High risk VBA2C anyone?

[gummybearmama]

I have just about given up hope on a vaginal birth (though my csections were totally necessary because I am very high risk). I am not sure it is even an option for me but I was wondering if anyone else has had a VBA2C while also high risk? I am switching OBs and will be asking them once I meet the new Dr.

[songbird516]

What do you mean by "high risk"? Also, there are some great VBAC stories on Mama Birth blog. Some are even after 3 and 4 c-sections!

[gummybearmama]

I have had intraheptic cholestasis of pregnancy severely two times with both previous pregnancies. My liver and gall bladder were shutting down and my bile acids and liver function were out of control. Besides the insane itching which cannot be relieved by medications or lotions, I had to deliver early (37 weeks) to prevent fetal distress. My babies are born with low birthweight and jaundice, thank goodness that is where it ends. However I am at higher risk of jaundice myself, hemorrhaging and uterine rupture. So, they pretty much just say I need a csection..but having had 2 already I am slightly nervous about a third.

[songbird516]

Have you read "real food for mother and baby?" I would focus on some dietary changes if you haven't already, that might help with the liver function during pregnancy. I don't know what your diet is like, obviously, but it can be very helpful to avoid GMOs, eat only whole real foods, no artificial sweeteners and judicious use of natural sweeteners. Nutritious foods like egg yolks, shellfish, liver and other organ meats, full-fat, grass-fed dairy, and pastured meats can help to build up your nutrient stores and have everything functioning as well as possible BEFORE pregnancy to make the next pregnancy lower-risk.
If you have to be induced, a VBAMC is much riskier, and really not advised. So I would focus on getting as healthy as possible before the next pregnancy and see what develops before thinking about a VBAC, personally.
Here is a great article about pre-conception and pregnancy nutrition.
http://www.westonaprice.org/children...ption-to-birth
I had a mild version of PUPPPS during my first pregnancy, but nothing the second time around. I had changed my diet quite a lot, and I think that this helped a lot. My second pregnancy was easier than the first. Also my placenta looked a lot better the second time, even though he was born a week "overdue". My midwife said that nutrition plays a huge role in keeping the placenta healthy and functioning properly.

[Minniebees]

I have ICP, too. How much Urso were you taking? I've seen women with bile acids approaching 200 and they were only on 300 mg per day. There is an upper level per kilogram for this medication, which is kinda odd for an adult medication. It's much more common for kids. But anyway, the upper level is pretty high. I didn't have any change in my bile acids until I started 1200 mg per day, and I think they need to be upped again. Maybe more would help your BA stay within control?

I know you want a VBAC, but this condition is very serious, as you know. I wanted a full term baby, but my medical team and I are not comfortable going past 36 weeks, so that's what we're doing. It's not what I WANT, but it's what we need to do to keep the baby safe, KWIM? Feel free to PM me, but I'm not on much right now. I spend almost all my time at the hospital, and when home, I'm feeling so sick and sleepy that I spend that time in bed. My induction is coming up soon, thankfully, and I'll get back to normal then.

Sara, you should read this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678574/ not everything is caused by a bad diet, and PUPPS is a completely different condition. ICP is very serious. It kills babies.

[songbird516]

Originally Posted by Minniebees Sara, you should read this: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2678574/ not everything is caused by a bad diet, and PUPPS is a completely different condition. ICP is very serious. It kills babies.

I'm sorry if you misunderstood me. I know that not everything is caused by a bad diet. I know nothing about this person's diet and I admitted that. But I do think that it's best to address ANY possible problems with diet before becoming pregnant, because you never know what it might help. I'm not advocating some crazy cleanse or anything, just eating whole foods with lots of nutrients and as few chemicals as possible. It can't HURT anything.

What I got from that article is that scientists aren't sure about what causes ICP, so why not try some dietary changes and see how it goes? Of course if the condition happened again, it would be necessary to treat and make a personal decision regarding VBAC or not. But until then I personally would try to get as healthy as possible to avoid it IF POSSIBLE.

[shan1212]

In both my pregnancies, my pelvis was not ready for delivery prior to 38 weeks. It went from being super narrow to cavernous, but if I'd had to deliver early via induction, I think my chances of a vaginal delivery would have been pretty slim. I know you weren't really asking for opinions, but your story jumped out at me because I've had a VBAC (so obviously I understand the desire to do so) and also had to weigh some health problems (though very mild in comparison to yours) into my decision (I have a condition of dysautonomia that can cause dizziness, dehydration, adrenal surges, etc.). I also had a friend who had ICP and delivered a healthy baby this summer (c/s after failed induction) so I researched it a little at the time. She was delivering with the same midwife (and very pro-VBAC practice) as I did, so I knew they weren't pushing her into having a c/s or anything. She's the one who finally made the call after 36 hours of labor.

So anyway, all this is to say that in your case, I would probably go for the repeat c/s if that is what your doctors feel is best since you are at increased risk of hemorrhaging and uterine rupture on top of the ICP. I am the first one to say that I think there are a lot of unnecessary c-sections out there - I feel that mine was one. But in your case it sounds like you have a whole bunch of risk factors to consider.

Hugs, mama. I do understand how daunting it is to make this decision.

ETA: And also, there's the issue of you needing an early delivery and the reluctance of even VBAC friendly practitioners to induce. I think an OB would be wary of using pitocin at 37 weeks on a VBA2C patient with an already increased risk of rupture and hemorrhage. I don't know the statistics, but I'm guessing the "soft induction" methods (I made that term up, ha) like the foley bulb would be less likely to work at 37w. Maybe somebody else with more knowledge can weigh in. I have another friend who tried for a VBAC (induced at 41+ with the foley bulb) and it failed. In my limited experience, it seems like if you can't go into labor naturally, you're looking at longer odds.