VBAC VS. Repeat C-section

Updated on March 12, 2008
N.O. asks from Rowlett, TX
13 answers

Hi Moms,

Ok, I really need advice on this one! I'm pregnant with my 3rd due in 2 more weeks and I can not decide whether or not to have a repeat c-section or a VBAC.
---A little about my history: 1st delivery was vaginal but baby was face up (Or stuck as you might put it) and after 2 hours of pushing she was delivered using forceps. VERY hard delivery and recovery all around!
2nd delivery: Baby was over 10 lbs at 39 weeks and doctors highly recommended c-section so there is no harm caused to baby during delivery which is the route I took and although the surgery itself was a breeze, recovery was a NIGHTMARE!---

I really do NOT want to have a hard recovery again but it looks as if baby # 3 is going to be a big boy like my 2nd child was and so I'm worried about that causing problems if I choose vaginal delivery.
I would like to hear any advice from Moms or Moms you know who had to make this decision and what was the best outcome for you.
The only advice my OB really says is that it's safe to have a VBAC if your baby's around 8 lbs or under which mine is already at 8 lbs and 2 1/2 more weeks to go!
I'm totally stressing and just can't decide which route to take....I guess it's mainly fear of the unknown!
Thanks so much Moms for your helpful advice!

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So What Happened?

Thank you so much for all of the helpful information!
In my heart, I feel it will be the safest to go the Repeat c-section route vs. the VBAC after reading all of the info you moms provided me.
As scared as I am about going the surgery route again (only for recovery reasons) I'm also hearing it's an easier recovery the second time around so I will cross my fingers and hope that's how it turns out for me!
Thanks again to all of you!!

**NEW Update*** I went through with the repeat C and was SOOO happy I did. All of the moms who said second time around is easier are RIGHT!
So much better of a recovery and I delivered a healthy happy 8 lb 15 oz baby boy!
Thank you all for your advice!

More Answers



answers from Dallas on

I know this is such a difficult decision. I went through it myself recently. I have a friend who had a very successful VBAC at 42 weeks completely drug free. I will always admire her for that. Personally though, I opted for the repeat C-Section. I can vouch for the fact that recovery is so much easier the second time around. The reason I chose the C route was because I knew I could never live with myself if the VBAC caused any problems for my baby. I know the C is major surgery with its own risks, but since the doctor said it is safer, I just had to take that advice. I completely respect everyone who does the VBAC and I haven't personally heard any bad results, but hearing the medical professionals talk about it I decided it was too risky in general for my taste. You know some states are beginning to make VBAC's illegal! I believe (not 100% sure) Oklahoma just passed a law along those lines. I don't think they should legislate our bodies, but wow it really makes you think!

2 moms found this helpful


answers from Oklahoma City on

I have not had vbac but here's some info:

VBAC Frequently Asked Questions from ICAN:

Q: Is the adage "Once a cesarean, always a cesarean" true?

A: No, this is outdated medical thinking. There wasn't enough information available 40 years ago on the risks of labor after a cesarean birth. Also most cesareans done then were classical incisions whereas now almost all cesarean incisions are low transverse or "bikini" incisions. Studies now prove that VBAC is indeed a safer alternative to a scheduled cesarean birth for mother and baby after a low transverse uterine incision from a prior cesarean delivery.

Q: My doctor told me my pelvis is too small to vaginally deliver a baby over eight pounds. Is this true?

A: No, the pelvis and the baby's head are not fixed bone structures. During labor the pelvis opens, allowing room for the baby, whose head molds to fit. The pelvis will actually open up 33% larger than it's pre-pregnant size with a squatting position. There are several factors that contribute to this. First a hormone called relaxin is released during the latter part of pregnancy which soften the ligaments and cartilage surrounding the pelvis. Also different positions assumed during labor will change the dimensions of the pelvis such as walking, climbing stairs and squatting. This combined with the flexibility of the baby's head gives ample room for babies to move through the pelvis. The baby's head is made up of five plates that are connected with soft tissues that allow it to mold during the birth process as the baby travels through the pelvis. These bones return to their pre-birth state within hours of birth.

