Wanting VBAC, facing RCS

[alittlesandy]

I just want to say, I am so thrilled to see this forum, and I want to thank the moderators and the forum leaders for their hard work. I love the forum guidelines, the way they are written is so compassionate and supportive. Thanks again!

So, some of you may have read my story before if you've been participating in these recent c-section threads, but I will repeat it here because I've come pretty close to finalizing my decision.

With my first baby I planned a homebirth with a wonderful group of midwives, and everything went perfectly until 38 weeks, when the midwives discovered that the baby was breech. I actually suspected this at around 36 weeks, because the head felt wedged under my rib cage and was very hard, and hurt a lot. But the midwife convinced me that I was wrong. So when she told me at 38 weeks that I needed an ultrasound, I wasn't surprised when we found out the baby was indeed breech. That afternoon I went to a chiropractor and acupuncturist, then spent most of the night doing special yoga positions and lying inverted on a board. We tried everything! The next morning I had an external cephalic version at the hospital. The doctor, a huge supporter of homebirth, tried for two hours to turn the baby, with two short breaks in between. It was a grueling and frightening experience, and didn't work. She sent me home, and I went back to the chiropractor and acupuncturist for one more session. While we were downtown buying herbs that might help, I had a contraction that knocked the breath out of me. Scared that this was it, I went home, elevated my legs, and drank a bunch a fluids in the hope that rest and fluids would stop the labor. It was not meant to be. The contractions progressed quickly, and six o'clock that night they were three minutes apart. The midwives told me it was time to go to the hospital. I had a c-section that night at 8:00 P.M.

I have to say, I was really surprised at how supportive and kind the hospital staff were, after all the horror stories I had heard. I was nursing within fifteen minutes of the c-section, the baby never left my sight, and we coslept during my whole stay. Nobody ever suggested circumcision, formula, or vaccines. The recovery wasn't easy, but I was at peace with the birth.

HOWEVER...

Although I knew the possibility of homebirth was over for me, but I didn't know the extent of the implications. I had no idea about VBAC bans, etc. I was about to learn.

When we started trying for our second baby, I was deeply hurt to find out that I was not allowed to visit or talk to the midwives. I had been friendly with them socially before the c-section and now I was literally shunned. They are not allowed to have patients with previous c-sections. I would have to do my prenatal care with an OB, and I would have to have an RCS. I just wasn't prepared to have that contact completely severed.

I immediately began investigating VBAC. The nearest hospital and doctor that does VBACs is almost three hours away. I live in a mountain town, so the drive is not an easy one. In good weather one faces a number of switchbacks, in bad weather the drive is a nightmare. Two other major factors: we don't know anyone who lives there that we could stay with, and I am the breadwinner. I get maternity leave, but it's unpaid, which means I really have to work right up to delivery, which I also did with my son. However, the window of time in which I could go into labor is about 2 weeks. When to go down? Where to stay? What to do with our toddler? We cannot afford to stay in a hotel. I can't imagine driving down in labor.

See how complicated this is? I really want women who think VBAC is the only option to understand that many women are not faced with easy choices.

Because of all of these complications, and because of my research into VBAC versus RCS outcomes, we are strongly leaning toward RCS. On the one hand, I fear and dread another c-section, and I mourn the loss of a vaginal birth, but on the other hand I am hopeful that we can create a wonderful and memorable birth experience regardless.

I guess I'm hoping to hear from women who have had a similar experiences, or who have chosen RCS for whatever reason, and were able to be at peace with their RCS and their birth experience. Please no RCS horror stories! I'm nervous enough as it is.

[leigh09]

hugs to you, it can be difficult when your birth doesn't go the way you dreamed of.

With my first baby, I wanted a natural, unmedicated birth.  In a hospital though, just in case.  My baby has problems during the labour - he was not dropping and his heart was going crazy.  I had a c/s and when they opened me up the dr found the reason - he was so twisted in his cord he didn't have much room to move anymore.  He wasn't able to breathe at birth.

Anyways, the c/s was difficult and the recovery long.  I got pregnant again when ds was 10 months old.  My OB was very supportive and explained all my options to me.  I had a RCS because my children were born close together and I was almost scared to try VBAC after the birth of my first went so awry.  My third child was also born my RCS - I already had two so VBAC was no longer an option.

