VBAC Or Repeat C-section?

Just recently had a VBAC in February. My first delivery was a c-section, and this was my second. I couldn't imagine volunteering for a c-section again now that I've been through a vaginal delivery. The recovery is like night and day, and I wouldn't have been able to care for my first at all with a c. Either way you decide... I wish you the best, and a healthy happy baby.

I was in the same situation as you are with my second child. My first was an unplanned c-section and I was told I could have a VBAC with my second and had decided to do so. Well, he was a week late and I was miserable so I planned a c-section about 4 days in advance (after his due date). He ended up being 9lbs., 7oz. The midwife I had been seeing said if I had had a VBAC, it would have been long and hard. I'm glad I had a c-section. I wish you well!

I strongly advise you to NOT schedule a c-section for convenience!!! You have to understand the affects on not only yourself, but your baby. Your baby (as you have previous experience with) needs all its time to grow in your belly and will (in almost all instances) allow you to begin labor when your body and your baby's body is ready.
One thing to consider is if you're doctor has experience with VBAC, and if he's actually going to let you, or just telling you that with no intentions of carrying it out (which many doctors do). With a low abdominal & horiz. incision, you're best bet would be at least try a VBAC (with NO induction). Induction after a c-section increases your risks of uterine rupture because pitocin makes the uterus contract abnormally - stronger, and longer. If you have the option of a natural birth after c-section, that is your best bet. Its not only the recovery time that affects your body, its the long-term affects c-section can have on your body, and the risks you are putting on your baby. C-section babies have higher risks of breathing problems due to possibility of coming to soon (if scheduled), and the fact that the birth canal is not "squeezing" the fluids from their lungs.
I would rather end up with a c-section beause it was needed than end up with all the possible after affects from the surgery just because it was convenient (for you or the dr.) when I knew I could have the option to avoid those.

I highly suggest researching the website www.ican-online.org - you'll more than likely find all the information you need there.

I would also highly suggest hiring a doula!!! They can be a tremendous help (on you and the father) during labor!!! Check out www.dona.org to find one in your area.

D. B.
Childbirth Education & Support
www.esalibirth.com

You've gotten a ton of responses already! I wanted to be a rebuttal to the ones who questioned, what difference does it make how the baby is born and I've had csections and they went fine, what's the big deal...

My csection was preplanned, scheduled in advance, no hurry, no bustle. I held the baby as soon as I was out of recovery and nursed within a reasonable amount of time. My recovery was picture perfect, no infection, no nicked bowel or bladder, walking (if slowly) the next day, no narcotics after I was released on the third day. As easy and good an experience as it could be.

My vbac was very different. It was a spontaneous labor, so every hustle and bustle you can imagine, this time with a toddler to get settled with grandparents, a mad dash to the vbac-friendly hospital some 45 minutes away. No pain meds (wouldn't have had time for them if I'd wanted any). It was crazy.

I'd do the normal, natural birth over the scheduled c in a heartbeat.

It was SPECTACULAR. It was EXCRUCIATING. and WONDERFUL. And excruciatingly wonderful. The time between his birth and my holding him is measured in seconds, not hours. I was completely lucid; no being doped-up, can't hold my eyes open, shaking from the anesthestic, puking if I try to sit up. You've heard of the "runner's high"? When you feel so good after you excerise? I was FLYING. For two or three hours afterward, I was so high off the endorphins and bonding hormones they were about scraping me off the ceiling; I couldn't wipe the smile off my face. Remember how you felt physically after the section? Now imagine being able to sit up, swing your legs off the table, and walk down the hall, babe in arms, talking and laughing. Remember how you were on a liquid diet after the surgery? I was inhaling a ham and pineapple pizza two hours after the birth. And the recovery was no comparison. You're not allowed to lift x number of pounds for x number of weeks after the surgery. Can you imagine not being able to pick up one of your babies when she's in front of you with her arms lifted up? No way.

So there is no way, NO WAY, short of a medical emergency that I would voluntarily sign up for major abdominal surgery for the birth of my baby. Imagine for a moment that this new baby was entering your life through adoption instead of birth. Would you voluntarily sign up for an elective surgery the day someone handed you a newborn? Heck no! So why would you choose that for this baby?

