Is anyone usure of (or was unsure of) whether or not to vbac?
It seems like most people on this board feel very strongly about attempting to vbac and to be honest, I am kinda jealous b/c I wish had stronger feelings on this subject. Instead I don't know what to do!
I met with the vbac dr. He was very nice and seems like a great dr. He has done hundreds of c-sections and says his success rate is about 80%. However, he put my success rate at 50%. He said for people that were dialated to a 10 and pushing when they had their c-section, he gives them about a 10-12% chance. People who never labored have a 75-80% chance. And someone like me (dialated to 7) would fall somewhere in the middle at about 50.
I'm ok with that number, even though it was lower than I expected. What I can't seem to get past is the increased risk to the baby. I KNOW it is still a small risk, I've looked at the numbers over and over. But I just think to myself, if something were to happen to the baby (vbac-related) I could never forgive myself. My instinct is to give myself the higher risk rather than the baby.
This dr is fully supportive of me having a vbac. When I asked what his personal recommendation was, he said if this was going to be our last child he'd recommend a RCS, if we wanted at least a third he'd recommend vbac. We don't know at this point how many we want.
The other factor is, he delivers at a different hospital than I had my son at. This hospital, for c-section patients, does not tie your arms down, gives you the baby right away, and gives you the baby while you are in recovery. These things are NOT options at all with my current hospital. So it might be worth it to switch to him just for that, but....that hospital is farther away, the doctor's office is farther away, there is a longer wait time at the dr's office, and I love my current doctors.
I know no one can make this decision for me and I'm not asking you too. I think it was helpful just to get everything down in writing! If anyone has a similar story and would like to share it and how they ended up coming to a decision...please do! Otherwise, thank you for listening to my long blabbering thoughts!
Re: Is anyone usure of (or was unsure of) whether or not to vbac?
Oh here is my intro where I posted my story- https://community.thebump.com/cs/ks/forums/thread/55993183.aspx
Also, after looking at my records this vbac dr determined I have a single layer closure
But said that that didn't bother him at all. It bothers me a little though!
This! Some days I am 100% sure I want to VBAC then the next day I feel like I should just go ahead with the RCS....I think about the decision literally everyday! I would also love to hear others opinions/decisions they made!
This is me exactly!
It is a really tough decision. Both a rcs and VBAC have definite risks. I had my c/s a few months ago. I went into spontaneous labor, dilated to 10, and was pushing. However, the baby was sunny-side up and had fetal distress. The OB said that I am a good candidate for VBAC since the c/s was for fetal (not maternal) indications.
(You said your doc said that a woman who dilated to 10 is not a good candidate for VBAC.. is that in cases of CPD only?)
Anyway, most days I am convinced that a TOLAC is in my future, because I have read literally dozens of scientific articles/studies that show that VBAC has a reasonable risk profile for good candidates. I believe ACOG recommends that women with a single, low, transverse uterine incision be given a trial of labor if they are reasonable candidates.
OP, you are right that VBAC has slightly higher risk for baby, while RCS has slightly higher risk for mom. And that makes it a really difficult decision that each mother needs to make on her own. At least I take solace in the fact that either way the risks are small.
I'll be following this thread to see what other people have to say, because we will be TTC when DD is one year old, and like I said, I'm thinking: VBAC 80% likely, RCS 20%.
I was completely unsure and somewhat leaning towards an ERCS up until about a month ago. For some reason I suddenly just knew that a VBAC was the right choice for me, and I haven't hesitated since. There is a lot of great info out there re: VBAC, an honestly that's what helped me decide which way to go. Prior to reading up on VBAC, I thought they were so risky and dangerous and that c-sections were so much safer (yes, i was that ignorant!) I now know that as far as my particular situation, a VBAC is a much safer option than a RCS.
I'm now looking for a doula to help me get through a VBAC and to help me make sure an unnecessary c-section doesn't happen.
I know it's a scary decision; I would recommend reading as much as you can about VBACs - there is a lot of good info out there to help educate you. I found this website especially helpful. https://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/weighing-the-pros-and-cons/ The comparisons were a big eye opener for me, and really allayed the biggest fears I had re: a VBAC.
GL with your decision!
Honestly I don't know (CPD was not mentioned though). Since that particular scenario didn't apply to me, I didn't ask any more questions.
Safer for who though? That is my issue! I think it is hard to just make a blanket statement saying they are safer (of course I don't know your particular situation). They are safer for the mom but a RCS is safer for baby. This is my whole hang-up; if they were safer all the way around, I'd be on board! As it stands, I am having such a hard time with this decision.