I understand wanting to have a VBAC and wanting to have an ideal birth.  I totally support all mothers who chose VBAC.  However, I found a RCS was a very easy recovery (both times).  My OB said it is a lot different doing a scheduled cs versus one that happens after a day of labour.  Sometimes I feel a bit ripped off because I don't have a chance to have what I view as a "perfect" birth.  My DH told me basically to not sweat the small stuff - I am a healthy mother of three healthy children.  Many women are not so lucky, even if they've had vaginal births.  Since looking at it his way, I've stopped mourning the loss of my birth experience and instead consider myself very blessed.

[leigh09]

Oh, one more comment - my first child was gone to the hospital nursery after his birth, just to get checked over.  This was the most unnerving part of my c/s with him.  I thought I had a baby, but wasn't able to hold him and had no idea where he was.

I talked about this with my OB, who said in non-urgent circumstances (ie RCS), the baby never leaves my sight.  This was true with both baby 2 & 3.  They were checked over and wrapped up in the OR, came with me to my hospital room, and stayed with me every moment until we were discharged.  They both coslept from birth, nursed within the first hour of birth.  Circumcision was never mentioned with my boys, nor formula.  Our hospital experience was actually quite pleasant.  :)

[AlexisT]

My first C was for fetal distress caused by severe preeclampsia. I never labored. I was admitted to the hospital for PE, I got a bad strip, and that was that (I was totally unripe, so an induction would have taken forever).

For #2, my initial thought was VBAC. This was, of course, conditional on something that neither I nor my obstetrician could ever guarantee: making it to labor. It turned out that my first pregnancy had unmasked chronic hypertension, which left me at increased risk for repeat preeclampsia. The HTN on its own posed issues. I was with a university faculty practice, so they were evidence based, did not ban VBAC, but ran a little conservative--not touchy feely. My OB did say I had to be prepared to go straight to a C section. I think she would have advised RCS if I had pressed the point, but (and I will give her every ounce of credit for this: she had excellent patient skills) she left it up to me. The other OB in the office (there are more OBs in the practice, but I saw only 2 of them for prenatals) did try to give me a discouraging speech, but I basically said "Let's see what happens, why worry about this now?"

At 20 or so weeks, I went and asked point blank how long she thought I'd go and she said that with my history, I had a very high chance of requiring delivery at 36-37 weeks. I kind of knew that, but hearing 36 weeks made it very real and depressing. There was a trial called HYPITAT that said, basically, delivery is preferable to expectant management of hypertension after 37 weeks. My BP was controlled so that didn't come into play, but if it went up, I would either deliver at 37 (if it did not worsen enough for immediate delivery) or immediately, if I were already past 37. I knew my chances of going into labor before that were slim. At that point, I began mentally preparing for an RCS.

I wound up doing much better than expected--I maintained excellent BP control. But I came to realize that as each day passed, and I went past the point where I had developed PE with my first, that I was just too nervous. I was really, really scared of having another emergency CS. My BP did get a little flaky right at the end, and the OB said she wouldn't have wanted to bet on what would have happened if I went to 41. I had my repeat C at the dot of 39--OB would not schedule it a day earlier. At that point, I was not dilated and had had no contractions, so I don't feel like if I'd just waited a few more days I would have had the baby. I think I would've gone to 41. (ART pregnancy, perfect dates.) I'm okay with it. I could have waited it out, but I was driving myself insane, and honestly, I was tired. It was a long, high risk pregnancy, I was on twice weekly NSTs from 32 weeks, regular growth u/s, I got sent for BPPs a few times and one hospital overnight.

[AlexisT]

As for the surgeries themselves:

My first went okay, technically. My anesthetist was lovely. He was really the bright spot of the experience. The surgery went ok, no separation in the OR, baby brought right to me. Bad things: It was very chaotic, I don't think the OB on call even introduced himself, postnatal care was a nightmare and my dd and I were completely neglected. (This was not in the USA and the hospital where I had her has subsequently had some very negative press for its maternity care.) I had incision issues that interfered with healing. It separated and infected and I had to be patched up with Surgi-Strips. It healed well in the end, but they picked a very poor incision site. (Right on the bikini line, when I already carried weight in my stomach--weight plus pregnancy/surgery = massive flap.) If you imagine a sideways v, with the stomach on one side and the pubis on the other, they did mine right on the point.

