VBAC vs. C/S question - Mothering Forums

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#1 of 26 Old 11-18-2005, 03:55 PM - Thread Starter
 
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Hi. I'm going to try for a VBAC this go-round, but was wondering if anyone has any data or links for the benefits of laboring prior to a repeat c-section (should the need arise)? I saw this mentioned on another board, but no follow-up details or documentation was provided.

Any help would be great.

p.s. - I'm not due 'til May06 and want to investigate before discussing all this with OB. Thanks!
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#2 of 26 Old 11-18-2005, 08:12 PM
 
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try the links in the resources thread stickied at the top of the vbac forum.
http://www.mothering.com/discussions...d.php?t=159627

my favorites would be the ICAN website and their mailing list (now at yahoo groups)

www.vbac.com
www.gentlebirth.org
www.midwiferytoday.com
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#3 of 26 Old 11-18-2005, 11:46 PM
 
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Here's some info in this thread in the vbac forum.
http://www.mothering.com/discussions...d.php?t=371340

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#4 of 26 Old 11-19-2005, 01:49 PM - Thread Starter
 
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Thank you both for the information. I will review it all carefully!
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#5 of 26 Old 11-19-2005, 11:42 PM
 
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No links, but the baby does do better with some labor, as in not being premature, and more ready to breath,...

Good luck.

"The great enemy of the truth is very often not the lie, deliberate, contrived and dishonest, but the myth, persistent, persuasive and unrealistic."
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#6 of 26 Old 11-20-2005, 01:13 AM
 
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I would highly suggest that you dig on your own rather than read from sites that lean more towards VBAC than repeat cesarean sections. You are more likely to develop your own views on what is best for you and your situation.

In one of the Cesarean Support threads this was discussed and there were links supporting both ideas, laboring vs not laboring. The one thing that stood out for me personally is that maternal outcomes are better when a cesarean is scheduled vs when a woman labors first.

Kim
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#7 of 26 Old 11-20-2005, 03:04 PM
 
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Moved to VBAC...

anna kiss partner to jon radical mama to aleks (8/02) and bastian (5/05)
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#8 of 26 Old 11-20-2005, 04:00 PM
 
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Quote:
Originally Posted by OnTheFence
The one thing that stood out for me personally is that maternal outcomes are better when a cesarean is scheduled vs when a woman labors first.

Kim
I agree that the OP needs to work out what suits her best. She may not know that until after the fact, however. My worst recovery of three was the only one in which I didn't labour at all. I have pain for months. I had two sections with labour, and the pain was completely gone after two months with each of them (and that's despite the fact that I had an infection and a toddler to look after with the last one).

Having had three different sections, of three different types (emergency with labour, scheduled with labour, scheduled without labour), there is nothing on this earth that could convince me to schedule a section without labour again.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#9 of 26 Old 11-20-2005, 04:45 PM
 
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everyone is different though. I have had two planned csections with very little pain and excellent recoveries!
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#10 of 26 Old 11-20-2005, 07:07 PM
 
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Quote:
Originally Posted by OnTheFence
everyone is different though. I have had two planned csections with very little pain and excellent recoveries!
You are blessed. I have met very few(can count on one hand) women that had sections with such good recovery and little pain. Most are hurting in some fashion for YEARS.
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#11 of 26 Old 11-20-2005, 09:21 PM
 
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Read the VBAC Companion. It is so full of information and facts, and compares all types of sections (emergency, scheduled with and without labor). The thing that I remember the most is that the outcome for babies is better the longer the mother labored before she was sectioned. This has to do with the baby releasing horomones that are necessary for life outside the womb, and also with babies not being removed prematurely, as ultrasound can be very wrong on predicting size, dates, etc.......
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#12 of 26 Old 11-21-2005, 07:19 AM
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cathicog, I'm another woman who had a c-section with a recovery that was not bad at all. The drugs took away nearly all of the pain. The most painful part was when I was in labour before the c-section. I know several woman who have had c-sections and none of them talks of ongoing pain that lasts for years on end! Perhaps you've just happened on some women with unusually dire experiences.
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#13 of 26 Old 11-21-2005, 07:34 AM
 
