How do you know when to 'give up' & get a RCS vs another VBAC trial?

[JTA Mom]

I'm not pregnant (thank goodness!) but it's been something I've been thinking over since my last birth.

History:

First pregnancy: Ended up going into spontaneous labor at 16 weeks & gave birth. 

Second pregnancy: high risk since we didn't know what caused the first one. I also developed mild pre-e at 37 weeks. Induced. Had a bitch OB (and yes, she was) who started talking about c/s me 8 hours after induction with mag. sulfate. Fought her until 22 hours later, when she lied (said my platelets were low, freaked my mom & husband out. When questioned if c/s is smart because my clotting ability would be very low, admitted they weren't low/crashing. By that point, damage had been done). The epidural was ineffective (duh, I could still feel my entire left side) so had a spinal, which turned out to be high. Felt I couldn't breathe, freaked out & put under. Due to being on mag.sulfate, I was confined to a bed for 24hrs and baby was in NICU because he had breathing problems due to the mag. sulfate. 

Third Pregnancy: went for vbac. Had contractions for 26 hours, went to hospital when they were 3 min apart. Only 3cm, but they checked me in because I was a VBAC. When I got an epidural, the horrible anesthesiologist messed it up. It became a high, uncontrolled spinal, he wouldn't listen to me and I was left like that for 30-45 min until dh came back. I thought I was going to die. Another anesthesiologist got called in, realized the mess up, I got it taken out and from then on the head anesthesiologist had someone check up on me. I had to lie flat on my back in case of spinal headache, followed by back labor for hours, another epi (done by the head anest,, MUCH better), pitocin since my labor had slowed, and internal monitoring. Around midnight, the baby began crashing after each contraction. I felt him go absolutely still inside of me, saw the line plummet on the monitor, the nurse had me rolling over, rubbing my belly, etc. It took 5 of those before I called for the OB. She said I was at 4cm, I asked for a c/s. At that point, I felt like I had nearly died, and now my baby was near death, screw it. Good call, because when he was born, he had an APGAR of 1.

So, my question:

I hate surgery. I hate recovery from a c/s. I don't have much help after a c/s, dh's job is such that taking 6 weeks or even one week of unpaid leave is a no-go. All of my births had some trauma to them, but after a failed VBAC, the feeling of shame & failure was intense. My sister gave birth vaginally 2 months ago, and it brought back all of the pain of labor. I'm not sure I want to go through all of that and then get a c/s again. The only options, where I am, is to get the one midwife who does do VBA2C or get a RCS. Honestly, I'm not sure about a homebirth. Having lost a child already, I'm skittish about doing anything to risk losing another one. But recovery is difficult, I won't have much help, healing from major surgery, pregnancy AND breastfeeding a newborn takes a HUGE toll on my body. Plus, I now have 2 kids to think about. But another surgery, feeling them yanking around inside me, I don't know. I've already heard from everyone that since I have c/s, I need to stop having kids. Argh.

Tl;dr: When facing another VBAC vs RCS, how did you make your choice? How did you come to peace with that choice? 

[CoBabyMaker]

This has been a tough one for me too.  I think the best answer is that it is highly personal.  I can tell you what my experiences and what influenced my decision.  I'm not pregnant yet either, maybe later this summer or early next year.  My DH does have a job where he can take a few weeks off IF it's the right time so we are sort of trying to plan around that (as much as one can plan that sort of thing.  ha!).  It was a tough choice for me to come to because I very strongly believe in natural birth and it does sort of feel like giving up.

1st baby:  Planned natural birth, read every book.  Felt totally prepared for labor...ended up with back labor, pit and an epidural that numbed me to the point that I couldn't even feel if I was pushing or not.  Dr. came into try with forceps but by the time he came baby had moved back UP!    Ended in a C/S after 50 hours labor and 3 hours of pushing because baby's heart beat crashed and was not recovering every time I pushed.  

