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Repeat c-section or VBAC?

post #1 of 16
Thread Starter 
With my first daughter, I had a vaginal delivery at 36 weeks. I had pre-eclampsia with HELLP syndrome and was induced. No epiduril as my blood platelettes and vitals could not handle anything. I wasn't even allowed Tylenol! My daughter only weighed 5 lbs, 2 oz, but I ended up with around 500 stitches from extreme tearing with her. I didn't know how to really care for everything at the time (the doctors never explained, nor did the nurses - I didn't even know them as this was at an emergency facility), so I ended up with a pelvic infection and sutures that had to be redone. :

With my second daughter, I had a c-section delivery at 38 weeks. My OB (which is the same as with this baby) felt pity on me for what I went through with DD1 that she couldn't stand the thought of me possibly going through that again. She also thought DD2 was a big baby, but ended up only being 6 lbs, 2 oz. My recovery from the c-section went great. I was up walking around, straightening my room up, and breastfeeding that evening.

With this baby, I'm torn about which option to take. I feel my OB will allow me to elect for a c-section again if I like, but I'd like to experience a "normal" vaginal birth as well. I'm also planning on having my tubes tied this time around. I have awhile yet to decide, but it never hurts to start planning this early.
post #2 of 16
I am not in your situation but I would certainly check out the ICAN organization. http://www.ican-online.org They have a lot of info on there that may be able to give you sound medical advice. I think that from what you said, maybe your birth experiences were not at all what you envisioned or would like and this time you need to discover what is best for you and your baby. It also seems like the medical community has failed you not once, but several times just alone in that they convinced you that your babies were going to be big and weren't, aside from the extreme trauma you experienced. I am sorry that you have to go through that! From a midwifery prospective, pre-eclampsia is easily combated and if that is a worry for you, but since you didn't have it with your second you may not be worried, I could tell you many things you can do for that. Otherwise, you just need to make the best decision for you. If you are going to have your tubes tied, which I would also look very thoroughly into that and all the risks involved, then your Dr. will likely suggest another section because tying of the tubes is a surgery in itself and they can do it all at once. Sorry this is lengthy but you should have all info at hand to make a sound medical decision! I am an advocate for sound medical advice! Good luck!!!
post #3 of 16
HELLP syndrome is not easily combated and is quite serious and often comes on without any warning. I don't know a midwife that wouldn't refer to an OB for a pregnant woman with HELLP. I think it is sound to try and plan a vaginal delivery. Just keep an open mind with your history. You have had a vaginal birth before and I'm sure you can again. The tearing last time around was most likely the position you were in to push and the way you pushed. Self led pushing would be better and if they have a squat bar or your doctor would allow you to lie on your side to push, you should be able to avoid extensive tearing. You could try applying warm (not hot) moist compresses for an hour or so before pushing to soften the tissue so it can fan out more easily. Also, pregnancy yoga may help keep that area of your body more supple. Avoid stairmasters and ellipticals while you're pregnant because those tend to tighten vaginal muscles.
post #4 of 16
One other thing to consider, I've heard (I know, anecdotal) that having your tubes tied when you give birth has a higher chance for it to self-revert. My sister's doctor refuses to do the operation until at least 6 weeks post-partum for that reason. Something you might ask your doctor about.

Also, I had a 4th degree tear with my first son, and have never had any serious tears since then. Took longer to stitch me up than my last labor took, but #2 baby took 1 stitch, and haven't needed stitches since for any of my others, though 2 of them have been 2 lbs larger than my first, including a serious shoulder dystocia the midwife had to literally stick her whole arm up me for (sorry if TMI). If you're considering a VBAC, I wouldn't let that be the reason for a repeat C-section, though it truly is up to you, and what you feel best for you and your children.
post #5 of 16
I am a different position, but kinda similar. With my DD I had a very long labor(30hrs) that ultimately ended in an emergency c/s due to severe uterine fatigue and my DD crashing. I had pushed 3 hours and was in different position and such and basically pushed her so tightly into my pelvis that it was extremely difficult to get her back out(either way). Due to her being so incredibly stuck the Dr who performed the c/s had to make a T incision on my uterus, which has resulted in a very fragile scar tissue that would very likely erupt if I were to go into labor. I know the facts-I have researched and for my situation a r c/s seems like the safest route for this LO and myself. I also am very much considering getting a tubal because I don't want anymore children after this and DH and I both are on the same page with that.

