C-Section Or Natural Birth For Women With Dysautonomia?

[Elenapap11]

Hi everyone!It has been a long time since i last visited the forum so i have missed quite a lot of what is going on here but i always think about my big family over here who have supported me through some very rough years of my life since i was diagnosed with dysautonomia.For those of you who have been in this forum for a while you might remember that i was doing much better over the last 18 months and i was thinking of having a baby.Well,now i am in week 23 of my pregnacy and relieved to say that POTS and my other health issues have not gotten worse during this time(though i did have 2 mild POTS crises and i ocassionally get tachycardia and low blood pressure-but not as serious as it used to be and i recover very quickly without feeling exhausted).

Anyway,i am facing a dillema these days and i would like your opinion.My gynecologist wants me to try for a natural birth as according to him my pregnacy so far has been great but my G.P. who has known me for many years and knows my issues(GERD,Epilepsy,Asthma and POTS)said that if she were me she would opt for a c-section to minimise the risks.The thing is that my gynecologist only knows me for 6 months now and though he is informed of all my problems he has seen me at my best so he keeps telling me that i look perfectly healthy to him and sees no reason in not having a natural birth(with epidural).Do you think he is right or is it just that he might not be aware of what POTS is all about?I am afraid that if i have a long and painful delivery i might soon get back to bedridden state and daily crisis and i really don't want this(especially for the first months of my baby's arrival).Plus,i am 34 years old and this is my first baby so i have more chances of having complications during labor(according to articles i have read.

How have you given birth to your children?Which of the two options is best for a woman with POTS?i am really looking forward to your answers because i am troubled and feel that once again doctors are confusing me rather than giving me answers.(maybe there are no answers to this question but i hope you can help me there)

Thank you in advance!

[coloredblood]

I WAS ABOUT TO ASK THE SAME QUESTION! I am 22 weeks pregnant. Also my first baby. I have met with cardiologists and maternal fetal medicine (MFM), high risk OB/GYNs and my Ob/Gyn whom I have been seeing for years and years. MFM is who everyone is looking to for answers. I have been given a plan A and a plan B. I wanted to see what other women have gone though and how it went.

Plan A is get to the hospital early in labor and put in an epidural really soon into things. Lots of monitoring and keeping me laying back the whole time. Delivering vaginally.

Plan B is get to the hospital early in labor and put in an epidural really soon into things. If anything doesn't look right or if I'm not doing well or if baby is not doing well, do a C-section.

Most of the doctors are on board for this, but I have found some are worried about me going into labor at all. It is a lot better for the baby (as I've been told) to go into labor naturally and then go with plan A if possible. It's exciting and scary!

I'd love any input too!

[Bigskyfam]

3 csections here

[Bigskyfam]

Congrats by the way

[Elenapap11]

Thank you BigskyFam!You had 3 c-sections.so how long did it take you to recover and did it exacerbate your symptoms?

Coloreblood congratulations!We are very close.My due date is 28 June.I suppose yours is around those days too...I haven't seen any MFM and to be honest i don't know if there is one where i live so i just have to rely on my other doctors.I am going to see a cardiologist in a couple of weeks too so i will ask him what he thinks too and let you know.As for what's best for the baby i have heard various opinion.Some suggest that it's best for the baby to come out from the birth canal in order to strengthen its respiratory system and others told me that with ceasarian we will avoid complications that will put a strain on the baby.My biggest fear is going for a vaginal birth and then if something goes wrong i ll be rushed in an operating room for an emergency c-section with general anesthesia...and i really don't want this.If i am to do a c-section i'd like to be awake when my baby comes out.

[JuneFlower]

Ok I am a registered who has 17 yrs experience in Obstetrics. I work day in and out with new moms.
Your GP is so wrong, IMO. There are so many reasons why a csection is more risky for mom and baby. You can actually see it in the mortality rates for both. But also in practice , less admissions to NICU, less pain and gas and faster recovery for mom.
Some people who should not push. -history of aneurysm or other similar thing. Severe back orthopedic problems could potentially cause an issue.
My daughter has PoTS and lie blood pressure and I would never encourage a csection. Your obstetrician knows their specialty.
Sorry I fe do strongly but I have seen many new moms separated unnecessarily from their baby due to complications from an unneeded csection.

Go for the vaginal delivery!
June

[kim5204]

I delivered my 2 vagnally my symptoms flared afterward but probably from the lack of sleep.

[Aimes]

I delivered both of my girls vaginally. The only thing I had an issue with was the epidural. It made my BP bottom out, but was fixed quickly with some medication. I did really well during labor and delivery. I was a little symptomatic after but I'm sure I would have been with a C-Section also. I was mostly glad to not have to go through the recovery process of a C-Section. Having said all that, we're all so very different. Continue to have conversations with your doctors and do what you're most comfortable with. Good luck and congratulations!

