VBAC vs. scheduled repeat c-section - pros/cons

[babyjonesmama]

I would like to discuss pros and cons of trying a VBAC versus scheduling another c-section. I had an extremely traumatic birth with my first child, and ended up with emergency c-section. Without going into long details, he was OP, vaccuum failed, epidural ran out, I felt them operating on me, and was put under general anesthesia. Following the surgery, I was drugged up, in severe pain for months, and really felt like I missed out on the first important few days and weeks of my son's life. I also didn't sleep for a full week, two days before his birth and the whole 5 days we were in the hospital. I just really wasn't there.
While my gut instinct is to try for a VBAC this next time, part of me wants to consider the other option. If I scheduled a c-section, I could be well-rested, alert, present, and actually there to greet my baby as they enter the world. I missed out on all that the first time, and I feel awful about it. I realize that if I try a VBAC and it doesn't work out, I could end up in the same situation again this time, missing out on the birth and the first days altogether. Does anyone have any insight on this? Has anyone chosen to do a repeat c-section for this purpose?

[roadfamily6now]

I had my first baby via c-esction after 12 hours of labor. Turns out she was footling breech.
My next 5 pregnancies were all VBACs, including one at home (UBAC)
My last pregnancy ended in a scheduled c-section for no other reason except I am stubborn and I get my way (long story and I would love to share it if anyone is interested)
Anyway, yes, I have seen both worlds and in my personal experience I can say that there is nothing Pro about scheduling a c-section for no medical reason.
Sure, I knew when baby would come so I could plan my life around that. I am a Doula and a Childbirth Educator so I Knew exactly what I was walking into and that did not make my recovery any easier. In fact, for me, my second c-section recovery was brutal. I was abandoned by my support person once baby was born and all alone in the OR for nearly one hour while they continued to stitch me up. Because I was a surrogate, I did not even have a baby to care for and I am thankful for that because it took me a long long time to fully heal physically after the surgery. Emotionally I was fine about the baby but I beat myself up pretty badly about having chosen that path instead of just doing a VBAC.
It's been 2 years now and I still regret it but I am healing and dealing. I would choose a VBA2C over a c-section for any future pregnancy.

Good Luck momma!

[AustinMom]

Originally Posted by babyjonesmama

While my gut instinct is to try for a VBAC this next time, part of me wants to consider the other option. If I scheduled a c-section, I could be well-rested, alert, present, and actually there to greet my baby as they enter the world.

Just to let you know, a well-rested, alert, present and actually there mama is QUITE common after a well supported VBAC. I'd venture to say more common with a VBAC than with a repeat CS.

Look into the NIH conference if you want some science behind safety and which is a better choice medically.

Also, emotionally, I don't see how a repeat CS is better at all. It seems to me like you have a lot of healing to do, which is what makes you want to avoid the trauma of your previous birth, and not so much a cesarean section or a VBAC that ends up with a cesarean. I'd heal from that. Rebounding From Childbirth Towards Emotional Recovery is a wonderful book, it helped me A LOT. Interview more than a few care providers and Doula (you be best off with a Doula) before you choose one and make sure you bring this up with your interviews. Let them know you want to avoid trauma, and how they are going to do that. Our Doula said something wonderful, "I can't guarantee you a vaginal birth, but I can guarantee it won't be traumatic for you or your baby." That's the stance a care provider should have, and as a care provider they should encourage you to do what is safest for you and baby, and that's not a repeat CS, and that's not avoiding identifying the pain that was caused by your last birth and just scheduling a repeat CS.

Join your local ICAN group, or just go to a meeting and check it out and get some insight on how to avoid birth trauma. There are lots of supportive women there who are in your same position.

Much love to you. Feel free to PM me if you want more info.

[mamatoElias]

I am a maternity center nurse and I have seen a lot of VBACs and a lot of repeat c-sections though I have not personally had a c-section. I think a successful VBAC can be a wonderful, healing experience for the whole family and I am 100% supportive of women who want to VBAC (or HBAC).

That said, I think a repeat c-section can also be a healing experience (no flames please!). You most likely wouldn't have a general this time, so you could be awake and aware for your baby's birth. Find out if your hospital will keep baby with you or if baby will have to go to the nursery while you're in recovery. I would suggest either finding a hospital that doesn't separate mom and baby or working to have an exception approved ahead of time. My experience is that most (though not all) women who are having scheduled repeat c-sections do so much better the second time around. I'm not sure why though I would assume part of it has to do with not laboring for hours or days before the surgery and part has to do with knowing what to expect. These women seem to have better pain control and get up and around much easier post-op. Overall, I would say most women who choose a repeat c-section would rate the experience as fairly positive.

