I recently received the following comment:
This is a really great post. I had never heard of women having a VBAMC before…but now that I know about this I am curious. I have had 1 CS, after a 24 hr homebirth turned emergency. Our daughter was born still after Csec to save her life was performed…
Our miracle baby was born c-sec after more than 24hrs of VBAC-ing labor. His heart rate de-celled enough times that we decided to get him out, after I was stuck at 9/5 cm’s for many, many hrs with no progress!
As it turned out, i had an obstructed labor…and a Bandel’s Ring, so baby was never coming out vaginally. So, now I am concerned for the next baby (prob a yr from now). Should I attempt another VBAC? How do I find out if I have a true Bandels Ring? What are things I can do to prevent this from happening?
I’ve done some research into this topic, but it is frustrating.
What is “Bandl’s Ring”? There are two types of uterine muscles, one to help the cervix dilate and the other to help push the baby out. At their juncture, rarely (usually during a prolonged and/or obstructed labor) a ring develops around a “depression” in the fetus, usually over the neck. [Click here to see a picture of a woman's abdomen, showing the stark outlines of the baby's body, due to a Bandl's Ring. Sometimes when this happens, even a birth by C-section is difficult, because the ring prevents the birth of the shoulders and the rest of the body. Usually, the uterus will greatly constrict, which disrupts placental blood flow, and therefore oxygen flow, to the fetus. Bandl's Ring was named after the doctor who first identified it.
One source said that a T incision was indicated for Bandl's Ring. Since a T incision is usually (if not always) a contraindication to a VBAC, it seems pretty certain that it is not always necessary. One mother said that she had a Bandl's Ring but still had a vaginal birth, and someone else responding to the comment questioned whether she really had a "true" Bandl's Ring, since she actually had a vaginal birth. In the old days, and currently in areas of the world without access to medical care, Bandl's Ring frequently results in high perinatal mortality (many times the baby is stillborn, or dies of birth injuries soon after birth) and also maternal mortality and morbidity. Uterine rupture will likely occur after a Bandl's Ring develops, because the lower uterine segment is just stretched so thin, and subsequent contractions stress it even more. In the old days, it was sometimes necessary to dismember the fetus (who was usually dead, due to lack of oxygen); and even then, sometimes the woman died or suffered debilitating injuries to her internal organs.
One of the frustrating elements in doing the search was a paucity of materials on Bandl's Ring, especially recent materials -- many of the Google Scholar results were case studies from the 1960s and before; including at least one from 1891 (yes, not 1981, but 1891, right before an article debating chloroform and ether). This article from 1961 (click on the pdf to read the article) included many alternate names: ring of Bandl, contraction of the ring of Bandl, contraction ring dystocia of White, retraction ring dystocia of Pride, simple contraction or retraction ring, uterine contraction ring, or constriction ring of Rudolph. Then it launches into a discussion of what different doctors have differentiated between the various names (and perhaps various types) of ring.
Johnson also commented that the terminology and assumptions used in reference to pathologic rings are bewildering, and he, too, emphasized the difference between the rings of obstructed and nonbstructed labor, although he referred to both as contraction rings.
"Bewildering" is correct. I tried to find information on Bandl's Ring, Bandel's Ring, and "uterine constriction ring," and got precious little information. On one message board, someone identifying herself as a midwife said that once a woman develops a Bandl's Ring, it will always happen again, and the woman will always need C-sections. But on another board, a doctor said that since the woman asking the question was being offered a VBAC, then that was proof that a vaginal birth was still a possibility.
The blogger at Abundant B'earth wrote the following for a "complications project," which is a nice summary (and is more informative than Google Scholar turned out to be!):
Pathological Retraction Ring of Bandl
Definition and Etiology:
-Occurs in second stage labor (after dilation complete).
-Cause is 2nd stage obstructed labor due to CPD, malposition, uterine neoplasm/ abnormality, or fetal abnormality such as hydrocephalus.
-Uterus tries to compensate by increasing in tone and intensity & frequency of contractions.
-As a result, the lower uterine segment lengthens and thins, and becomes tender.
-Upper segment becomes hard and thick, and progressively retracts.
-The physiologic ring at the junction of upper and lower segments becomes extremely pronounced. Ring rises in abdomen.
Si/sx: ["symptoms"]
-Hypertonic contractions
-presenting part driven/jammed
-mother experiences severe pain and excited or restless emotions
-maternal pulse, temperature rise
-palpable, taut round ligaments; may also be visible
-Baby entirely or almost entirely in lower uterine segment.
-ring felt as transverse ridge, as high up as umbilicus or potentially even higher
Differential Diagnosis: May appear to be constriction ring. (see chart Frye p. 1043)
Complications/Sequelae:
-rupture of the lower segment, maternal hemorrhage
-placental abruption
-maternal exhaustion, inertia, and arrest of contractions
-uteroplacental insufficiency with resultant fetal hypoxia and distress.
