To VBAC or not to VBAC? « Back to Group Discussions

[GranolaMama09]

I need some advice/insight/input from the Mommas I trust.  I'm really waffling on whether or not to have a VBAC.  P was an emergency section after failed induction at 39w6d.  I was at 3cm when I arrived so we skipped straight to piticon.  I never got past 7cm and I went to section for fetal distress approximately 17-18 hours after arrival.
I have been told I have a low cervix and a small birth canal (oh the irony since I have 'birthing hips' but not the canal to go with it).  I also have a vaginal septum the doc will have to sever during delivery before the head crowns or it can cause some serious damage/possibly fatal hemorrhaging if the baby rips it.  I am obese.  I was nearly 11 lbs and DP was nearly 13lbs - I'm already measuring nearly a week ahead.  We're definitely anticipating a large baby!  I have extreme asthma during this pregnancy.  I have a genetic anomaly that makes having general anesthesia impossible so I'll have to get an epidural for the just in case scenario.  My mother didn't have any successful vaginal births and my grandmothers had some serious complications with their births.  I have until my EDD and if don't go into labor by then I'll be sectioned anyway.  DP and I talked a little and he would prefer I not VBAC because of the risks but he will support me whatever choice I make because it's my body, my life, my decision.  My doctor will support a VBAC up to my EDD or up to the point of something going quirky (GD, placenta previa, breech, etc.).  A planned section is safer than an emergency section from a failed VBAC.  But a section at all is risky.
If I don't have a VBAC then I'll never really get to experience 'normal' birth and labor.  If I have a section it could potentially weaken my ability to BF successfully.  I'm more knowledgeable about BFing this time so I feel like I could probably work through that but still... I am a little phobic about surgery in general but since I've already done it once I know what to expect so it's not as scary.  I will only be 25 at birth and it has been three years since my last pregnancy/birth/section which is a plus.  
What do you think?  VBAC or no VBAC?  

[LDoulaSteph]

Hi! I don't have an answer for you on whether you should choose to VBAC or not to but have you thought about hiring a Doula to support you through either scenario. I'm not trying to just market Doula's because I am one, I think in your situation you might really benefit from that support both with whatever birth you end up having and with breastfeeding afterwards. A doula can help you learn to advocate for things like skin-to-skin immediately after the birth (even with a section) and keeping baby with you all the time. These things can be really helpful in better establishing breastfeeding because you seem to really want to do that :)

I wish you the best and I hope you get some good advice. Good luck mama

[buko]

I really can't speak to the vaginal septum issue, which may be very significant, for all I know-- but I would be very skeptical of the "small birth canal/pelvis" "diagnosis."  It's a common one when inductions fail (and yours failed d/t distress, YK?)  Bottom line-- you were induced before your EDD and ended up with a section... exactly like 50% of all first-time moms who are induced.  It's an extraordinarily common consequence of such an induction, and usually has little if anything to do with a mother's anatomy, etc.

As for this...

A planned section is safer than an emergency section from a failed VBAC. 

I am not sure of this-- at least, I know that, all things being equal, a planned section is absolutely NOT safer than an unplanned section that occurs after labor begins.  It would be safer than an emergency section d/t uterine rupture, but the likelihood of that is, AFAIK, about 1/2 of 1%, if you are not induced.  (And I'm sure you know that uterine rupture is rarely catastrophic.)  The biggest problem with a planned section is iatrogenic prematurity, as baby hasn't indicated his or her "doneness" by natural means.

I would really, really do some research and ask some questions on a larger board about this vaginal septum issue.  I wish I knew something about it, and whether it's a serious consideration/could seriously complicate things, or if it is a lot of sound and fury over nothing.  If it is the former, you might want to go ahead and schedule a RCS, but I'd do it later, rather than earlier.  If it's the latter, I don't see anything else that should really prevent you from attempting a VBAC (except for an unsupportive spouse or doctor-- not that they are unsupportive, but IF they are, that will be a big hindrance).  As I'm sure you know, a VBAC is significantly safer and healthier overall than a CBAC.  

