Thu 26 Jun 2008
To Scheduled-C or Not to Scheduled-C
Posted by Liza under Personal, Knocked Up Again
I had my regular prenatal appointment on Wednesday, and am now in the phase of being pregnant where you have to go in for prenatal visits every 2 weeks. This baby’s estimated due date is 10 weeks and 5 days from now.
I promise, I won’t get graphic in this post where I talk about whether to try to have Esmerelda Freugenspiegel by scheduled c-section or traditional delivery.
But if you would rather not go through my thought process about matters obstetrical — or you suspect that I would rather you not go through that thought process with me — then I invite you not to click through to the rest of this post.
I am waffling on the decision to deliver baby #2 by scheduled c-section.
On the one hand, there’s something very nice about the idea of waking up in the morning, taking Noah to day care, and going into the hospital to have the baby in a nice predictable way. And about being able to plan when I’ll be out on maternity leave.
There is also some risk — granted, only a 1-2% chance — of severe complications (uterine rupture) in attempting a vaginal birth after a c-section (VBAC).
When Older Experienced Midwife and I discussed it at my appointment on Wednesday, it was clear that she was working hard to keep her emotions under control. Until a few weeks ago, the practice had never had a mother have uterine rupture. Without specifying what exactly that meant, she said that the results can easily be “catastrophic.” I think that means that either the mother or the baby died. And in that particular case, it was actually NOT a VBAC.
On the other hand, from everything I’ve been told, the recovery from a vaginal birth is much, much, much easier than recovery from a c-section. There’s a reason why mothers can routinely leave the hospital 2 days after a vaginal birth — and in many cases, even have the baby in a birthing center or at home. Our bodies are designed to have babies that way, and recover quickly from it.
I asked specifically about Young Perky Midwife’s opinion that I was not a good candidate for a VBAC.
Older Experienced Midwife reviewed the medical notes from Noah’s birth for a few minutes and then explained:
There’s nothing in your history that specifically indicates you’d be a BAD candidate, but several factors that keep me from saying you’re a GOOD candidate: you have big babies, we weren’t able to get you into active labor with cervadil or pitocin — but that was at least partially the baby’s reaction to the pitocin. This baby might react differently.
This decision is really up to you. We’ll support you in whatever choice you want to make. Scheduled c-section recovery is a lot easier than your last one was. At the end of the day, I would say it probably works out to be a little bit safer for you to have the baby vaginally, and a little bit safer for the baby for you to have a scheduled c-section. But both are close and probably safe.
We also talked about what limitations there are. They will not induce labor this time — I either go into labor or I have a c-section, but we don’t jump start. They will only let me go to 41 weeks gestation. (September 16) If I haven’t gone into labor on my own by then, it’s scheduled c time. I don’t have to quit waffling until either then, or the baby shows up.
The other argument for baking the baby as long as possible is that the last few weeks of gestation are mostly about the baby putting on weight — and as much as the idea of pushing 9.5 lbs out of my body on my own is scary — is that everything I’ve read indicates that larger babies that aren’t big because of gestational diabetes, are generally the healthiest.
And I can tell you for sure, the idea of caring for Noah while recovering from a c-section is scary. He likes to climb on me. I would be restricted from going up and down the stairs more than twice/day, and from driving, for the first 10 days after surgery.
Then there’s completely the non-medical factor: short term disability insurance payments during my FMLA leave. A healthy vaginal birth gets 6 weeks of short-term disability; a c-section gets 8 weeks. That’s two weeks of additional partially paid time off.
Various bonuses and reduced expenses while home mean we could probably afford to have me out for 2 unpaid weeks out of the 12 (I’ll have 4 weeks of vacation accrued by Labor Day Weekend). But of course it’s riskier to plan to spend savings than to plan to be at least partially paid.
If you’ve read this far, I have only one specific request for you. Feel free to comment including your opinion, but please don’t judge.
Jill and I will make the decision we think makes the most sense for our family, all factors being considered. It might or might not be the choice you recommend or would make, but there’s no reason to try to make us feel badly about whatever that decision turns out to be.




June 26th, 2008 at 8:49 pm
Well, as rewarding and empowering as it was to have a vaginal birth, let me just say “It hurt. It hurt like M*#@%r F*&%#$r! The ring-of-fire is aptly named!” And Maxim wasn’t even 6 1/2 lbs! Not nearly the size of Noah.
Remember I’ve had surgery before in the “female regions”, which was a painful recovery. But I think I’d have to call the difference in recoveries a toss up. They were both bad…just different. Bad in the belly or bad in the vajayjay?
June 26th, 2008 at 9:07 pm
I had the c-section first time around then moved heaven and earth to get my VBAC the second and had an absolutely wonderful experience. Child 1 wanted me to be mobile and I was. Baby 1 9lbs 2oz, baby 2 8lbs 2oz.