I have read the link you posted and a ton more. Believe me, I have read anything I can get my hands on!
I am 95% sure I want to vbac when I get pregnant for many reasons. I am about as good as a candidate as you can be. My c section was for breech positioning. I also dilated almost 6 cm and was 100% effaced and not in labor. My incision is low, double stitched too.
I also want one because my c section was a horrible experience. My anesthiologist didn't insert my spinal properly, and I was cut open without being numb, so I had g/a and I and DH had to miss her birth. Due to my emotional and physical pain, I feel like I missed out on so much of the first few weeks of her life.
Also, when I have lo#2, I feel with a vbac, I will be able to care for each of them better.
I also want 3 children, and want to try to be a surrogate for someone else, and I am not willing to have too many c sections.
Another thing that is weighing heavily is that my c/s experience was fantastic... My DS never left my side, he was laid on me, we bf'd as soon as we got in recovery.. I owe it all to my incredible OB.. And my recovery was a breeze. One of my fears is my VBAC wont be as good of an experience...
My OB is the one pushing for a VBAC.. She said there is no medical reason for me to have a repeat c/s... She is of course leaving it up to me, and will support me regardless.. But she would like me to try. We have a "let's wait and see what happens" plan and I'm okay with that and feel really good about it. I don't have to commit to anything and I'm hoping I'll just feel really strongly one way or the other when it comes closer... Good luck with your decision!
I've felt that same way since DS was born and now that #2 is on the way, I am really starting to question it. I do feel like I missed out on a special life experience by not delivering DS naturally and I would love the opportunity to try again. Plus, as frustrating as it can be, I love the excitement of not knowing when the baby will come. Scheduling a baby's birth just seems so unexciting to me. And I think the recovery of a vaginal birth will most likely be easier with a toddler at home. I was completely miserable and in horrific pain after my C/S and I can't imagine dealing with that with a 22-month old AND a newborn to care for.
But at the same time, there are a few practical reasons to go for the RCS (knowing when so we can have care for DS set up, longer paid maternity leave, and knowing for sure that my OB--whom I love--will be the one to deliver---I'm not a fan of 2 of the other doctors in her practice).
And DH is no help...he keeps saying "just do what the doctor tells you to do".
So needless to say, I will be discussing all of this with my OB when I go for my first prenatal appt. (5+ long weeks from now...)
My long blabbering reply...
With my first, I stalled at 7cm. 4 hours later, OB says it's time for c/s. I'd been in the hospital for 3 days trying to be induced, so when she said it wasn't happening I believed her.
With my second, I stalled at 6cm. 6 hours later, OB says try nipple stim and try laying in this position (had epi by then so couldn't do birth ball or walk). 10 hours after that I had a baby by vbac.
Failure to Progress can mean "failure to progress fast enough and I've had a long day delivering babies lets get his over and go home" At least that's how I felt my case was.
All that was just to say that even at 50%, it's still possible.
Anyway, I didn't have many doubts about attempting vbac. But I had many doubts about succeeding. My main goal was to have a better birth experience - by switching doctors, switching hospitals, knowing what hospital policies were for things like obersving the infant and sending them to the nursery. And every time I passed some personal milestone, it made me a little happier (made it past 38wk still pg, went into labor on my own, water broke on its own,... stuff like that).
I say you should plan for a vbac. A rcs is always an option and requires no planning. You can always change your mind.
Also...
ACOG states: "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans, according to guidelines released today by The American College of Obstetricians and Gynecologists". ...."The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC,"
I constantly go back and forth,honestly I do not know that I will be 100% on any decision I make. I am one of those woman who made it to complete 10 cm (had a cervical lip but pushed past it). Pushed for 2 hours. I was thrown the "Big Baby" Card and CPD card.
My medical records have no explanation of a cervical lip, and "state" that DD was in the ROA position (not perfect position but doable by any means), but I do not think that is completely correct. I believe there was some sort of mal-position that caused her to get stuck. There is so many things that I have found from reading that could have prevented me from pushing my daughter out. My water was artificially ruptured at 4 cm, I was started on pitocin, I had an epidural. I did not move for nearly 12 hours. I was at 9.5 with cervical lip and told to push past it. I did not get the chance to feel a complete urge to push.
This is what lead me to believe that my dd was mal-positioned (https://www.plus-size-pregnancy.org/malpositions.htm). I had days of early labor that litterly knocked me on my rear end. It was painful, exhausting and nothing I had expected. My daughter was overdue. (While she was born at 41 weeks I believe had I not gone to the hospital at 40 weeks 6 days in huge amounts of pain, thinking I had a UTI- which I did not have but ended up being induced because I was post dates anyways- that my daughter would have probably stay in until my real induction date that Thursday) I had signs of early transition- I was vomiting, felt the need to push at 7-8 cm, and the cervical lip.
