Sunday, November 11, 2012

VBAC: A C-Section Mommy's Dilemma

If you have read my birth story you will know that we ended up having a c-section. Which was not how I wanted things to go after over 48 hours of active labour. But, that is the way it went, and I have done some work to come to terms with the emotions that brings up. 

Now that we are expecting #2, a question that has been on my mind (and on my OB's mind...) is whether or not I would like to try for a VBAC (which stands for Vaginal Birth After Cesarean). 

Oops! I just said the V word...ACK! Please spammers stay away!! 

I knew that this would be something I would have to think about, so it's not like it snuck up on me. I have been thinking about it for a long while. But since I just had my first appointment with my OB, he asked what I want to do so that they can book the surgery if needed. So yeah, it's very real now. 

It's a question that is fraught with emotion, with logic, with uncertainty. I honestly don't know what to do. I am not a person that deals well with unknowns. I like knowing "all the facts" and making informed decisions. But in something like this, there are no for-sures. There are just a ton of what-ifs and could-bes. 

My OB said that since I was fully dilated for a long time, and 2 vaccuum attempts failed, that it was a case of Peanut's head just being too big to actually pass through my hips (the correct term for this is Cephalopelvic Disproportion or CPD). There is some debate out there if many cases of CPD are just baby being in a non-ideal position, and not truly CPD. In my case, I don't know. Peanut's head was indeed very large, so I tend to agree with my OB's assessment. With this "diagnosis" he said the statistics for me having a successful VBAC are at about 40%. 

40% is an interesting number. Depending on who I have mentioned this to I get either "oh, that's awesome! Totally go for it!" or "40%? Yikes. I would go for the section". It's all in how you look at that chance. Personally, I look at it sort of like a 50/50 thing. A flip of a coin. 

In addition, my OB says that while I have the minimum 18 months between my deliveries for a VBAC, the ideal is at least 24 months. We have 19 months. This puts me at a slightly increased risk for uterine rupture. 

Ahhhh uterine rupture. This is the issue I think most people are worried about in the whole VBAC decision. Basically it is the chance that your previous scar will open up under the strain of labour. This is a very serious thing if it occurs, and can put both mom and baby in serious jeopardy. So yes, it is a very big concern. However, while I do have an increased risk, the risk is still sitting at about 1% according to most sources I can find. Which seems to me like it is a pretty rare occurance. So while I don't want to gamble with safety issues, I still feel like VBAC is a pretty safe option for us. 

I think the biggest thing that is weighing over me is the "what-if" scenario of me attempting the VBAC, going through labour and ending up with a section anyway. So basically, a complete repeat of last time. Undergoing a cesarean section after such a long and trying labour left me exhausted and sore and the experience itself was just not pleasant. My body was in complete shock, and I couldn't enjoy the birth at all. I really don't want to experience that again. Hubby asked me if he thought I could handle it emotionally if I attempted a VBAC and it failed. And it was a question that really made me think. In the end, I just want my baby to be born healthy, and so of course I would be ok with however that occurs. But it would be a huge disappointment to experience it all over again, and to not be able to do it. Again. Add to that the harder recovery with a toddler and a newborn and, to be honest, this option is not looking very good to me. 

If it was guaranteed that I could have a successful VBAC, then I would be all over it. But the ax hanging over my head of what if I can't do it is really hard. 

There are some positives to going for a repeat c-section. A lot of them are sort of superficial and make me feel silly for even considering them, but nonetheless, they are there in my mind. 

-I know what to expect from the surgery
-It would most likely be a calm, happy birth. I should be able to have the baby fairly quickly for skin-to-skin and to attempt nursing
-There is something nice about knowing the exact birthdate. Mostly it helps ease the logistics of getting Peanut looked after while we are in the hospital. We can arrange everything ahead of time and organize and prepare. 
-Honestly, I am a little scared of labouring in this hospital. I think I was spoiled with labouring in the small hospital last time. We were 1 of only 2 couples in the hospital. We had 2 rooms to ourselves, it was nice. This time we are at a very busy main hospital, which means most spaces will be shared. Superficial, but still something I think about. 

But, there are also negatives. 

-This is, realistically, probably my last chance to have a vaginal birth. If we have more children, they will most likely be cesareans if I have already had 2 cesearean births. 
-There is an increased risk of placental problems in subsequent pregnancies due to uterine scar tissue. If we do get pregnant again, the placenta can attach very close to the cervix (placenta previa) or it can grow too deeply into the uterine tissue, which is much more serious (placenta accreta) and can lead to hysterectomy. 
-The recovery is going to be difficult. I assume it will be more difficult than if I had a vaginal birth. This is a much bigger issue this time. Now I have a toddler and a newborn, and Hubby can't take as much time off this time, so his support (which was so amazing last time) will be absent during his work hours.
-It's surgery. 
-I will always have that question of "what-if" in my mind. What if I could have done it? What is it like to have a successful vaginal birth? Will I feel like I took the easy way out? 

So what's a c-section mama to do? It's such a personal thing...every person I ask has their own reasons for their advice they give, and they are all right. I can think of equally compelling arguements for each choice. The only thing I know for sure in my mind is that if it comes down to a choice between inducing labour for attempted VBAC or a repeat cesarean, I will choose the surgery. Hands down. I feel like induction will guarantee me an end in surgery, and I don't want that. I don't want to go through a horrible labour to end up in surgery again. However, if I go into labour naturally, maybe I want to try. 

Which is leaving me with the current plan of scheduling the surgery, and if I go into labour on my own beforehand, attempting the VBAC. The only question now left is when do I schedule the surgery? 39, 40, 41, 42 weeks?? I don't know. 

It's something I wish I didn't have to decide. But the reality is that it is on my plate. I am thankful to have a say in the matter, and to be in (relative) control of my birthing choices. It's just hard to make those decisions for yourself. Especially when there are so many unknown factors. 

Any other c-section mamas out there who are faced with or made this choice? What were your reasons? Looking back now are you happy with your choice, or would you have chosen differently? 



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