November 30, 2008 1:51 PM
VBAC question
This was left as a comment today on a post from last year: Cesareans up, surrender down.
I don't have the experience to answer this, but I'm guessing some readers out there have some information/suggestions/encouragement/resources to share:
With my first son I HAD to have a c-section because I had not progressed on my own and he went into distress and it was to save our lives.For our second child, we were going to try v-bac. Then my Doc told us that for how long I had been in labor, about 4 hrs, that I should be dilated more then the 1/2 cm I was. He suggested doing a repeat c-section since I was not progressing again.
Well, we did it, thinking it was best, and afterwards he tells us that if we decide to have another child it would be c-section. We could not try v-bac. Does anyone understand why this is? My hearts desire was to have one vaginally, to get that real feeling I had accomplished something, but now I can never have that.
I want to know why it was fine to try the second time round but not after that?
Crystal
Online resources:
Ask Dr. Sears: Vaginal Birth After Cesarean
Trusting Our Bodies: VBAC
Comments
Dear Crystal,
I totally understand your desire for a vaginal birth.
If I were you I would get a second opinion. Ask around and try to find a doctor who will let you attempt a VBAC next time. You can find testimonies online by women who have given birth vaginally after two or even more C-sections. It can work.
Try to determine why labor wasn't progressing any faster: were you moving enough during labor or were you lying down? Are you just naturally slow?
Various things can slow labor down, such as having an epidural or being strapped to a bed. Moving around (walking, rocking, getting into whatever position you feel like...) or having a warm bath can speed things up. You can dilate up to twice as fast in a warm tub.
Learn everything you can about the physiology of birth. A little knowlegde can really empower you in this area.
To answer your question, doctors are usually wary of VBACs because they are afraid that under the stress of labor your uterus could tear along the scar line from the C-sections. The more C-sections, the more scar tissue and the higher the risk of rupture. Not all doctors have the same comfort level with this kind of risk though. Some of them are reluctant to attempt a VBAC at all, some will attempt it after one section but no more and some will attempt a VBAC after 2 or more sections.
Finally I suggest you pray about this and seek God's leading. Psalm 37:3-4
Blessings,
Helen (who used to be a medical student before she became a mother)
Posted by: Helen | November 30, 2008 3:44 PM
There are two factors at work here. One is the number of uterine scars. The other is the comfort level of the doctor. I'm guessing that the commenter's doctor wants to "allow" VBAC, but is scared of it, possibly for liability reasons, which was the reason for her second C-section. Some doctors will attempt VBAC after two or even more, but she will have to search hard and possibly far to find one.
Posted by: Salome Ellen | November 30, 2008 4:12 PM
Please don't believe you MUST have another c-section. Your post shows you don't really believe that anyway. Research and find a supportive caregiver!
1. read books by Nancy Wainer Cohen
2. Contact International Cesarean Awareness Network at http://www.ican-online.org/
:)
Posted by: anne sokol | November 30, 2008 6:48 PM
I don't know anything about repeat C-sections, but I really appreciated the links, Mrs. Barbara.
4 weeks ago I had every reason to expect that my 4th birth would go smoothly till I found out Baby had turned frank breech and I would have a C-section the next morning. There was no time to research options or even find out what the surgery would be like. Dr. Sears was very reassuring, especially that a C-section was truly necessary and that I'm not likely to have to have another one again! You might try looking up lack of progression...
Posted by: Cheri F. | November 30, 2008 6:55 PM
I am a two time C-section mom. Once you've had a C-section, your risk of uterine rupture during a VBAC is 1 in 100. However, each C-section weakens your uterus, and might increase your risk. It may be your doctor saw that your uterus wasn't in the best shape, and this is why he suggested #3 should be born via C-section...But I would ask him yourself! :)
Posted by: Kristina | November 30, 2008 7:50 PM
Being able to VBAC after cesarean requires a lot of mental and psychological energy. You believe that your body can't do it and now you doubt that you can give birth naturally. That's a huge hurdle. But it can be done. I have personally met women who have had VBACS after 2 or more C-sections. I myself went on to have bigger babies after my first C-section baby.
