what are the pros/cons for vbac?

[spu]

Hi Ladies,

I had a c with my twins, after 4 months of bedrest, an induction and 15 hours of labor... turns out I still had part of my cerclage in place during labor (which we didn't know about until my 8w follow-up appointment!) and would have ended up with severe hemorrhaging if I continued vaginally... gives me the willies...!

Now that I'm pg again (10w), my o.b. was thinking a c would be safer due to the risks of a vbac... I know the risks with a c, but what are the risks with vbac? I didn't think there were any unless there was major scar tissue in the uterus or the uterus wasn't stitched properly or healed properly after the c...

Thanks for sharing with me. I go back to my o.b. in 3 weeks, so I want to be prepared with my own information too. don't want to have a c if I can avoid it... coming home with 4 year old twins and a new baby will be a challenge if I end up with another c...

thanks!!
susan

[velcromom]

Here's a link to tons of articles with vbac info of all kinds.

http://ican-online.org/resources/white_papers/index.php

[JanetF]

So your surgeon recommends surgery? Gee how surprising :roll IMO there are no pros to surgery you don't actually need.

[OnTheBrink]

Well, this isn't really a "risk", but it's certainlhy a "con" in my eyes.

My VBAC labor was 63 hours long. It was intense and horrible, honestly. I was in "transition" for at least half of that. It was not real transition, because I was stuck at 1cm. But everything else was there - frequent and long contractions, nausea, the red line on my butt, all that good stuff. Still - just 1cm. I was planning on a homebirth. I was certain it would be easy and wonderful. It wasn't.

What happened was that, because of the incision from the cesarean and the remaining scar tissue, the nerves of the uterus did not communicate with the cervix. So, as my uterus was contracting and acting as though it was near birth, it never sent the message to my cervix. My cervix couldn't open on it's own. It was so frustrating!

We ended up transferring to the hospital after 54 hours. I went in wanting and hoping for a cesarean. The midwife at the hospital said no and manually dilated me to 4 cm. That was wretched. But - it worked. It was just what my body needed to figure it out. After nine hours of labor and 2 hours of pushing, John Michael was born vaginally - and perfectly. Still, I wouldn't want to repeat that labor!

I joke that I've tried both birth openings and both suck. So, unless they find another one, I'm done!

[AnditheBee]

Wow, OnTheBrink, that's an amazing birth story! Yikes!! Glad everything turned out okay, but you have my sympathies for an awful-sounding experience!

As for spu's question: The medical risks that are increased in a vbac are a slightly higher risk of uterine rupture (minimized by NOT being induced and by having a low transverse scar and only one prior c-sec); and placenta previa and accreta. The risks of these placenta problems go up with each c-sec, so they're still extremely low after only one surgical birth. It does pay, however, to make sure that the placenta places well clear of the scar, since the scar tissue can sometimes "attract" the placenta.

Do you research and you'll find all the statistical info on these risks. UR is the primary risk that doctors associate with VBACs; however, the risk of UR is around .7% if you are not induced--which is lower, in fact, than the chance of many complications associated with any type of birth, whether VBAC or not. Go armed with knowledge and you'll blow them out of the water. :thumb

[tika]

I would like to gently suggest that you talk to another care provider, possibly a midwife-not a surgeon-who supports normal birth with a scar on the uterus.

[juliema]

Wow, OnTheBrink, that's an amazing birth story! Yikes!! Glad everything turned out okay, but you have my sympathies for an awful-sounding experience!

As for spu's question: The medical risks that are increased in a vbac are a slightly higher risk of uterine rupture (minimized by NOT being induced and by having a low transverse scar and only one prior c-sec); and placenta previa and accreta. The risks of these placenta problems go up with each c-sec, so they're still extremely low after only one surgical birth. It does pay, however, to make sure that the placenta places well clear of the scar, since the scar tissue can sometimes "attract" the placenta.

Do you research and you'll find all the statistical info on these risks. UR is the primary risk that doctors associate with VBACs; however, the risk of UR is around .7% if you are not induced--which is lower, in fact, than the chance of many complications associated with any type of birth, whether VBAC or not. Go armed with knowledge and you'll blow them out of the water. :thumb

Actually, uninduced it's closer to .4%. :wink

[aprilushka]

Uninduced/unaugmented is 0.4% according to the latest and best study and the risk of death/brain damage due to trial of labor as a VBAC after one c/s is 1 in 2000 (the overall risk of death to baby in low risk women is usually around 2 to 3 in 1000). Of course, that is in conjunction with other risks that all women face with birth.

If a woman wants two or more children after c/s, than VBAC attempt is definitely the safer choice, even many in the medical community agree on that, b/c of the risk of placenta accreta after 2 c/s. People will argue about those who only want one more should do, but I think when you look at the totality of risks and benefits (not just the catastrophic risks), the benefits of VBAC far outweigh the risks, while that is not really true of repeat c/s, the main benefit of which is only to avoid a slightly enhanced catastrophic risk.

[OnTheBrink]

If a woman wants two or more children after c/s, than VBAC attempt is definitely the safer choice, even many in the medical community agree on that, b/c of the risk of placenta accreta after 2 c/s. People will argue about those who only want one more should do, but I think when you look at the totality of risks and benefits (not just the catastrophic risks), the benefits of VBAC far outweigh the risks, while that is not really true of repeat c/s, the main benefit of which is only to avoid a slightly enhanced catastrophic risk.

