You had a cesarean with your first baby, and now you're pregnant again. Should you plan for another operation or go for a vaginal birth after cesarean, also know as a VBAC? What are some of the risks associated with having a repeat c-section? What makes you a good candidate for a VBAC? We'll give you the facts to help you determine which option is best for you.
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Preggie Pals
“VBAC or Repeat C- Section?”
Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription.
[00:00:00]
[Theme Music]
Dr. Kelly Harkey: You had caesarean section with your first baby and now you are pregnant again. Should you plan for another operation or try for vaginal birth after caesarean, also known as VBAC? I am Dr. Kelly Harkey. I am the medical director of the Women’s New Borns Care Line at Scripps Health. I’m here today to talk about what factors you should consider for making this important decision for you and your baby. This is Preggie Pals, episode 25.
[Theme Music/Intro]
Sunny Gault: Welcome to the Preggie Pals, broadcasting from the Birth Education Centre of San Diego. I am your host, Sunny Gault. Have you joined the Preggie Pals Club? This exclusive membership gives you access to all of our archived episodes, written transcripts of the shows plus some bonus interviews. Have you ever wondered what happens after our interviews are over? Well, we are keeping the mikes open for another 5 minutes after the show. Again, this is only for our member’s and you can access all these great information through the web or through our Preggie Pals App. Visit us at our website, https://www.preggiepals.com for more information. Alright, let’s introduce the panelist that are here in this studio and Christine, let’s start with you this morning.
Christine Stewart: Sure, so, I am Christine Stewart- Fitzgerald. I am 40 years old. [Laughs] in another…soon to be 41[Laughs] yeah!
Sunny Gault: How quickly? [Laughs]
Christine Stewart: In another two weeks!
Sunny Gault: Oh jeez! And you are due tomorrow?
Christine Stewart: I am due tomorrow! So, I think this is gonna be another girl. I have 2 girls, twin girls that are now 3 years old.
Sunny Gault: Do you know for sure when you are having?
Christine Stewart: It looks like, unless there’s a major surprise it looks like, it’s gonna be number 3! Yes….
Sunny Gault: Really? Oh wow!
Christine Stewart: So my husband is way out numbered.
Sunny Gault: There is a lot estrogen in your house! [Laughs]
Christine Stewart: Yes, he basically said that we got a get a big dog with cojones.
Sunny Gault: Right. [Laughs]
Audience: Make up for it. [Laughs]
Dr. Kelly Harkey: You've got your own sorority.
Audience: Yes! [Laughs]
Christine Stewart: So, you know I think I am really excited about this topic because I had a caesarean with my twins and I am looking forward to a VBAC this time around.
Sunny Gault: But it wasn’t a planned caesarean?
Christine Stewart: No it wasn’t.
Sunny Gault: Okay!
Christine Stewart: We did natural un-medicated but, unfortunately fallen in to the trap of failure to progress….
Sunny Gault: Sorry!
Christine Stewart: So that’s what we ended up with.
Sunny Gault: Ya, we’ll talk about that little bit, more later in the show….
Christine Stewart: Yeah.
Sunny Gault: And we have a new panelist. Veronica, introduce yourself please?
Veronica Miranda: Hi, my name is Veronica Miranda. I am 31, I am a graduate student in anthropology at the University of Kentucky and my due date is April 18th, so I have ways to go. This is my first child, my first baby and I actually am still trying to figure out what kind of birth I am gone have. It’s probably a hospital birth. But, I am gonna be doing field work in Mexico, so I have to research my options in Mexico.
Sunny Gault: Oh wow!
Veronica Miranda: Yeah.
Sunny Gault: Wow, okay that’s interesting! Okay! Rachel?
Rachel Gonzales: I am Rachel Gonzales, I am 29. I am a product rep for doTERRA Essential Oils. My due date is April 10th. We will find out the sex of our number two baby, next Friday the October 12th and we are hoping for a home birth. We had a Birth Center water birth with my first, he’s two and half and we’ll see how it goes this time.
Sunny Gault: So you’re first a little boy, right?
Rachel Gonzales: Yes!
Sunny Gault: Okay! So do you have a preference now? I know it is an a weighted question but, I have to ask?
