[jwoodbri]

In a nut shell version:
-1st CS scheduled due to breech
-2nd CS scheduled due to not knowing better and VBAC bans at area hospitals

Thoughts for VBA2C:
-shorter recovery time while caring for two older kids
-avoid increasing RCS risks to myself and possible future pregnancy
-not being able to immediately have baby placed on me or wait until the umbliical cord stops pulsing etc

Thoughts "against" VBA2C:
-finding a supportive OB & hospital (& the distance)/ do like current doctor/hospital
-comment from radiologist on my file re: ultrasound and thinning around my scar
-worried about not trusting myself, my body &/or ability to have a natural VBA2C
-fear of blaming myself if I push for VBA2C and something happens to the baby

The really long version:

When I first found out I was pregnant with DC#3 I definitely wanted to find out more about VBA2C because I wish I had done one last time. I wish I had made more of an informed decision and didn't want to have the same regret if I just went straight for another RCS. I really like my OB and have had good experiences at our hospital. The last time I met with my regular OB I asked about ultrasound results and she read me the comment made by the radiologist who wrote the ultrasound report. She commented that she thought it was odd that they had left a comment but simply said that it did not mean that the thinning was abnormal it just could be that they felt like mentioning it that day for whatever reason. I don't think she was that concerned by it.

Well the comment stuck with me as I feel like if I do have abnormal uterine thinning around my scar then I would be ok with a RCS. However if they were just commenting on the normal thinning around the scar then I would still consider it. I mentioned all this to another OB at my last visit and she was more concerned about the comment as she currently has a patient with abnormal (maybe extreme would be a better word?) thinning and apparently consulted with a hi-risk OB out of Boston who said she needed to be deliver early (3-4 weeks early!!!) so she thought given my interest in a VBA2C and the comment that I should meet with a high-risk OB to discuss my situation and have another ultrasound to check my uterine lining. But it's not until May 12 and I'll be 30 weeks then. The high-risk OB does do VBACs but not sure yet how VBAC friendly she is and I would have to transfer to her hospital about an hour away. (Not too far but traffic can be terrible there.)

I'm also a little worried if I wait until the appt. that it will be too late to transfer to an OB, if I find one who would support me, because of how far along I would be at that point. If the high-risk OB that I will see thinks everything is fine but for whatever reason can't take me as a patient or I want to find a different OB. (At this point I feel more comfortable in a hospital setting even though I know unfortunately by doing so is probably increasing my chances of a RCS. And midwives in the state of NH can't take VBA2C clients.)

Another thing I have read is that you are much more likely to have a successful VBAC the more you believe in yourself and your ability to be successful. Here I'm having doubts. I also know having a natural childbirth with as little intervention as possible increases your chances of being successful. When planning for DS#1's birth I always just figured I would get the epidural. I figured I wouldn't kid myself into thinking that I would do a natural birth. Not a big fan of pain and at the time this was fine with me. (I'm now more inclined to question medical practices and strive to live more naturally and organically etc.)

So now I find myself leaning towards just accepting a RCS again because it's easier and I can then move on with my decision and focus on trying to make a CS as family centered as possible. But the other part of me thinks I shouldn't give up so easily. So the options that I see at this point are either wait and see what the high-risk OB says or try to actively pursue leads on VBA2C friendly OBs and hospitals.

Thanks for "listening" to my ramblings which I realize are probably only semi-coherent! It helps just to write it all down. Love to hear any thoughts or advice...

Thanks again,
Jess

 

[mamatolevi]

I recommend you find an ICAN group. You'll find great support there.

I had my VBA2C in 11/07 and felt many of the same things. I decided it was more important for my long term health to at least try. A good doula who has VBAC experience (either her own or through her clients) may be able to help you work though it. My doula was invaluable to both me and my husband.

VBA2C is just as safe a VBAC. They are no more high risk than any other vaginal birth. Any dr who says otherwise is lying to you.

