To VBAC or not to VBAC. That is the Question.

There are women who feel they've been wronged because they've had cesareans. They sense they've been permanently damaged and feel the medical establishment has failed them in some way. I am not one of those women.

Robey was born by cesarean because he was no longer safe inside my body. My labor with him progressed quickly - from 5 cm to 9 within a few hours of being admitted to the hospital. But he was under stress the whole time, his heart rate was skyrocketing, he was face up in the birth canal - and then my cervix stopped dilating - just stopped dead at 9 cm for hours on end. So he came out through a small slit cut into my abdomen by a smart, capable doctor. I healed quickly and felt fully recovered within a few weeks. In reality my body probably took a bit longer than that to heal, but I was so overwhelmed by the baby blues and the burdens of early motherhood that worries over the surgery were the last thing on my mind.

There are women who are adamant about attempting a VBAC (vaginal birth after cesarean) for spiritual, physical and therapeutic reasons. I am not one of those women. So when I learned that VBAC is not an option in this small town (due to medical malpractice insurance premiums primarily), I was not alarmed. I felt a bit dismayed that I didn't have a choice but also a bit relieved that I didn't have to make the choice.

My doctor would schedule the C a week or so before my due date, I'd check in, adorn the gown, get drugged up and wait for them to cut into the fading scar just below my hair line and remove the baby from my womb. I'd never have to suffer through a single labor pain, my husband wouldn't have to pace the hall, wipe sweat from my brow or hear me curse the world for the pain of childbirth. I wouldn't have to weigh the pros and cons of epidurals, episiotomies, assisted births or the many other birth plan options. Plus, I'd get two extra days in the hospital and two extra weeks paid maternity leave. 

At my last appointment, however, I started asking a series of what-if questions about the delivery that led my doctor to inform me about their practice's partnership with a larger, university-affiliated hospital in a city 60 miles away. There, I could attempt a VBAC. I would continue under his care until my 37th week when I would drive weekly to visit the doctors in this larger city. Then, when I went into labor, my husband and I would drive 60 miles to the hospital where I would attempt a vaginal delivery .

So now we've been doing the research, talking to friends and asking advice. Did you know the odds of delivering vaginally are higher for a VBAC than the odds of delivering vaginally with your first child? VBAC patients deliver vaginally 80 percent of the time and the vaginal delivery rate for first-time moms in the U.S. is somewhere around 75 percent. Plus, the risks of VBAC are low - so low that I'm still unclear why malpractice insurance companies won't cover them in most small hospitals.

I'm leaning toward the VBAC option primarily because of the recovery times. While I can't imagine a recovery much quicker than the one I had last time, I hear vaginal recovery times are even quicker. And, they say the recovery from a cesarean is much harder the second time around, especially if you have another young child at home. And - mind you - my child is a clingy, 30-pound toddler who still wants to be picked up, carried around and held by his mommy everyday. That's not likely to change when a new baby comes. Yet, I'll be under orders not to lift anything over 10 pounds for up to 6 weeks.

Jeromy was leaning toward the scheduled cesarean until he learned about the dangers of repeat cesareans. Though slight, your odds of complications in future pregnancies - including miscarriage - increase with each cesarean. Since our family plans may include more children, and since I have a history of miscarrying, why increase the risks of future pregnancies unnecessarily?

But then there's the 60-mile drive to the hospital. Did I mention my labor progressed quickly the last time? Seriously. I only labored at home for 90 minutes before the pain and the spacing of the contractions was enough to send us to the hospital - where I was admitted at 5 cm. I know every pregnancy is different, and I might not progress as quickly this time, but I could progress even faster. And I'm definitely  not likely to stall out at 9 cm again.

Realistically, the odds of a highway delivery are slim, but the odds of a painful, hour-long drive in a highway-bound vehicle are a sure thing. That's 60 minutes of active labor with no drugs in sight. While we're likely to get there in time to deliver, we're also less likely to get there in time for me to be numbed from the waist down. Yes, I'm talking about an epidural. I don't know if I'll be screaming for it or not, but after laboring for 60 minutes in a highway-bound vehicle, I'd like to have the choice (see it's all about choices with me).

I don't have to decide today. Right now, I'm 26 weeks, so I have about 10 weeks to mull it over. In that time I'll be listening to my body, watching the baby's position, praying about the decision, reading about VBACs and asking advice from friends, doctors and co-workers.

So - if you have any advice or experience with VBACs, let me know sometime in the next 10 weeks.

Comments

[karen]

Ali, I'm really glad for you that you are searching out all the options now- that'll leave your mind at ease, I'm thinking.

I'd never heard about this VBAC. I always figured that the choice was the woman's, unless for real medical issues.

I will say this. I know a woman that had two kids VB- then a scheduled C-section. She did have a miscarriage at four months and that was so hard for her, but she became preg again. I also know a gal that's had 6 c-sections. She's fine.

And, I know of a woman that was advised against a VB because she had such a hard time w/her first. She died two weeks after the birth of her son due to a collapsed vein in her heart. She found a doc that disregarded the 1st doc's opinion.

I had four VBs. No pain meds. Episiotomies, all. I could go on and on.

