Wanted: reasons for not choosing a VBAC

[rachdent]

HI gals

I've recently had a second caesarian where I was hoping for a VBAC, which has left me in a spot of bother. You see I was supposed to be writing an account of my VBAC for a freelance job I have. Anyway now I've decided to do a comparison of why some women opt for VBACs and others prefer the repeat caeser option. There'll be no bias towards either, it's just an informative article on women's choices.

If you decided on a repeat caeser I'd love to hear from you via PM, email (Pink.Ink077@gmail.com) or reply to this post. Please let me know why you wanted to have another caeser and (if you've already had the birth) if you were happy with your choice. You can also include any other info you think may be useful.

Thanks,
RACH!

[pegasus]

Hi Rach

I'll send you an email

cheers

[clarebear1983]

I have decided on a repeat c-section for several reasons:

1. I had an induced birth in 2004 and everything went wrong. Everything was fine till my waters were broken and i got an epidural (even though i didnt really want one). Suddenly DS went into feotal distress, DH fainted from stress (and the blood from the drip) and my blood pressure went from high to sky high. Next thing i know the dr has decided on a c-section, I am preped in the matter of a few minutes, wheeled into surgery alone with no one to hold my hand and put under (epidural failed to work!!)...................I woke up from the emergency c-section confused, disorientated and completely upset with what had happened. Then DS had respiratory failure and had to be shipped of to a childrens hospital 40 minutes away.

All this was a negative experience for me. Although I am thrilled my son lived I am livid that control was taken away from me!!!!!! All i can remember from his birth now was the rushing around, the fear and the confusion and I dont want that this time.

I have decided on a planned c-section because I can have a spinal tap since i am immune to epidruals for some reason, so I will be awake. It will be a nicer atmosphere because it wont be rushed, it wont be laced with fear and confusion. DH will be able to be with me and he wont faint from stress n wont see any blood. I will remember everything of this birth as being about WHAT I WANT and it wil be positive.

2. I have done VBAC research and am very apprehensive about it. What could go wrong did go wrong with my first pregnancy. I am not going to risk it happening again. I want to have control over this!
VBACs have a small risk of uterine rupture. This risk may be small but too high for me to risk my childs and my life on it. 1 in 200 is just too much for me. I already get enough pain at the site of my c-section and am scared already of rupture. I dont want to live the entire labour in fear.
At 20 weeks i have a low placenta so i am definately not risking a VBAC just in case this goes wrong as well.
I dont find being on the baby monitor pleasant and if i have a VBAC i will have to have it on the entire time. THis does not count as positive for me.
My hospital does not usually allow VBAC's (well they do but once your in labour they decide to section you-a girl in my last pregnancy class had this happen)
If my blood pressure goes up like it did with my last pregnancy i will have to be induced which will lead to a c-section because VBACS and induction dont go together....pregnancy induced hypertension runs in my family and DH's family.
I am not completely sure about VBACs and i was told you have to be completely sure and positive about your wanting a VBAC in order for it to work safely.

[MissLou]

Clairbear,
I'm totally with you! I had a shocking first preg experience which ended up as an emerg c/s. I'm due in Feb 07, and had thought about VBAC for this time around, but wanted to be in control due to the horrid way things turned out last time. Let things be safe for both mum & bub I say - any risk is too high for me.

[clarebear1983]

Clairbear,
I'm totally with you! I had a shocking first preg experience which ended up as an emerg c/s. I'm due in Feb 07, and had thought about VBAC for this time around, but wanted to be in control due to the horrid way things turned out last time. Let things be safe for both mum & bub I say - any risk is too high for me.

I AGREE-any risk is too high!!! and would you believe when i went to my antenatal appointment monday night the midwife dared to ask me "what dont you like about VBACs" and when i said everything she had this really rude look on her face. I mean, I have already had it written down that i want an elective c-section so im sick of getting the third degree every time i get a new midwife! And its not like the hospital has a high VBAC reputation anyway!!! If they want to change my mind PROVIDE ME WITH INFO THAT MAKES ME BELIEVE ITS 100% SAFE AND I WILL THINK ABOUT IT but i am NOT RISKING MY LIFE AND MY BABY'S LIFE because I almost lost my first

[rachdent]

Hey gals

Just wanted to say thanks for your thoughts on VBAC vs Caesarian. I found myself nodding at much of what I read. As long as people are happy with they're choices and not forced into either way, then all is good...

Keep the thoughts coming please!

[Mrs Potts]

Hi Rach

My first pregnancy ended with an induction 10 days overdue. All went fine, I dilated to 9cms after about 10 hours (yes, 10 hours!). At that point, my contractions stopped. Fortunately for me, my bub wasn't distressed but a c/section was called for. It was the most wonderful thing I had heard that day!

When I became pregnant this time, it didn't take long to decide that I wasn't prepared to try for a VBAC as long as there was a chance that there could be similar issues. I was lucky that my Ob was very supportive of this decision.

