- Pregnancy
- Baby & Toddler
- Parents
- Getting Pregnant
- Baby Names
- Product Reviews
-
Registry
- Community
-
More
Want a personalized experience?
Download the free app
D.C. Area Babies
VBAC vs repeat C-section
I don't really know where else to post this, so I'm hoping a few people here can chime in. I'm 2 weeks away from my due date and I'm still not sure if I want to try for a VBAC or a repeat C-section.
I pushed for almost 3 hrs w/my son and ended up needing a Cesarean b/c his head was turned and face up and just would not come out. My OB thinks I'd be a good candidate for a VBAC based on the reason for my C.
As the end gets nearer, I am really starting to FREAK out. I'm worried about uterine rupture ( which I know there's only a 0.3-1% chance of) and I'm also worried about laboring and then ending up w/ a C-section anyway, which is the riskiest of the scenarios. I hated my C-section, so I'm really scared to go that route again. I was a basket case during the procedure, I found it to be painful and my recovery was really tough. But i can't stop thinking about the what ifs involved w/a VBAC. If anything were to happen to the baby I could never forgive myself. I just don't know what to do and wish someone else would make the choice for me. If amyone has made it this far, do you have any advice or words of wisdom? If you had a repeat Cesarean or VBAC, how did you decide which to do??
This discussion has been closed.
Re: VBAC vs repeat C-section
My thought was that if you are a nervous wreck during the VBAC, is that really the way to go? Maybe go back over your reasons for wanting the VBAC and see what still holds true for you now. Is it just because the original C-section was so tough to recover from or were there other reasons as well? Did you feel 'cheated' out of a vaginal birth the first time around? Did that lead to any PPD?
For me I didn't have the option of VBAC through my particular doc since they were less than 2 years apart. However even if I did that is not a choice I would make - I would not want the risk and I never had the feeling of being cheated out of giving birth vaginally. The first time around I was induced, made it to 10cm and then they realized she was breach (butt first). I had been in labor all night from the foley catheter (a balloon that puts pressure on your cervix) and I was at 4cm when I got to the hospital around 7. I got the lowest dose of pitocin while my doc went to do a scheduled C-section. By the time he got back at 10AM I was 10 cm, in incredible pain (the anesthesiologist was in the c-section and I don;t think the nurses believed the pain I was in). They say she turned but I doubt she was ever head first to begin with. So emergency C-section for me. Recovery was awful, I had my incision open up about 6 weeks out and it took until after 9mo pp to fully close after many rounds of antibiotics, a stitch, many of those sticky stitch things, etc. Then I had retained placenta that needed a D&C around 3mo pp.
For #2 it was a scheduled C-section. While it felt really weird to be just waiting in post-op to go have my baby and I was a lot more freaked out about getting the spinal (the first time around I would have given it to myself if they had given me the needle). But it went really really well and my recovery was a breeze. I was picking up my 20 mo old within a week to put on my lap or in the crib etc. I was easily driving at 2 weeks and was taking the 20 mo old to daycare every morning. Now I am sure not everyone has such an easy 2nd c-section but I really think not laboring and them not rushing it as an emergency really helped the overall process.
That is just my experience though and of course you have to decide for yourself, but maybe writing out the pros and cons of each would help. And like I said, revisit the reasons for wanting a VBAC in the first place - they may be strong enough to overcome your current fears. And aren't we all a little afraid at the end, no matter the birthing choice? Just because of that I might lean towards your original decision, but again who wants to be a nervous wreck during their birth?
Good luck, there are so many decisions we make as moms and we can only be as informed as possible and do what we think is best at the time.
I don't have any advice either as I am in the same boat pretty much.
My c-section was due to never progressing past 4cm and DD never dropped into the birth canal because her head was too big (thanks DH!).
I'm planning on attempting a VBAC but I am also scared of the risks. My midwives have eased my mind somewhat by telling me about how much more cautious they are while a VBAC'ing mother is laboring. It means more monitoring, but I'll take it.
TTC #1 Cycle 14 - IUI#1=BFN, IUI#2=BFP | TTC #2 Cycle 8=BFP!!
I am vbac. my recovery from the c-section was horrid and I never want to go through that again, especially taking care of 2 children. C-section is major surgery and you can have complications, of which I did (my bladder was nicked, it took me about 12 weeks to feel normal again, OB fell on me during the operation which messed up my back, I had an allergic reaction to the anesthesia and they gave me reglan because I threw up a few times and that sends me in a weird psychotic state, I also was unable to see DD for 7 hours after birth) I am going with a midwife this time and taking hypnobirthing classes and hiring a doula. If it happens because of something I can't control, then I am more knowledgeable and know why I would need one and can accept it, but I won't do it again if I can help it
Have you contacted ICAN for support? https://ican-online.org/chapter/search
They helped me make a decision for vbac, and I am very determined to do it.
