anyone who hasn't made up their mind about VBAC yet? - Mothering Forums
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#1 of 47 Old 09-19-2007, 10:03 PM - Thread Starter
 
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We just found out that i'm pregnant again (hooray!).

however, it's really brought the VBAC question into sharp focus. i used to really, really want one. now i'm not so sure.

is there anyone else here who's still in the process of deciding?

if there are others like me, i think it'd be nice to have a thread where we can hash it out, without feeling like we're raining on the pro-VBAC tone of this board.

(don't get me wrong, i love the pro-VBAC tone. but i also get the feeling that women who have committed their hearts to VBAC don't benefit so much from those of us that are questioning whether it's right for us).
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#2 of 47 Old 09-19-2007, 10:19 PM
 
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I would like to hash it out too, (but don't have anything insightful to say right this second.)

I think there's a thread, kind of a recent one, called "risks of a c-section" and there were some mamas giving some good info about risks of both VBACs and c-sections, not necessarily pro-VBAC but just real conversation about it. you might want to read that one to start.
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#3 of 47 Old 09-20-2007, 09:35 AM
 
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yes, i'd be interested. Not pregnant yet, but will probably plan to VBAC, But my mind is still a bit torn and very nervous either way!
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#4 of 47 Old 09-20-2007, 01:46 PM - Thread Starter
 
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oh good, i'm glad i'm not the only one! right now, i feel scared of both VBAC and a repeat c/s. i don't want to make my decision out of fear. i'm just not sure how to get to a place where i feel confident.
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#5 of 47 Old 09-20-2007, 09:40 PM
 
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I'm here with you. My heart says VBAC but my mind is scared. Scared that I'll end up having a 40 hour labor again and still end up with a c-section like last time. I guess I'm most afraid of my birth experience repeating itself. I'm scared that I'll try so hard to have a VBAC and fail again. I think it is the feeling of failure, that something is "broken" about my body.

The appeal of a repeat C is obvious...schedule it, know when the baby will arive, know it will arrive safely, get a good nights sleep beforehand, have childcare pre-arranged, etc. But I really, really don't want a c-section! I also really, really want to experience birth naturally.

Ugh. So yeah, I'm still a bit torn. Mostly worried that if I try for a Vbac I'll have a long labor only to end up with a c-section anyway which makes the recovery so much worse. I guess I fear the fear. I know how much fear plays into the birth experience and wouldn't want my fears to affect it.

Amazing how much mental work I still need to do surrounding the birth of my son that was a year ago. A year ago right now I was in labor in fact!
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#6 of 47 Old 09-20-2007, 10:07 PM
 
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Originally Posted by Eclectica View Post
The appeal of a repeat C is obvious...schedule it, know when the baby will arive, know it will arrive safely
Whoa Nelly... what can guarantee THAT?

The death rate of neonates born by c-section is NOT zero. As a matter of fact, a study last year found that the neonatal death rate for uncomplicated births via elective c-section was DOUBLE the rate for uncomplicated vaginal delivery (I believe this only consdered primips): http://www.associatedcontent.com/art...accompany.html

Granted, this study doesn't take VBAC into account, nor elective repeat cesarean... but when you think about it, seems pretty obvious that birth via major abdominal surgery would carry a higher risk rate than birth via the way that's spent millions upon millions of years evolving. I mean, it would be nice if we could just lie on our backs for 90 minutes while the lima-bean sized baby crawls up into our external pouch like mama kangaroos do... but let's give nature a little credit for having come up with a passable system ;-).

For the general topic of the thread, though... I think that I might have more of a struggle with the idea of VBAC if I didn't feel like I knew "what went wrong" and how to prevent it next time. If you come out of your c-section birth without any notion of how you got there or what you could do differently, it would be really hard to go into the unknown again, I think. So, even though I personally don't have any indecision about doing a VBAC, I can understand where the indecision comes from.