Afterward I questioned everything, felt like I failed and was frankly pissed at my medwives for not helping me try other things to get baby in a better position/supporting me more through labor.  (Birth Story here if you want more info) 
 

2nd baby:  Was planning to VBAC at a hospital but switched to a homebirth midwife for a variety of reasons.  Labor went much smoother and quicker.  Lots of great support.  Everything was going well, it was taking a while but I was ok with that.  I pushed in pretty much every position possible for 3 hours and again baby's heart rate dropped and wasn't recovering when I pushed.  We tried taking a break from pushing my body was pushing at that point and baby wasn't doing well. Off to the hospital we went for another c/s.  (That birth story here)

I am SO glad I was able to try.  FOR ME it answered a lot of questions about my body.  My midwife thinks I have an android pelvis which makes it tough (at best) for my babies to get through.  Both of them were in the 6 pound range so it's not like I have large babies.   Her honest answer when we talked about it was :  Becky, No one can tell what will happen next time.

I had said when I was pregnant that if the VBAC wasn't successful that we would be done.  We want more kids though.  (We looked at adoption and even started saving for it but just never felt peace over it.)  FOR ME, I can't go through the VBAC process again emotionally.  As much as I loathe saying this, I don't believe my body can do it.   Also, to even try a VBAC I would have plan a homebirth and pay for that (3k) as well the hospital (about 2 k) in the event that we transfer (which I feel is likely).    That's a lot of money to us and I just can't see more than doubling our out of pocket costs when I don't actually believe my body can birth a baby. 

So I will be having a c/s if/when I have another baby.  That being said, we have lots of family in town to take the older kids when we go to the hospital and DH can take time off if it's the right time of year.  If it's not a time when he can take much vacation then my mom can come out to help with the older 2.  We've already discussed this as I know that recovery is hard.  She makes me crazy but I know she loves my kids and she will be more than happy to help.  I am doing what I can nutritionally and supplement wise to build my body up and be as prepared as I can.

That all being said, I honestly believe my peace over this choice is from God.  It goes against some strong feelings I have birth and yet I am ok with it.

[MaryLang]

I agree so much with CoBabyMaker!
After my first two births, birth center 1st (ended in transfer c/s), hospital VBAC attempt 2nd, planned VBA2C turned previa, even though my c/s's go against my beliefs about natural birth, it feels like it's whats best.
I can't emotionally connect with the idea of HB after so many c/s's and it would be near impossible to find an OB to take me VBAC.
It's important to do what you can to support your body and make the c/s as much a sacred process as possible.
As much as recovery sucks, well it's what I have to do. And like pp said, after a lot of prayer about it, I feel at peace too.
 

Edited by MaryLang - 6/11/12 at 5:11pm

[lbkw]

Found this thread really interesting. I just scheduled RCS this morning and I'm kind of upset about it but trying to resolve the feelings. My story is a little different since this was my first "VBAC" pregnancy. My 1st baby was a natural delivery and my 2nd was breech/transverse. I knew the chances of another breech/transverse baby would be higher this time around but have been hoping to have a head-down baby to attempt a VBAC. As I approach 36 weeks, it's looking unlikely that this baby will turn so I did schedule. Dr. suggested that I do it during week 39 so I would not go into labor and need to have a "rushed" section. My last 2 babies have just been 7lb so I put off until 39w4d (a Friday) since that's pretty much the latest I could do. I hate feeling like I've given up without even trying. I hate the wait and see of wondering if baby will turn. It makes me want to cry when I hear about women going into labor and having vaginal deliveries. My c-section baby is 3 1/2 and I definitely don't dwell on her birth, but it's hard to think about having another. Clearly, I can't stay pregnant forever and if c-section is safest birth for me and my baby, than it is what it is.

[dancingflower]

Oh I feel you!

What brought me to this thread is that my period is, today, three days late. We have been trying to conceive and I am pretty regular so I am sure I am pregnant again.

I had two CSs, the first was scheduled and the second a failed vbac, and a first child dying too (irreparable birth defect). Now I have to choose again.

It is very very very personal, so personal that makes it so difficult. Because I have to be highly aware of myself. I am hoping that I may have better wisdom a little deeper into the pregnancy. The hormonal change in both my pregnancies made me a true "zen master" during it. I felt also very brave so maybe I can work on my fears. So I'll be cooking this decision.

I must confess I am leaning towards a scheduled CS.