-maternal fistula, lacerations more likely
South Carolina Regulation 61-24
Midwives shall obtain consultation for, or refer for care, any woman who:
(39.) develops pathological retraction ring.
Midwifery Management/Care Plan
Transport at once.
Medical Management
Tocolytic medications.
Holistic Midwifery Volume II p.241, 251, 376-7, 1038-45
Human Labor & Birth p.655-7, 662-3, 664-5, 671
11/2/2009
So, I don’t know how common it is. I don’t know what the rate of recurrence is. It seems that uterine fatigue is the chief cause of it (although there are other factors — for instance, fetal malposition may cause obstructed labor which may lead to uterine fatigue due to a lengthy labor), which makes me think that perhaps red raspberry leaf tea may help to prevent it. I don’t think there are any contraindications to this tea in the third trimester, although some people think it might increase the risk of miscarriage in the first trimester. This website says, “Red Raspberry leaf does not start labor or promote contractions. It is NOT an emmenagogue or oxytocic herb. What it does is help strengthen the pelvic and uterine muscles so that once labor does start the muscles will be more efficient.” So, this may help in general to prevent uterine fatigue. Chiropractic adjustments and optimal fetal positioning may help to prevent fetal malposition (along with the mother being upright and mobile during labor, if she desires). Cephalopelvic Disproportion (CPD) is over-diagnosed, but it may occasionally happen even in well-nourished mothers. [In developing countries, many women have malformed pelvises due to poor nutrition in childhood and adolescence, and many cultures have child-brides which leads to many still-developing adolescents giving birth to children, so the incidence of true CPD is higher there.]
Filed under: C-section, studies & stuff, VBAC Tagged: | baby, Bandel's Ring, Bandl's Ring, birth, C-section, cephalopelvic disproportion, constriction ring of Rudolph, contraction of the ring of Bandl, contraction ring dystocia of White, cpd, obstructed labor, obstructed labour, pregnancy, pregnant, retraction ring dystocia of Pride, ring of Bandl, simple contraction or retraction ring, uterine contraction ring, VBAC
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I don’t think Bandels ring is very common. Every time I have seen it during a c-section that I scrubbed into it was like, “oh look, she has a Bandel’s ring.” However, I asked one of the Ob’s who is very up on the latest infomation and he told me it does not necessarily happen the next pregnancy. I should ask him for references. I will if I remember.
Just a quick note, there is a bandl’s ring, which is an exaggerated retraction ring…. a normal development in second stage which defines the upper and lower uterine segments.
A bandl’s ring, or pathological retraction ring gets pronounced and rises in the abdomen as the lower segment stretches out. It is thought to be the result of an obstructed birth.
A constriction ring is another thing altogether, caused by uncoordinated muscle contractions, often as a result of manipulation of the uterus in labor. In this case, the lower uterus may not be taught and the baby may not be well applied to the cervix.
Crazy. I have never even heard of Bandel’s ring.
Kathy you have done a stand up job investigating Bandel’s ring. What do you know about Tuberculosis (active TB) and it’s effects on the neonate/fetus? One of my students said, in her oral report, that TB causes Galactosemia in the fetus. I was curious about this. So I asked her what the mechanism was that caused the galactosemia. She didn’t know. Still curious.
I have actually never taken care of a woman with active TB. I live a sheltered life! But if I go to Guatamala to help deliver babies, I might run into a few. Just curious really.
Good post. Your google research skills are stellar. I applaud you.
When the bandl’s ring was brought up on Rixa’s blog, I recommended getting the pink kit which teaches one to map their pelvis, and find what positions open them up the best. This may be helpful if the cause has something to do with mom’s pelvis. It is a great resource.
I’m not convinced that length of labour has anything to do with it. While I’m not coming from a medical persepective I myself have experienced it. I went into labour with my 2nd child the day after my due date and laboured for total(including pushing) of about 9 hrs of feelable contractions. Dilated to 10cm with baby very high up. Pushed for around 2 hrs, no progress and heart rate started dropping so emergency section. Dr’s notes said abnormal look of stomach but can’t say I noticed that
Anyway when they did section I had the Bandl’s ring so they had to do T cut as couldn’t pull bubs out. It was the 2nd ring my dr(originally south african which I believe he had seen the other one) had seen but no one else in hospital had ever known about it. Bubs was 10lb, 36 cm head, 55 cm long. Two interesting things though. He was transverse right up till 37wks when I had an awful hr of pain when I believe he turned. And trying to push hurt so much I couldn’t push properly. This compared to my previous labour where pushing with contractions eased the pain a little. Previous bubs was induced day after due date, 7 hr labour from drip put in, 9lb 13oz, 35cm head, 53 cm long coming out with such a round head everyone thought she was a section instead of vaginal delivery. Theoretically considering they were very similiar size, both day after due date, same length of pushing time, etc I should’ve got the ring with the first one when I was induced hence contractions a LOT stronger. One difference being baby 1 was quite low but baby 2 was high up. Neither labour was a long labour by normal standards.
