WEBVTT - 114. Quick Kick: Am I a good candidate for a VBAC?

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<v Speaker 1>The information in this podcast is provided for education and

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<v Speaker 1>research information only. It is not a substitute for professional

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<v Speaker 1>health advice.

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<v Speaker 2>Welcome everyone, I'm Rigid Maloney, and today I've got a

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<v Speaker 2>bit of a different format for you. Every now and then,

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<v Speaker 2>we're going to add in what we're going to call

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<v Speaker 2>the quick Kick. Now, this is where Pat and I

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<v Speaker 2>have chosen snippets from our entire catalog that we may

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<v Speaker 2>not have dedicated an episode to yet, but they answer

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<v Speaker 2>a commonly asked question that need an immediate answer. So

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<v Speaker 2>we're starting off with one that we often get asked,

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<v Speaker 2>and that is who makes a good v back candidate.

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<v Speaker 3>So if you've press play on this quick kick, you've

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<v Speaker 3>possibly had a.

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<v Speaker 2>Previous caesarean section to birth your baby, and your thoughts

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<v Speaker 2>are now turning to how you're going to birth the

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<v Speaker 2>next baby.

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<v Speaker 3>I want to start first with a quick definition.

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<v Speaker 2>A V stands for vaginal birth after cesarean, and another

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<v Speaker 2>term you might hear is TOLAK, which stands for.

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<v Speaker 3>Trial of labor after cesarean.

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<v Speaker 2>Feedback has its own set of considerations which Pat and

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<v Speaker 2>I talk about, using a patient's story as an example.

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<v Speaker 2>The full episode is number thirty four which will be

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<v Speaker 2>linked in the show notes. But for this quick kick,

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<v Speaker 2>we've honed in to one of the most important questions

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<v Speaker 2>to ask if you're thinking about a vaginal birth after cesarean.

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<v Speaker 2>That is, am I a good candidate for a feedback?

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<v Speaker 2>In this nippet, Doctor Pat starts off by talking about

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<v Speaker 2>assessment of your previous birth in history, and then the

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<v Speaker 2>important complications or issues that might arise during pregnancy that

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<v Speaker 2>change the answer to this question as you get closer

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<v Speaker 2>to your baby's birth.

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<v Speaker 3>Let's get quick on the kick.

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<v Speaker 1>So who's a good candidate?

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<v Speaker 4>I think the first thing that we should talk about

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<v Speaker 4>is that you have to want it.

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<v Speaker 1>Yeah, yeah, so Lucy wanted it. Yes, she really wanted it.

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<v Speaker 1>Whereas you know, if you are ambivalent, yeah, really, or

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<v Speaker 1>you really don't care.

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<v Speaker 2>And that's okay too, It's really, it's really okay.

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<v Speaker 4>Absolutely, it's got to be discussed in a judgment free zone.

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<v Speaker 4>And these days you might only be having two babies.

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<v Speaker 4>And if you just say, look, if my patients say

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<v Speaker 4>to me, look, the first one was born by caesarian.

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<v Speaker 1>Section, and they'll just give me another of those.

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<v Speaker 4>Yeah, And I'm sure a planned section is going to

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<v Speaker 4>be nicer than the emergency section I had last time anyway.

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<v Speaker 2>And can I tell everybody a planed section is just

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<v Speaker 2>so much.

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<v Speaker 1>It's really nice. Yeah, it's not such a say this

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<v Speaker 1>every day. It's not such a bad baby to all

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<v Speaker 1>come in on.

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<v Speaker 2>If that's your option, yeah, yeah.

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<v Speaker 4>So that is not that is not not a problem.

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<v Speaker 4>And if that's what the woman and her partner want,

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<v Speaker 4>then decision mate.

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<v Speaker 1>That's fine. So I think feedbacks are number one for

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<v Speaker 1>people who.

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<v Speaker 2>Want them and the people that want them. Like for myself,

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<v Speaker 2>it was a deep psychological need to have a vaginal birth.