I have only two pieces of words to share:

Schedule CSs are much easier than emergency ones., surgery and recovery. In the vaginal birth the baby descends towards the birth canal during labor. In CS, the cut is done considerably higher. My emergency CS was much longer and I could feel the violent movements of the DRs trying to bring DS who had already descended a whole lot. It truly felt like he was stuck. In comparison, in my scheduled CS, I felt nothing. They cut it and took the child out in what felt like less than 5 minutes. In my SCS, I was calm, ready and prepared. In the ECS, I was tired, a lil scared and disapointed. The recovery for the SCS was a breeze, walking the same day, hopping on public transportation (I was poor) in less than a week. In the recovery of ECS, I was very sore from all the hustle and bustle In my belly during the surgery and to complete the whole ordeal, I had a infection that got me re-admitted in the hospital for four days of IV treatment, leaving my newborn at home. I do not regret trying my VBAC but it is true that scheduled CSs are easier.

The other thing is, wait for your decision to grow on you, but be committed to not let the beaurocratic fight for it to dictate your choice. I mean, do not weigh in too much if it will be easy or hard to get a professional to do a vba2c. Feel free to feel yourself. Then move the world around you to do it as you wish. In the worst case, if you desire but can't get a VBAC, at least you understood yourself around the issue and you will be better emotionally resolved. Well, that is what I'm trying for myself: put fear appart, put discouraging hospital fight appart, and see what I feel to be best. After I know myself, I'll go out there, get informed and see what happens.

Oh , a foreigner writing without spell check is a pity!

[roadfamily6now]

Your births were traumatic because of the people who were managing your births. Labor and Birth does not have to be like that! 

Consult with a variety of care providers in your area to see what your options are.

[JTA Mom]

Originally Posted by CoBabyMaker 

 FOR ME, I can't go through the VBAC process again emotionally.  As much as I loathe saying this, I don't believe my body can do it.   Also, to even try a VBAC I would have plan a homebirth and pay for that (3k) as well the hospital (about 2 k) in the event that we transfer (which I feel is likely).    That's a lot of money to us and I just can't see more than doubling our out of pocket costs when I don't actually believe my body can birth a baby. 

So I will be having a c/s if/when I have another baby.

That all being said, I honestly believe my peace over this choice is from God.  It goes against some strong feelings I have birth and yet I am ok with it.

The bolded is a big issue for me as well. The feeling of failure afterwards was intense. As for peace, I don't think I'm there yet. I keep searching for it, but I'm not sure I can find it by looking. A big part of it might just be my intense fear of surgery. I did not like being awake & aware during my second c/s. I felt like I was being eviscerated, and honestly, no matter how much my 'logical' part of my brain kept telling me everything was okay, I think the deeper, animalistic part was freaking out. I guess if that fear wasn't there, I wouldn't feel as much conflict over the whole thing. :/

Originally Posted by lbkw 

I just scheduled RCS this morning and I'm kind of upset about it but trying to resolve the feelings. My story is a little different since this was my first "VBAC" pregnancy. My 1st baby was a natural delivery and my 2nd was breech/transverse. I knew the chances of another breech/transverse baby would be higher this time around but have been hoping to have a head-down baby to attempt a VBAC. As I approach 36 weeks, it's looking unlikely that this baby will turn so I did schedule. Dr. suggested that I do it during week 39 so I would not go into labor and need to have a "rushed" section. My last 2 babies have just been 7lb so I put off until 39w4d (a Friday) since that's pretty much the latest I could do. I hate feeling like I've given up without even trying. I hate the wait and see of wondering if baby will turn. It makes me want to cry when I hear about women going into labor and having vaginal deliveries. My c-section baby is 3 1/2 and I definitely don't dwell on her birth, but it's hard to think about having another. Clearly, I can't stay pregnant forever and if c-section is safest birth for me and my baby, than it is what it is.

I am so sorry. (((hugs))). How is everything going so far?

