Met with an OB yesterday to get signed off for a V2BAC. NOW feeling conflicted in decision.

[abouttobe5]

(Background:  My first was an emergency section after 17 hrs of labour at home, 7 of which were stalled at 7 cm and my daughter was in a terrible physical state when she came out - 10 days in ICU due to major complications of stress in uterus.  My son was born 5 days post dates when it was discovered I had next to no amniotic fluid and labour would be next to impossible for success.  He was born 3 1/2 yrs ago and now I am 9 weeks away from expecting my third.  I wanted to do a VBA2C from the beginning but met with an OB who in my town has to give a written approval for me to labour in the hospital after sections.  I'm working with midwives, who are incredible and supportive of whatever I choose) 

I *knew* that the OB would have some challenges in that he would want to make sure I knew exactly what I was getting into with a VBA2C.  

He was very good, very personable, remembers doing the section on my 2nd baby (3 1/2 yrs ago) as there was a little drama leading up to it with another OB who dismissed me at the hospital saying I wasn't a candidate for an immediate section (turns out I was and Blake came into the world within an hour after seeing the new ob).  I do have a lot of respect for him as he has a great bedside manner, supports the choices of women, and is professional yet warm.  

But he did have to do his job in explaining what can happen in labour of a VBA2C.  And what the chances of uterine rupture are compared to women without having had a section or just one section.  (he said very slight with none, 1/1000 with 1 and between 1/200 and 1/500 with a second) He was explaining there is no way to know leading into labour or even in labour if and when a rupture could occur.  He can measure the scar thickness a thousand times but it still just depends on how a woman does throughout labour.  If it happens, it happens.  And when it does, often they don't know as there aren't a lot of signs that develop really quickly.  

But when they figured it out there are only minutes to get me into surgery due to complications with the baby and me.  Everything could go fine or there could be serious challenges - death of baby, maternal death, hysterectomy, major blood loss, etc. etc.  And if the right personnel weren't on hand (no anesthesiologist for example as there is only one on staff at any time in our hospital and he could be in surgery somewhere else)

He did say that if he had a choice, he would always choose vaginal over section, barring there are no complications.  Even if one section has happened in the past, he would suggest a VBAC over a section.  But, he said, I have possible serious more likely complications than a woman with no or one sections.  (which I knew)

He said "I don't want to fear you into making this decision but I think it's only fair that you know all of the potential challenges...." 

Well, now I totally have fear.  Not totally, but I"m only 80% sure I want to do a VBAC and 20% of me is worried that if something does go wrong, then I would feel incredibly guilty.  Especially if something happens to my baby.  :(   I was 100% VBAC before talking to him and I don't blame him (he was doing what I expected, his job) but I'm definitely wavering now.  And that makes me upset too.  

I'm so conflicted.  My DH, upon hearing this, wants me to make the decision as it is my body but he doesn't understand why I would even risk it.  I still like my odds but I'm worried that even if I did go into labour, every pain I would wonder if that is my uterus having challenges and am I or my baby in danger.  That feeling of "what if" would linger the whole time.  And I'm wondering how much of a distraction that would be in labour - my guess is a major one.  With my daughter, I made it to 7 cm and stalled for 7 hrs.  Then she was a serious emergency section when we transferred from home to the hospital.  If I were to stall again at 7 cm, I think in the back of my head the thought of "omigod, what if something happens now" would still be there.

I realize I"m totally acting and thinking on the "what if" and "fear" right now.  Which I always talk to people about NOT doing.  Make decisions based on facts and what your heart says, but not by the fear that someone has instilled in you based on their experiences. 

Ugh....I would love some thoughts, ladies.  Any advice/help/words of wisdom would be appreciated. I know personal experiences are just that, personal experiences, but I think I'm conflicted with 1) whether or not I should do this and 2) whether or not its considered giving up if I do choose a third section.  

[Lynann]

I've only had 1 c/s and then a very successful HBAC, so I cannot comment on the VBA2C situation.

I would suggest that you take a bit of time to refocus yourself after talking to the OB. Maybe talk it over with your midwives too. If you really can't shake that fear factor then maybe you do need to rethink your options. NO matter what the rest of us may think or suggest, at the end of the day only you can know what the right decision is for you, and only you have to live with the decision you make.

Hopefully some mamas with VBA2C or VBAMC will come and share their stories with you, and that might help clarify what you need to do for you.

