VBA2C or Elective C-Section?

[ania0214]

Has anyone tried a VBA2C (VBAC after 2 sections)? How did you decide?

I'm 30 weeks pregnant wih my 3rd and I'm having a hard time deciding as I already tried a VBAC but had to have a c-section due to an infection.

Does anyone know which is actually safer? I can find comparisons about a VBAC and elective section but not much about VBA2C vs elective csection.

I welcome all stories and information.

Thanks.

[womenswisdom]

You could probably find some good info here:
http://vbacfacts.com/quick-facts/
and here:
www.ican-online.org

[mssmith611]

The research I did said that the risk of uterus rupture from two low transverse cesareans in labor is about 5% so I guess you would say elective repeat is "safer" but still 95% of women will not have a rupture so I think it is a tough one.

[womenswisdom]

Originally Posted by mssmith611 

The research I did said that the risk of uterus rupture from two low transverse cesareans in labor is about 5% so I guess you would say elective repeat is "safer" but still 95% of women will not have a rupture so I think it is a tough one.

According to this study by Landon (2006), you may be misinformed. The rupture rate they found was 0.9%, so over 99% of women did not rupture.

You will also need to consider the risks associated with repeat cesarean, including hemorrhage and infection as well as risks to future pregnancies, such as placenta accreta and percreta.

[Bmorefarmgirl]

Acog supports vba2c for "some" women according to this blog post. It breaks down some important facts.
http://vbacfacts.com/2010/07/21/acog-issues-less-restrictive-vbac-guidelines/

While the risks for vba2c are not zero, neither are the risks for a cbac. It is (of course) major surgery, and the risks of repeating surgery are as real as any risks of vaginal birth or vbac.

Good luck,mama! Keep seeking out good information to fully arm yourself to make a decision! There are women who have done it! I met a woman at an ICAN meeting who had a successful home birth after 3 caesareans. I am trying for a vba1c myself this November.

There are lots of interesting discussions in this forum on uterine rupture, including this one
http://www.mothering.com/community/t/1293804/how-common-is-uterine-rupture

[katelove]

Originally Posted by womenswisdom 

Originally Posted by mssmith611 

The research I did said that the risk of uterus rupture from two low transverse cesareans in labor is about 5% so I guess you would say elective repeat is "safer" but still 95% of women will not have a rupture so I think it is a tough one.

According to this study by Landon (2006), you may be misinformed. The rupture rate they found was 0.9%, so over 99% of women did not rupture.

You will also need to consider the risks associated with repeat cesarean, including hemorrhage and infection as well as risks to future pregnancies, such as placenta accreta and percreta.

I agree, 5% seems awfully high. I have never seen a figure like that. 0.9% is the figure I see most often.

I agree with PPs, there are risks associated with either option. One thing to consider is whether you intend to have more children. Each c/s increases your risk of secondary infertility and of placenta praevia and placenta accreta in subsequent pregnancies. If you don't intend to have more children then this isn't going to be a factor for you.

[ania0214]

Thank you all for your replies! I appreciate it.

I have read that the uterine rupture is about 1.8% for a woman with 2 prior c-sections. So I do feel the risk is not too high but then again whenever I speak to my doctors (it's a group) they do not feel I'm a good candidate for it.  They are a very pro VBAC group but on different occasions they reviewed my history and all of them agree I would not be a good candidate but that they would support me if I really wanted to do it. So I'm back to square one of not knowing what to do.  I do want to have 1 more child after this one and because of that a VBAC seems the more right thing to do.  But maybe a c-section is safer?

[fayebond]

If you want more than this one baby, please consider alternatives to this doctor group.  I looked into four hospitals around me before deciding on one, and even then, you can still change (birth centers and home birth are both legal in my state for VBA2C: the ACOG even recommends VBA2C unless there are other pressing complications).    

CS is not safer for me as the future mama and that's my biggest concern.  They all said after my first CS, "healthy mom, healthy baby, be happy", but now that I'm preggers its "uh, are you sure you want to try to labor, its risky".  Hellooo?  People, pick a side.  If I'm healthy, then why can't I just plain have this baby and be left alone and we call it good?  