Rachel Gonzales: No I, as long as it’s one or the other, we are happy!
Sunny Gault: Yeah [Laughs].
Dr. Kelly Harkey: So you are happy?
Sunny Gault: Are you? [Laughs] Dr. Harkey have ever seen an in-between? [Laughs]
Dr. Kelly Harkey: No aliens at this point [Audience Laughs] I think she’s in a good shape; she will get one or the other.
Sunny Gault: Okay good, good, okay, thanks for joining us today ladies.
[Theme Music]
[Featured Segments: News headlines]
Sunny Gault: Here’s a look at an article that’s making headlines around the internet. This comes from…. actually I got this from “Circle of Moms”. You guys familiar with that website? I Love that website. There are a lot of good articles on there and a lot of moms talking. But this headlines says, “Miracle Baby Thriving after Mom quote, unquote frozen during pregnancy. So, this is kind of interesting, check this out. There was a 33 year old woman. She suffered cardiac arrest when she was 20 weeks pregnant and otherwise she was a perfectly healthy woman. Doctors kept her and her fetus alive by cooling her to about 90 degrees Fahrenheit which is about 9 degrees below our normal body temperature and she was kept in this condition for 12 hours during which her fetus was actually observed to be shivering. So, I guess, they did an ultra sound or something and saw this. Ultimately, the mom was revived and she was brought back to the normal temperature and she fully recovered. Her baby was born at 39 weeks and basically this is an update, the article is updating the status. The baby has reached a very normal development milestone and is over 2 years old. So anyways [Laughs] when I saw this headlines of course, it’s gonna shock you like, what mom frozen? What is this about!? What do you guys think about that?
[00:05.24]
Christine Stewart: Gosh, I just have to say, I think that’s so cool. I mean, what a miracle of science that you can, I mean help the mom and the baby, coz I think wow! You know, who knows maybe 10 years ago, 20 years ago…
Sunny Gault: What would have happen?
Christine Stewart: Yeah.
Sunny Gault: Right!
Christine Stewart: Yeah.
Sunny Gault: Dr. Harkey, I’d love to hear your take on this? [Laughs]
Dr. Kelly Harkey: Well, I think what we are doing is we are taking some of the knowledge we already know, we know for so many years that when people experience cardiac arrest from hypothermia or for being in cold water or ice long periods of time that you never give up on trying to resuscitate them in to their body temperature comes back to room temperature because they do much better than the people who are normal body temperatures.
Sunny Gault: So why is that?
Dr. Kelly Harkey: It shows your metabolic rate weigh down at those cold temperatures.
Sunny Gault: Okay.
Dr. Kelly Harkey: So you don’t have this same tissue destruction when you’re cold like that.
Sunny Gault: Okay.
Dr. Kelly Harkey: So the tissue is preserved and especially what they were doing here, we are seeing a lot of that now with new borns who have had traumatic births where they are worried about brain injury. They are cooling those infants immediately. They are doing a lot of that in Ready Children’s Hospital here in San Diego and it’s really reducing the incidence of brain trauma.
Sunny Gault: Really?
Dr. Kelly Harkey: Yeah.
Sunny Gault: Okay.
Dr. Kelly Harkey: So that means some of this is still experimental but it’s certainly….. this is just an extrapolation I think of, some of the other things we already know.
Sunny Gault: Yeah, I am very glad that this didn’t harm the fetus, but that would be something that I would be concerned about. It’s one thing about, you know, woman being able to recover from that, a grown woman, would you have any concerns about you know something happening to the fetus?
Dr. Kelly Harkey: I think, you’ve gonna have to see what that long term of effects of this are because often times they are subtle things that we don’t see in until later on in the developmental years but you know, the fact that they were able to do this successfully certainly deserves some attention.
Sunny Gault: Its promise right?
Dr. Kelly Harkey: Yeah.
Sunny Gault: It’s promising. Okay, what do you guys think? Veronica and Rachel, any thoughts on this article?
Rachel Gonzales: Well I just think it’s really amazing. It’s something that I haven’t heard of before and is definitely out of the box from any one of the normal things you hear about but I think it’s pretty awesome that they were able to save the baby and the mom and stay like that but it’s you know, stepping out of the box so do speak.
