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VBAC Cubby - vaginal birth after cesarean

VBAC vs. Elective Repeat C-Section (ERC)
~ a message board archive
From Trish ~ My first pregnancy was wonderful - no problems. My daughter was late, then later, then very, very late! When I was 12 days past due, they admitted me and tried to induce me (even almost 2 weeks late I was only fingertip dilated with no dropping). They first tried 2 cervidil suppositories. The only thing the second one was successful in doing was breaking my water. Then they hooked me up to pitocin . . . nothing. Barely 1 cm. So 13 hours after my water broke, I had my daughter by c-section. She was 8.5 lbs. (but I am pretty little) I am so thankful it went well and I had a wonderful recovery.

So here we are, 3+ years later and I am faced with deciding between a repeat c-section and a vbac. I have to be honest . . . I am leaning towards the repeat c-section. Part of me wonders if they had induced me on my due date last time, would I have actually had a 7.5 lb baby instead that I would have been able to deliver? Anyway, there's no way to prove that. I just feel like I know what to expect with the repeat. My doctor was supportive about it when I told him. But I feel like I am stuck between a rock and a hard place. The thought of vbac absolutely terrifies me because of rupture, etc.

From miche ~ I personally am very pro-vbac. My vbac was a wonderful and safe experience. Most are. I did a lot of research and believed that in my case the benefits of a vbac strongly outweighed the risks. I don't want to force you into sharing my opinions, but I will welcome you to ask any specific questions you have. I found that despite the scary prospects of a uterine rupture, the real world chances of it happening to me and resulting in a bad outcome were very small and very acceptable to me.

As for people who have chosen a repeat c-section there are some who visit this forum as well! We'll be happy to discuss ideas to help you have a wonderful birth experience whatever your choice may be. There are some things you can do to prepare either way!

From hedra ~ We're here for informed choices - not forced ones! If your informed choice is a c-section, then I don't think that anyone here will think any the less of you. We mostly get frustrated when people don't bother to become informed FIRST.

Small frame doesn't necessarily mean inability to birth big baby. Just like big frame doesn't mean ability to birth ANY baby. I have a sister-in-law who has hips that look like they're designed for birthing from the outside, but even her smallest baby was a 'failed VBAC' (because her uterus heals so well, they let her do a VBA4C attempt!). And I have a friend who is 5'2" on tiptoes and a size 2, who birthed a POSTERIOR 8 lb 12 oz boy with a 14.5 inch head. So don't measure your capacity by the size of your frame. It isn't a fair measure.

My second thing for you to know is that your pelvic hinge will open more on a second pregnancy than on a first - the relaxin hormone will work better this time. Which means that even if there was a true cephalo-pelvic disproportion (which is more often just non-optimal fetal position), that won't necessarily apply this time. Your pelvis is NOT the same size each time.

Next info for your mental hopper: You were induced with an unfavorable cervix last time, it sounds. That increases your risk of c-section, in general. Not that it was necessarily a wrong choice (they did try to ripen first), but it has more risk of not working out. Until you are actually due this time, there is no way to know if your cervix will be ripe sooner. My first son was 15 days overdue (went into labor on day 12 post-due, though, like you). And like you, even without induction, my cervix just wasn't budging - I went into labor with an unfavorable cervix, really. It wasn't until late in the labor that we determined that my son was actually not QUITE lined up straight, and as soon as he turned that little bit, my cervix said 'what? hey! okay, right, off we go!' and I dilated like a textbook example after that. Second son? Cervix was ripening more over time beforehand, and by the time I went into labor I was already 4 cm dilated (on my due date, BTW). It can vary dramatically - don't make the mistake of assuming what WILL happen based on what HAS happened.

Last info for today: (as if it wasn't enough!) My midwives have had good luck reducing the size of a second baby when the first was BIG for the mom by just having her eat organic meats. Whether it is the leaner cuts, or the lack of traces of chemicals/hormones/antibiotics (that are designed to boost growth), or the fact that by doing so the moms pay closer attention to a healthy diet, they don't know, but when moms do that, the baby comes out healthy as a horse, but a good bit smaller than the previous baby. I'm considering doing that, this time. My last boy was 9 lbs 6 oz - and while he was still a fine fit for me, I wouldn't mind a smaller one.

