*UPDATE* To VBAC or not to VBAC?

[Amy in NH]

I have a similar history in that I had 4 unmedicated births, but my last two were born at home.  I would go out of my way to do a VBAC. 

 

And Congratulations!

 

[Lucy]

Listen to your gut.  That's the bottom line.  With how far you would have to go for a v-bac, I would be nervous too.

 

Uterine ruptures are more rare, but they do happen.  I had one.  I live 5 minutes from the hospital, and it was still touch and go.

After my rupture (baby #2) and three c-sections, I was told I could have had even another baby or two.  We decided to stop.

My doc said that some docs will limit the number of sections, but he's known women who have had 10. 

 

I'm pro V-BAC, many of my friends have had them and it went beautifully

But really, if your gut is speaking to you, listen.  God gave us gut feelings for a reason.

Congrats on the new baby! 

 

[8circles]

Uterine rupture is more like 1/100. At one time it was thought to be much lower than it is, which is why the recommendations changed and fewer hospitals do VBAC now.

 

Can you tell me where you found this?  I wasn't aware that they had changed again - the last time I researched this was when they started saying basically nobody should do VBAC's so I thought I was up on the latest.  

[bolt.]

I know you didn't mean any harm by this, but I do want to let you know that many women might be offended by what you wrote. 

 

Major abdominal surgery is always a big deal. Risking life threatening complications is a big deal. Being separated from your baby for up to many hours (as is standard in MANY hospitals) is a big deal. Being unable to pick up your other children is a big deal, Being unable to drive is a big deal. The numerous infections that many women get is a big deal. So yeah..it's a big deal. I'm gad yours went well, I'm glad you recovered well. But I sit each month with 20-40 women who have issue surrounding their births, and for them being told "it's no big deal" is part of what keeps them upset. It denies them their own emotions, and minimizes what they have gone through. So please....be careful with your words. 

 

I'm sorry to hear that. I'm also surprised.

 

I think it's a matter of how your expectations meet reality. It might have been easier on me (emotionally) because I was factual in my mental preparations. I think the sense of betrayal comes *both* from (apparent, American) medical pressure, *and* from being encouraged to envision that we will be the kind of women that will find an uncomplicated way through birthing. (That's just speculation: I experienced no medical pressure on my decisions, nor did I have an ideal birth pre-envisioned to be spoiled.)

 

People have abdominal surgery all the time -- and some people have a harder time than others (infections, etc.) I didn't know they had support groups to help people recover from that, though. It must be different when it's a birth.

 

 

 

Because some women have had quite traumatic c/s experiences.  So yes, some women are horribly terrified of going through that emotional trauma again and having another c/s. 

I would totally grasp the reasoning if a woman herself, or a close acquaintance has had a previous traumatic c/s. It's just the generalized sense of fear or shame (I don't know which, or maybe it's something else, I don't ask) that almost all pregnant women seem to express about the possibility that they might "have to" have a baby via surgery. There seems to be a sense that it's just an upsetting terrible thing to have happen to you... even though it happens to lots of people... and even though *nobody* reacts like that if a lady is going in for day surgery to remove a cyst or something.

 

I'm not saying their feelings are wrong. I'm saying I'd like to be able to understand where the feeling comes from, and why it is so prevalent. It's a curiosity to me: there's an incongruity that I can't figure out. And maybe it's just too sensitive of a topic and I won't be able to gain any understanding because people will react to me and my wondering. That's OK too. No pressure. It's just curiosity.

[Ann.without.an.e]

Is there a price differential between a VBAC and a C/S? We don't have maternity coverage, so for us it would be around $4K more for the C/S, even with cash pay options... Definitely something on my mind. My husband doesn't care as much, though of course it is a LOT of money. I guess I should rephrase and say that he doesn't want it to be the deciding factor, while I feel the weight of that extra money deeply.

 

 

 

HUGE difference.  My last c-section was $30,000+  

With our insurance we are going to pay the same amount either way (either birth will max our out of pocket). 

[8circles]

Charleigh, I think you should do what you feel comfortable with.

 

But, I'm always a bit puzzled when people talk about uterine rupture VBAC risks because it just seems so out of proportion to other equally valid risks.  I feel like "uterine rupture" sounds really awful and I feel like it's assumed to always end badly.  I think it's something like 94% of uterine ruptures end very well.  I'm sorry, I know I'm being very un-scientific but I don't have my research handy & don't have time to do it again.  Anyway, I just wish all the risks were talked about instead of just this one that people respond so strongly to.  Not all uterine ruptures are catastrophic. 

[8circles]

I'm sorry to hear that. I'm also surprised.

 

I think it's a matter of how your expectations meet reality. It might have been easier on me (emotionally) because I was factual in my mental preparations. I think the sense of betrayal comes *both* from (apparent, American) medical pressure, *and* from being encouraged to envision that we will be the kind of women that will find an uncomplicated way through birthing. (That's just speculation: I experienced no medical pressure on my decisions, nor did I have an ideal birth pre-envisioned to be spoiled.)

 

People have abdominal surgery all the time -- and some people have a harder time than others (infections, etc.) I didn't know they had support groups to help people recover from that, though. It must be different when it's a birth.