Originally Posted by dancingflower 

Oh I feel you!
What brought me to this thread is that my period is, today, three days late. We have been trying to conceive and I am pretty regular so I am sure I am pregnant again.
I had two CSs, the first was scheduled and the second a failed vbac, and a first child dying too (irreparable birth defect). Now I have to choose again.
It is very very very personal, so personal that makes it so difficult. Because I have to be highly aware of myself. I am hoping that I may have better wisdom a little deeper into the pregnancy. The hormonal change in both my pregnancies made me a true "zen master" during it. I felt also very brave so maybe I can work on my fears. So I'll be cooking this decision.
I must confess I am leaning towards a scheduled CS.
I have only two pieces of words to share:
Schedule CSs are much easier than emergency ones., surgery and recovery.
The other thing is, wait for your decision to grow on you, but be committed to not let the beaurocratic fight for it to dictate your choice. I mean, do not weigh in too much if it will be easy or hard to get a professional to do a vba2c. Feel free to feel yourself. Then move the world around you to do it as you wish. In the worst case, if you desire but can't get a VBAC, at least you understood yourself around the issue and you will be better emotionally resolved. Well, that is what I'm trying for myself: put fear appart, put discouraging hospital fight appart, and see what I feel to be best. After I know myself, I'll go out there, get informed and see what happens.
Oh , a foreigner writing without spell check is a pity!

To the first bolded, I experienced the same with my second c/s. I think because he was crashing, I knew it was warranted. Also, because I had btdt, I knew all the 'tricks' to keep me feeling better (pillow to cough, moving a lot from the beginning, requesting stitches rather than those damn staples, etc). Physically, it was easier. Mentally, not so much.

The fight is a big figure in the equation. In an ideal world, if I could find a hospital that would allow me to labor and move around, I would choose that. My biggest issue with homebirth is the death of my firstborn and the near death of my third born. Had I been at home, I'm not sure we would have noticed the crashing as fast as we did there. It would also have taken some time to get to the OR. The pain/issues from c/s are so much less than the pain/issues from losing a child. But I really, really, really do not want another surgery. I know my family well enough to know that the support I'd need after a major surgery is just not there. And then my mind swings round & round again. Argh. 

Mentally, pregnancy makes me a bit more anxious, so I feel like I need to make a somewhat solid decision before that happens. That's the rub though. Also, I am stubborn, and other people telling me no (providers) with no solid reasons (ACOG says it's ok, I have no contraindications against VBA2C) the more it makes me want to stick to my decision. I guess if a provider had other reasons to reject me than the fact that I had 2 c/s, it would make sense, to me. 

I kinda feel like if I go for a VBA2C and fail, I will not try for any more VBACs. After that, there's nothing concrete on the safety of VBAC to mom/baby, and I feel comfortable going for repeat c/s. I realize now that had the ACOG not recommended VBA2C, I would feel more comfortable/peaceful in going for RCS.

Originally Posted by roadfamily6now 

Your births were traumatic because of the people who were managing your births. Labor and Birth does not have to be like that! 

Consult with a variety of care providers in your area to see what your options are.

While I am sure you meant this as comforting, it was not. The OB at my second birth (second live birth, my first I birthed at home unexpectedly) was awesome. She didn't pressure me either way, let me be, etc. Had I had her the previous time, I am sure that I would not have had a c/s. I do not have the privilege of picking all of my care providers ahead of time. Birth happens at all times of the day/week, and people get sick, go on vacation, are busy with other clients, etc. I guess I am reacting this way because it seems as if you are saying it's my fault for having shitty births because I chose the wrong people. 

[fayebond]

JTAmom, *HUGS*

I'm looking at my first VBAC but I completely understand how you feel.  For me the biggest most annoying thing lately is how, by saying I'm open to home birth, someone feels they have to rejoice that I've drunk the Koolaide.  I havn't drunk anything and I don't have any illusions about this, people.  I don't feel like everyone ought to do what I'm about to do and frankly I hope many don't ever have to be where I am right now. Its an intensely personal decision as to where and how a woman gives birth.   And when you figure out what's best for you then If you are most comfortable with another CS, then that's probably right for you.  If you aren't comfortable (and lbkw doesn't sound like she is) then look around and seriously explore other options.  The baby comes out eventually, but how and when and how it all works out is partially you, partially your caregivers or lackthereof, and partially the roll of the dice.  Just don't let anyone else's expectations be your guide.

[JourneytoPeace]

I'm in a very similar situation. First 2 kids were c-sections, both "medically necessary" inductions turned to failure to progress. It took those births to figure out that the only way *my* body can VBAC is if I'm not induced and go without an epidural (my first 2 were malpositioned and once I was numb it was all but impossible to move them- even with my doula physically moving my Epidural ridden body for me-). So, with my 3rd I planned a VBA2C with the assumption that I'd only go through with it if I went in to labor on my own. I did. And my labor was fairly short (for me) and normal until 5 minutes before birth when my daughter's heartrate went from normal to nothing. She was born with an APGAR of 0, her heartrate was quickly resuscitated to normal but she still wasn't breathing on her own. She was sent to the NICU where she passed away the next day.

