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anyone who hasn't made up their mind about VBAC yet? - Page 2

post #21 of 47
Maternal and child mortality outside of developed nations is also a no brainer and obviously has no bearing on the capacity of a well nourished adult woman to bear children despite how many scars she has on her uterus. Afghanistan, for example, has almost no access to healthcare, unbelievably poor nutrition and young women having babies. It's a war zone with no infrastructure not a suburb in New York! Other parts of the world where women die in childbirth have similar scenarios but also include genital mutilation which unsurprisingly leads to fistula and death in a large number of birthing women, many of whom are more strictly girls since plenty of girls are infibulated and sold in marriage under the age of 12. So that comparison is ridiculous. If you look at road traffic accidents in countries without tertiary healthcare being available you'd no doubt find many people dying of injuries that are relatively easily fixed in the developed world but you won't see people quoting those statistics to demonstrate why we shouldn't be driving cars. It's just nonsense. Healthy well nourished women with access to appropriate care, ie not malnourished girls in war zones, birth just fine. If they didn't, the human race wouldn't be surviving and thriving, right? Why does logic go out the window just because surgery is involved?

I have frequently engaged in public debate via the media with various surgeons in this country and on the one hand they argue that women in Australia shouldn't birth at home because women in developing countries die in childbirth and on the other, they argue that studies such at the 2005 N.American hb study can't be applied to Australia because it's from another country. That just shows the logic that's not involved in this POV. It is a point of view, it's not an evidence based position. It's the mix of our internalised misogyny with their own misogyny and all supported by the money that's to be made from carving up our healthy bodies and trying to convince us that one c/s means c/s forever despite the evidence.


Honestly, I feel so worn down by the whole "debate" when it's no more complex than whether formula or breastmilk is the appropriate way to nourish a baby. Women don't come to MDC to "decide" whether or not they want to ff or bf because it's an evidence based board thus bm is the acceptable norm. How did birth become optional and c/s on a par with vaginal birth? All choices are not equal, surgery is not safer than birth. Of course it's apropriate to debrief and learn in a situation where your breastfeeding relationship has not been successful (or you've ended up with a c/s despite not wanting one in case you don't follow my analogy) but presumably the point to that is to put in place better support for subsequent breastfeeding relationships, not debate whether or not you want to bf a second, third or fourth time. Birth is normal, breastfeeding is normal.


ETA: Australian maternal mortality 2000-2002 showed 14 women died as a direct result of pregnancy or birth. Yes, that small! But of those 14, 12 died because of complications related to previous caesareans for which they were having subsequent surgery, mostly pph from placenta issues. Surgery being safe is an invention of surgeons and so many of us buy into it that's it truly shocking to me.
post #22 of 47
Quote:
Originally Posted by Emily's Mama View Post
I am very scared of having regrets whichever I decide and I really do change my mind from day to day.
Yeah, I can really relate to this, as well as your reasons for leaning towards a VBAC ultimately.

danotoyou2 I do like your "best case scenario" approach, I'd love to be optomistic like that, but the fear keeps getting in the way. You mentioned pre-eclampsia striking again, did you have it with your first pregnancy and not your second? Pre-eclampsia was my c-section causing labor complication so that is why I'm asking.
post #23 of 47
Eclectica,

Yes, pre-eclampsia in first but not in second. It came on at 42 weeks with my first, so I knew the odds of it striking again were low (around 10%), but I adjusted my diet drastically to try to offset that further. Lots of proteins and green vegetables. I also monitored my blood pressure daily in the third trimester; and I'd recommend that for anyone at risk. Sometimes it just isn't enough to have it checked at those weekly visits with a care provider. It made me feel better to see for myself that I was still healthy.

I had fears, but I stayed *very* busy which helped to keep me distracted from those fears. Plus, I got a bit militant about birth.
post #24 of 47
Janet, I didn't know the numbers you gave about only 14 women in Australia dying in 2000-2002 in pregnancy or birth. It is lower than what I would have expected, and I will certainly quote this (the 12 out of 14 being related to surgery) to others in discussion, esp in supporting VBAC. It does give me some relief to know this.