Q: I have had more than one cesarean. Is it possible for me to have a vaginal birth?

A: Absolutely. Studies have proven that two or more cesareans do not significantly increase the uterine rupture rate compared to having one prior cesarean in the absence of induction medication. There is a correlation however to an increase in placenta accrete with each cesarean surgery, a condition in which the placenta imbeds into the muscular layers of the uterine wall. This can cause problems with retained placenta which often results in hemorrhaging and even a hysterectomy may be needed to stop the bleeding. Another strong reason to avoid repeat cesarean births.

Q: My doctor says scheduling an induction will maximize my chances for a vaginal birth. What do you think?

A: Actually the opposite is true. Inductions as well as augmentation of labor contribute to a marked increase in uterine rupture rates and thus should be avoided if possible. Induction also leads to a higher rate of cesarean section than spontaneous labor. If an induction is medically indicated, close monitoring of mother and baby is highly recommended.

Q: I can't find a doctor willing to support a vaginal birth after cesarean.

A: Finding a doctor to be supportive can be difficult. Do not take someone's word that there is not a doctor in your area willing to support your birth. Take the time to make an appointment and go in a see several doctors and/or midwives. Ask questions and listen to their answers.

Q: Is it true that ACOG is recommending all women have a repeat cesarean?

A: No. ACOG (American College of Obstetricians and Gynecologists) says that most women with one previous cesarean delivery are candidates for VBAC and should be counseled about VBAC and offered a "trial" of labor. However, they have revised their recommendations to include that an obstetrician be immediately available during the labor of a VBAC woman.

Q: My baby is breech. Will I have to have a cesarean?

A: Not necessarily. It depends on how your baby is positioned and the experience of your doctor/midwife. With a skilled caregiver a breech vaginal delivery can be as safe or safer to mother and baby as a cesarean birth. Turning the baby is the best way to avoid a cesarean however and there are many techniques available to turn breech babies to a vertex, or head down, position.

Q: Doesn't a vaginal birth cause problems like pelvic floor "damage"?

A: Lead researcher Dr. Alastair MacLennan in an interview with Reuters Health states, "80% of the problems a woman having a vaginal delivery has, also happen to a woman having a Cesarean section." Most often it is the interventions like episiotomies, vacuum and forceps deliveries that contribute to urinary and fecal incontinence, uterine prolapse, and pelvic floor damage rather than the vaginal birth itself. Women who have had cesarean deliveries also experience urinary and fecal incontinence and other concerns due to the surgery or simply as a result of the hormones of pregnancy and/or the drugs used during the delivery.

Q: Wouldn't a cesarean be safer than a vaginal birth after a cesarean?

A: A cesarean section is major abdominal surgery with all that entails. The surgery itself, as opposed to medical problems that might lead to a cesarean increases the risk of maternal death, hysterectomy, hemorrhage, infection, blood clots, damage to blood vessels, urinary bladder and other organs, postpartum depression, post traumatic stress syndrome, and rehospitalization for complications. Potential chronic complications from scar tissue adhesions include pelvic pain, bowel problems, and pain during sexual intercourse. Scar tissue makes subsequent cesareans more difficult to perform, increasing the risk of injury to other organs as well as placenta previa, placenta accreta, infertility, ectopic pregnancy, uterine rupture in subsequent pregnancies and the risk of chronic problems from adhesions. There are also risks to the baby such as respiratory distress syndrome, prematurity, lower birth weights, jaundice, lower APGAR scores (APGAR is the means of assessing the health status of a newborn), and finally in 1 to 9 percent of cases the baby is scarred or even maimed by the scalpel.

Q: What is the real percentage risk of uterine rupture?

A: This is a difficult question because there are many factors that attribute to uterine rupture. It is widely accepted thought that for a woman who has had one previous lower transverse cesarean, the risk is 0.7% or 7 in 1000 women. If a woman has had two or more prior lower transverse cesareans her risk only increases slightly. Induction or augmentation will however increase the risk dramatically from 0.7% to 5%, and with a classical or T-incision the risk is found to be between 3% and 5%.

