January 14, 2010
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VBAC vs. C-Section
With baby #2, I am given the option of trying to go for a VBAC (vaginal birth after ceasarian) or have an elective repeat c-section. At first glance, it seems like VBAC would be the way to go…but there are a few risks involved. There is a chance of uterine ruption with a VBAC….but the chances are low, like 3% (recent studies are showing that the percentage may be even lower) with a horizontal incision c-section. However, it’s still a risk that I have to think about. The consequences for both mom and the baby are pretty bad because it does take a while to prep for a c-section, even if it’s an emergency. It’s not a cut you open right when it happens kind of deal. I think it took at least a half hour (maybe even an hour) to prep me for mine and I already had the epidural in. The other thing is that if I do opt for a VBAC, I have to go in as soon as I have contractions so that they can monitor the integrity of the uterus….and absolutely no pitocin (increases the chances of rupture). I didn’t really get too much pitocin last time since Tyler didn’t respond well, but that resulted in my 41 hour labor.
So right now, I’m leaning towards a repeat c-section. The reasons being:
1) My mom had originally chosen a VBAC with my younger sister and at the last minute changed her mind. When they cut her open, her uterus was see through thin. One contraction and it would have ruptured. I know it’s not a genetic thing, but the fact that it happened to someone so close to me makes me very nervous.2) Most ob/gyn’s recommend a minimum range of 12-24 months between pregnancies (the birth of one and the beginning of the next) to let the uterus fully heal. I am right around the 12 month mark. My ob/gyn said it was okay, but I know others would probably not even give me the option of a VBAC. This is by no means a strict guideline and I know plenty of people who have had much less than 12 months between pregnancies with successful VBAC’s. But it is something to think about.
3) My uterus didn’t heal as quickly as it should have the first time around. It should have gone back down to normal by my 6 week post partum appointment and it didn’t. I had to go in for a follow up ultrasound to see if there was anything wrong. There wasn’t, but it just healed slower than expected.
4) Tyler had a 30%ile head circumference and didn’t make it past station 0 with 40+ hours of labor and 2.5 hours of pushing. For those of you who had babies, you’ll remember that there’s the negative numbered pelvic stations, then 0, then the positive numbered stations. Once you’re at +2 or +3, the baby’s head is pretty much starting to clear the pelvis. So at station 0, the baby’s head is too high up to even try to use assisted delivery devices like the forceps or vacuum. A c-section was the only way to get him out…again with a 30 %ile head circum. So unless the next baby has a teeny tiny head, I’ll probably end up in the same boat.
As much as I would love to attempt a VBAC, I feel like there are too many what if’s weighing on my mind, and I’d just be worried about them all the time. I know recovery will be much harder with the c-section, but, hey that’s what percocet is for right?!
Comments (10)
Looks like you had a lot to think about. I’m glad I didn’t have to make that decision, but I see your reasonings for choosing c-section again. I think I would too.
wow.. I didn’t know there is so much to consider for VBAC… I think I would choose C-section too after all those reasonings. My friend is in the same situation as you. I believe she is opting for C-section
that sounds like a well thought out decision. with the way you’re talking it sounds like you’re going to deliver imminently.
very interesting – i didn’t realize the risks involved with vbacs. it does sounds like c-section is a more controlled way to go.
I’m not a mother so I don’t have experience with this, but my very good friend was in your situation a few years ago. Baby #1 was a c-section because she wasn’t progressing. And when she talked to her doctor for #2, he gave her both the pros and cons of a VBAC. She asked if he had personally seen one go wrong, and he said yes. Which is kinda scary to think about. I think if I were to have to choose, and already having the scar, I would say to do it again.
I was in a similar situation as yours… when I was in labor it didn’t progress well and ended up with a c-section. I actually begged for one (bartered w/my OB around the 2.5hr mark and was prepped for the OR by 3hrs of active labor). My OB told me I was not a good candidate for a VBAC at my 6wk post partum visit right off the bat. When are you due?
@injeannieous -
I’m due in July. Did your ob tell you why you wouldn’t be a good candidate? We were given a choice at the 2.5 hr mark to go in for a c-sec or to push for another half hour and if the baby still didn’t come out, there would be no choice. We opted just to go for the c-sec right then and there because of a bunch of other factors: we had meconium in the fluid, BB’s heart rate kept dropping and it wasn’t coming back up as fast as they’d like and I had spiked a fever and they were afraid I was getting an infection. I don’t think that half hour would have made any difference though.
@hanaleiway -
At work,I have seen a few babies come in that were a result of ruptured uteri and that’s what scares me the most because they really were not in good shape.
@MissMamacita - It was b/c I had difficulty pushing out baby #1. Jonah was 8lbs 6oz when he was born, and my OB said baby #2 generally tends to be larger/heavier than #1. I don’t think my pelvis ever expanded enough to let him out. I forget at which station he was before they wheeled me into the OR. I didn’t know what recovery would be like and foolishly begged for a c-section. I don’t know how I’ll get up the nerves to have a c-section again, 2nd time around. My friend had a natural birth, but had severe tearing (3rd degree, I think she called it), and that doesn’t sound like fun either. The joys of becoming a mom, huh?
Wow, this is a really good topic. I havent wrote about my labor but I ended up with a C section… sounds l ike you an I had very similar stories. (meconium fever etc)
I thought about a Vbac, but I think I’m going to do a Csect if I need to deliver a 2nd time around. My OB said 24 months of healing before trying a Vbac.
FYI: I also asked my OB how many babies I can have with C sect and he told me usually 3 kids at most.