For my second, we were able to plan and avoid some of the issues with my first. Everyone introduced themselves; it was very calm. My section was scheduled on a day my regular OB would be in the hospital, so she could do it instead of someone I hadn't met before. She made a new incision a few cm higher, and did a double layer closure with internal stitches. It healed wonderfully. The only things I would change are newborn care: they wiped him off before showing him to me, and did take him to the nursery. I didn't bother fighting that because they said he'd be back before I went into recovery and I knew closure might take a while--it was just for a detailed exam and bath, but in retrospect I would've delayed the bath. He was ready for me when I got out though (my hospital has the ORs directly opposite the LDRs). Closure did take nearly an hour.

The other thing I would have done in retrospect is demand that we treat my anemia more aggressively. I didn't, and wound up with hemoglobin of 9.8 on the day. I'm a bleeder--nearly 1L out. (I lost more with my first, and the OB said they did try their best knowing that my hgb was down.) I felt awful and they had to pump a ton of fluids in to keep my BP up, so then I swelled. Despite not having PE this time, my urine output was still lower than normal, so with all of that, I got to keep my IV and catheter till the next morning. Overall, though, it was much better. My hospital was optional night nursery only--I did choose to use it, and on the first night I feel there was no question about it. If I hadn't, I would've had to get my husband to stay. It wouldn't have been safe for the baby because I was weak, dizzy, doped up and had trouble moving, even to lift him from the bassinet. On day 3 he wound up under the lights, so again, nothing I could do. Formula was entirely up to me--I did give some and told them not to wake me the first night, but after that they brought the baby in regularly, even when he was on phototherapy.

I am probably more flexible about many hospital things than many MDCers but I feel like all my choices were mine and not pushed on me in any way, which made a huge difference psychologically. I felt that my decisions were respected and that my providers worked with me to make my experience positive. So even though it wasn't 100% perfect, I am so much happier with how my second section went.

Phew - that's two long posts!

[CI Mama]

Originally Posted by alittlesandy 

When we started trying for our second baby, I was deeply hurt to find out that I was not allowed to visit or talk to the midwives. I had been friendly with them socially before the c-section and now I was literally shunned. They are not allowed to have patients with previous c-sections. I would have to do my prenatal care with an OB, and I would have to have an RCS. I just wasn't prepared to have that contact completely severed.

Oh, mama, this part of your story is so heartbreaking. It's just so unfair. I'm sorry!

In terms of the VBAC ban at your hospital, does that mean that they require you to schedule a c-section? Are you allowed to have a trial of labor? I am wondering if having that choice would be important to you, and if there's a way to negotiate with your doctor about that option.

I don't have much advice, just wanted to post to keep this thread moving & hopefully get you some more good advice! Please keep us posted on how things go for you!

[thorn]

I'm sorry.  I can't imagine living so far away and having to make choices like that based on distance and money and things that are very important!  I wish that it was an easier choice for you ((hug))

[Buzzer Beater]

Hi Sandy,

I had my first c/s in 1991. I was induced for postdates (didn't know any better), had three days of labor, then off to surgery with a dx of cpd. But you know by the time I was dilated to ten I could hardly blow my nose I was so tired. I really, really didn't want surgery of any kind because I'd had it before (on my ribs and sternum) and I am a big puss. The whole thing sucked- my husband walked out on me because I wouldn't sign the consent for the c/s... didn't come back for almost a whole day until I had been pushing with one awesome nurse for four hours... badgered by my mother and gp to get the c/s... I stayed in the hospital for a week after that. I was a complete wreck. And then they told me she didn't actually look postdates. 

My last pg I was set up for a home birth with a great midwife. Had the birth kit and tub, took a great class, hired a doula. Then at 37 weeks I got PE, had super low fluid, and a breech babe. Second c/s. And it was okay. This time I knew I needed it. I was scared shitless even though I knew I would make it, but I was 45 and the thought of recovering from that made me so fearful. I remember crying in the ob's arms while they put the epidural in. She was awesome- I had just met her that day, and she and the rest of the staff made it all bearable. I nursed dd2 right away and was up and about in no time. Disappointed, yes. But my only choice.