I was told that a vbac is a great option for the majority of women who have had a c/s, and this hospital and Dr have routinely done them, but for me it is not a good option. I know there are risks involved and I am at terms with that, my likelihood of rupture is very high and I just don't feel that it is worth the risk. If I could have a vbac or and hbac I would. My DH would have never agreed to having another without a c/s-the Dr took him aside and was very grave and said that he would likely lose us both if I attempted vbac. This is my experience and I know there may not be people who agree with my decision, but it is mine to make for my health and my family.

I'd look into your options and weigh the risks and benefits.
post #6 of 16
Thread Starter 
Yes, yes, HELLP syndrome is a very scary situation. Even though I had no complications with DD2 and am no longer considered high risk, it is still something I watch for and try to stay on top of just in case.

I won't have my first OB appointment until the end of this month or beginning of next month. My OB likes to see her patients around 10-12 weeks so she can tell more about the pregnancy. I don't feel like she gave me bad info about DD2's size; it was very hard to tell because my uterus is tilted and I'm small internally as well. I even went to Johns Hopkins University Hospital during that pregnancy and they forecasted she was going to be huge. After the c-section, the OB told me sometimes it's hard to judge due to mother's internal size, position of uterus, and other factors, especially when you get 32 weeks or more. (My OB got me started on Clomid, got me pregnant; then I moved to the DC area after becoming pregnant; stayed there until 32 weeks and came back to regular OB.) It was complicated. Lol.

With this one, I'm very seriously leaning towards a repeat c-section. My DD2 was lying horizontal during the c-section, so the doctors were forced to make a slightly bigger incision than normal. Since I'm looking into having my tubes tied I think I'd rather have it all done at once rather than seperately. I just wonder about the recovery with a repeat c-section, tubal litigation, and breastfeeding all at once. I did cramp slightly from last c-section and breastfeeding, but nothing to overreact about.

I have fertility issues that alone would probably be enough birth control; but I want the reassurance of having my tubes tied. (I can't ovulate whatsoever without the use of Clomid.) What is your sister's doctor's success rate of tubal litigation? Most of the OBs here suggest having your tubes tied after childbirth or during c-section if that's what you want. o.0 Even though I don't think I could become pregnant without the use of fertility drugs, I still want to check into it.
post #7 of 16
having had a section and a vaginal birth I would chose a vag birth any day of the week. It's VERY very unlikely that you will have HELLP or even pre-E if your last pregnancy was normal. I to tore badly after a 36 hour induction with my son. With my twins I had pre-E and a breech twin A so we did the section. The recovery from the section was really easy for a section (I was up and walking around the next day and breastfeeding was great) but the incision pain was terrible for weeks and it's still sore 19 months later! The recovery from the Vag birth was tough but I was my normal self in a week! From the stand point of safety, c-sections carry an increased risk of early birth (and the problems associated with that including breathing troubles and BFing woes), infant death and a 3x higher rate of maternal mortality compared to vaginal birth. Ultimately it's your choice, but c-sections are still major surgery and not the normal way we were meant to birth.
post #8 of 16
it's not an easy decision, given that you may have not had things go how you wanted in the past.

i get it - i was told if i waited 2-2.5yrs between labour that my chance of another preemie would be no higher than women who have never had a preemie (because there is no medical explanation why he came early. ds was so wedged up under my diaphragm that there was no chance of turning him

so i have those concerns. i felt in so many ways that my body failed in my son's birth, but seeing him transition from being on machines to finally being in my arms was healing. i know there is no reason that they know of why i can't have a vaginal birth, but sometimes i flashback and am afraid it will fail again. every day i just try and see this as a possibility to have the birth i hoped for. i hope the same for you!! my daily mantra has been just let this baby be born in october - any day in october (i'm due on the 19th)

it's scary, but the idea of a vbac fills me with such joy. i hope you end up having the choice and that it is the one that is about how powerful you are and not on past things that may not have gone as you had hoped.
post #9 of 16
Thread Starter 
Overall, my C/S went the way I wanted it to. I had a speedy recovery. My vaginal birth on the other hand was botched from the beginning. I really think that's why I am afraid to pursue a VBAC in some ways.

Has anyone experienced a repeat C/S? If so, what was your experience like?
post #10 of 16
i am not meaning to discourage you from vbac but my dd was a rcs and it was a breeze for me. i felt no pain, got to discuss with the ob the details of the surgery beforehand (my biggest issue was that i wanted my dd nursing ASAP). i also had her in a very baby-friendly hospital and they routinely hold off unneccessary procedures like bathing, measuring, etc until even the next day. i am also having a rcs with this baby. however it does still linger in my head if i could have had a successful vbac. my dh, however, reminds me that i am no less of a mother for not vaginally delivering my babies. we all have to make decisions that sit best with us.
post #11 of 16
Thread Starter 
My c/s was a breeze compared to when I had my daughter. My OB has stated already she feels it would be almost impossible for me to deliver a baby over 6 pounds. I'm not a small woman, more on the average side, but it just seems like that's not one of the things my body can handle.

