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VBAC
VBAC calculator - WWYD if your chance was 50/50?
In a previous post, I asked for unbiased info about VBACs. In one of the links that was posted in a response, there was a calculator that is suppose to calculate your chance of VBAC success. For me, it said my chance of success was 54% - I'm guessing the things counting against me are age and weight. If there is any legitimacy to this calculator, I would have a hard time committing to a VBAC if my chance of success is only 54%. WWYD with a number like this?
If anyone wants the link to the calculator, here it is:
This discussion has been closed.
Re: VBAC calculator - WWYD if your chance was 50/50?
If something tells me my chances are 50/50, I tend to think it doesn't know what the hell it's talking about. I don't need a calculator to tell me "maybe it will work, and maybe it won't." Anyone can do that. So I would disregard it.
I would calculate my chances based on discussions with a pro-VBAC midwife or doctor.
I just took the quiz myself and I don't think it's a very good indicator of your ability to VBAC. It's way too basic, and leaves most of the indvidual circumstances of your pregnancy and labor.
FWIW I scored a 58.3% chance (using my pre-VBAC stats) and I just had a VBAC, so I would take it worth a grain of salt and put about as much faith in it as a Chinese gender chart.
I can tell you right now that that calculator is going to give me very bad odds. So to answer your question, yes, I would try anyway.
And here's why. We don't know what studies or algorithm that calculator is using--a medical study can be flawed if it was poorly designed and there may be other studies contradicting it or flat out disproving it. It's very simplistic.
For example, it asks you if you had a prior cesarean for arrest. OK, but why did the arrest happen? Did it happen because you were induced on an unripe cervix? Did it happen because you had a malpositioned fetus? Did it happen at 3 cm or 10 cm? Did the OB give you adequate time to push or did they rush you into a c/s? Did you have an epidural and so did you get it at 2 cm or 7 cm? Were you able to labor or push in different positions if you weren't progressing, or did you only try one thing before the cesarean? So for that question alone I can think of numerous variables that could change your odds.
I also think the opinion of a doctor or midwife who supports VBAC and has reviewed your individual situation is much more valuable than an internet calculator. My OB thinks I have a good shot at VBAC. I'm going to take his word over a website that doesn't know the specifics of my situation and see what happens.
You'd be much better off to find a care provider who supports--truly supports--VBAC and get their opinion. Personally, I would regret not trying, even if my odds were not great. You may not feel the same and that is OK too. It's a personal choice.
I'm definitely still going to talk to my doctor about it. At the beginning of my pregnancy, he said that the decision was up to me. I don't think I would call him pro-VBAC or pro-RCS. Instead, I would hope that he is pro-Patient. Maybe I'm missing something, but I would tend to think that talking with someone who labels themselves as "pro-VBAC" or "pro-RCS" would make them biased and bias is what I am trying to avoid in making my decision.
I think people label someone as "Pro-VBAC" if they AREN'T Anti-VBAC. I interviewed a doctor prior to my second pregnancy who was actually really great and honest and said that he supports a woman's right to attempt a VBAC but there were many doctors in the practice that would say that but then force a CS at the 11th hour (when you were in labor). THAT is what I was trying to avoid. I wanted an honest provider. Unfortunately, MANY providers aren't "Pro-patient". They are run by their insurance, schedules, own opinions, etc. I considered my midwife pro-VBAC because she honestly felt it was a viable option.
That calculator gave me 82%. I did successfully have a VBAC. To answer your question, even if it gave me 50% I would still have attempted it. If it ended in a CS, then so be it. But that is just me.
I think you are maybe misunderstanding what most of us mean by a doctor who is pro-VBAC or supportive of VBAC.
Being a pro-VBAC doctor doesn't mean they would push all their patients to have a VBAC or disrespect the wishes of a patient who preferred RCS. It means that when a patient comes in wanting to VBAC, they listen to her and work with her to achieve that goal. It means they believe VBAC is safe and that the majority of women who try it will be able to deliver vaginally. It means they are familiar with the research and have an accurate understanding of the risks and limitations a VBAC mother faces, instead of inflating the risk of UR and imposing restrictions on her that are not supported by medical evidence (that last part is key).