Wonderful thoughts headed your way through your childbirth considerations. It’s not an easy one.
June 26th, 2008 at 9:46 pm
I have no advice because I have no experience with this at all. I just wanted to say that I know that either you will make the right choice or that life will lead you in the direction you’ll need to take. I’ve been reading along (also due in Sept) and I just wanted to post a comment. Good luck!
June 27th, 2008 at 7:43 am
I talked to my doctor about VBAC, and because Kara was such a big girl, and because my body was never fully ready to deliver vaginally, she recommends a c-section but added the choice is up to me. While I like the idea of quicker recovery time and going through the “traditional” childbirth experience, I will probably go the c-section route. Partly because uterine rupture, no matter how small a risk, scares the bejeezus out of me, and partly because I don’t think I could handle going through labor again only to end up with a c-section AGAIN. If I do go with a VBAC, I can’t be induced, either, so I might not even get the chance.
Do whatever feels right for you. Good luck, Liza!
June 27th, 2008 at 7:44 am
P.S. Kara was a full week late before we decided to induce. Was Noah on time? I can’t remember.
June 27th, 2008 at 7:58 am
Frema, Noah was also a full week late.
Aunt Anna, the thing about the c-sec is that abdominal surgery does a number on your core muscles. So it isn’t just about pain, but about moving pretty much your entire body, except maybe your arms & head.
June 27th, 2008 at 8:17 am
Hi Liza,Auden is 11 months old this week, and we are talking about the second. Before I ever got pregnant with him, I dreamt very very clearly that I had two boys. So for us the question is less around boy or girl, and more on the very questions you raise in this post. At the outset with Auden, I opted for natural childbirth (no epi) in the hospital. At the end, his heartrate started to tank, and they did an emergency c-section. All the gorey details are on my blog if you’re interested. But in short, because I didn’t have the epi, I had to go into general surgery. It was horrible for Steph because she couldn’t be with me, she ended up with baby first (terrifying), and worst of all I missed the birth. So … I’m not even pregnant yet and we’re having the same conversations! I would like to do VBAC, but there is a part of me that is so tempted by controlling the timing and the extra two weeks off. Funny that you mentioned those two things as well! Right now I am leaning towards VBAC, but this time with an epi so that if I have to have surgery it won’t be a crisis, I can be awake and there with Steph, so I can meet our baby right away. I am already putting money aside so that I can still have those extra two weeks, in the case I am successful with the VBAC. I wish you luck in making your decision - I know it will be tough!All best, Natalie
June 27th, 2008 at 8:22 am
I have the same questions myself. I had a c-sections after trying to push out my son for 3.5 hours. I developed a fever and it was either forceps or c-section. Obviously I didn’t want to take the chance with forceps. My recovery was absolutely horrible - I have never been in so much pain in my life. This is making me lean towards a vbac with my next child, but at the same time, I know the recovery of a planned c-section isn’t as bad, so I’m torn (no pun intended). I already have a scar - do I really want to blow out my cooter, too? I’m curious what people will say in your comments - maybe it will help me make my decision, too. Good luck with whatever choice you make!
June 27th, 2008 at 9:03 am
I had an emergency c-section with my first, and a scheduled c-section with my second, just because I was wayyy too afraid of repeating the labor/c-section combo I had with my first. That being said, this time around I’m somehow a little braver and thinking with a more open mind. I have considered a VBAC, and I think if this were my second baby instead of my third I really would go that route. I have two other children to care for, feed, play with and drive to school, and I live in a tri-level style house (can’t wait to try the no stairs thing, ha!) so having a lighter recovery is a beautiful thought. But all in all I can’t get over the possibility of a rupture, or of exhausting myself with labor again only to end up in the OR.
I’m tentatively scheduled for my third c-section between the 8th-10th of September. The recovery from my second (scheduled) c-section was easier than the first, I have to say, because with two kids I just didn’t have the luxury of focusing on my pain or limitations. Here’s hoping the third one is even smoother. (EEK!)
June 27th, 2008 at 9:43 am
LIza- My partner had our first, and I had the second, and Julia has a heart condition that neccessited a c-section. I have to say, I LOVED having the c. Just like you said, we left Spencer with one set of grandparents, my parents and partner came to the hospital and we went in all ready for it to happen. Now, maybe because I had an infant in the NICU I was up and at em very quickly, and I have to say, the only problem I had was that I had a cough going into the surgery, so coughing afterwards was tough and painful. Other than that, if you make up your mind that you’re going to recover quickly, you probably will. I, too, had a 3 and a half year old at home, and we just made sure that he knew that if he needed to be carried, it wasn’t going to be from me! I also think I drove fairly soon afterwards, probably a week. And I went back to work six weeks later.