[GranolaMama09]

Originally Posted by LDoulaSteph 

Hi! I don't have an answer for you on whether you should choose to VBAC or not to but have you thought about hiring a Doula to support you through either scenario. I'm not trying to just market Doula's because I am one, I think in your situation you might really benefit from that support both with whatever birth you end up having and with breastfeeding afterwards. A doula can help you learn to advocate for things like skin-to-skin immediately after the birth (even with a section) and keeping baby with you all the time. These things can be really helpful in better establishing breastfeeding because you seem to really want to do that

I wish you the best and I hope you get some good advice. Good luck mama:Hug

Oh I absolutely believe in the importance of doulas!! I've looked into being one myself!! The hospital I would be delivering at advocates for baby in rooming - my daughter never left my side except for one mandatory check I couldn't go to because I wasn't able to walk yet and had no partner to go in my stead (not an issue this time). I should clarify that I successfully ebf my dd until 5 months at which point I began taking PPD meds which dried me up overnight even though they were 'bf safe' and at the time I didn't know about supplements to encourage production or relactation. If we decide not to VBAC I know my provider (and partner) are supportive of a 'crunchier' section with things like immediate skin to skin, bfing within the first hour, etc. I was able to do this with DD as well. Unfortunately, a birth doula isn't in the budget for us although I have a friend who is training to be a pp doula that is going to use us for 'practice'.

[withlittlelungs]

I would definitely research VBAC as much as possible before making your decision. Also look at the risks of severing the vaginal septum (I am not at all familiar with this) and weigh them against a repeat c-section. I think it is great that your doctor will even consider a VBAC, because I know that is not common with the majority of OBs. 
If you decided to go with a VBAC, you aren't locked in to that decision. Once you are in labor you can see how things are going/how you are feeling, and if you decide that a c-section feels like better choice you can go for it. You don't have to wait until it becomes an emergency. 
Just remember that if you do choose a VBAC, prepare yourself that your doctor/hospital staff could start pushing you for a c-section. I really wish that you could afford a labor doula (we can't either ), because I think it would be extra great in your situation. 

[GranolaMama09]

Originally Posted by buko 

I really can't speak to the vaginal septum issue, which may be very significant, for all I know-- but I would be very skeptical of the "small birth canal/pelvis" "diagnosis."  It's a common one when inductions fail (and yours failed d/t distress, YK?)  Bottom line-- you were induced before your EDD and ended up with a section... exactly like 50% of all first-time moms who are induced.  It's an extraordinarily common consequence of such an induction, and usually has little if anything to do with a mother's anatomy, etc.

I'll be honest, I really don't think 12 hours before my EDD makes that much of a difference.  We know the EXACT date of conception so we KNOW the dates were right, kwim?    My daughter went into distress because the birth canal was too small.  Yes, inductions commonly lead into sections there's no denying that.  However, my mother and grandmothers had similar problems for similar reasons and I have other body parts (jaw bones) that smaller than the average adult so it wouldn't shock me, kwim?  As far as the septum, it could rip while dilating even and cause damage/bleeding or it could stretch enough to completely dilate but it will block baby's passage out the vagina so it must be cut before it rips/baby gets to it.

As for this...

A planned section is safer than an emergency section from a failed VBAC. 

I am not sure of this-- at least, I know that, all things being equal, a planned section is absolutely NOT safer than an unplanned section that occurs after labor begins.  It would be safer than an emergency section d/t uterine rupture, but the likelihood of that is, AFAIK, about 1/2 of 1%, if you are not induced.  (And I'm sure you know that uterine rupture is rarely catastrophic.)  The biggest problem with a planned section is iatrogenic prematurity, as baby hasn't indicated his or her "doneness" by natural means.

I know uterine rupture is unlikely, I'm not terribly worried about that.  If for some reason I need and induction we will not attempt a VBAC.  However, I am blessed with an awesome OB who agrees with most of the crunchy community that most inductions are unnecessary and only suggests them out of actual necessity.    I disagree that unplanned sections are just as safe as planned.  At that point you have to hope there is an OR available, you have to hope baby hasn't gone into distress, you have to hope for all kinds of things and from personal experience, recovery SUCKS because you're exhausted from labor.  A planned section means you know there is an OR available, you know baby isn't going to be in fetal distress, and there is more control over the whole situation.  Personally, an unplanned section is more dangerous because I CANNOT have a general anesthesia.  It could kill me (essentially the genetic anomaly I referenced is an allergy to general).  In an unplanned/emergency situation we'd also have to hope there is enough time to place other means of sedation like an epidural or spinal block and that they're working properly.  My biggest concern is definitely that baby wouldn't be 'done' with a planned section.  But again, I have an awesome OB and she's willing to let me section as late as 39w5d.  While not as perfect as baby indicating doneness, it's closer to EDD than most OB's would allow.  However, it's DEFINITELY one of my major deciding factors.