Anyway that is my 2 cents worth.
Wow, another danger in birth. I don’t know, I haven’t read this thoroughly, but I am thinking that this is where herbs and homeopathics could be really helpful!!
Interesting…I was just trying to research if an ultrasound is standard practice after a Bandl’s Ring C-section. I had to be induced with high blood pressure and after 24+ hours of hard contractions I still hadn’t dialted past 4cm. The MW and OB decided a c-section was a good idea. After opening me up they commented that I had a Bandl’s Ring (I think I still had a horizontal cut). My MW told me that I may be able to have a VBAC if I went into labor naturally on my own but that I would never be induced again. I was hoping to find out if an ultrasound is standard practice after a Bandl’s Ring is discovered because I was not given one but had to go in six weeks later after continued heavy bleeding and have a D and C due to some of the placenta still being on board. Anyone know? Thanks for the info.
I really don’t know, but I would think it would not be, because when the uterus is cut open during a C-section, that provides a much better internal view than an ultrasound could give. It’s more likely that the doctor just missed a piece of placenta when he thought he removed it all. Usually it comes out in one piece, and they check the placenta to make sure it’s all there, but it’s possible it looked complete even though a small piece was still in your uterus.
Thank you for this information! I am considering TTC # 4 soon and with this I’m trying to decide whether to VBA3C or to have a RCS. A Bandl’s Ring is something that was found with my 3rd c-section but I find it interesting that hypertonic contractions are mentioned since that is what I had with my 2nd labour and then the 3rd. One thing I am looking into if we do TTC #4 is chiropractic care since I wonder if malposition is the problem since I know that CPD is rare but I believe malposition is a lot more common and could explain why I haven’t been successful this far with a vaginal birth. Thanks for the great links and article, it was very helpful.
am so releived that after 7 years i have managed to find others who have had the related problem of a bandls ring. with my first child the labour was so painful i thought i was gonna die, and after being started off on the sunday night and then eventually starting to push for two hours on the tuesday morning, they decided i needed a c-section cause my son sheart was dropping badly. after opening me up more surgeons were called to give me a classical section because of a bandls ring. thankfully my son and myself were fine but anytime i tried to ask questions to find out what it actually was i kept getting fobbed off. after 7 months i fell pregnant with my daughter and was told had to have c sections with all my children..
Thanks for commenting! I’m sorry it took you seven years to get this information, although I am glad it is not a common problem.
A classical incision for a C-section definitely increases the risk of uterine rupture in future pregnancies/labors compared to the low horizontal incision; although I know one woman who had a VBAC without a problem after a classical section (and was induced, which further increases the risk of uterine rupture). It’s not a choice most women will make, however!
should it have been picked up through the monitoring during labour? at one stage they thought my son had died inside me they couldnt find his heartbeat, thankfully this was a false alarm. i was having constant contractions and was dehydrated, but they let me go on for another 24hrs. i thank god the doctor who eventually came in rushed me to theatre when she did. my son was born covered in a rash from head to toe and i was told its one of those things, but now im not so sure.
Not necessarily. Typically Bandl’s ring happens after a long, hard labor, but not all long, hard labors will cause a Bandl’s ring. Also, fetal distress may be one indication of the baby not tolerating labor, but with so many cases of fetal distress with so few cases of Bandl’s ring, it’s not something that is common.
As you can see from the picture in the post, in severe cases, it may be obvious from looking at the mom’s belly that the uterus has formed a Bandl’s ring, but it’s not always obvious.
Having “constant contractions” should have been picked up by the monitor, but sometimes the EFM doesn’t pick up the mother’s contractions properly — there are numerous birth stories of mothers who were having constant contractions, but the nurses refusing to believe they were even in labor, because the EFM belts were malpositioned, and just didn’t pick up the contraction. While constant contractions can be a sign of Bandl’s ring forming or having formed, it usually is just a sign of too much Pitocin (syntocin/oxytocin) which, again, usually does *not* lead to Bandl’s ring.
Fwiw, dehydration can also cause an irritable uterus — one of the “tricks” to stop preterm labor contractions, or to distinguish between “real labor” and “pre-labor” is to drink a large glass of water and see if the contractions stop. I don’t know about dehydration during labor causing constant contractions, but it’s possible. Even if it didn’t cause any worse problems, it’s still terribly uncomfortable to be wanting something to drink, and to know that your body needs fluids, and to be denied it.