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<v Speaker 2>It took me years and years to work with my

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<v Speaker 2>mindset after my babies to accept the fact that I

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<v Speaker 2>didn't have vaginal births.

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<v Speaker 1>Yeah, so that's a thing.

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<v Speaker 4>Okay, some people are very fixed on that, and there

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<v Speaker 4>are other people for whom it's not such a strong,

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<v Speaker 4>deep need, but it's a strong preference, yeah, and rather that.

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<v Speaker 1>And there are a.

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<v Speaker 4>Good number of people who don't mind, yeah, or don't

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<v Speaker 4>or really aren't fast at all, And it's not part

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<v Speaker 4>of what they would look at when they're looking back

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<v Speaker 4>on that birth and saying do they feel good about

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<v Speaker 4>it psychologically or not? If they honestly don't mind. So

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<v Speaker 4>those people might just elect to have another section.

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<v Speaker 1>For the people who prefer it or really really want it.

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<v Speaker 1>The discussion should start early.

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<v Speaker 4>Yeah, so moving on to who's moving on to more

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<v Speaker 4>of who's a good candidate?

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<v Speaker 2>I read on I thought a reputable website until I

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<v Speaker 2>talk to you about it, which said ninety percent of

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<v Speaker 2>women are good candidates for feedback.

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<v Speaker 1>That's got to be overstating it.

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<v Speaker 2>Yeah. Yeah, it wasn't a reputable.

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<v Speaker 1>It's got to be overstating it.

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<v Speaker 2>Yeah, it's so tricky. I mean it was a pregnancy association,

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<v Speaker 2>and I thought I will Yeah.

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<v Speaker 4>Look, you know, it depends the definition of good candidate.

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<v Speaker 4>Ninety percent of people may tick someone's technical boxes about

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<v Speaker 4>what you have to have, what has to be there

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<v Speaker 4>for the v back to be safe. But I look

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<v Speaker 4>at more than that about a good candidate. And one

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<v Speaker 4>thing you've got to look at is the circumstances of

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<v Speaker 4>the first berth.

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<v Speaker 1>Yeah.

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<v Speaker 2>Yeah, so Lucy had a breach.

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<v Speaker 4>Yeah right, so she's she had a breach in her

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<v Speaker 4>first pregnancy. Babies in a breach position and the vast

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<v Speaker 4>majority of obstrations, including myself, would have delivered that baby

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<v Speaker 4>by section.

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<v Speaker 1>Yeah, but what that.

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<v Speaker 4>Tells us though, if we do a Caesar for that

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<v Speaker 4>woman because the baby's reach. For all, we know that

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<v Speaker 4>woman labors like a.

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<v Speaker 2>Complete champion, Yes, and she never win, just.

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<v Speaker 4>That she didn't go into labor or certainly didn't get

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<v Speaker 4>to advance. So in some ways that you know, in

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<v Speaker 4>many ways, that's a good start. Yeah, let's say we've got,

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<v Speaker 4>for argument's sake, another patient who is a very small,

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<v Speaker 4>very short petiitue woman with a very tall husband, who

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<v Speaker 4>made a very big baby and obstructed at four centimeters

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<v Speaker 4>in that inner first labor, couldn't get beyond four centimeters,

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<v Speaker 4>did decease, the baby came out four kilos. So she's

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<v Speaker 4>another baby with the same partner. I'm nervous ready, Yes, okay,

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<v Speaker 4>I'm thinking not a great candidate. That'll probably happen again.

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<v Speaker 4>And there are two ways we can go with that.

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<v Speaker 4>We could we could decide not to do it, not

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<v Speaker 4>to do the feedback and just do a book section,

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<v Speaker 4>or we could say, let's see how you go. But

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<v Speaker 4>you're really going to have to progress very nicely in

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<v Speaker 4>that labor. And you know the art of this is

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<v Speaker 4>working out which way to go.

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<v Speaker 2>Yeah, and experience, I would imagine, and yeah, that's.

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<v Speaker 1>Right, because there isn't a strict rule book about things

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<v Speaker 1>like that.