Sunny Gault: Yeah, yeah for sure!
Christine Stewart: I think it’s really excellent. I would just want to know how accessible this information is to physicians. How if this happen to somebody else, somewhere else….
Sunny Gault: Would they know to do the same thing?
Christine Stewart: Exactly. What they know to do the same thing and then how…. would they know how to do it?
Sunny Gault: Yeah.
Christine Stewart: How, I mean like Doctor….
Dr. Kelly Harkey: Yeah, I am sure this is new stuff and….
Sunny Gault: Yeah.
Dr. Kelly Harkey: This was probably way out on our limb, I would yes! Probably one of the major University settings are….
Sunny Gault: Yeah.
Dr. Kelly Harkey: Big trauma units were they’ve had, you know, some experience with hyperthermia.
Sunny Gault: Yeah, Alright, well thank you guys for sharing this information!
[Theme Music]
Sunny Gault: Today, we are talking about VBAC Versus Repeat Cesarean and little bit of disclaimer, we’re not trying to sway our listeners to choose one or the other instead, we wanna talk about evidence based care, in other words what does the latest research tell us. Now joining us as our special guest expert is Dr. Kelly Harkey- he is an OB/GYN. He is also the Medical Director of Women and Newborns Care Line here in San Diego for Scripps Medical Centre. So Dr. Harkey welcome to the show! Alright…
Dr. Kelly Harkey: Glad to be here.
Sunny Gault: Yes. What do you typically tell your patients, coz obviously you’ve been doing this a while, you have had a bunch of different patients come in and out. If a woman comes to you and she’s had a C-section in the past and she’s trying to make this decision, what’s the first thing you say?
Dr. Kelly Harkey: Well usually I start this dialogue very early in my relationship with the patient’s especially when you do the first new OB visits and you see the patients had a cesarean section, you wanna take the appropriate history and you wanna find out why they had this cesarean, how big the baby was. All the important features are gonna help you guide the patients with this pregnancy and I will start, I kind of open at the door at the first visit. I’d say you know, you can have some choices in this pregnancy, you’re gonna have the choice of considering just repeating a C-section if that’s what want to do, or because of the way your cesarean section happened last time and we can go through some of the what is, or good risk factors in or what are risk factors for not doing another cesarean versus you know, what actual improves you chances of having success with the VBAC and I say you know, having vaginal delivery is probably a still an option for you too. Now a lot other patients know immediately when they’re at their first visit what they want to do.
Sunny Gault: Is it an educated choice or is it just something that they’ve heard or?
[00:10.00]
Dr. Kelly Harkey: Well, I think it’s an educated choice, then I say well Okay, if that’s what you want to do, that’s fine and we’ll have this discussion as we go and if you change your mind fine! You know, some of them just come in and say no, I want no part of labor, I had a enough of with the last one [Audience Laughs] I just want my C-section.
Christine Stewart: Too posh to push. [Laughs]
Sunny Gault: Alright! [Laughs] I have never heard of that, that’s kind of funny!
Dr. Kelly Harkey: Yeah. [Laughs] and the other say you know, I am very interested in having a vaginal Delivery and I feel like I missed out last time and I really would like to commit to that and as long as everything looks like I am a good candidate for, then I would like to head the direction and you try to support that if everything looks good.
Sunny Gault: Yeah, Christine let’s talk a little bit about your situation and why you want try for VBAC. Let’s talk about your background first?
Christine Stewart: Sure, Sure, so I have twin girls and I did an un-medicated birth with them, so it was a 21 hour labor.
Sunny Gault: Okay, then.
Audience: Poor thing.
Sunny Gault: Oh my god! Wow.
Christine Stewart: But I kind of knew what was I going in to, so I can say actual it was bearable and something…
Sunny Gault: How many weeks were you, I am sorry, when you gave birth?
Christine Stewart: I actual carried them full term. I delivered three days before the original due date.
Sunny Gault: That’s amazing!
Christine Stewart: So that’s what I’m learning so much more it is unusual and I think a lot of that its just a there are a lot well we just say perceived risks with multiples and often they are induced it at earlier at 38 or 39 weeks…
Sunny Gault: Right.
Christine Stewart: Which I really decided I wanted to wait as long as we could cook ’em in oven [Laughs]….