I was just in attendance at a home birth where the mother developed a bandl’s ring. The slender petite first time mom had bloody show and a few restless nights over the 4 days preceding the onset of regular birthing sensations indicative of a true active phase. She showed signs of transition through the late morning after two sleepless nights, and waited for her body’s signals to push. Initially they came intermittently. All afternoon and evening she assumed different positions, spent time in the water and worked through steady sensations. By night she was having difficulty using her legs, and preferred to assume various sitting positions. Just after midnight, a retraction ring became visible between the pubic bone and navel, and began to rise and thicken ’til it was very pronounced just below the navel around 3 am, perhaps accentuated by the anterior placement of the placenta. The mother was bothered by the pain stretching her round ligaments. Sensations seemed to increase, and the ring was not visible while she bore down, and the round ligament pain slowly disappeared. After seeing the top of the head, the baby did not begin to crown for well over an hour, and crowning (after the baby’s occiput stayed under the pubic arch) itself took close to an hour. Her tissues yielded while the baby’s heartbeat remained strong and thick meconium emerged. She sustained a second degree tear with the last push that birthed the head into the birth pool. Three more contractions and three position changes later the mother was helped out of the pool and delivered her 9 lb baby while standing, supported from behind, before 6 am. The uterus remained high and narrow, the fundus firm, just before the placenta emerged an hour later, at which point the fundus could be felt just below the umbilicus.
From what I’ve been reading, if uncorrected, the obstructed labor presenting with a bandl’s ring can produce rupture of the uterus, which is more likely with higher parity (more previous births) and with a previous cesarean scar. The physiological ring is generally not externally visible.
In this case, it looked similar to a distended bladder, but it was obvious that the thicker part was at the top, so it looked like the uterus had an elastic band around its midsection.
Anyway, I’m all for women taking the time they need to birth their babies, but this one had me feeling very nervous at times.
I had a Bandl’s ring with my second child. He and I were both lucky ot come out of it alive and the birth, by C-section, was harrowing. I had been on pitocin for three days ( on in AM, off in PM) with little cervical dilation, just like my first birth. But I developed a fever, and an additional cramping ( which was ignored by medical staff). An Emergency csection was initiated only to discover that the baby was stuck ( due to the BAndl’s ring). After my son was “yanked out” I began to bleed precipitously and needed an immediate blood transfusion to save my life. I also had a hysterectomy right there on the spot. My son was in NICU for a few days but he was OK. His Apgars were 1, and 8 respectively, so he recovered from the trauma very well.
I don’t think the obsetrician on call knew what hit him. I don’t even think he knew what a Bandl’s ring was until after the fact. The while thing appeared to be managed badly. My son and I survived by the Grace of God or luck, certainly not medical expertise .
I hope the birthing esptalbishment is more aware of this condition now than they were 13 yrs. ago. I was attmepting a VBAC at the time, was 41 yrs old but in excellent health .
Wow, what a story! I’m glad you and the baby are okay!
Thanks, I don’t want to scare anyone, just inform. I never got to have a vaginal birth but I am small and my sons are both big guys ( then and now). My mother, grandmother and sister all had long difficult labors.
I had a Bandl’s ring when my son was born. I was in labour for 5 days, and I can honestly say I thought I was going to die. I was terrified and in agony, but my son was ok so the labour was allowed to continue. After 4 1/2 days the midwives decided it was never going to happen on its own, so I was induced (and given an epidural thank goodness). There was very little progress over the following 12 hours, and then my son’s heartrate started dropping so they did an emergency C-section.
I remember them struggling to get him out (“big shoulders, this one” was the surgeon’s comment), which was probably due the Bandl’s ring. My son was absolutely fine. I lost a lot of blood and was very ill, presumably because of exhaustion since I’d already been in labour for so long by that stage.
The consultant who came to explain things afterwards said I would need C-sections in future.
They don’t know why the ring formed. The baby was posterior, which can’t have helped. I took red raspberry leaf tea tablets for several weeks before the birth, which clearly didn’t help.
It is so nice to find info on Bandl’s ring. Thank you! I had my son in August 2009 and when I came home to search ‘Bandl’s ring’, there was virtually no information. (This info was posted after.)
I labored for 24 hours and then had to have emergency c-section. The little bugger just wouldn’t come out. Once in the operating room it seemed to be taking a very long time. Then I heard the anesthesiologist say to the OB “Do you want me to do it?”. I thought “huh, that is strange, what would he need to do?”.
Turns out they couldn’t get the baby out with the one incision, so they had to do a T. They STILL couldn’t get him out, so they needed someone to go in from the other side (vagina) and push on his head. They had to pull someone in from outside the sterile field to do this as there weren’t enough extra people scrubbed in (normally not that many people are needed obviously). The baby came out not breathing, but he was quickly revived.
As the doctor was sewing me up she told me I had Bandl’s ring and that I would always have to have c-sections. I later asked her how many she had seen. She said she had been doing -c-sections for 15 years and this was the 3rd she had seen.
The staff were searching online while I was in recovery to find out more info on Bandl’s ring. Apparently they were still talking about it in the operating room the next day.
