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wanting a VBAC but not sure about risks?

Emma - posted on 11/24/2009 ( 16 moms have responded )

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i had ny first baby 2 years ago. after a long induction and 36hrs of labour and only dialating 3 cms i ended up with an emergency c section. i was really down as i wantd a vaginal birth so bad. we are hoping to have another someday soon and i really really want a VBAC but am not sure on how risky it would be.
if anyone was in any similar situation i would love to hear about it.

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App+7mnejhu - posted on 11/25/2009

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You have some great info already shared with you. I too had a long 30 hour labor with my first that ended with emergency c/s. Then I had a successful VBAC a year ago. It was an amazing experience. There are small risks involved with VBAC but there are more risks with repeat c-sections which are unfortunatley too often not even talked about. Most women have a great chance of having a VBAC. The important thing is to find a midwife/dr. who is 100% supportive and encouraging. There are some great websites to look at. I also have a VBAC blog that has some great resources if you are interested it is www.thepathtovbac.blogspot.com. If you have any more questions I'd be happy to share with you.

Ella - posted on 11/25/2009

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Here's some info I found...Hope it helps.=)



What are my chances of giving birth vaginally after having a c-section?

As long as you're an appropriate candidate for a vaginal birth after a cesarean, also known as a VBAC, there's a good chance you'll succeed. Of course, your chances of success are higher if the reason for your prior c-section isn't likely to be an issue this time around.



For example, a woman who has already had an easy vaginal delivery and then had a c-section when her next baby was breech is much more likely to have a successful VBAC than one who had a c-section after being fully dilated and pushing for three hours with her first baby who was small and properly positioned. (Having given birth vaginally boosts your odds dramatically.)



That said, it's impossible to predict with any certainty which women will achieve a vaginal delivery and which will end up with a repeat c-section. Overall, about 60 to 80 percent of women who attempt a VBAC deliver vaginally.



If you decide to try it, you'll need a caregiver who supports the idea. Your caregiver must also have admitting privileges at a hospital that allows VBACs and where appropriate coverage is available around-the-clock.



An increasing number of hospitals have strict criteria regarding who will be allowed to attempt a VBAC because of controversy about their safety, specifically the potential for uterine rupture — a rare injury, but one that can be catastrophic for mother and baby.



What would make me a good candidate for a VBAC?

According to the American College of Obstetricians and Gynecologists, you're a good candidate for a vaginal birth after a c-section if you meet all of the following criteria:



• You've had only one previous cesarean delivery and it was done with a low transverse (horizontal) incision. Having had more than one c-section or an incision in your upper uterus that was vertical — also known as "classical" — or T-shaped puts you at a greatly increased risk for uterine rupture. Note that the type of scar you have on your belly may not match the one on your uterus, so your practitioner will need to review a copy of your c-section report.



• Your pelvis seems large enough to allow your baby to pass through safely. (While there's no way to know this for sure, your practitioner can examine your pelvis and make an educated guess.)



• You've never had any other extensive uterine surgery, such as a myomectomy to remove fibroids.



• You've never had a uterine rupture.



• You have no medical condition or obstetric problem that would make a vaginal delivery risky.



• There's a physician on site who can monitor your labor and perform an emergency c-section if necessary.



• There's an anesthesiologist, other medical personnel, and equipment available around-the-clock to handle an emergency situation for you or your baby.



VBACs are controversial, and you may find it difficult to decide whether to attempt one. The best approach is to talk to your practitioner about your individual chance of success. Start the discussion early in pregnancy so you'll have time to carefully weigh the benefits and risks.



What are the benefits of having a VBAC?

A successful VBAC allows you to avoid major abdominal surgery and the risks associated with it — including a higher risk of excessive bleeding, which can lead to a blood transfusion or even a hysterectomy in rare cases, as well as a higher risk of developing certain infections. A c-section requires a longer hospital stay than a vaginal birth, and your recovery is generally slower and more uncomfortable.



