do your breathing excercises when you can't breath !
    

If anyone's still interested ...

My daughter was delivered through an emergency c-section, full anaesthetic.
The cause was "failure to progress" ((sp?) dystocia ) but there were many
little things that went wrong and I didn't have my regular OB for the delivery.
When I got pregnant for my 2nd, I combed the parenting notes files for 
information about VBACs, since I felt that my first delivery had been mismanaged.
When I talked to *my* OB, there  was never any doubt in his mind that I would
have a trial of labour. He claimed that there was a 75% chance I would be able
to deliver vaginally (even though I was a grade B risk pregnancy).  He was
very positive and encouraging throughout. 
When I arrived at the hospital (my water broke and the contractions were 5 minutes 
apart immediately), I had to maintain that same positive, determined attitude that
my doctor had.  The nurse-midwives were saying things like "Are you sure your 
doctor said you could have a trial of labour???" and referring to me as 
"Mrs. Nightingale - she's a previous section" , and asking, with a worried look, 
"Do you feel....epidural-ish?".  Well I plodded along and delivered a healthy
8 lb 4 oz baby - vaginally.  
My c-section was under full anaesthetic so I had a rough time. I couldn't eat 
and was hooked up to the catheter and IV for 3 days.  I felt like my guts were 
going to fall out.  After delivering vaginally, I had a small tear, my rear end 
was sore and I walked like a duck, but I was so exhilerated - I had a full 
breakfast 2 hours later, washed, phoned some people and napped until my visitors 
arrived in the PM.  
Anyway,  I'd deliver vaginally if there was going to be a 3rd time and , I 
would say if you are interested and your doctor is on your side, go for it.

Candace

    Interesting...I've just been reading this (old) string, because I'm
    pregnant with #2, and am a "previous C", too.  The reasons for the C
    were a lack of progression due to a small mom/large baby, and also
    fetal distress caused by the cord being wrapped around the baby's neck
    three times.  After breaking water naturally, followed by 21.5 hours of 
    annoyingly painful, always induced, but never "hard", labor, I was
    actually pretty glad to have the C.
    
    My (new) doctor for #2 told me on my first visit that my chances of
    delivering naturally were 1 in 5 or 15-20%, calling that "good odds". 
    Hmmph!  I'm perfectly happy to have another unplanned C (wait for labor
    to begin and then do it), and my doctor is into "patient autonomy", as
    he puts it, so he's reserving any pushiness until *I* make a decision. 
    He did ask me to go to a VBAC seminar at the hospital, prior to or
    during my Lamaze re-training.  
    
    We shall see...personally, if I wanted any more kids after this one,
    I'd say cut me open and install a zipper!
    
    M.
    

	I have had two VBAC's.  Both my VBAC's were induced.  If I had 
	a choice, Vaginal is much easier.

	First C-Section was due to failure to progress, Ryan was posterior
	head and wasn't going anywhere.  They assumed that my pelvis was
	to small to deliver Ryan (7lb 7oz.).  I didn't think recovery was
	that bad til I delivered naturally.

	When I was pregnant with my second child I was scared to death of
	a vaginal birth.  I wanted my Dr. to schedule the date and do 
	the C-Section.  This was a different Dr. from the first one, and 
	he is very conservative and C-Section wasn't an option.  We
	went through Lamaze again.  I kept telling my Dr. that if I didn't 
	progress this time that I didn't want him to wait the 26 hrs to 
	do the C-Section like they did with my first son.  We agreed that 
	if I didn't progress after 10 hrs.. we would discuss C-Section.

	Well after 12 hrs of pitocin I delivered a 9lb 15oz baby boy, 
	(so much for pelvis being to small).  30 minutes of pushing, I 
	was a little bruised from the size but recovery was 100% easier.

	For my third son, I was started on Pitocin at 9:00, water was
	broken at 9:30, relatively tolerable contractions til 12:30.  
	Between 12:30 and 1:00 I went from 3cm to 8cm, two more 
	contractions I was 10cm.  Pushed twice and Evan was born (9lb 2oz).
	
	After Evan was born I was ready to run around the block, it was so 
	easy.

	What really made me realize how much easier VBAC was, is that I
	had a tubal ligation, the day after Evan was born.  Just having
	the laproscopic (sp) surgery, was a big reminder of how much more
	difficult the C-Section recovery was.  The gas pains, holding your
	stomach when you laugh and cough, recovery of abdominal surgery.	

	If you can do it I would at least encourage you to try.  Talk to
	your Dr. and maybe come to some agreement as to reasonable time
	to let labor try and work.  I can't emphasize enough how glad that
	I was that my Dr. pushed me towards a vaginal delivery.

	Hope I was some help...

	Laurie

	I never had a VBAC, but I did have a CBAV ;-)  My second
	child was a C-section delivery.

	I agree with Laurie.  The recovery from the C-section was
	much worse than my first delivery, even though my first labor
	was 20 hours longer than my second!  

	Even though I recovered fairly quickly from my C-section, given
	an option, I would try to skip surgery.  I especially disliked
	the morphine, and not being able to get out of bed.  I threw
	quite a little temper tantrum about 12 hours after Andrew
	was born because I had buzzed the nurse to bring him to me,
	and she didn't come for 20 minutes.  (Of course, I waited until
	all my relatives walked in the room and "let go" then - wonderful
	timing those hormones have!)  After my vaginal delivery, I
	just walked down the hall whenever I wanted to get my daughter.

