Many good thoughts here...good discussion.
Another thing to figure in is that "THE HOSPITAL" is not a catch all, quality and availability of services vary widely. Its important to ask these question in relation to your home and midwife team and your local hospital, and how its staffed.
And how it is "Staphed" is something to consider too. My local hospital has a 30-40% staph infection rate for all admissions up from 26% in 2005, with MRSA raging all over it.....not a place I'd want to have a baby if I could help it.
And an acquaintance had an ERC and her baby was in the NICU three weeks for immature lungs. She spent those first three weeks in the NICU away from her 2 year old, and that made the whole transition to new baby in the family hell for them. Should they be grateful they had a live baby or regret not having had a VBAC that statistically would have gone off just fine?
Choices depend so much on what is available- in my town I can have a homebirth with a midwife, soon I can choose a birth center birth too, or I could have an ERC at the hospital with lower infection rates that does not do VBACs, or ERC or VBAC in the hospital that is very aggressive with intervention and not friendly to mothers who want to move or have intermittent monitoring and some of the docs require an epidural in place in case of rupture (an unmedicated VBAC is my bench mark for health and normal) plus it has mandatory separation of mother & baby in post op during recovery and is the place with high infection rates... or I could leave town and go somewhere with lower infection rates and better VBAC policies, and better post c-section care for mom and baby.
One reason I want to choose VBAC is to protect my future health and the integrity off my uterus. What about the long term risks of adhesions and bowel complications, reduced fertility, or gynecological problems from having my abdomen opened up uterus cut over and over again? Esp. if infection is part of the picture? I just had surgery to fix problems from my first c-section, I know I don't want to go through all that again.
I value spontaneous labor and all the related hormonal reactions that are too complex to be understood, but I suspect they are far more important than we have begun to realize. Like I value my body's natural oxytocin's ability to create love and attachment for me and my baby. I think the hormones of labor are a vital part of creating a healthy baby and mother. What if lack of natural labor hormones is part of the aspergers picture? What if you skip labor and have a child who is life long affected by a neurological disorder, or chronic lung problems from being born early and not getting squeezed out, what then? I believe nature has a purpose in its process of birth, and think its unwise to bypass that if you can help it.
Plus I believe in the energetics of the body, and spinals/epidurals/surgery are far more depleting than vaginal birth. In Chinese medicine c-sections are seen as cutting your meridians and they most often don't reattach right, just like circulation and nerves do not heal/ reattach perfectly, and it creates long-term changes in the flow called stagnation that affects all body processes, especially moods. I think these kinds of energetic problems were my worst post c-section complications. I really have not been the same since, the stagnation issue has been a big one for me, giving me symptoms in my back, low energy, hopelessness and anger. I need acupuncture to clear these things the way someone who had a major injury might need lymph drainage massage. Things just don't flow like they used too! I think submitting to that without good reason seems bad for maternal long term health.
I tend to think that we need to start at the lowest level of intervention that is safe, and react to emergencies when they arise. The question becomes what is the best plan if an emergency does arise, and how much do we let it effect the original course of action? I think VBAC is safest and most sensible option for me, but ideally we need to have surgery ready ASAP in case we are in the minority that poor egold (bless her) was in. But I can not go into the hospital here and have a peaceful, unmedicated VBAC. I know I could not birth in the circumstances available for me in the hospital that VBACs here. And I need to give myself the best shot at a VBAC since I think that is healthiest for me. I am afraid of the myriad of surgery complications from an ERC or "failed" VBAC, totally not worth the risk to me if I can help it, so really it makes best sense for me to try to birth at home.
I am aware of risks of death to my baby, even me, for homebirth rupture and
hospital VBAC/elective c-sections. None of the choices are perfect, none can guarantee a good scenario for mom or baby....so what to do? Original poster seems to want answer of what is safest, like minutes from the occurrence of a complication can be calculated and predicted, and the plan can be decided based on that. But no one knows even if you have rupture if it will effect you, or baby negatively at all (the story of the rupture that was undetected until the c-section illustrates this). I wish we could google "what is the right decison, God?". I feel like this is what you are really asking. You are in one of those places in life where safety can not be found or managed on a physical plane, your safety has to be found beyond your numbers, the research, etc in your heart. I think many people let others make this decsion for them- their doctors, their husband, the hospital because its such a huge level of responsabilty to do concisously. I think you are courageous to have even asked. If you find that place of peace in your heart, hold on to it and hope it carries you though if things do not go in the way you hoped, whatever choice you make. Be connected, find your intuition and faith, and do what feels best based on your ways of knowing, and pray to be on the better side of the stats and for mercy and peace if you are not.Meanwhile, from another thread, this link just puts it all in perspective!!!And this one tell you why it makes sense to VBAC.And this is a tear jerker (in a good way) that reminds me why VBAC is worth trying for!