That second c/section occurred last week. My recovery this time has been (from memory) much easier. The lead up to the surgery was very relaxed, which I think has made a great deal of difference to me mentally and physically.

I'd be happy to answer any other questions you might have.

Cheers

[Goosie22]

Hi,
I was bullied into it.

I was not permitted to attempt a VBAC due to the time of year(being due 31 of DEC) The hospital didnt allow it over Xmas:thumbsdown: .

[jembelina]

Hi,
I was bullied into it.

I was not permitted to attempt a VBAC due to the time of year(being due 31 of Jan) The hospital didnt allow it over Xmas:thumbsdown: .

*jaw drops to the floor*
What a crock!!!!!

[Briannabear]

Hi,
I was bullied into it.

I was not permitted to attempt a VBAC due to the time of year(being due 31 of Jan) The hospital didnt allow it over Xmas:thumbsdown: .
Geez thats a bit lousy! :eek:

[mamawu]

[ im sick of getting the third degree every time i get a new midwife!

I think that the midwife lobby is the worst for disrespecting women's right to chose how they will give birth. I had a c-sec for my DD and formed the view that the midwifery lobby in particular would rather a woman suffer all sorts of hell than have a c-sec. I respect that a c-sec is for some a fate worse than death but all I ask is that they respect that for me a traumatised labour is my idea of hell. I don't push anyone else under the knife - so why should I be forced to endure the third degree about what to me would be unnecessary pain and anxiety of labour? I got pregnant to have a baby not necesarily to have a labour or be bullied by midwives!

[pickles]

just a little side note the rate of uterine rupture for VBAC is much lower than 1: 200. The problem is in order to reduce the risk of any complications you need to ave everything 'normal' - normal pregnancy, not overdue by much, going into labour yourself and as little medical intervention as possible. It also needs to be something that you have psychologically prepared for. Birth can be a wonderful and empowering experience regardless of how it happens. Good luck to everyone and remember you can still have a 'birth plan' for an elective c/section :- music, drape dropped for the actual birth, photographs etc.
Pickles
DD 02/03
DS 03/05

[paulswife]

i had an emerg c/sect with DD (now 15 months) & am now pregnant with DD #2 due in dec. i would like to have a vbac, but to be honest, i am petrified! the pain is what scares me more than anything & i think i would rather have another c/sec. but hubby & i want 3 kids, maybe even 4. isn't there something out there that says you can't have too many kids via c/sect? can anyone tell me what the dangers to mother & child are if i go for a vbac?

(sorry to cut in on your original thread!)

[Briannabear]

I have PM'ed you Paulswife! :)

[angcaltam]

Here is what I've had & how my recovery was with each:

:yelclap: DS1 - induced due to being well overdue, took 2 days to get things going then it was just under 8 hours of labour and in the end it was 1 push and he was between my legs, 1 midwife was still out of the room and the other was at the end of the bed not ready yet. I didn't even get a graze from him, and felt fine straight away.

:confused: DS2 - I was induced again due to being well overdue, this time everything started faster. They thought he was going to be about 9 pound and they knew I could handle that no worries. But then after 2 days of being in labour and being fully dilated they decided to opt for an emergency c-section because there was something stopping him. I had staples with this one. So that is what happened and my recovery was the worst thing I have ever been through. I was still bleeding after 6 weeks because they had left a bit behind so had to go through a D&C while I was still trying to get over the c-section. And I swore that when I was going to have #3 I would do my best to have a VBAC.

:banghead: DD - Well, I had a Dr that was supporting my decision to try for a VBAC so I thought that was a good thing. He let me go 2 days over to try and let me go natural. I went to see him 2 days after my due date only to find that my pubic bone had moved into the way of the exit. I was crying because that meant that there was no way I could have my VBAC that I really wanted. So there was really no choice but to have a c-section. So the Dr rang to see when it could happen as it was easter time, so they booked me for good friday which was in 2 days time. I was so scared of what I was going to have to go through after. Well, we turned up to the hospital the morning of ready to go. Well, DH got to be with me both times but got to enjoy this one more as there was no panic. We went in and she was born. My recovery was so much fast then the last time, and I was home 2 days later, but with the midwife coming to the house. She got to take the stitches out and everything at home.

The only thing is that I found, with DS1 I bonded with him straight away then DS2, it took me a little longer and I got slight PND, then with DD I'm still trying to bond and she is just over 4 months old. I feel like the worst mum in the world for this and believe that it is because I couldn't have natural births with them.:gloomy:

DS1 was 7 p & 9 o
DS2 was 11p & 2 1/2 o
DD was 7 p & 13 1/2 o

If you have any questions for me please feel free to PM me.

