VBAC vs 2nd caesar?

[Two Little Buggalugs]

Hi ladies,

I was just reading the thread about uterine rupture and your responses have made me question what I'll do for my second birth. I had an emergency caesar for my first and was told that I'd probably have to have a caesar again next time because of that. Given my dd was in NICU, that didn't bother me - healthy bub was the main thing.

Then I read an article written by a mum who tried a VBAC and the baby went through the rupture and died. I was in tears, I couldn't imagine going through a pregnancy to lose the baby at birth. Even though the writer herself pointed out that this was extremely rare, my only post birth hormone-fuelled thoughts were that I didn't want to take even a small risk if it meant what this poor lady had gone through.

But the hormones have subsided and you've all raised some good points. My question is, since I laboured to dilation before my first caesar, what are the risks associated with VBAC vs a 2nd caesar? Are there any stats to compare or is just too individual a thing?

I was also told I would have to wait 2 years at least after first bub - is this always the case? I've read some other threads where caesar mums have had their 2nd closer than that.

[jade21887]

I personally, had a vbac 15 months after my daughter (emergency c section). It went really well. Look into all your research, Im pretty sure that having a vbac is safer than another repeat c section. look at birthrites.org (i think it is, otherwise google birthrites)

[lilpearl]

All studies show that a VBAC is far safer than a repeat caesarean (despite the fact that a lot of obs are very knife happy). If you ask an obsetricain for proof that a repeat caesarean is the safer option,t hey simply wont be able to come up with it. There is, however, lots of proof of VBAC being the safest option (in most cases - unless there was an underlying medical condition which meant caesarean was safer, or a particular problem during pregnancy). Most studies show that even a classical scar VBAC is safer than repeat caesarean. Also remember, that anyone can have a uterine rupture, even in their first pregnancy,a nd that a rupture without a scar is in fact more dangerous than a rupture of a low-segment scar, which rarely causes any problem for mother or baby, and which has never killed a woman (far less likely to killa baby than an un-scared rupture, too).

You should find lots of info at Birthrites (www.birthrites.org), which is a site dedicated to "healing after caesarean"....you can get onto mailing lists, and if you become a member, you'll get a quarterly newletter filled with info and lovely birth stories (VBAC and repeat caesarean).

Good luck with YOUR decision. :)

[becca74]

There is a 99.5% chance that your uterus will NOT rupture, which sounds like a pretty guaranteed win in that lottery, to me. That is they way I percieved that risk when making my decision to have a vaginal birth last year.

In terms of litigation, Obs are afraid that there is a 0.5% chance that they will be sued...it is too high for them, if you can imagine, to risk their financial future on those stakes. But your birth is about you, not your Ob. They also have a 99.5% chance that you will not sue them for having a UR as a result of vbacing.

The risks that I took into consideration when planning my birth last year were 1) that i was in good health 2) that my baby was in good health 3) that I didnt have placenta praevia 4) that I didnt have placenta accreta 5) that I didnt have pre-eclampsia. If any of those 5 things had been a negative, I would have seen it as a flashing red light to have a planned c/section.

Everyone has different comfort zones, you may have more points to take into consideration than the 5 I had. It is good to write up a pros and cons list, and research as much as you can to add to your pros and cons list. (I think I might bump up the vbac support thread, keep an eye out for it, it has valuble info in it).

Also, by about 6 months, your scar will have healed completely. You should be fine to ttc by about 3 months after you have your baby.

good luck with your decision making, I wish for you a beautiful sacred birth experience no matter what :thumbsup:

[Two Little Buggalugs]

Thanks for that info. I feel like I recovered well, so it's nice to know I've got options for the next time round.

Just wondering though, do I need to watch for some obs charging more for a vbac than a repeat caesar? Or is it always the same fees?

[lilpearl]

I don't think they can charge more for a VBAC. However, I have no personel experience of obstetricians at all (midwives rock!).