My sister had a uterine rupture and almost died while delivering. But it's not something I worry about, there is a risk of dying in a car accident and I still drive, there is a risk of choking on food and I still eat. The risk is so small to me, it's not something I even worry about.
I am not worried about anything with the baby either, I have never heard of anyone having issues with babies after vbac. Even my sister almost dying, her baby was fine.
I was told I would be scheduled at 42 weeks because on top of it, I'll be 40 years old, but I probably won't show up and just wait until I am in labor. My midwife told me that I had a good chance, even though my OB told me I would always need c-sections because my babies are too big for me. My midwife told me that was bullcrap basically.
I have met a lot of people who have vbac right after birth, and the recovery was amazing. They were in the park playing with their kids 3 days after delivery. On of the mothers who was also told she had a big baby and needed c-sections, had an even bigger baby vbac (almost 11 pounds) with no tearing.
If it works, then I will be happy, if not, then I can accept it, but I am determined to try, especially since my OB said I can't. But that is just my personality - my mom said I was that way as a child. You tell me no, I prove you wrong, lol!
I would suggest contacting your local ICAN leader - email or phone. They will spend time with you talking to you about any concerns, they really helped me.
I decided to go w/ scheduled c-s, the risk of uterine rupture was not worth it to me. If something happened, it would not just affect me, baby, DH but DD as well. For me - I could not bear the thought of leaving DD motherless.
My recovery both times was easy, a scheduled c-s is so much better of an experience than an emergency one, I have no regrets.
good luck in your decision!
Just some other stats according to NIH - the study was done over 4 years at 19 medical centers. They determined the risk for ur was .46 per 1000 births.
"To date there have been NO reports of maternal deaths due to uterine rupture."
"current research shows that maternal mortality is significantly increased for elective repeat cesarean, 13.4 per 100,000, compared to 3.8 per 100,000 when laboring for a VBAC."
So your risk of mortality from a repeat c-section is basically .0134%, yes your risk from a UR is higher, but there have been NO reports of death from a UR. There have been deaths from repeat c-sections, I think in my state alone there were at least 8 reported, but there were no deaths from UR.
The most important thing in the finding was that UR was more likely when using drugs to induce labor. "This study found that the risk of uterine rupture was higher when labor was induced with prostaglandins and highest when pitocin was used to stimulate labor." Then the rate of UR went to 24.5 per 1000
"A study published in the November 17, 2007 issue of the British Medical Journal showed the risk of maternal death was double in a c section vs. vaginal delivery."
Before you commit either way, it's best to do your own research and you can support local ICAN for that (or google, I just did a simple google "risk of dying from uterine rupture" and "risk of dying from c-section" and found my info) . Surgery is a risk, and sadly, OBs don't inform you of the risks. I got more papers to sign and more information about surgery when I had a mole removed then when I had my c-section.
for me, there was really no decision to make, vbac all the way. i hated my surgery and the recovery. it was complication free, it was just not how i wanted to birth.
based on the reason you had a surgical birth (same as mine, btw), i'd agree that there is no reason to believe that you would have difficulty birthing your baby vaginally. your body dilated, so that's not an issue, your baby descended, so that's not an issue. the only issue was his positioning and that is only somewhat in your control. have you ever visited spinningbabies.com? there are lots of things you can do during pregnancy to encourage optimal fetal positioning (chiro, massage, acupuncture, posture, sitting positions, never reclining, exercise, etc).
IMO, the risks involved with a surgical birth (and especially a repeat surgical birth) are greater than the risks involved with a vbac. did you know that difference in the risk of uterine rupture in vbac vs vaginal birth is statistically insignificant and only marginally greater than the risk of uterine rupture in a first time mother?
the only benefit that i can see to elective surgical birth is that you have control over when it happens. but that's about it. you have no control over whether there are complications, you increase your risk (b/c the risks to surgical birth outnumber the risks to vaginal birth) and if you ever have children in the future, you decrease the risk that they will be born vaginally.
none of these reasons for vbac might seem attractive to you, but these were the reasons that i chose to vbac rather than repeat a surgical birth.
i have a very helpful fear release exercise i can send you, if you like. just let me know. good luck with your birth, whatever you decide!