I think your issues on choice fit the occupation of birth- here :0). If the doc sees no reason not to try again the *natural* way- then, why not. But... well (this is kinda gross, but...) does one bleed for awhile after a c-section? Sorry so graphic- I'm a farm gal and am used to the gore-thang.

You can edit this if you wish.

[jen]

My sister had 2 kids at home w/a midwife and no drugs. She survived, but she had 2 kids prior in a hospital with drugs.

Since I got no kids it's hard to say, but I guess it depends on how much you trust your doc. I love my doc and would do whatever she says, even bizarre remedies.

Being scared of "stretching", "pain" and "bleeding" would lead me to c-sec, but then I think of all the other tough women that could handle it v-way and think I could do it too. I do other difficult things and you do too.

[tammy]

I am not only not an expert, I really have no idea since I had two vaginal births & no c-sections, but I do have a friend that had 2 c-sections & her comment was that it was much easier the first time. I just personlly don't think that I would want to worry about driving 60 miles while in labor.

[karen]

Good point, Tammy. It really could lead to more anxiety. I know of a gal that gave birth in her car going 60 miles to the hospital. Of couse, it was- like- her 5th or 6th kid!

[erin]

I've had two c-sections. I really really wanted to try a VBAC with Hala, but my doctor told me there was a chance my uterus could rupture during labor. That meant it would turn into an emergency and then possibly no more kids. He said he loves the idea of VBAC, but couldn't agree to go ahead with one due to the possible dangers. He advised me I could easily find someone willing to try a VBAC...but after doing the research, I didn't want to chance it.

My daughter came 3.5 weeks early, and my uterus barely held up. I'm very glad did not try a VBAC. To me, any risk is too much risk.

[erin]

also...the recovery from the second c-section was much, much, much easier than the first. I could get up on my own much faster. I could walk much faster. It was much better the second time. MUCH. Maybe it was because I knew what to expect too?

[Mich]

Do what is best/safest for you and this baby. Although Robey and any future babies are highly important, they are not as important (at this moment) as delivering this baby safe and sound.

I still don't know what I would choose in your situation, but if you agree with the above, maybe you can eliminate some of the factors affecting your decision.

This, of course, does not eliminate the factors of the longer recovery vs. the car ride, but maybe I have helped you narrow it down.

It's that car ride that scares the crapolla out of me. I wouldn't want to endure that extra pain and stress, not to mention the (albeit slight) risk of highway delivery.

You know, we could work something out where you (and a guest -- Nan -- Jeromy -- whoever) can stay with us as your due date approaches. We're only 30-ish miles from Akron. Just a thought. You know we'd do anything for ya!!

It's the unknown that messes everything up! Is there one option that you just know is **right** but the other option is more **appealing**? If so, go with the **right**.

[Alison]

Thanks to everyone already for good suggestions and advice. I'm glad to hear that the 60-minute car ride freaks others out as well. I thought maybe I was being whimpy to let it scare me.

I'm really glad to hear from Erin that your recovery was actually easier the second time. I was showering the day after my C, walking around and sitting cross-legged within a few days and nursing without any problems from the get-go. If I knew it'd be that easy again, I'd choose the C in an instant.

The offers to stay at friends' houses which also came in via e-mail are especially thoughtful. We're so lucky to have so many good friends.

And Mich, your advice to focus on THIS pregnancy, not future pregnancies or other external demands is so true. I was thinking that myself as I re-read my post this morning.

I still don't know yet which option (to use Mich's terms) feels *right* and which feels *appealing*. I do have confidence in my body to handle whichever option I choose ... but it will probably come down to selecting the one that feels safest and easist for our family.

So, continued advice is still welcome. I've loved hearing from each of you on this.

Oh, and Karen, the bleeding seems to be more minor with a C - because (sorry to everyone for the gross out factor here) they tend to 'clean you out' while they're in there.

[Jen Trombly]

I think the only thing you can be sure of here is an awfully long car ride (60 miles, at least an hour and a half?). You can't know how quickly you will recover or how your body will react to a second c-section or a VBAC, so I would concentrate on whether the thought of driving all that way was worth the stress. We decided on a hospital that was about twenty miles away and it was no big deal, but would I triple that? No way. Of course, I was in "early" labor for a day and a half by then...90 minutes! I'm jealous. I'm a little surprised you can't go anywhere closer- Columbus is 20 miles-ish right? Good luck with your decision!

[Alison]

Columbus is just as far - about 60 miles. When Robey was born in Tucson the hospital was 5 miles away but could be a good 20 minute drive with traffic. And you're right, that was no big deal. 60 miles is much, much scarier.

[Marcy]

I think I was pretty lucky as far as distance goes, walking across the street was pretty stress free.

[jen]

OH MARCY!!

[Becky]

Recovery after my second C-section was much harder than my first. But, then, my second pregnancy was with twins. It was harder all around.

[Busy Mom]

For whatever it's worth: 3 c-sections for me. No complications. The second time around felt more like abdominal surgery than the first one did, but it wasn't bad.

[shannon]

I have had 2 elective cesareans. First one for breech and second elective (preeclampsia too). My third c/s is in a week. I would have to travel 4hrs to attempt a vbac. I wish I had been able to have them vaginally. I just wanted to say that my healing was way better than the first c/s. I had other complications, but as far as healing and pain go...way less with the second. I am hoping this one will go even better than both previous. Good luck to you in your decision...