That’s my two cents, I wish you luck in whatever you choose…
June 27th, 2008 at 10:31 am
I’m on my first pg, but with twins am having to weigh my options on this as well. Less risk of rupture since I’ve never had a c/s, but there’s the not inconsequential risk of having twin A vaginally then going to c/s for twin B. Argh. Of course, one/both could be presenting inappropriately by then, which takes the choice off of the table. Oh, and did I mention the slightly increased risk of anoxia/brain issues for vaginally-born twin Bs? Ai yi yi.
No advice, but I feel ya.
June 27th, 2008 at 4:45 pm
Liza that was such a thoughtful and well-considered post. It demonstrates why this is definitely a decision you two will make wisely. I say go with your gut. Since there are issues either way, and I know you to be a wise and thoughtful person, I think the two of you will make the right decision FOR YOU. I’m sad that you even had to say “don’t judge.” What could be more personal and in what decision could a couple be more certain to find the answers? Especially since you have the experience of a C-Section you know what you’ll be dealing with and can make arrangements to ease the way.
Someone once told me that childbirth is the door and the rest of life with the baby comes after you walk through it. Once the health issues are resolved, the answer will come to you and you’ll wander happily into the room that is the rest of your life with Jill, Noah and Esmerelda.
June 27th, 2008 at 6:15 pm
Klove is having the same dilemma (should she get pregnant again and carry to term). To vbac or not to vbac. In her case the baby never descended, Klove’s hips never spread. This time that could be different. Klove also had a very easy, fast recovery from her C, and she’s heard that scheduled Cs are even easier to recover from. But.. we had such a bad experience being trapped in the hospital for that 4 day recovery time that the idea of only being there 2 days seems like a dream. And, Sassa is such an active child…
we’ll be watching what happens with you two and taking your experience into factor. And never judging.
June 27th, 2008 at 7:24 pm
Thanks for all the wonderfully supportive comments, everybody!
Chicory, you don’t HAVE to stay in the hospital for 4 days after a c-s. Older Experienced Midwife told us that her daughter left after 2 days, following her 2nd (scheduled) c-s. Personally, I was miserable and frustrated on day 4 — that was the day the nurse made me cry — and imagine that with a scheduled c-s, I would probably leave on day 3.
I’ll keep the blogosphere posted as we sort this out.
June 27th, 2008 at 8:14 pm
I trust you will make the decision that’s right for you and your family. I’m just glad that you got to talk about it with the other MW, because the first MW’s opinion never sat right with me. There are risks and benefits (big and small) to both choices and I wish you a peaceful and joyous birth in whatever form it comes.
June 29th, 2008 at 12:20 am
Hi Liza!
I think just letting the time go by is an excellent option. You can let the babe grow and grow. If you don’t go into labor by your due date — then consider the c-section more seriously. No one is going to try to induce you.
IF you do go into labor you’ll know really quickly if you want to go for it or not. The doctor on call will do whatever you want. I didn’t go into labor on my own for either of my boys. If I had had a c-sec with Freddy, I would probably have had one with Andy just because I couldn’t get myself into labor.
I love you lots! Best of luck with the decision making.
Madelaine
June 30th, 2008 at 5:58 am
Liza-
Both of my deliveries were scheduled c’s, one at age 34 and the other at 38. A prior surgery on my uterus put me at risk for that “catastropic” uterine rupture. (My ob used the same term as your midwife).
FWIW, The second c was much easier than the first simply because I knew what to expect. I asked for the drape down because I wanted to see my baby immediately, like the nano second she came out. I went home after 2 days and recovered nicely at home versus the 4 day hospital stay with my first. With #1, I was religious about the stairs rule, but with #2 I was more relaxed. Case in point, by day 6 postpartum, I was out at Restoration Hardware looking for bathroom lights for our almost finished bathroom. (BTW, don’t undergo serious remodeling in your third trimester). I didn’t drive, but I was much more mobile.
Like you, I got the 2 extra weeks of short term disability for a c and really appreciated it.
I would have given anything for a vaginal delivery, but it just wasn’t meant to be. So I made the best of my scheduled c’s.
I don’t envy you having to make this decision. But whatever you and Jill decide, it will be right for your family.
July 21st, 2008 at 10:57 pm
I was just making felt food & thought I’d read some of your archives, so sorry if you’ve already made this decision. I have experience with c-sections & VBAC. I had an emergency c-section with my first (weird thing with the placenta, never actually went into labor, but regardless needed a c-section RIGHT THEN). I really wanted to have the whole “child-birth” experience (crazy, I know). And I had to fight really hard to get it. There were issues finding a doctor (only one practice in northern NV does them), getting insurance approval, etc. I’m really glad I did the VBAC, and I would do it again. But if you’ve already had a c-section, you know what you’re getting in to. I wish you the best! Whatever you do will be the best decision! (Let me know if you have any questions about my VBAC, I’d be happy to chat!)