A VBAC Labor and Heart Decels

Since posting Xander’s birth story, I have had a few people ask me some questions.  For the most part, I answered them individually, but I think it’s a good idea to address them here as well.  So over the coming weeks, I hope to get a few posts up regarding those questions.

There was one question that I was asked that I really couldn’t answer.  “How did you know that the heart decels you had while you were in labor weren’t due to a uterine rupture?”

The short answer is I trusted the medical staff.  The nurse and doctor both told me that they could tell by the type of heart decels that it was a cord issue and not a uterine rupture.  This is something that they confirmed during  my c-section.  Not only was I told that Xander had the cord wrapped fairly tightly around his neck and that he had a death grip on the cord with one hand, but I was also told that my uterus was in excellent shape.

So the question got me thinking, how exactly did the staff know that I wasn’t experiencing a uterine rupture?  The first warning sign of a uterine rupture can often be changes in the baby’s heart rate.  If you look up the warning signs, studies often mention ‘prolonged fetal heart rate decelerations’,  and ‘fetal bradycardia’.

Fetal bradycardia is when the baseline fetal heart rates drops below 100 beats per minute.  I know with 100% certainty that this was not an issue with Xander.  I could see the monitor and kept an eye on Xander’s heart rate for hours.  I don’t ever recall it dropping below 100 more than once or twice and just for a few seconds, so his baseline was always above 100 bpm.

A prolonged deceleration is a deceleration that lasts longer than 3 minutes.  When the heart has decels that last 3 or more minutes, it becomes necessary to deliver that baby and often a prolonged decel will result in a true emergency c-section within the next 10 minutes.  The first decel that I had with Xander felt like it lasted about 10 minutes, but according to my husband (and later my doctor) it really only lasted about 90 seconds.  This was the most serious decel and it was attributed to my water being broken.  So I think it’s fair to say that Xander didn’t have this type of decel either.

So I was able to rule out these two types of decels, but that left yet another question, what type of decel was it?  I had no idea.  Then I had a thought.  Then I discarded the thought.  Then I chewed on the thought for a few days and finally I just picked up the phone.  I called my old OB’s office.  The one that I had reluctantly left earlier this year.  I wasn’t sure what would happen when I called.  I made sure to call and ask for the nurse that I had become friendly with during my pregnancy.  She promised me that my doctor would call me back but warned that it might take a week or so.

I was fairly shocked when I received a return call the next day.  I had a great conversation with my doctor.  He had reviewed my records and confirmed that no, Xander had not been having prolonged decels or bradycardia.  Xander had variable decelerations.  Variable decelerations are related to cord issues.  They aren’t associated with contractions or uterine rupture.  My doctor explained that if every pregnant woman were to be constantly monitored for 9 months, you would see variable decelerations all the time as the baby moves and puts pressure on the cord or as the baby grabs the cord and compresses it.  Variable decelerations are normal as long as the baby’s heart rate returns to a normal baseline.

So, if variable decelerations are normal then why the need for the c-section?  My doctor explained that the use of pitocin can worsen the variable decelerations.  This is why my pitocin was turned off for a while.  Xander was still having decels without the pitocin so they tried an amnio infusion.  The amnio infusion didn’t work as well as they would have liked and without the pitocin I had stopped dilating.  The thought was that in order for me to dilate those last 3 centimeters, I would need pitocin and it would need to be a higher dose than I had already been given.  Given my VBAC status and the heart decels, this was something that neither me, my husband or my doctor were comfortable with, so c-section it was.

So there it is, the long drawn out explanation of why Xander’s decels weren’t an indication of rupture.  I’m glad to know the reasons behind it, but at the end of the day, one thing still rings true.  You need to have a medical team that you can trust.  Not just for a VBAC, for any birth.  I was able to trust that my baby and I were being cared for properly.  I trusted what I was told, that the decels were not due to a rupture.  That it was safe to continue my labor and try the amnio infusion.  I trusted my doctor when she said we would need to do a c-section.  And in my heart I knew that doing a c-section was the right decision.  I knew it before she ever said the words.  I am beyond grateful that the medical staff properly identified the decels as variable, didn’t become panicked and allowed my labor to progress for as long as it did.

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