Tue 29 Jan 2008
To VBAC or Not to VBAC
Posted by Liza under Knocked Up Again
Yesterday, I had my first appointment with the midwives who were my primary prenatal care with Noah, and who hung out and tried to get my labor going just before he came into the world.
Jill and I have been debating whether or not to change baby-delivery medical practices — I like them, and they’re convenient to my work, but the hospital where they deliver is not very convenient to home. I have another appointment, later this week, with an MD who practices at the hospital 5 minutes from our house.
But whether or not to change isn’t the topic of this post.
This post is about the VBAC, or “vaginal birth after c-section” talk that Perky Midwife and I had yesterday.
Basically, her opinion is that I’m not a very good candidate, for 2 reasons. First, and primarily, because of why I had the c/s — “failure to progress.”
In spite of all the assistance medical science could provide to my body, once my body decided that it was time to have that baby, my body didn’t figure out how to go into labor. It hung around ignoring all that cervadil and pitocin, leaking amniotic fluid and half-assedly trying the occasional contraction.
The other reason is the one people usually guess — the extra large baby I was growing in there. I can’t compare to friend Frema and her supersized 11 lb bundle of love, but Noah was a well above average 9 lbs, 7 oz. There’s no reason to think that little Blur won’t be in that same range.
This practice has 2 VBAC policies that Jill and I are supposed to think about. We have until ~30 weeks to decide. First, they won’t let me try for a VBAC past my due date — when I hit 40 weeks, they schedule a c/s. And second, they won’t do the drug cocktail to induce or try to get things moving that they did last time. I can only VBAC if I go into labor on my own.
If I choose to do a scheduled c/s instead, they normally schedule them a week to 10 days before my due date. Any of you who have lived through the last 3 weeks of a full term pregnancy can well imagine how fabulous it sounds to reduce that last gigantic and unwieldy phase, especially if it is at the end of a Georgia summer.
The other thing that I have to appreciate about Perky Midwife is this. According to her original calculations, Blur’s due date is September 11. Fortunately, all of the u/s (including the surprise one yesterday) show Blur measuring a few days ahead of that. So against her normal practice, Perky Midwife recorded my EDD as September 9.





January 29th, 2008 at 9:22 am
My first baby was 9lb 2oz and I ended up having a c-section after she got stuck (I was induced, lastest through 5 hours of no-drug pushing - yeah pushing! - but ended up having to go for the c-section in the end).
Second time around, I was determined to have a VBAC so switched hospital systems as Cleveland Clinic was not encouraging (wouldn’t do it in other words) and hooked up with a midwife. I also had a version to turn Erin from the breach position as well, which worked amazingly well.
And in the end, the birth was beautiful and natural and 48 mins before my due date. Erin was 8lbs 20z.
Long story, short - depends on how much you want a VBAC to make it happen because most health care providers do not want you to have it. I had to work very hard to make it happen but I’m glad I did.
January 29th, 2008 at 11:34 am
I had a scheduled c-ssection a week before my due date with my second. My first was a “faliure to progress” c-section on her due date.
The first was an easier baby. She was less fussy. My husband swears it’s because of that last week. if I had to do it over again, I would have scheduled on my due date and waited to see what happened.
January 29th, 2008 at 12:04 pm
With KJ, I had an emergency c-section at 36 weeks. With Jack, I had a c-section at 35 weeks. This time around, I’m really gearing my brain and my body up to deliver this baby at a healthy 38 - an all time record for me. C-sections are no fun, but neither is natural childbirth. Pretty much either way we go, it’s trouble, eh? Personally, I’m planning a third c-section. I’m nervous on how my body would take to another round of labor having had two surgeries already, and there’s no guarantees I wouldn’t end up with a c-section anyway. The scar’s already there, eh?
Good luck with your decision!!
January 29th, 2008 at 12:30 pm
Well, as you know, Henry was 24+hours of labor and I just couldn’t push him out. I was just plain exhausted.
This baby? I’m bound and determined to deliver this baby on it’s due date, the first day of summer (Henry was born on the first day of spring).
So, I guess we’re going to do this: whichever comes first, labor or c-section.
Part of me feels like I *really* want a VBAC, but the other part of me doesn’t think I can handle that failure twice. If I could be guaranteed a smooth (and relatively swift) delivery, I’d go for the VBAC in a second. But, nothing’s guaranteed. Part of me thinks a planned c-section would take all the nonsense out of it. With a toddler and a family traveling, it makes more sense to schedule.
Basically? Yeah, no idea
January 29th, 2008 at 10:03 pm
Actual median delivery date for first babies is 5-9 days post EDD, depending which studies you believe. Actual mean delivery date for subsequent children is 3-5 days post EDD. Your odds of getting to your due date and having a c/s with this practice are greater than 50%, especially since your first came after that median time, and that doesn’t even bring into consideration what will happen after you begin labor on your own.
If I were in your shoes, I would probably audition the other practice and see what they do with VBACs.