My point is that if I do not try I believe that I will lead the rest of my life regretting it, even if my current doctor who said he would let me VBAC but believes I might end in a c/s again, I feel I have to do it for the sake of my children and myself. Not to mention we want at least three more children and I just cannot deal with the fact that while yes a c/s maybe 'safer' for baby, it is not safer for me. Maternal death is way higher with c/s after c/s. I do not wan to leave my daughter without a mother and my husband without his wife. Like it or not that could happen if I choose to have repeat c/s for my next three babies.
However if I try and fail- at least I tried right. Yeah that is where I get stuck because my c/s was an emergency. My epi did not take I was put under g/a and I did not hear my daughters first cry. I did not know she was a she until 4 hours after birth when my parents, his parent and our siblings all got to hold my daughter before me. I spent 4 hours gasping for air because of a complication that caused my vocal cords to paralyze thus being unable to breath. This was ultimately cause because I was vomiting during labor.
This is my fear- trying for a VBAC only to end up with a emergency c-section needing g/a. Sleeping through the birth of my 'team green' baby and not getting to hear his or her first cry or be the first person to hold him or her. If I could avoid that for 100% or even 90% or 80% curtain it would be a no brainer to me. I would choose VBAC and because it is not that, and it could happen again I lean towards having three repeat c/s. All so I can hear my baby cry and the doctor announce "its a.... " because while I do know repeat c/s are risky I know that it is possible to do 4 c/s.
Now will my husband be there for the birth? That is a whole other story.... he would prefer not to see me give birth at all VBAC or C/S. (In his defense...... he has an extremely weak stomach, passes out cold getting shots or having blood drawn. My mom would be in the OR if I choose c/s. He would be in delivery room if I VBAC but is zero help at all)
Sorry it is long but I wanted to share my reasoning in hopes that others would share theirs. So that we may all help each other.
Here are my thoughts as I've pondered this myself:
Yes, it is safer for the baby to be born via c-section than vaginally, but that is the case with any vaginal birth, not just VBACs. I look at it like this: if this was my first pregnancy and I was fully capable of delivering vaginally, I wouldn't avoid a vaginal birth and go straight to a c-section due to the risks. There is barely more of a risk to the baby being born via VBAC than there is a standard vaginal birth, and that slight increase in risk is due to uterine rupture, which we all know. I just feel like the risk of baby dying or having brain damage is so small. Risk of uterine rupture is about 2%, and of that 2%, less than 4% of babies will die or have brain damage.
It sucks to have to think of it this way, but the chance of me dying during a c-section is 3 times more likely than it is during a VBAC. If I die during an RCS and the baby lives, what good am I to the baby or my 2 year old? I hated feeling like I was having to decide what life was more important - mine or the baby's - but I feel like I have to take into account my toddler, as well. I have to make the best decision I can to get the baby here safely as well as get me through the delivery safely so my little boy still has his mommy, too. I hated thinking of things this way but I feel like because one option is safer for me and one is safer for baby, I had to look at it like this.
It sucks that it's such a hard decision to make and can be so stressful for moms. Obviously all of us just want to get our babies here safely (and for us to get through the process safely ourselves).
Hello. I'm new here.
I had my son via c-section. He was a breech baby, and I had a pre-term labor, so my doctor didn't even try to turn him.
It'll be almost 5 years since I had a c-section when this baby comes. My doctor just told me I can choose which ever I want. After a c-section, I just assumed I'd always deliver via c-section, so it was sort of a surprise. My c-section experience wasn't bad at all. I'm more afraid of trying to vbac and ending up with emergency c-section. I already have a scar and all... However, I'm now leaning toward vbac. We want one more baby hopefully soon after this one, so it's safer to have vbac for the next pregnancy. And the thing is, my due date so far is my husband's birthday! I know it's very rare that you deliver on your actual due date, but it'll be the greatest birthday gift for him!!
I couldn't take a child birth class due to the pre-term labor last time, so maybe I'll try that too...
Proud mother of two breech babies:)
This statement on VBAC.com was insightful, as well:
Overall, attempted vaginal birth for women with a single previous low transverse cesarean section is associated with a lower risk of complications for both mother and baby than routine repeat cesarean section. The morbidity associated with successful vaginal birth is about one-fifth that of elective cesarean. Failed trials of labor, with subsequent cesarean section, involve almost twice the morbidity of elective section, but the lower morbidity in the 80% of women who successfully give birth vaginally means that overall women who opt for a planned vaginal birth after cesarean suffer only half the morbidity of women who undergo an elective cesarean section.
