Vbac

andrea0418 · May 2015

I am really hoping for a vbac this time. I need to start a list of questions to ask at my first appointment because if I don't like their procedures/rules on vbacs then I'm switching practices and hospitals.
Has anyone had a vbac and can think of what all I need to ask?
I'm planning to ask
Do all 4 drs in the practice have to agree that I'm a good candidate?
What are the hospitals policies?
Can I go past 40 weeks?
Do I need to go into labor on my own?
Are there induction options?
Can I get an epidural?

I know there's more I need to ask....

lianeadine · May 2015

I definitely am going to pay attention to this post. I plan to talk to my doctor about it on Wednesday. I know I am over 35 and have heard that can be higher risk. Also I have heard that it depends on how the incision was done and sometime the outside scar is not the same as the inside cuts

andrea0418 · May 2015

I didn't know about the incision.
I'll be sure to ask how mine was stitched. Thanks!

DaphneMoon1 · May 2015

Yes, your first needs to have been a low transverse, double layer closure. (Most are in the states) They will want to review your OP note. If it's the same doctors they will have it.

One thing they will want to know and discuss is the reason why you had to have a c-section. For example, if it is because baby was breech, they will usually let you try. If you reached 10 cm and baby wouldn't descend they may be more hesitant.

I think your list of questions looks good! Good luck!

kmcox112110 · May 2015

I'm also reallllly hoping for a vba2c! My first appt is next Wednesday and I plan to ask as well. Here's hoping you get to try a VBAC!

andrea0418 · May 2015

@DaphneMoon1 yes it's the same dr/practice so they have all my records.
I had to have a csec because baby's heart rate kept dropping with every contraction. They had me in every position trying to see if that would help. They finally had me go for a csec and realized the cord was wrapped several times around his neck. So my body was progressing and dilating baby just wasn't ok in there.

js2552 · May 2015

I did a vbac and it was great. My first was a c section because when my water broke there was meconium and heart rate was dropping. I went through most of my second labor planning on having another c section and even went to a doctor that only specialized in sections. At 37 wks I changed my mind and told dr I wanted to go for a vbac. He reviewed my and said it would be ok to try for it. He was very supportive of my decision and didn't discuss if I went past my date. I ended up going into labor 4 days before my edd and it was an amazing experience. I hope to be able to have another vaginal birth this time. Best of luck to you. I hope your doctors support you with any questions you may have.

RunnerMeg · May 2015

Hi ladies! I am pregnant with #2, EDD 1/25, and hoping to VBAC. I have my first appointment with my OB on 6/24 and plan to talk extensively with her about it. I am open to switching practices if necessary.

Love supporting other VBAC Mommas and hearing successful vbac stories.

hendsa01 · June 2015

Hi there-I just joined the bump and my edd is 1/16/16. My first was an emergency C due to the classic "fetal distress" then of course once they performed surgery there was a nuchal cord. Blah blah. I had really awful care providers and went to a "chop shop" hospital with a high section rate. This time around I know better. I poured hours into picking a care provider. My new ob has the lowest section rate of all admitting doctors at the hospital where my baby will be born (18%) and has an over 70% Vbac success rate. I am hiring a doula with a lot of experience working with laboring VBAC candidate mamas. I will be starting prenatal yoga which I hope to continue with my whole pregnancy on Saturday. I will be seeing a chiro and acupuncturist throughout my pregnancy too. Good luck to all of you brave VBAC mamas!!! My new OB reminded me that VBAC is the safer option when choosing how to deliver #2. 50% of maternal deaths in the U.S. Are due to c sections...

Life is Exciting · June 2015

Thank you for bringing these questions up. I have my first OB appointment today and want to try for a Vbac as well. I know my hospital and OB practice don't have any rules against it, but your questions are great ones to ask. I had just planned on going in and asking if they think I'd be a good candidate for Vbac and also what the practice and hospital's Vbac success rates are.

Sovvy · June 2015

I'm planning a VBAC too.

Do you have a local ICAN network? That may be a really good idea for you.

Sovvy · June 2015

andrea0418 said:

@DaphneMoon1 yes it's the same dr/practice so they have all my records. I had to have a csec because baby's heart rate kept dropping with every contraction. They had me in every position trying to see if that would help. They finally had me go for a csec and realized the cord was wrapped several times around his neck. So my body was progressing and dilating baby just wasn't ok in there.

it sounds like you're a good canidate!