January 31st, 2008 at 12:41 am
My incision is still healing, yet I’m already thinking about this. I’m pretty sure I’m too chicken to go the VBAC route myself, but I know there are good reasons to. Good luck with whatever you decide to do!
January 31st, 2008 at 11:01 pm
VBAC has been a political football in the medical community for years. First it was discouraged (1980s) the the C-sec rate skyrocketed so VBAC became so popular that insurance companies would not allow women to choose and elective C-sec. Everyone HAD to have a trial of labor. OBs didn’t like being told what to do — so some data was found that showed an very small but very scary increased risk of catastrophe (mom and baby dying or nearly dying) with VBAC. I read the study. I’m not too convinced by it. However, the pendulum has swung all the way back to once a csec then always a csec. If something goes wrong with a Vbac the doc’s ass is on the line. So most docs don’t want to entertain the potential risks and liabilty of doing VBAC.
I’ve met women who have had successful VACS and I did deliver a few in my short OB career. As a mom — I’d go for the scheduled C-sec for baby number two. I’d love to pick my baby’s birtday and avoid the whole Sept 11th thing. I hated labor. I disliked pushing. I disliked healing in the ole vag area. I love my healthy babies.
Good luck in your decision making.
Madelaine
January 31st, 2008 at 11:29 pm
I understand your not wanting surgery if it’s unnecessary, and you’re probably worried about the recovery while caring for a baby AND a toddler, and the burden that would put on Jill.
But if a midwife, who one would think is biased toward VB in general, is counseling that C-section would be wise, I would take that seriously.
Talk to a few doctors to come up with a plan that assures the best safety for you and Blur. (Why does that always make me sing “Woo hoo!”?) And don’t be afraid to do some medline research on vbac after a failure-to-progress case, or ask the doctors how your specific circumstance changes the odds.
And I’m sure an army of volunteers, including me if I could figure out what to do with Adam, would line up to come to Atlanta to help out until you’re recovered, if that’s what ends up happening.
February 1st, 2008 at 8:25 pm
I vote for the C-Section. Pushing was hard! …and Maxim was only 6lbs!
Plus you have the bonus of not giving Blurry either our parents Anniversary ~or~ the most notorious date of our generation for a birthday.
February 1st, 2008 at 11:38 pm
The real question, Liza, is what *you* want to do. Everyone can weigh in one way or another, but it’s your body and your birth. This is yours to choose, not that of your blog readers, family members, friends, or coworkers. Frankly, it’s not even your providers’ decision. It’s yours.
February 2nd, 2008 at 8:22 pm
I’ll be there to take care of Noah regareless of when the next baby joins us, so just let me know. love to all
Mom/gradma
February 3rd, 2008 at 1:52 pm
Hi, I recently had a fabulous waterbirth vbac. I found ICAN to be a wonderful fount of information and support when I was making decisions about how and where to plan my vbac. www.ican-online.com there may be a local group in your area… best of luck and remember to follow your heart and choose the birth that feels safest to you.
February 5th, 2008 at 4:15 pm
I’m a big fan of VBAC in theory, but haven’t had a child, so anything I say is sentimental and not from experience. I think it would be great to try to let your body do it’s thing on its own, but I also believe that you have to follow your intuition and do what you feel is right. Good luck and I look forward to following your pregnancy and watching everything happen - no matter which way. ox
February 6th, 2008 at 11:21 am
I had a c-section with my first after he got stuck (he was transverse). The ob thought his presentation was due to the shape of my pelvis so after much thought I decided to go for a repeat section. Then I went into labor 6 weeks early and the nurses and ob all thought the baby would be so small I might be able to deliver her vaginally even if she did come out sideways, so we had a trial of labor and I had her vaginally (she was sunny side up– I just can’t seem to get them to come out the right way– good thing I’m not having a third or s/he would be breech). An unusual circumstance, to be sure, but it goes to show you you just never know how birth will turn out.
Good luck with your decision.
February 8th, 2008 at 8:55 pm
What a pickle.
I would go for the VBAC, assuming all the stars were aligned and I felt good about it. Because after two c/s you’ll never have the chance again. (assuming you want to have more kids)
Then again, to never have stitches in your lady bits has its pros.
February 15th, 2008 at 1:28 am
I have to second a visit to ICAN. They have a whole section devoted to VBAC on the new website. They also have a section on CPD (cephalopelvic disproportion) which sounds like it doesn’t relate to you but has info about FTP (failure to progress)also. The ICAN yahoo group is FULL of women who were told by their care providers that their bodies wouldn’t work yet they went on to birth vaginally. Amazing women with a ton of knowledge.
My $0.02.
February 15th, 2008 at 1:32 am
Oops, I meant to include the link to the CPD webpage:
http://ican-online.org/vbac/cephalopelvic-disproportion-cpd
March 5th, 2008 at 1:04 am
Liza - if you’re still reading, I updated my blog and answered your questions