Q: Can I have a VBAC if I have a classical incision?

A: The reason VBAC isn't recommended with a classical incision is that it is believed that the rupture rates are higher (3-5% vs. less than 1%). However, we don't have reliable stats since women with classical incisions aren't allowed in VBAC studies. An interesting note is that in many VBAC studies, women with "unknown" incisions (lack of records) were allowed in the studies. Their inclusion did not affect the results (which indicates that rupture with a classical incision is lower than they estimate).

Q: When is a cesarean absolutely necessary?

A: • Complete placenta previa at term.
• Transverse lie
• Prolapsed cord.
• Abrupted Placenta.
• Eclampsia or severe preeclampsia with failed induction of labor.
• Large uterine tumor which blocks the cervix
• True fetal distress confirmed with a fetal scalp sampling or biophysical profile
• True cephalopelvic disproportion (CPD- baby too large for pelvis). This is extremely rare and only associated with a pelvic deformity (or an incorrectly healed pelvic break).
• Initial outbreak of active herpes at the onset of labor.
• Uterine rupture

2 moms found this helpful


answers from Dallas on

This is a touchy subject for me. I had 2 c-sections, the first unplanned, the 2nd planned. When I was deciding to go VBAC or not (I desperately wanted a natural childbirth with no drugs or surgery), I did a LOT of research. However, my husband, who is a nurse, strongly discouraged me from the beginning that the dangers of VBAC are just NOT worth the risks! Some doctors won't even perform VBACS-- at all! My cousin, who is a nurse at a Children's Hospital in LA, has seen for herself BAD outcomes from VBACS, both for the mother and child (she herself had 2 c-sections). C-sections are fairly low-risk... i'm a low-risk type of gal. I am not a risk-taker at all. There are always going to be a number of people who are anti-hospital/anti-drug/pro-"natural", but the medical community (and I know many docs and nurses personally) comes down on the side of repeat sections b/c of the risk ratio. Also, my children were tiny-- if yours is over 8lbs already, then again, you are at an even higher risk. Also, I know people who have had natural or vaginal births that have had more complications and worse recoveries than those who have had c-sections-- everyone is different. But, at least you know what to expect, and I do believe that the recovery is less intense each time (from experience and from word of mouth). Listen to your doctor and take that advice. It sounds like you have reservations about VBAC from the tone of your posting-- follow that instinct.

1 mom found this helpful


answers from Abilene on

I just had my 3rd a month ago today. I choose the repeat c-sections.

Little background.

I had twins the first time around. I pushed my first daughter out (olivia) 5 lbs 4 ounces. Morgan was an er c-cetion. I was 5 weeks early, 12 1/2 hours labor and I had to have a blood transfusion and I hurt REALLY bad. I had a VERY hard time with the recovery.

My doc asked me what I wanted to do this time. I have a high pain tolerance, but I'd already been through labor and didn't want to do that ago. I still ended up laboring for awhile, but i had a planned c-section.

The planned section was way different than an er section. I still hurt dn't get me wrong. But by 2 weeks I'd already gotten off all pain meds, and was moving around the house and doing most normal stuff. I still had to take it easy, but wasn't in a lot of pain. Laughing, coughing and snezzing hurt.. LOL

After the section, I had my tubes tied, and the doc also sewed my muscel back together in my abdomine. Hope my 2-cents helps.

1 mom found this helpful


answers from Dallas on

I did VBAC but my baby was 7 lbs 10 oz.... If yours is going to be big do the c-section.

I don't know why your recovery was difficult, mine was a breeze. Address the recovery issues with your doc and see if he/she can help to make the c-section easier.

When in doubt, do the c-section.

1 mom found this helpful


answers from Dallas on

My first daughter was breach, so I had to have a c-sec. But my second, I REALLY wanted a vaginal delivery, and I almost didn't get one. The baby was sunny side up, but she ended up turning, and I had a wonderful vbac! She was only 6lb, 4oz, though, so it's hard to say. I would definately try for a vbac. My recovery was SO much easier the second time around.

