vbac after c-section? opinions? advice?

Michelle - posted on 01/12/2013

You may not be a candidate given your problems with your last birth. I had 3 vbacs after a c section with my son. It was a much better birth experience and a much better recovery.

Cassia - posted on 07/19/2012

Wow, excepting the hypogylcemia issue, that sounds so much like my first experience - pre-eclampsia, high dose pitocin, not getting past a 3... very similar!



If it helps ease your mind, pains in your scar area are normal. There is scar tissue there (obviously!) and the doctor did cut through nerves too. It is scary to experience though, I know. I had that especially in the later part of my second pregnancy and I was always afraid I may be rupturing (since that can happen without labor too). Luckily I wasn't. :) I've now heard many friends who have had c-sections also experience pain in that area. So freaky, but normal. :)



On the distance between pregnancies, you are just fine. The general recommendation is to have at least 18 months between births (NOT pregnancies, deliveries). Less than that has been linked to an increased risk of uterine rupture in some studies, but even then it wouldn't be a big enough difference to exclude someone - more like, if you are planning it, it's wise to plan for at least 18 months between births. But again - none of that affects you as you are very much beyond that anyway. :)



The thing with the choice to VBAC or have an elective repeat c-section (ERCS) is that neither option is without risk. I think it is easy to see the c-section as the safer option because it feels more controlled. But the truth is that the choice to have an ERCS actually brings a higher risk of things like hemorrhage and even maternal death. In fact, the risk of a baby dying because of a uterine rupture (in a hospital that is prepared to handle emergencies - which one would hope all hospitals with L&D would have since emergencies happen in other situations too) is actually very similar to the risk of a mom dying after an elective repeat c-section. Thankfully, both risks are extremely small. But I just wanted to put in that reminder, as I found it easily during my own research to think just of the risks of VBAC without remembering to weigh them against the risks of the other choice.



If you want to look at an article that compares the choice of VBAC to the choice of ERCS, I highly recommend looking into the NIH statement on VBAC: http://consensus.nih.gov/2010/vbacstatem...



One other bit of information - not all hospitals require only ice chips in labor. I've had four children now, and have dealt with four different hospitals (we moved). Most that I have dealt with have allowed clear liquids (so most juices were actually provided by the hospital) and one of the four actually allowed any food I wanted (I ate a sandwich). The requirement for ice chips only is based on a concern that if you had to have a c-section AND if you had to have general anesthesia AND if you then had enough stuff in your stomach to throw up, you could breathe it in (aspirate). Thankfully, general anesthesia is used very rarely now that spinal anesthesia is common (like epidurals), and even then it wouldn't mean you would always aspirate. So that is why many hospitals are now deciding that it is OK to allow laboring women more than ice chips. :) And in your case, it sounds like having at least juice would be essential.



My personal opinion - try for the VBAC. :) I was so nervous when I was trying for a VBAC in my second pregnancy. I was so afraid that something bad would happen or that the first experience would repeat itself. But I learned that every labor is different. My other three haven't been perfect, but none ended up requiring another c-section.

Angela - posted on 07/13/2012

I had a C-section with my first too. Then I had a beautiful natural birth Vbac with my second. I also agonized over the decision for a while. My original doctor recommended a repeat C-section. I did a TON of research online and spoke to 3 other doctors as well. Turned out that she was only advising against vbac because I'm overweight, (Which 2 other OBs with much more vbac experience and lower c-section rates said doesn't matter.) and she had seen one rupture and didn't want to see another. (Mom & baby were fine in that case too.) I'm SO glad I did the vbac, and I plan to do it again. The more I studied the issue the more confident I got in that decision. Some doctors seem to focus on the small risk of rupture with vbac to the point that they seem to forget about the multiple very serious risks of c-section. I think maybe they feel more in control of the situation in a c-section vs vbac where the rupture risk can be very unpredictable. However, as a patient I wasn't at all comforted by the doctors need to control things. ;)
For me, the thing that really tipped the scale farthest was the fact that I want more kids. Every c-section you have the risks go up significantly, both delivery/surgery risks and the risks of future pregnancy complications. That's a big thing to consider if you might want more than two. In your situation, to be honest, I would find a different doctor, or even better, a midwife, because it simply isn't true that you can only have ice chips during labor. I had juice, water, and some yogurt & berry smoothy that I brought from home. With your blood sugar issue they should have taken better care of you! Also, by the time you are ready to deliver you will have 2 yrs. between births. That's plenty of time. The pains might be caused by nerve damage, but they would be in your skin, not in your uterus, and should not affect your ability to vbac. The biggest concern I would have is if the pre-eclampsia happens again, as induction can raise rupture risk somewhat, you would want to research that to decide what type of induction you might be willing to use with vbac, or if you would section in that case. It really depends on what you are comfortable with. However, it is my understanding that pre-eclampsia often doesn't recur in the second pregnancy so it likely won't be an issue. I would just want to have a plan in case.
If you have any more specific questions I would love to help. It's a big, complicated, and sometimes scary decision, and you want to be confident in it and dealing with Doctors/midwives and nurses who are on the same page as you and fully supportive of your decision, whichever way you decide.

Sarah - posted on 07/09/2012

I will give you my personal and completely biased opinion. No to VBAC, sounds like you have a notion to think it's a bad idea anyways seeing that you still have pain there. My kids are 20 months apart and with my second child the doctor asked whether I was planning a VBAC or c-section. I told her that I couldn't risk bleeding out on the table leaving two children motherless.

This is the doctor's reaction:

"I don't like to steer mothers one way or the other, but we're always relieved when they say c-section because even though the risk is small, it is very real."

I live with those words ringing in my head. My sister in law had her girls 2 1/2 years apart and she was bound and determined to do a VBAC. Baby #2 wanted to bake so they had a c-section scheduled if she didn't come by a certain date. When the doc opened her up, he commented to her how she was thin and it was very possible that a VBAC would have led to a tear.

There is no shame in having children via c-section. I thank God every day for modern medicine, because me and my first child probably would have died in delivery. You are no less of a mom, you are in competition with no one. Just choose what is the safest option for both mother and child.