Sunny Gault: Exactly. [Laughs]
Dr. Kelly Harkey: Were both of the twin’s vertex or…?
Christine Stewart: Let’s see and you know what, I have to admit as a lay person, I don’t know all the terms but I know they were head down…. [Laughs]
Dr. Kelly Harkey: Head down, both were head down.
Christine Stewart: They were both head down…
Dr. Kelly Harkey: Stop me when I do that! [Laughs]
Christine Stewart: Yeah. [Laughs] they were in the correct…. both correct position.
Sunny Gault: Okay.
Christine Stewart: Yes, In my case they ended up kind of getting wedged and one did not wanted to descend you know first, they were maybe being little too polite. [Laughs]
Dr. Kelly Harkey: How dilated did you get?
Christine Stewart: 10cms fully, yes…
Dr. Kelly Harkey: Did you push?
Christine Stewart: No, never got to that point. So, I think in my case, I think that it probably would have helped if you know, we had someone you had maybe as more experience in me able to help do some hands on maneuvering. Of course, we’ll never know for sure, but I would’ve like to have done a Vaginal Birth and I think the option are in that, and that’s really kind of my motivation now looking for a VBAC, as having singleton I really believe it’s possible and talking with my health care providers. They’ve been very, very supportive in that.
Dr. Kelly Harkey: Well, if you look at the current literature you probably have about anywhere from 60-80% chance of being successfully with the story that you’re….. that you have.
Christine Stewart: Right and this baby's is in great position, so…
Sunny Gault: That’s good news!
Christine Stewart: Yes!
Sunny Gault: That’s really good news!
Christine Stewart: Yes!
Sunny Gault: Yeah, so hopefully next couple of days we are getting some good news from you [Laughs] saying- “it happened!” [Laughs]
Christine Stewart: That’s what I am hoping. [Laughs]
Sunny Gault: It Happened! [Laughs] Dr. Harkey in your experience why; let’s start by talking about repeat C-sections you know, then after the break we’ll talk about VBAC’s. Why do woman want a repeat C-section? What are the some of the reasons? We talked about convenience?
Dr. Kelly Harkey: Right, well I think convenience is certainly one of them. I mean, a lot of moms was with their second pregnancy usually have a smaller child running around at home, it’s sort of in a range of 2 to 3 years of age and so they like the fact that they can plan the date, they can get grandma fly out from New York, they gonna have child care all arranged and you know, just show up on the date that you have planned. I think there’s another set of women who are really called tocophobic or afraid of labor. If they had a bad labor experience with their first one and what they really don’t want is another long labor followed by a C-section.
Sunny Gault: Right.
Dr. Kelly Harkey: I think that’s a big fear in lot of women is, as if they were in 24, 36 hours, had a C-section they go the last thing I want is to be in labor for that long again…
Sunny Gault: Sure!
Dr. Kelly Harkey: and end up in the C-section again.
Sunny Gault: Yeah.
Dr. Kelly Harkey: So I think a lot of commute with that sort of mind set and the other is some cultural. There is some cultural reasons why people want C-sections. If you look at the Brazilian population their C-sections is outrageously high and its mainly because of cultural beliefs down there and when you get those patient up here in The United States, they want what they get at home and they’ll come and ask for an elective C-section.
Sunny Gault: Yeah.
Dr. Kelly Harkey: Even with first babies!
Sunny Gault: Yeah, Christine, are you worried about another long labor?
Christine Stewart: Well, I am not, not I won’t say worried but I guess I am taking a different approach. I mean, I have come to the edge so I know what labor looks like, what it feels like, so I think mentally, emotionally and much more prepared for it and I think you know, I am in pretty good shape physically, so it doesn’t scare me.
Sunny Gault: Yeah.
Christine Stewart: I know I think for me as a first time mom, twins….
[00:15.03]
Sunny Gault: Of twins
Christine Stewart: Of twins, yes… [Laughs]
Sunny Gault: I think it’s a big difference, you can’t stop with anything scary in! [Laughs]
Christine Stewart: It’s yeah! [Laughs] I know I think that the unknown, it is pretty scary and so I guess I want to put the message out there that you know, you can do it.
Sunny Gault: Yeah.