 

 

 

I would totally grasp the reasoning if a woman herself, or a close acquaintance has had a previous traumatic c/s. It's just the generalized sense of fear or shame (I don't know which, or maybe it's something else, I don't ask) that almost all pregnant women seem to express about the possibility that they might "have to" have a baby via surgery. There seems to be a sense that it's just an upsetting terrible thing to have happen to you... even though it happens to lots of people... and even though *nobody* reacts like that if a lady is going in for day surgery to remove a cyst or something.

 

I'm not saying their feelings are wrong. I'm saying I'd like to be able to understand where the feeling comes from, and why it is so prevalent. It's a curiosity to me: there's an incongruity that I can't figure out. And maybe it's just too sensitive of a topic and I won't be able to gain any understanding because people will react to me and my wondering. That's OK too. No pressure. It's just curiosity.

I didn't want another c/s because I felt like it was unnecessary.  Just like my first one which I think I was tricked into.  IMO & that of several experienced OBs, it would be purely elective major surgery and that isn't something I'm comfortable with.  I have no shame about my own c/s (which isn't a bad memory at all, just wish it hadn't happened) nor do I judge others who decide it's right for them.

 

To the bold, I can't figure out why this is confusing.  A c/s is not in any way comparable to day surgery to remove a cyst.  My abdominal organs were systematically removed from my body & then put back together like a puzzle.  It is MAJOR surgery.  Of course most people want to avoid it.  It is sometimes upsetting because it is often done due to an emergency.  It seems obvious that if it wasn't an elective from the get-go, it probably wasn't something the mother wanted to happen, thus it becomes somewhat upsetting that it had to happen.  

 

Delivering a baby vaginally is a natural process - that is how it is intended to work.  Sometimes that isn't possible & I'm grateful for the ability to have safe deliveries through surgery.  But why would it be a mystery why many/most people would like it to happen the way it was intended to?     

[sassenach]

It sounds like you would have to passionately advocate for a vbac and if your gut says c sect, you should just do the C.

I had 2 vbacs, but they didn't require induction.

Your state sucks.

 

ETA: gut, not guy.  Though, I'd take your guy's advice into consideration as well!

[RoughCollie]

I had to make the decision about whether to have a C-section with  DD, after I had an emergency one with the boys.  My doctor said he would let me make the decision, after giving me the facts.  Because there would be a 10% chance that my uterus would burst and one or both of us would die, I decided to have a c-section.

 

I really, really wanted to experience having my DD the natural way, and to look at this option as being 90% positive.  I couldn't take the risk for either of us because the consequences could have been dire and irrevocable.  I could not have lived with myself if something happened to DD because I wanted to give birth naturally.  I could not live with the idea that my triplets would be motherless, either.  So the choice for me was easy, except for the part in which I had to give up my chance to experience labor and childbirth.

 

(DS1 was born naturally, but he weighed only 2 lbs., was born as I was explaining to the nurses and doctors that I was not going to give birth that day because I didn't know how, and I never felt a labor pain because he and his brothers were extremely premature.)

 

I have often wondered if my doctor would have put his foot down if I'd decided to have a natural birth. Despite that, I am glad he left it to me to make the decision, because I thought that was respectful of me.

[BlueTaelon]

I agree with go with your gut but that said, many many women happily use a lay midwife, you can always transfer if baby doesn't show by 42-43 weeks. I planned a home water birth for #1, ended up an emergency c/s when I developed severe pre-e and HELLP syndrome. #2 I was honestly wavering between a UC because dd #1's birth was so traumatic/horrifying and a repeat C/S. When it came down to it I had a repeat C/S because dd kept going into distress and I was having heart problems due to low potassium and magnesium. While I wasn't thrilled with having another c/s the birth was 180 from how #1 went and was a pretty positive experience because I had an awesome birth partner who was able to advocate for me and my baby when I couldn't. (same hospital,  years apart) I was discharged 24 hours after my c/s and left at 36 hours (had to wait for baby to get d/c). Recovery was easy, I was only on Motrin by day 3 and half a Vicadin every couple hours before that. I was also up and taking care of the household by day 3, well at least I was cooking and doing laundry since there was no one else to do it. If #3 came along I would again waver between a UC and repeat C/S but it wouldn't be the end of the world if I had another c/s but I've had pretty easy recoveries. I remember going shopping at Target on the way home with #1, she was 5lbs and needed preemie clothes and diapers so I had to buy some:)  We won't talk about what I did on the way home with #2 lol:)

[Ann.without.an.e]

It sounds like you would have to passionately advocate for a vbac and if your guy says c sect, you should just do the C.

 

I had 2 vbacs, but they didn't require induction.

 

Your state sucks.

 

 

Yes, in this area, my state does, indeed, suck.   lol

 

Agh.  If they didn't make it so unlikely to happen I would definitely try it.  I wish my doctor here would schedule a section at 42 weeks and let me at least try to vbac if I do go into labor.  They won't.  Period.  Ridiculous!