[Tracie]

Hi Paulswife,

This is link to another thread where I posted some of the evidence based info relating to VBAC vs CS. Might help with some of your questions?

http://www.bubhub.com.au/community/forums/showthread.php?t=33925

Cheers
Tracie

[TigerBlueBear]

I AGREE-any risk is too high!!! ..... PROVIDE ME WITH INFO THAT MAKES ME BELIEVE ITS 100% SAFE AND I WILL THINK ABOUT IT but i am NOT RISKING MY LIFE AND MY BABY'S LIFE because I almost lost my first

Rach your article sounds like a great idea, but an observation that you might want to consider working into it is the issue of risk perception by women. I have come across many times comments by women which shows they were either misinformed or not informed regarding certain risks. I myself fell into this category with my first pregnancy - and the comments Clare made about wanting a risk free birth highlighted to me once again how our perception of risk can be distorted. (Although I think it more likely her comments were to make a point rather than a demonstration of misunderstanding of risks.) If this concept appeals to you to work into your article feel free to plagarise anything I have written here.

It is every womans right to choose her mode of birth and her right to have whatever reasons we want for choosing to birth the way we want.

However one thing we do need to do is to make sure the choice we make is an informed one - and not just informed but also balanced. This means that you cannot just accept information from one source - you need to consult various sources in order to ensure the picture you have is complete and balanced. Many care givers are very biased in their attitudes to certain procedures or philosophies even when medical evidence may not support their position.

All birth whether it is VBAC or CSEC carries a risk to both the mother and the baby. In both cases both the mother and/or baby can die or suffer permanent injury. So no matter how you choose to birth you have a risk. The only risk free way to have a baby is adopt.

The issue with VBAC or CSEC is not that one is safer than the other as the studies conflict on this. A number of studies have shown that a repeat csec is marginally safer than VBAC, the majority of studies show the overall outcome risks of both are roughly the same and the latest study shows VBAC outcomes are safer than csec outcomes. The opinions you will get from your obstetrician or midwife will also reflect this range as their opinion will depend on what they have read, what their personal experiences are and their attitude to birth as a whole.

There is a risk of uterine rupture during VBAC labour - there is also a risk of uterine rupture during an ERSC as well as there being risks of uterine rupture if you have had an abortion, any uterine surgery, more than five children - even if you have never had a CSEC before. The VBAC risk is less than 1 in 200 and the risk of the baby dying from it is less again, especially if your last scar was a lower segment incision. The statistics related to deaths from uterine rupture often include women who have had prior classical incisions or who have had catastrophic ruptures from events usually unrelated to a prior caesarean - these do have high death rates as the rupture tends to be totally unprepared for, and occurs in the vascular upper segment, resulting in high blood loss and extrusion of the baby.

Uterine rupture is just one very small risk, and compared to other life threatening risks during vaginal birth such as placental abruption, cord prolapse and fetal distress, is way down on the list of things to worry about - if you want to worry about things.

Now onto those wonderfully 100% safe caesareans. Mothers and babies die from CSECS - and not just the ones for whom it is an emergency. There are a proportion of women who have ECS for non emergency reasons who die or loose their babies. The rate is actually higher than it is for uncomplicated vaginal birth deliveries, as is indicated in several studies.

There is also the risk of haemorrage, amniotic fluid embolism (according to some), deep vein thrombosis leading to heart attack, stoke or pulmonary embolism, infection, fetal respiratory distress - thats just to name a few.

The reality is that like VBAC the risk of these things occurring is very low but there is a risk all the same.

The issue is not so much then of having a risk free birth but of identifying what the risks of both modes of birth are and deciding which ones you want to accept. Then in addition to this you need to factor in what are your beliefs in relation to birth, how do you perceive you are controlling a situation if this is important to you, how will you recover, what support you will have etc.

All of these factors weighed up together is what women should be using to decide if a VBAC or CSEC is right for them.

There are some people who are very radically pro one way or the other - often their motivation is that they feel that other people have missed out on vital information that would allow them to make a truely informed choice.

Try not to take offence at the midwife who wishes to point out the pros of VBAC any more than you would the obstetrician who wants to highlight the cons. Listen to both, do your research and make your decision, or in the case of the girls who have already made it - stand by your decision knowing all the facts and options.

And what did I do. Well I have a background in risk analysis and interpretation (among other things). I read about a million journals and books (well it felt like that many but I do know it was over 100) and I developed a risk profile matrix which included my personal factors related to my carer, my philosophy, my support etc. I then considered my different options including planned csec, csec at commencement of natural labour (private and public), VBAC at hospital (private and public), vbac at birth centre and vbac at home. I got hubby's feelings on it and after much soul searching decided the best option for ME was the vbac in hospital. I had a 27hrs labour and a fantastic birth that I would not swap for the world. I was in total control the whole time, with an obstetrician who supported me and my choices fully. My plan included a csec birth plan but we didn't need to use it. I did the same thing for my third child but this time (having moved) could not find an ob who would support me in the way I wanted. After much fighting for it I had my 2nd VBAC as a waterbirth under the care of birthing centre midwives - another stunning experience.

My experiences would not suit everyone, so it does not mean because they were right for me they would be right for everyone. But even if I had had another csec I would have been satisfied as I knew the risks and I made sure my team would support the birth experience I wanted regardless of whether my baby was born between my legs or through my tummy.