VBAC or Repeat C-Section??

moon1417 · March 2019

Hey Everyone!!

A few of us had discussed a VBAC/RCS (Vaginal Birth After Cesarean/Repeat C-Section) discussion thread. I had a C-section with my first because she was breech. I was not considering a VBAC until my doctor told me I would be a good candidate, and she thinks its the best option. I was really coming to terms with a RCS but now I just don't know.

I think this would be a good place to talk about anything related - have you had a VBAC or RCS - how were your experiences - what are your worries? lets talk about the pros/cons etc.

Also - I recently joined an evidence based FB group that has a wealth of information. I like it because it doesn't support woo (for example, you wont find an antivaxxer in there). I suggest joining and reading their pinned informational threads to get some basic statistics on them. It is also full of stories of both VBACs and RCSs. https://www.facebook.com/groups/birthaftercsectionfacts/

BigBadWolf12 · March 2019

Thanks for the group link. I'll probably check it out.

I also had a cs for my first because he was breech. It was textbook and I healed well from it, but hoping for vbac this time if possible.

Generally they said I'd be a good candidate for it. The only iffy thing now is the placenta placement. It was a little low at the a/s so we will check it again in third tri and go from there.

And of course other complications could arise between now and then changing my "good candidate" status, but that's where we are for now.

wabash15 · March 2019

@moon1417 The twins were a c-section due to positioning/size, so I was considered a good candidate for VBAC for my last. I did a VBAC and it was a great experience for me. I'd be happy to answer any questions you have.

peachy0709 · March 2019

I had a vaginal delivery for my first (and fourth degree tear), c-section for my second. I think ultimately I will do a RCS for a number of reasons (including the delivery date, given the proximity to a holiday weekend), but the thing that appeals to me about a VBAC is being able to walk immediately after having a baby (especially with 2 other kids at home!!)

moon1417 · March 2019

For me, I struggle with not being in control in a sense. For my first, she was breech but the doctor wanted said I was a good candidate for a version so we tried, and it failed - lost her heart beat and was rushed to the OR. It was pretty traumatic. I would like not to have a similar thing happen again.

I also know with the CS I lost a lot of blood and was anemic and had zero energy - it would be nice to have energy --- and like @peachy0709 said to be able to walk around, squat, pick up my toddler etc quickly after birth would be amazing. My recovery was pretty rough too, my incision opened and my husband had to pack it for like a month or longer before it finally healed.

The stats with a VBAC are something like you have a chance of rupture 1/200. As small as that is, my first had heart defects, which were 1/100 and so even though odds are low, it scares me to death.

I am thinking I want to make it to 40 weeks, if I go into labor, we will let it ride and see what happens but if not I'd like to just schedule the RCS for as close to 40 as possible.

Doc said she would let me go one week over due date, but the risk of meconium scares me bad too. And your chances of successful VBAC go down pretty much right away after 40 weeks I believe.

Doc also said it will really be a game day decision, we wont know until we check my cervix around my due date to even see if my body wants to progress on its own. I don't think I want to be induced for a VBAC.

thirdtimesacharm2019 · March 2019

@moon1417 I think it’s admirable that you are willing to wait until the day of to make that kind of decision. I would have to decide well in advance!

This baby will the my third c-section. DS1 was breech, starting this chain of events. I could have had a VBAC with DS2, and although it’s a great option for some folks, it was not for me. I was told the risk of rupture was 4% (not sure if that was tailored for me or just in general). And that was a little too scary for me.

wabash15 · March 2019

@moon1417 I was over 40 weeks with my VBAC. My midwife said the risks didn't really go up till 41 weeks, and if we hit that mark she would push for either induction or C. She did say some docs are super conservative and won't let a VBAC go beyond 40 weeks. I get with that scary experience wanting a sense of control. That being said even with a scheduled C there is only so much we can control about the experience. I will say that I had a fairly streight forward C recovery and the vaginal recovery was way easier. I think trying to chase after a toddler (or now 3 in my case) would be so hard post C. I was also a bit nervous of the risk of rupture, but thats why I chose a hospital birth. I don't have any direct experience with it, but I have heard that sometimes the second or third C is harder to recover from due to scar tissue from the first... Something else to consider. Thankfully we still have plenty of time to decide and you can sit with the idea longer and see what the best choice for you will be.

aecm · March 2019

I had an emergency c-section with my first due to a previously undiagnosed velamentous cord insertion / vasa previa. It was scary (and I’ve worked in health care, so very little scares me) and while I’m obviously glad we had that option and my daughter was born healthy...I hated not being able to see her right away and the recovery was not fun.