[Ann.without.an.e]

I agree with go with your gut but that said, many many women happily use a lay midwife, you can always transfer if baby doesn't show by 42-43 weeks. I planned a home water birth for #1, ended up an emergency c/s when I developed severe pre-e and HELLP syndrome. #2 I was honestly wavering between a UC because dd #1's birth was so traumatic/horrifying and a repeat C/S. When it came down to it I had a repeat C/S because dd kept going into distress and I was having heart problems due to low potassium and magnesium. While I wasn't thrilled with having another c/s the birth was 180 from how #1 went and was a pretty positive experience because I had an awesome birth partner who was able to advocate for me and my baby when I couldn't. (same hospital,  years apart) I was discharged 24 hours after my c/s and left at 36 hours (had to wait for baby to get d/c). Recovery was easy, I was only on Motrin by day 3 and half a Vicadin every couple hours before that. I was also up and taking care of the household by day 3, well at least I was cooking and doing laundry since there was no one else to do it. If #3 came along I would again waver between a UC and repeat C/S but it wouldn't be the end of the world if I had another c/s but I've had pretty easy recoveries. I remember going shopping at Target on the way home with #1, she was 5lbs and needed preemie clothes and diapers so I had to buy some:)  We won't talk about what I did on the way home with #2 lol:)

 

 

Our state has huge hurdles for midwives.  I don't know of any that deliver at home.  The only midwives I know of work in a doctor's office with a doctor and follow their policies and plans.  

[eloquacious]

HUGE difference.  My last c-section was $30,000+  

With our insurance we are going to pay the same amount either way (either birth will max our out of pocket). 

 

 

Right, I meant out-of-pocket differential. So in your case, it's not really a deciding factor.

 

Incidentally, our OB fees for C/S vs VBAC are $2500 vs. $2000 on the cash pay model, and the hospital is a couple thousand more, but not to $30,000. I wonder which is a more accurate reflection of the *real* price. I do think they bill insurances for SO MUCH that is overblown/extraneous. (For instance, a bag of saline that costs between $.44 and $1.00 to make is charged to insurances around $400. In France, by comparison, they would bill the insurance around $4.75. Still a mark-up/handling cost, but not to the extent that we have it here.)

 

One thing that frustrates me about the cash pay C/S package is that the epidural and anesthesiologist are a separate fee. Because, you know... those are OPTIONAL. Ha.

[Ann.without.an.e]

One thing that frustrates me about the cash pay C/S package is that the epidural and anesthesiologist are a separate fee. Because, you know... those are OPTIONAL. Ha.

 

Haha, literally spewed water. Lol

[Ann.without.an.e]

No message - double post

[Dahliarw]

I would trust your instincts as well.  But I would also keep in mind that you might feel differently a few months into your pregnancy.  So my advice would be go where a vbac is possible.  That way if you change your mind later on you don't have to change care providers.  You could also see if you do go into labor on your own (you never know) and go from there as well (schedule the section after 40 weeks).

[Dahliarw]

I had to make the decision about whether to have a C-section with  DD, after I had an emergency one with the boys.  My doctor said he would let me make the decision, after giving me the facts.  Because there would be a 10% chance that my uterus would burst and one or both of us would die, I decided to have a c-section.

 

I really, really wanted to experience having my DD the natural way, and to look at this option as being 90% positive.  I couldn't take the risk for either of us because the consequences could have been dire and irrevocable.  I could not have lived with myself if something happened to DD because I wanted to give birth naturally.  I could not live with the idea that my triplets would be motherless, either.  So the choice for me was easy, except for the part in which I had to give up my chance to experience labor and childbirth.

 

(DS1 was born naturally, but he weighed only 2 lbs., was born as I was explaining to the nurses and doctors that I was not going to give birth that day because I didn't know how, and I never felt a labor pain because he and his brothers were extremely premature.)

 

I have often wondered if my doctor would have put his foot down if I'd decided to have a natural birth. Despite that, I am glad he left it to me to make the decision, because I thought that was respectful of me.

 

For others reading this thread, the 10% statistic is not true.  Your doctor was misinformed.  

 

 

 

The rate of true uterine rupture with one prior low-transverse scar has been reported by ACOG to be between 0.2 and 1.5 percent (one of 67 to 500 women).2 Other studies involving more than 130,000 women undergoing a trial of labor for VBAC report rates that average 0.6 percent (approximately one of every 170 women).10,12–19

 

http://www.aafp.org/afp/2002/0901/p823.html

 

The risk for vbac is LOWER than the risk of a repeat c/s.

 

 

 

About 13 out of every 100,000 women who have a cesarean birth will die from surgery complications.  Only 4 out of every 100,000 women who attempt a VBAC will die as a result.

 

http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/putting-uterine-rupture-into-perspective/

[ktgrok]

Is uterine rupture a big deal?

 

Absolutely! Which is why this whole decision is so hard! 

 

I guess the difference is, if a woman has a uterine rupture during a VBAC, no one will tell her it is "no big deal". 

 

But if she has a c-section lots of pepole WILL tell her it is "no big deal". I wasn't minimizing uterine rupture, just explaining that c-section is a huge deal for many women. 

[ktgrok]

Is there a price differential between a VBAC and a C/S? We don't have maternity coverage, so for us it would be around $4K more for the C/S, even with cash pay options... Definitely something on my mind. My husband doesn't care as much, though of course it is a LOT of money. I guess I should rephrase and say that he doesn't want it to be the deciding factor, while I feel the weight of that extra money deeply.

 

I would never suggest making such an important medical decision based on money. 

[ktgrok]

I'm sorry to hear that. I'm also surprised.

 

I think it's a matter of how your expectations meet reality. It might have been easier on me (emotionally) because I was factual in my mental preparations. I think the sense of betrayal comes *both* from (apparent, American) medical pressure, *and* from being encouraged to envision that we will be the kind of women that will find an uncomplicated way through birthing. (That's just speculation: I experienced no medical pressure on my decisions, nor did I have an ideal birth pre-envisioned to be spoiled.)