If the comment from the radiologist is really bothering you then get second opinion. It doesn't seem to be bothering your dr - which is great.

There is nothing preventing you from consulting with other VBAC friendly providers while you wait for your appt with the high-risk ob. Call the L&D wards and ask nurses who they've worked with and what they are like. Have you considered a CNM?

the biggest thing to prevent a rpt c/s if you're in hospital (which is where I was for mine) is to keep moving. (most folks will tell you to show up pushing.) Avoid the epidural as long as humanly possible. Ask about a paracervical block for pain relief. It numbs the cervix and allows pain relief w/o closing the door to an epidural. You will still be able to walk around. There are some folks on the ICAN support group who are very knowledgeable about them and have had them.

www.ican-online.org

 

[writteninkursive]

Definitely check out ican-online.org.

I've had two c-sections and I'm DEFINITELY VBA2Cing this one! There were no medical reasons for my c/s and I want to REALLY experience birth. I will be having a 100% natural birth (in a hospital) with a midwife and a doula. It took some time, but I finally found a practice willing to accept a VBA2C (thanks to my doula and her endless supply of knowledge!) and everything is set and ready.

Even if you want a VBA2C, if you go through a regular OB, you're probably NOT going to get your VBAC. They are trained surgeons. They 'know' surgery. Midwives 'know' birth and birth support.

One of the absolute biggest factors in my decision to have a VBA2C is the fact that I have never felt the true affects of real oxytocin during birth. That's so devastating to me because it's the bonding, love hormone. And the synthetic kind (pitocin) doesn't cross the blood-brain barrier, so you never FEEL like you would if you gave birth naturally. How sad!!! I want to feel what birth is supposed to FEEL like, more than anything!

If you want a truly low-risk VBA2C, don't allow them to give you ANY drugs. Get up, move around, do what feels comfortable to you. Mentally prepare yourself to handle pain. Birth is pain, but it is totally bearable. You just have to prepare for it! The moment you start getting Pitocin to augment contractions, you have monitors on just to "be sure", you get repeatedly checked vaginally, and ESPECIALLY the moment you allow them to give you an epidural... THAT'S when your risk of problems really goes up! So go non-interventionalist and you should be able to have a VBAC with no problem.

Whatever you do decide, good luck! And decide fast so you can get ready if you do choose to VBA2C!

 

[floye]

My best advise is that you should do whatever is best for yourself and your family. The honest truth is that anything can happen when you give birth and you need to make a decision that you won't regret. Terrible things can happen with both scheduled c-sections and vaginal births.

I just had a great VBAC in January. I met with a GREAT doula who helped me trust and love my strong body and I did lots of yoga, reading Ina Mae Gaskins and preparing my husband and I to decline all medical interventions offered unless they turned out to be absolutely necessary. I had an excellent natural birth and it was the right choice for me, but it isn't the only choice.

Definitely check out ICAN and if you do decide to VBA2C educate yourself and your partner and make sure that everyone you invite to be in your delivery room is 100% supportive of you.

Best of luck.

 

[meatloafkend]

I totally know what you means when you say you don't want to focus on a VBAC if it doesn't work out, because maybe you could have had a calming CS experience instead. Don't think that way. If you want to try a VBAC, try. In my experience, I decided I would feel worse if I didn't try because then I know I didn't do everything I could to have a vaginal birth. I know you don't really have the most supportive birthing staff, but your own positive energy can go a long way. Consider hiring a doula to support you throughout the labor as well.

 

[wombatclay]

I second (third? fourth?) ICAN. There are local groups and a national online forum. The women there are a wealth of information and support.

You might also consider something like self hypnosis for birth to help prepare. I found that the Hypnobabies home study course was a big help when I planned my first VBAC because it gave me a space to process my fears as well as focus on options. Other mamas find the Birthing From Within program to be really helpful as well when thinking about birth options. If you'd rather not use a formal program, journaling or meditation might help you work through all the different conflicting elements of your options.