So that's my emotional pitch. If you're a stats/numbers person, how bout this? Studies have shown that a surgical birth has a rate of maternal mortality (that is to say, the mother dies) two to four times higher than in vaginal birth. That alone was the stat that made me go for it. I couldn't bear the thought that a cesarean made it more likely that I would widow my husband and leave my children motherless. And here's another stat: about 80% of women who attempt a vbac succeed.

ICAN (a cesarean awareness group) has four chapters in NC - in Raleigh, Nags Head, Charlotte, and Greenville. I don't know which of those you're closer to, but you ought to check it out! http://ican-online.org/chapter/search

Some of my favorite sites:
www.vbacfacts.com
http://plus-size-pregnancy.org/CSANDVBAC/csvbacindex.html

L., Mom of Two
Co-Leader ICAN of Nashville
Aspiring Childbirth Educator

Good Morning! I am having #4 and I delivered the first two and then had to have a c-section because of breech birth. I am going for the VBAC because of recovery time - expense - etc. My husband likes the idea of knowing when and where everything will take place just like yours, however, I have a two year old to keep up with and I don't want to take time from him and I remember trying to get up out of bed after my c-section -wow! Good luck with your decision, do what is best for you. God Bless, V.

HI M.. My 3yr old was a csection due to early induction at 37 weeks (baby was too big supposedly). and my almost 2 yr old was a VBAC because i was too stubborn to fall for the story again so I let myself go to 41 weeks before going back to a doctor. many said i was crazy but the thing is I moved from Florida to NC when I was 7months preggy and well doctors here were automatically jumping to schedule a csection which i did not want. well anyway i went into labor just fine and all went well. honestly if they're telling you you're a good candidate go for it.your husband is not the one going through major surgery if a csection is done. best of luck in w/e you choose.

M.,

You're an *excellent* candidate for a VBAC, and the evidence shows that vaginal birth is better for both mom and baby (unless a C-section is or becomes medically indicated, which it's not right now in your case). Check out ICAN-online.org for more information, because they have a ton of links to research and evidence comparing VBAC & C-section (esp. elective repeat C-section). The absolute risk of uterine rupture with a VBAC (esp. with just one prior C-section, and a horizontal incision, etc.) is very small -- and most of the uterine "ruptures" will be "dehisions" or "windows" in the uterus -- asymptomatic and not a problem for the baby. Complete or catastrophic uterine rupture is a tiny possibility, but having a natural labor (as opposed to being induced or augmented with drugs like Cervidil, Prepidil, Pitocin, miso/misoprostol/Cytotec) keeps the risk low -- when induction/augmentation agents are used, the risk of uterine rupture is much higher.

There are tremendous benefits to both labor and vaginal birth to a baby -- the medical literature is clear about this. Babies who get some labor and then are born by C-section fare better than those who got no labor at all. Complications to babies born by elective C-section at 37 weeks were twice the rate in babies born by elective C-section at 38 weeks; and the 38-week rate was twice the rate of complications of babies born by elective C-section at 39 weeks. So, by having an unnecessary C-section prior to 39 weeks, you double your baby's risk of things like breathing problems and other things that may land him/her in the NICU for several days or a few weeks.

Your chance of success with a VBAC is extraordinarily high, having had 3 prior vaginal births; and it sounds like your C-section was one of those that became necessary due to fetal distress after a possibly unnecessary induction (induction/augmentation is harder on a baby than natural labor). So, the reason for your C-section is unlikely to repeat itself, and if you don't take drugs to make your labor harder/faster/stronger, the risk of uterine rupture is minimal. Even with that, if they're monitoring you, the likelihood of your baby having any problems is low, because they will catch any problems and keep you safe.

I would try for the VBAC first. You never know whats going to happen during labor so you could end up with a c-section. But you have already delivered naturally before so you are a good candidate to deliver without c-section. My first was a c-section after 12hrs of labor. Second I got a Doula and she helped me through. I delivered a health baby girl the natural way. Recovery was faster from natural delivery than c-section. Go for the VBAC!

HI M.,

I had my first child by c-section due to the fact that she was a big baby and I could not deliver her naturally. My second child was born VBAC. I only have the two children and each are a true blessing from God. I Did not know when either of my children would arrive as I went two weeks over my due date with my first child and two weeks under with my second child. My labor was natural not induced.

