PREGNANCY-BIRTH Messages for April, 1999: c/s or vbac?

c/s or vbac?

From: hanna

anonymous@obgyn.net

Mon, 12 Apr 1999 10:22:29 -0500 (CDT)

****Thank you for getting back to me Dr. Hill. Just a few more questions if you don't mind.;-)

At Tue, 30 Mar 1999, D. Ashley Hill, M.D. wrote:

>To my knowledge there have been no studies directly looking at uterine prolapse and VBAC. It is probably no higher or lower than a "regular" vaginal delivery.
****I would have to agree with you here, but I would think if there were studies done on pelvic prolapse, it could give a better idea of who is at risk. My records show that I had a small pelvis with converging sidewalls (I was NOT told this before the delivery) My delivering Doctor had never met me before so I don't think he was aware of this either. I think if I had been told I had a small pelvis, I could have told him and he would not have let me labor so long.

Just curious, have there been ANY studies that give statistics on women w/ small pelvis that develop a prolapse after a vaginal delivery? or instrument assisted delivery?

>I want to be very clear that I am not arguing with your assessment of your labor and delivery. However, every day I hear "horror stories" about labors that were "too long," etc. When I review the records, this is rarely the case. Patients often have perceptions about their labors
and deliveries that are not always based on scientific evidence. *****I was in labor for about 18 hours which in itself is not that long. Just curious, would you consider 10 hours at 9cm too long with second baby? During this time I had a fever from 101 to 102.5 (while on meds for it) and the baby was in trouble twice. Not sure if it matters but pitocin was being used. What would you have done?

>And, despite what is published in many women's journals, pregnancy can be extremely hard on a woman's body.
****no doubt!!! ;-)

As you suggest, vaginal prolapse is fairly common after vaginal delivery, VBAC or otherwise. The only real way to prevent this is to not get pregnant. Obviously, this is not acceptable to most couples. Thus, many women end up "carrying" the results of their pregnancy for many years. ****Most days I would say it was worth the risk, but then again...

****I am curious what is considered a successful VBAC delivery? Would this be considered a successful VBAC even though as a result I will need additional surgery that is more complicated than a repeat c/s would have been?

And one more question (sorry !) What would you recommend for my next (and LAST!) delivery, my ob/gyn is open to whatever I decide but would like as many opinions as I can get. I do plan on resuspension surgery to lift the uterus and bladder when the time is right and I am afraid that another vaginal delivery will bring things down too far for that to be possible. What are your thoughts on this? Can uterine prolapse get to the degree that suspension surgery would not be recommended? Again, I am just looking for opinions.

Once again, thank you for taking the time to respond to my post!!!

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