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I think it's also important to remember that many c-secs also come with emotional costs that can last for years. I had my c-sec at 6am, went home the same day, only took panadol (paracetamol). Never had physical pain from it. However, my PTSD peaked at 6 months when I was suicidal and it's only now 2 years later that I'm really feeling that I'm out of the fog. The possible costs to mothers and babies of that are higher than any dollar value can reach. Women who have c-secs often have trouble bf and some never establish it leading to ff, there's PND rates which are about 12 times higher for c-sec mamas and yet almost negligible in home birth populations.

Anyhoo. This is a study from "Thinking Woman's Guide" which I think ought to be compulsory for anyone planning a birth regardless of previous surgery.

Hook B, et al, Neonatal morbidity after ERC and trial of labour. Pediatrics 1997;100(3):348-353. (TOL puke puke puke! bang: )

She says:

Quote:
Researchers matched 700 normal-weight infants born with low 5 minute Apgar scores after healthy pregnancies similar to infants with normal Apgar scores. Infants born after elective caesarean were nearly half again as likely to have low Apgar scores as infants born vaginally. Researchers also compared newborn outcomes between 500 women having planned ERC and 500 women having labour. Infants born after ERC were more than twice as likely to develop respiratory difficulties, mainly rapid breathing, and 2 versus none in the labour group developed respiratory distress syndrome. They were 3 times as likely to develop newborn jaundice. Another study found more need for mechanical ventilation and oxygen in babies born after ERC than vaginal birth.
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#14 of 26 Old 11-21-2005, 11:40 AM
 
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My chiropractor had an interesting story he told me the other day. I haven't researched it but I thought I'd share. he said that a butterfly must break out of it's cocoon on it's own (I think he said butterfly - I can't think of another creature that breaks out of a cocoon) in order to fly. If it is cut out, it never uses it's muscles properly in order to get the blood flowing to them and get it's wings working. I figured labor must do something good for babies; otherwise, why would we labor before a birth? My chiro brought that up after I asked what kind of impact a c-section birth could have on my dd long term. I was curious whether a c-s baby would need chiro care as much as a vaginally birthed baby since a c-s baby never squeezes and contorts through the birth canal. he said that c-s babies are often *more* in need of chiro care b/c the doctor makes the smallest incision possible and pulls whatever part on the baby he can get ahold up to yank the baby upward and through the abdomen.

Quote:
Originally Posted by Dal
cathicog, I'm another woman who had a c-section with a recovery that was not bad at all. The drugs took away nearly all of the pain.
I don't disagree with this since drugs definitely mask the post c-s pain.... but I HATED taking them. I would go until I couldn't take it anymore and then call a nurse in for pain meds. I hated taking them b/c I couldn't stand the thought of my brand new, hours old baby ingesting narcotics and heavy doses of ibuprophen (neither of which are proven safe for babies). I kept telling myself that the good of breast-feeding outweighed the risks from the meds but it didn't make me feel that much better!

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#15 of 26 Old 11-21-2005, 12:00 PM
 
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what a touchy subject..... I've had a cesarean and a VBAC and with the cesarean, while I didn't do badly in the hospital, it was scary and out of my control, and the whole experience stayed with me for a VERY long time afterwards. I had such a difficult time during the birth and post partum period with my son that it took 10 years before I was ready to try to conceive again, and that was only with the love and intense encouragement of my husband. I think its great that some women have non-traumatic cesareans. Unfortunately, I was not one of them. My cesarean was terrifying, uncomfortable and at times humiliating. I was amazed at how many people were allowed to come in and out of my room when I was undressed or discussing private details with the nurses etc..... I was unable to care for my baby by myself for a couple of weeks afterwards, and I had an infection in my wound that caused me problems off and on for years.