Christine Stewart: You really can!
Sunny Gault: Yeah.
Christine Stewart: So that gives me a quiet a bit of confidence this time around.
Sunny Gault: Of-course, of-course. Dr. Harkey let’s talk about some of the benefits and the risks of having a planned repeat C-section coz I know there is a difference if it’s an emergency, but let’s talk about the planned repeat cesareans.
Dr. Kelly Harkey: Well just to quick aside, I think some of the best information about what we’re talking about today is published in the Practice Bulletin by the American College, which say….. this is group of experts who come together and try to take the best evidence….
Sunny Gault: Right!
Dr. Kelly Harkey: And talk about the very issues we are talking today and these are available to people online. This is…. they can get to this through the https://www.acog.org
Sunny Gault: Okay.
Dr. Kelly Harkey: And this particular practice bulletin is number one-fifteen and it was just re-done in August 2010 so it’s fairly current information.
Sunny Gault: Yeah, we can put that link in our website, so people can refer to it.
Dr. Kelly Harkey: I just think it’s a very good reference that people have done all the works for us. They really have and in this practice bulletin really does support offering VBAC as an option, so Oncologists came out strongly stating that they should be available to people as an option. Going back to the other question which is also addressed in this monograph, when you look at the risk, I think we have comparatively back to the plan cesareans so we know kind of first levels are-including in the monograph I was just talking or referring to clearly there are some benefits to having a VBAC and they are increased recovery time, they have shown that the blood loss or the potential for hemorrhages is less in a VBAC, overall in a C-section. You know, the planned C-sections we talked about gives you some convenience factor.
Sunny Gault: Right.
Dr. Kelly Harkey: The worst category to be in however in terms of complications is attempting of VBAC and then ending up in a C-section and…
Sunny Gault: Which you may not know. [Laughs]
Dr. Kelly Harkey: Well I was gonna say it would be wonderful if you know that ahead of times.
Sunny Gault: Right!
Dr. Kelly Harkey: But you never will, so…
Sunny Gault: Yeah!
Dr. Kelly Harkey: That’s the problem is it you know the VBAC has some advantages, clinically over the planned cesarean section but if you failed the VBAC then you are in the category that has a higher complication right, so makes the decisions making a little more complicated.
Sunny Gault: Yeah.
Christine Stewart: Is it not also when it comes to repeat C-section, I mean as I understand it the more C-sections you have, then your greater risk as well, so if you have one C-section, then okay somewhat minimal risk but if you have further C-sections?
Dr. Kelly Harkey: Yeah, that’s an excellent point and one that should probably make. You know, every time you have a C-section, your next C-section is little more challenging from multiple directions. You have more scar tissue with each time you go in. You have a higher chance of uterine rupture every time that you go through the same scar site and depending on what you’re family planning is; if you’re planning on having lots of kids or you know, more than two every time you go and through the same incision, you increase the chances of having placenta acreda or placental issues that can lead to you know, massive hemorrhage and even death in rare cases. So, you wanted….. the VBAC actually reduces that risk a little bit. By doing a VBAC you kind of open the door to having a safer deliveries in future because you are not running a higher risk of having that placenta adherence and actually going in to the uterus which it can do.
Sunny Gault: Now what if somebody has multiple cesareans and then decides to do a VBAC. Is that an option? Does that, you know, does the risk just sky-rocket at that point?
Dr. Kelly Harkey: Well, you guys have done your home-work!
[Laughs]
Sunny Gault: We’ve got some smart cookies! [Laughs]
Dr. Kelly Harkey: Yeah, you know, this paper actually refers to that too, where for a while you know, people are willing to try one C-section but two C-sections was kind of okay, we are done. This paper really says it in certain instances in carefully selected patients that you can still consider doing a VBAC after two cesarean deliveries. Now your risk of uterine rupture goes from about 1% to about 4% with the second C-section. So, the risk of having an advent curve is higher. As long as you have the discussion and you both agree that the risks is acceptable, then that is something that you could offer. A lot of our data from multiple C-sections and having VBAC’s comes from big institutions like LA County General Hospital where they would get somebody who had 6 C-sections and roll in and would delivery the 7th baby on the table! [Laughs]
Sunny Gault: Wow!