For me, I will try to avoid spending the eighth month of pregnancy sick with bronchitis, which kept me from exercising and therefore led to an increase in blood pressure; I'll also avoid having a positive GBS culture (though I haven't decided whether to avoid the culture altogether, or to do what I can to wipe out the bugs before taking the test). Therefore I won't go straight to the hospital when my water breaks (if it breaks before active labor this time anyway) and I may even go with a homebirth this time. But that's specific to *my* experience, and everyone's is different... so probably the first step in knowing whether VBAC is the right decision for you is to look at "what went wrong" last time and figure out if it's preventable.
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#7 of 47 Old 09-21-2007, 03:34 AM
 
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I find the indecision many of us feel very sad and such a symptom of our sick birth politics that has decided surgeons are the ones to decide what's safe and what's not. Unsurprisingly, they've decided surgery is safe despite the significantly higher mortality rates for mothers AND babies, and of course, the 100% morbidity rate of surgery. Henci Goer says it best, that we should no more be wondering about whether or not to birth after surgery than we did before. As formula is to breastmilk, so is c/s to birth. Neither should be used for non-emergencies; bodies are meant to birth, babies are meant to be born. Political pressures aside, evidence shows what I'm saying to be true. A birth is a birth is a birth is a birth is a VBAC is a birth. Simple.
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#8 of 47 Old 09-21-2007, 03:49 AM
 
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Yes, that is true, a c-section doesn't guarantee a safe arrival, I should have been more specific rather than general. In my personal situation based on my past labor experience and the complications I had a c-section *might* be safter than a VBAC. Like you said, that study only considered 1st births with no complications. For me a c-section would not be elective if I went to my same ob/gyn it would be required.

Needless to say I won't be going to that same ob/gyn and hope to find a midwife who would take me if there is a next time around. Sure, I hope and long for a natural labor with a vaginal delivery...but I tried that once already and almost died. Is it worth trying again? I'm not sure.

You hit the nail on the head though with whether or not one knows "what went wrong" and how that affects your view of the experience. If you know of changes you could make next time around that may alter the outcome it seems like an obvious choice to try for a VBAC. There was a lot of grey area in my particular situation which complicates matters. No way of knowing if what happened was preventable or if it will happen again.
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#9 of 47 Old 09-21-2007, 02:19 PM
 
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I am not a VBACer, but work with VBAC moms. I highly recommend anyone making this decision to go to www.childbirthconnection.com (I hope I'm allowed to post this here!) It has a great section on evaluating VBAC vs ERC. It shows options, evidence, resources, etc.

Quote from the site: Your best approach is to become informed and clarify your goals well in advance and then seek care that is in line with your preferences and birth plan.

Good luck in the decision-making!

Sweetpea
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#10 of 47 Old 09-21-2007, 07:29 PM
 
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Thank you so much for this thread. I am a die hard pro-birth choice supporter (i.e. if you want a cesarean or a VBAC or a homebirth or a hospital birth or a UC you deserve the right and resources to have that). I fought tooth and nail last pregnancy for a VBAC and it went amazingly well. That being said, I'm 37 wks pregnant now and can honestly say that while I know I need to VBAC, this being in my body seems so huge, lol, and the next 3 weeks seem sooooo long. A very tiny part of my emotional mind would love to go in tomorrow and get drugged up and get a cesarean and have someone taking care of me and feeding me and cleaning up after me and having all of this waiting over, and the baby here and...

I wouldn't do it for those reasons, but its hard not to think that way when I have not slept since 2am and I'm so sick of being pregnant that I just want to cry.

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#11 of 47 Old 09-21-2007, 07:41 PM - Thread Starter
 
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i disagree that the research makes it clear that VBAC is better. in fact, my sinking suspicion is that VBAC is more dangerous for the baby. i keep seeing good research that shows this outcome... most recently the vermont/new hampshire VBAC project info on the ican website (www.ican-online.org). i also see good research that favors VBAC, but i'm trying to be very careful to not disregard anything just because i don't like its outcome.

that said, i was hoping to make this thread a place where we could freely air our fears on both sides without feeling pressure towards VBAC. for me, pressure to VBAC doesn't counter pressure to repeat c/s.