I am so thankful that I went to the larger hospital in our area! I REALLY didn’t want to…I wanted to go to the small one. However, upon my midwives recommendation after seeing I was having complications, I listened to her. I think things could have turned out much worse if I had gone to the smaller hospital and had someone with less experience that hadn’t seen Bandl’s ring before.
The only thing I don’t understand is, will the ring be there during my next c-section? Also, I wonder why my uterus didn’t rupture considering I was laboring for 24 hours and had pitocin as well (with no epidural).
Last question first — women can labor for days without developing a Bandl’s ring and without having a uterine rupture, even with Pitocin. Different women react to Pitocin in different ways (and it may be different in every labor, as well), with some women being thrown into full-blown labor with just a little bit of Pit, and other women not having any contractions at all, even with Pit at full-blast.
I don’t know if the ring will still be there during your next C-section; from the information I’ve gathered in the post and the comments, some women are not discouraged from having repeat C-sections even after a Bandl’s ring, unless (as in your case) they have to do a vertical incision which carries with it a much higher rate of rupture than a low horizontal incision. The best I can gather from what I’ve read, and from what I know of the uterus shrinking down after giving birth, it seems that the ring is a temporary thing (perhaps a form of constant muscle cramp in one ring of the uterus?), and when the uterus shrinks back to its normal post-pregnant size (going from the size of a watermelon back down to the size of your fist), the ring would resolve.
It seems that the main problem for future births is not so much that you developed a Bandl’s ring, but that you had to have a T incision. Because of the way the uterus contracts during labor, a low horizontal incision is the safest for a repeat in labor. When you cut vertically (in either a classic incision or a T incision), the part of the uterus that contracts strongly is cut, so in any future labors, the incision and scar is going to be facing a lot more pressure with the contractions, and is much more likely to give way and rupture than a low horizontal incision. I don’t remember the exact risk; I think it’s in single percentage points, somewhere around 5% of women with vertical incisions will rupture their uterus in future labors, whereas the risk of rupture in a low horizontal incision is less than 1%.
It is not totally uncommon for someone to have to push the baby’s head back up into the uterus; although usually when I hear that story, it is from women who have been pushing for quite some time and either ran over the arbitrary time limit for pushing, the baby’s heartbeat started going south and a vacuum or forceps didn’t work, or something like that. In other words, the baby’s head was already starting out of the uterus and down the vagina, but progress wasn’t made (at all, or not fast enough), so a C-section was performed instead. This may have been the case with you (you didn’t say whether you were pushing or not); but it may have been that your baby’s shoulders or other part of the body was wedged so tightly against the Bandl’s ring that they had to push him backward to wiggle him enough to get him out.
I was diagnosed with a Band’l Ring. I was at laboring at home for over 2 1/2 days. I started on a Tuesday at 1030am and it ended with an emergency CS on Thursday at 8:45pm. I was in active labor for about 11 hours (from Wednesday around 6pm to Thursday morning around 5am. My contractions were hard and very close together, then all of a sudden, the contractions eased to 5 minutes apart still pretty strong ( I could not talk through them) but no where near the pain like before.
I was 42 weeks. My baby had been LOA position since 34 weeks and the Bio Physical Profile was 8 out of 8. However, after all of that labor, I was only dilated to a 5. One side of my cervix was paper thin while the other side was not nearly as far along. I tried position changes from 5am (when the contractions eased) to 4pm. I was exhausted, and had painful contractions that were not progressing my labor at all.
430 pm, we headed for the hospital on the recommendation of doula and MW. Baby was put on monitor and had stead heart rate, but was not showing acclerations as she had done previously. They broke my water around 745pm which showed thick meconium. They took me in for an emergency CS at 830pm, baby was not born until 915pm.
Now I had never gotten to pushing, so baby was not stuck from pushing. Baby was stuck, doctor did a regular horizontal incision, but after a long time of grunting, she could not get baby out. A nurse went up vaginally to push baby out.
I heard about the Bandl’s ring from the MD and doctor at my 2 week check up,
Baby had apgar of 1 and had aspirated meconium. Baby was airvac’d to another hospital with a dx of HIE (hypoxic ischemic enchephalopathy) which is basically a cut off of either blood flow or oxygen flow to the brain. Our baby girl went to heaven 6 days later from the complications.
I am wondering a few things:
1) How did baby get so very wedged with out any pushing? I suspect that the hard fast contractions resulting from the development of the Bandl’s ring may have had something to do with it?
2) Are there any common criteria or occurences in births or the women that makes them more likely to develop a Bandl’s ring? And if so, what are they? What causes a Bandl’s ring?
3) Once you develop the BR for one birth, are you more likely to develop it with subsequent births?
4) If a cut off of blood flow and oxygen is something that has been seen in labors where a Bandl’s ring develops and my baby’s dx of HIE is defined as a cut off of blood flow or oxygen to the brain, then could the HIE have been caused by the Bandl’s ring? And if so, how could it be prevented in the future?
