VBAC versus repeat C-section

[Cait]

Hi! I recently found out that we're expecting again which is thrilling, of course, but it's also prompted some discussion about how I'll deliver this baby.

With DS DH and I had taken Bradley Birth classes and were all set to deliver vaginally (as I did w/DD) w/no interventions. I was doing great (handling the labor fine) until I got to about a 5 and the OB came in to read my strip and said, "Get her prepped for a C-section now." Long story short, DS was in extreme distress and wasn't breathing and his heart wasn't beating when he was born. Those were the scariest moments of my entire life.

I always just assumed if I got pregnant again I would try to deliver vaginally. My OB says I am a great candidate b/c of the three years between the births and b/c I didn't have a C-section b/c of something that would likely be a problem again.

My issues? A friend of mine who just delivered her second (via repeat C-Section) said her OB told her it was a good thing she didn't attempt to deliver vaginally b/c her scar on her uterous wasn't very strong and she said he said there would have been no way to know that prior to the delivery.

So now I'm scared of delivering vaginally and having something really awful happen. But, on the flip side, I'm also fearful of scheduling a C-Section and taking the baby too soon.

What are some thoughts? Are my fears steeped in statistical reality or what?

[clover]

The reality is that uterine rupture is rare. When done properly, vbacs are safe. If you are scared of uterine rupture, simply be sure that your vbac is performed in a hospital where you can have a c-section if necessary. According to my midwife who delivered my vbac, a baby must be delivered within 7 minutes of a rupture to ensure a healthy baby. This is why most hospitals require that an ob be present in the hospital when a woman is laboring for a vbac.

The statistics are this. 1 in 100 uteruses will rupture on a vbac. MOST of these are due to strong contractions caused by megadoses of pitocin, so avoiding pit will decrease your chances of rupture (I had a small amount during my vbac after labor started wth no problems). when rupture does occur, the baby has only 1 in 2000 change of death or even debilitating problems. The stats are 1 in 3000 for a woman who has never had a previous abdominal scar.

I think you sound like a great candidate. Insisting on not inducing labor and having an ob in the hospital while you labor will help your chances of delivering a healthy baby.

Good luck and congrats.

BTW....I bet the dr likely told your friend that because he is trying to convince all women to repeat c-sections rather than try for vbacs. Most drs would rather schedule the birth rather than hang out at the hospital.

[Cait]

clover,

I thought this too:

BTW....I bet the dr likely told your friend that because he is trying to convince all women to repeat c-sections rather than try for vbacs. Most drs would rather schedule the birth rather than hang out at the hospital.

The OB that told her this was my old OB (we moved) and I remember him trying to talk me into a c-section immediately following DS's birth if I were to get pregnant again.

I really, really appreciate your thoughtful reply. It makes me feel much better!

[Canameri]

Lurking


I don't know how many times I've heard women state that very quote: "It's a good thing I had the section b/c of the scar...". I also agree with above comment that in many cases it's just the doctor trying to convince the woman it was the right decision vs attempting the vbac. Kind of irritates me!

I had a very successful induced vbac. No problems. It really isn't that cut and dry, as every woman's needs and issues are so individual. I did quite a bit of research, had an excellent team of supportive, and knowledgeable people present at my labour and delivery and was quite confident I could do it. A doula is an incredibly invaluable person to have with you through this. You may want to consider one. My doula was one of my most valuable 'assets' during my labour that is for sure!

Best wishes!

Deb

[JulieD]

I agree with the above ladies... job security and knowing that you were the only one (who is going to talk to the Mom) that saw a part of her body that she can't see or know about - so that gives them a step higher - - and the Mom a sense of fear.

I have a very crabby baby so this is realllly short. Wishing you the best.
~Julie

[erkajo]

I had an emergency c-section with my first. It was awful, and I had a horrible recovery. The surgery was done because baby was in fetal distress -- from the time they lost his heartbeat to when I was first cut open was a matter of minutes. It was scary and awful. I can only assume that recovery was hard because the surgery was done so quickly and because I had been laboring for so long already. I was at the pushing stage and baby never moved into the birth canal.

