C-section or VBAC. Oh Wait, I'm Screwed Either Way. ;)

I have delivered 4 kids: #1 natural, #2 emergency c-section, #3 VBAC, #4, scheduled c-section. I argued with a couple of OBs over my delivery plans, and was adamant about #3 being as close to natural as possible after the horrifying recovery I suffered with #2. I feel that ultimately, it should the mother's decision as to how to proceed until emergency intervention is absolutely necessary. Good luck.

Well, I think it's a bit sad that you're not comfortable with having a midwife, but that's certainly a personal decision. Sorry you were made to feel bad about what happened.
One thing though is true, if your doctor isn't supportive of you having a VBAC you will likely end up with another section. Sad, I know, but that's the way it is.

There are midwifes who deliver in hospitals. I had my baby with a CNM in a hospital. Maybe that way you could find a supportive caregiver AND have the security of the hospital environment that you are looking for. They will have an OB on call in case of complications, but you will not see the doctor, unless your midwife calls for them.

I had a wonderful birth experience and always tell women to at least give it a try (to go without drugs or intervention). It was incredibly empowering.
Good luck.

A VBAC was not an option for me due to the way my first c-section had to be performed-my son was 32 weeks, breech, facing my back and way up high so my uterine incision had to be vertical. Did it get my son here and safe? Yep. And ultimately that was what became most important to me.

What I'm really trying to say is as long as baby gets here and you are both healthy that is ultimately *the* most important thing. I never let the fact that I didn't push my son or daughter out of my body make me feel like I was less of a woman or missed out on some magical birth experience. I guess I'm a little too matter of fact sometimes. But I have anatomical differences(a uterine & vaginal septum) that probably would have made a vaginal delivery impossible anyway. So I made my peace early in my pregnancy that I would probably be a section and my son and the cord around his next *twice* made that decision earlier than I expected.

A repeat section doesn't make you less of a woman, doesn't make you less of a mom-bottom line. And the repeat section was a snap. Way better/easier recovery than my first.

Please don't feel screwed by this decision. What will get baby here safe and sound? What will get baby here in the way that you feel comfortable-with a doctor in a hospital? Look at the answers to those questions to find an answer that you can make peace with and look forward to meeting your new baby.

I'd talk to the doctors not the people in the group. What do they know? I had a VBAC last December - 20 months after my c-section. Everything went perfectly. Find a doctor who supports it and go with it. If it turns into an emergency situation then have a c-section but at least give the VBAC a chance.

See if you can find an OB who specializes in high-risk pregnancies. Not that yours is, but I was lucky enough to have stumbled across an OB who is- and she found my desire to have a VBAC a rather simple proposition. Not that VBACs are to be taken lightly, but compared to what she usually worked with, I was easy! Also, my understanding is that there is recent research supporting VBACs; our local dr's offices let you look up info about the doctors online - maybe try finding a younger doctor?

If you have hospital options, call around. Some hospitals are more receptive to VBACs than others, and if you find one, they should be able to give you a list of OBs who have priviledges there. Then at least you know the doctor's hesitance won't be due to the hospital's rules. Also, a VBAC-friendly hospital will be more likely to have nurses who know the drill for a VBAC, since more monitoring is required. (The risk for a uterine rupture is very SLIGHTLY higher in a VBAC. Though the risk is slight, it still makes some docs and hospitals nervous.)

If you have to stick with the "lukewarm" doctor, you might want to see about having a doula who is enthusiastic about VBACs. She might be able to help.

I was going to refer you to the ICAN website, too. Maybe it'll be more helpful than the "support" group.

Good luck! You can do this!

Ok a midwife at least where i live always labors with a v-bac in a hospital under the supervision of a doc. Check with a midwife group and see how they work near you.
Maybe that will give you the comfort you need. I wanted to vbac so bad. Placenta previa screwed me out of that. I am hoping to find someone to give me a shot as a 2 time looser.