I asked about a VBAC with the twins, and was pleasantly surprised that my OB was very on-board with the idea. So that’s our plan for the moment. Baby A will have to be head down, and if it’s delivered successfully then they might have to try to internally turn Baby B. If they can’t get Baby B head down, then it depends on if there’s (no joke) “an old guy” OB around that’s comfortable delivering breach. No old guy + breach Baby B would mean I would get a c-section right after the VBAC.

So yeah - I’m really really hoping everything works out for a double VBAC. I’m dreading the possibility of caring for newborn twins and a toddler (aka 3 under 3) during a c-section recovery.

sourlemon · March 2019

This will be my 3rd c section. Had an emergency one with my first, scheduled with second, and this will be scheduled if all goes well.

Recovery after the second was much harder for me than the first. But the doctor had to remove a large amount of scar tissue And about half an inch of my skin all around the old incision, so that is probably why.

wabash15 · March 2019

@aecm I know this is a very personal choice, for me I absolutely did not want a vaginal delivery then a C-section....I was told by my MFM that those were the hardest recoveries. I hope your babies are more cooperative in terms of positioning than mine were. also as an FYI my baby B was changing position up until the last second...so even with twins they can keep you on your toes position wise.

peachy0709 · March 2019

Maybe this isn't the appropriate place to ask, but has anyone thought about tying tubes during a c-section? We had never thought to go that route until we had the genetic scare, and now it's something I am *mildly* considering.

thirdtimesacharm2019 · March 2019

@peachy0709 I’m getting mine tied at the same time. I refuse to go back on hormonal birth control (I’ve tried IUD and it won’t “stick”). And this is the absolute last kid that’s coming out of me!

Funny story, as I was being prepped for my last C-section, the doctor (who wasn’t my primary) asked if we were tying the tubes. I was extremely pregnant, hadn’t eaten all day, and DH had stepped out to take care of a few things ... so I’m like “you’re asking me now?!?” Luckily I said no or this LO wouldn’t be happening.

I do realize tubes can be untied (my mom had it done before my brother), so they better make sure those suckers are tight/burnt/donated to science 🤣.

peachy0709 · March 2019

@thirdtimesacharm2019 - HA. We were ready to be done after 3, but now that we had this scare, I just can't risk the mental anguish again.

wabash15 · March 2019

@peachy0709 if DH wasn't getting snipped and I was having a repeat C I would consider it. I don't want to be on birth control. Also we know we are done.

aecm · March 2019

@peachy0709 - I was asked if I wanted to consider tying my tubes at my 10 week appointment! We had JUST found out it was twins the week before and hadn’t even considered future BC. I’m on the fence at the moment. I mean, if I can successfully have a VBAC, then no way...but even if I have a c-section, I’m like 97% sure these two will be our last kids but I would want to be 100% sure before making that decision. But if you’re 100% sure (and I could understand why you would be!) then I say go for it!

@wabash15 - yeah, if they’re telling me I’m going to need a c-section for B before A has even been delivered, then I think I’ll probably just opt to c-section them both. But I would really love to try and avoid the c-section all together. Wondering if that’s why my recovery with DD was so rough? I was 8cm dilated by the time we were rushed in with her.

sourlemon · March 2019

DH is getting his "tubes tied" aka getting snipped after this kid, even though it'd be easy to do during my c section. I feel like I've done enough and it's his turn to contribute to our family size/birth control.