When are you due? Is there any way you can fight your ban? I got a lawyer (probono from Seattle) for a short time to try to fight the ban here, but she quit because our hospital is private and they can pretty much do whatever they want.

Why can't your midwives do vbac? That's crap.

[Buzzer Beater]

There is a gal who advertises periodically for clients who need legal help to fight vbac bans. You can find her on ICAN easily, or I can give you a pointer if you'd like to go that route, depending on your due date.

[Storm Bride]

Originally Posted by alittlesandy 

I guess I'm hoping to hear from women who have had a similar experiences, or who have chosen RCS for whatever reason, and were able to be at peace with their RCS and their birth experience. Please no RCS horror stories! I'm nervous enough as it is.

 I wasn't exactly at peace with my last c-section, but it was definitely a far better experience than any of my first four. Part of that was that I was the one to decide to have the section - I didn't like my own reasons, and didn't even think they were all that great at the time, but I did make the decision. That was the first onewhere I made the decision, without harassment, bullying or coercion. That counts.

For me, the other big things that made it better were dh being there for the spinal, being able to breastfeed dd2 on the OR table, getting stitches, not staples, for the outer closure, and the general behaviour of the nurses on the maternity ward. That was the only time where I wasn't being constantly harassed (or "helped", which was often worse) by nursing staff. For example, instead of banging open my door in the middle of the night, the nurse would open it quietly and check on me and the baby with a flashlight. That helps.

I think the first thing is to think about what aspects of your first c-section you had the most trouble with (aside from having an unwanted c-section in the first place). Then, try to work out ways you can address those particular issues. Maybe you want the drape lowered, to see the baby come out - that's important to a lot of women. Maybe you want the OR people to not have unrelated chitchat over you. Maybe you want to breastfeed asap. Maybe you want something else that isn't even on my radar. The first step is to figure out what would help, then you can start figuring out how to try to get those things.

I'm sorry you're stuck in this situation. It's appallingly common.

[catters]

Hi Sandy.  I had a very similar first cesarean experience.  Planned a very natural normal birth, and discovered DS was breech.  But I found out at 32 weeks.  I'm not going to detail what I did to try to get him to turn, but let's just say, if you can think of it, I did it.  A lot.  So, I was very disappointed and had a cesarean at 40 weeks.  When I found out I was pregnant with DD, I just KNEW I was going to have a VBAC.  I had a great and supportive OB (couldn't VBAC with a midwife either) and the hospital was VBAC supportive (at least if you had only had ONE previous cesarean).  Well, 41 weeks came and went and no sign of DD even approaching being ready (mind you, this is 41 weeks by MY dates, and 42 weeks by the traditional dates).  So, although my OB was supportive of waiting it out a few more days, I had the pressure coming down on me from a lot of people, to have this baby.  We were doing fetal monitoring, scary stories of meconium and stillbirth risks were being told me from every angle and I signed up to have another cesarean.  My choice - but I will admit that it was under duress and with a very heavy heart.

In terms of how they went, I had two pretty uncomplicated and smooth surgeries.  I got to see the baby right away, and they put them right next to me for the duration of the surgery and I was holding them on the way back to the recovery room.  Nursing as soon as I was back in the room.  The hospital nurses were wonderful to me, helped me get up and move really early, and I was out in two days both times.  Recovery, for me, is painful, I need to take the meds for about a week afterwards, and then Ibuprofen off and on for another week.  I have some friends who claim they didn't take anything after they left the hospital.  I can't really imagine how they did that, but, everyone's different.  

I wish I could say that I was "at peace" with the way my children were born.  I'm not, actually.  In fact, I've become a really annoying and vocal natural birth advocate!  I'm in a similar situation right now with wanting to VBAC again and all doors seem closed right now.  The hospitals near me just won't do it.  I live in Florida and the nearest hospital for me to even likely be seen would be over an hour away in Orlando.  I am now really considering a home birth if I can get the ONE midwife who will do them in the area.  Fingers crossed.  If not, we're considering just waiting until I'm literally pushing the baby out and then going to the hospital (which is, as my OB told me, the only way the hospital would let me deliver normally).  