If you plan to have more children, you should know that every c-section you have increases your risk in future pregnancies of placenta previa and placenta accreta, in which the placenta implants too deeply and doesn't separate properly at delivery. These conditions can result in life-threatening bleeding and hysterectomy. And a recent large study found that the risk of some other delivery complications also rises with each c-section.



Finally, if you were disappointed about having a previous c-section, you may feel a tremendous sense of pride and accomplishment at being able to deliver vaginally this time around.



What are the risks of attempting a VBAC?

Even if you're a good candidate for a VBAC, there's a very small (less than 1 percent) risk that your uterus will rupture at the site of your c-section incision, resulting in severe blood loss for you and possibly oxygen deprivation for your baby.



The risk of uterine rupture is somewhat higher if your labor needs to be induced or augmented. Some experts think it's reasonable to abandon the attempt at a VBAC if it looks like you're going to need oxytocin (Pitocin) to get your contractions going or keep them moving.



Also, if you end up being unable to deliver vaginally, you could endure hours of labor only to have an unplanned c-section. And while a successful VBAC is less risky than a scheduled repeat c-section, an unsuccessful VBAC requiring a c-section after the onset of labor carries more risk than a scheduled c-section.



With an unplanned c-section after laboring, you have a higher chance of surgical complications, such as excessive bleeding that could require a blood transfusion or a hysterectomy in rare cases and infections of the uterus and the incision. And the risk of complications is even higher if you end up needing an emergency cesarean.



Finally, there is the risk of the baby having a serious complication that could lead to long-term neurological damage or even death. While this risk is very small overall, it's higher in women who undergo labor before a c-section.



What kind of interventions will I need if I attempt a VBAC?

If you decide to try for a vaginal birth, you'll need continuous electronic fetal monitoring because a change in your baby's heartbeat is usually the earliest sign that there might be a problem. You'll also need an IV, and you'll have to refrain from eating anything during labor in case you require an emergency c-section later.

Missy - posted on 01/08/2012

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Your situation is almost identical to mine. I was induced at 41 weeks and the first induction failed. I went into labor several days later on my own . After 33 hours of labor I developed a fever and my baby , who had to have internal monitors placed through her scalp, was in distress so I had an emergency c-section. I was only dilated to 7 cms. Fast forward four years later and I'm pregnant again and I struggled to find ANYONE to help me make an educated choice about VBAC or repeat section. Finally, I found my current doctor who took the time to go over my family history and also a detailed history of my first pregnancy and labor. She said that 9 out of 10 women are good candidates for VBAC but in my case, bone structure is an issue ( I ( and my mom and sister who also had sections) have small bone structure which is why after 33 hours and copious amounts of pitocin, I only dilated to 7 cms. My baby just couldn't get the pressure needed on the cervix to dilate me) and, while she is very supportive of me either way, says that unless I have a smaller baby ( not likely!) , I probably would end up in a similar situation except this time, after my c-section, I can't be induced because of increased risk. Soooo...If I go into labor earlier than my due date and it seems my baby is on the smaller side, I may try for the VBAC but I'm ok with the fact that it may not be in the cards for me. I hope this helps! I know how it feels to be really torn about this decision.

Heather - posted on 03/01/2010

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hey you should visit ICAN org website and get some information on Vbacs plus do ALOT of research and meet with a couple different doctors and midwifes. Find out the vbac statistics of you care provider and the hospital you are planning to birth at. I am having a VBAC with a midwife this June but I have done alot of research and talked with alot of different VBAC moms which has helped alot.

Tiffany - posted on 12/01/2009

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I had a c-section when I was 19 and when my daughter was 8 months I found out that I was pregnant again, I had no problems with my scar opening up nor were there any dangers that i was in or my son either. Oh and by the way he was a vbac baby with no complications at all. And labor only lasted 5.5 hours.