Dr. Kelly Harkey: You know, and so in they fall data back you know they look at uterine rupture that’s what some of these numbers come from.
[00:20:11]
Sunny Gault: So it’s skewed a little bit, it’s not…
Dr. Kelly Harkey: Well, there you know, everything is possible. I mean, you know, you gonna have somebody you has 5 C-sections and can have a VBAC, that’s gonna be exception to the rule.
Sunny Gault: Yeah.
Dr. Kelly Harkey: And you are going only really see that. Nobody’s gonna plan that obviously, but you see it in some of these big centers just happens and the uterus stays intact, so really you know, everybody heals a little bit differently you know, it’s just some of the numbers are what they are. They give us some guidelines, but everybody is in an individual you have to kind of look at their particular risks.
Veronica Miranda: Dr. Harkey, I have a question about actually talking to your doctor and how to talk to your doctor about let’s say- your, this is your choices and options for a VBAC? So you have a medical Literature out there but then you also have to take the time for doctors to start practicing the Medical Literature. So how The United States still is has a high cesarean rate worldwide, it’s higher than the World Health Organization says it’s healthy….
Dr. Kelly Harkey: Right.
Veronica Miranda: So, how realistic is it for you to go and sit and talk to your doctor and your doctor not pressure you?
Dr. Kelly Harkey: I think you should do exactly what we are doing this table today. You should be informed. I mean, you should go in to your doctor with some knowledge of what you want ask and what you expect discussion to contain and you guys I mean, you guys are asking great questions, that is the questions you should ask your doctor too. Now clearly you are gonna run in to practitioners out there who just don’t VBAC’s anymore and…
Sunny Gault: Why?
Dr. Kelly Harkey: Well, a lot of the times it’s because they have had one bad outcome or they’ve had one bad lawsuit. I mean, there’s a lot of pressure to deliver the perfect baby and there are just practitioners now who’ll not go out on that limit anymore. They are just not going to take that risk in, you should probably find that out in beginning. I mean, ask the doctor straight out- you do VBAC? And if they tell you no, then you know what you are going to get. You are gonna get a talk in to a repeat C-section [Laughs], I think some of the bigger groups like Scripps Clinic which I belong to, we are trying to practice ethical medicine. We try to do what we think is right for the patient and we’ve set up our practice such that we always have 2 doctors and at night time we have a 2 doctors and a mid-wife always in the hospital so that there’s always someone there to attend to an emergency like uterine rupture. The other thing you can encounter in some of the smaller communities are hospitals that have just stopped doing VBAC’s period. They just won’t allow them and you need to know that too, cos you may have doctor who would do VBAC but he’s taking to hospital where you can’t and again those for due to legal pressures. They are due to fact that they don’t have the appropriate personal in the hospital to respond to immediately if something bad happens like uterine rupture. So it’s a great question and you really wanna get upfront with your doctor from very beginning cos you don’t want to find that out at 36 weeks that, you know, you thought you are having a VBAC and guess what there is no protocols in that hospital to allow that to happen.
Sunny Gault: We are gonna take a break and when we come back we’re gonna explore more about VBAC’s. We are gonna talk about some of the benefits and the risks associated with VBAC’s. We’ll be right back.
[Theme Music]
Sunny Gault: Alright and we are back. Today we are talking with Dr. Kelly Harkey. He’s an OB/GYN at Scripps La Jolla and we are talking about whether you should have a repeat C-section or go for VBAC. So Dr. Harkey what types of woman are good candidates? What makes you a good candidate for VBAC now?
Dr. Kelly Harkey: Well, when looking at the history of as to why these cesarean sections happened the first time, it gives you some clues as to how successful you might be with the VBAC. Then that the biggest probabilities of success through the strong predictors of being successful are…. there are two that kind of stands out. One is that you’ve had a part of vaginal birth in addition to your C-sections. Those woman tend to do very well cos they have already have sort of proven pelvis if you won’t and the other is if you can it all have it happen and again some of this out of your control as you want to come in spontaneously with your VBAC, cos it gives you much higher chance of being successful with rather than the induction. Things that are not good predictors are that the fact that your first cesarean section happened from a “Dystocia” that is pelvis is too small, baby is too big, that sort of…. it doesn’t rule out VBAC but its better if you had the first C-section for breach or fetal tracing issue that you never really got the try your pelvis….