1 mom found this helpful


answers from Dallas on

I am in the same situation....my first child was 9lbs 10oz, and she was "stuck" for 9 hours before we did a c-section. She was very sick at birth b/c of the entire thing. I am pregnant again due in June. I did not want to have such a long recovery period, but I asked my dr. She said that yes, many people can have a VBAC, but if the baby is over a certain weight they do not like to, and the chances of the mom bleeding out are greater due to the fact that they already have an incision in their uterus. I am waiting to see how large they believe this baby will be. I am not being pushed into anything that I do not want to do, my dr is great! A lot of drs out there will not do VBACs....they are said to be very high risk...others will tell you different, but more modern drs won't do them. Good luck w/your decision. I think I will end up having another c-section b/c I don't want the risks!!

1 mom found this helpful


answers from Dallas on


We have not gone through this yet, and my c-section delivery was fairly easy...I only had major gas pains into my shoulders (due to air being trapped in stomach cavity when opened and then closed the doc said)...other than that, it was a breeze. However, my hubby is finishing up his BSN (nursing) and said there is no way he would have me do VBAC because, while there are risks with ANY procedure...VBAC just has unneccesary risks and only mile benefits...mostly psychological ones that can be overcome. Injury to you or baby is not as easily overcome. Hope that helps!

1 mom found this helpful


answers from Dallas on

Hi N.,
Good for you for looking into your options and getting educated. I looked into VBACs pretty heavily when I was pregnant with my second...my first was also face up and a star-gazer, so we ended in a c-section. I did not opt for the VBAC for really ONE reason...the delivery between the births is recommended to be at least 24 months apart. Mine were not even 14 months apart so I felt 10 months of recovery still were needed to make it safer. Other than what advice you have been given, it is recommended that you labor un-medicated (from what I read) so that you are more in tune and aware if things start to change during the labor and delivery. Those are the two main points I found when researching it....the un-medicated thing did not bother me since I went that route with my first (up until the surgery), so really for me it was the time of recovery between deliveries.

1 mom found this helpful


answers from Dallas on

Hi there,
well,i have 4 daughters and the first one was a emergency c-section,the other was a vbac but the only risk is about having another vbac is that the baby could reopen your wound and tear you more,i tried to have a vbac again and it was really hard because the more i pushed the more it felt like my wound was going to pop open and was very painful...but i ended up having a c-section because the baby turned,and my 4th was also a c=-section,was not as bad as the first i was up on my feet the second day..became very easy and my kids were about 8lb each but good luck cause they are some big babies.....take care

1 mom found this helpful


answers from St. Louis on

Christian has given you wonderful information. It is your decision. No doctor or hospital can take away your right to informed consent. No where can anyone force you into a C-section if you are in active labor just because you have had one in the past.My aunt had her oldest via C-section almost 17 years ago. She then had her other 3 children vaginally. The ranged from 6 pounds to 9 pounds. She had no problems after any of them. Trust your body and believe in yourself. You will make the right decision. Do what is right for you.



answers from Dallas on

I too had my 1st child vaginally, my 2nd was breech so I had a c-section and my 3rd I wanted a Vbac and my dr. said that it was ok b/c I was a good candidate b/c it was not my body that cause the 1st c-section. HOWEVER Baylor/Allsaints is where I delivered all three and their policies prevented me from having a vbac. The hospital would not let me have one and told my ob that if he allowed me to do a vbac that I would have to deliver some where else. Check with the hospital and see what they will allow then check with your ob and see what he/she recommends then make your decision. It may be that you do not have the vbac option due to the hospitals policies. I hope this helps.



answers from Dallas on

Have you read Silent Knife? It is very informative about the risks of repeat C-sections and VBAC. You need to prepare yourself with as much information as possible to lessen your fears. Which ever route you chose, you should go into labor naturally.

I am a two time c-section mom going for another VBAC. Both my kids were big. My last child was over 10 pounds. I did not chose to have sections with either baby, my body just would not allow me to have them vaginally after days of labor and a lot of heartache. I would recommend to anyone to try to VBAC than a section.

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