However, in 2002 I was at my friend's house in Sydney when she got a call to say her sister's friend had just died during natural childbirth (in Sydney). I don't know the exact circumstances around it, but I believe she had some kind of haemorrhage. I'd never known anyone who had died in childbirth (well, as so few do, it's not surprising) and I hope never to again. I guess she was one of the two from the statistic that did die from non surgery related cause in that period of time. That really had a BIG impact on me when I recalled this late in my first pregnancy a few years later, and think it will probably still make me nervous in subsequent pregnancies I may have. Despite all the reason and logic that says that this is such a rare event, and even though I never knew her personally, it still stuck in my mind, and it's hard to let that go.
post #25 of 47
Thread Starter 
Swandira-
thanks for sharing your decision making process. when i mentally project ahead 8 months, my hospital stay for c/s vs. VBAC is one of the most important elements of the decision. i just can't imagine sleeping away from my little girl for 3 or 4 nights!

JanetF, i found this link http://www.aihw.gov.au/mediacentre/2006/mr20061018.cfm
it says there were 95 maternal deaths from 2000-2002 in australia. where did you get 14?
post #26 of 47
Quote:
Originally Posted by majormajor View Post
Swandira-
thanks for sharing your decision making process. when i mentally project ahead 8 months, my hospital stay for c/s vs. VBAC is one of the most important elements of the decision. i just can't imagine sleeping away from my little girl for 3 or 4 nights!
MM - I really hate hospitals, so I signed myself out the day after my c-section. 1st time I was young and intimidated by the staff and I stayed in 3 or 4 nights. I didn't know I was "allowed" to leave if I wanted. Second time I had my section about 8am, then left the next afternoon - staying only one night. They wanted me to sign a "I am signing myself out against medical advice" form. 3rd time I had the section about 9am and then left the next day. They didn't even bother with the form. Personally I found the one night I stayed with my 3rd way too much. If i have a section this time I WILL be leaving as soon as I can feel my legs again and I've had all the drips and stuff removed. I know it seems a bit extreme, but I think the best place for recovery and bonding with my newborn is at home, in my own bed.

I have been reading this thread with interest. I haven't really made up my mind whether or not to VBAC. I'd be aiming for VBA3C, which makes things a bit more complicated. Oh, and I only have 2 weeks till my due date As of right now I have no healthcare provider at all. I am just about to make dinner (it's 5:30pm over here) but I will come back later on and post some of my thoughts.
post #27 of 47
I'm really running out of time and need to make some sort of a decision as soon as possible.

In a way, I'm sort of tempted by the idea of an elective c-section. I could have child care all planned out for my older children. My partner could book time off from work etc. I could make requests, like for them to pass the baby straight to me, to be able to cut the cord etc etc. I have terrible pelvis pain. Some days I can't get out of bed without help. It would be nice to have that over with (though having a baby is no guarentee that it will go away). I don't feel really hopeful about my chances of VBAC. I've had 3 c-sections, all in the 2nd stage, failed forceps in two of them, and bigger than average babies. Do I want to go through hours of labour only to end it all with surgery? Wouldn't it be easier if I had a good nights sleep so I was more able to cope with surgery and a newborn?

My main objection is - it HURTS! Its major surgery!!! People really don't take you all that seriously. You've only had a c-section. People have them all the time! I'm sure everyone will be helpful for the first week or so, but then I'll just be dumped to look after 3 children, a newborn and a surgical incision. Having a newborn is hard enough as it is. Especially if you are struggling to get the hang of breastfeeding and suffering from lack of sleep. You really don't need to deal with the after effects of surgery.