I enjoyed having my son naturally, VBAC, after having had to have a c section with my daughter. There is also 8 years difference between my children. I was 28 when I had my daughter via c section and 36 when I had my son through VBAC. I recommend a VBAC if you can do so but it is a personal decision.

You sound uncertain as what to do. I suggest you talked it over with your obstetrician. Also if you attend a Church, talk it over with the Pastor, his wife, or someone you trust in the Church. Definitely ask prayer and seek God's guidance in your decision.

I will share part of my own experience with you.When my son was born VBAC it was time for me to push and I was doing so. Well the doctor said we either have to use the suction cup or do a c section as my sons shoulders were so large. My sister-in-law and husband were both in the delivery room with me. We had heard and read a lot about the suction cup harming a baby but we opted for the suction cup over a c section. My husband, sister-in-law and I started praying aloud right there in the delivery room as the doctor used the suction cup on my son. We prayed and you could feel the Lord's presence in that delivery room. My son was unharmed and the doctor was amazed at the peace and calmness in the room. He had never had the mother and others pray aloud like that and it sort of disturbed him to see such strong faith placed in God and not in him as a whole. I am a strong believer in the Lord and prayer. The Lord worked in the delivery room and I am ever so thankful to Him for this.

I am praying for you and your baby. I know you will come to the decision that is best for you and your soon to be new arrival.

Blessings,
N.

HI M.,

I agree that if your provider is willing to let you VBAC then choose natural. Natural labor and birth does prepare the baby for life earthside. The journey through the birth canal helps their lungs and exposes them to the healthy bacteria there.

Here is the link for the International Cesearan Awareness Network, ICAN, where you can find a wealth of information on VBAC and the safety of VBAC.
http://www.ican-online.org/

The risk of uterine rupture is low, I can't remember the percentage off hand. Also, induction and augmentation of labor are confirmed as risk factors for uterine rupture. If you do decide to birth naturallly, then I would let baby come on his/her time as any interventions could increase your risk for a repeat c-section or uterine rupture.

Best of luck on this journey.
J.

Don't let them cut you. Birth should not be convenient. A baby let's your body know when it is time to go into labor by releasing a protein that finalizes lung development. You should let yourself go into labor on your own. If during that process things go wrong and you do need a c-section at least you will know your baby was ready to be born. You should rent the video the business of being born to understand why it is important for your baby to be born vaginally. I understand that a healthy mom and baby are the most important outcome but major abdominal surgery is risky and a 2nd c-section is worse than the first due to scar tissue. Let your baby come when ready and let your body do what it was meant to birth a baby vaginally.

I would VBAC if it were me. Your risks are no where near as high as if you had had c-sections everytime. The recovery from a c-section is so much longer than natural child birth and I can tell you from experience the second c-section was harder on my body than the first one was. I was older - had more chidren to keep up with and the recooperation from it seemed to drag on. I'm sure others had more positive experiences. You know how to have babies naturally and if you have total confidence in your OB/GYN doc then I would do what they recommend. In my opinion the only positive to a c-section is that it's planned and you pretty much know what to expect. That's the only positive thing, in my opinion, about a c-section.

Hello M., I had a c-section with my first child ... I was in labor for 25 hours without progression. I had a VBAC with my second child and was so glad that I did! I wanted to for many reasons like you, the biggest being that I didn't want the longer recovery time and longer hospital stay when I had another one that needed me at home too. Also, I wanted to try it for the baby. I am so glad that it worked out. We also hired a doula to assist with the birth. She is in Raleigh and is wonderful.

I had an emergency C/S with my firstborn but after that I have had three VBAC's and would never want a c section again. Recovery time is so much faster and with 4 other kiddos around you need to be mom, face it you dont' have time to wait the 6 weeks to pick up anything over 10 pounds. I sure didn't.
I also had 3 high risk pregnancies due to Preeclampsia/toxemia issues. If your doctor is saying the VBAC is a good choice then I would go with that.
Good luck and congratulations!!!!

