VBAMC--risks to baby and mom

[GrandmaM]

Hi--I'm posting for my daughter since her computer is down. She'll pick up the thread when she gets the computer back.

She is expecting her third baby in December. Baby #1 was CS because mom was pre-eclamptic, had been in labor a couple of days, didn't respond to pit drip, and was told she had to have that baby. Baby #2 was CS because doc didn't want baby going past 42 weeks and first birth was CS.

This time around, mom wants to consider a vaginal birth. Due date is 3+ years past second CS, 5 years past first CS. Mom is now age 31 and in good general health, busy active SAHM with two little girls, chickens, garden, etc.

Two questions:

What are the risks to a baby going past 42 weeks?

What are the risks for a 3rd CS?

Thanks!

[katelove]

What are the risks to the baby in going beyond 42 weeks?

There are a number of risks to going beyond 42 weeks. As with repeat c/s the percentages are very small but increased nonetheless. This article http://emedicine.medscape.com/article/261369-overview talks about the risks of going beyond 42 weeks. It is referenced so you can check the sources. *However* it is an article written for health professionals not pregnant women so it doesn't soften the information at all.

What are the risks of repeat c/s?

This is an abstract of an article looking at the risks of repeat c/s. The percentages are small but, as you can see there is an increase with each c/s.

http://www.ncbi.nlm.nih.gov/pubmed/16738145

If you google, "increasing risk with repeat caesarean" then you will find lots of other articles but they all say more or less the same thing

My personal opinion is that these are difficult decisions to make and there are very valid arguments for going either way. I am not comfortable with going beyond 42 weeks myself but there are plenty of people here who are so hopefully some of them will respond and link the resources which helped them make the decision to go further.

[Ms. B. Sprout]

There are some risks for VBA2C and for multiple RCS set out in the NIH VBAC Consensus Statement. Mostly, though, it compares the risks of RCS and VBAC. Still worth a read, I think.

Maternal mortality and the risk of hysterectomy increase with an increasing number of cesarean deliveries. For hysterectomy, from the NIH statement, the numbers are: 

420 for one prior cesarean delivery, 900 for two prior cesarean deliveries, 2,410 for three prior cesarean deliveries, 3,490 for four prior cesarean deliveries, and 8,990 for five or more prior cesarean deliveries per 100,000

On the other hand, the risk of uterine rupture, the only risk specifically associated with VBAC, does increase with VBA2C. From the NIH statement: 

A recently published meta-analysis revealed that increasing number of prior cesarean deliveries may increase risks of uterine rupture; two or more previous cesarean deliveries were associated with higher rupture rates(1,590 per 100,000) than one prior cesarean delivery (560 per 100,000).

Those numbers almost certainly include women who were induced, however, and that artificially raises the reported rupture rates in the studies that were meta-analyzed. Furthermore, relatively few ruptures end catastrophically. Here is some info on catastrophic versus asymptomatic rupture. And more info here.

I was quite worried about rupture as I was in the beginning planning stages, but I looked over and over the numbers and eventually reached a comfort level with the risk. One thing that clarified my thinking was to compare the risk to other, OB-approved procedures. For example, amniocentesis carries a risk of spontaneous miscarriage that is roughly equal to the risk of rupture (all rupture, not just catastrophic) in a VBAC, but OBs routinely order that procedure.   OB fear of VBAC is fundamentally irrational when you look at it that way.

I am planning a VBA2C for September, and frankly rupture is only a very small concern of mine. I am far more concerned about optimal fetal positioning so I can push this baby out!

I know you didn't ask about rupture, so I'm sorry for rambling on about it . Best of luck to you as you make this decision.

[betho]

Hello!

I'm the daughter and thanks for the replies.  I've got some reading up to do.  One minor correction - my second wasn't that the doc didn't want to go past 42 weeks, he didn't want to go past 40 weeks.  We did a planned c/s on my due date because I showed no signs of going into labor at the time.  That was okay mainly because I already had pre-set maternity leave so the more time I was still pregnant, the less time I had with my baby, but life is so different now.  I was actually thinking of insisting on being allowed to go up to 42 weeks.  Not sure yet if I'd go past that but Kate gave a good article on that, so thanks!

[betho]

Oh, and Mrs. Sprout - rupture was the main thing I was concerned about, I do know it's less than 1% but I know it's the most often argued risk for medical providers who don't want to do a VBAC.  So thank you :)

[Lisa1970]

Repeat CS has much higher risk than VBAC. There are statistics online and I think you can find them on the ICAN site. I would look for them if I had more time. But go to ICAN and you should be able to find it.