I don't advocate that people just blindly choose cesarean or VBAC without looking at the risks. Cesarean saves many lives when its necessary. Its just sad that its gone from being used when necessary to being used when its convenient, all the while people underestimate how serious of a surgery it is, and what kinds of complications can arise. If you need to know about more women who have had difficult cesareans, I can get them for you. Sadly, most of the women I know who've had cesareans have had problems and negative experiences to some degree.
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#16 of 26 Old 11-21-2005, 05:47 PM
 
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I had a very traumatic first c-section. I was emotionally devastated and in a great deal of pain - the painkillers hardly touched it. I was also very physically uncomfortable most of the time, which is harder for me to deal with than the pain. (DH has commented on this - I can deal with a lot of pain with relatively little difficulty...but a fairly minor degree of discomfort will drive me nutty.)

I was ready to have another baby the next day. I wanted another one...I wanted to VBAC...I wanted more labour. It took me 10 years to conceive a second one and carry it to term. I'll never know if my first section had anything to do with that. I eventually came to believe that I'd never have a second baby (let alone the 3rd and 4th that I wanted) emotionally tormented me for years. And, all those years, I wondered if my section had done that to me...and I'm never going to know what part, if any, the surgery played.

C-sections can have a psychological and emotional effect that is much more complicated than most people ever realize...even many of us who've had one.

Lisa, lucky mama of Kelly (3/93) ribboncesarean.gif, Emma (5/03) ribboncesarean.gif, Evan (7/05) ribboncesarean.gif, & Jenna (6/09) ribboncesarean.gif
Loving my amazing dh, James & forever missing ribbonpb.gif Aaron Ambrose ribboncesarean.gif (11/07) ribbonpb.gif

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#17 of 26 Old 11-22-2005, 03:33 AM
 
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I could just choose to have my gallbladder removed..sure people do fine without it..lots of people have it removed all the time and my gallbladder could go out eventually anyways.

I have some friends who have had their gallbladder removed and they do just fine.

So why not?

Why not just have my gallbladder removed?

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#18 of 26 Old 02-14-2006, 07:30 PM
 
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It is the stress hormones (catecholamines) that are released during labor that initiate the flight or fight response and help babies survive outside the womb. This article goes into great detail on all the benefits of labor. It is better to be in labor prior to a c/section.

http://pregnancy.about.com/cs/laborb.../aa042300a.htm

also this one http://www.gentlebirth.org/archives/lbrygood.html
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#19 of 26 Old 02-15-2006, 04:53 AM
 
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Just wanted to add myself to the list of women who had a very simple, clean and quick physical recovery from a c/s (footling breech 'discovered' in early labour) but emotionally...

18 months later I still have nightmares. It was devastating. Traumatizing. Terrifying. Post partum was awful. I gave up breast feeding: if I can't even birth a baby, why should I feed it? I cried and cried, and I cry for the women who are crying with me.

Slowly but surely I am healing.

K

Kate: fumbling through the best years with W, L, F & V...newest arrival coming Jan '11
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#20 of 26 Old 02-15-2006, 12:15 PM
 
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I myself has a very pain free c-section. I know I was most likely a lucky few though. What I didn't like was that I couldn't see my baby tell 5 hours after they pulled him from my body. I for sure want a VBAC next time and think my baby will be healthier because of it as well.
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#21 of 26 Old 02-15-2006, 02:06 PM
 
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My c/s after labor was a breeze to recover from, I felt pretty good within a few weeks. But now, almost 15 years later, stuff is coming up. Things I never thought about, maybe didn't want to know, are undeniable now and there are a lot of emotions to work through.

I had a second c/s without labor. I had no idea about the benefits for the baby or I may have chosen differently. The recovery was horrid. It took me two years to feel like my body was healthy and strong and pain-free again. Major disillusionment after believing that all c/s were "easy" to recover from based on my prior experience.

