just a rant

[Aries1985]

Another very mainstream board I visit likes to talk about how wonderful repeat c-sections are and how terrible it is to even think of a vbac.

The data, unless my OB and I are interpreting it wrong, seems to indicate that vbacs are really safe, right? Yet people are going on and on about how a vbac is basically a death sentence to your uterus and even your baby! Seriously?

I'm terrified of another unnecessary c-section. If someone can give me a good reason why I need another one, then fine. Sign me up. But, I think it's absolute insanity and even potentially dangerous to just schedule for no reason, right?

Sorry, I'm just so over being attacked for not wanting another c-section because they are "easier".

[kltroy]

Well, it's never quite that clean cut, which is why there is such a difference of opinion. *Everything* has risks and benefits, and at the end of the day we all play the odds.

The new ACOG guildelines do a reasonable job of summarizing the best evidence on some of these (and completely ignore others). For example, with VBAC, the benefit is that the vast majority will have an uncomplicated vaginal birth. On average, 70% succeed in doing so, and this is including ALL women, single or double suture, supportive or non-supportive care provider, obese or healthy, etc etc. On average only about 7/1000 will experience a uterine rupture, and of those about 10-20% will result in death to the baby. So this means that a very unfortunate 10/10,000 will have a very bad outcome.

So those are the risks with VBAC -- generally small. Benefits are very good IF the VBAC is successful. Vaginal birth is better for mom and baby, avoids major surgery, baby has fewer problems, quicker recovery etc etc.

Similarly, there are risks to a repeat c-section, *especially* if mom is planning to have more than one more child. The risks with c-sections go up exponentially with each one, so 2 c/s is mildly risky, 3 is more so, and 4 is associated with a high rate of complications such as placenta acretia, increased blood loss, hysterectomy, pregnancy complications etc.

Everyone agrees that a successful VBAC is always better than a RCS. Most agree that an unsuccessful VBAC (leading to an RCS after attempted VBAC or possibly UR) is worse than simply having scheduled an RCS. But in both cases the risks are so small that it becomes more of a philosophical argument and individual decision.

Some of us highly value the experience of giving birth. Some of us feel that the advantages of having a vaginal birth are worth the possibility of failure, and that the worst likely outcome is that we end up back where we started, which is having another c-section. We know that we can stack the odds in our favor to succeed by carefully choosing a care provider, keeping ourselves healthy, educating ourselves, etc.

Other women may not know or care enough to do these things. They may only want 2 kids and they may be very afraid of labor. They may not have a complete understanding of how labor and vaginal birth benefit a baby. They may be subjected to scare tactics and provider bias.

At the end of the day, we all choose what we think is best. I feel like it is my job as a woman to provide other women with accurate information about their options, and the relative risks and benefits of each option. But at the end of the day, I can't change someone's mind and I don't really try to. I have 3 acquaintences who all had c-sections with their first, and were all "planning" VBACs with their second, though they weren't particularly adamant about it. They went back to the same doctor and hospital with baby 2 as they did with baby 1. They didn't do their homework, they figured they'd give it a shot within the terms that their not-so-VBAC-friendly OBs set. Two of them had CBACs and one had a VBAC despite the odds. They were all fine with the outcome, and they didn't feel "wedded" to the idea like some of us do.

Most women you will find here do feel quite strongly about having a fair shot at a VBAC, and I believe as a board we have a pretty high success rate (though I couldn't tell you what it was -- there is certainly some sampling bias here). So just know that you have a friendly place to come, where we don't think you're crazy here. Your local ICAN group will be another good online and in person place to work through some of the issues that may come up for you during this pregnancy.

Best of luck!

[Aries1985]

Thank you!

I'm just feeling very unsure suddenly because obviously I want to be okay and I want to leave with a healthy baby. This is my 2nd and we do want 2 more. My OB is about as supportive as I can get around here, telling me he's okay with going to 41 weeks, then I can transfer to a high-risk OB to pursue a VBAC. I'm scared of a rupture, but I'm also scared of needless surgery. The risk of infection and other complications is enough to make me want to stay away unless I have a really good reason.