So I would say that a doctor who is pro-VBAC is a doctor who is pro-patient autonomy. I think you will find very few OBs in this society who are irrationally biased toward VBAC.
By contrast, many doctors who are pro-RCS tend to flat out ban or discourage any patient from having a VBAC, regardless of her individual circumstances and what medical studies say about VBAC safety and success rates. Or they impose so many restrictions on VBAC that few women will be able to actually have one. And that is not pro-patient IMO.
I see what you're saying and that makes sense. In that case, I would say that my doctor is pro-VBAC because he was the one that brought the option up to me at my first appointment with this pregnancy. Before that, I didn't even realize that VBACs existed! I just assumed that I would have to have another c/s.
I guess I'm playing devil's advocate here, but why would me and the baby be "better off?" We were both just fine after my c/s. Which is why I'm leaning toward c/s - because I know how my body reacted to it the first time. I know I'm not guaranteed an easy procedure & recovery the second time around, but at least I know that I had success the first time. IRL, I know so many girls who had horrible vaginal deliveries (i.e tears, forceps, etc.) and some of them wish they could have c/s for #2, but I don't know anyone who had a horrible c/s experience.
I had a horrible CS experience. That was one of the reasons why I wanted to VBAC. I was apparently allergic to something in the spinal (turns out that no spinal/epi is exactly the same, chemical-wise), had to be knocked out in recovery, spiked a fever a million times after that, and my incision got infected. No fun for me! Plus my DS had some lung issues due to the CS that wouldn't have been the case had he been born vaginally. There are a lot of risks of CS's (especially if there are multiple) that doctors generally gloss over for some reason- for both mother and child. Yes, there are different risks if you VBAC for both mother and child. That's why it's important for you to do your own research and choose which risks you are willing to take and why.
FWIW, I did tear with my VBAC and it was still SOOO much better a recovery for me. I was out of the hospital in less than 24 hours living my life just fine without painkillers or restrictions like I did with the CS. I don't like to be restricted by such things and had a toddler to think about, so it was the right decision for me. (Oh, and I know some people who had vag deliveries who wished they could have had a CS, but it is hard to say that when you have never experienced it- I would do a vaginal again in a second. I'd only do a CS if it absolutely HAD to be done. . . really bad experience.)
Agreed. I think it would be kind of interesting for us all to calculate our "odds" and then see how many of us with terrible odds go on to have a vaginal birth.
Except I don't want anyone getting discouraged by some stupid online calculator.
Another thing to consider with going for a VBAC is if you want to have more than two kids. Once you get to 3+ c-sections, the risks of complications from surgery go up, and also the chances of having complications in future pregnancies go up, also (things like placenta accreta, where the placenta embeds itself into the scar). That alone was reason enough for me to attempt VBAC.
DS2 - Oct 2010 (my VBAC baby!)
I, as well as 3 of my friends, had what I would call horrible c/s experiences. Mine was so bad that if I knew I couldn't VBAC then DS would be an only child. I had another friend who said she had the same thoughts after her first c/s. She actually went on to have one more c/s, which went great, before having an accidental VBAC. She said that even though her 2nd c/s was great (she actually ate at BK right after being discharged from the hospital) if she was to have another child she would VBAC again. Ironically we just talked about this 2 nights ago.
I would be better off because I wouldn't have an increased chance of allergic reactions to the spinal/epidural or general anesthesia, no increased factor of infection from a MAJOR surgery, I wouldn't have internal and external stitches to worry about so I can actually take care of my child. Also, my child wouldn't have the risk of being cut during the c/s and having lung infections due to c/s (friend of mine her daughter had this and unfortunately I can not tell you why or what it is called, maybe someone else here can). I also have met some women who loved the fact that they never felt labor (because it is painful?) and elect to have another scheduled rcs. Great for them.