Also just an observation: it seems like many of the stories I read here, the women who developed Bandl’s rings were laboring at home or doing home births; I am wondering if in some crazy way, the two are inter-related??
Hmm… I don’t see how *where* you labor could directly cause your body to do or not do something, especially something on the inside. My guess is that your baby’s cord probably got pinched when she was stuck and that’s what caused the HIE, and I’m sure the meconium didn’t help things. It does sound like you did everything you could based on what you knew at the time and what you were seeing. I am very sorry for your loss
I would think that the common rate of homebirth stories on here is due to the higher level of curiosity/education of homebirthers. I am not saying that as an insult, but merely as an observation that HB moms are more likely to do homework and post online on forums like this.
I am sorry I cannot read all of the extensive discussion on this web page but in general some of these thing are worrying. I am a midwife in the UK and I must say from my point of view, 1 a Bandl’s ring as I understand is not a thing that necessarily repeats itself. and 2 if a woman has had a LSCS a home labour and birth is NOT recomended if only one or two “horisontal” or bikini insision caesarean labour in hospital with continuous electronic fetal heart monitoring is posible. In the UK we would never recomend labour with a clasical or T insision on the uterus there is a great risk os uterine rupture. Hope this is helpful sorry if I have repeated what others have said.
Oh and I must add if a woman has had one obstructed labour resulting in a C section, a sucssessful VBAC (Vaginal Birth After Caesarean) is far less likely not due to a Bandl’s ring but because there may always exsist a cephalic-pelvic disproportion (babies head cannot fit through womans pelvis) I a woman has had one vaginal delivery followed by a C section they are much more likely to have a sucssesful VBAC.
I had a bandl’s ring during the birth of my daughter 2 years. After labouring myself and not progressing, I was given inducing drugs and I had an epidural as I was exhausted and over the pain. After hardly progressing all day despite the drugs, I started to develop a fever. The Dr was called in, he lifted up the sheet covering my lower half and yelled to the midwife ‘What the hell is THAT!’ Not what you want to hear! The bandl’s ring was making my baby jam up the top half of my stomach- it looked crazy. There was also blood in the urinary catheter and baby’s heartbeat was going crazy and I was starting to go delerious from the fever. So a C-section for us. She was a big baby, 9.5pd, and I am small in structure. My Dr has probably been an Ob for about 20 years and had only ever read about Bandl’s ring, this was the first one he’d seen. I am now 7 weeks preg and researching my options too!
I have recently found out, 12wks after the birth of my son that I too had a bandls ring. Unfortunately the hospital I went to made so many errors with incorrectly inducing me, leaving me for 3 days in the ante natal ward, placing me on syntocin drip for 6hrs and overstimulating my cervix. The cause of the bandls ring was either from prolonged labour or incorrect use of syntocin, and the doctor didn’t diagnose the bandls ring, presumed it was a disdended bladder, made a higher incision than she should, which meant she couldn’t get my baby out, took her 15mins, used far too much force on his skull, which resulted in him dying of a subarachnoid hemorrhage and me enduring a massive obstetric hemorrhage and having my uterus rebuilt! So I’ve spent the last 3mths recovering physically and trying to deal with my emotions.
I will find out soon if I can conceive again, and if I can, I have to have c sections performed by a consultant as I will no doubt rupture, due to the bandls ring.
i just delivered at home, vaginally, and developed what my midwife called a Bandls Ring. it was visible around my stomach and my contractions were not normal. i had one continuous contraction for hours. She instructed my husband to massage my belly, and almost immediately the pain stopped and within 20 minutes my son was born. This is not to discount in any way what others have experienced, but it is so powerful and fresh I wanted to share
Tabitha, wow! Thanks for sharing that. It would be interesting to see if that had been tried by others before moving to a C-section.
I labored at home in the same way and tried belly massage, position changes, movement and I still had an emergency c-section resulting in a bad outcome. My full post is above. Its wonderful that Tabitha was so lucky, but with all I have read about Bandl’s rings, I wonder if what she had was a true bandl’s ring given that the baby was still able to come out vaginally.
We were minutes from transport, i wish i had pictures as it was very obvious to everyone in the room that there was a visible ring around my belly. My son waas being forced upwards into the top of my uterus, it looked like he was being forced transverse. This was my 5th baby, I and while am normally a quiet birther, this time I was screaming in , agony. I could hardly move, I had collapsed on the floor of my shower. I believe that as crazy as it may sound that in MY case, prayer and massage saved my life and that of my baby. I lamented the lack of photos, because I knew That people would not believe me.