M., as you are probably aware, at one time, it was assumed that VBAC was simply not possible for women with previous C-section deliveries. Medical research has now shown that simply is not the case, especially if your OB is savvy enough to consider possible future pregnancies at the time of the C-section.
Since your doctor has already said you are a good candidate for Vaginal Birth, I would tend to lean in that direction. You have already delinieated all of the pros and cons of VBAC vs C-section. It sounds as though your doctor has covered all of the risks of both procedures.
On a totally uninvited note: the unknown is a stress for your husband? Sorry, but that's just plain crazy! If that's the biggest stress he has in his life, he's the luckiest person on the face of the Earth. I'm sure he can handle the stress of an unknown birth date. The birth of a baby is ALWAYS rife with unknowns, even with a C-section, where you schedule your delivery according the calendar convenience, there will be unknown factors (many far greater than "When will the baby arrive?") It's nice that you are concerned with his feelings but, right now, it's about what is best for you and for the new baby. And anytime you start cutting into the body, there is an increased chance of infection and other problems. And, as you know, there is the much longer recovery with C-section, as well.
Your doctor is aware of your past delivery history. He or she has discussed with you the plusses and minuses of both types of delivery. He feels you are a good candidate for VBAC. If you have confidence in your doctor, trust him.
Good luck and congratulations on the new addition!

All other factors being equal, you have a 4 times greater chance of dying after a C/S than a VBAC. Morbidity (injury) rates are also higher for both baby and mom with a C/S.
Without induction, risk of uterine rupture is 0.5% assuming you had a low transverse incision. Induction or augmentation however,can increase rupture rate to 10%.
Therefore, it would make sense to plan a natural VBAC, not letting them use any drugs to induce or augment labor. (Remember too, that women with epidurals are more likely to "need" augmentation.) If it does not happen naturally by 42 weeks, then I would just schedule the surgery.
M., CPM

I had a VBAC 12 years after my first child by c-section(I only have two), but if I were to have another, I would never have another C-section, unless necessary. The c-section was an emergency after 10 hours of labor. I never got to "plan" when I was going to deliver. But I didn't care for the recovery period afterwards.

HI M.,

this is a really tough decision and definitely requires a lot of thought. I delivered VBAC, but I only have 2 children. I think the number of pregnancies plays a factor. How long ago was your C-section? This makes a difference. How much do you trust the fact that the DR. who did your C-section did so in a way that enables a VBAC? Recovery is definitely an issue, also. Are any of your other children old enough to help out? More than anything, I think this is a medical decision first and foremost. Everything else is secondary and a matter of convenience. A ruptured uterus is a very serious thing. I would have a frank discussion with my doctor. Expenses aside (C-sections are more expensive), what is the best medical decision for you? What would he recommend to his own wife? This is a good indicator or what you should do. I wish you the best! L.

alright M., i'll put my two cents in. let me start by saying i'm currently pregnant with my 2nd and had a c/s the first time around with a failed induction for post-dates... and my ob and i have worked out that if i start laboring on my own this time then i will do a trial of labor, but if not then repeat c/s it is! also, i'm a labor and delivery nurse. if i were in your shoes, i would definitely try for a natural delivery if i could. especially if you are in a hospital where they can perform a c/s immediately if needed (and it sounds like that happened last time). you are definitely an ideal candidate for a vbac. if the planned aspect is really the biggest reason for the c/s then you have to look at a major abdominal surgery for what comes down to planning. if you're comfortable with that, then i say go for it! but you know the recovery should be much easier with a vaginal delivery. as far as the risk of uterine rupture, it's a very small risk, and is pretty unlikely. you're right that there is always the risk of having a c/s anyway, but that's true of anyone who walks in to have a baby. in the end, you have to do what feels right to you, and not what your husband wants, your ob wants, or even what people on here tell you. you're obviously well-versed on all the pros and cons of each option, so you're going to make a well-informed decision either way you go. good luck and let us know what you do in the end! also, let me know if you have any further questions!
J.

I have had this happen before. I started out with a VBAC but I ended up having a C-section with my second child. I can say my recovery was a lot fast with the second C-section. It was nothing like the first. The best part was knowing that I was going to have her and that it would be easier on her and my husband. It went surprisingly well. I had labored for 24 hours prior and not only was it straining on me it was straining on my husband and the baby. I completely know were you are coming from.
It is a hard decision however I think you should maybe write out the pros and cons of what you would think would be best for you and your baby and don't worry about anything else. Whichever has the most pros would be the decision I would go with.