If you had a great experience that is awesome. I personally could NOT stand the fact that i couldn't walk after my c/s with out severe pain or go to the bathroom without help. I am a very independent person and I love the fact that my vaginal deliveries (even with episiotomy) had me up and going in no time without having to be knocked out before I could hold my child. I elected to have a c/s because I thought it would be easier. I was wrong. I had 3 vaginal births all with very different experiences and 1 c/s. Out of all of them, I would take my 5 days of labor (3 days active) natural birth any day.
If anyone is interested, here is the link to my original post:
https://community.thebump.com/cs/ks/forums/thread/47059775.aspx
The VBAC calculator was in the first link in Iris' response.
I'd have still tried with 50/50 chances, even if the chances weren't based on a questionable website calculator. If you go for an RCS, you have a 0% chance of VBAC. If you try for a VBAC with a VBAC-supportive team and you don't get one, then you probably needed the c/s. If you don't even try, you'll never know if you actually needed surgery or not.
FTR, my chances according to the website (going by my pre-VBAC situation) were 52 or 70% depending on what I put for arrest of descent. She wasn't descending, but we were completely aware that the reason she wasn't descending was that her head was tilted. It must be assuming that "arrest of descent" is a recurring issue, though in my case it was obviously not. 70% is pretty good considering more than 30% of births in your country are c/s even when it's not a VBAC attempt.
Before my VBAC, I talked to a friend who had a 4th degree tear with both of her children. 4th degree, if you don't know, means it goes all the way to and through the anus. It doesn't get any worse than that. As she talked about her horrible recovery from those births, I couldn't help but think it was still a much faster recovery than my completely uncomplicated c/s recovery. My c/s was fine, and the recovery was fine, but in talking to my friends, I found time and again that their recoveries were almost always better, even when their vaginal births didn't go very well. While, yes, it's possible to have a vaginal birth with a very bad, long recovery, it's rare.
For me, knowing I was coming home to a two-year-old afterwards, a better recovery was important. I also wanted to know my DD was ready to be born instead of scheduling her birth. Usually, waiting for labor is better for the baby. I tore during my VBAC, but not badly at all. I was sore for a couple of days, and that was it. I came home four hours after delivery and could bend over, pick up my toddler, etc. without assistance immediately.
I just did the calculator and it told me 74%. What is the average success rate?
IMG]http://i39.tinypic.com/qpqv84.jpg[/IMG]
Patiently waiting for little brother!
I just did the calculator and it told me 74%. What is the average success rate?
IMG]http://i39.tinypic.com/qpqv84.jpg[/IMG]
Patiently waiting for little brother!
First, I don't think that calculator is accurate at all. Second, even if I had a 50/50 chance at VBAC I would want a TOL. I agree with PP who said that if you have a TOL you have some chance at pushing your baby out. With a ERCS, you chance is 0. Plus, there are so many benefits to baby for a TOL.
FWIW, I put in my pre-VBAC stats and it was 81.2%.
I thought I was familiar with most of the abbreviations, but I don't recognize "TOL." What does that stand for?
Also, I'm not sure if it makes a difference, but my first c/s was due to DD being breech, so I didn't even attempt a vaginal birth. Does anyone know how that affects my VBAC chances - better or worse?
TOL = Trial of Labor (basically, being allowed to labor instead of being made to have an automatic c/s).
The fact your LO was breech actually makes you a good candidate - most breech malpositions don't reoccur, so you have a very good shot for a VBAC.
60-80%
Now there are three people who were given a good chance, but I still think it's a load of crap. I know my CS was not something wrong with me, it was from poor management of labor and restrictions while pushing, related to DD's position. Now that I know better and have providers that know better, I think my chances are pretty damn good.
Calculator gave me 46% chance of success. And that didn't even count the other major strike I had against me - gestational diabetes.
Well, I WAS successful and didn't have any issues at all except that my labor was long and slow.