[Bigskyfam]

I truly believe my pots symptoms flared after my 3 rd csection . And possibly started after I had epsteinbarr after my second pregnancy. 10 years difference in between 2nd and 3rd pregnancies. Just diagnosed last fall. My youngest is 6

[MomtoGiuliana]

I had a C-section but I really wish I had delivered naturally--which was my intent. I was not diagnosed at the time w POTS but I was very sick w POTS in my last trimester. I rallied a bit in my last two weeks. Anyway, I agree with JuneFlower that my understanding is that there are most risks and you are more likely to have complications w a C-section. (In my case, I had to have a C-section (under general anesthesia) b/c I had placental abruption during labor. It seems this is something in my family b/c my sister also had placental abruptions (she had 2). I don't want to alarm anyone--I don't think there is a relationship to POTS.)

I believe the additional loss of blood that occurs with a C-section and the stress of surgery can be very detrimental to a patient with POTS. Even women w/o POTS will have a longer recovery time. I was the sickest I have been w POTS in the 3-4 weeks following my daughter's birth.

Sometimes C-sections are necessary to save the life of the mother and child (as in my case) but many are done that are not necessary, from what I understand. There are some studies out there that have followed pregnant women with POTS and found that they can have healthy and normal pregnancies and labor. Perhaps search for some of these studies and share them w your doctor. And perhaps consider seeking some other opinions.

[JuneFlower]

Aimes- The epidural can make a lot of people's pressure bottom out. It is a very common side effect unfortunately. We usually can control that if it happens with IV fluids and sometimes some meds. (Happen to me twice and I don't have POTS).

I can also see how even a vaginal delivery would make POTS flare but I think it would be less than major abdominal surgery. Also you would have a lot less pain meds to worry about.

June

[castronovo112587]

I would say to go naturally. There's always a possibility you may get a flare of symptoms no matter which way and it would be a lot worse to deal with a flare if you were having to deal with the healing of a c section. Best wishes, keep us posted

[Elenapap11]

Thank you all for your sharing your views and personal experiences.JuneFlower thank you for the professional input.You really made me see things very differently.Perhaps i should just try for natural and if it's not meant to be i guess i will find out when the time comes.Giuliana i will try to find studies and give them to my OB.Rosey and Aimes thank you for your wishes.I'll keep you posted. Regarding epidural and low blood pressure...how low are we talking about?Mine is 45/85 to 50/90 maximum at the moment.When i eat salt it gets back to normal for a couple of hours but drops down again.Can it get any lower than that without passing out?

[JuneFlower]

Wow- not sure if anesthesia will give an epidural if its that's low. But maybe…I would ask OB for an anesthesia consult prior to delivery to discuss options in both a vaginal and surgical birth. They should know about your pressure so they can plan. There is a med they give to rapidly raise the pressure but I can't remember right now. Ugh. Good luck anyway. Everything will be great!

June

[JuneFlower]

sorry didn't answer your question. The pressure can totally bottom out- be unreadable for even normal people. But they bounce back with IVF and meds. It happened to me when I had a spinal tap so I don't think it is related to meds per say.

[Elenapap11]

Thank you JuneFlower!I will mention all that you told me to my OB on Tuesday.Very helpful information.

[JuneFlower]

Elena- ok . He or she may say it isn't something to worry about ahead of time. In which case, I'm sure they are right. But at least you know. And happy pregnancy.

[castronovo112587]

I've never had a c section but doesn't the spinal they give you for it drop your bp as well any way? I know general anesthesia will as well as an epidural of course.

[JuneFlower]

it can but usually not as much as the epidural. The needle is much bigger for an epidural and it goes in a different place. I think it might be a vasovagal response that happens. The spinal needle is much smaller. I don't remember hearing it happen with a csection but with POTS who knows?

[corina]

Surgery's a big problem for me, both general anesthetics and epidural make my bp drop. I thought I would be okay with an epi (I was earlier) but bp started to drop during surgery and hasn't come up over 110(systolic). I had surgery last July and am still in between 95 and 108 systolic which makes it quite difficult to exercize. Not to mention other stuff that popped up again. For me, I will only have surgery in case of emergency

[BallroomA]

Congrats!! I just delivered my little miracle in November. We had a natural labor and things were good for the first 6-8 weeks. I was really worried about how my body would react and discussed my options with all my doctors. I had a lot of complications during pregnancy and I was mentally prepared for a c-section.

I've been in the midst of a flare up which I'm sure lack of sleep isn't helping.

[MomWithPots]

Congrats on your first baby! I am so happy that your doing good with your pregnancy! Ive had 3 c-sections. I had to have one with my first as my son was having complications, he is ok though. After your first, most doctors prefer that method with your other children. I did not have a problem during my surgery, except my hr going up, but I was awake and nervous so its expected...it was after that I had issues! My hr was all out of wack (palpatations) and it took a few scary days to get it back to "my" normal. I think this was due to blood loss during surgery as I almost had to have a blood transfusion. Not to mention with my second, I developed a spinal headache and my symptoms flare up with severe pain...Not to scare you though! Everyone is different. When they place your baby in your arms, it will have all been worth it : ) Good luck and congrats again!

[JenniferInOhio]

I had undiagnosed POTS at the time of both pregnancies. I delivered both vaginally with epidurals. 38 hours of labor (from start to finish) with the first, 18 hours with the second. I didn't have any POTSy complications. At the start of both labors, I did experience heart palpitations.