I'm seriously worried about the impact on my long term health. Having surgery 4 times in the same place can't be good for you. I am VERY worried about the risk of complications, and the fact that having surgery increases my chances of death. I have 3 children already to care for. I can't really afford to do something that puts my life at risk. From the research I've done it looks as if I have a 0.9% chance of rupture (and it seems from what I've read rupture rarely = death for mother or baby like they'd have you believe) Scheduling surgery for something that has a 99.1% chance of NOT happening seems a bit over the top.

This will be my last baby. Can I live with the fact that I have never experienced birth, and that I didn't even TRY with my last baby? I feel defective. How can I get pregnant so easily but be unable to give birth? Is there something wrong with me? If I could have a VBAC then I think I would feel somewhat healed from those thoughts.

Also the idea of walking into a hospital, strolling down to the operating theatre, having a spinal block put in, then being presented with my baby really freaks me out. I just can't imagine that. Will my body actually notice I've given birth? I'm worried about the affects that would have on breastfeeding. Will it take longer for milk to come in? What happens to the baby? Surely labour kind of prepares them for the fact they are about to be born. I can't imagine peacefully sleeping and suddenly being yanked out into the world with no warning. (well, actually I can - when I was a teenager my mum used to barge into my room in the mornings, rip the curtains open and open the window and shout at me to wake up! Thats not the kind of welcome I want for my baby)

I'm really not sure what to do. I change my mind daily! When my pelvis is really bad and I'm crying in pain I think I just want to go into the hospital and have the baby taken out RIGHT NOW!!! Other times I feel totally relaxed, and I imagine myself having a UBAC! I'm not sure if I need to be putting effort into preparing for VBAC or making plans for how I will manage after surgery.

I'm about 99% certain I won't consent to an elective section. I'm kind of wavering on thinking about having an "in-labour" section. You know, where I'd call the hospital when I went into labour, and let them know I'm on my way, get there and go straight to theatre. That way I know my baby is ready to be born. And I get to bypass all the hours of pushing and the possible risk of brain damage to my baby when they decide to help out with forceps. On the other hand... if I go into labour, and everything is going fine, babies heart rate is good etc. why go for surgery when theres a chance I could avoid it? I could actually give birth! Again, it seems a bit over the top to do surgery "just in case". But what if I don't give birth and I end up with the hours of pushing and the attempted forceps delivery? What if, my worst nightmare comes true and they decide to give me an episiotomy. I REALLY don't want another part of my body mutilated.

Everyone else keeps asking me if I have my c-section scheduled yet. Or IRRITATING me with their comments about how I can't give birth. It really makes me want to go all out for a VBAC just so I can say "Ha, you were wrong!" But other peoples comments are not a reason to do or not do something. My mum was talking about it today, saying it really doesn't matter in the whole scheme of things. But it DOES matter. It really really DOES. She even had the cheek to say it wouldn't really matter much in the end if I didn't breastfeed. (had very bad problems with baby #3, where my nipples actualy went black and fell off! I tried pumping, but just couldn't keep it up. I don't feel guilty about it. Just sad. I feel that the c-section was partly to blame as I just couldn't get into a comfortable position to get a good latch and the antibiotics they gave me caused thrush) She said my little boy is perfectly fine and healthy even though he was formula fed, and that I was breastfed and I was the sickest baby around. And my brother has asthma, even though he was breastfed. But thats not the point. She just doesn't get it. : (p.s - she wants to come with me to hospital. My partner wasn't too keen at one point and i asked her if she would come instead. Now she thinks she is invited - even though i have un-invited her. She really isn't supportive of me having a VBAC. She thinks she'll be there to acompany me into theatre. In fact she and my dad were convinced I was going to die, because it was SO DANGEROUS for me to be having another baby after all these c-sections.... yet they think the safest thing is having another one??? Just after I told them my dad went out and bought a 7 seater car so he could fit in all these children he was about to inherit. I told my partner that, thinking he'd find it amusing, but he started freaking out too )

Ugh! I just don't know what to do!!! Add to that the fact I'm not actually booked at any hospital to give birth at. I haven't had any antenatal care at all this pregnancy. I'm in the process of filing a complaint against my GP and an obnoxious midwife, and trying to find a new GP practice. I'm not sure if i have time for all this!
post #28 of 47
I am trying to find the words to express myself without sounding like I do not sympathise with the agony of decisions about VBAC. I really, really do understand the fear, the concern and the stress planning a VBAC puts on you. VBAC was an easy decision for me as I was terrified, petrified, of another surgery. It helped that the evidence of the safety of VBAC was obvious. Whenever I needed to put it into perspective, I would remind myself that, statistically, the risks associated with uterine rupture are not any higher than the random risks associated with vaginal birth without a scar.