 

People have abdominal surgery all the time -- and some people have a harder time than others (infections, etc.) I didn't know they had support groups to help people recover from that, though. It must be different when it's a birth.

 

 

 

I would totally grasp the reasoning if a woman herself, or a close acquaintance has had a previous traumatic c/s. It's just the generalized sense of fear or shame (I don't know which, or maybe it's something else, I don't ask) that almost all pregnant women seem to express about the possibility that they might "have to" have a baby via surgery. There seems to be a sense that it's just an upsetting terrible thing to have happen to you... even though it happens to lots of people... and even though *nobody* reacts like that if a lady is going in for day surgery to remove a cyst or something.

 

I'm not saying their feelings are wrong. I'm saying I'd like to be able to understand where the feeling comes from, and why it is so prevalent. It's a curiosity to me: there's an incongruity that I can't figure out. And maybe it's just too sensitive of a topic and I won't be able to gain any understanding because people will react to me and my wondering. That's OK too. No pressure. It's just curiosity.

 

 

For some women, it isn't the emotional romantic stuff at all, it is that they were separated from their newborn baby, in horrid pain for days or weeks, unable to drive for two weeks to regular appointments or the grocery store and such, or had bad infections, had to have the wound opened up, packed daily, etc. Knowing that can be part of the package of c-section (and in my area the mandatory separation of mom and baby for 4 HOURS was JUST lifted..now it is more like 1-2 depending on how busy they are)....that is enough for anyone to want to avoid it if they can. Or at least should explain why they would want to avoid that if they can. Sure, people have major surgery (a c-section is NOT a day operation or outpatient proceedure by any means), but what if you had, say, an ovary removed, or gall bladder surgery, or what not, and wer hospitilized for several days, in pain for weeks, etc, and then found out you didn't even need the surgery? It was all a mix up, or the doctor just likes that treatment better, or whatever? wouldn't you be upset? And wouldn't everyone you know be upset FOR you? Well, imagine not only does that happen, but then everyone, when you share your experience, tells you, "so what? Surgery is no big deal, why are you upset? You will be fine, you can have more kids, why are you mad?" wouldn't that be maddening? That's what a LOT of women face after a c-section. 

 

But let's say the surgery is totally needed..baby really IS in distress. Sometimes those moms are traumatized too, just from the pain and the fear and the healing. On top of that, yes, it is a rite of passage for many women. (NOT ALL WOMEN). How it happens matters some too. Yes, healthy baby AND healthy mom matter, but sure, she has some wishes she would like respected. I always tell people, imagine you are preparing for a big wedding. You have met your dream man, and have always wanted a big wedding with your family all there, your beautiful dress that makes you feel pretty, your hair done up in your favorite way, the church you grew up in, flowers/music, whatever. And a great honeymoon to a pretty beach. But on the way to the wedding you are in a horrible car accident, and need major surgery. You are in the hospital for days, and end up getting married by a justice of the peace in your hospital bed, all bandaged up, no family there, no music, no minister, no dress. And your honeymoon is spent recuperating with your leg in a cast, so you can't swim in that pretty water at that gorgeous beach. Now, of course, what REALLY matters is that you are married. But no on is going to think she is being silly if she expresses regret that she didn't get her wedding day as she wanted, or that the honeymoon was ruined by pain pills and an itchy cast. People would understand and shake their heads and offer sympathy. And she would KNOW that what matters is the marriage, and be VERY grateful that she and her husband are alive and well, but yes, she'd be sad about the whole thing. That's kind of how some women feel about their births. And that's normal, and ok, and they are NOT overly emotional or being crazy, and they are not selfish, and they DO care that the baby is healthy, but it isn't ALL they care about. 

 

Hopefully that helps. (and I didn't go into the situations where the woman is treated badly, bullied, ignored, shamed, or hurt by the medical staff...those stories happen as well...and those women often have PTSD from the experience). 

 

I have known women that had a VERY traumatic c-section, planned a VBAC, and then had a very healing, empowering c-section when things didn't go as planned. But they still wish they had a VBAC if only for the quicker recovery. But those women are not traumatized by the second surgery because they were respected in labor, treated as humans, given options, etc. 

 

As for ICAN, it is for healing from C-sections emotionall/physically, planning a VBAC if you want one (as this thread shows many women have to fight their doctor for that chance), planning a better c-section if that is their choice, and helping prevent unwanted/unneeded c-sections in first time moms. I'm in a state with a c-section rate over 38%, with some counties over 50%, so this is a needed thing around here. 

[ktgrok]

Yes, in this area, my state does, indeed, suck.   lol

 

Agh.  If they didn't make it so unlikely to happen I would definitely try it.  I wish my doctor here would schedule a section at 42 weeks and let me at least try to vbac if I do go into labor.  They won't.  Period.  Ridiculous!

 

They can't force you to have surgery. You can always decline. You still have the right to informed consent and refusal, even when pregnant. 

[ktgrok]

I had to make the decision about whether to have a C-section with  DD, after I had an emergency one with the boys.  My doctor said he would let me make the decision, after giving me the facts.  Because there would be a 10% chance that my uterus would burst and one or both of us would die, I decided to have a c-section.

 

I really, really wanted to experience having my DD the natural way, and to look at this option as being 90% positive.  I couldn't take the risk for either of us because the consequences could have been dire and irrevocable.  I could not have lived with myself if something happened to DD because I wanted to give birth naturally.  I could not live with the idea that my triplets would be motherless, either.  So the choice for me was easy, except for the part in which I had to give up my chance to experience labor and childbirth.