I had 4 natural births and our daughter has had 3 (and one induced at 5 mo because of a severe chromosomal problem and her water had broken). However, I just remember a surgeon telling me (when one of my parents was having major surgery) that the body doesn't know the difference between 'surgery' (planned intrusion into the body) and an accidental trauma (such as being the victim of a car wreck or a gun-shot or stab wound). Whenever the body is traumatized, it kind of shuts everything down to slow speed so as to let all the body's energy go toward the healing process. Also, pain takes a lot of energy, so you're pretty much 'zapped' of energy just because of the trauma.

For this reason (plus all the others you got) I'd recommend having a 'natural' vaginal birth if possible. It's nice to know they can still usually do a C-section if it's indicated/necessary.

You know your own body better than your husband does (simply because you're INSIDE it! LOL), and most of your 'concerns' seem to actually be HIS concerns. Go with your 'gut' feeling -- even though your guts are squished!

I always wanted to have a natural childbirth experience, but it simply was not to be. In the end it was best to have both of my children by ceserean. There is a book that is very encouraging about VBAC. I can't think of the actual title. I think that some things you might want to take into consideration - how close are you to a hospital - if you are close to the hospital then I would be more inclined to let nature take its' course. How long has it been since your ceserean I'd think that if it has been at least 24 months between pregnancies then your body is probably had enough healing time and could handle a VBAC. I'm not sure that I would let them induce you if you decide to do a VBAC. I would think that natural contractions would be easier on the scar tissue. I'm not a doctor, and I have only read a few of the other responses. You have experienced both forms of birth. If it were me I would probably talk to the doctor about a VBAC unless he had reason to believe that a VBAC would be to dangerous for you or the baby or both of you. I know a VBAC might not be as convenient for your husband in the short term - but in the long term you might be back to doing more sooner and that might be a huge convenience for him. Good luck

Dear M.,

Congratulations on your 5 little miracles! I have 5 children too. My first I had trouble delivering as his shoulders were huge (he's now nearly 13 and 2 inches taller than me!) so my OB had me schedule a C-section for #2. She too was petite - maybe 6.5 pounds and yes, it is major surgery. My son was 2 3/4 and not entirely potty trained so the month it took me to recover fully was challenging. If you have an older child, maybe 10 or 12, hopefully they will be able to help you when you husband isn't there. Now with baby #3, I was supposed to have a scheduled c-section, but when I made it to the hospital (an hour away for insurance purposes) I was already 9 cm or so along so the doctor on call (it was a Saturday and mine was out golfing!) asked us if we wanted to do a VBAC and we said we'd try. I remember the worst part of it being the IV they gave me of maybe penicillian since I had missed something I needed to have in order to have a VBAC (I can't remember now what it was, but it was something important.) Anyway, that birth went fast and fine. That son is now 6 and is always on the move! With baby 4, I had a different doctor as my dear doctor had suddenly passed away from pancreatic cancer. This doctor said he would do a VBAC, but only if I was induced as he wanted to be there in case of complications. So I was induced and it wasn't too bad. In fact, I was reading a super good book and we have photos of me reading while in quiet labor. I did put the book down later on, but I really didn't want to! That daughter was fine. Number 5 (born just 14 months later - usually mine are 2.5 years apart) was a different story - but still good. I was in labor for a few hours at home and dropped and picked kids up at school, dropped off supper for a friend of mine who had had a baby a few weeks earlier, I figured I still had a few hours until the contractions were 3-5 minutes apart. A friend of mine rushed me to the hospital - same one, but she was flying so we made it there in 35 minutes - the ride was terrifying! In any case, the scheduled induced VBAC was out the window and I thought this son would be born in an hour or two - he took 8 hours! Luckily, there were no complications and the doctor on call never said we needed to do a c-section - Matthew just decided he didn't want to leave when I was 9 cm dilated!

Whatever you decide to do, please listen to your doctor and then when in the hospital, listen especially to the nurses. Not to knock the doctors, but those nurses are incredible! I think if you schedule an induced VBAC knowing full well that a c-section might occur, go for it. However, if there are any complications at all, go for the c-section. That baby is precious and so are you.

Good luck, I'll be praying for you. Let us know what happens!