One thing I found personally helpful with my VBAC was something my pro-birth OB said... she pointed out that I didn't have to make a final decision before the birth. I had had a very long labor with dd1 and found the c/s on top of that was really hard to recover from. So I was very worried that I'd try for the VBAC, have another long labor, and then a rc/s anyway. And I didn't want that. But what she helped me realize was that every labor/babe/birth is different and if my vbac labor started to mimic my first birth then we could discuss options... but that there wasn't any point in worrying about it ahead of time, or working myself up over something that might not happen.

It's not the general advice in vbac books (which often stress being totally confident as part of a successful vbac) but it worked for me. And dd2's labor was totally different, and ended with a successful VBAC. I guess, for me, it's the pregnancy portion that requires confidence and focus (as you find a supportive provider, a birth space, deal with family/friends/social conditioning, all while juggling older children and the aches of pregnancy) while the birth portion kind of takes care of itself. Vaginal is still the default, and once you've reached the actual birth it's the rc/s that requires the extra effort.

So perhaps come up with a list of things that worry you (for example, the thinning scar) and ways to address these at or near the birth (an u/s scan of the scar thickness at 38-39 weeks perhaps)?

 

[ShwarmaQueen]

I would personally attempt a VBA2C. I've read that the thickness of the uterus is a really bad predictor of u/r. If you were really serious about it, and the doc/hospital was refusing to allow you to attempt, you could always show up crowning!

 

[jwoodbri]

I was surprise to check back and see more posts. Thanks!

I have been checking out ICAN. Unfortunately there isn't currently a local group. And so far I haven't found anyone who has done a VBA2C in the area. I wish midwives could do them in NH and I did talk to a doula but she didn't have much info as the hospitals nearby don't do them. So I've been a bit discouraged but...

I'm making myself call around to the few leads I have tomorrow as I've been sitting around in a state of contemplation that clearly isn't getting me anywhere!! And if I don't do something soon I won't have a choice anyway.

Thanks for helping motivate me!

 

[writteninkursive]

Jess, don't give up!

If you find yourself a doula, you'll find yourself a bunch of information on who will deliver your baby and what hospitals are more VBA2C friendly and all that. I found a doula online at dona.org after about 12 weeks of searching unsuccessfully for a practice that would let me VBA2C. She hooked me up with a pair of midwives in the area and I was in and good to go by 16 weeks. There is so much politics that go into it.

Just remember, if all else fails, that if you really want a VBA2C and you can't find anyone willing to "let" you, you can show up at the hospital 9-10 centimeters dilated and they wouldn't even have the chance to try to cut you open. If you're relatively close to a hospital and you are okay with laboring almost completely at home, that's a viable option.

 

[spu]

hi there,

I went through all the same emotions when I became pg for the third time. I had 2 c's, both unplanned, completely different stories... so when this one came around, I was afraid to have another c, but afraid if I didn't. All your fears on both sides of the scenarios are completely normal to feel. The biggest thing I kept telling myself is a c is major abdominal surgery, and if I didn't medically need it, I didn't want to elect it. I kept my mind open and did lots of reading and talking with my midwife all along the way. When the time came for labor, I told myself, one way or another, this baby will be here by 9 am! (lol!)... and lo and behold, he popped out 35 minutes after arriving at the hospital - a smooth, uneventful beautiful vba2c. Who knew. I sure didn't think it would turn out that way.

If you can't find a doula, an ICAN chapter, or a staff member willing to support you, come here for support. There's lots of great medical articles out there and some fantastic books to educate you and in turn, you can pass along your confidence and reasonings to your medical staff. They can't force you, and they certainly can't 'scare' you because you can counter you can counter with medical statistics that are real on both sides of the coin. Keep researching. Print out articles, read books, and stay positive.

stay in touch!
susan