I would really, really do some research and ask some questions on a larger board about this vaginal septum issue.  I wish I knew something about it, and whether it's a serious consideration/could seriously complicate things, or if it is a lot of sound and fury over nothing.  If it is the former, you might want to go ahead and schedule a RCS, but I'd do it later, rather than earlier.  If it's the latter, I don't see anything else that should really prevent you from attempting a VBAC (except for an unsupportive spouse or doctor-- not that they are unsupportive, but IF they are, that will be a big hindrance).  As I'm sure you know, a VBAC is significantly safer and healthier overall than a CBAC.  

I've been researching the septum since my DD was born three years ago and with the size/location, it's a factor here.    Luckily, my OB and partner are supportive because they both feel it's my decision and it's their job to support that decision.  DP would prefer I RCS but he has been very clear that's just his opinion (which I asked for) that he reached after doing his own research but he will absolutely support 100% whichever way I decide.  In most situations I would absolutely agree that VBACs are better than CBAC but there are factors that need to be considered.  I'm afraid I'm so determined to have a VBAC that I'm making a selfish decision and not actively looking at everything involved and not making an objective, informed decision.  Does that make sense?  That's why I need you ladies - all of you are helping me mull things over and reach a decision I'm 100% comfortable with and sure of either way.  

[GranolaMama09]

Originally Posted by withlittlelungs 

I would definitely research VBAC as much as possible before making your decision. Also look at the risks of severing the vaginal septum (I am not at all familiar with this) and weigh them against a repeat c-section. I think it is great that your doctor will even consider a VBAC, because I know that is not common with the majority of OBs. 
If you decided to go with a VBAC, you aren't locked in to that decision. Once you are in labor you can see how things are going/how you are feeling, and if you decide that a c-section feels like better choice you can go for it. You don't have to wait until it becomes an emergency. 
Just remember that if you do choose a VBAC, prepare yourself that your doctor/hospital staff could start pushing you for a c-section. I really wish that you could afford a labor doula (we can't either ), because I think it would be extra great in your situation. 

Oh I searched for weeks to find one of two doctors (both at this practice) that will VBAC in my town.  It's the policy of the hospital they deliver at not to allow VBACs after 40 weeks but honestly, I felt privileged to be even offered the option since it's so rare in some places (including here!).  I am locked into my decision unfortunately - it's an insurance thing.  A planned section will only be covered if my doctor states it's medically necessary which she can/will do (if I ask) with reasoning due to previous section.  If I choose to VBAC, insurance won't cover an unplanned section unless it becomes a medical emergency.  While I'm sure my doctor would create a reason should I change my mind that's not something I really want to ask her to do.  I'm determined to research, research, research until I'm comfortable with my choice either way.  If it's VBAC I'll definitely be discussing with my doctor the how would we handle me changing my mind and if she says I can and she'll reason it out that it'll be covered AWESOME.  I anticipate that staff pushing a section if things don't go well but OB won't until it's actually becoming necessary (seriously, she's a CRUNCHY OB).  Lol, plus I dare them to incur wrath of partner on that one - if I say I want a VBAC and don't want to hear anything about a section until my OB comes to me and tells me it's necessary he'll chew up and spit out any staff that tries otherwise.    Luckily I have a labor doula that's a friend -she just moved out of state but she's great for questioning!!!  I'm sorry you can't afford a labor doula either!  

[LDoulaSteph]

Contact DONA (Doula organization of north america) and they can help to connect you with a volunteer or low fee/sliding scale doula. Most Doula's who are working towards certification will take clients on a volunteer basis to get the experience and the needed birth hours for certification. I did lots of volunteer births when I was just starting out. Also lots of Doula's will work on a barter system so if you have handy partners who can do some work around their houses or something like that :)

[withlittlelungs]

granola- I am sorry that you have to make a definite decision due to your insurance. The good thing is that you have a bit of time to continue to research 

LDoulaSteph- Thank you for suggesting that. I just contacted them! I hope that I can find someone in my area to help, because support during my first labor/birth was practically nonexistent. 