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Natalie - posted on 01/13/2012

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The risk in a VBAC is higher than if you never had a C-section because of the risk of a uterine rupture. I tried to have a VBAC after my first born and I had to be rushed to have an emergency C-section because of a rupture and had begun hemorrhaging. But you are monitored very closely for that as was I and they caught it right after it happened. Make sure that you talk with your doctor about your plans and ask what kind of monitoring do they do while you are in labor. For me they use to come in every hour and ask if I was feeling any pressure around or sharp pains around my scar. When I did I buzzed my nurse and she called the doctor in right away. Within 3 minutes they had the ultrasound machine ready and within 10 minutes I was being wheeled up to the OR. As long as your doctor and/or hospital is very cautious about that then it should be perfectly fine and recommended by many doctors. I wish you luck and I hope that you have or have had the labor you dream about! :)

Tina - posted on 01/11/2012

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I had a very similar situation there is plenty of good advice on here but ultimately you need to discuss what is best for you and your baby. If your doctor thinks it's safe enough to try again and you really want to give it a go there's no harm in it. I had an emergency c section with my 1st and another c section with my second because I wouldn't have been able to have a natural. The fact I had decent size babies and I just couldn't do it. It can be really hard to predict how a birth will go some people will have a terrible birth with the first and have a good birth with the next. Some people just can't do it. There's no shame in it. Everyone is built different and what matters is that you and the baby are okay. As much as I would have liked to have a natural birth the most important thing is that you and your baby are in safe hands.

Kate - posted on 01/09/2012

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I joined this circle not to long ago, so this answer might be out of date for you! I will post it anyway! I had to be induced with my first as I was 8 days overdue and had enough of the pregnancy. The induction did start labour but after 12hrs of only dilating 5cm I too had an emergency c-section. When I became pregnant with my 2nd, I told my OB that I wanted to try everything to go into labour on my own and hopefully have a vaginal birth, but just in case, had a c-section date scheduled as I didn't want to be overdue again! She told me that going vag at my age(40) was just as risky as having a c-section. I highly suggest you have that conversation with your Dr., as only they have your medical history, and also your age will be taken into account. I hope you get to have that VBAC! I gave birth to my little girl on the date we scheduled the c-section! I was hoping to go early, but yet again, my body failed me :( I was not surprised, but at least I knew I was in good hands with my OB and now I have my beautiful daughter...how she arrived seems so inconsiquential!!

Meg - posted on 08/24/2011

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Have you seen the movie The Business of Being Born? I highly recommend it! I really really REALLY recommend it actually lol

Amanda - posted on 12/11/2009

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i had a c-section with my son (not emergancy, they didn;t want to risk induction because of complications but he needed to come out). when my son was 8 months old i found out i was pregnant again i carried her to 39 weeks and was induced and had an uncomplicated vaginal dilvery. my obstatrician said the fact that they were that close wasn't much of a concern. i took me 35 hours to get to 6 cms then only a half an hour to get from 6-10cms. only 25 minuets of pushing. there were 4 other girls having inductions around the same time as me and they all had the same fast dialation from 6/7 cms to 10 and they all had fast deliveries to.

Ella - posted on 11/28/2009

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Quoting Loretta:

i hope to have a vbac with my next one but i was told i have to wait a year brfore tring to get pregnant again so i can have a vbac.



I was told that you need to give your body atleast two years before trying to have another baby. My doctor told me that your body isn't fully healed until two years after c-section. That it could cause your scar to open up while pregnant and be dangerous to you and your baby.  But all doctors think differently. I'm sure you know that already...lol.

Loretta - posted on 11/27/2009

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i hope to have a vbac with my next one but i was told i have to wait a year brfore tring to get pregnant again so i can have a vbac.

Ella - posted on 11/24/2009

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All three of my kids were c-sections. With my first I wouldn't dialate past 5cm. I was in labor for 48 hrs before they decided to deliver c-sec. My doctor said that he would like me to try VBAC with my second child being that C-secs are risky. So, I tried it and the samething happened with her. Still stuck at five cm, yet again. So with my last baby I just went ahead and had a c-section. I kind of feel bad because I never had the chance to experience a VB but I am greatful to have 3 healthy beautiful kids.

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