During my first pregnancy, I wasn't scared of cord prolapse, previa, accretia, etc. I wasn't scared the baby would be born brain damaged. I wasn't scared of stillbirth. It wasn't even on my radar. I had to remind myself that the only reason VBAC was on my radar is because of the fear the medical community had instilled in me and other pregnant women. Yes, it is important to know what to watch for in case of UR, but it is equally important to have a caregiver to know how to watch for any other emergent issue during labor.

In the words of Janet:

It is just a birth.

ETA: A pp mentioned the Childbirth Connection site, but here is the direct link to a comparison of c/s and VBAC:

http://www.childbirthconnection.org/...e.asp?ck=10210
post #29 of 47
My c/s was due to pre-eclampsia. Since i knew what to look for, it made my resolve to have my next baby vbac even stronger. I did make a deal with my family that if the Pre-eclampsia came back, i would schedule, and i meant it.

My grandmother had three kids, three c/s. my mom had three kids, three c/s due to pre-eclampsia, so i knew the risks....and the signs. My brother made the comment after my daughter was born that it's just family tradition...we just can't have babies. he didn't mean it to hurt me (he was only 13 or 14 at the time) but it cut like a knife (no pun intended). So my vbac decision was not taken to fondly. I do not regret my decision but i had moments of doubt during my pregnancy and I think it's to be expected, really. i think it's something that should be planned for and played by ear at the same time. Surgery really is a life saver, but that should be soley what it's for, saving lives.

"I don't need to be saved if I can already swim....and i realize the water may be choppy and i might get scared, but I will make it to shore"
post #30 of 47
One of the major reasons that we (my DH and I) feel VBAC is right for us is because it is so much safer for moms and we haven't found any true contraindications for the baby either. I already have a beautiful little girl who depends on me and I love her with all my heart so I have to take care of myself for her. I have to be here for her. -Iris
post #31 of 47
Thread Starter 
Sarah0404-what a tough place to be in! keep us posted on your progress and decision--i hope babe gives you a bit more time to get everything straightened out!

i just heard back from the vermont/new hampshire VBAC project. they said 6 in 10,000 is the chance of fetal death during a VBAC labor due to uterine rupture, and 6/1,000 is the overall chance of fetal death in a VBAC labor. similarly, 3/10,000 is the death risk from uterine rupture in a planned c/s, 3 in 1,000 is the overall c/s death rate.

really interesting. i think 6 (and 3) in 10,000 are low rates for death due to rupture, so i like those a lot. however, 6 and 3 in 1,000 are so high! i need to read back through the info they have on this project.
post #32 of 47
What does "overall chance of fetal death in a VBAC labor" mean? Is that the general risk of vaginal birth vs. just uterine rupture? Is that number given to put the other number in perspective? If this is just the vaginal birth neonatal death rate, then would the "overall c/s death rate" be ALL neonatal c/s death rates? I'm just a little confused about what this means exactly. It seems to contradict other studies showing neonatal death from c/s to be many times that of vaginal birth.

I found information recently that the risk of death from UR is .046%. This is not far off from the projects' stats of 0.06%.
post #33 of 47
Thread Starter 
Quote:
Originally Posted by TanyaS View Post
What does "overall chance of fetal death in a VBAC labor" mean? Is that the general risk of vaginal birth vs. just uterine rupture? Is that number given to put the other number in perspective? If this is just the vaginal birth neonatal death rate, then would the "overall c/s death rate" be ALL neonatal c/s death rates? I'm just a little confused about what this means exactly. It seems to contradict other studies showing neonatal death from c/s to be many times that of vaginal birth.