The dr found my Bandels ring after 10 hrs of unprogressive labor and I had a csection because my son’s heart beat kept dropping to almost nothing. They told me I would always have to have a csection from then on. I am now 7 mths pregnant with my second son, in the ultrasounds you can see the ring that misshapes my uterus, it also has caused placenta primera (placenta over cervix) because of the limited space. The baby is developing normally and seems very healthy, We plan to go in at least a week before the due date for a csection to avoid any complications. I have been searching for any info on women that have experienced this. I guess its pretty rare and I would still like info if any one has it on the late stages of pregnancy after a Bandles ring.
I delivered a healthy baby boy two years ago after five days of labor. He was transverse the month or so before but evantually was in the right position. My contractions were strange, they were strong and short and then would space out to 10 minutes apart with the strength remaining the same. I went to the hospital twice and wasn’t dialeted enough. Based on the strength of my contractions the nurses kept saying I would have him that night. Eventaully I went in, my water broke, I had to have help dialating, and than couldn’t deliver. During the C-section my baby was very stuck, I went into shock and hemorahged. The Dr.’s hand was stuck as he went in to remove the placenta. I am now going to have my second and plan on having a C-section as I don’t want to take any chances having to experience what happened last time. It was very traumatizing for all involved. It’s nice to see more info on this condition compared to a couple years ago.
Oh my goodness, I can’t tell you how relieved I am to find women who had a similar experience to me AND someone who truly seems to understand it all – thank you!
I had my daughter nearly two years ago; I quickly got to 7cm dilated after my waters broke and contractions started but then didn’t progress. Had epidural and oxytocin when I was too tired to continue but still nothing, so proceeded to CS. They opened me up and then I heard the crash call and that’s all I knew, as they put me under GA. When I came round I was told she had ‘got stuck’ so I needed T section and had to have several blood transfusions because my uterus was knackered. Luckily she was a healthy 8lb baby and apart from being very distressed (probably not meeting mummy for 5 hours didn’t help!) she was fine.
It was only when I had a de-brief several months later that I was told I had CPD and a Bandl’s ring and must always have CS in future. I’m now starting to think about number 2 and I guess my concern is that even with a planned CS (no contractions) something bad may happen again…..
I too had a c section, bandls ring, uterine tear and chorioamnionitis. Just curious how old are you gals? I am 42 and thinking about trying for another but terrified.
Thanks for collecting all this data! I had a Bandl’s ring with my daughter two years ago. Long labor and a T incision were necessary to get my daughter out. I recently lost a baby at 11 weeks due to a subchorionic hematoma. Do you have ANY information about the following:
Have you heard of hematomas being more likely after a Bandl’s ring or a T c-section incision?
When my OB did the D&C she noticed that my uterus was very tense and already “banding.” My OB is now concerned about future pregnancies for me. I guess I am just wondering if you know of any cases of uterine rupture in the last trimester (prior to labor commencing) in women who have previously had a Bandl’s ring with a T incision?
Kristina, no, I’m sorry but I don’t really have any information. Bandl’s Ring is fortunately uncommon, so there is unfortunately little information about pregnancies after a previous Bandl’s Ring. I wish I could be of more help. Sorry.
I’m also glad to find here some information on Bandl’s ring. I just delivered my daughter via cesarean birth after trying for a natural VBAC. I labored for 3 days without any drugs and did dilated to 10 cm. Everything was going great until the baby passed very thick meconium and heart rate begin to drop. My midwife let me push for a little while but baby did not move, so she decided for a CS. When they opened they noticed I had developed bandl’s ring and my uterus was so thin that started rupturing after they went in. It was a very long surgery. I also was told by my MW that I can’t VBAC anymore, which really broke my heart. I hope we’ll find some more information and in a near future be able to have more options for our subsequent births.
I am so confused, so, so, confused. My first baby; 40 hours of slow, unprogressive labour,3 cm dilation on pitocin and epidural, baby sat high, Bandl’s ring, c-section with no complications. Second baby; planned homebirth (HBAC), 10 hours labour, 7 cm dilation, baby sat high, at hospital noticed Bandl’s ring (again) and nurses thought it was a full bladder, c-section where OB said my uterine scar was almost fully ruptured and he could see the baby through the paper thin uterine muscle.
Now, the stories I’m reading here say that many women with Bandl’s ring had to have T incisions and difficult surgery for mom and baby. I didn’t have that, but both births I was diagnosed with the ring. Did I really have it? Could I have birth normally? Could it have been something else? I am having a hard time coming to terms with not being able to birht my babies – feeling a little robbed of a right of passage as a woman and mother.
Quite honestly, I don’t know. There is so little information that I was able to find about Bandl’s Ring, with or without repeat pregnancies, that I simply don’t know the answer. It’s possible that your care provider can find more information, if s/he can look up more medical databases and studies, but the information I’ve gotten has returned mixed results, with some sources saying you can try again, and others saying you shouldn’t. There was one woman who said that she was diagnosed with a Bandl’s Ring at a homebirth, but with some massage from her husband, it resolved itself and she went on to give birth a short while later. Is that a possible thing you could try in the future? Yes; but this is just one anecdotal story, so I can’t say whether it was a fluke, or if most women would have this positive results. [I'd like to think the latter, but I just don't know.] I wish I had more answers to give you!