You don't say why you are not comfortable having a midwife. Most midwives have supportive back-up docs that they work with, as needed. The last two births I attended were successful VBAC's. I have a 90% successful VBAC rate. While VBAC's are a higher risk than someone who has never had uterine surgery, it is still usually less dangerous than a repeat C/S, individual circumstances do vary however.
While even the ACOG has admitted this, many smaller rural hospitals won't do VBAC's because they are not set up for 24/7 emergency surgery. Just this spring there was a big national AMA/ACOG/ACNM meeting in Bethesda, MD, to discuss the rising C/S and the parallel rise in maternal death rates. The recommendation was to encourage more docs to do more VBAC's, although we are not seeing many changes yet.
The best way to avoid an emergency is to use a midwife, and not let them induce. According to the latest studies, most uterine ruptures (the main concern for VBAC's) happen:
1) when labor is induced or augmented
2) only a single layer of sutures were used on the uterus
3) "running" or "continuous" sutures were used instead of "interrupted" where each stitch is knotted off individually.
4) chromic suture is used instead of vicryl
So it is important to review your past surgery report w your HCP before deciding which route is best for you.
Also, to be taken into account, but oft overlooked, is the fact that sometimes EDD's are off, so to avoid accidental prematurity, it is best to wait until the natural start of labor to do the surgery. Although docs hate the inconvenience of planning a surgery this way, the baby's lungs are more likely to be ready when this approach is taken, therefore less chance of NICU time for respiratory problems! The best outcomes happen when baby is born between 39 & 42 weeks, so don't let them schedule surgery before 39 wks, if you happen to go into labor before that, it's okay, you still vcan get to the hospital in plenty of time to get a C/S if you want one, instead of a VBAC.
If you don't want to hire a midwife, another thing you can do, is hire a monitrice (like a private duty L&D nurse) to come to your house & safely monitor the baby's heart & your progress, so that you show up at the hospital, just in time to birth, but not in time for them to set up the surgical suite or call in the surgical crew. :)

i am so sorry you had such a rotten experience. it makes me nuts that VBACs are so demonized in the medical community, but i suppose it's a dreary effect of our society's litigiousness.
you need to sit down and figure out what your biggest priority is. if it's to have your baby in a hospital, prepare yourself for a c-section. there's no way the lukewarm docs are going to go along with VBAC even if they indicate they might.
if it's to have a natural birth, you'll need to figure out how to be okay with a midwife.
it's true there will be regrets either way BUT there are also advantages to each. it's this way with all big important decisions in life. you can only make the best decision based on the information you've gathered and your gut instincts NOW. if your future self starts beating you up for it, remind yourself that your future self wasn't sitting where your present self is. and then kick your future self right in the nuts.
i'm sorry there's not one clear and obvious path.
whatever happens, congrats on your pregnancy and i look forward to reading about a smooth birth and healthy happy baby!
khairete
S.

Honestly the ICAN chapter was telling you that to help you protect yourself from DRs who tell you what you want to hear to get your business. Here in VA it is endemic to have a DR who says sure you can have a VBAC, but then 3-4 weeks before the day they back out because they do not want the liablility. In almost every case is your DR is lukewarm you can bet that they are going to back out. The college of OBGYNs says that VBACs are safe, and that more DRs should be doing them and that they are often a better option for the patient. However because they are a "decision" that the DR makes whether to offer or not they can be sued and also scheduled c-sections fit into their schedule much better. I will tell you the I have never had a normal pregnancy, I am on the slightly high risk side, and I AM seeing a midwife because I want a VBAC and I want someone who really believes in them. It was refreshing to go into her office and have her assume that I wanted one instead of the other way around. My middle ground was to find a Midwife who practices with a DR and delivers in a hospital. Frankly it really doesn't matter who does your csection - the hospital will always have someone available to do one. When choosing a birth professional it really matters MUCH more whether they provide good prenatal care and good labor support. I think you have some missconceptions about Midwifes and how capable they are. I was in a large practice recently where you saw a number of Doctors and not a one of them was able to answer my questions as well as the midwife I left that practice for. She has tons more experience and is much more concerned about my concerns about previous preterm labor, pregnancy complications etc where as the DRs tended to brush off my concerns.

