I feel so lucky/guilty/heartbroken (sort of updated in #14)

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momW's picture
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I feel so lucky/guilty/heartbroken (sort of updated in #14)

I have a friend that I actually met just before she became pregnant 9 months ago. She found out that I was going to go for a VBA2C and was interested. We became friends and I shared with her my research and information. She started going to my dr and was all set for her VBA2C. She went in to the hospital yesterday morning in labor. The dr broke her water around 1 o'clock. Sometime in the afternoon she got an epidural and pitocin to augment her labor that was not progressing. Sometime early this morning she had the baby vaginally. The baby had SUA (Single Umbilical Artery) and was having breathing problems at birth so she was taken to a bigger hospital for observation. My friend was rushed into surgery because she had ruptured. I talked to her sister this morning but she was cutting out. She said they had to repair her bladder and uterus and I think she said she lost an ovary. She has not seen her baby girl yet and is still pretty out of it and recovering in ICU.

I'm so heartbroken for her right now. I have been so sick at my stomach all morning. I can't get this guilty feeling to go away. I adamantly refused pitocin augmentation during my labor and I wish I had taken the time to thoroughly make her understand why it was so important to me to avoid it. I'm so mad at my dr too. Why do they feel the need to augment labors?! If a VBAC labor stalls out, it could be for good reason. I've read in plenty of birth stories to know that it happens often. When a woman ruptures a lot of the time the labor will stall because the body knows something is wrong. Why couldn't he just leave well enough alone?! I'm sure he is really torn up right now (he is a very nice man), but I just wish OB's trusted and understood birth. Even the best ones, really don't have a clue.

This pretty much seals my decision that I will be using a mw and doing a homebirth for the next one.

I'm just kind of rambling right now. My thoughts are all over the place right now and my heart is breaking for her. I want to go up and see her, but I just feel so guilty right now. Logically, I know this is not my fault, but I still can't help but feeling like I just didn't do enough to help her understand the risks of augmentation.

I'm going to venture a guess that this will shut down VBAC's at this hospital or at least at that dr's office and they are the only ones that do them at all in our area. When it really should just make them realize how dangerous pitocin is to VBACing moms. One of the dr's in the practice induced my VBAC labor with DS with pitocin and cervidil. I didn't realize just how lucky I got with his birth until now.

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That is terrible Sad Correct me if I'm wrong though, but aren't you supposed to NOT use pitocin with a VBAC? For that very reason? Especially a VBA2C! While its great that doctors/hospitals are willing to "let" women go for VBAC's, shouldn't that involve cutting out ANY risk factors that could potentially lead to a rupture? I'm sorry your friend had to go through that. I would not beat yourself up about it though- the doctors should have known better about pitocin with a vbac- that shouldn't have been *your* responsibility, kwim?

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What really confuses me is that this particular dr was also my dr and would not entertain the idea of inducing with pitocin, but thought it was okay to use it for augmentation?! HUH, are you kidding me???

I didn't necessarily push her into the VBA2C, it's something she decided to do after talking to me. But I just feel guilty for cheering her on so much. VBACing is not popular around here, our local OB's won't even do them. I'm the only person I know IRL that has had a VBAC and the only person I know that has ever even thought about having a VBAC after 2 c/s so I just feel like it's my fault somehow. Logically, I do know it's not my fault, but I can't stop feeling guilty.

I also feel selfish even thinking this, but I know that this is going to be a huge step back for our area as far as VBAC's are concerned. No one is going to think pitocin for VBAC's is dangerous, they're just going to see VBAC's as dangerous.

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Aw hun that is a really hard situation. This is not your fault. I am so sorry that this happened. Sad We had a girl in our ICAN group that ruptured after a VBA3C. I has scared me a little.

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:bighug: I'm sorry your friend had a bad experience, and that you feel guilty about it. That's human nature, but please know that you didn't do anything wrong. She's the one responsible for her birth even if you made this doctor sound like heaven on earth. She's the one who should have educated herself about all the risks. She's the one who agreed to accept Pitocin augmentation, and that in itself wasn't even necessarily a bad decision.

ITA with your doctor's advice about not inducing labor with Pitocin, but that is very different from augmenting labor with Pitocin. Inducing labor requires a much higher amount, for a far longer time, than augmenting a slow or stalled labor. Pitocin has been shown to be very safe in VBAC moms by giving just a little push when labor has stalled, and it's far better than a repeat c-section when used properly. The VBAC protocol is to first ensure that nothing else is going wrong, then to start the Pit very slowly, and to only go up to a certain level which is about half what they would use on an unscarred uterus. I chose to try Pitocin when my cervix wouldn't finish dilating, but I made sure (and my midwife made sure when I wasn't able) that they followed the VBAC protocol.