eclectica-
i'm so with you on the fear! i hate the idea of making a decision based on fear. i just feel like, how can i not have fear? there's the potential of a terrible outcome on both sides. of course, it was always there with my first birth too. i think there's something about experiencing an emergency situation that really makes you realize bad outcomes can happen to you too. i think that's the real source of my fear and indecision... if it happened before, i'm naive to think it can't happen again.
that's neat that you were in labor a year ago! happy first birthday to your little one!
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#12 of 47 Old 09-21-2007, 10:29 PM
 
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majormajor- I'm not sure what section of the website you linked to includes the information you're using? I followed the link and found it provides information on 15 VBAC studies with the "bottom line" information. Some deal only with mothers, but the rest of the list includes:

Quote:
Bottom line: Risk of death for babies born by cesarean was nearly three times greater than babies who were born vaginally.
Quote:
Bottom line: Rate of cesarean delivery was positively associated with severe injury and death for mothers, even after adjustment for risk factors, and death for babies.
Quote:
Bottom line: Morbidly obese women and their babies experienced a higher rate of injury when the baby was delivered by repeat cesarean.
Quote:
Bottom line: The process of labor and vaginal birth prepare the lungs of a baby for breathing air. Even for mature babies, being born by cesarean deprives the baby of important hormonal changes that occur before and during labor, and increases the risk of having difficulty breathing and death for the baby.
Quote:
Bottom line: Bacteria in the intestine affects the overall health and immune system of babies. Babies born by cesarean section had higher counts of unhealthy bacteria and the lowest counts of beneficial bacteria, and babies born vaginally at home had the highest counts of healthy bacteria and lowest counts of unhealthy bacteria.
I also went directly to the study you mentioned and it says that the risk of infant death during vbac is the same as the risk during any "first birth"...and that this risk is higher than that during a planned c/s (6 in 1000 for "normal birth" and 3 in 1000 for a planned c/s). So I think the message in that study isn't that VBAC is more risky, it's that vaginal birth (VBAC or not) carries a higher risk of death. But the c/s carries a higher risk of non-life-threatening injury for the babe than a vaginal birth does. So it's sort of a trade off.

I totally get the uncertainty though...I had an unplanned, unexpected, and unwanted c/s with my first child. I did everything "right" but somehow wound up with a c/s anyway. With my second pregnancy I again did my best to make everything "right" but I also made peace with the chance that my birth would end in the OR. It didn't, and the absolute emotional high I felt after my VBAC birth helped me handle the very scary and physically damaging end of that birth experience. DD2 had shoulder dystocia lasting a few seconds shy of 4 minutes. She was finally freed but wasn't breathing and it was a scary few minutes. I received a 4th degree tear that required 100+ stitches, I have a bladder prolapse linked to the dystocia (her shoulder jammed into the bladder, causing damage), and even now at 3 months post-partum I have difficulty holding and passing urine/gas/stool and the scar line is painful from clitorus to anus (sorry TMI). After the repair I was warned to avoid dtd for 6 months and was strongly advised to avoid pregnancy for at least 2 years and to plan a c/s with future births.

I look ahead to a third child and wonder which is a better option? A planned c/s? Another VBAC? I know that the emotional devastation following my c/s had a huge impact on my self image and ability to mother my dd during the first few months. I had PPD and PTSD that required months of therapy and which are still not totally resolved. My VBAC left me with a sense of amazing accomplishment and pride that helped me through a mild depression (about the tear) and through the stress of the early months with two littles.

Now, shoulder dystocia can hit ANY birthing mama. And there is really no good diagnostic for figuring out who will or wont have a problem. It's honestly not a risk I ever considered (I was mostly focused on UR and other more "vbac specific" issues), but now it's something I need to think about along with the damage/healing of m perinuem. Many babes are physically or mentally damaged in a SD. We were insanely lucky that everyone came out as well as we did. So yeah, I totally get the concern about vbac.