I think the advice about ICAN is excellent! That group really helped me when I was researching VBAC.
I have a list of other good childbirth books here.
Posted by: Elena | November 30, 2008 8:17 PM
I TOTALLY understand where you are coming from. My first birth was, IMHO, a c-section for the dr's convenience. 2nd birth, dr switches on me at the last minute, and recommends another c-section to dh and me (in dh's presence). I did NOT want to do it, but did anyway. Birth #3, I changed drs. with my dh's blessing, and was induced for 2 days...ended up with another c-section and a very bad hemmorage. Birth #4 was a planned c-section and I was awake that time. (I opted to be put out with the others.) It was the best birth of the 4...but I still with I had stood my ground from the start. I do still feel somewhat cheated, but I do have 4 healthy children and that is what is most important.
My best advice would be:
1. PRAY!
2. Submit to your dh. If he is open, research and give him as much information as he wants. But in the end, go with what he believes is the best option.
You say: "My hearts desire was to have one vaginally, to get that real feeling I had accomplished something, but now I can never have that."
Your heart's desire should first and foremost be to keep yourself and your baby healthy and safe, whatever that might entail. Getting pregnant, staying pregnant, and delivering a healthy baby are accomplishments in themselves.
This subject, to me, is very much akin to the vaccination debate. There are die-hards on both sides, and it can get quite heated. But, like vaccination, it is an individual choice, and depends upon each families' situation.
I hope this helps.
Posted by: Beth | November 30, 2008 8:50 PM
I had my first via planned c-section (medically necessary and I'm glad we did, it was I think the best option available) and my second was a VBAC. I had to fight HARD for it though. I was in a practice with multiple doctors and there were two who were very pro VBAC, 4 who were theorhetically ok with it but not really pro VBAC, and 2 who were very against. It was decided early on that unless anything unexpected happened with that pregnancy I would have a VBAC, and then at 37 weeks one of the doctors tried to bully me into a c-section- even threatening to drop me from the practice. I simply called her bluff (which is what it was) and said that was perfectly fine I was happy to find another doctor and they backed down. I went on to have an uneventful (medically speaking birth). There are many many doctors who are partly ok with VBACS, but get really skittish when you start getting close to your due date or are in labor and then pressure you into a section. And while I understand their position (fear of law suit, responsible for your well being, dislike of the added lack of control that a VBAc brings) I don't think it is fair that those are the deciding factors for so many repeat sections.
Most doctors and hospitals though I have encountered won't consider a VBAC if you have had multiple ceseareans and no vaginal births. (many are more open to it if you have in fact given birth vaginally before). But there are still women who do give birth vaginally under these circumstances. Usually homebirth (don't know if you are open to that idea) but not always. The big thing you will probably want to do it to research all the care givers in your area before you ever get pregnant so there isn't the time crunch to find a doctor or midwife who is willing to work with you.
Something to consider just for your own piece of mind is that all labor carries with it a risk of uterine rupture- even that of women who have never had a c-section. Yes, those of us who have had this surgery do have a higher risk. But look up the exact numbers and you can see it isn't a big of difference as one is often led to believe. Yes, the thought of uterine rupture is scary, but it is important to keep it in perspective and then make you decision based on the most complete set of data that you can find.
As one commenter pointed out, there is the possibility that the doctor did note something about the state of your uterus that would give him cause for a VBAC and so of course it is good to ask. But for more practices it is simple 2 c-sections and then always a c-section no exception.
Posted by: tiffany | November 30, 2008 9:47 PM
Crystal:
"My hearts desire was to have one vaginally, to get that real feeling I had accomplished something, but now I can never have that"
I would like to encourage you to rid yourself from these feelings of "unaccomplishment". Whatever the reasons you had to have a C-Section you have accomplished much: you are a MOTHER. That is enough of an accomplishment.
