What is the story on Vaginal Birth After Cesareans (VBACs)?
I had a scheduled C-section with my first child. As a good liberal feminist treehugger, I was skeptical, but after some research I decided it was the best approach for my circumstances-- and for reasons I could have never foreseen, it absolutely was. The surgery went fine, and the recovery wasn’t too bad.
Now I am pregnant with a second child, and people are asking me if I am going to attempt a VBAC. I trust my doctor and will absolutely go with what she advises, but I’ve found a lot of conflicting information on the subject. I had the impression that VBAC was the sensible option for people who are eligable, but frankly, what I see on the baby message boards is pretty hard for me to relate to- it seems to me to be a lot of people who feel guilt or anger at their first C-section, and lots of them seem to be doctor shopping or intentionally going against their doctor’s advice. And with the rate of 1% uterine rupture keeps getting thrown around, which is pretty terrifying.
Is VBAC a medically sound choice for most people? Some people? Or is it something that people do for other reasons?
My ex had a VBAC for our second and she researched it. Her doctor, though we went with a midwife for the birth, said the actual numbers for uterine rupture is exactly the same as for a vaginal birth.
I know there are a few hospitals that will outright refuse to do them. The one we went to said if we were to come back they would refuse to allow her to have a VBAC. Other places were happy to have her try but she had to be hooked up to monitors at all times and was not allowed to walk around and things like that. She wasn’t allowed to get in to the baths and other things that women giving non-VBACs could do.
You should talk to your doctor about where you want to give birth at and see what kinds of rules they have. You might also look in to using a midwife. The both of us found them to be much better then the doctors. The midwife was around the entire time, knew when to call the doctor if need be, had no problem telling us what was going on as opposed to the nurses who flipped out at a few things.
I think you found the head of the nail. Most physicians recommend C-section for your second birth if you had a C-section with the first. Why take the unnecessary risk? Beside with a scheduled C, it’s like having tickets to the theater. You have an appointment, you show up on the scheduled time, you wait for the curtain to open (the doctor arrives) and you’re back in the recovery room with the baby in about 45 minutes. Less stress, and more focus on your child.
My wife had a VBAC with WagonPassenger#2. She wanted to do it for the whole “missing out on a vaginal birth” reason. WP#1 was taken via c-section after her head got stuck in my wife’s pelvis/hip socket during delivery.
The VBAC went fine, but it’s tough to find a doc who will do it.
ETA: I just texted her: she would still choose the VBAC, even over three years later.
My wife did it for the birth of our second child. She didn’t particularly care about doing it but her Ob-Gyn told her to do it saying that there was no reason not to. She did say that the recovery time was faster although she said that the birthing process was more painful.
Thanks all. I’m not sure that I’d be a candidate, but I know my hospital will do it.
I guess I’m trying to wrap my head around if this is a choice people make for medical reasons, or for other reasons (recovery time, desire to experience birth, etc.) I think my only preference is to avoid an emergency C-section if at all possible-- that seems like the worst of all worlds.
My wife had an unplanned C due to complications with #1 (cord wrapped around an ear; ended fine). #2 was a VBAC simply because there was limited risk and all was normal with her. Went very well.
It’s usually the hospital’s policy, not the doctor’s. You’ll be more likely to be able to have a VBAC at a larger hospital, that I do know for sure.
And then (generic) you might end up with a VBAC because the baby decided to make a very quick entrance! Seen that more than once - and one of them was from a woman with spina bifida and exstrophy of the bladder, which was why she’d had a prior section to begin with! :eek:
My ex had our two children ten years after a Cesarean for her first child. No complications, though labor was taxing on both, mainly because my son was about 8lbs 8oz and my daughter 9lbs 12ozs only 15 months later.
By the way: best of luck with your pregnancy and congrats on building your family. It is an interesting time for you right now, I am sure.
Oh, one other thought regarding a VBAC: I have some lingering recollection that you are kinda tall - ?? My wife is quite tall; her obgyn basically said that if the baby is the size we expected, she should expect a very straightforward delivery, which is what played out. She wasn’t a petite woman trying to push out a 10-pounder.