I've heard very different accounts of repeat c/s. Overall though, good accounts such as yours. The hospital I will be having my baby at is very mother friendly. DD2 stayed with me the entire time. They only removed her from me for a moment to weigh and get her vitals. But once I was back in my room, they brought her straight to me. They never even bugged me about keeping her in the nursery. I told them I wanted her in my room and that was that. Either way, I know the hospital staff isn't going to pose a problem with my wishes - my OB will make sure of that!
post #12 of 16
Originally Posted by Charlize View Post
I've had four. They've all been different. My initial recovery from my second one was better than my initial recovery from my first one. However, two weeks after my first, I was mostly back to normal...a bit of weakness and occasional aches lingered for about another month after that. With my second, I was still experiencing noticeable pain (not just aches, but pain) at the incision site 7-8 months after surgery.

With my third, the initial recovery was decent, but I had an infected incision, so it didn't close up promptly. Once it did, I thought everything was fine...until I realized that the numbness wasn't going away. That baby is now 3.5 - and I still don't have full bladder sensation, have a great deal of difficulty doing kegels (forget about any kind of "do some kegels while you're washing dishes" scenario)...and had no clitoral sensation for about six months.

My fourth recovery was absolute hell, but I also lost my baby, so I tend to treat it as being outside the "c-section recovery" box, yk?

Two emergency, two "elective". They all sucked, to a greater or lesser degree, and there was no rhyme or reason to what went wrong with each one.

ETA: I'm not urging anybody in either direction. I'm having a fifth c/s myself (in June) and I'm not even a little bit happy about it. I've just found them all so different that it concerns me a little when people ask someone else what their recovery was like and/or think they know what it will be like, because they've "done it before". Every surgery is a unique experience. You could have another very like your first, or very different - no way to tell.

Oh - and I will say that I hate them with a passion. I've never pushed out a baby, but I'll trade two days of excruciating labour for 15 minutes of c-section recovery, any day of the week. I like the really bad pain to come before I have a new human being to take care of and get to know.
post #13 of 16
Thread Starter 
I'm sorry for all the pain and suffering you've been through.

Even though I have several months to plan this out, I want as much info as possible - not from the medical community, but REAL people that know what it's like. I have my first u/s tomorrow. I know my OB is going to chit chat with me for a second or two probably so that she can kinda gauge which direction I'm probably gonna go, but it's my body and baby and I don't want to be rushed with the decision. Since I'm not seeing her for my first actual OB appointment until 12-14 weeks or something, she wants me to have as much information together as possible in regards to what I want.
post #14 of 16
Originally Posted by Charlize View Post
I'm sorry for all the pain and suffering you've been through.

Just remember that, even though it can be really, really hard, you don't have to make the decision now, no matter what anybody says. You can change your mind, either way, any time until the baby is actually out. (I'm not going to lie and claim that it's easy - trying to fight for your birth choices in late pregnancy or in labour is hard. I'm just pointing out that you're not signing a contract in blood, and if you say one thing now, you don't have to abide by it in October, yk?)
post #15 of 16
i agree, i didn't make my decision about a repeat c/s until i was at least 7 months pregnant, i might have been closer to 8 months and pushing the time limits for making a decision (as in booking operating room time). i had switched ob's (and therefore hospitals) part-way during my pregnancy from one who was forcing me into a c/s to one who was cool with letting me make my own decision and giving me time to think about it. i think actually being the one to make up my own mind is what gives me the most peace with it. if i had stuck with my first doctor and his "you have to have a c/s" attitude, i would not have had a good birth experience. it may sound odd, but my dd's birth was amazing because my ob put as much decisions as possible in my own hands.
post #16 of 16
Thread Starter 
I went for my first u/s today. The tech that did the u/s noticed my incision while doing the transvaginal and stated something about the scar tissue appeared "iffy." We were trying to make conversation and she stated dependent upon how the pregnancy progresses, she would recommend planning on a repeat c/s because she felt I could easily rupture. So, this is something my OB and I will have to watch as the pregnancy progresses.

I spoke to my OB momentarily afterwards with the tech and we all pretty much agreed it's a wait and see how things progress much further down the road before deciding.
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