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<v Speaker 2>No, And are there any other things that you would say, Okay,

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<v Speaker 2>well that makes somebody not a good candidate.

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<v Speaker 4>Yeah, I think if Well, it's my belief that if

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<v Speaker 4>you've had more than one previous section, that you shouldn't have.

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<v Speaker 2>I know, I remember when we had when we were

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<v Speaker 2>pregnant with that, you know, our third, your first, my third,

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<v Speaker 2>and I was trying to convince.

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<v Speaker 1>You, but I want to have so that is in

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<v Speaker 1>my fear. That's that's a problem.

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<v Speaker 4>There are some people out there who believe that the

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<v Speaker 4>numbers are okay for two previous sections, and virtually no

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<v Speaker 4>one thinks that the numbers are okay for three previous sections.

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<v Speaker 1>Yeah.

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<v Speaker 4>Yeah, I think that it doesn't come up that often.

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<v Speaker 4>But if we look at two previous sections, it's my

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<v Speaker 4>view that that's significantly the risk is significantly higher than

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<v Speaker 4>for one. And I don't think in twenty twenty, when

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<v Speaker 4>we expect very very good outcomes from the childbirth, that

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<v Speaker 4>that's one we.

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<v Speaker 1>Can live with.

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<v Speaker 2>I'm very pleased that I had a plan section in

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<v Speaker 2>the end, only because the obstrition. It wasn't people didn't

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<v Speaker 2>deliver the baby'sus.

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<v Speaker 1>I was there holding your hand.

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<v Speaker 2>The obstrition at my obstrition was saying, look, you know,

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<v Speaker 2>I don't remember her saying. Was I'm not sure what

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<v Speaker 2>to s what to what here? So things had thinned

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<v Speaker 2>and yeah, So.

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<v Speaker 4>If you've had multiple previous caesarian sections, the lower segment

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<v Speaker 4>of the uterus gets.

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<v Speaker 2>Very thin and two long labors, so.

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<v Speaker 4>We worry about the ability of that tissue to withstand

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<v Speaker 4>the forces of a subsequent tum labor. If you've had

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<v Speaker 4>one previous caesarean section, the lower segment of the uterus

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<v Speaker 4>will be a little thinner, but not so that it

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<v Speaker 4>adds a huge amount of extra risk.

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<v Speaker 2>What about the woman that's a vaginal birth, a cesarian birth,

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<v Speaker 2>because perhaps the baby was in breach. What sort of

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<v Speaker 2>candidate is she?

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<v Speaker 1>Perfect?

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<v Speaker 4>Okay, okay, because we know that we know she can

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<v Speaker 4>have a baby vaginally. Yes, so if she has another baby,

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<v Speaker 4>you're roughly the same size, she say, an ideal feedback candidate. Okay,

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<v Speaker 4>and yeah, that happens from time to time, vaginal birth,

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<v Speaker 4>the first caesar for the second for breach, or twins

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<v Speaker 4>or previa and then back to vaginal again.

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<v Speaker 2>Yep, And I think, can things happen like I remember

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<v Speaker 2>Lucy was telling me on the phone. I'm not sure

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<v Speaker 2>we talked about it during our interview just then, but

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<v Speaker 2>she was saying that you would check in every single

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<v Speaker 2>appointment and say, yes, we're still on track for a fback,

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<v Speaker 2>and things happen within a pregnancy that can change it absolutely.

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<v Speaker 1>So that sounds like me. I definitely would return to

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<v Speaker 1>it each.

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<v Speaker 4>Anti natal visit in a fairly methodical way, and in

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<v Speaker 4>my mind, I'm thinking, yes, we still meet the sort

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<v Speaker 4>of requirements. Okay, So the things that might arise during

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<v Speaker 4>the pregnancy that would really make us rethink the plan

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<v Speaker 4>for a feedback might be complications, and those might be

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<v Speaker 4>things like a.

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<v Speaker 1>Baby that was really too big.

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<v Speaker 4>Yeah, a consistent, reliable ultrasound evidence that the baby.