I agree with Beth. This subject can get just as divisive as the vaccination debate, but don't allow other people's opinions to make you feel less than just because you did not deliver vaginally.
And also, as the other commenters mentioned, do research and talk to your husband, but with the intention of keeping your safety and the baby's safety a priority.
May God guide you and give you peace.
Posted by: LadyLovas | November 30, 2008 9:55 PM
I'm just a postpartum / lactation consultant nurse but I've worked in the environment for about 4 years in two hospitals. Here's what I've heard in my workplaces:
Some physicians cannot afford malpractice insurance that covers VBACs so cannot do them.
Sometimes with multiple C-sections, there is an increased risk of a placenta previa (tearing away of the placenta) or accreta (placenta grows into the wall of the uterus).
Induction before the due date would increase the chance that a TOL (trial of labor) won't work.
More doctors are even letting scheduled C-sections go into labor to avoid the issues of the "near term" babies (transitioning in the NICU due to respiratory issues - common in the 37/38 weekers.)
So do the research beyond the blog world and find a balanced view to discuss with your OB.
(are there any hospital based midwives able to do a TOL in your area? They tend to be more patient if the 1cm per hour is the expectation)
Here's a study about rupture and risks of VBAC from Medscape:
http://www.medscape.com/viewarticle/458963
Sometimes the planned C-section can be a better experience for moms who've been exhausted after "failure to progress" in previous experiences. (based on what I've heard from postpartum moms)
The current state of maternity care is definitely in need of some changes, but since it may not change in time for your next birth - I hope for healthy baby for you.
Posted by: Val | November 30, 2008 11:03 PM
I know how you feel about the c-section. It is so so hard to not get to experience what other moms get to experience. It's going to take some time, but I think I'll eventually be able to be at peace with my c-section.
I don't have any help for you on the VBAC but thank you for asking the question as I will have to make that choice with my second.
Posted by: Debra | December 1, 2008 7:59 AM
One more thought if you do decide to go the VBAC route and find a supportive provider, is to hire a doula--a woman experienced in supporting a mother giving birth. Especially with failure to progress as a problem, it can make such a difference to have someone there whose whole function is to encourage you and who knows things to try to get labor moving along. Good luck! I was told I couldn't have a VBAC with twins, but I did!
Posted by: Queen of Carrots | December 1, 2008 8:38 AM
Crystal,
I would check out mothering.com's awesome VBAC board. A second section is NO reason to rule out a VBAC. Yes, it's tougher, but many, many women have done it and there ARE providers out there who will attend your birth! Don't give up; the birth you really want is possible!
~Laura
Posted by: Laura | December 1, 2008 11:05 AM
I had a VBAC homebirth after 2 cesareans, and then went on to birth three more children vaginally, two at home and one in the hospital. After my first csec, I became a member of ICAN (it was CPM back then) and eventually even became a chapter officer. I read every book we had in our growing chapter library. In addition, in those pre-WWW days, I headed off to UCLA's BioMed library and did extensive research there.
In addition to the recommendations you've already received, I'd recommend anything you can find by Bruce Flamm, even if it is dated. He helped my husband and I realize that we weren't doing some great risky thing and that, in fact, our birth choices have always been based on what is healthiest for the baby and for myself. (I tended to always put baby's health and safety above mine; however, one also has to realize that the mother's health and safety directly impacts the baby's well-being.)
