July 06, 2008,
L.B. asks from Sellersburg, IN on June 25, 2008
Is a Natural Birth Possible After 2 C-section Deliveries??
This is the first time I've asked a question on this site. I would like to thank everyone that takes the time to respond.
I was married a few months ago and have 2 children from my previous marriage. My husband has never had children. We are planning to have children in the future. With my previous deliveries I have had c-sections. However, if the baby is not too big this time I would love to share the experience of natural childbirth with my wonderful husband. Does anyone have any information on whether or not this is possible after 2 previous c-sections? I would also love to hear from anyone who has been through this.
Thank you so much for your input!!
Just to clarify.....by "natural" delivery, I mean vaginal birth not drug-free. Thank you.
J.H. answers from Lexington on June 26, 2008
i'm a labor and delivery nurse, and i will put my two cents in! i think you might have a hard time finding a doctor that will support your choice, for a couple of reasons. the first thing you need to look at is why did you have c/s before? if your babies were breech or sideways, or there was an emergency, that's one thing. if your labors were dysfunctional, and the babies never came down or you never dilated far enough, or when it came time to push you couldn't push them out (not meaning you were a wimp, meaning either they were big, or your pelvis is narrow, etc), that's another. the second scenarios are more indicative of IF a vaginal delivery is possible or not. the other thing to consider is that your uterus is a muscle, and each time it was cut into (for your two previous c/s), it had to heal, and that scar tissue isn't quite as strong as it was originally... with each subsequent pregnancy your risk of your uterus rupturing during labor increases, and although i can't remember the numbers off the top of my head, i know it's not a huge percentage, but it's also not something to gamble with. and i do believe if it's going to happen, it's most likely to happen in the earlier stages of labor (up to around 4 cms dilated). this is why most physicians choose to schedule a c/s for around 39 weeks gestation-- you're near enough to term that the baby is well developed, your body is more ready to deliver, and *hopefully* you haven't started contracting too much at that point. the question then becomes how do YOU feel about it all? there is a risk that it won't work, there is a risk your uterus could rupture (which really is as big of a deal as it sounds, maybe even bigger!), and there's also the chance that it could work and turn out the way you want it to! i suspect you somehow feel cheated of a "normal" delivery... i myself had a c/s with my daughter, and that's exactly what i felt. and for my next child, i would like the opportunity to try to VBAC (vaginal birth after cesarean) if i could, and if i can't... oh well. the thing is, no matter what way our children come into the world to us, we love them as much as we could-- no one way makes you a better mother, or a "failure" or anything like that. you need to figure out what's important to you, do some research, and find a doctor you trust, and then make your plan from there. good luck and keep us posted!
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B.P. answers from Charlotte on June 25, 2008
It's not that it's physically impossible or improbable, it has everything to do with whether you can find a doctor who is open to the idea. I'm not sure if by "natural" you mean drug-free natural or just a vaginal birth. If you mean drug-free, I would recommend you look into the Bradley method or Birthworks. If you take a class in either of those methods (whether you do drug-free or not) you'll have much more information and confidence to stand up to your doctor for what you want and to know when your doctor is telling you to do something just for the doctor's benefit.
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W.W. answers from Louisville on June 25, 2008
I've had 2 VBAC's after 1 c-section and I was amazed at the difference so I would highly recommend you pursue it if you can. Some great resources: www.ican-online.org (they have a local chapter that meets monthly), www.birthcarenetwork.com, and a book called "The THinking Woman's guide to a Better Birth".
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K.L. answers from Nashville on June 30, 2008
having a vbac is not safe you and your baby could die. However many women have tried this some succeed and some have to have c-section again. I myself would like to vbac knowing the risk, since you have had two sections its more dangerous than if you had had one. What was the reason for your sections? Faliure to progress, breach, or fetal destress, or shoulder width. I know how it feels when you want a vaginal delivery because I am in your shoes only I have had one c/s for fetal destress. I work in Labor and Del and have seen success and faliure. If you rupture there is not much time to save the baby and you could bleed to death.
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L.S. answers from Nashville on June 26, 2008
May I just say how delighted I am at the majority of these responses? How enlightened these mamas are! Go Mamasource!!