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<v Speaker 1>Was very big.

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<v Speaker 2>Yeah, And can we just recap what's a very big baby? Again?

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<v Speaker 4>Well, if for in a vback situation, I would start

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<v Speaker 4>to get a little concerned about a baby in the

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<v Speaker 4>top ten percent. Yeah, okay, because it seems it sort

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<v Speaker 4>of stands to reason that that baby might be slightly

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<v Speaker 4>harder to get out and might and might put more

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<v Speaker 4>forces on the scar from the previous section.

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<v Speaker 2>Yea.

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<v Speaker 4>Then other things that are potentially a complication and might

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<v Speaker 4>just add one risk on top of another significant diabetes

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<v Speaker 4>insulin dependent you know, preclams here, things that those are

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<v Speaker 4>things that might arise during the pregnancy. And then things

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<v Speaker 4>that we would know right at the start that might

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<v Speaker 4>just make us think this isn't a goer.

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<v Speaker 1>Would be placenta previous twins, Yeah.

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<v Speaker 2>Yeah, wow, vback with twins that would be risky, risky

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<v Speaker 2>yeah yeah. And what about Like my problem really was

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<v Speaker 2>that I just did not go into spontaneous labor. I

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<v Speaker 2>avoided the I was a terrible patient pat I avoided

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<v Speaker 2>the healthcare people and got to forty two weeks.

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<v Speaker 4>So yeah, well, so the perfect time I think to

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<v Speaker 4>labor with her with her vback is spontaneous labor term.

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<v Speaker 4>So let's break that down a little bit. Spontaneous labor

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<v Speaker 4>is definitely preference because if the patient wants are feedback

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<v Speaker 4>and there's some reason to induce, then our options are

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<v Speaker 4>quite limited.

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<v Speaker 2>In terms of how to induce.

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<v Speaker 4>Yeah. Right, So with the vback, patient by definition has

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<v Speaker 4>got a scar on the uterus from the previous previous pregnancy,

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<v Speaker 4>and if she suddenly needs to be induced for whatever reason,

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<v Speaker 4>the toolkits at a little lean that pross and jelly

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<v Speaker 4>that we put in the vagina to mature the cervix.

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<v Speaker 2>Can't use that pretty much.

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<v Speaker 1>Can't use that. It's not thought to be safe in

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<v Speaker 1>the way that it.

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<v Speaker 4>Can overstimulate the uterus. The drip that we might run

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<v Speaker 4>during an induction to get those contractions up and cooking.

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<v Speaker 4>Most of us don't use those that drip. For some

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<v Speaker 4>people consider it to be acceptable as long as we're

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<v Speaker 4>using the drip just to tip somebody in, but not

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<v Speaker 4>to whoop them along as as I usually put it.

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<v Speaker 1>So there's risks there. So the best induction, of course,

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<v Speaker 1>is the one you don't do it all.

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<v Speaker 2>Yeah.

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<v Speaker 1>Yeah.

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<v Speaker 4>And if the patient comes into spontaneous labor term fantastic.

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<v Speaker 2>Yeah.

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<v Speaker 1>Out post dates two problems.

0:11:44.559 --> 0:11:47.920
<v Speaker 4>There's some issue that that woman's not coming into labor

0:11:48.160 --> 0:11:53.160
<v Speaker 4>and that might need effort to get her into labor, including.

0:11:52.679 --> 0:11:54.439
<v Speaker 1>The use of drugs that we should be using for

0:11:54.480 --> 0:11:57.760
<v Speaker 1>a VBAC. And secondly, the baby's getting.

0:11:57.520 --> 0:11:59.960
<v Speaker 2>Bigger all that time, all the time. Yeah, I definitely.

0:12:00.000 --> 0:12:01.760
<v Speaker 2>I think that's why my babies were so big. You

0:12:01.800 --> 0:12:04.480
<v Speaker 2>know they had the two oldest boys had two more

0:12:04.520 --> 0:12:05.360
<v Speaker 2>weeks of cooking.