[Kimrose]

Hi there - well first, I'm not unbiased... I had a natural labor/pushing w/my first - which I worked VERY hard for - and the attending OB missed my son's breech position until they SAW his little butt coming. Docs generally are not trained/skilled in breech delivery today - so I had an emergency cesarean/unconscious - even though he was SO close to being born For me - it was traumatic - both emotionally and physically - and I NEVER, ever, ever wanted to experience it again. That said - OF COURSE if it were medically necessary this time around - TRULY necessary - I would absolutely do what I needed to do. The surgery left me with a "T" incision (sligtly higher chance of rupture) b/c my son was so stuck. I'm now almost 19 weeks along w/my second and have done WAY MORE RESEARCH than I would have liked to come to the informed decision that I TRULY think the risks w/VBAC (even w/my scar) are preferable to 2nd cesarean risks. One statistic I've read repeatedly/different sources - is that a Mom is 2 times more likely to die w/a cesarean birth than vaginal. TWO TIMES. It kills me that with all the "I had to have a cesarean b/c I did with my first" - I wonder how often women are told THAT/have it pointed out? I'd bet almost never. Again - the risks may actual be small - but so are the catastrophic uterine rupture rates. All in all - "kltroy" is pretty much right on - that it's a "weigh the risks and make your own informed decision" deal. It saddens me when women sign right up for a repeat cesarean b/c they hear what is often - really - physician preference - that "a cesarean is better" and don't do their own research re: the actual statistics. I was lucky - I did talk to a couple OB's via an online birth board and then a Midwife who's hospital based/works w/OB's - who all would have said "No." I KNEW that not only did I desperately not WANT another cesarean - but that weighing all the risks - I STILL thought a VBAC was a better goal. The other thought I had as I made my decision was that even if I found someone to "let me try" a VBAC (their words), I didn't want to have to "fight for things" while laboring. For me - a homebirth with a great Midwife ended up being my choice. I wish you all the information you need and peace of mind to make the BEST decision for YOU. I would DEFINITELY quiet all the naysaying voices while you gather information and decide - even if that means literally saying you don't want to talk about "birth" for a while at all. Also, if you search for more VBAC info you will definitely find TONS of women who've had successful ones - and lots that were told "No" many, many, many times before having their beautiful VBAC!! GOOD LUCK TO YOU!!!!

[justKate]

Originally Posted by Aries1985

Another very mainstream board I visit likes to talk about how wonderful repeat c-sections are and how terrible it is to even think of a vbac.

The data, unless my OB and I are interpreting it wrong, seems to indicate that vbacs are really safe, right? Yet people are going on and on about how a vbac is basically a death sentence to your uterus and even your baby! Seriously?

I'm terrified of another unnecessary c-section. If someone can give me a good reason why I need another one, then fine. Sign me up. But, I think it's absolute insanity and even potentially dangerous to just schedule for no reason, right?

Sorry, I'm just so over being attacked for not wanting another c-section because they are "easier".

Wow. I'm glad I found MDC before I found that board.

IMO, VBAC is slightly safer for me and slightly more risky for the newborn. When I weigh the risks of a VBAC, I consider my toddler. Putting her first, a VBAC would be best for our family.

[Aries1985]

Originally Posted by justKate

Wow. I'm glad I found MDC before I found that board.

IMO, VBAC is slightly safer for me and slightly more risky for the newborn. When I weigh the risks of a VBAC, I consider my toddler. Putting her first, a VBAC would be best for our family.

That was EXACTLY what I said to my OB. He told me that no one had ever said that to him before and he thought it was a great reason and was very supportive.

[ancoda]

I think you really have to look at the reason for the first C-section and decide if that or anything else similar is likely to happen again.
I had my first by c-section for preeclampsia that was quickly getting worse and worse. This was was partially contributed to by the not very good care I got from by first Ob and his staff. I have educated myself since then and know better how to care for myself during pregnancy and know better the early signs of preeclampsia. So there is a very slim chance that I will ever be in the position that I was with my first birth. I have had 2 successful VBACs and plan to have any future babies by VBAC.

[Aries1985]

Originally Posted by ancoda

I think you really have to look at the reason for the first C-section and decide if that or anything else similar is likely to happen again.
I had my first by c-section for preeclampsia that was quickly getting worse and worse. This was was partially contributed to by the not very good care I got from by first Ob and his staff. I have educated myself since then and know better how to care for myself during pregnancy and know better the early signs of preeclampsia. So there is a very slim chance that I will ever be in the position that I was with my first birth. I have had 2 successful VBACs and plan to have any future babies by VBAC.

Very true as well.

My first c-section I blame on an induction. I was 41 weeks, every one was totally healthy. I'm very lucky in that I have very textbook perfect pregnancies (except for lots of aches and pains!). But, my dd did not tolerate the pitocin at all. Really, if I had just left her alone, she most likely would have been born vaginally whenever she decided to come....but I didn't leave her alone. I learned my lesson that inductions were not a good idea. My c-section wasn't even "bad", either. I healed well. I didn't and don't feel traumatized or that it affected the bond with my dd. I just want something different without the long recovery period this time.