You might consider the reason for your last c-section as you make the choice to VBAC or repeat. If your first baby was breech or asynclitic or was distressed due to cord compression, it is an issue that is likely not going to repeat itself. In these situations, I would definitely VBAC. If you truly feel that baby was too big to fit, even after pushing in different positions with a care provider who was willing to be patient and let baby come in his/ her time, I MIGHT consider a repeat. Then again, I see women who had first babies who "wouldn't fit" after hours and hours of pushing and weighed 6 pounds give birth vaginally to 10 pound babies the next time around.

Best of luck with whatever you decide. This a personal choice- there is no right or wrong answer. It is about what is best for you and your baby. I hope your baby's birth is a peaceful and healing experience regardless of what choice you make.

ETA: Sorry for crashing the VBAC forum. I saw this on the main mdc page as a new post and thought I would offer a slightly different perspective since most of the mom's on the VBAC forum are probably very pro-VBAC.

[AustinMom]

Originally Posted by mamatoElias

Best of luck with whatever you decide. This a personal choice- there is no right or wrong answer. It is about what is best for you and your baby. I hope your baby's birth is a peaceful and healing experience regardless of what choice you make.

Bolding mine....
No fire towards you, but I think a lot of women don't know the benefits of labor for themselves and baby even if they have decided on a CS. Baby needs the labor, and so does mom's uterus and hormones, and all that is best when labor starts on it's own as well, so scheduling a repeat CS or an induction is not the best thing for either, even if you do decide not to attempt a VBAC.

[JTA Mom]

I think making plans for both is the best middle ground.

Write a birth plan for a VBAC and a C/S, think about what your 'lines' are and keep them clear.

Perhaps you want to labor for only so long/until a certain threshold (say, you are pushing for 2 hours and nothing is happening). You can also talk to your doctor about anesthesia choices, etc.

In this way, you can go for a VBAC and if you end up with a c/s, you will have control over it in such a way as to mitigate most of the 'bad' stuff you went through the first time.

Ami

[mamatoElias]

Originally Posted by AustinMom

Bolding mine....
No fire towards you, but I think a lot of women don't know the benefits of labor for themselves and baby even if they have decided on a CS. Baby needs the labor, and so does mom's uterus and hormones, and all that is best when labor starts on it's own as well, so scheduling a repeat CS or an induction is not the best thing for either, even if you do decide not to attempt a VBAC.

I agree. Thanks for pointing that out. The benefits of labor should not be overlooked, but I still maintain (IMO) a repeat c-section is a sound choice for some women (though perhaps waiting until labor has started would be ideal). Most OBs where I live will want to schedule a repeat a 39ish weeks. I suspect they could be talked into waiting until 40 weeks, but past that might be difficult. Sometimes its hard to find a MD who will wait much past 40 weeks for a normal vaginal delivery for a first time mom, so you might have a fight on your hands.

[kltroy]

I don't have time at the moment to give you my detailed opinion, but I did want to point you towards an excellent decision-making resource here:
www.childbirthconnection.org click on the VBAC or Repeat C-section link to the left of the page. They have an excellent summary of the *medical* evidence with risks/benefits of each choice.

This doesn't, of course, touch on any of the emotional aspects of the choice, but I think it's a good plan to be well informed about this aspect of your birth decision. Best of luck!

[babyjonesmama]

Thanks everyone for your advice. I have some thinking to do, and baby isn't due until March, so I have some time to think. I believe that VBAC would be best, and most healing for me. I do have a lot of fear, though, of repeating the trauma, the worst of which was just not being there when he was born. Hopefully things will go better this time. I've been looking into ICAN, and I do have the support of a really wonderful doula, so hopefully we'll steer things in the right direction as much as we can.

[LittleBattleAxe]

Big decision! A lot of what you choose would depend on WHY you had the c-section last time.

My 3rd was born via unplanned c/s. It went very well, considering, but I was never fully at peace with it until I visited with my new mw and she told me that she too would have called for a c/s under the circumstances of that birth.

VBACing is a very mental thing; there are a lot of emotional/psychological hurdles to overcome, and I would really encourage you to speak with a MW about your experience, what happened and what might have been avoided, etc. I would also encourage you to find a doula or childbirth educator who will help you to realize the depth of your inner strength, and help you to overcome your anxieties.

[CookAMH]

Originally Posted by babyjonesmama

Thanks everyone for your advice. I have some thinking to do, and baby isn't due until March, so I have some time to think. I believe that VBAC would be best, and most healing for me. I do have a lot of fear, though, of repeating the trauma, the worst of which was just not being there when he was born. Hopefully things will go better this time. I've been looking into ICAN, and I do have the support of a really wonderful doula, so hopefully we'll steer things in the right direction as much as we can.