Good for you, looking into all the facts now. There is a lot to consider.
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#22 of 26 Old 02-15-2006, 04:02 PM
 
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There's a section in the really interesting book What's Going On In There by neurobiologist Lise Eliot --

http://www.amazon.com/gp/product/055...Fencoding=UTF8.

It's not about birth, but brain development in utero and afterward and she has a fascinating section on birth and exactly how labor and going through the birth canal stimulate a baby's brain development,and releases certain hormones, etc... It's an excellent section and made me feel really good about the long labors I had prior to my two csections.

Astoria
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#23 of 26 Old 02-19-2006, 02:37 AM
 
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You all are really helping me. I am new to this board and have tried since I became pregnant to get both sides vbac and planned c.s. But it was always one way or the other.

I had a very traumatic c.s. with my first. In April 2003 I was in labour for 17 1/2 hours started on citotech (I think that was the name) the night before and pit the following morning. I got to 9 1/2cm and did not progress past that I had been pushing for about 1 hr - 2hr and was in excrusiating pain it felt like my son's feet were breaking my ribs. My CNM called in another doc and asked his opinion and they took me for a c.s. I was terrified as they wheeled me out I had not reserched anything on c.s. and was made to think that I really would not be able to take care of my baby. My CNM could not understand why I was so hystericaly upset and kinda laughed it off when I told him I wanted to be able to take care of my baby. I remember shaking so bad after they took my son out like I was going into seizures or something I was so scared something was going terribly wrong because I could not control my body, I thought my teeth were going to shatter. And then I was out and the next thing I remember is trying to force myself to wake up I could hear my family talking around me but could not wake up. I was so terrified because I didn't know what happened to my baby. I missed the first hours of his life he was 10lbs 19 1/2 inches. It took me weeks to be able to function again. And I still have pain where my incision is especially now that I am strectching with this baby. Everytime I tell this story I cry it is something I don't want to experience again. I am now due with my 2nd a girl on May 19th 2006 and I am so scared both ways and don't know what to do. My ob has pushed me to have a repeat planned c.s. I think he just doesn't want to take the time he says it is my choice but he wants to make sure I understand there are NO benfits to trying a vbac. Which I don't believe at all I am so much more worried about the babies lungs than my scar rupturing, I am an adult who could handle to have surgery or what ever kind of repair to fix me but my baby may not surivive with lung problems. And he had never suggested labouring before the c.s. had always told me that my recovery would be much easier if I do a planned c.s. than labour, he really had me beliving that I could not handle the recovery if I labour and still have to have a c.s. Now that I have read some of your stories I really feel I should try a vbac. I have recently decided to switch ob's because I am very upset my ob has not given me one bit of encouragment he lectures me on gaining weight every visit I have only gained 12 pounds since i have been pregnant, even at the first I had lost a couple of pounds and he still lectured me and gave me a pedometer and said to do 10,000 steps a day, ya right give me a break. I really felt he was punishing me at my last appointment and did not do a good ultrasound did not listen to her heart or anything. So anyways I have made an appointment with my sister in laws ob that she absoulutly loves and hopefully she will be more supportive if not I may look into a midwife. But anyways thanks!
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#24 of 26 Old 02-19-2006, 01:40 PM
 
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There's a good article about this topic at www.nejm.com (New England Journal of Medicine website). You have to register to see the article, but it's free. Here's the link to the full article:

http://content.nejm.org/cgi/content/full/351/25/2581

In case, you have trouble with the direct link, you can find it from the main webpage. It's in the December 16, 2004 issue and titled "Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery."

Here is a quote from the abstract:

Methods We conducted a prospective four-year observational study of all women with a singleton gestation and a prior cesarean delivery at 19 academic medical centers. Maternal and perinatal outcomes were compared between women who underwent a trial of labor and women who had an elective repeated cesarean delivery without labor.