Just want to add/clarify/muddy-the-waters on a few things:
"Just ask your doctor." There is a very real chance that your doctor won't go for it. That doesn't mean it isn't possible. You may have to interview several care providers (ob's and midwives) to find one willing to work with you. Lots dismiss it out of hand for dogmatic reasons (aka 'it's just not done') or liability reasons (it's high-risk legally, but not medically). I've known women to interview as many as 6 before they found one.
"You need time to heal." Most OBs want 18-24 months between deliveries. You're well past that; it shouldn't be an issue.
"It's only possible with a bikini incision." Yes and no. Firstly, it's worth noting that the skin incision and the uterine incision aren't necessarily the same. You'll have to get a copy of your records from the hospital to check. Also check whether the incision was closed with a single suture or a double. Some providers are skittish with a single suture. (The studies go both ways on this issue. It's certainly been done with a single. But they're sure to ask, so find out.) Secondly, you can vbac with any kind of incision; bikini, classical, T-cut, J-cut... It's been done. But the other incisions raise the risks a little.
"It's too risky that your uterus will rupture after two." Whether it's TOO risky is up to the mother's judgement. How risky is it? Well, the studies vary, but overall (and compensating for study size and what factors they did and didn't control for, etc) it's probably 1-2%. Which is, yes, higher than after 1 section (~.4%) or no section (~.2%). But it's still about the same as the other things that could happen to any mother that would result in an emergency c-section (aka. cord prolapse 1%, fetal distress 3-5%, etc). AND when it's compared to the equally real risks of repeat abdominal surgery, plenty of women decide it's six of one and half-dozen of the other. For a comparison of vbac vs csection risks http://childbirthconnection.org/article.asp?ck=10210&...
I also heartily recommend an independent childbirth course, like Bradley, when the time comes. Even if you're more "I'll hold out as long as I can" instead of "absolutely no meds", they're invaluable at laying out the pros and cons of all the issues out there so that you can decide what's best for your family. And it'd give you a lot more confidence in the body God created for you (that He designed to birth babies). Not to mention the awesome coping techniques. (I myself am a "hold out as long as I can" mom who actually held out the entire labor and delivery. And now I wouldn't do it any other way.)
www.ican-online.org has a great email support list and book list, if you're a reader. www.plus-size-pregnancy.org has MUCHO info on pregancy and birth topics, very evidence based. Also try www.vbacfacts.com
Write me if you have any questions. And it's awesome that you're thinking about this in advance. Way to go, mom!
ETA: "If baby's not too big this time..." You'd be AMAZED how often women give birth to babies bigger than the one they were cut for. The doctor's term for it big-baby is macrosomia or cpd (cephalo-pelvic disporportion). Lots of times it's really less about how big the baby is and more about whether the baby is malpositioned or whether the mother's movement has been restricted. A great video montage about this very thing: http://youtube.com/watch?v=roFVkDV45MM
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N.A. answers from Greensboro on June 26, 2008
A natural vaginal delivery is possible after a c-section. It may not be the safest option. There is a good possibility that you could tear your uterus at the incision sight from the 2 prior c-sections. There is a lot of scar tissue on your uterus because you have already had 2 c-sections which adds an extra danger. It also depends on why you had to have both c-sections during your deliveries.
My son was born by c-section due to the fact that I remained at 7cm for more than 5 hours after 10 hours of labor. The physician informed me after he was born that I only had a 30% chance at a vaginal delivery next time. He said my son's head was engaged in my pelvis when he pulled him out during the c-section. My son was only 7lbs 1oz. Three years later when it was time to deliver my daughter, I requested another c-section. I did not want to go through labor again and still end up in the operating room. After my OB/GYN delivered my daughter, he said that I made the right decision to have another c-section. Her head was engaged as was her brother's. The docotor said I would have never been able to get her through my pelvis. He said my pelvic bone was to small.