Bottom line: if your body doesn’t present higher-risk issues, it would increase the likelihood that a VBAC would be a lower-risk viable option.
Thank you! I’m m not particularly tall, and my first born was nearly 10 lbs. So far, this one seems to be measuring more reasonably.
I’m not sure if I am a candidate, as I ended up with Thrombocytopenia (pregnancy related low platelet count) the first time. I know my hospital, which is a bit of a baby factory, offers VBAC. I’m not sure about my doctor, but I’d be surprised if she didn’t.
From what I’ve observed, if a person is a candidate they want to try due to the “other reasons” particularly the recovery time. It has a big impact on the family and the older sibs. For example, if you have a C-section, you wont be able to lift your older child for a period of time. They may find this quite upsetting which will affect the homelife for everyone (regression from potty training, acting out, etc). Some people don’t have a lot of help and if you don’t have a lot of help, its really difficult to be recovering from abdominal surgery with a newborn and a toddler to wrangle. I’ve seen a few with the “I neeeeeed a “correct” birthing experience” but most people I know have wanted to at least try for VBAC for the practical reasons.
I only know two VBAC stories, and both would have preferred a C-section in retrospect.
My cousin had a low-risk VBAC. It went fine. But it hurt like a first birth, since it basically was. And she said if she’d known how much it was going to hurt, she would have just had a second c-section. I guess she didn’t have a lot of trouble recovering from the first c-section. and maybe she could have had more anesthesia, or something with the VBAC, I didn’t really go into details with her.
The wife of a co-worker had a VBAC and her uterus ruptured. She nearly died, and the baby did die, after a completely normal pregnancy. He was out of the office for two weeks, mourning the child and caring for her. Beyond those basic facts, he didn’t talk about it much, and obviously I wasn’t going to press for details.
That being said, in general, the cost of a vaginal delivery is less, the recovery time is usually less, and maybe the pressure of going through the birth canal is good for squeezing crap out of the baby’s lung, prepping them for breathing. If my doctor recommended a VBAC, I’d probably do it. But I wouldn’t want to risk it if the doctor had concerns.
I’ve had two C-sections, the first emergency, the second (semi-)planned.
My first reason for going for a C-section second time round was the risk of uterine rupture. From what I’ve heard, the risk is greater if your first section was less than two years ago, and my kids are almost four years apart, but I still wasn’t willing to take the risk. Apart from the ‘everybody dying’ part, doctors in Ireland often have a hideous attitude towards women’s reproductive organs, and I knew there was a solid chance that at the first sign of trouble they’d spay me like a cat. Which was not on my wish list.
The second factor was that the doctor who delivered my first kid told me I had about a 70% chance of a successful vaginal delivery, and a 30% chance of the same worst-of-both-worlds scenario again: lots of labour, then an emergency section. Also not on my wish list. I don’t know if you have any way of estimating your odds of successful VBAC, but I didn’t like mine.
The third factor was that I had a very easy recovery, both times. You hear a lot of stuff like this:
That has absolutely nothing in common with my experience. I had far quicker and easier recoveries than several of my friends who had vaginal deliveries. Both times, I was taking the baby out for walks in a sling by Day 6 and didn’t need any painkillers after Day 3. The fact of a new sibling had a big impact on the first kid, as it does on every older sibling; the fact of my C-section had no impact at all. I only missed one day of walking her to playschool, and that was because I was in the hospital.
The fourth factor was that I had a three-year-old who was all about the mama, didn’t like unexpected changes, and was about to have her life turned upside down. I figured it would be a lot easier on her if we could prep her: on Wednesday I’m going into the hospital to have the baby, you can come see us on Thursday, etc etc etc. Much easier for her than coming home from playschool one day and unexpectedly finding me gone, or suddenly having me in pain and ringing someone to come mind her while I vanished. Thing 2 decided to arrive two weeks early, so it didn’t go to plan, but there you go.