There are lots of opinions out there about VBAC. And, yes, it is sort of like the vaccination debate. I learned to keep my mouth shut about my birth plans around most people. Nothing seems to get some people angrier, it seems, than the merest suggestion that you didn't "love your c-section", or that you are actively trying to avoid this "wonderful surgery" or that your greatest concern isn't the convenience of the doctor...or the baby's "perfect round head". People will tell you that you are selfish, that you should be happy you have even one baby (as if wanting to avoid major abdominal surgery means you aren't happy about your baby!) and that you are crazy. Don't listen to them. Research, research, research. Don't fall for "old doctor's tales" or scare tactics or stories of Great Aunt Gertrude whose uterus supposedly exploded. Insist on facts, good studies, and solid evidence.
And pray.
Posted by: Rebecca | December 1, 2008 11:26 AM
Hi:
I found this book life-changing when I found it before my third son was born- it has a good section on VBAC. _Ina May's Guide to Childbirth_, by Ina May Gaskin.
Caveat: some of the information is decidedly unusual, but in my opinion, the useful info I gleaned from it made it worth while.
Good luck!
Posted by: Melissa | December 1, 2008 11:42 AM
My first was born at 31 weeks via emergency c-section because I was in heavy labor and he was transverse.
My second, I really wanted to do naturally, but I had switched doctors in the 7th month due to a move and the new doctor would not perform v-bacs.
I went to her specificially because her practice's website claimed to do VBACS, but she told me that she did not. She was the only doctor in her group on my insurance, so I was stuck.
I went into the hosptial already 3cm dialated, but they still insisted I have a c-section. It was terrible, because they acted like it was an emergency (it wasn't) and so they prepped me immediately and we didn't have time to get a babysitter for my older son. My husband wasn't able to be in the room during the birth because he was sitting outside with our son.
I was very upset about the whole thing.
Now I've been told that I can have one more c-section, and then the risks would be too high for me to continue to have children. We're quiverful, so we're definitely seeking a second opinion.
It's just so frustrating thatit feels like I have no real choice in the matter. I understand your frustration, Crystal!
Posted by: Lauren | December 1, 2008 12:26 PM
Barbara -- thanks so much for letting us discuss this on your site. I had an emergency c-section with my son and for months I couldn't even talk about it without bursting into tears. My first advice would be to realize that sometimes a c-section is necessary. I had to realize that it wasn't my fault and I wasn't any less of a mother because I had to have a c-section. As much as I want to have our next one vaginally, I realized that even if I try and fail, I am still successful as a mother. What our bodies do have nothing to do with our ability to love and care for our children.
Second, when I talked to my OB about doing a VBAC when I do get pregnant again, she told me that her hands were tied because of her malpractice insurance and she can't preform them. I think many doctors, whether they admit it or not, are in the same position. They would love to, but ultimately can't because they don't want a lawsuit on their hands.
I would suggest doing a lot or your own research and talk to people other than doctors such as midwives or doulas. They may be able to better answer your questions. That is what I plan to do with my next pregnancy.
Posted by: Momma | December 1, 2008 2:03 PM
I had c-section with my second son. My first son was adopted. I went to 40 weeks and no dilation at all. I went in to get induced. Still no dilation despite moving around, etc. finally agreed to the c-section per the doctor's advice (some 12 hours after the induction started). Going in I was flipping between "I won't get the experience of birth" to "Oh my God I'm going to finally get to meet my baby!". I have to say the decision was the right one as the doctor after the birth told me there was no way that baby was coming out vaginally as his head was too big....CPD was the official term. Meaning my pelvis was too small in relation to the size of his head so he couldn't "drop" and pass through ( I am a petite person). He never dropped which was why I felt fabulous the whole last month! So there are times it is ablsolutely necessary. I do not feel I missed out now at all. I have a healthy son and I healed super fast. Please do not feel you did not accomplish something wonderful by not giving birth vaginally. It is a miracle no matter how they come out!!