0:12:05.480 --> 0:12:06.240
<v Speaker 1>Well, that's right.

0:12:06.320 --> 0:12:10.000
<v Speaker 4>So there is a tide, you know, the perfect time

0:12:10.080 --> 0:12:12.000
<v Speaker 4>in the tide for a v back, and if you

0:12:12.040 --> 0:12:13.520
<v Speaker 4>happen to labor at that time, fantastic.

0:12:13.600 --> 0:12:16.400
<v Speaker 2>Yeah, it's a very big pressure if you're wanting a

0:12:16.480 --> 0:12:18.760
<v Speaker 2>v back and you're not going to spontaneous labor, you're

0:12:18.760 --> 0:12:20.760
<v Speaker 2>doing everything and nothing nothing works.

0:12:21.360 --> 0:12:21.800
<v Speaker 1>Yeah.

0:12:22.000 --> 0:12:26.040
<v Speaker 4>Sometimes if someone's very keen and we're up to post dates,

0:12:26.120 --> 0:12:28.600
<v Speaker 4>the sort of turn plus seven days, turn plus ten days.

0:12:28.600 --> 0:12:31.760
<v Speaker 4>Wherever your institutions post dates cut off, is.

0:12:32.320 --> 0:12:35.040
<v Speaker 1>It is possible to come in and break the waters. Yes,

0:12:35.160 --> 0:12:35.679
<v Speaker 1>that's safe.

0:12:35.840 --> 0:12:36.360
<v Speaker 2>Yeah.

0:12:36.400 --> 0:12:38.240
<v Speaker 1>What it does do is set the timer tick.

0:12:38.520 --> 0:12:38.800
<v Speaker 2>Yes.

0:12:39.160 --> 0:12:42.640
<v Speaker 4>Yeah, So if we do that first thing in the morning,

0:12:43.240 --> 0:12:46.720
<v Speaker 4>then we're either going to come into nice, strong, natural

0:12:46.800 --> 0:12:49.440
<v Speaker 4>labor and have that baby vaginally, or we're getting a

0:12:49.440 --> 0:12:53.160
<v Speaker 4>section at some point, because you know, the timer will

0:12:53.160 --> 0:12:55.400
<v Speaker 4>start to tack when the water's broken.

0:12:57.920 --> 0:13:00.480
<v Speaker 2>Thanks for listening. Now head over to the floor episode

0:13:00.480 --> 0:13:02.600
<v Speaker 2>if you want to hear one of our beautiful patients, Lucy,

0:13:02.760 --> 0:13:05.920
<v Speaker 2>describe her successful vback she had for her second baby,

0:13:06.000 --> 0:13:09.000
<v Speaker 2>and in this full episode, we also explore the additional

0:13:09.040 --> 0:13:12.400
<v Speaker 2>monitoring that you might need during a vback, what questions

0:13:12.440 --> 0:13:15.280
<v Speaker 2>to ask your care provider, what pain relief options are

0:13:15.320 --> 0:13:18.080
<v Speaker 2>available if needed in a vback, and how to set

0:13:18.080 --> 0:13:20.520
<v Speaker 2>yourself up to feel satisfied with your birth really no

0:13:20.600 --> 0:13:23.080
<v Speaker 2>matter how your baby is born. I hope you like

0:13:23.120 --> 0:13:25.000
<v Speaker 2>this format and if you have an idea for a

0:13:25.040 --> 0:13:27.520
<v Speaker 2>quick kick something you might think that is a common

0:13:27.600 --> 0:13:29.760
<v Speaker 2>question that others might have as well, send us a

0:13:29.840 --> 0:13:33.240
<v Speaker 2>DM on Instagram at the Kick Pregnancy podcast and we'll

0:13:33.240 --> 0:13:35.760
<v Speaker 2>put it on the list. In the meantime, we hope

0:13:35.760 --> 0:13:38.559
<v Speaker 2>this has helped answer your question who makes a good

0:13:38.640 --> 0:13:41.040
<v Speaker 2>v back candidate? Thanks for listening, Bye for now.