I'd bet good money that, if/when your friend checks her medical records, she'll find either symptoms of rupture (unusual pain, unusual decels in baby's heartrate, abrupt change in baby's position, etc.) before the Pit was even started, or that the VBAC protocol for Pitocin augmentation wasn't properly followed. Perhaps the doctor wasn't there and/or the nurses just did their regular Pitocin routine in spite of his orders? If it was my doctor, I would call and offer my support & encouragement to him. Something went wrong this time, and it's not necessarily his fault. He did a great job with you, right?

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I absolutely agree with Stacey... and I am terribly sorry that this happened and that it is affecting you so significantly.

BUT with that being said, you do not know all of the circumstances influencing the decisions that were made. I don't want to sound like I am blaming anybody, but for all we know, she could have refused if he was calling for a c/s earlier in the game. And then at that point, they have to do what they can. You just never know... so please don't blame yourself.

There are always 3 sides to a story... his side, her side, and then what actually happened. I hope she heals fast and gets to see her beautiful baby soon. Maybe you could send her a gift, with an offer to come see her and talk when she is ready. When that time comes, I would just be completely honest with her about how you feel. I'm sure she is not going to blame you for what happened. And remember that rupture can occur even with a FTM. It's very unfortunate, and I wish it hadn't happened, but it's not your fault and there are so many factors and decisions involved in child birth that it would be very difficult to single it down to one thing that caused it.

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I'm having trouble wrapping my brain around the fact that she delivered her baby vaginally, and then they noticed that she had ruptured. It just doesn't make any sense. If she'd ruptured badly enough to lose an ovary & require bladder repair, they'd have had her to the OR before she could deliver. Then I noticed the part about baby having a Single Umbilical Artery and my brain started rambling. SUA is often linked to a poor cord insertion. Poor cord insertion is often linked to placenta accreta. Placenta accreta is often linked to multiple uterine surgeries. I wonder if she actually had placenta accreta, not a uterine rupture? In that case, after baby was born, the placenta didn't deliver and/or she hemorraged, and they had to operate for that? Also, bladder repair, to me, indicates not so much a rupture (because they'd move it out of the way) but more likely adhesions from her prior surgeries that they repaired while they were in there fixing her uterus. Losing the ovary is the wild card, but it could have been from the blood loss before they got her into surgery. Just thinking out loud...

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That is a good point. Or if there was a rough manual removal of the placenta that caused her to rupture.

It's hard to know without reading her records and/or knowing her history.

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"Spacers" wrote:

I'm having trouble wrapping my brain around the fact that she delivered her baby vaginally, and then they noticed that she had ruptured. It just doesn't make any sense. If she'd ruptured badly enough to lose an ovary & require bladder repair, they'd have had her to the OR before she could deliver. Then I noticed the part about baby having a Single Umbilical Artery and my brain started rambling. SUA is often linked to a poor cord insertion. Poor cord insertion is often linked to placenta accreta. Placenta accreta is often linked to multiple uterine surgeries. I wonder if she actually had placenta accreta, not a uterine rupture? In that case, after baby was born, the placenta didn't deliver and/or she hemorraged, and they had to operate for that? Also, bladder repair, to me, indicates not so much a rupture (because they'd move it out of the way) but more likely adhesions from her prior surgeries that they repaired while they were in there fixing her uterus. Losing the ovary is the wild card, but it could have been from the blood loss before they got her into surgery. Just thinking out loud...

This actually makes a lot of sense to me. acreta is a side effect of multiple c-sections. hmmm I hope they are doing ok.

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"Spacers" wrote:

I'm having trouble wrapping my brain around the fact that she delivered her baby vaginally, and then they noticed that she had ruptured. It just doesn't make any sense. If she'd ruptured badly enough to lose an ovary & require bladder repair, they'd have had her to the OR before she could deliver. Then I noticed the part about baby having a Single Umbilical Artery and my brain started rambling. SUA is often linked to a poor cord insertion. Poor cord insertion is often linked to placenta accreta. Placenta accreta is often linked to multiple uterine surgeries. I wonder if she actually had placenta accreta, not a uterine rupture? In that case, after baby was born, the placenta didn't deliver and/or she hemorraged, and they had to operate for that? Also, bladder repair, to me, indicates not so much a rupture (because they'd move it out of the way) but more likely adhesions from her prior surgeries that they repaired while they were in there fixing her uterus. Losing the ovary is the wild card, but it could have been from the blood loss before they got her into surgery. Just thinking out loud...