 

(DS1 was born naturally, but he weighed only 2 lbs., was born as I was explaining to the nurses and doctors that I was not going to give birth that day because I didn't know how, and I never felt a labor pain because he and his brothers were extremely premature.)

 

I have often wondered if my doctor would have put his foot down if I'd decided to have a natural birth. Despite that, I am glad he left it to me to make the decision, because I thought that was respectful of me.

 

Did you have some unique circumstances that made the risk so high? The risk of a catastrophic rupture where someone dies is NO WHERE NEAR 10 percent for a normal VBAC. I don't even think it is that high for classical scars. I'm a bit curious....

[Dahliarw]

Did you have some unique circumstances that made the risk so high? The risk of a catastrophic rupture where someone dies is NO WHERE NEAR 10 percent for a normal VBAC. I don't even think it is that high for classical scars. I'm a bit curious....

 

 

 

Among less common incisions, classic and T-shaped uterine incisions are reported to rupture in 4 to 9 percent of cases, while low-vertical incisions carry a rupture risk of 1 to 7 percent.2

 

Still under 10%.  The risk only go above 10% (from what I can find reading) when there is a history of multiple c/s.

[Ann.without.an.e]

They can't force you to have surgery. You can always decline. You still have the right to informed consent and refusal, even when pregnant. 

 

 

 

Yes, but if my practitioner has a hard and fast rule of "no VBAC" then I will be scheduled to section at 39 or 40 weeks and if I go into labor before that they will stop labor for a section.  No doctor in my county will support a VBAC.  I will need to drive an hour.  If I thought I even had a 20% chance of going into labor on my own, I would make that drive and deliver in a hospital I am unfamiliar with and with a doctor I don't know.  I would love to try a VBAC, BUT I can guarantee with 99% accuracy that I will not go into labor on my own.  I have done this four times.  I tried everything imaginable with #4 to try not to be induced.  It didn't happen for me.  Even the doctor one hour away will not induce with a VBAC :(

 

I am extremely pro-natural child birth.  I had incredibly long labors with my first three.  With my shortest natural labor I was on a strong pitocin drip for over 24 hours and I still declined pain meds.  My labor with #1 was 80+ hours, 60 on pitocin....no pain meds.  I know all about natural labor.  The doctor was begging me for the last 40 hours to section and I absolutely refused because I saw no need for it.  With #4 a section was absolutely necessary. I am thankful for that section.  I don't want another.  The section rate at the hospital that I would travel to with the doctor who will entertain the idea of a VBAC is over 50%.  Over 50%!!!!  I am in a section happy area.  Doctors here that say they are VBAC friendly really aren't THAT friendly, and when the slightest thing happens they want to section.   No doctor is going to accept that I go late and that I labor long.  Both of those reasons together give me a 99.9% chance of a section.  You see, I don't fear a VBAC.  I fear the heartache of jumping through these rigged hoops knowing that my chances are so small for success.  The other concern I have is this.......VBAC is safer than section, but a planned section is much, much safer than an emergency section. Most attempted VBACs here end up in an emergency section, dictated by the doctor because he becomes uncomfortable about the length of time for labor, the progress, or some other crazy factor.  I feel like I am in a lose, lose situation but it is a rigged, nasty system.

[LMA]

Does the drs. around you not support VBACs at all or VBACs that are induced?

[Ann.without.an.e]

Does the drs. around you not support VBACs at all or VBACs that are induced?

 

 

right around me?  In my county?  They have an across the board rule that they do not VBAC, period.  Regardless of circumstances.  In the next county there are a few doctors who say they "might" consider it "if" the stipulations are met and there are absolutely no red flags or hiccups along the way.  They want everything picture perfect.  My labors are not picture perfect.....ever.  One of those stipulations is not overdue and not induced.  Those are the factors that I think make me 99.9% likely to be sectioned even if I make the trip to those doctors.  Also, the hospital these few doctors deliver at is extremely unfriendly to VBAC (with a section rate of over 50%) :(   In fact, just a year or two ago they were going through a battle trying to ban all VBACs from the hospital.  Like I said, a very VBAC unfriendly area.

[T'smom]

Several people have mentioned mom and baby being seperated (even a mandatory separation?!?!) for hours after a C-section. I have had 2 c/s in two different hospitals and that was not my experience at all. Yes, they had to stitch me up and stuff, but I was with both babies within an hour. And dh was with them every minute. I just wanted to say that that's not universal, because if I read that before having a c/s it would worry me.

[Ann.without.an.e]

Several people have mentioned mom and baby being seperated (even a mandatory separation?!?!) for hours after a C-section. I have had 2 c/s in two different hospitals and that was not my experience at all. Yes, they had to stitch me up and stuff, but I was with both babies within an hour. And dh was with them every minute. I just wanted to say that that's not universal, because if I read that before having a c/s it would worry me.

 

 

 

The hospital that I would drive an hour to be at (for the slim chance of a VBAC) has the reputation of a long separation.  The hospital here (where I delivered DS via section) is not like that.  Even with DS coming out so stressed and initially thinking he would be in NICU, when he rebounded super quick, they gave him to DH right away.  He never left DH's sight.  Then, he was with me and nursing within 1-1.5 hours.  So my experience was good too, in that regard.  The hospital closer to me is known for being more natural than the one I would travel to be at.  They encourage babies to be with moms, encourage BFing, etc. I have had two babies there and I love it.

