VBA3C........thoughts?

[Tan09]

Hi Folks!

Just wondering about your thoughts on a vaginal birth after THREE(3) c-sec's???

1st csec - preclampsia
2nd csec - elected (too scared not to. never really told about VBAC)
3rd csec - vaginal varicose veins....hideous!
4th.......????

I really feel like I've missed out on birthing 'naturally'. At the end of the day though I only care about a healthy baby but still would like to try for a vaginal birth.

TIA

[beej]

You might have great difficulty finding an Ob who will support your wishes, same for a midwife based program. I raised the idea of a VBA2C with my Ob and he fairly firmly said he wouldn't do it on his watch. Basically risks to mum and bub, and the legal implications if things go drastically wrong.

This was just one opinion, and probably more biased coming from a private Ob. I know there have been cases of lady's having a successful VBA2/3C's. Whether my Ob is into scare mongering or not, I'm not sure. I tend to trust his judgment and medical opinion.

Research will be your biggest ally if you do want to present a case to a caregiver. So, the more you research the better.

I hear you on feeling like you've missed out on the natural birth! Had I have know what I know now about DS1's birth and reasons for the emerg c/s I would have been more determined to try for a VBAC with DS2.

[Bree84]

Hi,
This is just my opinion so no-one crucify me please.
I had a c/s with my DD. She was a breach (transverse) baby. There is NO way I could have pushed her out naturally as she would have been bum first. My OB wouldn't even give me the option - and in a way, I was grateful to have the decision made for me.
At my 6 week check-up, I discussed the options for future pregnancies. While my OB said he would happily support a VBAC, if I was his wife he wouldn't let her have a VBAC; there were too many risks and he wouldn't subject a family member to this. After hearing this, our (DH and mine) minds were made up.
For future pregnancies, I will be having a CS.

[Japh]

I would talk to an IM about it as well as an OB if that's what you will go though with as your care provider. If you go public you have a better chance of a successful VBAC and your chance is pretty much non existent through private care. Very high chance of success through homebirth.

However if you go the hospital route be informed independently of your care provider/s and understand that you have the right to say no to whatever you don't want.

VBAC after any number of previous sections is a great deal safer in MOST cases that repeat MAJOR abdominal surgery. Most obs will try to scare the crap out of you with statistics of rupture though the truth is that the chance of rupture after section is only marginally higher than a first time pregnancy. MOST obs are more worried about their $$ than you.

Whatever you decide you need to be comfortable with. A VBAC will unlikely be successful if you are scared or unsure. If you do go the VBAC road hire a doula - they can be worth their weight in gold.

Good luck I hope you get what you want

[MrsL]

If it were me . . . i wouldnt even try a VBA3Cs . . the risks would be way too high . . . having a VBAC - even after having 3 babies already is like a first timer giving birth and all the stress it would cause your scarred uterus is worrying. There is no way any1 can deny that scarred tissue is weaker. This in turn x 3 would put pressure on that scar tissue.

You can go ahead and do this - even homebirth . . but bear in mind that if your given say an 80% chance of being ok (not having the uterus rupture) then just remember that there is another 20% who are not ok . . . that the baby or mother doesnt make it. People do die in child birth, babies do die in child birth, even in our 1st world country. So we may like to believe we're not going to be one of the unlucky ones, but you cannot expect this. Is this a risk your willing to take? Will you put your life and your baby's life on the line just for your desire to have a natural delivery??

And i've got to tell you, i WISH i was able to have a VB, but on both occasions it really wasnt an option if i wanted living babies and this is the cold hard truth. I am sad about the whole affair, but i know there was nothing i could do to change the situation . I am just grateful i have two beautiful boys.

So dont go thinking any less of yourself just because you werent able to deliver your babies naturally . . . there is no shame in having a c-sect and it doesnt make you less of a woman. It doesnt really matter a whole lot how your baby came into the world, just that they arrived safely.

[Beckyb79]

I think it should be taken on a case by case basis and it is hard to gage without knowing how thin the scar is.

Had a simular conversation with my obs last wk. I've had 2 previous CS. She told me that in theory a VBA2C is possible, but in my case the morph scan showed that the scar is thin (less than 3mm) and therefore there is a greater chance of rupture. I'm not willing to take the risk but if the result had shown differently I would consider it.

[livelaughlove]

I think that when looking a the research evidence, the risks of a VBA3C are much lower than the risks of repeat surgery. If you google "QLD health cesarean consent form" it will tell you what risks you sign up for when you elect for MAJOR surgery - many of these risks increase with subsequent surgeries,

[livelaughlove]

I think that when looking a the research evidence, the risks of a VBA3C are much lower than the risks of repeat surgery. If you google "QLD health cesarean consent form" it will tell you what risks you sign up for when you elect for MAJOR surgery - many of these risks increase with subsequent surgeries, particularly those involving the placenta. As much as we are led to believe cesarians are safe, there are actually very real risks involved. One of the risks mentioned on the consent form is death. So don't think you are being selfish and putting your experience before your and your baby's health - do your research and you may be surprised. The maternal mortality rate has actually increased with the increase in the cesarean rate, with little change in the infant mortality rate. Cesareans can be life saving, but they can also be life threatening, which is why many women who have had numerous babies are told to stop having more. Also, the risk of uterine rupture after 3 Cesareans is NOWHERE NEAR 20%. It has been shown the risk increases just slightly. I don't know off the top of my head but I know after one cesarean it is about 0.7% - many of the risks

[livelaughlove]

...of cesarean are much higher. I think for 3cs you mIght be looking at maybe a 1-2% chance of rupture (whIch, interestingly, is an emergency but actually carries a very low mortality rate). That means a 98-99% chance of NOT rupturing. Do the research, it's plentiful, then make a decision based on fact.

Best wishes x

Oh, and if you decide to have a VBA3C, find support from other women who have been there.

You will be hard pressed to find someone to support you in hospital (except a dOula), the VBAC success rate in most Australian hospitals is under 10-15%. And that includes any number of cesarean. Your best chance for success is having an independent midwife (homebirth, or take one to hospital with you), that's what the stats say.

[gecko]

Good luck Tan09,
My OB (in Brisbane) did say that he was fine to allow VBA2C (although did say no to VBA2C twins or a breech). And my successful VBAC was actually at a private hospital (with a ex-doula/student midwife)

If it was me and I was interested I would visit the hospitals (if that is where you intend to birth) and ask the midwives if they have had any attempts and (if private) who the OBs were.

When you read the studies looking at the incidence of uterine rupture from a VBAC, the risk is not that different than from a regular birth. There is a surprisingly large amount of medical journals that look at VBACs and it is not all against it.

Good luck