I am not involved with ICAN, but I have done tons of research before I made my decision (I do have a doula only because my husband is deployed and my family will need to be with my other children). I had a much better recovery with my Vaginal birth than with my C-section and my husband will be deployed so I just don't have time to feel bad for 6 weeks. My last child also was in the NICU for 5 days due to respiratory distress because I had to have a C-section without labor. For me, I can accept not having a VBAC, but I WILL NOT give birth without going into labor unless like last time there is no choice due to medical issues. Going into labor is very important for both you and your baby. You may also be able to find a DR who would agree to let you go into labor naturally before giving you a planned c-section (instead of having a scheduled one).

I ran into the same problem. I found that many doctor's don't even want to entertain the idea of a VBAC! Some say they support it, but you hear from their patients that a c-section was ordered anyway. I think the doctors just can't stand NOT to be in complete control. I'd love to share my experience.

My first delivery was normal. I was induced and gave birth to a beautiful girl that was 8lbs 5oz. I expected my second delivery to go by without a hitch. Silly me! Goes to show that ALL pregnancies and deliveries really CAN all be different. Right around my due date, my baby girl moved into a transverse position. VERY uncomfortable and, according to my doctor, should have been impossible. I consulted with my OB who said a C-section would be necessary. I asked if they could rotate the baby, and was told they couldn't. I must say that I still believe she could have and just didn't want to. She mumbled something about the placenta being in a bad place. I don't know how she knew this, since the only ultrasound she did was done by herself and only verified that the baby's head was in the wrong place. She even admitted she wasn't very good at reading the ultrasound. Anyway, I had a planned C-section. The night before my surgery, my baby turned to complete breech. My daughter was born at 8lbs 14ozs!

When I got pregnant the third time, I decided I would do all I could to avoid another C-section. Recovery had been longer than, I'd had problems with postpartum depression and had numb spots in my lower back for months afterward. All things I hoped to avoid. The OB that did my C-section wouldn't do a VBAC. I decided to look in the area for a doctor that would. I came on here and got wonderful advice from many mothers. One mother, Gail (who is a doula), advised I see Dr. Stephen Guy.

Dr. Guy also has midwives. I'm a bit particular about having women take care of me while pregnant, so this was ideal for me. They were very encouraging! I didn't have a doula, but had major support in my husband and mother. I went into labor about a week after my due date. I did have an epidural - had hoped to go natural. My son wouldn't descend properly, possibly because of his cord. Talk of another possible C-section (not by MY doctor but by the one on duty at the hospital at the time.The midwife was there but had to consult with him since the baby wasn't descending.) and a vacuum was made. I asked to try another position. Five minutes later, my son had descended and shortly thereafter was born! 9lbs 10ozs!!! Amazing! I was absolutely thrilled with his birth!

One thing I have learned is this: Fight for what you want. Unless your doctor can give you a legitimate reason why it's unsafe, don't let ANYONE discourage you. Get a second, or even a third opinion. Many friends expressed concerns that there would be complications. It was disheartening. There were a few times where I just wanted to give in, have a c-section. I'm SO glad I didn't!

Another thing to keep in mind: Ask questions. No one gave me any suggestions on what I could do to help my son descend. They were willing to try the vacuum, and if that didn't work, to go with a C-section. I was the one that had to suggest trying a different position to get my son to descend. Be as proactive and aggressive as you need to be.

If you choose not to have a VBAC, don't beat yourself up.You haven't failed! Regardless on how you child enters this world, you are the best Mom they will EVER have, and you are SuperWoman!