I had to have a c-section with my first and recovered pretty quickly. I chose to have another c-section with my 2nd and was happy I did. I feel like it was less painful the 2nd time and I recovered quickly again. It was nice to be able to plan everything, especially since we have no family here. My mother-in-law flew out to watch my 2 yesr old while my husband & I were in the hospital. Plus you go in at a set time and a half an hour later you have your baby. I loved it and will do it again if I have a 3rd.

My 2nd child was vbac.
Natural labor prepares the baby for coming into the world. It stimulates it's little body to prepare for breathing and and functioning on his or her own.

If your Doctors support you in your decision for VBAC, then my opinion is go for it!

Either way, have a great, healthy delivery!!

P : )

I have heard vbac's are riskier than another c section. My doc and another doc told me that c section was safer. I would not want to chance the uterus bursting, etc I had two c sections and the second was SO much easier! The recovery time was amazing compared to my first. I thought I was going to freak out with my first and the second was a breeze. I like that the c section does not stretch anything, tear anything, and there is nothing traveling through my opening. :o) No hemrroids, etc You are right to do your research. Good luck.

I completely understand where you are coming from. I found myself in the same situation just a few months ago. I was expecting my second child in early March. For my first child, I went into labor a week after my due date but after being in labor for 12 hours, with the last 3 hours pushing and no progress, my doctor gave me a choice of either continuing to push or go in for a c-section. I didn't want to cause my baby any undue stress or hurt her pushing her through a pelvis that was too small for her so I opted for a c-section.

This time around, I was determined that I was going to go VBAC but then my in-laws decided that they were going to come in to help me out with my 19 month old when the baby came. They wanted to come in a week early so they could spend time letting my daughter get used to having them around; she doesn't see them very often as they live in WI and we live in NC. We knew when we were due but my first baby was a week late so what was I to do. The doctors wanted to schedule a c-section a week before he was due but I worried that it would be too early and he would end up with "complications". On the other hand, if I waited to go into labor, my doctors warned me that he would probably be bigger than my first and the chances of him fitting through were just as slim as my first baby.

In the end, I opted for a c-section but only since they agreed to do it on my due date when I wanted it done. As it turned out, number 2 was nearly 2 lbs smaller than number 1. He has a little trouble with reflux so I wonder whether he came too soon. Should I have just let him come when he was ready and then let them do a c-section if I needed it? Who's to know? I recovered fairly quickly from my c-section but I only had two children to look after whereas you have a few more. I don't know if this helped you any at all but hopefully it is something to think about. I'm sure whatever you decide to do will work out just fine. Just make sure you have someone around to help you out if it's possible. Good luck and best wishes!

I just hopped online for a minute and didn't have a chance to read all the responses to your question. Here's my suggestion. I have 4 children myself. With the last two, the doctor has been more than happy to induce me at 39 weeks. (In my case, he does this because I live an hour from the hospital and I go from being dilated 4 to 10 in less than two minutes.) If you ask your doctor to induce you, it'll be scheduled, you'll be right there at the hospital if anything goes wrong with the vaginal delivery, and you won't put your uterus at further risk should you get pregnant again. While today's c-sections are safer and do allow mothers to have vaginal births afterward, the more of them you have, the higher your risk of uterine perforation later on...from what I understand. Also, you're right that a c-section IS major surgery and should be avoided unless necessary. You'll be in my prayers. Let us know how it goes. Congrats on baby #5! Yea!

I am a mother of two. My son is now 7 and I had to have a c-section with him as he was breech and I had lost all amniotic fluid and the doctor felt it was risky trying to tutn him. I recovered well. My second child is a little girl who will be 2 in Aug. My doctor gave me the option of c-section of VBAC. I chose VBAC as I wanted to experience both ways of child birth. My doctor told me the risk of rupture was low. I was induced at 38 weeks and in labor for 36 hours. I did ok, but my tubes were tied the next day and I tore so I was sore in two areas. The healing process was harder on me with the VBAC than it was with the c-section.

I had all 3 of mine naturally. Much better for mom and for baby. With a C-section they have to give you anesthesia and depending on how long it takes to get the baby out, the baby can get a lot of those drugs which also can be fatal. I would go for a VBAC and if it turns out you have to have a c-section you will at least know you tried. I also read something the other day about how women actually start the bonding process with their baby when they are pushing them out in the contractions. While it is up to you to listen to your heart just remember there are many more complications with a c-section. I'll be praying for you M..