[Hokey Pokey]

I personally, had a vbac 15 months after my daughter (emergency c section). It went really well. Look into all your research, Im pretty sure that having a vbac is safer than another repeat c section. look at birthrites.org (i think it is, otherwise google birthrites)


I totally agree. Also try to shy away from scare tactics people may try and tell you otherwise!...... ;)

[Happy mum]

Hi

I am only new to this site but just wanted to add my advice on this issue. I am currently 35 weeks preg with baby number two and am planning a vbac (Due 26th Feb 07). Up until a week ago baby two was breech (as with baby 1 born by elect c section for breech at 38 weeks in Oct 2004) and it was looking like a second caeser but baby has turned and is head down now so vbac is back on yay! I agree with the previous advice if you have no known medical reasons for the c section it is apparently a safer option for you to have a vbac. My main reason for choosing vbac was I hated the thought of not being able to pick up my two yr old son for a cuddle for 6 weeks! I knew he wouldnt understand why mummy couldnt pick him up but could pick up the baby so the recovery time was my biggest descision making help. I am nervous about the vbac but what woman isnt nervous to some extent about the birth wether it be natural or by caeser? All I can advise it do what feels right in your heart. Only you can determine what that is and dont let anyone elses pressures sway you either way unless it is for genuine medical reasons. Good luck with whatever way you choose to have your baby.:)

[Two Little Buggalugs]

Thanks for the input Nicole. I hadn't thought about picking up DD after a 2nd caesar, very good point.

Will you post a thread to let us know how your vbac goes? :)

[flib]

I've had 2 fantastic vbacs. They turned out to be totally uncomplicated normal, natural births without any stitches or tears. Who would have thought this could happen after a 36 hour labour and a baby that got stuck!?

It was so wonderful to be a new mum who hadn't just had surgery! especially when you have other kids to go home to!

Good luck.

Flib

[Briannabear]

I had planned for a VBAC but ended up with another c/s (non emergency one though).
It was really hard coming home to a toddler while recovering from the c/s. My wound took forever to heal because I just wasnt getting enough rest.
If I could have had a VBAC I would have absolutely done it.

[Happy mum]

Thanks for the input Nicole. I hadn't thought about picking up DD after a 2nd caesar, very good point.

Will you post a thread to let us know how your vbac goes? :)
I will let you all know how things go with my vbac. Looking forward to experiencing natural birth so that I can also compare the two. My caeser was great, quick recovery and not to uncomfortable through the whole thing but the vbac will hopefully be alot easier. Another thing people need to keep in the back of their minds with vbac is that you can not be induced if you go overdue. My hospital will give me to 10 after the due date to go into labour on my own and if I have not done so by that time I will have to have another caeser. There is always that chance with any birth that a caeser might be needed so never completely rule it out and then you cant be so disappointed when it has to happen. Thats my motto anyway. In response to Nix06 I will deffinately post a thread once the baby is born to let you know how we went.

[Two Little Buggalugs]

Gosh, I'm so clueless. I didn't even know you couldn't be induced with a VBAC. Is that because it would make labour too fast? Just goes to show, we're never completely in control of our bodies! Good luck with your natural birth Nicole. Look forward to hearing your experience and happy baby news!

[Shanaynay]

NIx, you can be induced with a VBAC. There are different risks associated with induction so different Obs and hospitals and have different policies. Some won't induce at all, some will go the whole hog.

So are you still shopping around for an OB? Why not save your $$$ and go public? Research shows you have the best of a VBAC under the midwifery system :thumbsup:

[mummyof5]

I had my waters broken by my m/w at home with my first HBAC, as I was at that point 16 days over, and was booked in for induction at local hospy anyway the next day. I had her the next morning, never had to go to hospy.
Personally, if i was hoping to acheive a VBAC, I would go with a midwife...

[Happy mum]

I had no idea other hospitals are doing inductions with VBACS. Sorry if my post was misleading. The hospital I am booked into do not do inductions with vbac because there has been evidence to suggest that the oxytocin or prostaglandins they use to induce your labour can soften the uterus and can increase the risk of uterine rupture, so I guess they dont want to take the chance. I have also been told as soon as my labour starts waters break, that I have to go straight to hospital to be monitered constantly (again normal practice at my hosp), so unfortunately I will spend most of the labour flat on my back in bed hooked up to a monitor but I still think the vbac will be easier.I am also going public and through the widwife clinic, and have found them to be wonderful. The midwife I have seen the whole way through my pregnancy has been really supportive of any decisions I have made. I guess you just have to check with your ob or hospital as to the regulations and rules they have in place for VBAC.

[nats]

I have also been told as soon as my labour starts waters break, that I have to go straight to hospital to be monitered constantly (again normal practice at my hosp), so unfortunately I will spend most of the labour flat on my back in bed hooked up to a monitor .

I wouldn't have thought that being constantly monitored would mean you had to be flat on your back :confused: You should still be able to assume the best position for you. If you think that having monitors on is too restrictive (want to use the bath etc...) you don't have to it! A good point to argue is this - Why should you be constantly monitored if there wont be any one there to constantly monitor the monitor IYKWIM.
:fingerscrossed: all goes well .... just keeep on reading :thumbsup:

[Mumma2Jack]

Hi all,
I am new to bub hub and so glad i have stumbled across this thread.
I have been so confused over this matter for a couple of weeks now.