I've been busy this afternoon looking up a whole load of stuff and I found this exact thing. I was actually coming on here to post my findings when I read yours. Please understand that I was emotionally writing as I was thinking in the OP and before I had time to really think things through and look up more information. I believe you almost have to be right about the accreta. I was so worked up about there being a problem that I wasn't even thinking straight this morning and lack of sleep from worrying all night on top of that.

There has to be more to the story than a straight forward uterine rupture. I'm hoping to talk to her soon and make sure she is as okay as she can be. If I find out more I will let you girls know.

Physically, she is okay. Emotionally, I'm sure she's a mess. The baby is doing very well though!!

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I am glad they are both doing well. Physcially at least.

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The more research I do, the more confused I get. I'm going to have to just be patient and wait for her to tell me what happened, I know. Some of the research does show a risk of bladder injury due to uterine rupture though.

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Sometimes things just happen hun, I had the same thing (minus the bladder issue) happen to me and I had never had a C-section at all! Sometimes placental accreta just happens for many reasons (calcification of placenta, hard attachment, partial attachment outside of the uterus)

Keep in mind she is alive, the baby is alive, and so right there with any hemorrhagic situation you've got two wins! Don't stress yourself, your not the doctor, and in the end without all the info you have no idea if this has to do with the pitocin or another problem all together.

Love and prayers for your friend and her family, I hope she makes a swift recovery and more importantly I hope the doctor's/hospital learn from this and not shut down VBAC programs out of fear and/or panic!

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I've come to realize the reason I'm so obsessed with knowing what happened is steeped more in emotion than really needing a play by play. Hear me out. I sort of had a meltdown last night. Since Clara's birth I've had this nagging feeling that has not gone away. My oldest daughter's birth is a very painful memory for me. Last week I decided that not doing anything to face that birth is obviously not helping. So, I decided to write her birth story. This is the first time I've ever even tried to consciously recall her birth day. I thought that by mostly getting the birth I wanted with Clara, it would all sort of melt into the background, it hasn't. The pain and fear is still there and is triggered randomly and easily.

I realized last night that I was trying to justify my friends rupture, I was trying to reassure myself that I will be okay. I know it's silly, but it just feels like if I knew that pitocin was the culprit then I would be safer because I would never again let that venom in my system. This is ridiculous though. I thought I had accepted my risks as a 2 c/s mom going for vaginal births, but I obviously haven't. The unfairness of it angers me and facing the reality of it terrifies me! I'm mad.....I'm mad because my births will always be teetering on the edge of disaster, I'm mad because I can't recall my daughters birth or the first few days of her life, I'm mad because I couldn't deal with the pain from her c/s and breastfeeding so I gave up breastfeeding, I'm mad because no one understands. Knowing that I could've easily been in the same position my friend is in scares me to no end. Understanding the why of it won't make it any easier for me, it won't make my risks any less, it won't ever make birth what it should be for me, I have to accept that, but at this moment I'm just going to concentrate on dealing with one emotional meltdown at a time. For now, that is writing DD1's birth "extraction".

I love you girls for being here for me and talking me through yesterday with the logic I thought I wanted and needed. Bear with me as I grieve my 12 year old daughter's birth, 12 years after the fact and a long time coming.

(btw- my friend is doing well. she still doesn't have her baby and probably won't until Friday. baby is doing good. and she doesn't seem to be as angry as I would be in her situation. of course it took me 10 years to get good and angry about my 1st birth so who knows what will happen behind closed doors when she stops trying to put on her brave face for everyone)

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"momW" wrote:

I've come to realize the reason I'm so obsessed with knowing what happened is steeped more in emotion than really needing a play by play. Hear me out. I sort of had a meltdown last night. Since Clara's birth I've had this nagging feeling that has not gone away. My oldest daughter's birth is a very painful memory for me. Last week I decided that not doing anything to face that birth is obviously not helping. So, I decided to write her birth story. This is the first time I've ever even tried to consciously recall her birth day. I thought that by mostly getting the birth I wanted with Clara, it would all sort of melt into the background, it hasn't. The pain and fear is still there and is triggered randomly and easily.

I realized last night that I was trying to justify my friends rupture, I was trying to reassure myself that I will be okay. I know it's silly, but it just feels like if I knew that pitocin was the culprit then I would be safer because I would never again let that venom in my system. This is ridiculous though. I thought I had accepted my risks as a 2 c/s mom going for vaginal births, but I obviously haven't. The unfairness of it angers me and facing the reality of it terrifies me! I'm mad.....I'm mad because my births will always be teetering on the edge of disaster, I'm mad because I can't recall my daughters birth or the first few days of her life, I'm mad because I couldn't deal with the pain from her c/s and breastfeeding so I gave up breastfeeding, I'm mad because no one understands. Knowing that I could've easily been in the same position my friend is in scares me to no end. Understanding the why of it won't make it any easier for me, it won't make my risks any less, it won't ever make birth what it should be for me, I have to accept that, but at this moment I'm just going to concentrate on dealing with one emotional meltdown at a time. For now, that is writing DD1's birth "extraction".