So, alas, I feel for you.  I've been there.  I am there again.  It's so so distressing how difficult and how much of a fight it seems to have to be for a VBAC, and even if you do want to RCS, it's seems like your only prenatal choices are OB's.  If you are lucky, you'll get a small practice where you are more than just a number, but, as I'm experiencing now, I have four doctors in the one practice, and they are rushed, impersonal and I'm in and out in 15 minutes or less.  At my last appointment, with a different doctor, he came into the office wearing a huge "NO BIRTHPLANS" button on his lab coat.   Ugh.  I'm requesting never to see him again.  The scariest part?  He's the head of obstetrics at the hospital that I have to deliver at (if we go through insurance).  Double ugh.  

If I chose to have a RCS this time, and it will be at a different hospital as we've moved to a different city, I am well prepared.  No chit chat during the surgery.  I see baby immediately.  I do not want the drape lowered, honestly, and I do not want to know what's going on unless there is a problem.  No residents cut or sew me up.  That's just me.  Like Storm Bride said, think about how YOU felt and what you want to go differently.  

[Jo Mama]

Hi,

I had hoped for a VBAC with my second pregnancy, but it was not to be.  I cannot tell you how incredibly easy the RCS was - even better than the first, and I thought that the first had gone very well!  The second time, they left my hands untied, which was REALLY nice, and the recovery was a total breeze - I was up walking around that night, and was ready to go home in less than 48 hours.  I never even took any of the hydrocodone they prescribed for pain; didn't need it - just ibuprofen a couple times.  Don't be afraid - you'll be an old pro the second time, knowing what to expect and all.  I am looking forward in a few months to my 3rd cesarean.  I don't feel I've missed anything - having that baby placed in my arms is all I care about.

[Storm Bride]

Originally Posted by Jo Mama 
Don't be afraid - you'll be an old pro the second time, knowing what to expect and all. 

OP: I'm not trying to scare you - not at all. But, this particular post hit one of my buttons, and i just want to mention something. The "you know what to expect thing" is a fallacy. I've had five c-sections. Five. They were all different. I had different recoveries. I was treated differently by staff, both in the OR and out of it. The three planned ones had more in common with each other than they did with either of the emergent ones, but they were still all different. (As an example, at six weeks post-op with my first, I walked home 15 blocks, uphill on a steep grade, from an OB appointment, with no difficulty beyond being slightly winded. At six weeks post-op with my second, I was getting around well, but couldn't have done that...but I was hiking at three months out. At six weeks post-op with my third, my incision had only just closed a few days prior, and wasn't up to anything beyond walking on flat surfaces. At six weeks post-op with my fifth, I was able to get around better than with any of my others. They were all different. I used to read about women having so much trouble with stairs, and just think, "huh? - stairs are no problem"...until my fourth one, where it was excruciating to lift my legs at all...and then I had a little bit of trouble again with my fifth. But, I never had an issue with any of my first three.)

I do think there are advantages to the experience not being one huge unknown (well, depending how terrifying you find OR, I guess - for me, it got worse, the more I knew what to expect). But, the "knowing what to expect" thing really isn't accurate. I wouldn't expect a woman who'd vaginally birthed her baby after an 8 hour labour to expect that she'd have the same labour next time, and I don't think it makes any more sense to assume it will be the same thing next time with a cesarean, yk?

For all that - many things did improve each time, as I learned more about what worked for me and what didn't. That personalized knowledge is really useful.

[Jo Mama]

Good Lord.  All I meant was there's a big difference between reading about c-sections and trying to learn what it's like, and actually having been on that table before.  I did not say each recovery or experience would be identical.

[Storm Bride]

Originally Posted by Jo Mama 

Good Lord.  All I meant was there's a big difference between reading about c-sections and trying to learn what it's like, and actually having been on that table before.  I did not say each recovery or experience would be identical.

Good Lord. All I meant is that this is not, in my experience, actually the case. When I had my first planned c-section, I had no idea what to expect. The whole situation was completely different than an emergent c-section. (Just one example - I didn't know I was going to spend an hour in L&D, waiting for a full bag - was it two? - of IV fluids to make its way into my system.) Then, I thought I knew what to expect with the next one, and I was wrong about that, because the OR staff handled things completely differently (same hospital and only two years apart - just different people, with different styles).