TW: I'm having him wait until the baby is 6mo to getting snipped, mainly due to SIDS concerns (my heart condition is one of the suspected causes of SIDS).

aevan011 · March 2019

I’ve only got like a 55% chance of vbac according to the handy dandy calculator, but my CS was due to arrest of descent only due to DS’s size. My OB from his birth was adamant that if the next baby is smaller I’d be a great candidate. I want to wait til due date before scheduling anything. I was 40 + 5 with DS. I’d like to see if my body will spontaneously go into labor, but I’m not against a RCS, and don’t want the risks that come with going too far overdue.

That said, I am in a FB group that’s evidence based like @moon1417 posted and have learned a ton and am still considering a RCS scheduled. There are risks with either route, obviously.

My main concern is risk factors increasing after due date. My hospital will not induce until after 40 weeks, and I haven’t yet asked what methods they’d use in a vbac case.

DH would prefer the control of scheduling another CS and knowing when the baby will come but as I’ve reminded him, he’s not the one being cut open and recovering.

Edit to space out paragraphs for reading

MamaK225 · March 2019

I'm planning to do RCS, and will be scheduling it somewhere around week 30. I want to try to make it as close to DD as possible. I was induced with DD1 at 40+1 because it was the Friday before the 4th of July weekend AND I knew it would be a loooooooong labor (family history). The right side of my cervix wouldn't fully dilate because of scar tissue from a LEEP that I had done 7-8 yrs ago, so I'm most likely not a good VBAC candidate anyway.

I'm planning to do RCS, and will be scheduling it somewhere around week 30. I want to try to make it as close to DD (8/16) as possible, debating between Friday 8/9 or Wednesday 8/14 - basically do I want to go home with a full weekend ahead of me (discharged Sat morning) or have a couple of days with DD1 in daycare to acclimate. I had a fairly easy recovery - once my bladder apnea cleared up about 15 days PP - and am only mildly concerned about a recovery from a second.

My question - which I'll discuss with my OB - is having a partial hysterectomy (uterus removal) while we've got me opened up. Given my PCOS and the 3 hysteroscopies I've had in 5 years, I'd rather not deal with *that* anymore. The only thing that would change my mind would be if DH somehow miraculously decided he wanted to go through (i.e. pay) for another round of IVF because we are officially out of embryos (DD2 that is currently cooking was lucky #13 after 2-12 failed to result in pregnancies) ... AND if our R/E opens up an office that is closer. Having to make a 250-mi roundtrip multiple times in 2-3 weeks was awful and I don't know how I'll do it if we are already trying to manage 2 kids at home (it requires me to leave the house before 5a so that I can have my butt-in-seat at work by 9a - as you can tell, my boss isn't exactly supportive

).

wabash15 · March 2019

@aevan011 you can't use cytotec for induction for a VBAC. you can use a folley bulb catheter to help expand the cervix and pitocin is OK. So it sort of depends on how your cervix responds... if the folley bulb is not working than my understanding is then move on to a C. They don't want to stress the uterus too much.
@MamaK225 not having to deal with a period any more would be nice....

WinchesterGirl · March 2019

We are hoping to try for a VBAC assuming I stay a good candidate.

I was induced, fully dilated, and pushed for 2.5 hours before DS's heart rate necessitated an emergency CS. My recovery was very unpleasant due to getting a skin infection & having to have DH pack the wound for WEEKS afterwards.

So, if we can safely avoid the ringer that is surgery recovery + those possible complications while juggling a NB and very active 2.5 year old... sign me up!

According to my doc and the online calculator, I am a very good VBAC candidate assuming nothing changes. Apparently getting to 10 cm & pushing bodes well for my body doing things more quickly the second time around.

I am nervous about it for sure, but I'm trying to build it up positively in my mind. Every labor is different, every baby is different, and we can do this! I've also been looking up birth affirmations online to continue to positive thinking.

MamaK225 · March 2019

@wabash15 - That's my other want to have it done "while you're in there"

peachy0709 · March 2019

@sourlemon - I hear you on the "I have suffered enough" argument. Initially DH was going to get snipped but all of a sudden he has been asking about me getting my tubes tied.... I think the scare of the potential diagnosis gave him a fear and now he's proposing we do both...

aevan011 · March 2019

@wabash15 I definitely know that cytotec is a hard No with a vbac. I only had pitocin last time, but would obv be open to the Foley if it could work.