MarleneG88 · June 2015

I'm going for vbac too!! My doctors don't seem to concerned with how my previous csec went or how I was stitched, but I'm getting my records just in case. Check out vbacfacts.com and birth without fear. Lots and lots of advice and birth stories there! I'm very lucky because according to vbacfacts my hospital system (kaiser) has some of the highest vbac rates in the country. Can't wait to do this!!

RunnerMeg · June 2015

Hi VBAC Mommas! I'm sure most of us have had our first appointments by now. How did they go? How was the vbac discussion with your doctor?

My OB's practice doesn't do vbacs so she referred me to another practice in the network. Met with him on Wednesday and he thinks I'm an excellent vbac candidate, but also said its hard to accurately gauge until later in pregnancy. But based on the length of time since my c/s and the type of incision, I'm a good candidate. He was also honest and said that the hospital he delivers at isn't quite as vbac friendly as the other big hospital in my city.

So on Monday I have an appt with another OB, completely different practice, who delivers at the better hospital. He has a reputation of being an excellent physician and very vbac supportive.

tjlfy6 · June 2015

I had the vbac discussion this week with my doctor. She didn't even look at my incision. She said the decision is mine as to what I do. My dr did say I would have to go into labor naturally on my own in order to have a vbac. If I would have to be induced she would just do a c section.

hendsa01 · June 2015

I LOVED my new OB-she was so supportive of my desire to VBAC and also said I was a good candidate. I am so glad my husband went to the first appointment because of how much information that she provided about safety of VBAC as compared with a repeat Caesarian (and I had told him this information in the past, he just trusts it coming from a doctor's mouth more haha). She was happy to hear that I've hired a doula and said it sounded like I've done my homework. In fact, I found out she was the attending OB for a different doula friend's successful VBAC (with twins no less!). It was a huge relief after this first appointment because of how back and forth I've been about choosing an OB vs. a midwife.

mrussello · June 2015

We had to opt out of a VBAC. My dr suggested it and then we had the discussion of why I had a c-section in the first place. Baby got stuck and the vacuum and forceps were unsuccessful. My pelvis is tilted backwards just enough to mess it all up. I couldn't do that again.

MarleneG88 · June 2015

mrussello said:
We had to opt out of a VBAC. My dr suggested it and then we had the discussion of why I had a c-section in the first place. Baby got stuck and the vacuum and forceps were unsuccessful. My pelvis is tilted backwards just enough to mess it all up. I couldn't do that again.

I'm sorry you experienced that but I love this because you guys TALKED about it. Your doctor gave you an option and you discussed it and came to a mutual decision together. So many docs are pushy and don't listen. I'm glad you have a doctor that listens and respects what you have to say! I remember when they were wheeling me for my csection and I asked my doctor if she does vbac and she said nope! And that was that, no explanation. That was hard for me. I've switched insurance now so I'll get a chance if everything is favorable, but that was hard to hear, a no without a reason.

mrussello · June 2015

Oh yeah. My dr is great. Everyone in the practice is and I love that more and more Drs are open to the idea. I wanted to try but the reality of it all is too much. I love supportive docs and you can find them in almost all insurances. Sometimes you have to look under those rocks. If your dr isn't listening to you, find another. My dr also said if your c-section is after a certain length of time, 2 years I think, everything should be good to go.

RunnerMeg · June 2015

mrussello said:
Oh yeah. My dr is great. Everyone in the practice is and I love that more and more Drs are open to the idea. I wanted to try but the reality of it all is too much. I love supportive docs and you can find them in almost all insurances. Sometimes you have to look under those rocks. If your dr isn't listening to you, find another. My dr also said if your c-section is after a certain length of time, 2 years I think, everything should be good to go.

Yes, this is exactly what my OB said. As long as it's been 24 months and the incision is low transverse with double layer suture closure (most in the U.S. are), then many Mommas are good candidates.

leap_frog · June 2015

I had a successful Vba2C with my 3rd, now pregnant with #4. I have a new OBGYN this time around. I am unsure if they will let me vbac again. I did have to be induced with #3, and from what I understand, most Drs. will only try if you go into labor on your own.

steph_pegasus · June 2015

Gah my first appt isn't til the 30th! I had the intake nurse meeting and they sent a form to the previous hospital for the ob to review my vbac report.
My only concern right now is that the nurse changed my due date up a week because she based it on my LMP, but I know for a fact when I conceived, which puts my due date a week later than the nurse told me. I don't want to risk being induced so I'm going to talk that over with the ob.

MarleneG88 · June 2015

StephPegasus said:
Gah my first appt isn't til the 30th! I had the intake nurse meeting and they sent a form to the previous hospital for the ob to review my vbac report.
My only concern right now is that the nurse changed my due date up a week because she based it on my LMP, but I know for a fact when I conceived, which puts my due date a week later than the nurse told me. I don't want to risk being induced so I'm going to talk that over with the ob.