I think that I will go for the vbac again for a couple reasons... first, planned c/s leads to early birth and related lung problems. I want to enter labor naturally so that my babe is the one deciding that they are ready to come. I want them to experience the beneficial hormonal changes of labor and the stimulation of contractions. Second, I'm comfortable now making decisions during birth. If the situation seems to be tending towards a malpositioned babe (dd1) or a babe who might be heading towards a SD (long pushing phase, dd2 was 4+ hours) then I comfortable saying "let's move to the OR". I know I can request an ultrasound during labor to determine my babe's position, I know what back labor feels like and what a "normal" contraction feels like, I know how to listen to my intuition even when I'm all the way gone in labor land. I think for me it would be important to my physical, emotional, and spiritual recovery to know that I TRIED the natural birth process before moving to the surgical delivery.

I guess I am very very thankful for the existance of c/s. It really can and does save lives of mamas and babes. But it is a major surgical procedure, it has risks for mama and babe, and I think it should be saved for situations where it's a life saving operation instead of being used as a preventative measure. If that makes sense? It's like grabbing for the parachute just because you think the plane "might" go down or you're told there could be some turbulence ahead. Sure, the parachute can save your life if the plane is falling...but jumping out of the plane carries risks too and so you'd better be certain the plane really is crashing before taking that step!

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#13 of 47 Old 09-21-2007, 11:33 PM - Thread Starter
 
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wombatclay, i don't like the first 2 studies you quoted (design issues). the third doesn't apply to me. the fourth and fifth, i haven't read into, but the bottom lines seems plausible to me. however, they don't do much more than explain why babies sometimes die after a c/s.

what really interests me about the vermont/new hampshire VBAC project is that it makes VBAC look bad, but it's on ican's website anyway. in every other case, they ignore research that makes VBAC look bad, and highlight only what makes it look good. i'm guessing they were invested the the project before it started. who knows. however, i don't like the way they say VBAC death rates are the same as first time vaginal birth death rates. i haven't seen the raw data from the project, of course, but the national death rates include premature babies and all sorts of other high-risk situations. i seriously doubt they're including vaginal premature deliveries in their VBAC numbers (usually trials include only only 37+ weeks moms). so, i think they might be comparing apples to oranges with the intent to deceive here.

i am also confused about how they cite a .2% chance of rupture with a planned c/s, and compare that to a .5% chance of rupture DURING a VBAC. if anything the VBAC group should have higher rates of pre-labor rupture than the c/s group, since their gestations are longer. but they don't seem to include pre-TOL rupture in the VBAC group. or if they are, the wording doesn't make that clear.

i just want to make sure i'm making a fully informed decision, you know?

anyway, thanks for telling your story. pushing for 4 hours, oh my! i remember my OB telling me to gear up for a long pushing phase with DD because she was sunny side up. i didn't like the sound of that!

i also understand what you mean with your parachute analogy. but for me (at least, in the place i'm in right now), the numbers are all that matter. i want to know the odds of death and serious injury for me and baby with VBAC and c/s. i want to know them more precisely than i can... i think at some point, i'm going to have to accept that i'll have to make my decision with less information than i want. i hate that, and i think it's a big part of my hangup right now.

ah well, thanks for listening to me ramble.
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#14 of 47 Old 09-21-2007, 11:45 PM - Thread Starter
 
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hey, look at the vermont/new hampshire thing again (the "birth choices after a c/s"). the table at the end says 6 in TEN thousand and 3 in TEN thousand risks of death for VBAC and c/s. that's a horse of a different color! i wonder which one is right.

i think i'll email them.
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#15 of 47 Old 09-22-2007, 01:04 AM
 
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I'm really happy to see this thread, because it means people aren't just making decisions based on emotion. Emotions are important and shouldn't be ignored, but they aren't by themselves a source of knowledge!