Sunny Gault: Right!
Dr. Kelly Harkey: So you don’t really know you know what the dimension are…
Sunny Gault: Yeah, cos your pelvis probably isn’t gonna change, I mean I know It kind of expands a little bit but at the same time it’s pretty much what you’ve got! [Laughs]
Dr. Kelly Harkey: Exactly!
Veronica Miranda: How common is that? How common is it for you to have small pelvis and a big baby? I mean…
Dr. Kelly Harkey: Well, I mean it’s all relative. I mean, we always talk about the three P’s in obstetrics, it’s the passenger, the pelvis and the power [Laughs] and it’s a passenger you really can’t change the weight of the passenger, it is what it is! The pelvis is a fixed dimension as well, so in a labor process you know the only thing that I have any control over is the power or that is this labor adequate to try and keep things move in and you know, you can have a woman with a good pelvis, if she’s got a 10 pound baby there could still be a dystocia or in ability to get that kid through that and she could have an eight pound baby next time and do very well with that and you see that sometimes. You’ll see a baby with a syncletic come in right angle where too big on the first time around and the second time they make it look easy, with little bit smaller baby who want to comes to pelvis you know the right sort of the right angles you need.
Sunny Gault: But isn’t it hard to tell like how big your baby really is, I mean with ultra sounds and stuff?
Dr. Kelly Harkey: It’s very difficult with the technology that we use today. The ultra sounds in turn can be off plus or minus a pounds so that are yes, I mean as an obstetrician we haven’t done so well in the literature either we are guessing. But you know often times you can tell is this a really a small baby or is this a really big baby and is the baby’s in-between you have trouble guessing.
Sunny Gault: Yeah.
Dr. Kelly Harkey: Sometimes it’s very clear with ultrasound and you know outside measurements you allow this kid, this kids is fully over- you know 4500 grams and we got an issue here.
[00:26:36]
Sunny Gault: Right!
Dr. Kelly Harkey: But let me go back to the other predictors that are decreased probabilities of success, statistical includes increased maternal age, non-wide ethnicity, gestational age, its gone past 40 weeks or if you have gone passed your due date that decreases your chance of having successful VBAC as well.
Sunny Gault: Why, why does it?
Dr. Kelly Harkey: Probably I am not sure on the, I probably is placental sufficiency thing, that is this placenta gets older it’s just not going to tolerate labor as well, and also probably because there’s probably a reason that you haven’t gone in the labor earlier, that maybe there’s a size, you know pelvis disassociation again.
Sunny Gault: Okay.
Dr. Kelly Harkey: Obesity is a risk factor for not doing well with VBAC. History of Preeclampsia or blood pressure issue’s and short intervals between pregnancy and I am not really sure why but statistically if you have your kids close together you have less the chance of having a successful VBAC and then increase Neo-Natal birth weight which we have already talked about.
Sunny Gault: Okay, what are the odds if we you know, seem to be a good candidate for VBAC, what are the odds that will have a successful VBAC?
Dr. Kelly Harkey: Well there have been a lot of studies done obviously and when you sort of take the overall sort of rain is it the study shows you, pretty much it’s between 60 to 80% success rates, if you’re a good candidate.
Sunny Gault: Okay.
Christine Stewart: Okay.
Sunny Gault: It sounds good Christine [Laughs] as promised!
Christine Stewart: I am happy, yup [Laughs]. You know, and I think all I have to say one of the things I am doing this time around differently is that when I had my twins you know, I’ve….. since I have learnt so much that mobility and movement really helps you know get baby’s moving going down, so the last time around I was pretty much sitting on hospital bed the entire time….
Sunny Gault: Yeah.
Christine Stewart: Which really doesn’t help so, this time in my birth plan I am really planning on getting up, walking around, moving around using a birthing ball; taking as many pro-active measures as I can to really help the babies move, so I am really hoping to have a different outcome.
Sunny Gault: You think that, that could help Dr. Harkey?
Dr. Kelly Harkey: Well as you know, I am married to a mid-wife so…
Sunny Gault: That’s right, I didn’t tell our listeners but yeah you probably have to perspective on that [Laughs].