The good thing is that this hospital has a lot in place and seems well versed and supportive of TOLAC. So I trust that they’d advise me appropriately. They have wireless monitoring so I won’t be stuck in bed - which is not an option I had with DS1, my movement was pretty limited. I hope being able to move might help as well, especially if I get the chance to push again, I can think of 789 positions I’d rather be in than in a bed on my back.

I just pray I don’t need any of it, but I’m trying to be realistic in the thought that a VBAC just may not be possible. A RCS isn’t the end of the world for me.

peachy0709 · March 2019

I've started struggling with this question because my parents (who are very, very selfish people) don't seem to understand the restrictions of a c-section even though I've already been through it once. Now that we'll have two kids that need help instead of just one, they have been difficult about being at my house for up to a month to help me with the big kids. That said, I'm really worried this baby is going to be very big and a VBAC wouldn't even be possible anyway.

wabash15 · March 2019

@peachy0709 hugs. Thankfully we have time to sort it out, but I'm sorry your parents may not be super helpful.

MamaK225 · March 2019

@peachy0709 - Ugh, I'm so sorry. I think it's hilarious that people give so much leeway to people who have an appendectomy or a gall-bladder removal, but act like a c-section is like getting a tooth filled. Like, IT'S MAJOR SURGERY PEOPLE. I also find it interesting when (grand)parents offer help, but only on their schedule - especially when/if they're retired. I'd really hate for you to make a major medical decision based on the limitations (whether real or imagined) of others, instead of what is best for you and baby. That's not a fair position to put you in, at all.

My mother is of a similar mindset and it's driving me insane. I told her if her schedule is so restricted (between her - cue eye roll - precious "yacht club" and extensive cruise schedule) that she can only come when it's convenient for her, to not come at all - we'll hire help if we need to, instead of listening to her complain about how much of a sacrifice she's making/how busy she is. I'm actually considering flying my FIL down here to stay (as along as he pleases) to remind her that others are perfectly happy to do whatever they can to see their grandchildren - and their children. On the outside, he's this super scary, intimidating biker guy from out west, but is the BIGGEST softie and I just love him to death (he's the one parent that DH & I agree that we absolutely love).

sourlemon · March 2019

@peachy0709 are you asking them to stay with you for a month or are they local?

Maybe I'm being naive, but I dont expect taking care of 2 older kids after a c section to be any harder than taking care of just the one from last time. Now, the 2 older kids play together and the nearly 5 year old knows how to get a lot of things on her own -- snacks, drinks, toys, books -- and often helps get stuff for the younger one. Last time, she was just barely 2.5 and used to being around us all the time so it was a huge adjustment. This time, they are used to being around each other a lot and rely on us less. We will still be sending them to daycare/kindergarten during the day though.

peachy0709 · March 2019

@sourlemon - They live about 2 hours away. My youngest won't be 2.5 yet so there is still some lifting that she may require in and out of the car. She'll also be starting at a new preschool so I think she'll be clingier. DH's job requires long hours and sometimes travel so I want more reliable support with the lifting all around.

sourlemon · March 2019

Can you start teaching her to climb into the car on her own? Both of my kids are able to climb into both of our main vehicles (one minivan and one SUV) so all I have to do is buckle them. Of course, when the little one is being a brat I still have to pick her up, but I hope to have her fully trained by August.