I found information recently that the risk of death from UR is .046%. This is not far off from the projects' stats of 0.06%.
yes, the 6 in 1,000 in the VBAC death rate. i didn't ask whether that was neonatal or perinatal... i'm guessing neonatal. i'm having an awfully hard time finding more info on this. i also don't know if that's all risk groups or what. the fact that it is 2x the neonatal death rate for c/s doesn't surprise me--seems to be in line with the body of literature on VBAC vs. c/s. what does surprise me is how HIGH both these rates are. i've seen VBAC studies where the c/s neonatal death rate is closer to 1 in TEN thousand. so, i'm pretty shocked at 3 in ONE thousand.
the VBAC death rate also seems higher than what i've seen in other studies. usually, it's more in the range of 1 to 3 per thousand (for low risk women, i think). just a bit higher than any first vaginal birth, usually. but 6 in 1,000? if my baby had a 1 in 166 chance of dying at my hospital, no way would i VBAC. i'm not interested in a repeat C with a 1 in 333 chance of neonatal death either.
i wish i could find out more about this project. anyone know anything?
post #34 of 47
Do they have a source for their numbers?
post #35 of 47
Thread Starter 
the beginning of the handout says "This document was created by obstetric doctors, midwives, and nurses from hospitals across Vermont and
New Hampshire. It is based upon thorough and thoughtful review of medical studies of VBAC. It is a collection of everyone’s understanding of these studies."

and it lists just Mozurkewich, Hook, and Levine as footnotes.

so, i was initially thinking that these were their results, but i guess they're just the project leaders' summation of the existing literature. the project, btw, has apparently been successful in getting smaller, rural hospitals that had previously banned VBAC to offer it again. so, that's good. the ACOG recognized the people involved with it and gave them some kind of award. that's pretty much all a google search on it turned up.
post #36 of 47
I didn't post it in this thread since it wasn't on topic but since things have swung round a bit to research... if you're doing in-depth research and don't mind having to locate the full study through your library or a subscription database...

Check out http://www.worldserver.com/turk/birt...bac2005-9.html You've probably already been there, but this site lists much of the VBAC research that's been published (pro-vbac, con-vbac, undecided-vbac, etc) and it has an international perspective (so some studies may not be available in english). It provides the citation info and an abstract of the research/findings. It's not exhaustive, but combined with a search of something like PubMed (http://www.ncbi.nlm.nih.gov/sites/entrez) you'll have a fairly good representation of national and international findings.

On a related note, there is a study in the works that is going to be a random controlled study of c/s and vbac. It's unique in that women will be randomly assigned to vbac or repeat c/s at 38 weeks. I'm very interested in seeing how they control for other factors (and which ones they choose to address) and what their results will be. But it's probably going to be another year or two before the study ends and the data is published.
post #37 of 47
After reading this entire thread, I'm still not sure what I'll do:
I really don't want another c/s but my 1st birth experience was so traumatizing (56 hours of labor with just about every device shoved in my yoni ), I just don't know if I can go through that again.
post #38 of 47
You know, the choice doesn't really need to be as black and white as "vbac" or "repeat surgery"...

I talked a lot with my fabulous OBs about this... how I really wanted a vbac but was scared that my first birth would repeat itself and I'd have another unwanted c/s on top of another horrible labor. Long story short my first babe had an abnormally large head, she was OP, and she was asynclitic. My water broke on it's own a day before contractions began. I got to the hospital at 5cm, reached 7cm quickly, and then stayed at 7cm despite everything we tried. After 32 hrs of excruciating back labor we tried drugs and then the c/s. I was a wreck.

Basically my OBs said each birth is unique. They also said that IF this birth started to follow the pattern of my last birth they would bring in a portable u/s machine to check dd's position/head size and that there was no reason I couldn't opt for a surgical delivery if the info we got then wasn't what we wanted to hear.