There is one study that put your odds of VBAC at around 13% if you had your c/s after pushing, but I've never seen that replicated in any other study. Almost every study I've seen says that at least 60% of women who attempt VBAC will be successful, even if their primary cesarean was for CPD or FTP.
One study I read that looked at not only how far dilated you were but whether your c/s was for a recurrent or non-recurrent reason found that women who dilated 8 cm or more and then had a c/s for a non-recurrent reason had a VBAC success rate of over 93%. So it's an oversimplification to say if you had a c/s after pushing that you have low odds. If your c/s after pushing was because your baby was in a bad position, you actually have great VBAC odds because now your body is experienced at dilating and pushing and your next baby is likely to be in a better position. Even if you had a VBAC for CPD, your odds of a successful VBAC are at least 60%. The same goes for a c/s for FTP at 7 cm. I think your odds are probably better than your doctor is giving you, IF you have a supportive doctor. That's a big if sometimes.
What exactly was the reason for your c/s?
If you've had one low transverse incision, your odds of a rupture are a lot lower than 2%--it's closer to around 0.7%. You would have to do over 7000 ERCS to avoid one fetal death from uterine rupture.
I think something to consider when we are talking about whether VBAC or RCS is safer for the baby is that cesareans do carry risks to the baby too. A baby born by c-section, especially a c/s done before labor begins, is at increased risk for respiratory distress and NICU admission. Children born by cesarean have an increased rate of asthma. A new study just came out recently finding that children born by cesarean had more respiratory diseases 3-6 years after birth. Babies born by cesarean are colonized by different bacteria than babies born vaginally, and we have no idea what kinds of effects that may have on long-term health. It may be nothing or it may be profound, we just don't know.
You make a lot of very good points- thank you
how can you determine odds?
I assumed that the percentages he gave me came from his experience. But now I wish I had asked! I just can't imagine a doctor who has done hundreds of c-sections, quoting me from some study when that is not what he has seen in practice, you know?
ETA: Arrest of descent, OP position, and fetal distress. As far as my dr, I think he is supportive but even if reading this you think maybe he isn't supportive enough, he is the best it's going to get unfortunately! VBACs are very, very, very uncommon here
But the thing is, I'm not really worried about the risks you listed. Those are the smaller ones. Of course I don't want my child to have asthma later in life or to spend the beginning of their life in the NICU, but that is not something that will shape my decision. The risks I am focusing on are the big ones- maternal death, baby death, CP, etc. In other words, I'm not going to avoid a c-section because I'm afraid my child might get asthma, but I might chose to avoid it because of the higher rate of maternal deaths- make sense? I know everyone might not use this reasoning, just a little insight into my brain at the moment
Thank you for all your information though. I am definitely saving this whole thread, it has been so helpful!
Of course it makes sense. Everyone has to choose which risks they are comfortable with taking. I believe in discussing the entire picture so that people can make an informed choice.
I am so glad you posted this... I go back and forth every day. This is a great board for information, but like pp's said, most here are very pro-VBAC and almost make me feel guilty for considering otherwise!
I have seen two docs who are both pro-VBAC, but both recommended I do a RCS. They did say it is my choice, but said I have a smaller liklihood of success. I went into labor and dilated on my own, pushed for 2 1/2 hours, and had a c-section due to "failure to descend." Doc was unsure of head position, but this could have been an insignificant factor...
It is a huge decision. There are more risks to infant with a VBAC, more risks to mother with a RCS. And like you, I think I want more children which might be a factor too. If I KNEW I could be successful I would choose a VBAC in a heart beat, but it was completely devastating the first time around and I'm not sure I can put myself through that again.
I wish you the best with your decision...
I'm glad you posted this too and have been thinking of posting almost the same thing. I waiver back and forth on a RCS daily. DD was breech and there wasn't enough fluid to atttempt a version. I actually thought my ob was pro-c/s (and had told me there wasn't enough fluid to attempt a version to make my decison easier) but it turns out she's pretty pro-vbac.
I know I have a long way to go but part of me wishes this baby would be breech with low fluid and then I wouldn't have to make any decisions. And I could make jokes about my cervix being a prototype for a Lazyboy.
I didn't have a bad experience with my c/s, recovery and DD is a wonderful, healthy child. I don't know what to do besides wait and see.