The fifth factor was that I think people who believe one form of childbirth is ‘better’ or more ‘valid’ than any other are morons. The only *expeeeeerience *I wanted from childbirth was the one where I had a healthy baby, a healthy and minimally traumatised me, and a minimally traumatised three-year-old. All of which, thank the gods, I got.
I had a an emergency C-section, general anesthetic and everything, and found it intensely traumatic in ways that probably shaped my personality forever. I will always be sad that I was unconscious and did not see my son for hours after he was born, and that the general anesthetic combined with pain killers left me too groggy to really feel anything for a couple days. It was not the C-Section, it was the emergency part. If the rate of emergency sections during an attempted VBAC is higher than in a normal vaginal birth, I’d schedule a section.
If I WAS going to attempt a VBAC, I’d have an epidural put in immediately and make sure it was working. I had to have general anesthetic because the guy doing the epidural was incompetent or the pump was broken (really not sure) and he was still screwing around with it when everything went tits-up. If it hadn’t been for the emergency general, I am sure I would feel much better about it.
I seriously get upset 4 years later even typing about this. And I am not an emotional person.
I had an emergency cesarean section with my first, and a VBAC for my second. My particular circumstances made me a good candidate for VBAC, and I’m glad that I did it. I did research what practice and hospital had the most successful VBAC rates in my city and used them for my care, and would recommend looking at those statistics for your hospital and doctor before making a decision.
That said, I find birth a difficult subject to find good, objective information on. It is highly emotional for people (as you’ve seen), and, like many other hotly contested subjects, much of the information out there seems skewed towards one side or the other. Obviously, when researching seven years ago, the research I saw led me to believe a VBAC was a good idea, but I also can’t deny that I did not want another cesarean section and that may have led to some confirmation bias on my part.
As far as the risk of uterine rupture, the risk for women who had a low transverse incision (which is what I would assume you had), are less than 1%. (There also is a risk of uterine rupture even with a scheduled repeat cesarean - the uterus can rupture before labor begins.) ACOG’s statement on VBAC says that VBAC is associated with fewer complications than a planned repeat cesarean delivery, but not fewer than a repeat cesarean after laboring. (I’ve seen the VBAC success rate stated as 60-80% several places, but don’t know the source of those numbers.) This 2010 NIH article shows evidence that maternal mortality risk is less for VBAC than for a repeat cesarean (3.8 vs 13.4 of 100,000).
So yes, I would say VBAC is medically sound for many, perhaps even most, women, but all the circumstances need to be taken into account.
You certainly sound like you had a faster recovery than I did after my vaginal birth. I had painkillers for a week, had problems walking into Target for diapers for two weeks.
And my vaginal was easy compared to other stories I know. My cousin ripped all the way to her anus and was nearly bedridden for a month.
It is hard to get good information. Whenever I even mention VBAC, I get told that I need to find a doctor that is committed to VBAC. But that isn’t what I want- I want a doctor that is committed to me getting out of the hospital with a healthy baby, whatever it takes to get there. I did feel some pressure and got some flack when my first was born by C-section, but it turned out my platelets crashed and the baby was sunny side up with a cord around her neck (not to mention 10 lbs), so planning a C-section actually saved us a lot of trauma. A provider that had pushed hard to avoid a C-section would have been a net negative in that case.
I think the relevant information for me would be the complication rate for a planned C-Section bersus the complication rate for an attempted VBAC, successful or not.
I remember your thread where we talked about your doctor recommending a c-section. I’d still go with “trust your OB” - if you really need to look to find an OB that is even open to the idea, then it sounds like it isn’t a good idea. Yes, they are trying to reduce their medical malpractice rates, but the medical malpractice rates are reduced for a reason when they don’t take risks.
My mother in law had a VBAC fifty years ago - and it worked fine. One of my girlfriends tried it, and ended up with the emergency c-section. I only gave birth once, vaginally, so have no experience to share.
I’d also consider the stats on your chance of having another large baby. It seems like women who have one large baby tend to have large babies, but maybe its confirmation bias on my part.