In any case, "you know what to expect" isn't the same thing as there being a difference between reading about c-sections and having been on the table.  As I was addressing what you said, not what you meant (which I had no way to know), there's no "good lord" about it.

I've been tripped up by the "I know what to expect" stuff, so I like to make it clear that it's not necessarily the case. I've never known what to expect.

[alittlesandy]

Thank you to everyone for the great replies. I have to agree with most of what has been said here, both the positive and negative. Truly, all of these posts have been so helpful.

I am both less afraid and more afraid this time around, if that makes sense. It does help that I've experienced this before. For example, going into the OR that first time, I was shaking I was so afraid of the epidural. A needle in my spine seemed incomprehensible to me. That ended up being a piece of cake, so I won't be quite so afraid of it this time. However, I still get wigged out about the fact that the epidural can go up too high, resulting in my not being able to breath and having to be put out with a general so they can intubate me. It's that somewhat irrational fear of random and rare complications that still freaks me out.

I really overdid it after my first c-section. I was driving, visiting, doing chores, cooking, all within about ten days. This time I am insisting on taking to bed for about two weeks, and to hell with being a good hostess.

Jo Mama, I completely agree that knowing what to expect will make things easier this time around (and the last time I was still in disbelief that I was even having a c-section). However, Storm Bride, I agree that recovery could go either way. Although this time I will prepare myself for it, I am older, heavier, and more out-of-shape. I also have a toddler. So while I hope this recovery is easier or as easy, I am fully prepared for it to be more difficult.

[Storm Bride]

Originally Posted by alittlesandy 

I really overdid it after my first c-section. I was driving, visiting, doing chores, cooking, all within about ten days. This time I am insisting on taking to bed for about two weeks, and to hell with being a good hostess.

I am boggled by the fact that people expect a new mom, let alone a new mom who is also recovering from surgery, to be a "good hostess". (It drives me nuts that I sometimes expect that of myself!) If people want to visit you, they can freaking well help. Definitely remember to take it easy. It really does help in the long run, and you'll be glad you did after the first couple of months are over.

[alittlesandy]

Originally Posted by Storm Bride 

I am boggled by the fact that people expect a new mom, let alone a new mom who is also recovering from surgery, to be a "good hostess". (It drives me nuts that I sometimes expect that of myself!) If people want to visit you, they can freaking well help. Definitely remember to take it easy. It really does help in the long run, and you'll be glad you did after the first couple of months are over.

OMG, after my first c-section it was absurd. One week after the birth a friend of mine was visiting and wanted to go to the bookstore. DH said, "You should go, it will be good for you to get out of the house. So I put the baby in the sling and off we went. I was still had postpartum bleeding and literally started gushing blood while walking around. The baby was crying in this quiet bookstore. I started crying and we went back home. Two weeks after the birth my parents came for a visit and I cooked them dinner. I was so exhausted I literally fell asleep at dinner. My mother realized how stupid it was to have me cook dinner and she and my stepdad quickly excused themselves and went to their hotel.

This time around, I'm so frustrated because my mom wants to come and "help" with DS. She is seventy, and completely useless. Don't get me wrong, I love her dearly (and it's not because of her age, she has always been this way), and enjoy her company, but she won't drive, won't lift DS or change his diaper, won't cook because she "can't find anything." AAAAAaargh!!! I'm begging my sister to come take charge of things and hoping she will.

DH is also pretty useless, because although he was wonderful with the baby, and is an amazing and engaged father, he has no understanding of or compassion for physical pain or weakness. He's one of those types who has never been sick a day in his life.

Luckily, now I am older and wiser and plan to simply take to my bed with the baby. Let everyone else figure out the rest.
 

[catters]

Oh yeah, I hear you.  We literally MOVED from Florida to Wisconsin two weeks after my second c-section.  I was storing boxes and driving and packing things within five days of my surgery.  I bled forever and needed the 800 mg of Ibuprofen for probably WAY too long.  What an idiot I was!!!  If I do, in fact, end up having another c-section, I WILL be taking it easy.  I'll be taking it easy again either way, but I hopefully have learned not to push it.  :)