[genniemom]

Hi Andrea,

I don't know you but I just wanted to offer some words of encouragement. I think that looking at risk factors and percentages is not usual for most women, so it can be difficult to understand and put in perspctive.It aways helps me to remember that everything has risks. The risk of a third c/s is able to be broken down into percentages as well. Here is a link to an article about the risks to repeat c/s. http://health.usnews.com/health-news/family-health/womens-health/articles/2009/05/21/risk-to-baby-rises-with-repeat-c-sections

Your doctor is just trying to do his job in helping you realize that your decisions are completely your own. No doctor or midwife can guarantee you a healthy baby or a perfect delivery. This is both frightening and empowering. The best you can do is to make a logical decision based on information. If something bad happens, it doesn't necessarily mean that you chose wrong. Most people would not tell a woman whose baby died in hospital that she should have chosen to be at home. I have a friend who chose elective cesarean for her twins and became badly infected internally after the surgery. I have plenty of friends who were satisfied and happy (and healthy) having repeat c/s. I have yet another friend who just became the first VBA3C at our local hospitals. They all faced risks and dealt with the consequences of their decisions, just like everyone else. I'm sorry that you have such a difficult decision to make, but please realize that whatever you choose, you are still most likely to be a healthy mom with a healthy baby. No one else can make this decision for you, and the fact that you have a choice is very lucky. (This doesn't mean that you should feel obligated to choose VBAC just because you have the option. It just means that I wish that everyone had the option.) I hope this all helps somewhat, and good luck with your decision, whichever it ends up being.

[fayebond]

My personal (good for me but not for everyone) birth plan:

Plan A, HBAC

Plan B, VBAC

Plan C, CBAC

Plan D, UBAC at the bus stop because it happens too fast to call anyone (ergo the Bradley classes and extensive reading, my birth history is FAST)

thus, my perspective on your two questions:

2) CBAC is not giving up, its moving on to another part of your plan.  I won't consider it a failure for me if you promise not to consider it a failure for you.  Its part of the plan for a reason.  Figure out where on the plan it sits for you, considering your birth history and family worldveiw.  If you end up with one for reasons you don't agree with in the end, that's different, but there should be some clear reasons why you would (and not a vague "baby needs it" from some random person, but a clear, logical reason you decided on beforehand or later during with your medical team).

1) You have everything to gain and nothing to lose by trying.  No one can say whether or not you will rupture, but if you do, even the ACOG says that you will have a good 30 minutes to get that CBA2C (and whether at a hospital or minutes away like me, that's standard of care of ALL pregnant ladies.  If they can handle pregnant ladies, they can handle your VBA2C).  But only you can decide if you "should" do it, that's you.  

Scarily and awesomely, all of it is on you.

Call your midwife, or talk to a doula, you sound like you need some face to face encouragement.  The doula agencies near me set up meet-n-greets where you can talk to them for free for the first hour, find one near you and tell them you need a boost.  Or hit up an ICAN meeting, or someone who can give you that thumbs up in person.  Your mama instinct is not something to silence, just don't let everyone else's instincts get in the way.

[abouttobe5]

Thanks so much ladies, I really truly appreciate everything you are sharing me with.  I am realizing that I'm still under 1% chance of having anything go wrong which are really great odds in my favour!  I think I also need my hubby to be behind me so I need him to come around on this.  I don't want him freaking out or getting frustrated halfway through labour.  Obviously we have to have some really close talks over the next few days and then make the decision we can go forward with.  

Thank you all for everything.  I appreciate it.  :)

[kungfumoose]

I just had a VBA2C. I chose it mainly because I want to have the option of having more children. Every c- section you have gets riskier, and from what I've read, after the 5th section, the danger levels for rupture just being pregnant are above what I am comfortable with.

Make sure you read and research the risk factors for BOTH options, and how each choice is likely to impact any future decisions, then choose the best choice for YOU.
It's okay to be afraid, but too much fear can negatively impact your birth.
For me personally, it was the right choice, I'd love another VBAC, and my chances if success are higher now that i have a proven pelvis, but I'm not certain that it will be the right choice in the future. When I get pregnant, I'll research, think about it, and choose what is right for me at that time. I hope it's another VBAC, but it may not be.

You're not a failure if you do what you think is right. No matter the outcome, if you follow what you believe to be the right choice, you are a success!! Good luck!

[abouttobe5]

Originally Posted by kungfumoose 

I just had a VBA2C. I chose it mainly because I want to have the option of having more children. Every c- section you have gets riskier, and from what I've read, after the 5th section, the danger levels for rupture just being pregnant are above what I am comfortable with.
Make sure you read and research the risk factors for BOTH options, and how each choice is likely to impact any future decisions, then choose the best choice for YOU.
It's okay to be afraid, but too much fear can negatively impact your birth.
For me personally, it was the right choice, I'd love another VBAC, and my chances if success are higher now that i have a proven pelvis, but I'm not certain that it will be the right choice in the future. When I get pregnant, I'll research, think about it, and choose what is right for me at that time. I hope it's another VBAC, but it may not be.
You're not a failure if you do what you think is right. No matter the outcome, if you follow what you believe to be the right choice, you are a success!! Good luck!

Awww, thanks for your story!  

I did go ahead and schedule a section a few days past my date just in case.  Plus I have a biophysical u/s at 38 weeks in case there is something going on already that would indicate a section is necessary.  Between my own hesitation and my DH's hesitation, this just makes us feel better.  But it still gives us to about 40w5d to go naturally.  We're good with our decision and it doesn't feel like a failure at all, which I found intriguing.  If anything, I felt calm, prepared, and ready for whatever happens.  :)