a long intro: vbac after 2 c/s?
Hey there. I had two c/s with my first two babies. My first c/s was scheduled because I had (borderline) GD and DS was measuring large. I had no progress at 39w4d, the day of my c/s. If I'd progressed we were leaning more toward an induction, but I was really afraid of a failed induction leading to c/s, and my doctor didn't want me to go overdue with GD. DS was 8 lb 15 oz. I had DD 16.5 months later, via repeat c/s, VBAC not an option with my then-OB. She was 8 lb 13 oz at 38w6d, I had borderline GD in that pregnancy but I think both babies' size was more genetic than GD (both babies similar in size to me and my siblings). I have to say, my c/s experiences were very positive. I was up and walking the same day, felt great the next day, not much pain at all. My OB is well known as a talented surgeon, which I think was a big factor.
So now we've moved to a new state, and yesterday, I met with a new OBGYN. We hope to have a 3rd baby in 2-3 years, and I wanted to find a doctor now to handle yearly exams or random issues, but also to make sure I had a relationship with an OB comfortable with a 3rd c/s. I never really thought VBA2C would even be an option, we're now in a pretty small town, albeit one with a pretty highly respected hospital. Anyway, he was really questioning why my former OB hadn't had me go through the trial of labor first, and mentioned that he'd be very comfortable allowing trial of labor and possible VBAC delivery with our 3rd baby.
I'm SO clueless to all of this. However, I will say the idea definitely intrigues me. This would absolutely be our last baby, and would I maybe one day regret never at least *trying* to labor? I really don't feel optimistic that it would work for me - I never progressed in my other pregnancies, both babies would have been 9-10 pounds had I kept "cooking" longer, etc....but I'd definitely like any information that can prove those pessimistic thoughts to be unfounded! 
So basically, I wanted to say hi since I may be lurking around here, and to see if anyone has some good factual information on risks of VBA2C vs. risk of a 3rd c/s? I think my biggest fear (AFTER the obvious fear of harm to my child or myself) would be going through a painful, possibly med-free labor then needing a c/s in the end anyway and feeling really defeated. We're obviously a loooong way from needing to make a real decision here (no 3u3 here!!), but I just feel it can't hurt to educate myself no matter what I end up deciding.
TIA!
(read it. you know you want to.)
anderson . september 2008
vivian . february 2010
mabel . august 2012
Re: a long intro: vbac after 2 c/s?
Hi mlf!!
I have some info about VBA2C floating around, let me see if I can dig it up for you
https://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm
They've lightened up a bit on the issue- VBA2C is now considered safe, but still a lot of MDs are hesitant since the new guidelines are well.. too new! And of course, malpractice suits and $$.
My personal story, and why I am NOT chosing a VBA2C:
CS#1- borderline pre-e... put on bedrest, induced at 37w0d. After 50 hours of induced labor- I only got to 8cm, baby was in fetal distress: had c-section.
VBAC ATTEMPT: No longer high-risk, no pre-e, no bed rest! Great VBAC candidate. Went into natural labor at 39w4d. 12 hours I labored at home and arrived at the hospital 8cm already. I took NO drugs at alll, no epidural, pain meds, no pitocin, all natural. When water broke, it was meconium stained, so we went to the c-section suite "just in case." I started crowing, pushed for one hour- turns out baby was sunnyside up, so resident at the nationally ranked, best in class, teaching hospital decided to help me deliver him by manually turning him as I pushed so he'd get out of sunnyside up position. Didn't work- in fact, it tied the cord around his neck twice- no one realized this until I started pushing again- with each push, he'd get strangulated- suddenly he had no heartbeat. Since I had no drugs, they gave me general anesthesia, kicked out my DH. During the hast of the emergency surgery, they knicked my uterine artery causing massive blood loss for me, I almost bled out.. baby was born with apgars of 2 and 7- needed a 2 week NICU stay. He suffered an intrauterine stroke due to the oxygen deprivation. Finally, after 2 years of therapy and countless tests at the children's hospital- he's been cleared and is totally "normal!"
In the NICU, they first thought he wouldn't make it through the night, then they thought he would have cerebral palsy or other irreverible brain damange and global developmental delays. Well... we sure proved them wrong. He's 100% awesome, healthy, alive, and well. I don't know if I could live with myself knowing my failed VBAC attempt may have caused him permanent disability or even death.
Thus, I am NOT trying for a VBA2C with my 3rd and final PG. I stronly feel this way ONLY because I had a horrible outcome from my VBAC attempt- I am assuming if it didn't go so horribly wrong and wasn't so traumatic, I'd probably try for a vag birth, but again, I won't consider after all we've been through...
Good luck to you- make sure to research, read + and - stories, talk with real medical professionals, etc...
That sounds like a wonderful OB! The fact that he seems educated and is encouraging you to try what is proven safer is so great. Now, since your body grows "big" babies, and your family has "big" babies (I put it in quotes because over 10 is when I consider BIG) maybe you were built for having "big" babies - no? A 3rd CS is still major surgery, and if you can hop up like that, imagine what it could be like without the numbness, the staples, the detached feeling.
My surgical recovery as incredibly easy. I had no pain (took no meds) , no infection, no problems. But that doesn't mean if I did it again I wouldn't. Also, birth is something to be experienced. It's life altering. I want to be in charge of what happens to my baby from the moment of conception and I feel like if I surrendered to another CS I would be giving up my control. Relying on someone else to deliver my baby instead of giving birth. Just MO, but there you go.
GL in your decision!
As pp mentioned, ACOG has changed their policy on VBA2C, saying it is safe for many women:
https://www.medicalnewstoday.com/articles/46394.php
Here is a study that just came out this year finding that VBAMC is not really any riskier than VBA1C:
https://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2010.02498.x/full
Here is an article on a 2006 study that also found no large increase in UR for VBAMC
https://www.medicalnewstoday.com/articles/46394.php
There are studies finding that VBA2C does increase risk of UR over VBA1C, but they still show a low rupture rate overall:
https://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2009.02351.x/abstract
And here is a really good webpage that looks at a lot of VBA2C studies and talks about what they tell us about VBA2C
https://www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm
You should also consider the risks and benefits of VBAC with the risks and benefits of having a third cesarean. You should be able to find some studies looking at multiple cesareans.
HTH! I think it's great that your OB is open to either choice and you can decide what seems best for you.
Iris427! Who IS that grown up girl in your siggy??? What a DOLL! Seems not too long ago we were all anxiously awaiting news of her arrival over on 3rd tri. Thank you SO much for the wealth of info - I printed the articles and look forward to studying the info.
To the others, thanks for your input, too! I appreciate it.
(read it. you know you want to.)
anderson . september 2008
vivian . february 2010
mabel . august 2012
Yeah, I definitely don't feel like either of my babies were too "big" at the time of their births ... it's more thinking that if I'd gone 2 weeks overdue - how big would they have gotten in those 2-3 weeks?! BUT - I know what you're saying, how do I know my body wasn't built to handle that? Like my (then) 105lb grandma who delivered my 11lb uncle!
(read it. you know you want to.)
anderson . september 2008
vivian . february 2010
mabel . august 2012
Aww thanks! I can't believe how big your LOs are already--how is your daughter 9 months already?? They are both adorable.