[Georgetown HB Mom]

"I'll be honest, I really don't think 12 hours before my EDD makes that much of a difference. We know the EXACT date of conception so we KNOW the dates were right, kwim? My daughter went into distress because the birth canal was too small. Yes, inductions commonly lead into sections there's no denying that. However, my mother and grandmothers had similar problems for similar reasons and I have other body parts (jaw bones) that smaller than the average adult so it wouldn't shock me, kwim? As far as the septum, it could rip while dilating even and cause damage/bleeding or it could stretch enough to completely dilate but it will block baby's passage out the vagina so it must be cut before it rips/baby gets to it."

Hi,

I am due at the beginning of April with my 5th baby so I was just cruising around the March club to see what ya'll are chatting about and came across your post. I wanted to give my 2 cents. Here is some of my background so you know I came to my conclusion with some book knowledge behind it. My BS degree is in Respiratory Therapy and I was a NICU therapist for many years. I attended many births in the hospital where trouble was going on. I had a homebirth with my second baby and started midwifery studies soon after. I studied for three years before putting it on hold as I had my 3rd baby and wanted to be at home more.

Yes, the 12 hours before your EDD can make a world of difference. Even if you know the date of conception. The actual sperm meets egg may not have actually occured until a couple of days later, maybe even as many as three to four days later. Your dates are still an estimate. The majority of first babies gestate for 41 weeks. The start of labor occurs by the baby releasing a chemical from its lungs to let the mother's body know when to initiate labor. This signals that the baby's lungs are 100 percent mature. Baby's like people develop at all different rates. Your baby may not have started labor until 41 weeks or it may have been ready at 40.5 weeks. No one knows for sure. It is not an exact science even with dating ultrasounds and women tracking their fertility etc. Your daughter never dropped into the birth canal. You only got to 7cm. She never went past the cervix. What led to her distress was the pitocin inducted contractions. Pitocin induced contractions are much, much harder on the baby than contractions produced by your own body. You may have a small birth canal but you won't know that until a baby actually tries to pass through it and in order to do that you must be completely dilated.

It is horrible that your hospital has a "policy" on not letting VBAC mom's go past 40 weeks. That is just absurb. I refuse to follow hospital policies because you can't group everyone under the same umbrella. If I were you and I decided to do a VBAC (which is what I would do) is go along with your doctor. If you don't start labor by your EDD then let them schedule the section. Then on the scheduled day, don't show up. They will not come and drag you to the hospital. They may not even call you to find out where you are. Wait until labor starts on its own and then go to the hospital. Your OB can not fire you from his/her practice without a 30 day notice so when you show up to the hospital at 41 weeks in labor they have to take you. Refuse to sign a consent form for a c-section right then. Tell them if it comes to that because you or the baby are medically in need of one then you will sign the consent, otherwise labor will continue on its own. Remember you are an adult. You have hired them to provide a service to you. They can give you suggestions but you are the one that makes the final decision.

Take Care,

Lisa

[withlittlelungs]

Lisa,
I know the post was not directed towards me, but I wanted to thank you for it. I really think that the majority of women (myself included) forget that WE are in charge. The doctors cannot make us do anything. I think your suggestions for Granola are awesome. I would never have thought not to show up to a c-section. Thank you for stopping in and sharing your advice! 

[Georgetown HB Mom]

Originally Posted by withlittlelungs 

Lisa,
I know the post was not directed towards me, but I wanted to thank you for it. I really think that the majority of women (myself included) forget that WE are in charge. The doctors cannot make us do anything. I think your suggestions for Granola are awesome. I would never have thought not to show up to a c-section. Thank you for stopping in and sharing your advice! 

Awwww...Thank you for your kind words.

[GranolaMama09]

Thank you for your insight and good luck with your new babe!

WLL - I'm glad it was helpful for you too'

[akind1]

I really can't speak to the septum issue.