 The doctors can be worried about thier liability, that's their right.  And you can find a care provider who is mainly concerned with your FUTURE and present health. If 1.8% is the risk of rupture, why aren't 98.2% of their patients successfully having VBA2C unless some other factors (stress, pressure to just sign the paper and finish, monitoring incorrectly) are in play? 

[womenswisdom]

OP, have they said *why* they don't think you are a good candidate? What is it about your history or present situation that makes them think you will not be successful? What is their overall vbac success rate? Also, why do you think they are vbac supportive? Because they said so or because you know people who have successfully vbac-ed with them?

[dlm194]

Originally Posted by ania0214 

Thank you all for your replies! I appreciate it.

I have read that the uterine rupture is about 1.8% for a woman with 2 prior c-sections. So I do feel the risk is not too high but then again whenever I speak to my doctors (it's a group) they do not feel I'm a good candidate for it.  They are a very pro VBAC group but on different occasions they reviewed my history and all of them agree I would not be a good candidate but that they would support me if I really wanted to do it. So I'm back to square one of not knowing what to do.  I do want to have 1 more child after this one and because of that a VBAC seems the more right thing to do.  But maybe a c-section is safer?

That figure comes from a 2005 study done by Macones, et al. There were 12,535 women in the VBA1C and 1,082 in the VBA2C group.  In both groups, about 30% of the labors were induced and about 35% were augmented.  About 36% of labors in both groups happened spontaneously.  They reported a uterine rupture rate of 0.9% (113 ruptures) in a VBA1C and 1.8% (20 ruptures) in VBA2C.  The authors stated “prostaglandins were used in approximately 20% of the cases of uterine rupture.”  They later stated that inductions/augmentation of labor was strongly associated with uterine rupture.  The VBAC success rate was approximately 75% whether the woman had 1 or 2 prior cesarean deliveries.

You can reduce your risk by avoiding an induction.  Landon did a study where he showed a 0.9% rate of rupture VBA2,3&4C.  However, he also used the data from the study where he combined all VBACs (after 1, 2, 3 and 4 c-sections), to show that the risk of UR with a totally spontaneous labor is only 0.4%.

[Sam2012]

Hi, could you please tell me did you have vba2c or did you go for elective section? And
how did you decide and how did it go? Im in the same situation and don't know what to do? Im on the internet everyday doing the research and still can't make my mind up. thanks

[yallcomeback]

I'm planning a HBA2C, I'm due next summer and it hasn't crossed my mind to plan a RC. There's no way I'd want to go through that yet again unless there was a true emergency. All the research I've done leads me to believe that vbac is definitely the safest option for most people and I believe it is for me! My first HBAC didn't work out and I'm doing everything I can to be successful this time!

[Wishfulmommy]

I would also like to do vba2c too. Which state is it that lets you have vba2c at birthing centers and other options. Do these studies talk about any damage to the babies, brain bleed or neurological damage?

Thanks,

waiting for your response.

[fayebond]

Originally Posted by Wishfulmommy 

Which state is it that lets you have vba2c at birthing centers and other options. 

 I don't know about other states, but in Oregon, you can do a Vba3c at a birthing center, provided there are at least 12 months between your last CS and the conception of the VBAC baby.  Also in Oregon, you can do just about anything you want in a homebirth when it comes to VBAC numbers.  The only limiting rules about homebirth here are for liscened MWs, and you don't have to be liscened to practice (only to advertise your practice, bring pitocin, etc, so some MW groups have liscened and unliscened MWs who work together).  There are a few rules about due dates and not going too far over or under that time, but overall, the rules are pretty relaxed.  In the Portland area, many hospitals support VBA2C, at least verbally, although Legacy Emmanuel has a reputation for being the best at following through on that one.  

There's a couple research hospitals around here that are studying VBAC in general, and none of the studies I read talked about bleeding or other damage to the brain.