I don't know that I feel "cheated" out of having a vaginal birth, but I am disappointed it didn't work out. I kow some women have a very specific birth plan in mind and it's devastating when it doesn't work out for them, but I don't feel that way. Mainly, I just want to avoid surgery b/c I'm a wuss I guess and the recovery time is much longer than a vaginal delivery. But, like I said I'm also terrifed of a uterine rupture and also of laboring and ending up needing a Cesarean anyway. And I know plenty of women tear and heal just fine, but I'm really scared of having an awful tear too. My son's head has always been in the 95% and up and this baby's head is at 95% as well.
I keep finding conflicting info, which is frustrating. I feel like there's a lot of pro-repeat C and pro-VBAC info and all of these statistics are just adding to my fear. I think I'm actually leaning towards a repeat C-section, but I still don't know. Thanks to everyone for their input!!
Lindsey- your C-section might have been complication-free, but from what I remember, your birth experience was fairly traumatic, right?? I am sending you tons of positive labor vibes and really hope you have a fantastic VBAC. The reasons you listed for going the VBAC route were the same ones I had, but I am starting to have an overwhelming fear of other complications during labor. I've never felt so conflicted in my life!
I would love the fear release exercise. I almost feel crippled with fear when it comes to childbirth and keep envisioning worst case scenarios.
I found one detailed article and then it looks like they made it a little more readable for a bigger journal - both were published this year. One in March and one in June. I may be able to get the full article at work on Tues and send it to anyone interested (my work has a lot of journal subscriptions). Here is the excerpt that seems most pertinent:
"Overall rates of maternal harms were low for both trial of labor and elective repeat cesarean delivery. Although rare in both elective repeat cesarean delivery and trial of labor, maternal mortality was significantly increased for elective repeat cesarean delivery at 0.013% compared with 0.004% for trial of labor. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between trial of labor and elective repeat cesarean delivery. The rate of uterine rupture for all women with prior cesarean was 0.30%, and the risk was significantly increased for trial of labor (0.47% compared with 0.03% for elective repeat cesarean delivery). Perinatal mortality was also significantly increased for trial of labor (0.13% compared with 0.05% for elective repeat cesarean delivery)."
Now keep in mind when they say 'significantly increased' they mean statistically significant. They ran the numbers through a calculation that determines based on sample size and other parameters if the difference is truly real or if it could just be because of low sample size etc. Their conclusion was "Overall the best evidence suggests that VBAC is a reasonable choice for the majority of women. Adverse outcomes were rare for both elective repeat cesarean delivery and trial of labor. Definitive studies are lacking to identify patients who are at greatest risk for adverse outcomes."
Another review article looked at stats for VBAC-1 vs VBAC-2 had some good statistics to look at "VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel)."
I'm due on Friday and I'm going for a VBAC. I ended up with a c-section (after being induced and 30 hours of labor) because DDs head was just too big (95% - and it's still 95% even though she is 25-50% in height and weight). My recovery from my c-section was pretty easy and I really had no complications related to the c-section (infection, etc.). It's just the more I read, the more I realize that vaginal births are better for both mother and baby. The long held belief that "once a c-section always a c-section" just isn't true any more. My OBs have definitely put more restrictions on me - for regular vaginal births they allow you to go up to 42 weeks, for VBACS only till 41 weeks (though I did manage to squeeze a three extra days out of them - so my c-section is scheduled for 10 past EDD), I have to be continuously monitored once I get to the hospital and I can not be induced. If I go in to labor on my own and stall or my water breaks with out contractions and but I am past x cm dialated, they MAY consider a small dose of pitocin; but I'd have to be pretty dialated for them to do it. I've gotten a lot of push back from people who just don't understand why I just won't go with a c-section, but I just feel like the risks are small and I trust my OBs and my hospital - and myself. If I ultimately end up with a c-section I'm okay with it, but I would like to try to birth as nature intended. I know it's a hard decision, especially when you're so close - you just need to do what you feel the most comfortable with. If the statistics are not compelling enough for you (they are for me) then just trust your intution. You can't be wrong with either decision.
ETA: I forgot to mention that also factoring in my decision is that my DD is two and knowing I have to physically be able to take care of her and meet her needs was the tipping point (even though she does go to DC). It's going to be hard enough for her as it is and not having mommy able to hold her comfortably or pick her up for a while just breaks my heart.
My OB said "There is a 1% risk of uterine rupture, but there are lots of 1% risks in labor." I also asked about tearing, and he said he would spend more time stitching a bad tear than doing a c-section...so if you're worried about a tear, know that a good OB should be able to deal with that. That means if you have a midwife, making it clear that you won't any real tear to be fixed by an OB (that's what they are there for...surgical procedures).
I personally hope to VBAC. I do feel a loss at not having had a vaginal birth. But most of all, I do not want to spend 4 days in the hospital again.