I had to have an emergency c-section with my first- my doc was very supportive of me doing a VBAC with my second- even after 2 days of labor in the hospital! I am glad I was able to experience that. But by the time my third was due- we had moved and I had another doc at a different hospital. The policies were different and although I had a successful VBAC, my doc was very hesitant to let me try again. Well, my due date came and went and there was nothing- so I told them to go ahead and schedule me. As soon as they hooked me up to the monitors- I went into labor. But it was a long labor and after about 4 hours of not progressing past a 4 the doc came in and told me that he would let me labor a couple more hours and then do the c-section or we could do it right away- I chose right away!
I am glad I did because my little boy was 9.8 lbs and 23" long! He was huge!
I suggest you try for the VBAC- let your doc know how important it is for you to try, but be aware that since you have had a previous c-section- you are considered a high risk pregnancy and any sign of trouble will cause them to do an emergency c-section- which could save you and the baby. I am not saying this to scare you- but to make you aware that your risks are increased. That being said- having a VBAC is still relativity successful and usually there are no complications.
I am really glad that I was able to experience both. I did prefer the VBAC- mainly because the recovery time for me was so much easier and I was able to hold my other baby(my first) right away instead of having to wait for a month to be able to pick up more then the weight of the new baby. I have since had 3 c-sections- and even though I don't really like being cut open- the experience was great with all of them- having a baby- no matter how they come into the world- is amazing!
Good luck!
~C.

Your doctor will usually be honest about whether you are a good candidate. What necessitated your c-section the first time around? Stalled labor, hips not wide enough, cord wrapped around baby, baby have a short cord, breech? If it was because of cord wrapped around baby, breech, HR of baby dropping, baby had a short cord, etc. you MAY be a decent candidate for a VBAC...but if your labor was stalled (even with supplementation like Pitocin) or it is believed that your hips are not wide enough to accomodate a vaginal birth-- then probably not. You should know that if you do a VBAC, you cannot be induced and generally they do not like to supplement the labor (Pitocin) because of the risk of uterine rupture. Also, it depends on how far apart your babies were (my docs like a full 18 months+ between childbirth and pregnancy to consider a VBAC).

I would NEVER do a VBAC that was not in a hospital and supported by my doctor. Too bad you don't live in this area -- Chicago has a ton of hospitals and OB groups that are supportive! Oh and just as FYI- my doc said they are now calling them TLACs- trial labor after c-section....just to keep people's expectations realistic. VBAC kind of implies success and some are honestly not successful.

I am planning a VBAC with my 3rd in May. 1st was vaginal, 2nd c-section due to short cord (failed induction after 20 hours because his poor cord was 6" -- he COULDN't COME OUT!).

Best of luck!

Hi-so sorry you had negative ICAN meeting experience. And remember-once a cesarean is not always a cesarean!! You need to find supportive folks who can be positive around you. Make sure you have a birth plan that spells out what you want to have happen during your labor and delivery. Good luck to you!!

I don't have any advice, but I just wanted to give you a hug. People can be so annoying when they get on their soapboxes (I try not to climb on mine too much LOL :)

Take care and good luck. I hope you find the right doctor for your needs!

I am stunned by your comments. Since when is surgery a better option than VBAC? Every pregnancy is different. I have 4 kids. Three I had to be induced and one came on her own. My children were between 8 pounds and 12 pounds and no one ever suggested c-sections. I think you plan for both up until the end. C-sections are supposed to necessary in certain situations not all. If it is a safer route for you then you should look at it that way. You want a healthy baby and mom. I know there is faster recovery for VBAC's. ANd there are people out there who have done both. With two big hospital systems in Cleveland I am surprised there isn't someone who can accommodate your wishes but also let you know when and if a c-section would have to be done. My mother had 5 c-sections and she was a great mother. DO what is right for your body.

yes, you can have a vaginal birth after c-section! My 1st & 3rd pregnancies were vaginal. BUT it will depend on your body & the health of the baby. All three of my babies were in distress during birth, with the 2nd in critical condition. All three were wrapped in the cord. My labor was non-productive, & I ended up with a Pit Drip with all three.....which did not help with the 2nd- at all!

