Dillards 32: To VBAC or not to VBAC

[SassyPants]

Just a little info on RH incompatibility. 

What Is Rh Incompatibility?

Rh incompatibility is a condition that occurs during pregnancy if a woman has Rh-negative blood and her baby has Rh-positive blood.

"Rh-negative" and "Rh-positive" refer to whether your blood has Rh factor. Rh factor is a protein on red blood cells. If you have Rh factor, you're Rh-positive. If you don't have it, you're Rh-negative. Rh factor is inherited (passed from parents to children through the genes). Most people are Rh-positive.

Whether you have Rh factor doesn't affect your general health. However, it can cause problems during pregnancy.

Overview

When you're pregnant, blood from your baby can cross into your bloodstream, especially during delivery. If you're Rh-negative and your baby is Rh-positive, your body will react to the baby's blood as a foreign substance.

Your body will create antibodies (proteins) against the baby's Rh-positive blood. These antibodies usually don't cause problems during a first pregnancy. This is because the baby often is born before many of the antibodies develop.

However, the antibodies stay in your body once they have formed. Thus, Rh incompatibility is more likely to cause problems in second or later pregnancies (if the baby is Rh-positive).

The Rh antibodies can cross the placenta and attack the baby's red blood cells. This can lead to hemolytic anemia (HEE-moh-lit-ick uh-NEE-me-uh) in the baby.

Hemolytic anemia is a condition in which red blood cells are destroyed faster than the body can replace them. Red blood cells carry oxygen to all parts of the body.

One of the symptoms of HA is hyperbilirubinemia (yellowing of the skin/jaundice).

[nst]

and I can tie my shoes  but seriously - I hope prenatal care was used. 

 

 

[LovelyLuna]

picture via Pickles.

[nst]

clearly they don't know that their photo with the scrawl is being used and they aren't getting paid

 

[Mr. Pink]

Looks like he has an IV? Poor baby. One of my newborns needed an IV for ten days and I'm having some rough flashbacks of them needing to re-insert it a few times during that time frame

Having an unhealthy baby is the hardest thing. Hope Sam is on his way to good health soon!

[jozina]

I hope they're both doing well and were sensible with all of it.  The wording is a little odd and that's definitely a baby getting more than routine care.  Poor child.

Doctor hat on with c-sections/VBACs:

-VBAC after 2 c-sections is generally not recommended because the risk of rupture during labour/delivery is deemed too high and much riskier than a repeat c-section for all involved.

-No set limit to the number of c-sections.  In the past a lot of women seem to have been told 2 or 3 only but it's not like there's a hard line in the sand. I think the highest repeat one I've personally seen with an 8th.  That was a difficult procedure!!

-Which is part of the problem.  As you have more c-sections you have more scar tissue, it takes a lot longer to get to the baby, you're more likely to have bleeds and get damage to other organs, for instance the ureters can get bound up in scar tissue and you can accidentally cut them. The bladder often gets attached higher up on the uterus which means you can inadvertently cut it when opening up OR you can need to cut higher up the uterus, which causes more problems with the below.

-The bigger thing rather than rupture is that with each c-section your risk of the placenta covering the c-section scar increases, as does the risk of it growing through into the uterus proper or other organs.  That's nasty, potentially deadly stuff which usually results in a hysterectomy.  If you have more c-sections and you get more adhesions/scar tissue and the uterine incision ends up being higher up then odds of the placenta covering it are higher.  With someone who has had say 5 c-sections yes the risk of rupture is a real concern, but the operation itself and being damned sure the placenta is where it should be or you have very, very skilled obstetric surgeons waiting in the wings should someone start bleeding out is the bigger worry.

And finally:

-But most of that goes out the window if someone has a partial rupture or the uterus is paper thin, in which case they get a very definite "It is inadvisable to get pregnant again. You and/or your baby could die". A VBAC attempt in labour for 40 hours immediately made me wonder about that.  I wouldn't assume she's got a definite limit on how many babies she has because of a c-section but nor would assume she'd be fine to keep popping them out given all of her history.

And another very big baby plus is making me hope even more she had a glucose tolerance test.

[calimojo]

2 hours ago, SassyPants said:

Big babies do not mean mature babies or babies with stable respiratory neurologic function.

IDMs (infants of diabetic mothers) are often huge and so immature. 

I've not ever seen a mother have an elective c-section at 37 or even 38 weeks because the baby was too large- never. I think few doctors would risk that treatment.

Babies at that gestational age can revert back to fetal circulation and become among the sickest and most fragile babies in the NICU.

I have to back up my fellow nurse Sassy on this.  IDMs can be large and still behave like a premie, and many of the worst premies that I have cared for have been those right on the cusp of full term.  Often the babies that are several weeks premature are fiesty and strong because they have had their maturity hastened by stress hormones that are produced as a result of a hostile or suboptimal uterine environment. 

When I worked labor and delivery and nursery, I was often much more worried when I attended a birth of a 36-37 week baby boy, than I was a 33 week baby girl. 