I had my son by emergancy C section 19 months ago and i am now 19 weeks and due the end of June.

I always wanted vb with Ds but did what had to be done.I would love to have a vbac with this one.
I talked to my ob about this last week and he said that i am more than willing to try BUT...(always the BUT!)
There runs the risk that scar might tear and put bub in danger.I would never want that to happen.
Dh and i have alot of trouble getting pregnant.
But im in two minds as there are risks either way i go.
I am planning on asking my ob for some facts when i see him in two weeks.

Do any of you know if having big babys can also make this hard to have vbac?
Ds was 10 pounds and i dont think the next will be anything under looking at family genes!LOL..

Once again.So glad i found this thread.You all have been a very positive eye opener..Thaniks heaps.:thumbsup:

[kas_chat]

Just a really quick hello. My son was born 22/08/03 after 30+ hours of labour that started 7 days over due. He was 4405g delivered by caesarean. I really, really hope to have a vbac this time around and have been doing LOTS of reading. A very useful website was CARES SA (web address http://homepages.picknowl.com.au/caressa/).

And a very helpful book was Ina May's Guide to Childbirth by Ina May Gaskin which I have just finished reading. I borrowed it from my local library. I also am expecting another baby over 4kg and I know I am having a boy. I am scared of what will happen but am hoping that I am involved enough this time to know at what stages to say not yet to the epidural and continuous feotal monitoring and other medical interventions. I am planning to use water in labour as much as I can and have enlisted the support of a student doula and a special GP who does vbac ante natal care and have enrolled for a special midwife led care program at the hospital where this doctor works. I also am considering a home birth with a indeendant midwife and two student doula's... but are waiting a few more weeks to make my final decision... I want to visit the hospital a few more times and get a bit more familiar with the surroundings. Finances are an issue because I have no private health cover and will be using the maternity payment to cover any costs.
The first two doctors I spoke to with this pregnancy were hestitant and wary when I mentioned I was planning vbac and they did not give me any positive feelings... so thats why I went looking for other options.
I am due on 31 April 2007 and are really really aware of the looming date.
Take care Mumma2Jack... if you don't get warm and caring attitudes look elsewhere and make a few phone calls before you settle on medical carers. YOu can ask them if it is their personal opinion or scientific fact that leads them to give you certain suggestions... and warnings... ie risk of tearing the scar... which study are they saying that based on? Will that GP or Ob be at your labour as well as just appearing for the birth? Who will be there during your labour? etc...
kindest regards and warmest wishes to you...
there's lots of us in similair positions on bubhub...

kas_chat

[Bessie]

I'm just hopping on here in a bit of a rush (wingey bub lol) but just wanted to add that you can get fetal montitoring which will allow you o be mobile, it's remote. You still have belly straps which is annoying, but you don't have huge leads restricting your movement. I think its called remote telemetry.

Also worth considering - the stats for uterine rupture include a large percentage of ruptures which haven't resulted in maternal or fetal death. I transferred hospy at 32 weeks as the doctor at my local hospy recommended a hopsy with 24 hour theatre cover. That way they can deal with uterine rupture in minutes thus reducing neagtive outcomes for mum and bubs.

Its well worth finding which hospy is most vbac friendly in your area. There ar ehuge differences between hospys and some hospys tend to attract vbac friendly staff. Also, stats for CSections show you're much better off for a VBAC in a public hospy.

Good luck!

[Bessie]

Another afterthought lol
Avoid induction at all costs!!! Not only is it incredibly painful (and there are risks already mentioned in the thread) but you want to avoid interventions... google cascade of intervention, basically as you have more interventions the likelyhood of having a CSection increases.
Active birth and birthing positions is another great tool for VBAC. My DS was a forehead presentation and we managed a natural birth by switching postions. Good positioning can also open up your cervix more and decrease pain. Google optimal foetal positioning.
Research as many pain relieving natural alternatives as you can, they are like weapons in your armoury against CSection.
Write a really good birth plan, this will outline your preferences and will still be flexible... just incase.
atb!

[Mumma2Jack]

Thanks you both for your replys.
Its such a comfort to know that there are others out there that understand where i am comming from.

I just had dinner with my family and had a huge debat about this with my sister who insistes that c section is way to go again- no if ,no buts ,just do it.

I was a little hurt as i tried to explain to her that she had no idea how i felt as she had a VB with her DD.She had an awful birth and is scared of anyone having Vb now.
But shes not me.