I understand your concerns & fears. But if there is something medically at issue here, then you have to be prepared for the worst.....in a hospital, with competent doctors. You cannot allow your fears to put your child at risk. & honestly, you cannot control everything....sometimes you just have to fly with faith!

Soooo that takes us back to the beginning: what was the cause & reason for your c-section & can it happen again? Did your baby's #s drop, was the child in stress.....what factors were present which resulted in the drs judgement call to proceed with a C? That's where your focus needs to be! Not on the fear of another C.....what will happen, will happen. Wouldn't you rather have a C & a healthy baby to hold in your arms.....should the events occur again? Be prepared & forewarned & place yourself in a position of trust! Peace....I wish you a safe & healthy delivery, regardless of the method!

I don't have advice from experience, but I know of an OB who is very supportive of natural birth. Dr. Stephen Guy, who practices at Miami Valley Hospital, is worth contacting. My baby was breech, and it was my first, and as a 41 year old mother, he supported us having a natural birth. Maybe worth a check. Good luck!

Ugh. That sucks. I had a doctor that was completely supportive of doing a VBAC and I bet if you keep looking you can find a doctor like this. the other option is hire a midwife or doula to be with you as you attempt the VBAC. They can speak up for you if the doctor is pressuring you. I have known so many women who have had successful VBACs and it is worth a try! Don't let those pessimistic doctors persuade you to at least try!! Good luck with whatever you decide.

First of all, a support group should be just that- supportive. The group should be ashamed of themselves for making you feel bad. My husband has a friend that said I had a c-sec because "i obviously didn't push hard enough". His friend is not a bad guy- but i will never forget him saying that.
Your labor sounds similar to mine. I wanted a vaginal, but I didnt want to get upset if things went awry. Well, I keep progressing (very slowly) but my doc said since I wasnt in any danger and that baby was okay that we could keep on going. Well after 30 hrs I started pushing. Finn just did not want to come out. He never dropped. After pushing for a long time and trying the vaccum, still no progress- so on to the OR. Now for my next one my doc said we could try vbac, but she didnt think it would be super successful. She is not saying that because she doesnt want me to do a vbac get upset that it doesnt work and go through the same thing. and my husband (a surgeon) says that people tend to recover from a scheduled csection better then a emergency one. So that is another thing to take into consideration.
I personally havent decided yet (i have another 4mnth) and I think I am going to wait a bit to see how the end of the preg. goes (if the baby drops, etc)
good luck! and dont let anyone make you feel like you are not doing everything in your power to make sure that your babies are as healthy as possible- which in the end is the most important.

I too had an unplanned c-section with #1. My water broke and I was having no contractions at all. The hospital put me on a pitocin drip and had me walking the halls for hours. I wouldn't progress past 5 centimeters and the baby's head was tilted. The OB tried to straighten his head so he could move down the birth canal and help me dilate but it didn't work. The baby's heart rate started to be all over the chart so they took me in for a c-section. I was so upset but more worried about delivering a healthy baby at that point. I would like to try for a VBAC but I am scared so I will see what I decide when that time comes.

This all being said my sister-in-law had a VBAC. Her OB was actually the one who suggested it. She delivered successfully in a hospital with an OB so it is possible. Good luck with your decision but the most important thing is a healthy baby and mama in the end.