Interesting! I never thought about that - about wanting 2 or more children. I only wanted one more (my VBAC baby), but that's a great point about how a series of cesarean births can make things riskier as you go along.

[eleven]

I joke that I've tried both birth openings and both suck. So, unless they find another one, I'm done! :laugh:

I think shorter recovery time is a big VBAC pro. OnTheBrink is absolutely right that labor is difficult and painful (mine was only 52 hours before the cesarean), but my recovery time after the surgery was much, much longer. I was in pain and couldn't do a lot of "regular" things (like climb up onto our high bed) for several weeks.

Women who have cesareans also have a higher occurence of breastfeeding difficulties.

It's great that you're doing your research and are advocating for yourself!

[~Nikki~]

My VBAC labor was 63 hours long. It was intense and horrible, honestly. I was in "transition" for at least half of that.

That's a real bummer. :( But I just want to make sure that the person who posted doesn't think this is typical (I'm sure that's not the point you were trying to make, but you never know what kind of info people will retain!) My c-section labour was 44 hours long. My VBAC labour - while intense - was only 4 hours long. And the reason it was intense was because I refused all meds. I feel that it really helped my body do its thing, to keep the drugs out of my body.

Definitely do as much research as you can, before making a decision. From what I remember, the risks of rupture are very very small. A c-section is a major surgery, no matter how you look at it, and there are many risks that come with that.

In my opinion, the only "pro" of having a scheduled repeat c-section, is knowing the day your baby will be born. After my first child was taken out of me, I know that my first thought was "Well, this isn't such a bad thing. At least next time around, I won't have to sit around for weeks wondering 'Is this the day?'" I have to say, I'm glad that I read up on VBAC's before deciding on a repeat c-section for such a silly "pro."

Research your heart out, and don't let the surgeons tell you that a c-section is the "safest" and "best" way to deliver a child. People who make a living off doing surgeries, have a bit of a skewed opinion on the topic. :P

[OnTheBrink]

I think shorter recovery time is a big VBAC pro.


My VBAC labor was 63 hours long. It was intense and horrible, honestly. I was in "transition" for at least half of that.

That's a real bummer. But I just want to make sure that the person who posted doesn't think this is typical (I'm sure that's not the point you were trying to make, but you never know what kind of info people will retain!)

With both of these, I feel like I didn't make my point clear. I heard over and over again how great a VBAC is, how it's so much better than a cesarean birth, how all you have to do is decide to do it and find a good care provider and it will be perfect. I want the OP (and everyone) to know that it's not the case. Cesarean births are not always bad experiences and VBACs are not always good. My recovery after my cesarean was much quicker and less painful. That doesn't mean that it was the "better" birth at all. They really are far too different to compare. I just am on a mission to let moms know that VBACs can be difficult and even disappointing as well. I think it's better to know this possibility up front than to go into it with unrealistic expectations of a guaruntee that just can't be guarunteed.

[JanetF]

What I don't understand about this is why we're so concerned about VBAC causing a hole in the uterus, (maybe, and with really tiny odds provided you stay away from chemicals) but somehow lining up to get a really big hole FOR SURE is somehow ok? Normal physiological birth is always safer except for a VERY small number of women and that's regardless of previous surgery.

[OnTheBrink]

Yeah, I was truly never at all worried about a rupture during my VBAC. I figured there were more likely things to worry about. I ended up with complications that I never knew were a possibility, which was very frustrating. I doubt I would have opted for the cesarean if I had known about what might happen, though.

I think that some (very few) vaginal births can be very unsafe and that most cesarean births are, in fact, very safe. Still - it only makes sense that vaginal births should be the norm. I think we all agree that cesareans serve a great role when used appropriately. But, of course, that's not typically how they are used.

[CarolynnMarilynn]

I think too that you have to factor in the risks of a c-birth:

-a nick in the bladder
-bowel problems (ileus)
-complications related to epeidural/spinal anesthetic
-incision extensions
-infection (about a 1/5 rate)
-medical malpractice
-pain (100%)
-increased respiratory distress in the baby
-nerve damage to the area around the scar
-adhesions (on the inside of the body)
-UTIs related to the catherization
-greater blood loss
-losing immediate time with your baby skin-to-skin
-100% need for immediate cord clamping
-100% need for manual extraction of the placenta (by hand)
-increased chance for amniotic fluid emboli
-increased chance for blood clots
-100% exposure to antiobiotics, with rates of reaction 1/1000, and anaphylaxis of 1/10,000

I think this is a good thread and some excellent points have been made. Of course, there are also risks to a vaginal birth, but, hey, "birth is as safe as life gets".

[mwherbs]

in a surgeon's mind I think that the risk of being sued even 1 or 2/1000 is bigger than the risk of being sued if they perform a C-section.
the risk of having a uterine rupture elevated for a while when docs( BTW some still induce VBACs) did inductions especially with prostaglandins and cytotec, pitocin less so -- but there is an increased risk of uterine rupture when using cytotec even in an unscarred uterus- so the background risk would be calculated differently.
so to have a vbac, your baby would be born in it's own time when it's body is ready to be born -- all sorts of things change and shift just before and during labor- hormones, pain receptors, lung tissue, your body may respond by retaining a bit more fluid to thin the rich blood so bleeding would not have as great of an effect on your blood supply--- will write more later got to dash