I think that if you and your husband conceive a child in love and you carry the baby in your body nurishing it for 37-40 weeks, that is as NATURAL as it gets. It is more important for you and your entire family to experience a safe and healthy delivery rather than a vaginal one. You definitely would not want to end up in any kind of crash emergency situation. Your husband won't be cheated out of anything if he is blessed to be the biological father of a beautiful, happy & healthy baby boy or girl!
God bless your family as you continue to grow together!
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C.E. answers from Nashville on June 25, 2008
YES! Please look up Ina May Gaskin's excellent natural birth book: Ina May's Guide to Childbirth - it's the most recent of her two books and is an excellent resource and general source of inspiration for natural birth aspirants. She is a midwife. Alot of doctors might discourage you, or give lip service to the idea of VBAC, but not real support - it will be important to find the right provider.
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A.M. answers from Memphis on June 26, 2008
Yes it is possible! I would recommend joining ICAN to start:
I would go on but you should find everything you need through them. Have you read any books on cesareans or obtained your medical records? Anything by Nancy Wainer Cohen or recommended by her is good. I would also try to obtain midwifery care as VBAC success rates are much higher for those with a midwife vs. an OB.
This is a great FAQ on VBAC after 2 or more cesareans, followed the link from ICAN
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D.P. answers from Raleigh on June 26, 2008
Hello L., it definately "is" possible. There is support for you too. Look up VBAC on the internet ... you should find some good information. There are also local support groups that may be in your area. You definately also want to hire a Doula. A Doula would definately help, but of course not a guarantee. We hired a wonderful Doula and I can refer her to you if you like. I had a successful VBAC with my second child (thank you God!).
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S.W. answers from Knoxville on June 26, 2008
I know that it is possible. I had 2 successful V-BACs (Vaginal - Birth after C-section). Our oldest daughter (14) was an emergency C-section. When we became pg with our middle daughter (11) I was determined to experience natural birth (as in vaginal, no medications - period) due to the pain and healing time of the C-section. And I did successsfully - she was born in the birthing tub. When we became pg with our third daughter (10), I was determined again to do another V-BAC. Which I did; she was also born in the birthing tub. The water is body temp and helps relieve the intensity of the contractions, you are more relaxed and the plus side of it is that you're also weightless, so you don't have gravity to conquer while having contractions and pushing pains.
The major medical consideration first is to be sure to know what kind of incision was made with the C-sections. You can request those surgical reports from your previous attending OB-GYN. If you were given a "smiley face" incision directly above your pevlic bone on the pelvic surface and on the inside of your uterus, you have greater possibility of giving birth naturally - tho you will be considered high-risk. If the incisions inside your uterus have been an "up & down" incision, then, no you won't be able to have a vaginal birth because there is more risk that the old incision scars will rupture during actual birthing. God bless you and good luck with your choices and decisions.
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A.B. answers from Nashville on June 26, 2008
Two of my daughters had to have c sections. I asked my gynocologist's nurse about this same question. She said NO. to not let my daughters go into labor once they had a c section. Sometimes it turns out okay but there is always the possibility that it won't. She told me of a delivery she was nurse at with my gyno. Said when they cut into the woman, the uterine wall was so thin around the previous scar that she could see the baby thru it. Said the gyno told her this is why he never let a woman go into labor that had had a c-section. Until the gyno cuts into the abdomen, he doesn't know if the uterine wall is thinned out or not. Please forgo the pleasure of labor and have that third c section. Your husband can be in the delivery room with the c-section. It is not the same but it too is an awesome experience. I was in the delivery room with three of my grandchildren's births. One my gyno was in there with my daughter's gyno. My gyno danced around the delivery room with my granddaughter and pronounced her beautiful while my daughters gyno took care of her. I'll never forget that experience.
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K.D. answers from Atlanta on June 26, 2008
From what I understand, it is possible. However, your best bet is to find a VBAC friendly doctor and let him tell you if you individually are a good candidate, and what the risks are. Hope it goes well for you. I'm newly pregnant with #2, and the first was a section, so I'm in the process of finding the right doctor too. I'll let you know when I find one!