You may find that you will want to leave your options open until the last minute - give yourself a chance to go either way (if you find yourself gaining comfort with a VBAC option), and then have an ERC 'out' at the tail end of the due month. I also recommend writing out your feelings on the subject - it is possible that your feelings are jamming up your decision making, and writing them out will help you decide what is most important to you, what you are willing to go for, what you are willing to let go, and what is really important to you. Because that is a complex equation, writing it out may help you clarify it.

From hunter ~ I've never had a c-section, so I can't comment from personal experience, but I believe the most recent statistics show that more than 80% of VBAC attempts are successful, and the death and injury rates for VBAC are much lower than with ERC. Check out ICAN (International Cesarean Awareness Network) online, they probably have the most current information about that.

You didn't mention what position your baby was in, or how she was presenting, but baby's position can make a *huge* difference from one labor to another. My first baby was in the "proper" positioning and I had a textbook labor and delivery. My next two were in less-desirable positions, so I had to change *my* positions for laboring and delivery to compensate. If you had pitocin, I imagine you probably had an epidural, which probably limited your mobility, which may have kept you laboring in a position that wasn't optimal for the position your baby was in. Here's an article about Optimal Fetal Positioning with some ideas of how to get your baby into a good position and keep him there.

From LadyEo ~ I had an elective repeat c-section. It was a very difficult choice for me but I feel I made the right one for me. One thing I will stress is to do research--read, read, read--on both sides. I was told and believe I was a very good candidate for a vbac, but like you, I was terrified of rupture and other complications with my pregnancy. What finally made me decide was something my doctor said to me. She was supportive of either choice I would have made, by the way. But she told me that since I was so apprehensive about the vbac, I was literally tense when I talked about it to her, it could affect my labor. And I thought about it for a while after that before I decided on the repeat. Since I had HBP, induction at the end of pregnancy was likely and that leads to increase rate of c-section anyway.

All the ladies here will support you in your decision. Like they said, they support informed decisions. Just know what the risks are and make the choice you are most comfortable with.

From hedra ~ If you are comfortable with hypnotherapy, that can help you release your anxieties. (That is, fears in advance not based on what is happening then but on what you are afraid MIGHT happen, usually out of proportion to reality.) That can help you release the tension enough to make the difference. But yes, if you are tense at the mere thought, you need to either manage the fear, or not go that direction. If the fear seems reasonable (not anxiety type), then that's useful info.

This is one of those times when you need info from all parts of you - mind, heart, body, and soul. There are a lot of ways to integrate those aspects, and permit yourself to treat each as a respected voice in your decision. And there are ways to work them together so that you end up with a single conclusion, not pulled in two directions (as it seems you are, currently). Part of that can be just grieving the choice you cannot make because one part of you is holding strongly to a different choice. At the same time, make sure that you don't let any of the parts keep you from finding out what EACH of the parts 'thinks' . . . for example, many people when their hearts fear, don't let their minds examine 'dispassionately' the data that is available. Anything that conflicts with the fear gets rejected no matter what the mind would otherwise say. The same for the soul - a lot of us will let our minds dictate what is 'right for us' based on a data set, without really letting ourselves explore what makes us feel whole, complete, connected to the universe or the Divine, part of something greater, in awe, or inspired to humility or grace. All of those are valid parts of the decision, too. It is kind of like driving a 'four-in-hand' (four horses on a wagon) - you have to communicate with ALL four horses, not just one or another, or the wagon ain't goin' nowhere (or not fast, or it will get tangled). No single horse gets to have all the power, or do all the pulling.

So explore all the aspects - what do you fear and hope, what are the facts (despite the fears and hopes), what does your body say (and how can you respect it best), and what will inspire you to feel complete, connected, and in Awe. Write them up separately, then deal with them individually so that you can get them working together. One or more may have to 'give', but if you treat that as a true loss for that aspect of yourself, and grieve it properly, you won't come out the other side feeling bereft, foolish, angry, or empty.

From Trish ~ Thanks and hugs to you ladies, you sure have given me much to consider. I am, like Anne was, just terrified of VBAC complications like rupture or something else. It scares me because how would they know for sure I had a rupture. Anyway, with all you've written so far, you almost make me think I could do a VBAC. Almost. I have 6 months to go, and I really think I may end up leaning on you. I've started looking at the ICAN link, and just requested a book from the library, "Birth Your Way". It seems astounding to me that an ERC could be riskier. I just want to do what is best.

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