Anyway.See my Ob next week and will be making sure he takes the time to explain all the pros and cons of both to me.

Thanks again ladies.Great to know somone understands me!:hugs:

[Brenda]

Just thought I'd share my experience. DS1 was 10 days overdue and I was induced. He was born 12 hours later by emergency c/s. For DS2 I was determined to have a VBAC, I hated the thought of recovering from another c/s with a toddler and a newborn. From my first appointment with an Ob I stated that I wanted to try for a VBAC and was told that it depends firstly on why you had the first c/s as to whether that would be on the cards. For me it was due to fetal distress and labour not progressing fast enough so an attempt at a VBAC was fine for me.

I was told that the way to go though was for labour to start and progress naturally ie. Induction going by the stats would probably lead to another c/s. A few days b4 my due date I started to get mild contractions (apparently my body practising) so I did everything I'd read to try and bring on labour, raspberry leaf tea, nipple stimulation etc etc. In the end after two days of practising I went to the hospital and had an internal to be told I hadn't started dilating but everything was favourable for it to start any time. The midwife said that by having the internal that could possible help start labour. Four hours later it all started, waters broke, went to hospital and DS2 was born naturally 5 hours later.

For me VBAC was a wonderful experience! and I'm so glad I got to experience it. I was out of hospital less than 24 hours after giving birth and more than capable of doing everything that needed to be done including picking up DS1.

As all the other ladies have said research the subject as much as you can. I'm pretty sure than when it comes down to simple stats a VBAC (although it does have it's own risks) is less riskier than another c/s.

Good luck with your decision.

[lilpearl]

A really important issue, regarding fetal monitoring....Continual fetal monitoring with a CTG machine has been shown to have NO BETTER OUTCOME for babies than women who are not monitored continuously. The only difference in groups who HAVE continual monitoring and those that DON"T have continual monitoring is that those who DO have a much higher chance of ending up with a caesarean. Remember, that means that those who DON"T have continual monitoring have just as much chance of having a healthy baby, but more chance of a normal, vaginal birth. So, the outcome is only that continual monitoring leads to more incidence of caesrean section. These studies can be found on the Cochranes website, and also in books relating to Caesarean, VBAC, and monitoring during labour. A good bookstore to find these books is Capers online. (Most can't be found in regular bookstores). Furthermore, a midwife having a quick listen to the babies heartrate with a hand-held doppler every 15 minutes or so gives the same information as continual CTG monitoring, without all the hassles and negative statistics that come with it. Basically, CTG monitoring is a lot easier for hospitals, and, they feel, lowers the chance of litigation as they can say "we monitored continuously...we took all precautions", never mind the evidence. Most hospitals only have the midwife come in every 1/2 - 1 hour.....it wouold only take a little extra attention for your monitoring to not interfear with your labour.

The birth centre (within the RPA) where I had my VBAC did not believe in continual fetal monitoring (nor did the regular labour ward). Although I only ever went with midwifery care, I spoke to an obstetrician there once who said that CTG monitoring of a VBAC is completely unnessesary. I completely agree.

[Happy mum]

Thanks for the information Liana. I dont really want to have the continuos monitoring and have brought up this issue with both my midwife and two different obs at the hospital and all have said that I will have to have the continuous monitoring and I will not be able to have an active labour (and they did tell me I will have to stay on the bed the majority of the time). I totally agree with nats earlier post, what is the point of the monitor if there is no-one monitoring it! Doesnt make sense. I will bring up your point of the increased risk of c section with them at my next appt and ask if they can limit the time I will be needed to be monitored for. In the end as long as my baby comes into this world safely and healthy then that is the most important thing to me. You girls are so knowledgeable and have certainly helped me with all the info you provide. Thanks heaps! xx

[lilpearl]

Happy mum - good for you :) I would also like to stress that this is YOUR birth, and it is all up to you, not them and not me, but you - You have the right to REFUSE anything at the hospital that you don't want. If they "make you" be monitored against your will, that is abuse. You have a legal right to choose what you will and will not have done during your labour, and who is present during your labour. This is your birth, not theirs. Also, don't let them "make" you sign any form to NOT have monitoring - that is immoral of them, and really isn't supposed to be allowed. You don't ahve to sign anything to NOT have intervention - it should be the other way around. I would suggest, in fact, that if they push further for the CTG issue, that you ask THEM to sign a written statement that declares that continual fetal monitoring will not lead to a higher chance of caesarean section. See their mouths drop! Good luck! Stay empowered, don't be bullied.