or Connect
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › WWYD? Elective repeat caesarean or vaginal?
New Posts  All Forums:Forum Nav:

WWYD? Elective repeat caesarean or vaginal?

post #1 of 49
Thread Starter 
I'm curious as to your opinions on this issue. Here are the basic details. Let's say you had a couple, Jim and Janet, who were infertile. Twelve years of failed IVF attempts, ovarian stimulation, tests, Progesterone, Lupron, you name it. They decide to ask "Jane" to carry a child for them, and after many failed IVF attempts, Jane gets PG on their very. last. embryo. ever.

Jane had a c-section before. Even if Pitocin or other drugs are not used, there is still a risk, however small, of uterine rupture should Jane attempt a VBAC. Jane, while she would prefer a VBAC herself, is willing to undergo an elective repeat C-section. Janet and Jim, fearing for a birth complication, would far, far prefer a c-section because there is comparatively less risk to the baby.

Your opinions?
post #2 of 49
Are you asking as the surrogate or as the parents?
post #3 of 49
If *I* were Jane I would have a VBAC. The risk of u/r is small. The risk of complications from elective repeat c-section is greater. Also, thinking of later pgs, a VBAC after 2 c-sections is much harder to find a care provider to support you.
post #4 of 49
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
post #5 of 49
Thread Starter 
Quote:
Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
Though Jane's health is by no means irrelevant to the issue, one factor here is the danger to the baby. One question to ask, then, is how dangerous c/s is for the baby vs. VBAC.
post #6 of 49
Thread Starter 
Quote:
Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.
Jane doesn't want more kids.
post #7 of 49
AFAIK, C/S is safer for the baby while VBAC is safer for the mother. If I were Jane, I'd push for VBAC. I can't even imagine being in Janet's position, so I can't say. If she cares about the baby more than she does about Jane, I'd assume she'd push for a cesarean.
post #8 of 49
VBAC from both sides, but I'd let Jane decide.
post #9 of 49
VBAC.

if the parents are unwilling to consider Jane's position/feelings on this that would creep me out. Jane is carrying their child yes and that should give her SOME consideration.
post #10 of 49
here is some info about the risks of repeat c/s from ICAN:


"Recently, a few physicians have claimed that elective primary cesareans and elective repeat cesareans are safer for babies, and even for mothers, than vaginal birth.1,2 While selective use of the medical literature might seem to back up this claim, a review of the studies which consider short- and long-term risks of cesareans does not.

Elective cesareans put babies and mothers at risk, use valuable and limited healthcare resources, have negative psychological and financial consequences for families, and substantially increase serious risks in subsequent pregnancies. The high rate of cesarean in the United States has not resulted in improved outcomes for babies or mothers. Additionally, vaginal birth after cesarean (VBAC) is still less risky for mothers and babies than cesarean section, despite recent claims to the contrary. ICAN is opposed to cesarean sections performed without true medical indication."


Risks to the baby from elective cesarean section

• Babies delivered by elective cesarean have an increased risk of neonatal respiratory distress syndrome (RDS), a life-threatening condition,3-7 and other respiratory problems that may require NICU care.

• Babies delivered by elective cesarean have a five-fold increase in persistent pulmonary hypertension (PPH) over those born vaginally.6

• Babies delivered by elective cesarean are at increased risk of iatrogenic (physician-caused) prematurity, usually related to failure to conform to protocols for determining gestational age prior to delivery, or errors in estimating weeks of gestation even with the use of clinical data.7,8 Prematurity can have life-long effects on health and well-being, and even mild to moderate preterm births have serious health consequences.9

• Babies delivered by elective cesarean are cut by the surgeon’s scalpel from two to six percent of the time.10 Researchers believe these risks to be underreported.


Risks to the mother from elective cesarean section


• Up to 30% of women who have a cesarean acquire a postpartum infection. Infections are the most common maternal complication after cesarean section and account for substantial postnatal morbidity and prolonged hospital stay.