Maybe if you do have to induce they could do foley bulb? That's one of my questions for my next visit

RunnerMeg · June 2015

According to ACOG, pitocin induction isn't contraindicated for vbac, just the use of cirvadil or cytotec. But yeah, I know many OBs are hesitant to induce. The OB I met with on Monday said he would have no issue inducing with pitocin if I was already at, say 3cm and partially effaced. Of course I would prefer to go into labor on my own, but it's good to know there are options.

MarleneG88 · June 2015

RunnerMeg said:
According to ACOG, pitocin induction isn't contraindicated for vbac, just the use of cirvadil or cytotec. But yeah, I know many OBs are hesitant to induce. The OB I met with on Monday said he would have no issue inducing with pitocin if I was already at, say 3cm and partially effaced. Of course I would prefer to go into labor on my own, but it's good to know there are options.

Mine won't induce and also will only let me go to 41 weeks. I'm ok with all that, my daughter was born at 38+6.

steph_pegasus · June 2015

@RunnerMeg pitocin isn't great for labor either though, with the scar. I don't want to have it at all - hoping to go non-med and as few interventions as possible. Obviously have to talk the ob about all this but from my research on the birth facility she/her colleagues deliver at it seems highly likely that they will be open to it.

MarleneG88 · June 2015

@StephPegasus I also want to go Med and intervention free. Hoping I can handle it!!

RunnerMeg · June 2015

I also hope to have as little intervention as possible too, but I'm trying to be realistic and open to all options. I had the same desires with my DS, but birth had its own plan lol.

Pitocin contractions are just horrible, so if nothing else I'd prefer to not experience those again.

My OB also won't let me go past 41w, which I am totally okay with. My DS was born at 41+6 and was just under 10lbs. If this baby can arrive in the general vicinity of 40w, I think I have a much more realistic shot at a successful vbac.

steph_pegasus · June 2015

@RunnerMeg I was just telling DH earlier that because of the c/s I'm a lot more open to hospital procedures this time round, but still hoping the ob will more on "my side" this time about how I'm hoping to manage labor & delivery.
@MarleneG88 part of the mental prep is the right mindset. I read a great book called The Thinking Woman's Guide to a Better Birth - very educational re: meds, interventions, etc. If you haven't read it, I highly recommend it.

RunnerMeg · June 2015

@StephPegasus - I love that book! And yes, 100% relate about feeling more open to hospital interventions this time around. Hindsight is always 20/20, but I often wonder if I would have been able to deliver DS vaginally if I had agreed to be induced closer to 40w instead of closer to 42w. I dilated to 10cm in only about 9 hours, so I wonder if DS had been 2 weeks "smaller" if he would have fit. But I was soooooooo against induction or anything last time. I never entertained it until 41.5. Hopefully this time our bodies will know more what to do haha.

steph_pegasus · June 2015

That's the hope! We'll have to do more regular check-in on the board as we progress. I know there are more than just the few of us in this thread.

MarleneG88 · June 2015

Thanks for the book recommendation @StephPegasus !! Will definitely look into it. My problem was posterior baby and, in my opinion, I should have moved more during labor. Hoping spinning babies and forcing myself to at least squat and walk a little will help. Very nervous about having a successful and safe vbac, can't wait to hear everyone's stories!!

JuliaK2084 · June 2015

I was entertaining the idea of a vbac but my birth was a traumatic experience for me and I am scared. I know what a c section is like and the recovery. I pushed for 4hr with no movement. Contractions being lost and pushing for nothing. At the end I was exhausted. When they did the surgery they realized baby faced my stomach rather than butt which they missed when admitting me. I was 36w and my dd was 6lb 2oz I hope to make it ft.

katiedid0907 · June 2015

DS was born in August 2013 and was a breech baby. From what I've read it seems like I am a good candidate to try for VBAC this time around, but my first appointment isn't for another week so I have lots of questions to ask the doctor. I hated the c-section recovery and although vaginal birth probably isn't a picnic, it would be easier on me (recovery wise) with a 2.5 year old running around the house. If i have a c-section i won't be able to lift him up for weeks! We will see what the doctor says. I am looking forward to getting an opinion (or two if necessary) from a professional.

gatorrn06 · June 2015

Although I get the desire to have a "normal" birth, I do not understand potentially putting the babies' life at risk for a vaginal birth. Having a c-section does not make one less of a mother. I had a c-section with my first after 18 hours of drug free labor due to failure to get passed 5 cm and fetal distresss. My daughter was tangled in her cord and could not drop. At the end, I had a healthy beautiful girl and that is all that matters. I will be having a repeat c-section as I am not willing to risk uterine rupture. I know a c-section is not without complications but I feel it is what is right this time around. I also understand many people have successful vbacs but it is just not for me. I hope that everyone makes their decision for the right reason. Best of luck no matter what you chose.

steph_pegasus · June 2015

^ thanks for your input.