I'm glad you came here for input. The emotional healing is a huge thing to go through and process, and it's not easy, especially with trauma. Encourage yourself with the truth that every labor and birth is different. Things will go entirely different with this new baby (congrats btw ). Many women here develop birth plans with specific requests in order to avoid a repeat of prior trauma, and that is totally normal. Build your desires for your next birth for exactly how you want it. Envision what is a perfect birth for you - is that laying on an operating table to be cut open or is grunting and striving while you push your baby into the world, into your arms? (I want the latter! ). For me, there are many things in hindsight from my DS's birth that I am wiser about now in order to [hopefully] avoid next time. You have those ideas too, and it can help shape your birth plan. I am sorry you had a traumatic birth - you lived it and it's very real! I agree with the advice to bring this up with your care provider and definitely get a doula. I think the ICAN meetings can be very helpful and healing too. Give yourself the chance to really process what happened, and have faith that it WILL NOT be repeated. If needed, read books about childbirth (Ina May's Guide to Childbirth is very good), read positive VBAC stories (there are many on here!). Learn what the ranges are for normal childbirth and understand the variations that can occur (with things still being A-OK with that labor), and secure the support you need.

[cathicog]

You might also want to read Silent Knife, and the sequel, Open Season by Nancy Wainer Cohen. Also, A good birth, a Safe Birth, by Diana Korte...both excellent references for helping decide which way to go. Planning is key, I think. Physiologically, waiting for labor to start and be in an active labor pattern before calling the midwife/going to the hospital is probably the biggest thing you can do to help avoid future surgery, and trauma. Going in too early(even tho most hc people say to come in then) probably does as much damage as getting Pitocin and the epidural(don't flame, I know some women do need it, especially with Pit). Waiting til contractions are 2-3 min apart, 60-90 seconds long and you can't talk or walk thru them- by that time, active labor is well underway. If you plan a homebirth, you can move freely to get the baby in a good position, and eat and drink to keep your strenght up. Usually shortens the labor too. And since it wouldn't be a first baby, that might probably shorten labor,as well...Hope that helps...

[Storm Bride]

I've never had a successful VBAC, so I can't speak to the pros of that.

I've had two emergency sections, and three scheduled sections. Two of my scheduled sections ended up being after labour started. I honestly can't give you any pros to the experience. I had the most "control" over the last one, and it sucked the least of any of them. But, honestly, they were all miserable experiences and getting my tubes tied the last time around was the best part. I love babies, and I love being pregnant, but I'm profoundly relieved that I'll never face another c-section.

The only good part was being awake when my baby first came out. But, honestly, even that was a double-edged sword, and I had to remind myself constantly that the baby would be better off being with me. For myself, I'd have preferred to be unconscious. Being awake and aware for your baby's arrival is amazing, but for me, being awake and aware while I was being operated on wasn't amazing at all.

I'm not even sure why I'm responding, because not everyone feels the same way I do, and I've heard lots of people say that a repeat can be a healing experience. (Actually, maybe that's why I'm posting...to be another voice...it wasn't healing for me at all.) Maybe it's just that the "awake while being operated on" aspect gets overlooked when people talk about how nice it is to be awake for the baby's birth. That doesn't bother everyone, but I'm not alone in finding it...creepy.

My second son (third c-section) turns five tomorrow. I was talking about his arrival with my mom today, and mentioned something to her that I'll mention to you, as well. Scheduled c-sections have a good rep for being less painful, having better recoveries, etc. That was my experience when ds2 arrived. (Briefly: 1st section was an "emergency", 2nd was schedule with no labour, ds2 was scheduled, but I went into labour first). My initial recovery was comparatively great...good mobility, manageable pain, etc. However, tomorrow it will be five years since I've felt anything resembling normal bladder sensation (I have just enough to be able to make it to the toilet before I pee myself from being at the bursting point). I spent most of a year unable to feel anything in my clitoris. It took months and months to be physically able to enjoy sex (any kind) again. This is all because of nerve damage and numbness from my third c-section. That numbness has also compromised my ability to do kegels, many abdominal exercises, and some stretches in the hip area.

I know what the stats say about section recoveries. But, the reasons I caved in and had my last by section had nothing to do with any of that. Barring the stillbirth of my third son, scheduled c-sections are the most horrifying experiences of my life.