Jen,
I know exactly how you’re feeling in regards to your births. I feel the same way, so many questions, and so much disappointment! I’ve been trying really hard to get over it, and no one seems to really understand how painful it is to not be able to birth naturally. I know sometimes we just have to accept the facts, but the truth is, it just hurts!
Every now and then I get curious about the frequency of abnormal uterine contractions, I don’t know anyone who had the kind of troubles I had with my pregnancies so it’s nice to hear. My story is a little different but I accepted all the troubles I went through and just consider myself fortunate to have 3 healthy daughters and I am still in one piece. I might have considered having one more baby but my feeling were very strong that it was time to stop a few years ago, I had a tubal ligation done 7 years ago, at my consult the doctor questioned me about being sure about the decision but after the procedure which included another abdominal surgery, the doctor said my uterus was pretty beat up and I had made a wise decision.
15 years ago I went to the hospital 4 days before my due date with my first child after my water broke at 2 am. She had been transverse for days and fairly high, they did an ultrasound and said I absolutely had to have a cesarean right away. The cesarean was difficult, they had a very hard time getting her out and apparently ended up cutting a squared U after the initial cut. The strange thing is no one discussed this with me. Our baby had a little distress, high white blood cell count and low blood sugar, she stayed in NICU for a few days and then got cleared. My recovery was difficult. 2 years later I was pregnant again in a new state with a new doctor who realized I didn’t have enough information in my file so after requesting more info from the old hospital he sat down with me and explained the first delivery but never mentioned Bandl. He said I was high risk and needed c-sections for sure. I lost that baby at 5.5 months due to chromosomal issue, for my safety we opted for an “extraction” and d and c instead of induction. Then a year later I was pregnant again with our 2nd daughter. I had complete placenta pre via and started hemorrhaging at 34 weeks, ended up with an emergency c-section at 35 weeks and a baby on ventilator for a day and in NICU for 3 weeks- that’s another story. At that point no one said anything about my uterus contracting in a band, we just needed to get our baby well and myself recovered which again was really tough. They had been worried about the placenta detaching but thankfully That wasn’t an issue for them. The doctor only told my husband that I shouldn’t be doing much more of “this”. We thought we would just have our 2 girls but we felt really good about just one more so we had our 3rd, The placenta started settling down low over my cervix again but moved up as I grew and we made it to our scheduled c-section date (2 weeks before due date). Everything went fine, I finally got a baby in my recovery room, she did really well and it’s strange I never asked what cut the doctor did on my uterus but I do believe my difficult recoveries were due to all the scarring I had on the inside.
Love having my 3 girls. I just have to say #1- be good to yourself during pregnancy and take it easy especially if you have any troubles and #2- be happy for whatever experience you go through if you get your healthy baby you are not deprived of the “experience”. The only labor pain I understand is the pain I felt during my first and second late miscarriages. I never wished for “natural” birth just healthy outcome for all of us
I had a bandl’s ring after a 30 hour attempted homebirth with my son being posistioned posterior and brow. I was fully dialated in 4-6 hours and pushed off and on the rest of the time. I ended up with an inverted T and just wanted to share that inverted T moms are and can vbac. Check out the Special Scars website or group on facebook. Lots of inv. T moms are vbacing in hospitals and at home. I am currently 29 weeks pregnant and HOPING for a vbac with 2 doctors in Richmond VA.
Jessica
That’s really great news, Jessica. I didn’t have a T incision on any of my CS, but my doctor said I can not VBAC anymore because of uterine scar being almost fully ruptured and uterine muscle being so thin that they could see the baby through it.
I wish you the best VBAC!
I labored very quickly and got stuck at a 9 for several hours, they kept saying they could feel a “lip” on one side of the cervix… eventually they told me they couldn’t wait any longer and we went in for a c-section (instead of NUCB/VBAC). I don’t remember anybody mentioning seeing a ring on my stomach or when they took her out, is this possibly Bandel’s ring, or something else? She was 10lb 12oz at 41.5 weeks, 14.75″ head, no complications during pregnancy, FWIW.
They also said she was OP and asynclitic
Just wanted to share I had a vbac after an inverted T incision and bandl’s ring (attempted homebirth with firstborn long labor 30 hours 24 hours dilated and pushing my son was posterior brow). My vbac (in hospital) went wonderful. Ihad pretern labor at 31 weeks (losing plug and 4 cm dilated)stayed in hospital for 4 weeks and in hotel (5 min from hospital) for 1.5. Had #2 at 36 5 days! 4 hours total (I waited for hubby to get there lol) just wanted to encourage other moms who have had a ring. Jessica ( wife to nathan and mom to nolan june 11 2009 and bradford september 17 2012) joyfullyobey@netzero.com