M.W. answers from Huntington on June 26, 2008
Yes, it is possible, but you have to make it so. Most dr.s will not do VBAC's anymore, and in many states the midwives are now allowed to help, but in other states they can. You may have to search far and wide for a supportive caregiver, or do it yourselves. My friend Theresa had a waterbirth, after 3 C/S, her story was on utube last yr, its probably still around cyberspace somewhere.It is very inspiring to watch! Look up "HVBA3C" or "home water birth after 3 C/S" I can't remember the exact title.
A good book to read to help you prepare for the birth is: "The Christian Childbirth Handbook" by Jennifer Vanderlaan. "Pushed" by Jennifer Block is another good new book out there. Sheial Kitzinger has a new book out too, but I forget the title.
I've seen a few people warn that a VBAC was "too dangerous" I'd lke to see stats on that before I would believe it. The info I have from WHO & NIH, say a C/S has 4-6 times the maternal mortality rate of a vaginal birth. Greater morbidity rates for mother & baby too. Yes, any birth from a scarred uterus is more dangerous that from an unscarred uterus, that's why it is important to keep the primmary C/S rate down in the first place, but lets not make it more dangerous than it has to be!
B.M. answers from Johnson City on June 26, 2008
It depends on the nature of your c-sections, and thats something you would have to speak with your doctor about. And, another thing is many hospitals now are refusing do vbacs because of "liability issues". So even if your doctor says its possible, the hospital still might not go for it. Before you get pregnant I would speak with your obgyn and ask them these questions and what the policy is at the hospital they are affiliated with.
J.S. answers from Charlotte on June 26, 2008
It is possible, but very few doctors recommend it because it's pretty dangerous to you. I've heard of doctors who allow a "v-back" after one c-section, but not 2. Talk to your doctor about it. Since your youngest is 6, it might be possible since you've had plenty of time to heal.
K.W. answers from Charlotte on June 26, 2008
Yes. I had an emergancy c-section with my daughter. That was a big question for me as well. My Dr. said that in the future I should be able to deliver "naturally" without any complications. Good Luck and Best Wishes!
A.H. answers from Chattanooga on June 25, 2008
I am the proud mother of three girls 17,14 and 12. The first and third were c sections and the middle one was not. I work in the medicla field pretty closely with the ob/gyn's in this community and all of them will do vbac after c sections. The only limitation they set is in the way your incision runs if you have a horizontal bikini cut no problem. My c sections all resulted in the size of my daughters and toxema with my first. My middle girl was less than 8 lbs where the others were not. I say go for it, talk to your doctor.
T.C. answers from Nashville on June 26, 2008
I don't think any doctor will let you have a Vaginal Birth after 2 C sections. Its too risky for you, the doctor and most of all the baby. Thats why its hard to find a doctor that will support a VBAC after 2 sections. After 1 c section they will let you attempt a VBAC (Vaginal birth after cesarean) Its too risky for your uterus to rupture with 2 c-sections. Your uterine wall weakens with every incision. But discusss your concerns with your doctor/midwife.
K.F. answers from Nashville on June 26, 2008
I have read and heard from other people that a vaginal birth is possible after a c-section. I suppose it would depend on your personal situation so I would consult your Dr but it may be just fine.
J.A. answers from Raleigh on June 26, 2008
I am pretty sure they wont let you because of scar tissue that has developed from your c-section. But I understand where you are coming from I had my first vaginal and body was back fast, with my son I am still fighting this annoying flap of belly hanging. so annoying and they say the only way to fix it is tummy tuck who has 8grand to spend on that. There may be a specialist that will allow you to have a vaginal chack around.
J.B. answers from Louisville on June 26, 2008
My first was a c-section (for some reason my 110lb body just couldn't get out a 10 lb baby....hmmm, wonder why?) and I was determined to have a natural childbirth the second time. (and just to clarify, by "natural", I actually do mean no drugs. Hehe!). The problem I ran into was finding a doctor that would deliver a VBAC. Some of them just won't pay the insurance premiums for the high risk birth from what I understand. I ended up going with a midwife in Indiana in a hospital setting. And after A LOT of labor I did successfully have the natural birth I wanted. Even with another almost 10 pounder! So, yes, it is possible. The trickiest part was finding a doctor that was willing. Good luck to you and I hope it works out for you!