Oh - and my one labour-free c-section didn't go that great. I was less incapactitated than after my first section. (I don't know if that was the lack of labour - it wasn't because I was "well rested", because I'd had insomnia the night before. I think it was mostly because I was carrying a considerably lower load of post-op drugs, and was "allowed" to eat.) However, I was in quite a bit of pain for 7-8 months. My daughter also used to stop breathing as a newborn. She'd just...stop, and then start up again after missing a couple breaths. It was scary - beyond scary - and we were told by a nurse that it's very common with c-section babies. I know it's anecdotal, but she was the only one I didn't labour with, and the only one who had that problem. (That was also the only time I had trouble producing milk or colostrum at first. I've been told that's not related, but I have my doubts.)

I already know I sound nuts, but I thought I'd throw another perspective into the mix. Barring a compelling reason (probably medical, but there are others), I'd never even consider choosing a scheduled section over a VBAC attempt.

[texmati]

Originally Posted by babyjonesmama

Thanks everyone for your advice. I have some thinking to do, and baby isn't due until March, so I have some time to think. I believe that VBAC would be best, and most healing for me. I do have a lot of fear, though, of repeating the trauma, the worst of which was just not being there when he was born. Hopefully things will go better this time. I've been looking into ICAN, and I do have the support of a really wonderful doula, so hopefully we'll steer things in the right direction as much as we can.

Oh mama, my heart goes out to you! I had a gen anes birth with my DS 10 months ago, and I'm due with a suprise baby in January. The most awful part of my experience is the abscense of memories-- birth, nursing, holding him, the first few days-- gone forever.

I remember a nurse laughing at me when I told her that I wasn't there when my son was born. I feel sometimes that even a repeat section would be better than missing it entirely.

[pacificbliss]

This was a tough decision for me too. DS was a c-section. He was born at 41 weeks 2 days and was 8 lbs 12 oz. I labored 46 hrs total and spent 10 hrs stuck at 7 cm. We tried everything. He was asynclitic. I was devastated, I felt like a failure. The c-section itself was ok. The hospital is"baby friendly" so he went to my chest within 5 minutes, never left the room and I had him on my chest as they wheeled me to recovery. I receovered physically pretty quickly.

Since I felt like such a failure after having DS I knew I wanted to try for a VBAC. I wanted to set myself up for success though so I talked to my midwives. Since I went into labor on my own and go to 7 cm and asynclitic presentation was the reason for the c-section they felt like I would be a good candidate for VBAC. I decided if I needed indution or pitocin for any reason or if I went past dates I would opt for the repeat c.

In the end DD was born at 38 weeks 1 day by drug-free natural VBAC. It was very healing for me.
I should say both babies were beautiful newborns with apgars of 9 and 1 and 5 minutes. They both took to breastfeeding without any trouble and the healing time was about the same.

So, now that I have rambled all I can say is you need to look in your heart for what you need to heal. If you decide to try a VBAC talk to your health care provider about how to keep the situation under control. It sounds like the most important thing to you is to be "present" for the birth. I think that can be achieved with a c-section. Talk to them about how to make that happen.

Again, sorry for rambling. This decision and outcom are very close to the surface for me still as DD is only 8 weeks old. I hope whatever you choose you get the healing birth you need. Congratulations on the pregnancy.

[HeatherB]

I also had a GA c/s for my first birth. I know all too well the feeling of not being their for your child's birth. After working very, very hard in labor for him, that was one of the most devastating things for me - not just a c/s, but not being there, not seeing him, not knowing where he was or what was happening. I *still* don't know the details of his birth or first hours? minutes? (I don't know how long it was) because I wasn't there. And when I did wake up and my DH was holding him for me to see, I could only see a blue figure and a blanket in his arms - there were no faces, no baby, because my eyes were cloudy from the anesthesia. That is not how we are supposed to meet our babies.

I've since had two HBACs and am pg with another due in November. My first HBAC was VERY healing for me. I got to the place in labor where things went wrong with my first, and yet I got PAST it. I had *amazing* support - an immensely supportive and patient MW with tons of experience, her assistant, my DH who rode the roller-coaster of emotions with me, and even my chiropractor who came and adjusted me while in labor to help ensure baby wasn't asynclitic again - and they all played a vital role in the success of that birth. I think the support is crucial for a VBAC, and therefore *highly* recommend HBAC with an excellent, very experienced, very supportive MW.

Even though I tore a good bit with my 2nd birth, I could get up! I could walk into the living room and eat birthday cake! I could roll over in bed and sit up and nurse my baby and do ALL of those things with only a small fraction of the pain I had with the c/s. I could pick up my 2.5yo, walk without help, and feel like a living, breathing, member of society.