Results Vaginal delivery was attempted by 17,898 women, and 15,801 women underwent elective repeated cesarean delivery without labor. Symptomatic uterine rupture occurred in 124 women who underwent a trial of labor (0.7 percent). Hypoxic–ischemic encephalopathy occurred in no infants whose mothers underwent elective repeated cesarean delivery and in 12 infants born at term whose mothers underwent a trial of labor (P<0.001). Seven of these cases of hypoxic–ischemic encephalopathy followed uterine rupture (absolute risk, 0.46 per 1000 women at term undergoing a trial of labor), including two neonatal deaths. The rate of endometritis was higher in women undergoing a trial of labor than in women undergoing repeated elective cesarean delivery (2.9 percent vs. 1.8 percent), as was the rate of blood transfusion (1.7 percent vs. 1.0 percent). 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).

Conclusions A trial of labor after prior cesarean delivery is associated with a greater perinatal risk than is elective repeated cesarean delivery without labor, although absolute risks are low. This information is relevant for counseling women about their choices after a cesarean section.


Basically, the risks are low no matter what you decide, but both maternal and fetal outcomes appear to be better without laboring. If you read the whole article, you can get a better feel for where you are likely to fall within the group and make a better informed decision. Obviously, everyone is different and no one is going to have the same experience as another person. You have to decide what's right for you.
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#25 of 26 Old 02-20-2006, 02:04 AM
 
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i'm another one who had a very easy recovery physically from my c/s-- my medwife and doc joked about how i should be on one of those birth shows (baby story, etc.) to showcase how wonderfully i recovered.
however...
i was in emotional anguish for more than a year. i felt robbed of my daughter's birth (i'd been induced for no real reason-- i was due around christmas-- and was sectioned at 2.5cm after only a few hours of weak labor due to "fetal distress") and left out of some sort of club of women. i felt like i wasn't allowed to participate in talk of labor and birth, like i was unqualified; i mean, everyone knows how a c/s is performed, what was unique or exciting about my daughter's birth?
i got pregnant again when my daughter was about 14 months old and eagerly started planning a homebirth. we unfortunatly had to transfer to a hospital (i'd been in labor for more than 36 hours, 24 with hard, regular contractions but my cervix wouldn't budge past 2cm; my midwife was concerned my labor would be prolonged and i would be too tired to push in the end). i was terrified someone would take my vbac, but i was exhausted (no sleep for 2 days) and had been in active labor for so long, i requested an epidural. after many troubles with the epi (let's make a long story short, shall we?), i did have my son vaginally that evening. it was the most amazing thing i've had the privelage of doing. after my right leg regained feeling (botched first epi), i felt well enough to run around the block. it was completely different from my c/s, even with my "amazing" recovery.
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#26 of 26 Old 02-22-2006, 08:55 PM
 
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I'm sort of an unusual one-most women looking at VBAC's seem to be mamas with only prior c-sections-I had two vaginal births with my daughters, and a c-section with my youngest, my DS. Even though I knew the c-section would be coming about two weeks prior to the birth, and I researched, asked LOTS of questions, and came up with a birth plan that was as hands-on as a c-section can get, it still wasn't the same as a vaginal delivery. The recovery sucked bigtime for me with the c-section-and was much harder than bouncing back from a vaginal birth (hemi's, a tear, and all!) Mine was supposed to be scheduled, but surprise surprise, my water broke the night before the scheduled section, I went into labor with piggybacking contractions within an hour, and DS was born by c-section soon after. I'm not sure if my recovery would've been easier had I not been in labor first, but either way, the c-section recovery really sucked.

I'm leaning strongly toward VBAC this time-and my OB supports that if that is what I choose (surprises the heck out of everyone around here-in the past year or so they've gotten to the point where the hospital has become very VBAC unfriendly, and they rarely do them anymore, which is sad). I know I really had no "recovery" with my daughters-I felt terrific and ready to go, and that did not happen after DS's birth.
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