	Lastly, the post-surgery restrictions were a bit of a burden
	to me (no driving for 2 weeks, no exercise for 6 weeks, etc).

	Karen

>>	Lastly, the post-surgery restrictions were a bit of a burden
>>	to me (no driving for 2 weeks, no exercise for 6 weeks, etc).

Wow, I had 2 C-sections, and had no such restrictions afterwards.  I was
told to be sensible, basically.  But I was driving as soon as I got out
of the hospital (standard transmission), and doing as much ordinary stuff as I
had time and energy for as soon as I got home.  And I was up walking within 12
hours after each delivery (somewhat gingerly for a couple of days, I admit, but
it seems to me I was getting around normally by the time I went home - I was
only on painkillers for a day or 2 in the hospital).

I did find my recovery much faster after the second C-section, mostly, I think,
because the first time I had 24 hours of labor before the delivery.

					cheryl

	I asked my doctor if I could adjust the 2 week no-driving limit
	and he said I could not.  He said the problem was not with the
	stitches, but with the dizziness that can sometimes occur.  Having
	experienced that even a few days after going home, I understood
	what he was talking about.

	I was up and about the day after surgery, but then flat on 
	my back the next day.  Those pain meds have a way of letting
	us overestimate our recovery.  My cousin ended up on complete
	bedrest one week after her C-section because she did too much
	in the first days after delivery.

	Karen

    
    
    	I had 2 C-sections. The second time around I asked for plain
    Tlyenol with no codeine, instead of the standard pills and shots. 
    I was driving after one week and was doing pretty normal things slowly,
    just no lifting of heavy things until the stitches came out. 
    I didn't consider a VBAC mainly because of the low success rate.
    I'd rather deal with the known than the unknown.
    
    
    Eva

    
    I had 2 c-sections (planned) followed by a VBAC.  HAHA!!  THAT was a
    mistake!  I wanted to "see what it was like".  Well, I think I'd be in
    the minority here, but I likened it to poking toothpicks in your eyes
    ... for oh 12 hours ... or years ... or so.  Never EVER! again!!  If
    I'd had the vaginal delivery with my first baby, he'd be an only child
    (-:
    
    If you go c-section, do it with a spinal.  If you go "natural" ... ask
    yourself Why?! (-:
    
    The driving with the c-section, as was explained to me ... was because
    you can get shooting pains from recovery, and that would be "dangerous"
    while driving.
    
    With both c-sections, I was walking w/in 12 hours.  Not real
    comfortable, and laughing/coughing definitely KILLS!, but it was much
    easier to deal with than L A B O R !!!!!!  Ow!  (-:
    
    Your mileage may vary ...

    Well, I've only had one baby (c-section) and have nothing to compare it
    with.  I was out of bed by 6 hours or so (couldn't go anywhere, I still
    had the cathetar in me).  I was walking to the nursery as soon as the
    cathetar was taken out.  It really wasn't as bad as I expected.
    
    I was told not to lift anything heavier than the baby for the first 6
    weeks and not to drive for two weeks because if I should get into a
    situation where I had to panic break the shooting pains from the incision 
    could interfere with my ability to do just that (similar to what Patty
    said).
    
    sandy

    I'm another who had a CBAV and I thought the c-section took a lot
    longer to recover from. It was unplanned, but due to my failure to
    to fully dilate and the baby being in distress they decided to do one.
    
    I wasn't out of bed till the next day and I thought I'd never walk
    standing straight up again. It was very painful for the first 5-6 
    days but then I seemed to improve dramatically. My doctor told me
    no driving for 10 days and to take it real easy. With my son's
    birth I was up and walking within hours and though I couldn't sit
    comfortably for a couple of weeks I was up and about within days.
    
    Also, the medication I was getting for the pain really knocked me
    for a loop. I was getting shots every 4 hours of I think Demerol,
    and I had some real terrible nightmares/night terrors. Did anyone
    else get these?  I guess I don't have a very high tolerance for pain
    because I decided the shots were worth it. I took percosat for the
    next couple of days and after a week I could manage with just Tylenol.
    
    All in all I'd much prefer to go naturally but you have to do what's
    best for the baby and yourself.
    
                          Barbara
     

I have only 1 C-section birth as experience, but I would
certainly opt for a VBAC.  (Though I hear that women
generally find recovery easier for subsequent C-section
births.)

I only received Percoset for the pain afterwards which
seemed to have no side-effects.  I remember wanting
to go home but I really missed the hospital bed.  I felt
like I had done 300 sit-ups and getting into a prone
position was particularly painful those first few nights
at home.  (I was in the hospital for 4 nights.)

My doc's orders were no driving for 2 weeks, don't lift
anything heavier than the baby, and limit the stair
climbing.

My LaMaze instructor had had both kinds of deliveries.
Her summary went "After a vaginal delivery I couldn't
sit down; after the C-section I couldn't lie down".
I think she had a pretty bad tear from her vaginal 
delivery so her feeling was that neither one was preferable
-- they were just different.