I had a baby last year by VBAC. Before I conceived her I was completely sure I would have a VBAC, but then I got pregnant and had several complications and ERCS was starting to look really attractive to me. I spent a whole weekend, about 25 weeks along, thinking that maybe I would just go on and do the ERCS -- I have extremely long labors, after all, and I wasn't sure how my older child was going to deal with being away from me for what could realistically be several days. I did my research and, yeah, c-sections looked a bit scarier statistically than VBACs (though VBACs do have occasional horror stories too), but the odds were overwhelmingly in favor of me having a healthy baby either way. I wound up picking the VBAC mainly because I didn't want to be unable to laugh without pain for maybe a couple of weeks; after all, I did have a three-year-old in the house!

Anyway, although I did have all kinds of (sometimes conflicting) emotions about how to meet my baby, I found myself making the decision based mainly on practical concerns.

Nealy
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#16 of 47 Old 09-22-2007, 08:45 AM
 
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I can relate to being scared about both VBAC and ERCS.

It seems that many of the studies I have read (but I need to read more!) give conflicting results, or like majormajor said, they are not comparing "apples with apples" so to speak. You can't use a study about baby and mother death and injury in 1st time vaginal or C-section with VBAC or ERCS. Unfortunately many studies do exactly that and women quote these to support their views, but that just makes me feel more skeptical then.

It also does not help when I hear things about how women have birthed naturally for thousands (millions, doesn't matter....lots!) of years, because even though this is true (and I believe in our bodies being amazing creations of God, but our world is also somewhat flawed), many many many women have and still do die in natural childbirth all over the world every day. Not long ago I remember reading about how 1 in 6 women in Afghanistan dies in childbirth. Of course there would be many various reasons for this and a total difference and possible lack of proper assistance and care, but this is the reality for so many women around the world. We are very lucky in countries like Australia, US and Canada, where most of us are from, that the rates are not this high. So my mind automatically goes to this thought, NOT that I should trust in my body to do what it naturally should. Anyone else feel like this?

I am very scared of having regrets whichever I decide and I really do change my mind from day to day.

I have 2 main reasons for leaning towards a VBAC. First, despite my fear, I KNOW I will feel extreme joy to give birth the way I didn't the first time. I think it will help me a lot to feel great achievement. I am planning to do Hypnobirthing course to help release my fear too. The other is that it seems the general consensus from both the medical community and the general pro-VBAC supporters is that the mother is less likely to die after/during a VBAC than ERCS. Of course I want the best for my baby and to deliver a healthy baby and would be distraught more than words could say if anything happened to my baby, BUT I certainly want to be around to raise it! And around for my first daughter! And around for my husband. It seems a lot of anti-VBAC people focus purely on the baby's well-being (focus on UR, etc). Well I think my well-being is important too!
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#17 of 47 Old 09-22-2007, 10:43 AM
 
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Originally Posted by JanetF View Post
I find the indecision many of us feel very sad and such a symptom of our sick birth politics that has decided surgeons are the ones to decide what's safe and what's not. Unsurprisingly, they've decided surgery is safe despite the significantly higher mortality rates for mothers AND babies, and of course, the 100% morbidity rate of surgery. Henci Goer says it best, that we should no more be wondering about whether or not to birth after surgery than we did before. As formula is to breastmilk, so is c/s to birth. Neither should be used for non-emergencies; bodies are meant to birth, babies are meant to be born. Political pressures aside, evidence shows what I'm saying to be true. A birth is a birth is a birth is a birth is a VBAC is a birth. Simple.
:

I haven't gotten to the bottom of the thread yet, but what about letting the baby decide when it's ready to come out? Scheduling a cesarean is something that is life-saving when there is truly a threat to mother and/or child, for example severe pre-e or IUGR, or if it's known in advance that labor will be fatal to one or both as in the case of placenta previa. In those cases of course getting the baby out is a priority! But just to avoid a long labor "in case" it ends in a cesarean again? Ask yourself this: if you had to go back to the events leading up to the cesarean, would you have just scheduled a cesarean around your due date? I mean, why bother going into labor at all if it MIGHT end up in a cesarean? (And there are people who really take this line of reasoning. I'm just not one of them.)
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#18 of 47 Old 09-22-2007, 02:19 PM
 
