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#1 of 24 Old 07-12-2012, 11:21 AM - Thread Starter
 
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Not pregnant yet, just researching.

 

I was so sure I wanted to go for a VBAC, but I'm not so sure now. After reading tons on uterine ruptures, it scares the crap out of me. 1 in 200 is not so slight. It bumps down to 1 in 600 with a repeat c-section. I don't plan on having more kids after the next, but who knows. I just keep asking myself WHY I want a VBAC so badly. I had a horrible recovery, so every part of me wants to avoid that again, but it's more than that. I have a strong desire to have a vaginal birth. Why is that there? Having a c-section would be easier in some sense. I wouldn't have to travel as far. No surprises (hopefully). But I know I would feel like something was missing. OTOH, if I did try for a VBAC and my baby died, I would never forgive myself. I do believe my risk is higher, because I have a uterine anomaly. According to a solid study I read, that bumps my uterine rupture risk up to 1 in 100, but it did not specify the type of anomalies that increase the risk (maybe all of them?). 

 

I know I don't *need* to worry about this right now, but I'm a huge researcher by nature, and we are TTC soon. 

 

I guess a question I have for you, since you've probably done your research, too, is what other risks am I missing? I've heard so many say that VBACs are safer than c-sections, but it doesn't seem that way. If that's what you think, why? What other serious risks might a c-section bring? The only one I can think of is infection, but I don't know the stats for that, either. 


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#2 of 24 Old 07-12-2012, 02:11 PM
 
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I was worried at first too, but the more facts I learned (not birth stories, not forum anecdotes, actual medical studies and hospital stats in my state) the more I want a VBAC.  I think there are several reasons why a VBAC is a good idea, but like you my first impulse was based on the recovery (omw that was AWFUL).  The #1 reason for me is that the risk of my dying from a CS is higher than the risk of my baby dying in a VBAC (and also higher than the odds of dying in a car accident, ironically).  I want to be here for my kids, and DH is awesome but still, my two children will benefit from my being here more than I benefit from the convenicen of schedualing a second CS.  The chances of having an verifiably medically unecessary CS at a hospital (from EFM alone, let alone anything else they do) are 1 in 10. Thats much higher than the odds of anything going wrong even at a home birth.  

 

 

the ACOG rules on VBAC http://www.acog.org/Search?Keyword=vbac  Note that they recommend that everyone be given the chance to VBAC, because its so much healthier long term.  

 

A bit more explanatory is  http://guideline.gov/content.aspx?f=rss&id=23853  

 

For an online series of essays based on the above facts http://www.childbirthconnection.org/article.asp?ClickedLink=293&ck=10212&area=27

 

My FAV resource, though, is actually a book.  "Obstetric Myths versus research realities", by Henci Goer.  A nearby ICAN group http://www.ican-online.org/ will probably have a copy you can borrow, that's where I got mine.  I want to buy a copy but its like $40 so that will be something I save for.  :)  Yes its a medical reference book, I am that much of a geek... 

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#3 of 24 Old 07-12-2012, 02:39 PM
 
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It's great you're doing your research now, before those hormones kick in! I understand where you are coming from and I really wanted a vbac because I felt I had been robbed of the true "birth experience" I read about online so many times. I ended up being the one in 200 and my son died, but if we had been in a hospital rather than at home there is a chance he would have made it. Yu need to talk to your OB about what your hospital protocol would be and ask if he or she has ever seen a rupture. Those moms who lost babies in a hospital setting in my group tended to have symptoms that were missed; tenderness, asymmetrical belly, flu like symptoms, difficulty straightening up...the problem is so many if the symptoms can be conflated with labor and only when baby is really in trouble is it more clear what might be going on.

Other increased risk factors are single sutures on your previous sections, the number of previous sections or any uterine surgery including d&c, size of fetus and the time between your previous section and conception (studies vary but the risk decreases with around a year between section and conception).

Talk to your OB, get a second OB's opinion if you don't feel the first gave you adequate answers, and good luck with your decision smile.gif
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#4 of 24 Old 07-12-2012, 02:40 PM
 
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It's great you're doing your research now, before those hormones kick in! I understand where you are coming from and I really wanted a vbac because I felt I had been robbed of the true "birth experience" I read about online so many times. I ended up being the one in 200 and my son died, but if we had been in a hospital rather than at home there is a chance he would have made it. Yu need to talk to your OB about what your hospital protocol would be and ask if he or she has ever seen a rupture. Those moms who lost babies in a hospital setting in my group tended to have symptoms that were missed; tenderness, asymmetrical belly, flu like symptoms, difficulty straightening up...the problem is so many if the symptoms can be conflated with labor and only when baby is really in trouble is it more clear what might be going on.

