To VBAC or Not to VBAC?

Today I am 37 weeks pregnant and starting to panic. My first pregnancy ended in a C-section after 18 hours of labor, reverse dilation (didn’t even know this was possible until then), and a baby that just wouldn’t "drop." The physical recovery was long, and even the mental recovery was tough becuase I’m super freaky about surgery, surgery scars and generally anything involving cutting open perfectly formed flesh. To this day, I hate having my feet touched because I had surgery on my toe when I was two. I know, get over it right? So when I found out I was pregnant I started looking into the possibility of doing a Vaginal Birth After Cesarean (VBAC). After all, two of my friends did it, so why couldn’t I?

After I had my daughter I watched a documentary about modern maternity care and birthing options. After watching it I thought to myself, "Crap, I should have watched this before I had my daughter." But I didn’t. Maybe I would have been able to avoid having the C-section, maybe not. But I wanted to be more informed this time around. I am a fact-based decision maker, so here is what I found. Also, be warned—I have translated a medical bulletin into my own words. You will probably be offended and I'm certainly not using medical terms here, but at least it’s easier to read this way.

Vaginal Birth After Cesarean Facts

- The risk of your uterus blowing up is the biggest concern (about a 1% chance if you’ve had one previous cesarean)

- The VBAC success rate is 60-80%. If your labor was screwed up last time you are less likely to be successful (i.e. failure to descend, failure to progress scenarios).

- Successful VBACs have fewer negative side effects than repeat cesareans. BUT, if you go through a trial of labor and end up having a C-section anyway, you and your baby are more likely to die than if you had just done the scheduled repeat cesarean. You can’t just look at VBAC statistics because the definition of a VBAC is that you successfully had a vaginal birth. You also have to consider those who tried and failed. Make sure you look at those statistics too.

You Have a Greater Chance to Have a Successful VBAC If:

- You’ve had only one previous cesarean

- You’ve previously had a successful vaginal birth

- Your labor is spontaneous

- You have a “bikini cut” incision

Your Chances of a Successful VBAC Decrease If:

- You’re overweight

- You’re of an advanced maternal age

- Your baby is huge

- You’re babies are very close in age—think Irish twins

- Your labor was screwed up last time (failure to progress, failure to descend, failure to dilate)

- You’re past 40 weeks

If You Are Going to Attempt a VBAC Make Sure You:

- Don’t get induced

- Don’t get Pitocin to speed up labor (or other labor “augmenting” drugs). It makes contractions stronger and puts more stress on your scarred uterus.

- Have continuous fetal heart rate monitoring when you’re in labor. Heart rate changes are one of the indicators of uterine rupture.

- Have units of blood on hand, just in case your uterus explodes

- Are in a hospital with a surgeon readily available, also in case your uterus explodes

- Wait until as long as possible before getting an epidural. The medical bulletin actually says studies don’t show that it affects the outcome, but lots of other people’s experiences said that being able to move around helps get the baby in the right position. This is also what my sister-in-law who used to be a labor and delivery nurse recommended.

Personally, I have my C-section scheduled for Oct. 25. If I go into labor before that on my own and everything is progressing nicely, I will attempt a VBAC. Here are a couple of other blog posts I found on VBACs if this awesome post wasn’t enough:

- Helpful tips on birthing options at Well Rounded Birth Prep

- A successful VBAC story on Adventures in Mommyhood

- An OB’s opinion on VBACs on The Skeptical OB

- The Unnecesarean. Enough said.

Do you have any VBAC stories or additional information? I'd love to hear it!