Let's face it. The only reason either of us got pregnant again is the hope that the loss of our children was a fluke. That it WON'T happen again. We have to go off that assumption or we'd spend 9 months of pregnancy going crazy. My struggle is that I'm very aware of the risks of both VBAC and repeat c/s. For many personal reasons, I don't feel like a planned c/s is the route I need to go. It's been a hard pill to swallow because I know it's not the "typical" loss mom response of induction or early repeat c/s. Like i mentioned, i know that has risks too. There isn't one right answer for everyone. For better or worse, many OBs/Neonatologists/etc have been over my daughter's medical records and have been able to give many things that didn't cause her death but can't pinpoint what did happen. I have an OB who is comfortable attending another VBA2C for me and that is the route we're going. I say sit with each decision (ok, I've planned a c-section and then ok, I'm planning a VBAC) for a couple weeks and see how they make you feel. The other thing I've come to discover is that it's much easier to plan a VBAC and decide later you'd rather have a repeat c/s than vice versa. Good luck with your decision.

[fayebond]

Originally Posted by JourneytoPeace 

The other thing I've come to discover is that it's much easier to plan a VBAC and decide later you'd rather have a repeat c/s than vice versa. Good luck with your decision.

Ditto.  Once CS is written on your chart, no matter who wrote it, you can't go back to that hospital until you are ready for that CS to happen.  I learned that the hard way with baby #1 ("But wait!" "There's no time, the baby is coming out, you need a CS!")

 I found it helpful before this pregnancy to talk to as many different healthcare people as I could.  A doctor won't actually make an appointment with you until you pay them, but, you can go the the hospital's free L&D tours and talk to everyone in sight.  Birth centers offer alot of classes and group-meeting things you can attend either for free or a small fee. 

[Kynid]

I am having a RCS because my first birth, which ended in CS after 4 h45m of pushing, was very traumatic for me and DH. We both wanted a VBAC at first, but the anxiety of think of last time made us both decide we would not be willing to risk it and would rather have a RCS. I feel at peace with that now. 

[anj_rn]

I have to say that I agree that it is a very personal decision.

Pregnancy #1 - I chose a group of midwives that delivered in a hospital setting, but ended up transferred to an OB due to severe HEG (lost 15 lbs in 1st trimester).  swiched back to my original OB to have a practice w/only women.  Planned on a natural birth, except for the IV for fluids since mt HEG lasted throughout pregnancy.  At 39 wks, DS was transverse with the cord around his neck, so they scheduled a c-section.  All 8 lbs, 11 oz of him came out fine, but the cord had been around his neck twice, and he liked transverse.

Pregnancy #2 - Stayed with OB (since CNMs in Texas can not do VBACS), and planned for a natural childbirth again.  At 38 4d  check, DDs head was down, but I was not dilated or effaced at all.  My OB was on call over the weekend, so she said come back Fri, and we can decide whether to induce or schedule a section, but you can not go post dates (which I knew from the beginning).  Did everything we could think of to get DD moving, but she was not going anywhere.  Friday I was still not dilated & not effaced at all.  We scheduled a section for the following Tuesday.  I chose not to induce because I knew that my body was not ready, and I would end up with the section after 14 hours of awful induces labor.  I was also hoping that we could have a few more days to get labor started.  No luck, and all 8lbs of her were fine.

I can say that a scheduled section is MUCH easier (I was with my BFF when her labor was transitioned to a section).  You go in 2 hours before your scheduled time, they go over your history, etc. You change clothes, they start an IV, you chill out and watch TV, listen to music, whatever.  the doc and the anesthesiologist come & talk to you.  At go time I walked into the OR, the nurse helped me up onto the table, they did a quick spinal (very easy to hold still when you are not contracting), and then had me  lay down to start prepping.  At that point DH came in and was with me the whole time.  He followed the kids to the nursery (at my request), while they sewed me up.  My recoveries we not that bad (I think since there was no hurry).  I can say the with my 2nd child the OR was not prepped when I came in, and I had a panic attack sitting there waiting.  They calmed me down, and DH came and held me.  I was fine once we started, but the anticipation killed me.