Dr. Kelly Harkey: And I watched her have both of our children, my two youngest children naturally and she used all those techniques quite successfully so and I have watched a lot of patients. I think that all patient should use a technique that are comfortable with. All support I think is a good support. I hope you do very well.
Christine Stewart: Thanks! [Audience Laughs]
Sunny Gault: In General Dr. Harkey, what advice do you have for women out there that are kind of on the fence that are trying to determine which one to presume?
Dr. Kelly Harkey: Well, again I always, I never try to make decision for my patient. I don’t think that is my place. My place is to provide them with as much information as I can, answer their questions, let them choose and then be very supportive of whatever it is they’ve chosen. Nothing is sensed down here. I mean, a lot of woman will do that. At the very last minute they’ll decide that they want to go one way or the other. We’ve had people who have had their C-sections scheduled for next week and they come in great labor. They are 6cms and you go- do you really wanna a C-section? [Laughs] you got one there.
Christine Stewart: Yeah.
Dr. Kelly Harkey: And you know, and some of them say yeah, I guess I’ll do though and do fine you know, and you’ll have just the opposite that the people planning their VBAC will go, I have changed my mind, now I wanna my C-section. So, it goes both ways and I think that you know, you have let them do that too, have that last minute decision making change if they wanted and just be supportive of whatever they wanted to do and your job is to provide them with information to make that decision.
[00:30.32]
Sunny Gault: Alright, thank you guys! This was a great conversation and thanks to Dr. Harkey for being with us today. Of course, there is so much more to discuss when deciding whether VBAC or repeat C-sections is best for you, so we’ll be continuing this discussion online on our Facebook page and also through Twitter. If you are posting to Twitter be sure to use the hash tag Preggie Pals.
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[Featured Segments: Ask The Experts]
Sunny Gault: Before we wrap today’s show, here’s a question for one of our experts.
Caroline: Hey Preggie Pals, this is Caroline from Cajahoka Falls, Ohio and I have a quick question about drinking alcohol during pregnancy. Before I got pregnant my husband and I really liked having a glass of wine with dinner or while we are sitting relaxing watching t.v. and I don’t have that glass of wine anymore but really there is so much information out there with different opinions from different experts about benefits of having maybe an occasional glass of wine while I’m pregnant. So really I just want to know what the really information is. Are there any health benefits to drinking wine or to having any other types of alcohol during pregnancy? Thanks!
Dr. Kevin: Hi Caroline, this is Dr. Kevin I just wanted to thank you for your question. It is a great question. It is quiet controversial. I’ll let you know what the current imitation by the American Congress of OBGYN stance says the currently say no alcohol during pregnancy. The big question is we don’t know how much alcohol is needed to cause a condition called Fetal Alcohol Syndrome. That condition is very devastating and we don’t know what level of alcohol can cause, so the current recommendation is again you are in the US by ACOG is no alcohol. Having said that you are correct, they are several European studies that have said that there are maybe some benefits to an occasional glass of wine. There is a French study that says that maybe a decreased rate in maybe ADHD in sons is born to women who have an occasional glass of wine. Having said that because of the fact that nobody is really gonna do a blind randomized study and give woman alcohol and then test the effect on their children, in the US again the current imitation is no alcohol. I hope that helps, I hope you have a great pregnancy and if you have any questions, give us a call. Thank you so much, bye!
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Sunny Gault: If you have a question for one of our experts, call the Preggie Pals hotline at 619-866-4775 and we’ll answer your question on our future episode. That wraps up our show for today. If you have a question or a comment about our show, we would love to hear it and for our regular listeners don’t forgot to check out the Preggie Pals Club. You can learn all about it on our website which is https://www.preggiepals.com . Alright, coming up next week, we are continuing our ongoing series focused on child birth preparation methods and we are focusing on the “Bradley Methods”, so thank you for listening to Preggie Pals- Your Pregnancy Your Way!
[Disclaimer]
This has been a New Mommy Media Production. Information and materials contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though such information in which areas are released to be accurate, it is not intended to replace or substitute for professional, medical and advise or care and should not be used for diagnosing or treating healthcare problem or disease or prescribing any medications. If you’ve questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified healthcare provider.
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