[eloquacious]

Several people have mentioned mom and baby being seperated (even a mandatory separation?!?!) for hours after a C-section. I have had 2 c/s in two different hospitals and that was not my experience at all. Yes, they had to stitch me up and stuff, but I was with both babies within an hour. And dh was with them every minute. I just wanted to say that that's not universal, because if I read that before having a c/s it would worry me.

 

 

My first C/S it was almost four hours before I saw him, but that was due to the incredibly nasty rushed nature of it: I hadn't had any pain meds, and they had to get him out, STAT. They put me under general anesthesia, and it was only when a nurse was about to give my son some formula and my husband replied, "Nuh-uh, he's breastfed only," that they said, "well, I guess we could take him to her." My husband was shocked... "You think??" 

 

The second C/S was by far a more empowering/recuperative experience, as someone mentioned above. I had tried for a VBAC and "failed," but being able to be awake (with a spinal) and see him right away, as well as knowing that he was with my husband or me the whole time, was super helpful.

 

I can't even think of what I'd say if they tried to keep my wee man away and I was awake.

 

If we do wind up having to schedule a C/S because labor doesn't start or I am overdue, I will try my best for a "family-centered" or "natural" C/S. There are things you can do, even with a Cesarean, to make it less medical/brutish. You can allow the cord blood to pulse. (They did this with our second, per my wishes.) You CAN hold the baby right away, etc.

[ErinE]

Several people have mentioned mom and baby being seperated (even a mandatory separation?!?!) for hours after a C-section. I have had 2 c/s in two different hospitals and that was not my experience at all. Yes, they had to stitch me up and stuff, but I was with both babies within an hour. And dh was with them every minute. I just wanted to say that that's not universal, because if I read that before having a c/s it would worry me.

My last section, they gave the baby to me in the OR (after getting stitched up and moved to a stretcher). We were wheeled into our room together. No separation at all. It was fantastic.

[ktgrok]

Yes, but if my practitioner has a hard and fast rule of "no VBAC" then I will be scheduled to section at 39 or 40 weeks and if I go into labor before that they will stop labor for a section. 

 

 

The women I know in this situation just canceled the c-section at the last minute...the morning of or night before. And if you go into labor, they can't stop labor or do surgery without your consent. You can just not consent. They can't force you. 

 

You see, I don't fear a VBAC.  I fear the heartache of jumping through these rigged hoops knowing that my chances are so small for success.  The other concern I have is this.......VBAC is safer than section, but a planned section is much, much safer than an emergency section. Most attempted VBACs here end up in an emergency section, dictated by the doctor because he becomes uncomfortable about the length of time for labor, the progress, or some other crazy factor.  I feel like I am in a lose, lose situation but it is a rigged, nasty system.

 

I do get that. And for some women, and you may be one of them, having a peaceful birth/pregnancy is more of a goal than having a vaginal birth, for personal reasons. If that is the case, then yes, scheduling a repeat surgery makes sense. For some women, having a vaginal birth is something they want so much that they are ok with having to fight the medical establishment, even in labor. They have their personal reasons for that being the case. Everyone's priorities and risk/benefit ratio will be different,and that is ok. 

 

Oh, and in case you do go the route of VBAC, I would highly suggest a doula. Highly. Doctors tend to be slower ot come up with bogus reasons for a c-section when there is another person in the room. 

 

Finally, do contact your local ICAN chapter, if there is one, and see if there are any other options in your area you may be unfamiliar with. 

 

Hugs. 

[Bree]

Have you looked into the ICAN group on facebook for your area. They were able to give me some good options to VBA2C. I did have to drive an hour but it was worth it. I am usually late by over a week with my babies, but I did actually go into labor and deliver my 2nd on her due date, so you never know. VBAC for me has a lot quicker recover than a section and it doesn't hurt so much if the kids jump on you after ;)

[Forget-Me-Not]

It is a rigged, nasty system. I can relate to so many of your posts OP. I'm sorry it's such a crummy situation for you :(

[Renee in NC]

Midwives are only allowed to deliver under the supervision of a physician.  Home births are not technically illegal, but midwives are not legally allowed to supervise.  Therefore, you either must find an undercover midwife or have the baby without help.  Sad, huh?

 

 

While it is not illegal to give birth at home -- some women do it by accident -- it has been illegal to do so with the help of a midwife in North Carolina since 1983. As most women aren’t willing to give birth unassisted, home birth is not an option for them. 

 

Not true.  CNMs are allowed to supervise homebirths in NC as long as they have a supervising physician.  That does *not* mean the doctor has to be at the birth.  If a doctor did have to be present, then the freestanding birth center where I had 3 of mine would have been illegal as well.

 

http://www.ncbirthcenter.com/

 

The midwife who delivered my second at Womack Army Hospital is doing homebirths (legally.)

 

https://www.facebook.com/pages/Birthwise-of-Central-NC/274342755952941

 

There are others as well.

[eloquacious]

Not true.  CNMs are allowed to supervise homebirths in NC as long as they have a supervising physician.  That does *not* mean the doctor has to be at the birth.  If a doctor did have to be present, then the freestanding birth center where I had 3 of mine would have been illegal as well.