Other increased risk factors are single sutures on your previous sections, the number of previous sections or any uterine surgery including d&c, size of fetus and the time between your previous section and conception (studies vary but the risk decreases with around a year between section and conception).

Talk to your OB, get a second OB's opinion if you don't feel the first gave you adequate answers, and good luck with your decision smile.gif
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#5 of 24 Old 07-13-2012, 09:31 AM
 
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argggg i just lost my post but here we go again :)

 

i think that what makes it hard to decide to have a VBAC is the risk of rupture,  knowing that also means acknowledging that your baby could die, and no mother wants to imagine that they would willingly put their baby at risk.

 

the risk of rupture is around 0.5%, but that number often includes windows or dehiscences, which are not catastrophic, often including women who have been induced which increases the risk of rupture.  the rate of true catastrophic rupture ranges from 0.08%-0.8% in the literature.

 

it is important to keep in mind that their are risks in all pregnancies, and women are more likely to experience the death of a baby from cord prolapse or placental abruption and shoulder dystocia, all of which occur at a greater rate than uterine rupture.

 

fortunately, VBAC is considered safe, even with the risks, and the risk of losing a baby is about 1.9 in 10000.

 

elective repeat c/s also has risks. the risk of maternal death is 4 times higher, and you also have the risks of surgery like the need for a transfusion, emergency hysterectomy, bowel and bladder injuries and obviously illness/infection which can cause death. if you are definitely wanting to have more than 2 children, then the risks of a repeat c/s increase with each section.

 

i don't know if that helps. i don't think that the decision to VBAC can be solely decided based on stats and numbers because birth is not just a physical event, but also an emotional and spiritual experience, and there are so many factors that influence how you will decide.

 

good luck! there are many wonderful resources available to you. check out the AOM VBAC guidelines, and the NIH VBAC guidelines, both great places to start. childbirth connections also has a great section on VBAC.


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#6 of 24 Old 07-13-2012, 11:19 AM
 
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I found that knowing more facts bolstered my confidence in my gut feeling.  DD's pregnancy I felt that the doctor I had with wasn't right for me, but ignored that vibe.  Now I feel like I want a VBAC and I am trying to go with my gut in a rational, prepared way.  To me, VBAC isn't asking for failure, but giving my body and my baby the best chance of success.  I found that when I had my facts and my care provider lined up, my gut settled down (it was fantasizing about an oops UBAC for awhile there!).  Side note, several VBAC mommas have said that they fantasized about UPUBAC after thier CS, just to avoid all the worry and planning and prep.   Your gut wants VBAC for a reason, so I hope you are able to come to terms with that reason and find a plan that works for you.

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#7 of 24 Old 07-13-2012, 01:29 PM
 
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Anne - I'm thinking about VBAC right now.  Even though my OB says I'm one the few "perfect candidates", I'm unsure that I really want to.  Before I got pregnant I really thought that it was what I was going to do, but now that I'm faced with a choice I just don't know.  There are pro's & con's either way.  

 

I too worry about uterine rupture.  I know the stats for it are small.  However,  as Lovelsla has point out if it happens to you it's really not that rare.  The other thing to consider about rupture is that it might not kill your baby, but it could damage it.  This study (http://journals.lww.com/greenjournal/Abstract/2012/04000/Uterine_Rupture_With_Attempted_Vaginal_Birth_After.6.aspx ) looked at the outcomes of babies of uterine rupture.   So while, VBAC it considered safe I really wouldn't attempt it without being in an excellent hospital that was able to do a CS immediately.

 

So there are risks either way.  From what I can tell it seems the babies have a better outcome from RCS, but of course there is more risk to the mom.  The question really is how much more risk to mom...I don't have the links to the studies, but it seems risk has a lot to do with your current health and whether or not the CS is an emergency.   

 

I think you also want to look at how many children you want to have.  The risk increases with each c-section, but if you don't want more than 3 kids.... 

 

Here is another study that looked at VBAC outcomes... again it's just an abstract, but it should give you a place to start http://www.ncbi.nlm.nih.gov/pubmed/20629481?dopt=Citation

 

I did not really enjoy the recovery from c-section, but it was worth it for my beautiful little boy.  The little secret is that not all vaginal births are easy peasy recovery either or so I've heard from a couple of friends that had difficult vaginal births.   I may go for VBAC, but I'm not interested in a long labor that might end in CS anyway.  Plus, I'm not wanting to go post dates as my due is extremely accurate.  I also only want 2 kids...So, then I think a repeat CS is not such a bad idea either. 

