MSE Parents Club Part 3

MadDogWoman_2

Hi Elle,

That is fabulous news, lovely to hear that they are talking of WHEN

You've been in my thoughts.

Re milk supply: Oats and fenugreek are good, also make sure you are keeping hydrated.

If it's allowed try and get lots and lots of skin to skin with him as it will encourage milk and feeding.

MDW

BrunoM

We had a swing chair that for the life of me I cannot remember the brand as a swing, he liked it for a week or two and that was it, never again. However, it was of a sort where the chair section lifts off the swing and can be a stand-alone rocker chair, which he likes and is very useful for lockdown while nipping to make some breakfast or similar! He has just worked out how to get out of his Bumbo so all the more reason for a convenient portable chair with straps...

He slept through the night again! - ish - he did in fact stir twice for loud and protracted grumblings, one time at 3am I got as far as his door before he went quiet again... but in the end we got up at 6.20 with him having done another 11 hour stint without a feed or any need for comforting back to sleep.

OH woke up twice panicking because she thought she'd been feeding him and he had vanished from her side when she dozed off! So even if he doesn't really need night feeds any more we'll still be dreaming them for a while it seems...

keelykat

These light mornings are annoying,even with a blind and curtains there's too much light coming through and Elliot keeps getting up at 5:30-6am (i don't like early mornings lol).

Today my hubby has left before 6am to do the elections, so i won't see him untill about half ten maybe 11 tonight gonna be a loooooong day! Oh well, best get my mom a birthday card and pressie and take Elliot for a walk around the park or something.

Yawwwwwwwwwn!!!!

keely.

ladybirdintheuk

Bruno - I've done that so many times! Or I've been dreaming I was feeding her, and then started to say to izzy "that baby sounds just like you" then realised!

3 - Is it worth speaking to your HV about starting weaning? She sounds even hungrier than Izzy was when we started weaning.

Lu_T

3 - we didn't do BLW and I got an NCT book off amazon called First foods and weaning. it's just a booklet really butit has a good schedule about what meals to give at what stage, how much and some handy recipes. i'll be using it again this time.

Caz - Imogen went thru a stage of staring up at trees. She loved the light through the leaves. Strange child!!

Sami - sending labour vibes to you.

Anyone know anything/have experience of water births after c-section? It's what I'd like but want to do some research before I see consultant in 2 wks. Weezl, Susan - any idea on scientific/medical sources? TIA

ETA - Elle - mega news about Rhys. So glad he's making progress. A friend had a prem baby and was told 30 days is a magical number so will keep everything crossed for the next 10 days or so. Kangaroo-care (skin-to-skin where you carry/cuddle them on your chest) is also meant to be great if you're able to pick him up. But I'm sure they're advising you about all of this. Love the mention of 'when he goes home'. Hang on to that hope xx

weezl74

Lu T oooh thanks for the challenge, I love a bit of research!

The likelihood of a successful VBAC depends on a few things about your obstetric history.

It might therefore be useful to know:

at what point in your labour did you have your prev section, and what was the reason for it?

Tell me to butt out if you'd rather not say!

Lu_T

Weezl - not at all! Thanks for the offer. Imogen was back-to-back and after a 5-day off & on labour & 17 hours established I'd only got to 9.5cm. Therefore the official reason for my c-section was failure to progress. At my 16wk appt with the consultant he said there was no reason why I couldn't have a VBAC, but I spent some time in the pool last time and know this helped, so would love to have a waterbirth this time around.

I'm also planning on refusing continuous monitoring and there's something called the Cochrane review which supports the fact that continuous monitoring in VBACs (as recommended by NICE) actually increases the incidence of another c-section!

Am meeting consultant on 16 June, so just gearing up for some major research so I'm armed! MW calls him 'God' and that's how he seems to think of himself, so I'm hoping he's my only obstacle. Has anyone met with the Supervisor of Midwifes before delivery to discuss a 'different' birthplan?

chocaholic110

We bought a Rainforest swing from ebay for £40 and resold it for £40 so in effect I didn't pay anything for it. Just as well really as Tom wouldn't go in it. Then again he wouldn't go in his bouncer / pram / pushchair or anything really until recently when he is now happy to go in the pushchair or his smart-trike.

To all the people who have never dropped / injured their babies, I would add a "... yet!" to that statement as I think something happens to every baby at some point - just wait until they start walking! Mind you, I do think some babies are more accident prone than others; Tom is very adventurous and very clumsy - not a good combination! DS was very clumsy (dyspraxic) but wasn't adventurous and DD was very adventurous but also very agile and I don't remember them having as many bumps and bruises as Tom has had. I haven't dropped Tom but 10 year old DD was holding him one day and dropped him. Don't know how I did it but I dived across the room and caught him before he hit the floor. Must be a mother's instinct as I couldn't have caught a ball like that!

Elle - fab news! I'm really pleased for you all!

Breastfeeding - I think Tom was permanently attached to me until he was about 6 months. He still loves breastfeeding now and the not feeding during the day was short-lived as I gave in when he was poorly and haven't managed to stop again. He only asks when we're in the house though so it's not as bad as it was, having my top pushed up in public by an insistent baby! Considering I was stopping feeding at 6 months, 12 months, 15 months etc though we're still showing no signs of stopping and I'm getting a bit sick of hearing "he'll still be doing that when he's at school"

weezl74

Lu_T wrote: »

Weezl - not at all! Thanks for the offer. Imogen was back-to-back and after a 5-day off & on labour & 17 hours established I'd only got to 9.5cm. Therefore the official reason for my c-section was failure to progress. At my 16wk appt with the consultant he said there was no reason why I couldn't have a VBAC, but I spent some time in the pool last time and know this helped, so would love to have a waterbirth this time around.