 

http://www.ncbirthcenter.com/

 

The midwife who delivered my second at Womack Army Hospital is doing homebirths (legally.)

 

https://www.facebook.com/pages/Birthwise-of-Central-NC/274342755952941

 

There are others as well.

 

 

Perhaps this applies to HBACs? 

[Ann.without.an.e]

Not true.  CNMs are allowed to supervise homebirths in NC as long as they have a supervising physician.  That does *not* mean the doctor has to be at the birth.  If a doctor did have to be present, then the freestanding birth center where I had 3 of mine would have been illegal as well.

 

http://www.ncbirthcenter.com/

 

The midwife who delivered my second at Womack Army Hospital is doing homebirths (legally.)

 

https://www.facebook.com/pages/Birthwise-of-Central-NC/274342755952941

 

There are others as well.

 

 

 

Ok, so technically a CNM can deliver at home under a supervising physician, but there are none anywhere near me.  This is because of a stipulation that a physician has to be available and ready to assist 24-7.  Chapel Hill is hours from me.  The birthing center you link to is affiliated with a network of physicians so they probably have that required physician oversight.  From their website

"The birth center is affiliated with UNC Family Medicine".  There are absolutely no midwife centers or homebirth midwives near me in NC.  There is one midwife birthing center in SC that is not terribly far from me (45-60 minutes?), but it will not allow VBAC (they say this on their website), and even if they did allow VBAC, they have now been shut down because they do not have a physician available 24-7.  This was very recent so their website is still up and they are fighting to reopen.

 

http://www.wbtv.com/story/23374976/ft-mill-birthing-center-shut-down-by-officials

 

"The South Carolina Department of Health and Environmental Control (DHEC), the licensing agency for CCMC, is enforcing a regulation that has never been previously enforced on any SC birth center.

It is a regulation that requires a physician to be "on call and available to provide medical assistance at the birthing center at all times that it is serving the public." Our initial license to operate, and each subsequent annual license renewal, was approved without this provision."

 

 

Even if I lived in Chapel Hill, the center you listed would not be an option.  But I am very glad they will consider a VBAC for their previous patients.

 

http://ncbirthcenter.com/1219945.html#5

 

"At this time we can only offer VBAC's to our established patients whose prior pregnancy under our care ended with a Cesarean birth"

[Ann.without.an.e]

Update to post #1

[Desert Strawberry]

Great update!

 

 I would like to point out that not all inductions are aggressive. I have been induced twice, both very gently. I only received meds (cytotec in one and pitocin in the other) until my labor kicked up. Nothing more after that. 

I know your previous labors were long and hard, but that isn't always the case. Cranky the pitocin to high levels increases risks and Isn't always necessary.

[Mothersweets]

That's great that you found a hospital that is willing to do VBACs! I say go for it.

 

I've had 7 successful vbacs  - Started out with 4 normal, va**nal births, had a csection with #5, had baby #6 just over a year later, was induced for baby #7 a little over a year after that, and went on to have 5 more va**nal births (12 total babies).

 

Good luck with whatever you choose.

[prairiewindmomma]

It's worth it. As I said in my pp, I did drive an hour to get to a large vbac facility. I had an awesome ob who vbac'd twins and breech babies. I had two inductions...the ob ruptured my waters and I went into labor about 6 hours labor. I only had to go onto the monitors hourly, and I had to have a heplock in place. I needed a touch of pitocin each time at the end as my pattern of labor is to stall then, but it was a lovely experience each time.

 

Has your gut changed?

[Ann.without.an.e]

It's worth it. As I said in my pp, I did drive an hour to get to a large vbac facility. I had an awesome ob who vbac'd twins and breech babies. I had two inductions...the ob ruptured my waters and I went into labor about 6 hours labor. I only had to go onto the monitors hourly, and I had to have a heplock in place. I needed a touch of pitocin each time at the end as my pattern of labor is to stall then, but it was a lovely experience each time.

 

Has your gut changed?

 

My gut never had a bad feeling about the actual VBAC itself. My gut had the feeling that it was never actually happen with the OBs I was considering. If that makes sense? I was hearing flat out "no" or "maybe 'if' and I knew I would never meet their "ifs" (like going into labor on my own). I didn't want to jump through hoops for no reason. 75%+ success rate is a pretty good gamble. In my opinion?

[texasmama]

Wonderful update!

[Terabith]

Given the new information, I would *definitely* try for the VBAC.  Especially since you've had to be induced, it's unlikely you're going to go into labor and be ready to push in 20 minutes flat.  And if that happened, you'd have a great story and the problem would be solved! 

 

How do you feel about trying for the VBAC under the new situation?

[eloquacious]

 

 

UPDATE

 

I finally found that the largest hospital in our region will support VBAC.  I hadn't checked with them because they have a reputation for being very high tech medical.  I called them and they are supportive for VBAC.  The nurse on the Baby Line was incredibly nice.    I asked what their success rate is and she said 75%+.  She said they have worked so hard the last few years to change their anti-natural reputation and they believe in the mother being in control over the birth.  She gave me the name of a large, reputable OB that is connected to the hospital network that is very supportive of VBAC.  This practice will let me induce with a VBAC.  One reason this hospital is more supportive is because they are so large that they always have 4 OR units prepped and can do a section asap.  So what do you think?  It is a 45 minute drive....is it worth it?  I really hate the idea of major surgery.  At the same time, I hate to jump through hoops and end up with an emergency section.  Agh, decisions, decisions.