 

Oh, and I would add LoveIsla gave some excellent information about talking to your doctor! 


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#8 of 24 Old 07-13-2012, 09:34 PM - Thread Starter
 
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Thanks, everyone. If I do go for a VBAC, I will be doing it with midwives in a birthing center inside a hospital, so no worries there. I wouldn't feel comfortable personally doing it outside a hospital. 

 

Mandib50, you said I have a 4 times greater risk of dying from a c-section. Do you happen to have any links for that stat?

 

ETA: Good point also about asking the midwives if they've ever seen a rupture. Thanks for that!


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#9 of 24 Old 07-14-2012, 07:41 PM
 
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Originally Posted by anne1140 View Post

Thanks, everyone. If I do go for a VBAC, I will be doing it with midwives in a birthing center inside a hospital, so no worries there. I wouldn't feel comfortable personally doing it outside a hospital. 

 

Mandib50, you said I have a 4 times greater risk of dying from a c-section. Do you happen to have any links for that stat?

 

ETA: Good point also about asking the midwives if they've ever seen a rupture. Thanks for that!


yes, i do have links. i have to dig them all up but start with these two and i'll post some more for you. the stats seem pretty consistent.

http://www.aom.on.ca/files/Health_Care_Professionals/Clinical_Practice_Guidelines/CPG_VBAC_-_Final_-_November_2011.pdf

 

http://consensus.nih.gov/2010/vbacstatement.htm


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#10 of 24 Old 07-14-2012, 08:18 PM
 
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VBACFacts is a VERY comprehensive website about everything you could ever want to know about vbacs. This is their page on vbac vs rcs: http://vbacfacts.com/vbac/

 

For me, there was never a doubt, I was going for a vbac, and it was successful. I did only have a single suture row & it ended up not mattering for me. I will be having another vbac in October. FWIW, a few things: If you do want more kids, your chance of rupture DROPS after your first successful vbac: http://vbacfacts.com/2008/06/17/uterine-rupture-risk-drops-significantly-after-first-vbac/ You could rupture at any time during your pregnancy anyway (as could anyone else). I hate to say it, but as devastated as I would be to lose my full-term baby, I have two other kids and they would be more devastated by losing me. IDK your hospital's policy, but in mine, you have to meet w/ the OB to discuss your chances of having a repeat c/s w/ each vbac pregnancy, so s/he could give you a lot of info on vbac vs rcs. We did the first vbac in a hospital and I would be totally fine doing subsequent ones at home (but dh isn't :p ). If something feels "wrong" during labor, bring it up and make a stink if necessary. I don't mean regular labor pain, I mean something, to you, feels WRONG. I would not hesitate to speak up, loudly, if at any time something felt off to me.

 

You WILL make the right choice for YOU and there are benefits to having a scheduled c-section. (Can I just say how thrilled I am that Mothering's relaxed rules now mean that I can say that???) I had a scheduled breech c/s and it was no big deal. *For me*, recovery from c/s and vaginal birth were painful in different, but equal, ways. 

 

LoveIsla, that is terrible and I am truly sorry for your great loss :*(


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#11 of 24 Old 07-14-2012, 08:24 PM
 
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If you're doing it inside a hospital, then perhaps you will feel safe enough. If something goes wrong, they have the staff and equipment to deal with the emergency.

 

Vaginal birth recovery is (usually) awesome. I'd recommend it if you can get the vaginal birth thing going!

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#12 of 24 Old 07-15-2012, 12:07 PM
 
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If you're doing it inside a hospital, then perhaps you will feel safe enough. If something goes wrong, they have the staff and equipment to deal with the emergency.

 

Vaginal birth recovery is (usually) awesome. I'd recommend it if you can get the vaginal birth thing going!

This...just make sure it is a hospital and midwives with experience with VBAC and uterine rupture.  As long you have the right the people supporting you the evidence does point to it being a safe option.

 

"While rare for both TOL and ERCD, maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOLe rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 3 per 1,000 and the risk was significantly increased with TOL (4.7/1,000 versus 0.3/1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death... Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD."  http://www.ncbi.nlm.nih.gov/pubmed/20629481?dopt=Citation

 

 

Also - http://www2.cfpc.ca/local/user/files/%7B2CEB26D0-7D69-4FFE-8D01-C7DAF4D59E1E%7D/Maternal%20Death%20C-Section.pdf  - Maternal death in the 21st century: causes,

prevention, and relationship to cesarean delivery 
 
"Most maternal deaths are not preventable. Preventable  
deaths are equally likely to result from actions by nonmedical persons  
as from provider error. Given the diversity of causes of maternal death,  
no systematic reduction in maternal death rate in the United States can  
be expected unless all women undergoing cesarean delivery receive  
thromboembolism prophylaxis. Such a policy would be expected to  
eliminate any statistical difference in death rates caused by cesarean  
and vaginal delivery."
 