Posted by: Susan | December 1, 2008 2:36 PM
I don't have the time to tell my whole story, but in a nut shell, I had a c-section, then a vbac, and then another, very unwanted c-section. We were contemplating having a home birth on the 3rd one to avoid the possibility of another c-section, but decided to stick with the "safety" of the hospital. I now wish I would have done the home birth, especially after watching Ricki Lake's documentary..."The Business of Being Born." It is a very EYE-OPENING documentary on the major problems with obstetrics and how woman are basically set-up for a c-section the moment they step into the hospital to have their baby. My goal now is to try to let every 1st time mom know about this video, to help her be aware of what will very likely occur if she does not become educated and assertive in the delivery of her baby.
Thank you to all who have commented, it has been encouraging to read. Especially, those who spoke of vbacs after 2 c-sections. We want more children, but I am still dealing with the devastingly difficult experience of my last c-sect. delivery.
Posted by: Sara | December 1, 2008 2:53 PM
Wow! There is a lot of great info here. I haven't had a c-section, but I would highly recommend (for any mother) listening to the Holy Spirit's voice, doing lots and lots of research, and understanding that you are in charge of your healthcare. These are things I had to do before my son was born as he was going to have some special needs. Please understand that fear does a lot of negative in labor from prolonging it to increasing discomfort. It is important to resolve issues before delivery. I never worked so hard as I did when preparing for my son's birth. I researched, met with potential care givers, toured facilities, made written birth and post partum plans etc. I chose what I felt was right for us and surrounded us with people who agreed. With God's help and by His mercy, we accomplished what most said we would never be able to.
Your feelings are very real. It is also true that God has a perfect plan for you. He will teach you. He will giude you. May you receive healing, and may we all find the grace to accept what He will bring.
Posted by: Greta | December 1, 2008 3:30 PM
Dear Crystal...
Here is my story -
1989 #1 baby - C-section for "failure to progress" (which in hind site - it was because I was induced due to my water breaking but obviously my body was not ready to deliver)
1992 #2 baby - Fabulous amazing and easy VBAC (no induction)
1994 - #3 baby - another amazing VBCAC
1995 - #4 baby - repeat of #1 baby - water broke/induction/12 hours later c-section
1998 - #5 baby was told I HAD to have a c-section. I was obedient, scheduled the c-section & then went into labor the morning of the scheduled section. They decided it would be easier to wait until my "scheduled" time to do the c-section, but the baby decided to come 3 hours earlier - yet again another fabulous VBA2C!
2003 - #6 baby was told not only that I had to have a c-section (even though I had had a vaginal last) BUT that no one in our county would do a VBAC. So I left the county and drove an hour north a delivered vaginally.
2007 - #7 baby -- this time I was harrased and threatened and told that I was risking the life of my child if I had a vaginal. The doctor said that I had multiple risk factors - my age (known as AMA - Advanced Maternal Age - I was 44), the number of children I had (Grand Multi Paras is my title) and of course two c-sections (and they did not seem to care at all that I had had two vaginals since my last c-section 12 years prior)
I had to sign a "failure to comply" form as well as other release forms and had to leave the county. There was a lot of pressure to give in to their demands. If I had been younger and had less children, I probably would have "caved". If you want a vaginal delivery, you can have one. No one is going to do major abdominal surgery on you without your consent (talk about a legal nightmare) One nurse did tell me that noone can make you have a c-section. That if you show up in labor and dilated to a 6 or 7 or 8 - they will deliver your baby.
I am not telling you that this is what you should or shouldn't do - it really is up to you. I do have a dear friend who did have a uterine rupture after one c-section, so there are risks, as with every pregnancy.
However I will say that I think women are talked into c-sections far too often.
Posted by: Beth Lambdin | December 1, 2008 5:28 PM
I actually just gave birth yesterday. My second VBAC after two C-sections. So it CAN be done. have hope.
Things to consider: what was the reason for your past C-sections? If your first was "failure to progress" and so was your second, I imagine you will be hard-pressed to find a doctor who will let you try to progress on your own a third time. However, the definition for "failure to progress" is very broad, and you may be able to find a mid-wife or doctor who will consider that second C-section to be someone getting "itchy scalpel finger syndrome." I would, anyway.