• Other serious complications for women undergoing cesarean include massive hemorrhage,12 transfusions,13 ureter injury,14 injury to bowels,15 and incisional endometriosis.16,17

• Women who undergo cesarean report much lower levels of health and well-being at seven weeks postpartum than women who have vaginal births.18

• Women who undergo cesarean section have twice the risk of rehospitalization for reasons such as infection, gallbladder disease, surgical wound complications, cardiopulmonary conditions, thromboembolic conditions, and appendicitis. Rehospitalization has a negative social and financial effect on the family.19

• Women who undergo cesarean section report less satisfaction than women having vaginal births.20,21

• Women undergoing cesarean are at increased risk of hysterectomy in both the current and future pregnancies.22,23

• The maternal death rate is twice as high for elective cesarean as for vaginal birth.24

• In subsequent pregnancies, women with a prior cesarean have higher rates of serious placental abnomalities which endanger the life and health of the baby and the mother.25-27 Women are rarely told that a cesarean places future babies at higher risk.

• After cesarean section, women face higher rates of secondary infertility as well as higher rates of miscarriage and ectopic pregnancy.28,29


References are included if you view the paper at the ICAN site.
post #11 of 49
Quote:
Originally Posted by velcromom
• Babies delivered by elective cesarean are cut by the surgeon’s scalpel from two to six percent of the time.10 Researchers believe these risks to be underreported.
They ARE underreported. In fact, in my case, the hospital lied about them. My dd came out screaming and screamed for HOURS after she was delivered by c-section. I'd cry too if my first introduction to this world was having a knife cut my head.

The hospital told me that it must have happened in utero when "her head was banging against my pelvis." I was a mess of hormones and drugs making me loopy so it didn't occur to me to question them at the time. Wouldn't she have had bruising if it happened in utero? Funny how cuts in utero can be so straight and even. :
post #12 of 49
VBAC. No question. Safer for both short term. Safer for both long term.

-Angela
post #13 of 49
Vbac.
post #14 of 49
Vbac.
post #15 of 49
I would have the operation because I could not handle the brain flooded with oxytocin thing if I was not the intended mother.
post #16 of 49
vbac.

i agree that it would seem very disrespectful of Jim & Janet to not consider Jane's preferences for the birth of the baby she is carrying for them.

and while i agree that in some cases, a repeat cesarean is better for the baby while still carrying an increased risk for the mother, in many other cases it is not true. if it is a scheduled cesarean, they will likely not wait until the mother goes into labor and instead schedule it in advance, risking birth that is too early for the baby. the increase of incidence of respiratory distress for babies born via cesarean is also telling for me.

just as i would never coerce a person into donating their kidney to me if they were the only match for me in the world, i would not feel comfortable requesting a woman have major abdominal surgery with significant risks when she has offered the gift of allowing me to become a parent.

~claudia
post #17 of 49
Quote:
Originally Posted by alegna
VBAC. No question. Safer for both short term. Safer for both long term.
:
post #18 of 49
Quote:
Originally Posted by Kleine Hexe
If *I* were Jane I would have a VBAC. The risk of u/r is small. The risk of complications from elective repeat c-section is greater. Also, thinking of later pgs, a VBAC after 2 c-sections is much harder to find a care provider to support you.
charles baudelaire,

, to what kleinehexe said to you about this.
post #19 of 49
Quote:
Originally Posted by velcromom
VBAC. Jane has a 99% chance that her uterus will not rupture. She also must consider the long-term effects to her future reproductive health and the fact that a second c/s will introduce much difficulty in avoiding an unwanted c/s if she had another child.

If a 99% chance that the uterus will not rupture is not satisfactory for the parents they should seek a surrogate with no prior c/s, with the understanding that there is no such thing as a 100% guarantee that it won't happen no matter who their surrogate is.

How do they feel about the potentially lethal risks that have a greater chance of occuring than UR, for any pregnant woman? Cord prolapse, placental abruption, etc? If they are accepting of those risks, why are they more concerned about a risk that has a lower chance of happening?
charles baudelaire,

, to what velcromom said to you as well.
post #20 of 49
VBAC! As a surrogate I might also add that even though she says she is willing to undergo a section for the IPs, if her real choice is to vbac she may possibly regret doing the section. I am speaking from experience (Although my c-section was not a repeat, it was a first)
New Posts  All Forums:Forum Nav:
  Return Home
  Back to Forum: Birth and Beyond
Mothering › Mothering Forums › Pregnancy and Birth › Birth and Beyond › WWYD? Elective repeat caesarean or vaginal?