And yes, armchair diagnosis aside, in that picture, we can conclude that Samuel had some difficulty adjusting to life outside the womb.  It is also safe to assume that at the time the picture was taken,  Samuel had great color, and his muscle tone looks good.  And based on how Derick is allowed to handle him,  he must have been stable at this point.

As to why he would have an IV?  It could simply be a 'just in case' situation or it could be that he needs antibiotics or needs IV access in case his blood sugar bottoms out quickly and he needs IV dextrose. 

The oxygen apparatus he has on looks to be what is either a high flow nasal cannula.  Babies born by c/s are at a higher risk for extra fluid in the lungs that might persist for a few hours after birth. 

I do feel for Jill.  Jill and Derick are not easy to feel empathy for as they seem to make so many poor decisions, but questionable judgment aside,  Jill is a product of how she was raised.  She hasn't been taught to really think things through, and to consider consequences.  When you are taught to trust in God in the very concrete way that the duggars believe, you never consider consequences.  I makes me angry when people misunderstand their faith so much that it leads to a complete lack of the ability to think critically.

[Baaaaaabe]

1 hour ago, SapphireSlytherin said:

Babe

You rang?

[HarleyQuinn]

Catching up but damn he's a big boy and that's a lot of equipment around him. Did Jill wait too long again?

 

[JessaBlessa]

She didn't learn a thing last time, did she?

[kacarlton]

How can she be refused a c-section though? If she shows up in labor with x number of c-sections behind her, what would a doctor do, just refuse to touch her and leave her in agony to die in childbirth? I get that more than a certain number isn't ideal, but once she's already in that situation what's left to do?

I was thinking this too. And does anyone else remember when Mechelle was advised to stop getting pregnant because her uterus was failing? I think it was around baby 15 or 16. And she didn't stop until menopause. And that is Jill's model, sadly. These folks seem to only listen to docs when they say something the Duggars want to hear. Sigh.

[Greendoor]

1 hour ago, speller24 said:

I'm not a mom, and have never been pregnant, so I have probably a dumb question. How does one create such large babies.  All the babies in my family have been in the 6-7 range so 9-10 lbs seems huge! Is there something going on genetically? Guys I'm an idiot lol. 

My mother was #3 -she weighed 10 lbs.

I was #1  weight 7lbs even.  My brother #2 and 2 weeks early  7lbs 3oz

My brother in law #1  7 lbs.   My husband #2 weighed 8 lbs

My son #1 weight 7lbs 12.5 oz

I think you can add a bit of weight to your own birth weight - we eat more calories now.  And in most cases subsequent children weigh more than the first. 

 

[Mela99]

1 hour ago, Kailash said:

If I were Jill I'd tell Derrick he could go to SA without me.

I don't think Derrick can go further than the toilet without Jilly hovering

[Rachel333]

I hadn't heard that about subsequent babies usually being bigger. With me and my siblings each of us weighed less than the one before. I was the first at 9lb13oz and the youngest and smallest was 7lb3oz. Granted, she was a twin so that's still pretty big (her sister was almost 8lbs). Also, anecdotal evidence means basically nothing. 

My great-grandmother had two sets of twins at home and each baby weighed about 9lbs. We wonder if she had gestational diabetes.

[candygirl200413]

Wait that makes all the sense at least in my family because my sister as a singleton was the smallest weight wise (I wanna say like 6lbs/4oz, possibly a little lower?) while me and my twin brother were a little bit heavier (brother was first at like 6lbs/8oz and I was obviously last at 7lbs/5oz, also the largest twins my ob delivered at the time because we were 41 weeks). But I just learned that I apparently wanted out at 6 months in utero and my mom had to get something to keep me cooking longer.

 

Also I know mom's don't necessarily have to have gestational diabetes to have heavy babies, so is it just a really hearty diet?

 

[calimojo]

6 minutes ago, kacarlton said:

I was thinking this too. And does anyone else remember when Mechelle was advised to stop getting pregnant because her uterus was failing? I think it was around baby 15 or 16. And she didn't stop until menopause. And that is Jill's model, sadly. These folks seem to only listen to docs when they say something the Duggars want to hear. Sigh.

seems to be true, sadly.

 

In terms of if Doctors can refuse to care for her,  they can and they can't.  A physician could possibly refuse to care for a patient who was non-compliant, difficult, deceptive, etc.  However, what I think the Duggar girls have done so far is to just follow with a lay midwife, and then when a crisis occurs they go to the local ED and at that point, the OB on call can't really refuse.  He/She can make it clear they will deliver the baby, and treat mom only during the hospital visit.  So,  Jill could continue to get pregnant, and try for a home delivery and then when that fails, go to the ED and end up with the OB who is on city call that day/night.  She could do this as long as her uterus holds up. 

However if she were to continue to get pregnant and plan to follow with a specific OB,  at some point, that OB might conclude that Jill is non-compliant and presents to high of a risk for them to take her on electively as a patient.  They could then 'fire' her from their practice. 

Who knows what Jill and Derick will do.  Derick might appreciate the fact that being a widowed father of several little ones will hurt his missionary career so perhaps he will make a headship decision to reduce the number of pregnancies, by using NFP or condoms.  Or as nutty as Derick is, I could see him taking a righteous vow of celibacy since preventing pregnancy is sinful but celibacy in the name of God would likely be a noble pursuit. 