And -http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2005.00793.x/full  -- To compare the maternal implications of strategies of vaginal birth after caesarean section (VBAC) attempt versus elective repeat caesarean section in women with one previous lower segment caesarean section.
 
"The frequency of hysterectomy and of maternal death did not differ significantly between groups (0.2 percent vs. 0.3 percent, and 0.02 percent vs. 0.04 percent, respectively)."
 

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#13 of 24 Old 07-15-2012, 01:16 PM
 
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I don´t have time to write down the stats right now , but I had 3 cs , one with a vertical cut and 18 months after that , I had a normal , uneventful delivery . Yes , there is a risk , but for me the risk of cs is a lot greater than that of vbac .

I would encourage you to go to a hospital , I did as well " just in case " , but I´d definitely give it at least a try !

There is a great fb forum for women after multiple cs as well as special scars , for me it´s the best place to find the answers you are looking for , since it is made up of people , that have lived through multiple cs and the problems , that led to them and sometimes were caused by them , not just doctors running down statistics . 

Plus , in most cases they are men anyway , how is a MAN going to be a real judge of something he will never , ever be able to experience 

I can send you the link , if you like !


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#14 of 24 Old 08-15-2012, 04:13 PM
 
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I don't know if the original poster is still checking this thread, but I'm 20 weeks pregnant now, and considering VBAC and I too have a uterine anomaly - what is yours?  I have a bicornuate uterus, with short cervix, two preterm births in my history. I'm curious to know if anyone has any info/experience with VBAC with a bicornuate uterus. This baby is on the same side as my last baby, which was a c-section. But prior to that, I had a vaginal delivery (other side of uterus) at 32 weeks.

I'm leaning toward VBAC, but wondering how the bicornuate uterus affects the stats for rupture or other complications. I'm not sure much research even exists about that.

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#15 of 24 Old 08-16-2012, 10:27 PM
 
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sunseeker, I suspect there is little research on your specfic issue, if only because no one even obthered to call it "vbac" at one time, and at this time, its kinda semii-unpopular to even try.  IF you can get it in your head that you want it, give it a try, there 's nothing to lose.

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#16 of 24 Old 08-22-2012, 06:53 AM
 
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I will go on record saying my vaginal recovery was harder than my c-section. 1) I had a nasty, front-to-back 4th degree tear. That just sucks. and hurts, alot. 2) I was dealing with my toddler too, as well as a newborn.

 

However - I took good care of myself and my doctor did a fantastic stitching job, and I healed beautifully, to everyone's amazement (I know people with 2nd degree tears that don't heal well, I was very worried about mine healing properly)

 

Even with all that said, I would, and am, aiming for another VBAC - there is no guarantee that another c-section recovery would be as easy. there are all kinds of complications that can ensue during and following surgery.

 

Also, I don't know that outcomes are better for RCS babies than VBAC babies - there are a lot of benefits for a baby to be born vaginally vs surgically (for their lungs, especially).

 

I know several friends that opted for a RCS and are at peace with that choice. I know another that tried for a VBA2C that had a placental abruption (that can happen to ANYONE, regardless of prior c-sections or vaginal births) that had an emergent c-section - and she is also at peace with that (the result was a healthy mom and baby - the staff were well preparred for emergency)

 

I think the important thing is research, pray, meditate (whatever is your cup of tea), and be at peace with whatever you decide.


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#17 of 24 Old 08-30-2012, 05:02 AM
 
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Some great facts on this thread so I won't bother posting links, but like others said, ask your midwife/doctor if they've ever seen a rupture.  This was my first question to my midwife, because it's such a scary concept and I really didn't know much about it aside from that it was very dangerous.  Neither of my midwives had seen one in their practice, but reminded me that because I was having a VBAC, it was their policy to have me deliver in the hospital just in case there were complications.  It was a small, country hospital, but the OBs on staff there were notified that a VBAC was coming in, and were ready to step in if anything went wrong. 

 

Nothing did.