E.W. answers from Chattanooga on June 25, 2008
I had a c section also with my daughter. The next time I was pregnant I asked the doctor about a vaginal birth. Every doctor is different. My doctor had no problem with it. I had no problems with healing and had the ultimate c section experience. The way he desribed it to me was if there were complications with prior c sections and the healing didn't go well or if the c section was an emergency and they had no time for delicacy then all doctors will have a problem with it. It also depends on how long it has been since your last c section. You need to discuss it with your doctor and see what he/she says. Also, look at WebMD.com or google the phrase and see what you can come up with. Investigate on line and you might have a better idea of what exactly this will entail before you go to your doctor. (I lost that child so I never did go through the experience.)
My step daughter had 3 c sections. Mainly because her first one turned into an emergency and the doctor butchered her abdomen and it took her 6 months to heal properly. The next docto refused to let her have natural childbirth because of all the damage.
R.N. answers from Jacksonville on June 26, 2008
Hi, L.. Yes, it is possible to have a vaginal delivery after c-section. There is even term for it. Physicians call it VBAC (Vaginal Birth After Cesarean). Now, I don't know your situation or history, so your dr will have to let you know what your options will be during your next pregnancy and delivery. Make sure that when you go for your initial OB appointment when you do have a bun in the oven that you make it known to your Dr that you wish to go the VBAC route. They will be able to guide you. Congrats on your happiness, and best wishes!
S.B. answers from Charlotte on June 26, 2008
Yes it is possible to have a natural birth after c-section.It used to be no..once a c-section..always a c-section.Talk to you doctor and go from there..good luck..
P.L. answers from Greensboro on June 26, 2008
Yes, L., it is possible. If your doctor says so. I had my son in 1989 via c-section, because he was too big(8 lbs,9.4oz) Then I gave birth naturally to my daughter in 1998. (6 lbs, 5oz) I had no complications. I had a wonderful doctor that took care of me. The second time giving birth, I really didnt want to go through the pain from healing from the c-section again. Everything was fine, and since my children were so far apart in age, it was more possible for me to give birth naturally the second time. As in your case, your children are old enough, you've probably healed enough to go through a natural child birth your third time now. Good Luck!
L.C. answers from Raleigh on June 25, 2008
I am a part of New York mamasourse(since we used to live there) and last week they had that discussion and there was 2 laddies that had VBAC after 2 c sections. However, you will have to look hard to find a doctor that would do it(they have to carry huge insurance for that) and the hospital would have to be level 3(that's what they were saying) I think it would also depend on how many years it has been since your last section and what kind it was.My 2 cents
J.D. answers from Raleigh on June 26, 2008
First of all let me say congratulations on your obvious happiness. My first child was a fully natural child birth. It took me about 5 full weeks to recover due to episiotomies and excess bleeding. My next child was breech and very large so I had a c-section. I was able to drive 12 hours by myself with a 4 year and a 3 week old with very little pain. I had an easy time recovering from the C-Section. Several other people have told me the same thing. As far as having a natural child birth after the c-sections it depends on several things. First, how the incisions were performed. If you have bikini line incisions you should be able to deliver vaginally. Second, the physician and hospital you plan on using. Some physicians and hospitals will not perform a VBAC. I work at one that is like that. I am currently pregnant and they did give me the option. They say there is a slightly increased risk of having an emergency C-section. The majority of the danger is to the baby. My physicians discussed all the options, the dangers, and the benefits. I was then able to have an informed decision as to how I wanted to have this child. I am having another C-Section because I enjoyed the relaxed nature of knowing what was going to happen and when. I was able to plan more with my other children and with work. I hope this helps. If you do want a vaginal delivery speak with your doctor right away to make sure that they and their hospital will perform the VBAC.
