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? 



  1. Good luck, Amy. Those are some really tough choices to make. But, you have totally thought them through.

  2. I'm writing a paper on VBAC right now for school (not sure if you knew I'd gotten in to the midwifery program at Mount Royal). My gut tells me you should give it a try... the reward is amazing. But no one can make that decision for you. If you need any more resources, let me know... Also, is there an option at the hospital to labour (and potentially birth) in water? It can be an extremely effective pain management tool and can help move things along since it's easier to change positions in the support of the water. All the best Amy! Whatever decision you make will be the right one for you.

  3. It's such a personal decision! I naturally delivered my 2 boys, my SIL tried a VBAC but with failure to progress with both of her labors, she ended up with sections. Best of luck to you!

  4. WOW..we are in the exact same boat!!! I too am a c-section Momma and am currently 14 weeks pregnant with #2. With #1 I had a section at 36 weeks due to fetal distress, so I never went into labor, I have no idea how I would have done in that situation...I just don't know. I have a slightly different decision ahead of me because if I choose a scheduled c-section, I can stay with my same doctor(s), same hospital, etc, if I want to go the VBAC route I HAVE to switch to a closer but smaller hospital that has a not-so-great reputation which scares me. I am "leaning" SLIGHTLY towards the scheduled section but I have a meeting soon with the local doctor to talk about the VBAC, it's so stressful and I wish it didn't have to be. Good luck with your decision and I can't wait to read your birth story however it goes!!!

  5. Many OBs won't let you go beyond 40 weeks if you have had a c section before. The risk if trying to vaginally deliver a baby after 40 weeks isn't one that they are willing to take because the baby can get too big, increasing the risks for uterine rupture. My OB scheduled me for a repeat c section a few days shy of my due date with # 2, and since I didn't go into labor on my own, the decision was basically made by my body!

    The other thing I wanted to mention was that, in my case, my incision healed so much faster and overall recovery was noticeably faster the second time around. When I asked my OB about it, she said in some cases it's almost like your body remembers how to heal because it did it before, so it seems much easier the second time around.

    Anyway, lots of us mommies relate to your dillemma - but like you said, it's all about that precious little bundle in the end. Best of luck to you


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  7. Wow Amy! I could feel for you while I read through your post. I don't feel like I am in the right place to give you any advice on this. but it seems like you are capable and strong enough to make some touch choices that others would have easily hesitated to. But as you know life is all about taking such decisions at the nick of the time of course after thinking it through from every angle. Good luck!

  8. I'm a c-section mom and had a VBAC when my oldest was 22 months old. I was told everything you were about potential risks. I'd do VBAC again in a heartbeat. The thought of running after a toddler while recovering from a c-section was really what did it for me. It was a much easier recovery. (My c-section was emergency.)

  9. Amy I totally get where you are coming from. My first was an emergency C becuase he was breach. My second was a VBAC... I had to convince my doctor to let me and in the end I was able to do it. Good luck with the decision, whatever you do will be the right thing for you.

  10. I feel like I could write this post - right down to your reason for the first section. Thanks for sharing.


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