Fast forward to my second pregnancy. I was scared of another c-section. Doctor wanted me to have a repeat C because she felt that I would never have been able to deliver any baby vaginally, although she was 100% supportive of me trying for a vaginal delivery. She actually sent me home with every book she had on VBACs. But I ended up with placenta previa that never moved up, and at 36 weeks, they decided I could not have a VBAC.


In the middle of my second c-section, I actually heard one of the attending doctors gasp, and so I knew something wasn't right. After I was in recovery, my doctor came in and told me that she had never seen such bad scarring -- all from my previous c-section. I just had not healed well. She said she was amazed that I had ever carried another baby to term. And, sadly, she advised me not to have anymore children.

Now - let me first say that I trust this doctor implicitly. But I have had 2 years to think about it all. And the fact is 1) I DID carry another baby to term, and the pregnancy was actually great. My c-section was on my due date, so you can't get more "term" than that - lol. 2) If I had not had placenta previa, I would have tried for a vbac, and assuming everything went well, doctor would never have seen my scarring or known what my previous scar even looked like, and we never would have had any reason to think that I couldn't have another baby, much less 5 more. 3) I know many, many women who have vbacs and no one ever knows what their scars looked like before delivery.

Now, I will tell you, I am scared to have another baby because of what she told me. I have not ruled it out, but I also don't want to go against medical advice. But I will tell you, no matter what my decision, I will get second and third and fourth opinions on the subject. I would advise you to do the same. Make sure you get all the facts and read every piece of literature you can get your hands on. 99% of the literature actually supports vbac, and that information really put my mind at ease. Good luck!

[LadyEo]

I know this is a tough decision. It took me from week 5 to week 27 to decide on my repeat c/s. I just could never get comfortable with the risks, even though I knoew they were very small. There were other issues as well.

If you are worried about taking the baby too early, could you schedule the c/s after you hit 40 weeks? Then you know it will not be too early for the baby(if the due dates are right). That still gives you the option of a v-bac as well.

[Tami C]

I had 2 scheduled repeat c-secs. Both times I was checked every week to make sure the baby was growing well and was term for delivery. I was too afraid of the statistics to try for a vbac, but that's just me. I would say if your doctor supports you and you feel confident in yourself, try.

[adismom]

I was all set for VBAC, but again in my last appt. my OB/Gyn discouraged me saying that it is too risky..and that even if the OT is ready and she is around, anything can go wrong...

I just keep swaying from one side to the other... I so badly want to try VBAC, but with a unsupportive DR., I feel very scared...And also if something happens to my child, I will never be able to live with the guilt that it was my decision to attempt a VBAC that caused it... my OB/Gyn said that even if I had some dilation or labour last time around, she could consider VBAC for me, but she doesnt think it is a good idea. I asked her what she would do if she were in my place..She said 'by nature I dont take any risks with anything in life, so I wouldnt take risks here either'..I wanted to tell her C-section also has its own risks, but maybe she is confident of her own ability to do c-sections...

Oh man! I just want to cry!! I cant even think of changing my Gynec at this late a stage..
But I so much want to have a VBAC...

[karin]

Adismom, if you really want to try VBAC, go for it! It is wrong of your doc to allude that there are no risks to a repeat c, no matter how good a surgeon s/he is.

I changed midwives 4 times in my last pregnancy! And ended up with my incredible midwife at 30 weeks. I have another friend who changed in labor! It is worth it to attempt the birth you want.

Yes, there are risks to VBAC, but in all truth, they are very small. Unfortunately, try telling that to malpractice insurance companies. There are also risks to cesarians too, and I'm really confused as to why surgical risks are glossed over.

In the end you have to decide where your comfort level is and go from there. A supportive caregiver is a must!