I also made a deal with myself...if I was having contractions but not making progress at any point during my birth I'd give it 5 hrs and then go to c/s. I couldn't stand the thought of having a long labor ending in another c/s. I needed to either progress (didn't care how slowly, any progress would do) or go for c/s and I felt 5 hrs with no progress was about all I'd be good for. Turns out my birth was 12 hrs total from 1st "maybe contraction?", closer to 9 hrs total from "water breaking". But the thing is, I had a backup plan that I had thought out, a c/s backup birth plan, and I had a mental scenario I was comfortable with. "I can do X but not Y. I will ask for Q and then R and then P. I will tell people F and then S and then ask for B." and so forth.

A vbac requires IMO a lot more dedication and trust than a non-vbac birth just because you know what can go wrong and you know that "bad things happen to good people" so to speak. A vbac mama often has birth trauma on top of all the normal angst and that's important to acknowledge. Give yourself permission to birth and permission to change your mind if necessary. And find people who support you 110% no matter what.
post #39 of 47
Quote:
Originally Posted by wombatclay View Post
You know, the choice doesn't really need to be as black and white as "vbac" or "repeat surgery"...

I talked a lot with my fabulous OBs about this... how I really wanted a vbac but was scared that my first birth would repeat itself and I'd have another unwanted c/s on top of another horrible labor. Long story short my first babe had an abnormally large head, she was OP, and she was asynclitic. My water broke on it's own a day before contractions began. I got to the hospital at 5cm, reached 7cm quickly, and then stayed at 7cm despite everything we tried. After 32 hrs of excruciating back labor we tried drugs and then the c/s. I was a wreck.

Basically my OBs said each birth is unique. They also said that IF this birth started to follow the pattern of my last birth they would bring in a portable u/s machine to check dd's position/head size and that there was no reason I couldn't opt for a surgical delivery if the info we got then wasn't what we wanted to hear.

I also made a deal with myself...if I was having contractions but not making progress at any point during my birth I'd give it 5 hrs and then go to c/s. I couldn't stand the thought of having a long labor ending in another c/s. I needed to either progress (didn't care how slowly, any progress would do) or go for c/s and I felt 5 hrs with no progress was about all I'd be good for. Turns out my birth was 12 hrs total from 1st "maybe contraction?", closer to 9 hrs total from "water breaking". But the thing is, I had a backup plan that I had thought out, a c/s backup birth plan, and I had a mental scenario I was comfortable with. "I can do X but not Y. I will ask for Q and then R and then P. I will tell people F and then S and then ask for B." and so forth.

A vbac requires IMO a lot more dedication and trust than a non-vbac birth just because you know what can go wrong and you know that "bad things happen to good people" so to speak. A vbac mama often has birth trauma on top of all the normal angst and that's important to acknowledge. Give yourself permission to birth and permission to change your mind if necessary. And find people who support you 110% no matter what.
: Thank you so much for this. Reading it made me feel a lot more comfortable and in control.
post #40 of 47
Thread Starter 
wombatclay-
yes! this is where i was trying to go with this whole thread.

DH and i have spent a lot of time talking about this lately. my thoughts of the moment are that i won't even make a decision until around 35 weeks. if, at that point, things look good for a VBAC for me, then i think i'll go for it. one big dealbreaker for me is another unstable lie--DD was transverse until 36 weeks, then OP, and i think her late turn had something to do with her cord troubles. i know there's a big correlation between breech/unstable lie and problems.

another thing i do no want to endure again is a wonky heartrate in labor. the thought of watching it drop again and again is too much. however, i think my OB will feel the same way, so i'm not too worried there.

my big hangup right now is whether i'll get the epidural or not if i do VBAC. does anyone know how willing they are to insert the epidural cathether and not medication? i really hate the idea of general anesthesia for a birth.

this might all change 10 times in the next 8 months, of course.
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