F.J. answers from Huntington on July 06, 2008
After reading some responses, I would agree about the danger of the uterus tearing with a vaginal delivery. What happens the uterus gets thinner each time. That is why a woman's first delivery usually last much longer than the rest. NOTE: I have had both vaginal and C-section. I would suggest the C-section because the experience was not much different. You still feel the same way the first time you hear that baby cry! Personally, the pain and risk of a vaginal are not worth it! You will still be so thankful and happy. The holding of the baby and all is the same!!!! GOOD LUCK
P.G. answers from Lexington on June 26, 2008
A vaginal birth is possible after 2 c-sections as long as your uterine incision is horizontal (down near the bikini line). If a previous c/s has been done using a vertical uterine incision then the risk for uterine rupture is usually considered too great to allow a woman to try a vaginal delivery. I was a labor and delivery nurse for 7 years. I have seen many women deliver vaginally after cesareans, including my own sister. The fact that your last c/s was 6 years ago is good too. That means the scar on your uterus has had a long time to heal. Some doctors are very supportive of VBAC (vaginal birth after cesarean), while others will not even consider it. So be sure to talk with your doctor early on about this. Hope this helps!
S.S. answers from Lexington on June 25, 2008
if that is your goal, the most important thing to do is find a doctor who will support you. many doctors refuse to let you vbac(vaginal birth after cesarean) your best bet may be to go with a midwife. they are almost always willing to do whatever is safe. in regards to your comment on natural meaning vaginal, not drug free, i had an epidural with my first and drug free for my second, and i would never never never use an epidural again. my drug free delivery was over in 2.5 hours, and was amazing. you may consider it.
C.C. answers from Knoxville on June 26, 2008
LOL!!! I can't answer your question about delivery after c-section (I think your doctor should be the one to answer that), but I just had to respond to your comment at the end -"by natural I mean vaginal not drug free". I laughed because during my first pregnancy I kept going on and on about having a "natural birth" and it was a HORRIBLE delivery. When it was over the nurse said "you did very well, you never even asked for drugs" and I said "YOU MEAN I COULD HAVE HAD DRUGS?!!!" But to be fair, I then went on to have my second child drug free also - and at home, no less! It was still bad but I survived. I just think it's good that you are more informed and know that you have a choice!
L.M. answers from Charlotte on June 26, 2008
VBAC is an acronym for vaginal birth after ceserean. It is definitely possible, hence, the need for the acronym. The best advice you could receive for your body and based on your past births is from your doctor. I'm sure that everyone is different. I have seen many women on this site that have done it and I doubt their doctors would put them at a known risk. Good luck!
M.D. answers from Louisville on June 30, 2008
Congratulations. I wanted to throw in my two cents, if you decide to do VBAC, I recomend taking the husband coached Bradley Method classes, they will help you prepare. The are great. Also if you have a C-section I hope you recover quickly and enjoy your baby just as much. I spent a lot of time preparing for the actual birth. I had a drug free vaginal birth, it was a great experience but later got postpartum depression and I didn't prepare for that possibility at all. I also didn't take any classes in parenting of teaching the baby to sleep and so the first year was pretty rought. Although I treasure my birth experience in the end it was only one day and parenting is forever and there is so much more. (I would take a c-section over postpartum depression anyday) Well Good Luck. Be happy. Wishing you a very healthy baby that sleeps through the night :)
D.F. answers from Jackson on June 28, 2008
Yes it is possible to have a vbac but make sure you discuss all your options with your physician. I am a neonatal icu nurse so ive seen the worst situations that you can imagine. I also had to have an emergency csection with my first child so when it came time to deliver my second, i decided that it wasnt worth the risk and opted for a repeat csection. The risks that accompany a vbac are mostly toward the baby and i decided that an abruption or any other complication was just not worth it.
S.L. answers from Louisville on June 30, 2008
L. B.,the inquiry you have is so important! Please listen to Ann B.,Julie H. and Kitha L.! Please don't gamble and perhaps put your life and/or your baby's life in jeopardy. God bless,S. L.
J.G. answers from Louisville on June 27, 2008
Yes you can VBAC (vaginal birth after cesarean) after multiple sections. It is better for you and your baby. You can contact groups such as ICAN (cesarean awareness network) for more information. You would probably want to wait for an epidural as long as possible if you want to increase your chances of a successful vbac. Any interventions can increase the chances of a section even in women that haven't had a section before. I vbac'd my twins. Happy birthing.