Vbac Question...

Jayna - posted on 10/23/2009

BTW, Erin, you are awesome...I agree with everything you say and so nice to have your profession insight!

Jayna - posted on 10/23/2009

the risk of uterine rupture is very low! Please watch : "The Business of Being Born" and "Born in the USA" which are both great documentaries about birth, c-sections and VBACs. Get in touch with your county's birth network. Find a doula to assist you if you plan to use an OB. Good for you to research now before you get pregnant! Knowledge is power!

Megan - posted on 04/16/2009

I think it is great that you are doing your research that will prepare you to make an informed decision. My best advice is to find someone who is 100% supportive of a VBAC. I had a friend who thought her hospital midwife was supportive but as it got closer to her due date the midwife started saying things like if it takes more than so many hours we will do a c/s, if your baby is too big etc....she even sent her in for an ultrasound and was told her baby was probably too big. Luckily she switched midwives and ended up with a successful VBAC. Ask what their success rate is and what things would cause them to do a c/s. If they are things that don't go along with your research than you probably will know that they aren't 100% going to support you. The complications are so rare and actually c/s complications are greater than VBAC complications. There are many things to do to help you succeed in the birth you want. It's great that you are already wanting to prepare your body for pregnancy. One thing I found out in my research is that you should do nothing to induce and epidurals can increase the chance of another c/s. Also Epidurals and spinals often slow baby's heart rate which is also a symptom of uterine scar giving away so it could just be a false alarm but most likely would lead to c/s. Exercise, good nutrition, eliminating sugar are all good things to do. Your emotional state also has a lot to do with a successful VBAC. As for knowing anyone who had complications I don't personally but in Dr. Sears Pregnancy Book there is a small section on VBACs and it says that with a low-transverse incision the risk of uterine rupture is 0.2% So 99.8% chance your uterus will not rupture. Also in a survey of 36,000 attempting VBAC women no mother died of uterine rupture and study of 17,000 no infants died as a result of uterine rupture. There is more in the book even though it is a small section there is some good info. I know some other people recommended some good books and websites here are some more websites I found while researching: www.childbirth.org/section/VBACFAQ.html, www.childbirthconnection.org, ican-online.org, www.vbac.com. Hope some of this helps and I really recommend VBACs!

Erin - posted on 03/11/2009

Bronwym, sounds like you had an awesome OB, most doctors don't spend quite som uch time with their patients actively trying to make sure you get what you want.

Bronwyn - posted on 03/06/2009

My VBAC was referred to as a trial by scar. I was told that at any time, if my C-section scar started to hurt, I was to have an emergency C straight away. If your scar doesn't hurt at any time through the later stages of your pregnancy, then you might be alright. You have to remember that your doctor works for you, not the other way around. You look really healthy so start working on your abdominal muscles, building your core and you might just be alright. I had an awesome OBGYN and we worked through everything together. My first, I was induced at 41 weeks and after twenty hours of full labour, I finally had an emergency C. If my second had to be induced, I would have had another C. Never again will I be induced, so lucky my waters broke two days before my scheduled C. Another eighteen hour delivery and with some help from the suction cap on her head, she delivered no worries. I would also look into whether you are ok with tearing or if you want an epesiotimy (I know it's spelled wrong). I knew I was going to tear so I asked to be cut.
Make sure you write down all of your questions and ask your doc when you have your first appoinment.
Good luck!

Erin - posted on 03/04/2009

Crystal I want to mention an experience we had at work just last week. A woman came in to have a scheduled repeat cesarean section just because she had a section before. Well, the placenta had migrated to the anterior (in the front) position and the doctor did not know b/c her ultrasound at 30 week said it was in the fundus (at the top). Well he did the usual cut (and I must say he is an incredible surgeon and a great person) but that cut happened to cut through the placenta. Then in the process of stretching the incision to get the baby out the placenta then abrupted (broke away) from the uterine wall. The baby then needed to be resuscitated and was showing signs of neurological damage from lack of oxygen. The bay had to be shipped to a hospital with a NICU, we only have a level 1 nursery. The mother also lost over 2 liters of blood.

So it goes to show you that repeat cesarean ARE NOT as safe as everyone thinks they are. This is a perfect case of a complication that WOULD NOT have happened if the mother had been offerred and encouraged to VBAC.

Everyone talks about the risks of VBAC but the risks of Cesarean are always downplayed b/c in reality they are less risky for the doctors in regards to malpractice insurance coverage and conveniece, not the moms.

And as for ACOG's recommendation of having a 24 hr anesthesia and OR when planning a VBAC, well... If a hospital can't deal with the very rare complications of ANY vaginal delivery (eg: prolapsed cord, surprise breech, or placental abruption) in a manner timely enough to save lives then they shouldn't be doing deliveries at all. Period.

Crystal - posted on 02/25/2009

Thanks!

Nancy - posted on 02/21/2009

Something that I forgot to mention but which I was given to think about when pregnant with my second and planning for a VBAC was that any other doctor doing any other surgery on any other muscle in the body would not distract you from using that muscle for it's intended purpose once it has healed from the surgery.  If you had surgery on the muscle in your leg and were then told you could never walk on it again because the scar might rupture would you just give up walking because it is easier for your doctor or would you expect that the doctor should do a good enough job of sewing up the muscle so you would be able to use it again for it's intended purpose?

The uterus is a muscle that should be repaired good enough to function appropriately when it is cut into.  If your doctor tells you that it might rupture, I would turn that back to the doctor and question them about whether they did what they were supposed to do when they repaired it in the first place!

Just my 2 cents...

Nancy - posted on 02/21/2009

I had a c-section with my oldest. 25 months later I had a totally natural, drug free VBAC 3 weeks after having an external version (second baby was upside down, like her older sister but we caught her early and turned her the right way). 27 months later I had another VBAC that was pain med free, but it was not a natural birth because I was induced since I was more than 2 weeks late.

The doctor who did my c-section was not willing to allow me to try for a VBAC (and she had never had a patient who was still nursing through a pregnancy (which I did twice)). I switched to a group of midwives who delivered at our local hospital and had two successful VBACs!

I did not have any complications, so I cannot help you with that, but if you have any questions about my experiences I would be happy to help!

Erin - posted on 02/15/2009

Check out the website for International Cesarean Awareness Network (ICAN) they have great information. Also just in case you need ammunition to convince your doctor get the book Thinking Woman's Guide to a Better Birth and Obstetric Myths vs Research Realities both by Henci Goer. Great books with a practicla explanation of the research and politics behind the VBAC controversy. Another great book is Jennifer Blocks's Pushed. Chapters 2 and 3 have a great discussion regardign vbacs and the misinformation that is out there. Please read up on it.

To directly answer your question. I know of one VBAC that went badly - she had a uterine rupture. Docotr did an emergency cesarean with a local anesthetic b/c anesthesia was not in house at the time. Thank GOD she had an epidural (though I am generally not a fan) in addition to the local anesthetic. But all in all she and the baby lived and they are both happy and healthy. I must say as an aside that her labor was induced which increases the risk of rupture.

The stats in general are that you have about a 75% chance of succeeding at a vaginal birth dependign on the circumstance, and you have about 0.5% chance of rupture if it has been over a year between the cesarean and the next pregnancy, they did a double closure of the uterine lining, and you go into labor on your own. The risks go up the more interventions are used such as Pit, and prostaglandins.

Be sure it is something you want and be prepared to fight for it. If your doctor isn't VBAC friendly find one that is.

I hope this helps.