If both your C-sections were through the same scar, then your chances are better. Take good care of the scar. Put oil on it morning and night (wheat germ oil is good). Research laser infrared treatment for scar tissue. I used this with AMAZING success in just a short time. Chiropractors are a good resource for this.
Finally, if you really want to try for it the third time around, BE INFORMED. Doctors are a lot more likely to work with you if you have read hte studies, understand the risks, and can talk about why you should be given another chance. Then HIRE A GOOD DOULA. I've been on all sides of this, and firmly believe the only way I was able to achieve what I have is by the support and wisdom who are trained to help women do what their bodies were designed to do.
Check out Ricki Lake's documentary "The Business of Being Born." Be determined enough to fight for what you want. And get you a good team to support you. Good luck!
Posted by: Lora Lynn @ Vitafamiliae | December 1, 2008 6:24 PM
Dear Crystal,
I completely understand all the emotions you are feeling. I have had Csection, VBAC, VBAC, and Csection. I highly recommend you educate yourself before seeking out a medical professional who will consider a VBAC. VBACS are definitely out of favor right now. However I would not change either of my vaginal experiences. The recovery is not even comparable. An excellent book is The Silent Knife. Oh, I wish I could sit and have coffee with you and talk about this. This is something so close to my heart. After my first birth, literally weeks, I was determined to have a vaginal birth next time around. I read everything I could get my hands on.
Posted by: jen t | December 1, 2008 7:17 PM
All of the comments above are excellent; there's not much I can add. I grieve that not-so-necessary c-sections are performed so frequently. Sometimes I think that that's one of Satan's tactics for reducing the number of children born.
Posted by: Peggy | December 2, 2008 1:23 PM
Crystal,
If, after all your research, you do decided to go VBAC, I strongly recommend that you seek out a Bradley method birthing class. If you are unable to find an instructor in your area, next best is is Susan McCutcheon"s Natural Childbirth the Bradley Way, available on Amazon. Even if drug free isn't your thing, the Bradley method is heavy on parental education of the birthing process. The more educated about what is happening to our bodies during childbirth we are, the less tense, and less tension = less pain, and easier deliveries. Education and relaxation would be the cornerstone of a successful VBAC. Of course, we can't forget a midwife or OB who is open to your desires. I pray you and your baby are able to have the birth that is best for both of you. God Bless.
Posted by: Bridget | December 2, 2008 1:50 PM
I have had 3 vaginals, and then ended up having to have an emergency csec with my last delivery (twins--heart decels in one of them during labor). Since then, I've moved to OK, home of the "no doctors will perform VBACS"--and it will be hard when I eventually, God willing, am blessed with another delivery to be made...either a midwife nearly an hour away, or to the hospital in OKC, even farther.
I am okay with my csec--oh, I wish it had been a vaginal--the recovery would have been a lot easier on me, physically. But it was never a matter of "desire" on my part--I wanted the healthiest outcome for my two boys, and if that meant being sliced open like a Christmas turkey, then so be it. ;-)
But I will push hard for a VBAC, when/if I have the opportunity...
Rachel
Posted by: Rachel | December 2, 2008 3:53 PM
Thank you all for your comments. In case you were wondering, my first csec was because of failure to progress and decel of baby's heart rate. This last one, born on 11-25, was I think because the doc didn't want to do a vbac. He did give us the option of trying, but was pretty insistent and convincing that it would be best. Don't get me wrong, I love my boys and am blessed that nothing bad happened to them, I just didn't understand why there was/is such a difference after 2 c-secs. Thank you all though and I will definitely research it as much as possible in case we do decide to have another, or God decides.
Crystal
Posted by: Crystal | December 2, 2008 11:09 PM
Get yourself to a midwife asap. There, you will find a wealth of information and support that you cannot put a price tag on.
Posted by: Kristin | December 3, 2008 3:06 PM