HimandMeplus3 · June 2015

These are all great questions to ask. I just had this conversation with my OB last week even though I didn't think I'd be going for a VBAC. We went over my incisions, why I was induced before, why I had a csection previously (was it more of a baby issue vs a mommy issue), length of labor before csection, likelihood of having baby early again due to complications. I am an extremely poor candidate for a VBAC, sadly. I was induced at 37.5 weeks due to GD and pre-e, I labored for 72 hours, I pushed for 6 of those hours but baby never came under my pubic bone, and I ended up with chorio. My epidural also basically failed. I am already very diabetic, have a heart murmur, and have a high probability of pre-e again. I was upset that I won't get to try to birth vaginally, but in the end, I just want a healthy baby. My OB said he would support a VBAC if I hadn't labored so long, if the csection was due to positioning or heart rate, or if it was just because of infection last time as long as he didn't have to use cytotec or cervadil. He was fine with the use of pitocin, so I'd say many of you stand a good chance at VBACs. I wish you all the best of luck.

RunnerMeg · June 2015

@HimandMeplus3 - I'm sorry you won't be able to attempt vbac, but it sounds like your OB had a great conversation with you about it. Good communication and support to the patient go so far in having a good relationship with a physician.

@gatorrn06 - I appreciate your input. Im sure you didn't take your decision to have a RCS lightly, as you recognize that CS also have their own risks. It's a very personal and important decision, one that no Momma takes lightly, whether choosing TOLAC/vbac or RCS. You are supported in your decision to have a RCS, so please do not assume or infer that anyone else is choosing TOLAC/vbac for the wrong reason.

at cesarean, for anyone who would like it.

These rates come from peer reviewed studies (Guise study, MANA study and Lieberman study)

The mortality rates (for babies) are as follows:

Hospital TOLAC (trial of labor after cesarean)/vbac mortality rate = 1.3/1000
Hospital ERCD (elective repeat cesarean delivery) mortality rate = 0.5/1000
HBAC (home birth after cesarean) mortality rate = 4.75/1000
VBAC in freestand birth centers mortality rate = 4.82/1000

According to ACOG, "at an individual level VBAC is associated with decreased maternal morbidity and a decreased risk of complications in future pregnancies."

The maternal mortality risks are as follows:

Hospital TOLAC/vbac maternal mortality rate = 3.8/100,000
Hospital ERCD maternal mortality rate = 13.4/100,000

Since maternal deaths are so rare, they are measured per 100,000, whereas infant deaths are measured per 1,000. The risk of death for a baby born to a mother attempting a VBAC is an increase of 0.08%; the risk of death for a mother who attempts a VBAC is a decrease of 0.0096%. In other words, there are approximately an additional 9-10 deaths per 100,000 for women who choose ERCD and there are approximately an additional 80 deaths per 100,000 for babies whose mothers choose VBAC in a hospital setting.

A primary concern for repeat cesarean sections is the potential impact on future pregnancies. With each cesarean section, the risks increase. According to Silver RM, et al., "The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries."

katiedid0907 · June 2015

@RunnerMeg Wow! Thank you for your well-researched evidence-based information...very helpful!

RunnerMeg · June 2015

@katiedid0907 - you're welcome.

Before I became a sahm I worked in oncology clinical research at a large academic cancer center. So data and evidence-based medicine is in my blood. I know our OBs all have discussions with us and go over the risks, I just really wanted to be fully aware and informed about everything.

HimandMeplus3 · June 2015

@RunnerMeg Yes, my OB is seriously amazing with communicating the ins and outs of my pregnancy and delivery. He's made me extremely comfortable with my choices so far. I've only met half of my 4 doctor team for this pregnancy (I have an OB, a MFM, a cardiologist, and an endocrinologist) , and so far I LOVE them all which is more than I can say about last time. I think a positive relationship with your care provider(s) is key to enjoying/feeling comfortable/feeling secure in your decisions regarding your pregnancy. I love that you're so informed and that you're sharing your knowledge with all the mommas so they have a heads up in this game of child birth! A huge round of applause for you

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