 

Also, has anyone been induced with a VBAC?  That is what makes me lean toward the VBAC, but it also makes me nervous as the risk of rupture increases with induction.  

 

 

The hospital we are hoping to VBAC at is about 45 minutes away, as well. The time/distance hasn't been a major concern for me, as I doubt (given my history) that we will find ourselves in an emergency situation.

 

I just had my final appointment with my OB today... the consensus we reached is that he will let me go to about 41 weeks or so before we induce, so I'm scheduled to go in next week Monday to start on Pitocin and a mechanical induction (Foley catheter?). 

 

My second baby was supposed to be a VBAC, and they induced with Pitocin. He handled it well, and by the time they decided to do a section because of his positioning (hand first) I had been on Pit for over 24 hours with no sign of rupture or distress. I should note that my first baby, who was much smaller, didn't handle the Pit well... his heart rate crashed as soon as they gave it to me, which lead to the emergency C/S. 

[8circles]

Just read your update. Great news!!!! I would definitely say its worth it. As i said, I was somewhat induced for all 3 of my VBACs (labor started as late as 13 days post dates and was never regular so they gave low pitocin to keep them going). All were fantastic experiences and the docs that said they were supportive actually were.

 

Best of luck to you on your birth. Please keep us posted.

[Ann.without.an.e]

Given the new information, I would *definitely* try for the VBAC. Especially since you've had to be induced, it's unlikely you're going to go into labor and be ready to push in 20 minutes flat. And if that happened, you'd have a great story and the problem would be solved!

 

How do you feel about trying for the VBAC under the new situation?

I think I feel ok knowing that I can be induced if needed. If going into labor on my own was a prerequisite to a VBAC then I felt 99% sure I would not be able to VBAC. I was not opposed to the VBAC as much as the idea of jumping through hoops for no reason. I wasn't getting any positive reactions to the idea until I contacted this hospital/OB. I hated the idea of resorting to a doctor because they "might possibly consider a VBAC if everything is just perfect".

[Dahliarw]

I think I feel ok knowing that I can be induced if needed. If going into labor on my own was a prerequisite to a VBAC then I felt 99% sure I would not be able to VBAC. I was not opposed to the VBAC as much as the idea of jumping through hoops for no reason. I wasn't getting any positive reactions to the idea until I contacted this hospital/OB. I hated the idea of resorting to a doctor because they "might possibly consider a VBAC if everything is just perfect".

 

Even if you're not comfortable with induction, being somewhere where they will give you time to go into labor on your own and are supportive of VBAC is HUGE!  And there are non-pitocin ways to induce.  If you can find a good naturopath or midwife, they can give you herbs that can help kick things into gear too.  So there are lots of options.

[gardenmom5]

#4 was induced with ARoM.

#5 was augmented with Pitocin. srom and contractions never got into a good pattern.

[Lori D.]

First, congratulations Charleigh! :) May this be a safe and smooth pregnancy and delivery!

 

 

My VBAC experience:

 

DS #1 was an emergency c-section, due to a hidden strep infection and clear infant distress as labor was progressing.

 

DS #2 was VBAC, and because of the strep the first time around, since labor was progressing slowly, they said my option was Pitosin to speed up labor if I wanted a VBAC, OR we would have to go with another c-section to prevent another strep infected baby (which harbors in the mom's V.). I REALLY didn't want another c-section, so opted for the pitosin; but like 70% of women on Pitosin, it made laboring naturally impossible (I made it 5-6 hours on the Pitosin before begging for the epidural). I so could NOT control the pain and relax that I was not dialating. Once the epidural kicked in, it was VERY smooth sailing -- went from 5cm to 10cm in under 2 hours, pushed for a little over an hour, and we had NO problems with the VBAC. In fact, DH, who was a paramedic on the fire dept. at the time actually got to deliver, with the very laid-back doctor at his elbow. :)

 

Recovery was SOOO much easier and faster, and I had more energy, with the VBAC than with the C-section. On the other hand, if you DO go with the C-section, that will ensure you 6 full weeks of family and friends doing all the cooking, shopping, and cleaning, as you are not allowed to drive, and not allowed to lift and/or hold anything heavier than the baby. Might be nice to have those extra weeks of training family into helping!! ;)

 

 

But of course, every birth, whether natural, c-section, VBAC, etc., is a unique story and journey. Blessings to you, your family, and your new little one, whatever route your journey takes! :) Warmest regards, Lori D.

 

 

PS

I just need to add that, for me, because DS #1 was such a very scary and touch-and-go situation (he had to stay in the hospital for the first 10 days for IV of antibiotics for the strep), I was SO okay with it if a VBAC didn't happen, even though that and natural childbirth were my wishes -- I just wanted my baby safe, whichever way he got out into the world! :)

[ktgrok]

Well, at a 75% success rate, that is virtually the same rate as any first time mom. So ask yourself, would you tell a first time pregnant woman to schedule a c-section because she MIGHT end up with one anyway? Of course not. And even IF you end up with a c-section you will know that your baby got those extra weeks to grow and mature. It could be the difference between nicu time or not. 

 

And yes, I've known women that had inductions..some Foley bulb, some with pitocin. The drug to avoid is cytotec, but I can't imagine they would give that to you anyway. And there is always the option of going past 42, with close monitoring, to go into labor. A friend had a VBA2C recently, and went to 43 weeks :)