 

[Paigerin2]

33 minutes ago, Rachel333 said:

I hadn't heard that about subsequent babies usually being bigger. With me and my siblings each of us weighed less than the one before. I was the first at 9lb13oz and the youngest and smallest was 7lb3oz. Granted, she was a twin so that's still pretty big (her sister was almost 8lbs). Also, anecdotal evidence means basically nothing. 
My great-grandmother had two sets of twins at home and each baby weighed about 9lbs. We wonder if she had gestational diabetes.

Holy cow- twins at 9lbs a piece? Your great grandmother deserved a medal!

 

[Funwithfundies]

8 hours ago, SapphireSlytherin said:

40 hour labor is criminal.

I went through 40 hours of labor with my first son.  I was induced, as I was approaching 2 weeks overdue (by the time he was born, he was exactly 2 weeks past the due date).  I was being cared for by two CNMs (one eventually took over for the other) in a hospital, with an MD in the building ready to take over at any time.

Forty hours in, I was finally fully dilated - literally pushed once, and then all hell broke loose and we were off to the OR (baby's heart rate dropped).  I get what you're saying re: 40 hours of labor, yet the crazy thing is that, in the moment, I was genuinely shocked when they told me I was having a c section.  As crazy as the pain was, it never occurred to me to ask for a section to put an end to the labor.  I *did* ask for pain meds (which were useless), and then an epidural (which was heaven).  Maybe because I felt fully supported, it never occurred to me to ask to end the labor/go to a section?  IDK...tl/dr - despite being the hardest thing I had done in life to that point, 40 hours of labor didn't seem insane to me in the moment.

[bella8050]

I will be interested to hear what the Dillards have to say going forward. I remember the People article last time where it seemed Jill was not going to let the c-section stop her from having a large family with her claim she told the doctor to stitch her up good with her future pregancies in mind.  

Reading on here today Tori Spelling's pregnancy history popped into my head. She had four c-sections in five years and nearly died with the fourth pregnancy. Even though she said how she was afraid she was going to die and leave her kids motherless she still went on to have a 5th child this year. Plus she claims to be broke. There is just no getting through to some people. 

[feministxtian]

9 minutes ago, Rachel333 said:

I hadn't heard that about subsequent babies usually being bigger. With me and my siblings each of us weighed less than the one before. I was the first at 9lb13oz and the youngest and smallest was 7lb3oz. Granted, she was a twin so that's still pretty big (her sister was almost 8lbs). Also, anecdotal evidence means basically nothing. 

My great-grandmother had two sets of twins at home and each baby weighed about 9lbs. We wonder if she had gestational diabetes.

My oldest was my biggest newborn at 7lb 9oz...but she went over 41 weeks. My first son was born between 36 and 37 weeks and was 7lbs even. My second son was also a 36-37 weeker and was 7lb 4oz. My grandson was a 35-36 weeker and was like 6lbs. He made up for it though, he'll be 5 in October and is near the top of the height/weight charts...My first granddaughter was a scheduled c-section at 39 weeks and was almost 9lbs. Her sister was a scheduled c-section at 36 weeks (my daughter's busted up pelvis and hip were giving out) and was almost 7lbs.

[mango_fandango]

Oh jeebus. I hope to the FSM that she doesn't go to Sintral America any time soon. She will have a newborn and a toddler to deal with. It was bad enough for her with just Izzy... two kids would prob give her some kind of breakdown. 

I have no idea what Rh factor I am. It appears to be a different system to ABO. I do know that my mum is O- and Dad is O+. My brother and I are both O-.

[Rachel333]

29 minutes ago, Paigerin2 said:

Holy cow- twins at 9lbs a piece? Your great grandmother deserved a medal!

She was definitely a very hardy woman! She raised her siblings and then had a bunch of babies of her own (all girls) and raised them on a farm during the Great Depression. She ended up living to 103 and was healthy and mobile all her life. Her daughters are now in their 80's and 90's and are also all active and healthy.

[Funwithfundies]

8 hours ago, FakePigtails said:

It will be interesting to find out whether she intended to deliver in the hospital or not as well as how this will affect their family planning. Some women can safely have a lot of c-sections, but it just depends on the person. From the cases I've heard of it sounds like doctors can tell how the uterus is doing from looking at it during each surgery and estimate how dangerous another pregnancy would be.

My second birth was an attempted/failed VBAC, leading to an emergency section.  After congratulating me, the doc immediately said that my previous c section scar was paper thin and on the verge of rupturing, and that if we wanted a third child we needed to wait 18 months before trying to get pregnant (and obviously no more VBACs).

[Paigerin2]

18 minutes ago, Rachel333 said:

She was definitely a very hardy woman! She raised her siblings and then had a bunch of babies of her own (all girls) and raised them on a farm during the Great Depression. She ended up living to 103 and was healthy and mobile all her life. Her daughters are now in their 80's and 90's and are also all active and healthy.

That's awesome! I love stories like this- I wonder how long that labor was!

 

[HarleyQuinn]

She must have tried at home, right? No way she goes that long in the hospital.