The Business of Being Born Message Board

Q: When my son was born, I desired a natual delivery. I labored on my own at home for about 8 hrs, then went to the hospital where they put him on an internal fetal monitor and did not allow me to move around at all. His heart rate would drop during each contraction and it appeared to get worse over time. They finally decided to do a c-section and found that the cord was wrapped around his neck three times. He was fine though. It sounded like I could not have had him vaginally. What do you think based on the above information? I was would like to do an alternative VBAC with my 2nd child but I am little scared to put the baby at risk should something similar occur.

A: The first part of your question asks if it would have been possible to deliver vaginally. That is impossible for me to say without having been there. When the cord is wrapped around the baby’s neck (called a “nuchal cord”) we often see dips in the fetal heart rate. The important thing is that overall, we find the heart rate reassuring. This means that even though there may be some dips, the heart rate pattern still has other components that indicate the baby is doing well. In that case, yes, a vaginal delivery is possible. When those signs are not there, it is necessary to deliver surgically. This is a very real reason to do a cesarean section. “Fetal distress” as a reason for a cesarean delivery may be overused, but it is impossible for me to say if this was your case. However, good for you for laboring at home for so long! You should be very proud of yourself for each of those contractions you got through.

Absolutely consider having a VBAC. The success rates of having a vaginal birth depend on various things, one being the reason you had your first cesarean. In your case, it sounds like the reason was due to the baby and not your body. “Fetal distress” versus “arrest of dilitation” (stopped dilating). This bodes well for you in the future. The chances of having another problem with a nuchal cord should not weigh into your decision. It is healthier, under normal circumstances, for a woman to begin labor even if the end result is another cesarean. There are physiological processes that occur with labor that benefit both mom and baby.

Make sure that you have a copy of your surgical report. It is important for your next health care provider to see the type of incision that was made. You can have a trial of labor with a horizontal incision but not a vertical, or classical, one. The Classical incision is associated with a higher rate of uterine rupture. Chances are extremely high that you had a horizontal incision but it is helpful for the health care provider to know that.

Also, when it is time for baby #2, please ask your health care provider what his/her rates of VBAC are, as well as his/her philosophy. Look into the hospital rate as well. Do your research.

Having a cesarean birth can be disappointing if you wanted a natural birth. Although thankful for the health of your baby, you may be left with feelings of anger, frustration, doubt… It is helpful to talk through this as much as possible and to know that you are not alone. Look into your local La Leche League for a support group or search for an online group.

Take care,

Hilary Prager, CNM, MPH
Women’s Health Liaison and Public Relations Chair for NYC Chapter of ACNM
www.nycmidwives.org