Hi Lu,

Preliminary research looks promising, I've highlighted the bits that seem good! It seems to depend on whether 'God' decides that your 9.5 dilation last time counts as full dilation, or 9cms dilation. This seems to make a difference cos getting to full dilation and then halting might mean something about your pelvis size, whereas getting to 5-9cms means your cervix does efface and dilate well, but a malpresentation (like your back to back) lead to maternal exhaustion and excessive pain. From your history, I personally would argue that your cervix is up for it, as long as difficult presentation doesn't scupper things!


'Some studies have found that your chances of a vaginal birth after caesarean depend partly on how far the last labour progressed before the caesarean was performed. If you had any degree of dilation at all then, next time around, dilation up until that point at least should progress more smoothly.

• 67% if the woman's previous c/s had been performed at 5cm dilation or less
• 73% if c/s performed at 6-9cm dilation
• 13% if c/s performed at full dilation.

It concluded: "Patients who attempt a VBAC may be counseled that a cesarean delivery at full dilatation is associated with a reduced chance of a subsequent successful VBAC"

However, the next study looked more closely at women who had caesareans for their first babies, specifically for lack of progress in the second stage of labour. This was often after a failed attempt at instrumental delivery (ie with forceps or ventouse). It reached quite different conclusions.


Vaginal delivery after previous caesarean section for failure of second stage of labour.

The study looked at 103 women who attempted a VBAC after having a caesarean in the second stage of labour. The VBAC rates were:

• 80% overall, for women who reached full dilation in their first labour
• 75% for women who reached full dilation last time and had a failed instrumental delivery.

Conclusion: “In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.”
Medline abstract: Jongen, Halfwerk, Brouwer (1998)


Lack of progress in the second stage might be treated as a sign that the baby was really too big to be born through the mother's pelvis - that there was true cephalo-pelvic disproportion. After all, if the cervix is fully dilated, what's stopping the baby from coming out? And if she has a failed instrumental delivery, so even forceps of ventouse could not make the baby budge, what else could explain it?


Perhaps the mother is exhausted and unable to push, perhaps she is in a position which reduces the room for the baby to be born (eg on her back or propped up), or perhaps her body is simply taking a long rest - a 'latent phase' before pushing the baby out. Perhaps the baby was in a difficult position, such as posterior or face presentation. Perhaps the baby went into distress for some reason, and needed to be delivered immediately. Many of the possible explanations are things that need not be repeated for the mother's next birth.


So why did these two studies reach such different conclusions? UK obstetrician Danny Tucker (of the Women's Health website) said "Something tells me that it has something to do with the differences in labour management between University Medical Centre, New York and practices in the Netherlands" (post on misc.kids.pregnancy newsgroup)
What was the reason for the previous Caesarean?

The study by Hoskins and Gomez mentioned above gave more details about what the previous c/s was for, compared to the VBAC rate for the next baby. The VBAC rates were:

• 73% if the previous c/s was for malpresentation
• 68% if the previous c/s was for fetal distress
• Between 13% and 73% if the previous c/s was for an 'arrest disorder', ie slow or no progress in labour, as discussed above - depending on how far dilated the woman was when her c/s was performed.

Attempt and success rates for vaginal birth after caesarean section in relation to complications of the previous pregnancy

Holt VL, Mueller BA
Paediatr Perinat Epidemiol 1997 Jan;11 Suppl 1:63-72
This study looked at 10,110 in Washington State, USA, who had a caesarean for their first baby. The women most likely to attempt a VBAC with their second child were those whose first c/s had been performed after induced labour, for genital herpes, for fetal distress, or for breech presentation. On the other hand, the women whose first c/s was for a large baby, apparent cephalopelvic disproportion, prolonged labour, diabetes or problems with the placenta, were less likely to attempt a VBAC.
This means that the group of women who attempted VBAC is not fully representative of all women who have had a caesarean - arguably, the women who might have been less likely to have a VBAC, did not attempt one. Overall 64% of the women attempted a VBAC, and of those women, 62% did give birth vaginally. Of the women who attempted a VBAC:

• Half of women whose previous c/s had been for a large baby, labour problems (eg slow progress), or chronic medical conditions, gave birth vaginally.
• Three-quarters of women whose c/s was for breech presentation or problems with the placenta, gave birth vaginally.'

.....and I've read somewhere that 'the geeks shall inherit the earth....' or perhaps I misheard...


PS Sami, happy EDD plus one, lots of love and luck to you m'dear

weezl74

sorry Lu just realised there's an extra component here... Are you saying you're def. gonna be in consultant-led care this time, ie he gets to say if you are in water or not, or can you still choose mw led or homebirth and therefore definately have water if you want?

Does the consultant-led unit have a birthing pool? Is it first come first serve? How far is it from theatre? I ask this because if they enforce consultant-led care cos of last times FTP, they'll be mostly doing it out of (probably v misplaced) overcaution about uterine rupture, and therefore would want to get you to theatre asap...

PS here's a linkie to a birthstory about a home waterbirth after a section...