I know how you feel with the idea of a possible second C-section looming over your head, but being worried about trying for a VBAC, especially if you feel as though you're not being supported either way. My husband is an OB/Gyn, and he was actually the one who suggested I try for a VBAC with my second son. Our first son just happened to be breech around the time when he should have turned, and he stayed that way. We went ahead and scheduled a C-section at 39 weeks, but my OB at the time tried an external version to try to turn the baby the day of the C-section. If that had been successful, he would have induced me, and we would have gone from there. However, when he tried to turn the baby, the baby's heart dropped, an he his little behind just wouldn't move out of my pelvis. So, back to the OR I went. I never labored, never dilated, nothing. It had been my first major surgery at the time, and although I healed rather quickly, it was still very h*** o* me physically, emotionally, and psychologically. My son is four years old, and even during my recent second pregnancy, I felt less than a "mom" because I never experienced a "normal" birth. I was a little scared when my husband suggested the VBAC, but he's in a practice (where I go) that has many supportive OBs. Even the OBs who were less supportive still respected my decision to try. They rotate patients, so it was really a guessing game of who would actually deliver me (except for my husband, who made sure to have time off around my due date). The doctors allowed me to go over my due date, and I started laboring three days later. I labored from 4:30 am until 10:00 pm, when after I had my epidural and my OB broke my water, the baby's cord prolapsed. So, despite the fact that I tried, I still had to go back for an emergency C-section. It was one of those rare things that can happen. Am I unhappy that I had to have a C-section, again? Absolutely not. By that point, I was exhausted and just wanted my baby out and healthy. It would have been too dangerous to progress further. I feel like I did the best I could in the situation, and now I have a second beautiful son in my life.
I think the best thing for you is to find a knowledgeable and supportive OB or midwife who understands your situation. My husband is a newer OB, so more up-to-date and trained in things like VBACs, so maybe finding someone who is more recent in his/her training might help. That being said, my husband and other OBs are only comfortable with VBACs in certain situations, so it'll depend on what happened with the previous C-section. And, the American College of Obstetrics and Gynecology recently put out an article stating that it can be okay in certain situations for a pregnant woman to try for a VBAC after two previous C-sections. So, that might be something to keep in the back of your mind, if you end up having to have another C-section. I hope that helps!

I certainly do feel the same. My water had perforated 24 hours before I gave birth. Labor had been stalled for 7 hours and they just took me right in and I couldn't say no way. Who am I to say I don't warrent this and the risk of infection is so totally worth it. Number 2 I so want to try VBAC as well. If you see questions I've asked you will see one about VBAC or No. I felt much better after I asked that question. I am going for the VBAC next time. I am so completely scared that I will rupture and lose my uterus and be unable to have any future kids but I just feel like I missed out on part of the birthing experience. Honestly I can't help but cry every time a friend tells me about their successful vaginal birth. One recently told me if the next baby has that big of a head she's asking for a c-section. I told her you say that now but once you are healed you'll want to try again. I'm under 5 feet and very petite. My son was almost 9 pounds. Yes looking back I wish I would have made them do things different during my labor but in all honesty my pelvis could be undersized or shaped wrong. A local doula told us her story about that. She's a larger woman and she tried a VBAC but ended up with another c-section because her pelvis isn't shaped correctly. She was really glad she tried.

If you look at my questions about VBAC or NO I'll warn you there is one horror story about VBAC on there but the rest are really encouraging. GL

I am really sorry you came away from that meeting feeling that kind of guilt/judgment piles on you.

I have a couple of thoughts--One is: Can you take the time to schedule a consultation with this person:
Dr. Mark Landon, chief of obstetrics at Ohio State University Medical Center and VBAC proponent. He has done tons of research on VBACs supporting their use/safety, and is supportive of them if they are safe for the mom & baby to try (each case has to be evaluated separately, of course, I'm sure).

He may be able to put you in touch with a VBAC-friendly doc in your area, even if you can't schedule an appointment to see him.

If you do go with a c-section, maybe you can try get your doc on board for a "natural c-section," which aims to try to recreate the vaginal birth process as closely as possible if you a c-section:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/
This can only be used in non-emergency c-sections.

Lastly, have you found any practices in your area that use CNMs (certified nurse midwives)? These practices are usually more open to the idea of VBAC than the traditional ob/gyn-only practices.

Best of luck to you and the baby.