There were definitely a few times after DD2 was born that I had to pick up DD1 and carry her long before I was "allowed" to, but sometimes it couldnt be helped. I remember once we were in Target about 6 days after the C section and I had to pick her up and football carry her out of the store. It wasnt until we got outside and I squatted down to have a talk with her that I realized I messed up. This time I hope to be more careful about that type of stuff, but my DH travels a lot of work too so I'm sure its gonna happen.

peachy0709 · March 2019

@sourlemon - We are definitely working on it, but she is a total barnacle. It's been her personality since day 1 and I had a TOUGH recovery last time. I'm impressed you were able to carry her 6 days after - I genuinely was hardly moving at that point. We still have never figured out why my recovery was so difficult - given that I recovered from a 4th degree tear like it was a first. Something just didn't take right for me with it. Fingers crossed this time is better.

wabash15 · March 2019

@peachy0709 I very much had to fudge my guidelines post c-section. We had no family or help and DH was back to work the day after the twins were born so pretty much from when we left the hospital I was hoisting 2 car seats, driving, going up and down stairs. I tried to rest when I could but there just wasn't a choice..... if your parents won't help have you looked into a post partum doula? I wish I had known about them. They can help watch other kids, do light cleaning, cooking, help you out... it might be an option. I really hope your recovery is way easier this time.

aecm · March 2019

@sourlemon I can’t believe you a) went to Target, b) were able to pick up your kid, c) could carry your kid football style and d) squat down without noticing crazy amount of pain only 6 days after a c-section!! I was barely getting my mesh panties pulled up and making my way down the stairs at that point! I probably wouldn’t be so scared of a repeat c-section if I knew I would be capable of doing all that in less than a week. Seriously, mad props to you...that’s supermom territory as far as I’m concerned!

sourlemon · March 2019

@aecm after both c sections we went to Target on day 3 (day after getting home) because I needed out of the house in order to keep moving. If I sit in the house all day I don't move enough. I'm weird.

And I definitely felt all that after the fact! But at the time she was being so awful and I was sick of it and embarrassed because her fit throwing was causing the baby to scream and I just snapped. Adrenaline sure helped! And I was much more careful after that!

sourlemon · March 2019

And DD1 was small... probably only around 20 pounds at that point.

thirdtimesacharm2019 · March 2019

What I loved was the post c-section instruction to not lift more than 10 lbs. DS2 was 9 lb 4 oz... so I was over the “limit” with him and a diaper bag. That didn’t last too long.

@sourlemon Kuddos on strolling Target within a week. #babynumberthreegoals

(edit for spelling)

peachy0709 · March 2019

That's a good point about size of kids - my kids are huge (my not-quite-2-year-old is already 30 pounds), which is why I'm so worried. *TW* *TW* *TW* *TW* (I'm super serious about this TW...) I've also had multiple (yes... more than one, which is horrifying) friends have their incisions come open after recovery from over-exerting themselves.

MamaK225 · March 2019

@peachy0709 - That is absolutely the main concern re: overexertion! Some thing people need to truly be aware of; it's not just that you might "hurt" yourself, but cause real, extremely painful damage. And I absolutely agree. DD1 will be 3 when DD2 arrives, and she's been hovering at 39 lbs for 5-6 months now. I've already pulled back from picking her up, carrying her, etc. to get her used to it well before it become mission-critical.

sourlemon · March 2019

My older daughter turns 5 in 2 months and weighs 32 pounds. We had to really push to get her to gain weight for her heart surgery 11 months ago because she had to be at least 30 pounds. We got her to gain 3 pounds in the 8 months leading up to the surgery, but since then she's only gained 2 pounds. She's just skinny. My 2.5 year old on the other hand is a tank compared to her sister...but she only weighs about 25 pounds. Still small compared to most kids her age.

MamaK225 · March 2019

@sourlemon - My little sister and I were nearly identical to your daughters: I was tall, skinny (and maybe slightly underweight) *forever* and she was just ... solid bricks. It's so funny how it all works out. She's now 5'9-5'10" and thin/athletic build and I'm a piddly (compared to her) 5'7" and much more curvy. We're just over 3 yrs apart, too.

moon1417 · March 2019

@peachy0709 along with your TW - TW... Is my incision opened on day 6 because my dog jumped on me.. he is 30lbs and it took more than a month for it to close up. I will not be making any target trips with my DD1 if I have a C-section haha.

peachy0709 · March 2019

@moon1417 - I am so sorry to hear that!!! I hope the rest of your recovery was uneventful.

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