Sunday, April 05, 2009

C-section or VBAC...

One of the toughest things about this pregnancy has been this dilemma:

To VBAC or not to VBAC?

(For those of you who don't know, VBAC stands for Vaginal Birth After Cesarean...)

At first, I thought that another c-section was a no brainer. I'm still leaning heavily in this direction. The first couple of people I saw at my practice group tended to recommend repeat c-section. They stressed that it was totally my decision, of course, but they didn't see the need to risk a uterine rupture because of laboring on my previous c-section scar.

You see, the risk of uterine rupture during VBAC is anywhere between 1 in 200-500, depending on who you ask. Some uterine ruptures are small, but they do necessitate immediate surgery and c-section. Some are much worse, and the mother or the baby could die or sustain serious damage, like birth defects. There is no way to know if you'll be one of the 1 in 200.

It seems that my practice group is split between the men and the women on this one. All the male doctors think you should play the odds and try for a VBAC, as long as the reason your first baby was c-section was that it was breech. All the female doctors and nurse practitioners think it would be wiser not to risk your health or the baby's health. This includes a female doctor who told me, "I had two VBACs, but that was before I saw a uterine rupture. If I'd seen that before then, I don't think I would've tried it." Encouraging, no? And I do find it interesting that the guys (who have no experience with actually giving birth) are the ones advocating for VBAC...

Even if I do want to attempt a VBAC, I would have to go into labor on my own. They would not induce me because the contractions would be too hard on my scar for too long. So that's another down side...

Add this to the stories of women I've known who've had horrible problems with tearing and healing from vaginal birth and women who are going to have to have surgery to repair their bladders, and you can see why the thought of just tearing up the same area again sounds pretty appealing. And then there was the gal I talked to recently who said that a doctor at the hospital told her that they'd had 3 uterine tears just that day...

There are certain things I care about deeply, and then there are other hills I'm simply not willing to die on. Natural childbirth? Hah! My goal has always been that we both come out alive and healthy, however it happens. Homemade baby food? Nah, the jar is just great. Now breastfeeding... that's a hill I nearly died on, but it was worth it. And I was determined ahead of time that I would do everything in my power to breastfeed. I succeeded, but it was really tough. I may post about that later. But I couldn't put my energy into everything. I had to choose.

So we have a set, scheduled date for my c-section. But its 2 days before my due date. Normal protocol is to set it earlier, like early in the 39th week. David and I talked about it, and we decided to give me a little better chance to go into labor on my own and give him plenty of time to cook fully. And if I do go into labor on my own before the 29th, we'll pray about it again then. God can talk me into a VBAC if its what He really wants for us... =)


Brandy said...

I have had four C-sections.


The first was an emergency situation. The second was scheduled because that is what my doctor suggested.

Looking back now, I sort of wish I had tried a VBAC with my second, but at the time I hadn't done any reading and was really nervous about it. We decided to try a VBAC with our third (not inducing, like you explained), and I prayed the same prayer you mentioned. We waited. And waited. My first had been born fifteen days early. On the eighth day overdue, we scheduled a C. We had given God a "deadline" so to speak. Basically, we prayed that if we were making a mistake and risking my life, would he keep me from labor. And He did.

Our fourth, as you know, almost died and had to be born by C-section in a great hurry.

I think for those of us who have to make this decision (over and over sometimes), it often goes back to the idea that we wish it had been different with our first. For instance, I always wonder if I knew then what I know now if I would have been able to do it naturally the first time.

But we can't change the past. For me, my uterus was so thin during the last baby that even the surgery was too difficult and we are unable to have any future children. I am still grieving that, but also thankful for the C-section because my children might have been motherless had I labored.

All of this is to say that it sounds to me that you are counting the cost and doing what you can. There is no "right" answer in these sorts of situations.

God will direct your steps. He always does. :)

Ellen said...

Thanks for the encouragement, Brandy. I think we're taking a somewhat similar wait and see approach. It's very hard to know for sure what will be best for you and baby, and that's the toughest part. Not having a choice last time was easier in a lot of ways.

You're not the only person I know who's had a thin uterus that caused big problems. Those situations feel awfully close to home, and I am definitely concerned about that.

I will be praying for you as you grieve your inability to have more children. I know something about that kind of sadness, even though we now have the child I thought I would never have.

Kristin said...

Thanks for posting about this. I'm in the process of making the same decision right now. I'd love to hear any future thoughts or have links to any resources you have read.