With my 3rd birth (2nd HBAC), I was feeling amazingly well even more quickly. I had only a tiny "skid mark," and was up trying out my new baby carriers at 3 days, taking him to watch my 5yo play baseball at 9 days, and felt *fully* normal at 2 weeks. I was absolutely amazed by the quick recovery!

Here's an article that opened even *my* eyes to some of the dangers of repeat c/s (and I'm a birth junkie and feel I'm pretty well informed):
http://www.philly.com/inquirer/healt...-sections.html

Each c/s gets more complicated and difficult from a surgical perspective, and increases the risks for future pregnancies and future c/s. It's also harder and harder to get support for a VBAC after more than one c/s (though ACOG officially says you should be able to VBAC after 2, and the stats show that the risk for UR does not go up significantly with more c/s). I really do feel like, in the birth culture we have here, that if you want a VBAC, it needs to be done after the first c/s. That's also why I recommend pulling out all the stops and getting the absolutely most supportive, experienced, and committed team you can for a VBAC. While it's absolutely possible to VBAC after 2 c/s, it's a LOT harder to do.

Hope my rambling helps a bit.

[HeatherB]

I just saw this article from Mothering and thought you might like to read it:
http://www.mothering.com/pregnancy-b...after-cesarean

[VBACMama2007]

I just wanted to say from my experience, when I was making the choice to VBAC, to me it was a matter of common sense. Repeat cesareans equal many many more complications and a longer recovery time. I had no support from my family when I was going for my VBAC (they told me my "uterus didn't work"...yeah, I know ), just my husband and my midwife. Turns out that was all I needed. I think I had to get over a lot of stuff in my head before I had my VBAC. Reading Nancy Wainer Cohen's books helped me a lot and so did Ina May's Guide to Childbirth. My opinion is that, ANY option is better than surgery (unless you NEED one for medical reasons). I agree with one of the PP who said that women need labor and so do the babies. After my c-section, my son came out wheezing because of the fluid in his lungs and listless because of the epidural. He wouldn't nurse at all and the experience was just traumatizing for me since I could feel some of what they were doing. I had pain for at least a year and instead of nursing my son, I had to pump. Also, I think I dealt with post traumatic stress too because I was terrified to sleep flat on my back for months. I had to sleep in a sitting position. After my VBAC, after 15 mins of pushing, my son was placed on my chest and was breathing fine. He nursed instantly and he was so alert. I had to post traumatic stress. I had minimal pain (2nd degree tear) and was up and moving around instantly. So, from my experience and from my research, I believe that VBAC has many many more pros and cesareans have many many more cons (many woman seem to forget that it is MAJOR surgery). But only you can decide what is best for you and your family .

[jen6]

Hi-

I am on the fly, typing quick, so hopefully this makes sense. I agree that this is a very individual decision, there is no right or wrong. I also agree that the goal is to have a non-traumatic birth, which is going to be defined in very personal ways for you given your prior birth experience. Having had a very medically interfered with, traumatic 1st birth, and an attempt at a VBAC that ended in a uterine rupture and a 2nd emergency c-section, if I had it to do all over again, I would do the VBAC again. Laboring untampered with was amazing and worth everything else that came with it. My son was 9 lbs, posterior, and a few other complicating things happened that led to the uterine rupture. Knowing what I know now,I would focus on a few different things based in hindsight that might have made the experience better. If you want to have a more indepth chat, feel free to PM me.

You can do this! The medical model is focused on self-interest and the fear of losing a license. Most providers will sight scary statistics, etc., etc. I AM the scary statistic, : ), and I say it was worth it!! I think it is easy to think that a "planned" c-section means more control, and a VBAC less. I don't think that is true. I have used this analogy for myself--which I posted somewhere else on the VBAC boards-that birth is like swimming the English Channel. Some people get a calm sunny day and some people get the storm of the century and a leg cramp. You can prepare and plan all you want, no one controls the weather.

I wish you all the best!

[baglady]

I'm struggling with this too. DS was an emergency c/s. I didn't hear the first cries; I didn't see him at the moment of birth and neither did DH. I actually have a video of me holding DS in the recovery room and I have no recollection of the event.

My DH is wonderful in every way except for his ability to react/support in a medical situation/crisis. He freezes and just stands there.

No woman on my maternal side has not ended up with a section since I was born 30 years ago. These were different births in different cities with different providers.

My last doc had a once a c-sec always a c-sec policy. My new doc is very pro vbac. I'm confused. I'm absolutely terrified to miss the birth again. I feel like I don't care if the baby comes out of my ear I just want to witness it.