 

I have had two VBACs (and like another poster said, your risk goes down further with each one), with no complications aside from a slight tear for each.  Recovery for me was WAY easier with each of the VBACs. I was out of the hospital and living normally the following day for each birth.  After the c-section, life was hell for a good 2 months.  Sneezing made me want to die. =P  I have been told that repeat c-sections are easier to recover from, because they're planned and you don't usually have a chance to go through labour first like with an emergency c-section.  No idea if this is true or not, but it does make sense, given that your body isn't going through as much prior to the c-section.  I laboured for 3 days before my c-section.  I suffered during recovery. 

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#18 of 24 Old 08-30-2012, 04:34 PM
 
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A note on the "emergency CS is harder because you labor first" theory: I was only in real labor for an hour before my CS.  OMW the recovery was horrid.  I felt like a gramma zombie for two weeks, and wasn't really up to anything for months and months.   I probably would have been in labor for longer if I'd schedualed it because my OB recommends a couple hours of induced labor before a CS for baby's lungs, and doubt it would have made any difference.  Laboring isn't necessarily going away with either option.

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#19 of 24 Old 11-24-2012, 09:18 PM
 
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Hi guys, i have had two c sections, first one was emergency and the second one was repeat unnecessarian.  I would really like a chance of vba2c and even found providers(am not pregnant currently but was doing my search). I honestly have not looked through the studies or what not but more than uterine rupture i am scared something might happen to the baby, like fetal hemorrhage or something and you might have succesfu vbac and still have a baby with brain bleed. is that possible? Also, one poster on this board said they went out of state to get vbac done and recieved support from an ICAN chapter out of state. I  was curious as to which state has a really good ICAN chapter? In NY, I found about three providers that were willing and the hospitals would do vba2c. The good thing is that ACOG allows women to have vba2c now with no recommendations either for it or against it...not sure what that means.....

 

hoping to hear some advice :)

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#20 of 24 Old 11-29-2012, 12:31 PM
 
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 1 in 600 with a repeat c-section.

Uterine Rupture is 100% in a c-section.  What else would you call a 4+ inch wide hole in your uterus?

 

NO ONE is at a 0% risk. First time mom's face a slight risk of rupture. Ruptures can happen before labor even starts.

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#21 of 24 Old 12-01-2012, 04:19 AM
 
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Roadfamily6now, that is an ABSURD thing to say. Csections are a carefully controlled surgical incision done under a aesthetic with extensive monitoring of mother and baby. Ruptures are your uterus being shredded by pressure along your old scar, and often through your cervix, bladder and in all directions from your scar. My placenta abrupted because of the rupture and I had one major blood vessel left supporting my uterine tissue. Some ruptures lead to hysterectomy because the uterus cannot be repaired. Spontaneous rupture can happen, but in vbac candidates it overwhelmingly happens after the onset of labor (and typically several hours in which is why monitoring is so important) as the muscle and scar tissue give out under the intense pressure of contractions.
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#22 of 24 Old 12-05-2012, 10:51 AM
 
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A better way to think of it is 99.5% chance of no rupture!  And again, most ruptures are not catastrophic for mother or child.

 

Sorry, loveisla for your terrible loss. 

 

I see people have pointed you to some good resources.  There is also a great private facebook page with excellent resources and support for VBACs.  http://www.facebook.com/#!/groups/183444955077965/?bookmark_t=group

 

I've tried for vaginal birth (usually at home) 4 times and ended with c/s four times.  I still cannot let myself "off the hook" to try again.  Even though support is nearly impossible to find, I will not sign up for surgery.  I know my body was made to birth (that's got to where the strong urge comes from.)  Some of my viewpoint comes from a severe hemorrhage after my 3rd c/s.  I never went into labor that time since my midwife dropped me when I was ten days past EDD. I nearly died from the c/s complication. So there are risks both ways and with all I've researched, I believe the risks are less and the benefits are greater with vbacs.  I am trying for a vba4c this spring. Good luck to you!


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#23 of 24 Old 12-10-2012, 07:55 PM
 
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#24 of 24 Old 12-12-2012, 10:19 AM
 
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Originally Posted by MichelleZB View Post

If you're doing it inside a hospital, then perhaps you will feel safe enough. If something goes wrong, they have the staff and equipment to deal with the emergency.

 

Vaginal birth recovery is (usually) awesome. I'd recommend it if you can get the vaginal birth thing going!

 

Just make sure it's a VBAC-friendly hospital. I recently had a VBAC birth in a wonderful, supportive hospital, and I know that made the difference. Look up Csection and VBAC rates of hospitals to determine how supportive they really are. 

 

FWIW, my recovery from my vaginal delivery has been much easier, in all ways, than recovery from my section. Everything from walking to breastfeeding is just better. 


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