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It also does not help when I hear things about how women have birthed naturally for thousands (millions, doesn't matter....lots!) of years, because even though this is true (and I believe in our bodies being amazing creations of God, but our world is also somewhat flawed), many many many women have and still do die in natural childbirth all over the world every day. Not long ago I remember reading about how 1 in 6 women in Afghanistan dies in childbirth. Of course there would be many various reasons for this and a total difference and possible lack of proper assistance and care, but this is the reality for so many women around the world. We are very lucky in countries like Australia, US and Canada, where most of us are from, that the rates are not this high. So my mind automatically goes to this thought, NOT that I should trust in my body to do what it naturally should. Anyone else feel like this?
There's a study I ran across the other day... lemme dig it up... ok, here it is: http://www.ncbi.nlm.nih.gov/sites/en...t=AbstractPlus

Basically, the upshot is... if you look at low-income countries with c/s rates below 10%, there's a negative correlation between maternal and infant mortality and c/s rate... the higher the rate of cesarean sections, the lower the mortality statistics.

When you get above 10%, and when you look at middle- and high-income countries, the correlation disappears.

So what does that mean? That means that, where fewer than 10% of births OVERALL are done by c/s, some women and babies die unnecessarily who would have been saved by the availability of a c-section. But if more than 10% of the babies are delivered by c/s, additional c-sections are NOT saving any lives.

When you look at the c-section rates in countries like Australia, the US, and Canada, you can see that they're MUCH higher than needed to prevent unnecessary infant and maternal death.
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#19 of 47 Old 09-22-2007, 03:12 PM
 
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It's like grabbing for the parachute just because you think the plane "might" go down or you're told there could be some turbulence ahead. Sure, the parachute can save your life if the plane is falling...but jumping out of the plane carries risks too and so you'd better be certain the plane really is crashing before taking that step!
What a great analogy!
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#20 of 47 Old 09-22-2007, 03:28 PM
 
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When planning for my VBAC, I did a LOT of research... odds of uterine rupture related to spacing between pregnancies, induced labor, gestational age, etc, odds of pre-eclampsia striking again, odds of serious complications from cesarean, blah blah blah... there are SO many things that can go wrong in childbirth! When I look at the worst case scenarios, of uterine rupture, shoulder dystocia, problems with placentas, fourth degree tears, etc... and I look at infection, embolism, long recoveries and babies getting cut... it's overwhelming! Who can decide: What am I more comfortable with?

In the end, for me, it comes down to the BEST case scenarios!

If everything goes perfectly to plan, which is better? I think that most people can agree that a gentle, natural birth with no tears beats a planned, complication free major surgery any day. Even if that surgery goes to plan and there are no complications, it is still major surgery and involves getting cut open.

And, my second birth was a wonderful VBAC with a few small tears that healed quickly. It wasn't what I planned (it was loooong!), but it was easy. There's no way that a c-section, even a GOOD one, could compare to that.

So, consider looking at the best case scenario, rather than the worst one.

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#21 of 47 Old 09-22-2007, 08:53 PM
 
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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.
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#22 of 47 Old 09-23-2007, 02:54 AM
 
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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.
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#23 of 47 Old 09-23-2007, 03:36 AM
 
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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.

Danell - Craft Savvy mama to Evan (3/31/06) and Andre (8/29/07)
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#24 of 47 Old 09-23-2007, 11:20 AM
 
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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.
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#25 of 47 Old 09-23-2007, 12:28 PM - Thread Starter
 
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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?
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#26 of 47 Old 09-23-2007, 01:35 PM
 
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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.
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#27 of 47 Old 09-23-2007, 05:37 PM
 
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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!
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#28 of 47 Old 09-25-2007, 12:39 AM
 
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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
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#29 of 47 Old 09-25-2007, 02:18 AM
 
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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"

In love with the Hubs (6-03) & : Kookie Pookie Girl (c/s 5-05) & Bouncy Big Boy (vbac 2-07) & : Miss Cheeky Cheeks (hbac 11-08) 100*90* 100lbs = Las Vegas : Almost there!
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#30 of 47 Old 09-25-2007, 12:49 PM
 
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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
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