I love you girls for being here for me and talking me through yesterday with the logic I thought I wanted and needed. Bear with me as I grieve my 12 year old daughter's birth, 12 years after the fact and a long time coming.

(btw- my friend is doing well. she still doesn't have her baby and probably won't until Friday. baby is doing good. and she doesn't seem to be as angry as I would be in her situation. of course it took me 10 years to get good and angry about my 1st birth so who knows what will happen behind closed doors when she stops trying to put on her brave face for everyone)

If it helps at all I do understand. I totally understand the anger and the frustration and I DO understand the feeling of what if. I am going for a vba3c and I have these emotions daily. It is probably why I am struggling so much with deciding on my care provider. Hugs to you!

ETA - I am glad your friend is doing ok.

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Awww, I'm so sorry for all the feelings this is bringing to the surface for you. :bigarmhug:

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I understand her brave face.... its either brave face (my situation was different, i was very disappointed that i tore and then DD had jaundice and i just wish i could have done anything different for either, but i couldnt, so i stayed in shock over it instead of flipping out every time they wanted to take my baby's blood) or shut down.... it took me over 3 months of recovery to get mad about DD's birth as well. i sucked it up well for a while.

Also, in your situation i would feel the same. You are in shock, confused, and the educated side of you wants to know what went wrong and how it should have gone because you might be in the same situation and you want to know better. but just because she's your friend you want to defend her from bad things, and bad choices made by those she trusted with her health. you feel responsible for the bad things that happened because you gave this person your vote of confidence too.

I'm glad she is doing better and the baby is doing fine though, this is still a happy ending, just with a couple different twists where you weren't expecting it.

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Sorry about your friend Sad Glad she and baby are physically ok though.

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I'm really sorry this happened to someone you're close with (and someone you helped during pregnancy). But as a doula/birth educator, I just wanted to throw a few points in there, based on my own experience/education.

-What stacy said, I'll echo. All of it.

-This sort of thing actually happens more than we like to think. When I had a client come to me for help with a VBAC last year, I started researching. I had always heard 'the risk of rupture is so small', etc etc. Then I started doing reading, talking to other doulas/midwives... almost every one of them had seen at least one rupture in her career. So, while it's not the 'normal' course of events, even during a VBAC, it does happen enough that any VBAC momma needs to know the signs/symptoms. But I agree in that I don't think this was a case of straightforward rupture... just to be clear. I think other things were at play here.

-You cannot hold yourself accountable for the actions of this woman or her medical team. If you're forcing or bullying people to have VBACs, that's one thing, and you should probably address that, from the point of view of 'informed consent' or the right to make one's own birth choices, etc etc (not to mention the fact that you're not a medical professional, and shouldn't hand out medical advice)... BUT I don't think that's the case, and that's certainly not how you presented it. If all you did was give this woman info after she expressed a desire to VBAC, and then cheered her on/supported her decision, you did a GOOD thing. YOU are not responsible for her choice. Neither is her doctor - if she researched and read all the lit you gave her (which, if she didn't, you're REALLY not accountable), then she would have known the risks and should have been able to say either 'yes' or 'no' to any intervention with confidence. If she put the reigns in her doctor's hands, then she needs to be content with the fact that she handed over that control, and blaming him at this point isn't fair.

-It's really easy to have guilt and anger when things don't go as planned with a birth... but the reality is, birth isn't something you can plan! Even the most natural and normal births have some aspects of 'the unexpected' - it's the nature of birth. And I think that because so many births turn out with a live baby and live mom, we forget that it always carries the potential for a negative outcome. A small potential, but it's there... ALL birth has that shadow lurking in the corner, no matter how 'normal' the preg and birth are suspected to be. Accepting this is an important part of caring for birthing mommas - it's something I had to accept before becoming a doula (if I lost a client or a baby, ESPECIALLY because of a decision made because of info I provided, I have to live with that). If you want to work with pregnant moms (whether in any official capacity, or just as a supportive BTDT momma), you have to come to terms with this.

-re: your own difficult birth... I'd recommend reading Birthing From Within, and doing some of the birth art exercises, as a way of exorcising some demons. Dealing with your traumatic birth is important, or else it's just going to keep coming up everytime you see a birth that DIDN'T turn out 'perfectly' (I use that term tongue in cheek).

good luck to you and your momma friend, and I hope her and babe make a quick recovery!!