But, I had a successful VBAC with #2, and hope to again with this baby. My first baby, like yours, was a section due to distress, failure to progress/decend, etc (stalled at a 7 after 26 hours of labor). The first provider I had with #2 also had major roadblock at 40 weeks - not delivered by then, automatic section. I ran like hell. Seriously. That's a relatively arbitrary place to draw the line (one day more or less - even a week - isn't likely to make much more of a difference. refuse to go in) -  Baby #1 was born at 41 and 6. Cytotec >Pitocin+AROM . . . ugh. (I knew better! just not brave enough to refuse induction. and frankly, by that point, very ready to be done being pregnant)

I switched to another practice that I liked much better, that took a wait and see approach. Towards the end - again, I carried past 41 weeks  - they were getting concerned. my blood pressure was rising, fluid levels appeared to be decreasing, but I did go into labor on my own, with a little help from the breast pump, and delivered a baby nearly a full pound heavier than my first after only about 10 hours.

Doulas are awesome - I was so grateful to find one that had VBAC'd herself, attended several at the hospital I delivered at, and was just an awesome person. She's now a dear friend.

As to measuring ahead (by ultrasound or external tape measure?) ultrasounds are not great for that. ballpark at best. tape measure on exterior . . .this is your second baby. your uterus is stretched out a little more, you will measure ahead abit. Also, purely anecdotal - #1 for me always measured ahead, big, on ultrasounds and soft tape. He was a whopping 6 lbs 14 oz when born at 41+6. My second always measured small on ultrasound, I gained very little with her (less than 10 lbs), exterior soft tape was usually right on target, or a bit small. She was 7 lbs 12 oz. (BTW, I am also overweight, obese by BMI standards. I started first 2 pregnancies at 225. This one I started around 215)

Best of luck in your decision - just wanted to offer some encouragement.

[GranolaMama09]

Thank you for your encouragement!  It's nice to hear some success stories as well.  At this point I'm just continuing my research and then I plan to talk to my OB and see if she's still willing to support me with the addition of the SCH and the extremity my asthma has reached and also see exactly what the procedure would be if I did a RCS.  I also want to know at what point she'll no longer support a VBAC - like if they think baby is 8lbs is that the cut off?  If I gain more than the 20lbs she has suggested will I no longer be allowed to VBAC?  I don't even know if she has those cut offs but I want to know what they are if she does, kwim?  Then we'll make our decision - regardless we at least have time before we have to really pick one way or the other.

[akind1]

For me, the only reasons I could see to have a RCS would be those that would necessitate it in any other sort of pregnancy  - breech (because while breech babies can be born vaginally, it's precious few doctors that have experience with vaginal breech birth) - placenta previa, placenta accretia . . . Size isn't so much an issue. I meant to say, work lots on positioning. When the doctor who did my c-section reviewed my records (he was not my care provider for the pregnancy  - I had hospital midwives) he said the #1 reason I ended up with a c-section was poor positioning. Baby was completely OP. (likely caused by AROM so early in labor - baby lost what cushion and manueverability he had, and no one really checked his position during labor or tried to get him into a better one).

With #2, I had an awesome nurse, who knew what to feel for, and helped me into different positions to get baby in the best spot. Not to mention, I did regular chiro visits and massage therapy to help get my pelvis in the best shape (alignment and relaxation of muscles and tissue) it could be. I've been slacking on that this go round, and need to amp it up.

Though, I must say, go with your gut. Sometimes a mama just *knows* her baby needs to be born surgically, even though the reasons are unclear during pregnancy. I have had more than one friend that this was true for, and none of them have regretted it.

[GranolaMama09]

Thank you again! That definitely made me feel better about the possibility of not choosing a VBAC although we're still pretty much on the fence. My current OB was not my OB for my daughter and she was appalled they they induced me. Lol, I love my OB. She's so crunchy she may as well be a midwife! That's why I take her opinion seriously usually. Ie, I am incredibly upset I'm having to take Advair twice a day. But my OB doesn't prescribe anything willy nilly and we'd tried weeks of getting it under control without it. So I take it and my OB will be even more vigilant during U/S. A good friend just sent me her hypnobabies stuff suggesting I do the fear cleansing session (as I'm scared either way that I'll make the wrong decision and cause harm to me or baby) before making my decision. I plan to do that along with a few other things and perhaps we'll make an official decision around Christmas time.

[withlittlelungs]

saw this and thought you'd be interested, granola! http://banned-from-baby-showers.blogspot.com/2012/03/vbac-vs-repeat-c-section-by-abbey.html

[GranolaMama09]

Thanks - off to read now while I've got a few minutes.