Before You Schedule Your Repeat Cesarean Learn About VBAC
VBAC stands for vaginal birth after cesarean. I have so much to say about VBAC. The problem that I am having is that there is so much information that I want to share with all of you but it would be irresponsible of me to rewrite the book (or books and websites and references in the case). It would be irresponsible because I would never be able to do as good a job as the people who have already laid the groundwork and let’s be honest, I make enough grammatical errors on this blog that it makes me hope my old high school English teacher doesn’t stumble upon me somehow.
What I am going to attempt to do instead is provide you with the information you need. I am going to kind of give you a quick reference list, point out some facts and point you in the direction of all the rest of the information that you could need to make an informed decision and make the necessary plans to have a successful VBAC. it’s really sad that it has to be laid out that way really. We should just be able to go have a baby after a previous cesarean without having to plan our way into it but that’s life and the world (or country rather) that we live in.
One of the best references for VBAC information that I have found has been this site. Jennifer is AMAZING, a wealth of information, an advocate for all birthing women, a force in the VBAC community and really she is just very nice to chat with. On her website, she has a quick facts page on VBAC vs Cesarean. Below is what is on the page…
Quick Facts – VBAC vs. Repeat Cesarean
If you have had a cesarean, your next baby can be born vaginally safely. This is called a VBAC or vaginal birth after cesarean.
The risk of uterine rupture (UR) after one “bikini cut” cesarean is 0.2% – 0.4% and the risk of infant death or injury is 0.05%. (Landon 2004, Gonen 2006, Cahill 2006)
Risk of miscarriage from an amniocentesis is 5 – 20 times greater than the risk of infant death or injury from a VBAC. (March of Dimes, Landon 2004)
A repeat cesarean section (RCS) lowers your risk of UR in your current pregnancy, but it does not eliminate it.
Additionally, the risk of complications increase with each RCS including your risk of UR in future pregnancies, whereas the risk of UR decreases by 50% after your first VBAC. (Mercer 2008)
In all 50 states, hospital and doctor attended VBACs are legal and in some states it is legal for a midwife to attend an OOH (out-of-hospital) VBAC, yet 90% of women have a RCS due to misinformation, hospital VBAC bans, and unsupportive medical professionals.
RCS risks to the mother: infection, prolonged pain, hysterectomy, hospital readmission, adhesions (internal scar tissue), infertility, hemorrhage, pulmonary embolism, heart attack, stroke, and death.
The CS rate in the US is 31%.
The World Health Organization says that 1/2 to 2/3 of these surgeries are unnecessary and contribute to our high infant and maternal mortality rates.
VBAC has risks.
Repeat cesarean has risks.
Be sure to understand the risks and benefits of VBAC versus the risk and benefits of repeat cesarean.
Read a letter written by two doctors supporting VBAC and opposing a VBAC ban.
Read a letter written by a certified nurse midwife supporting VBAC and opposing a VBAC ban.
Take the time to find a VBAC supportive provider.
Having a repeat cesarean does not guarantee a good outcome for you or your baby.
Read…
* Dr. Marsden Wagner’s Born in the USA: How a Broken Maternity System Must Be Fixed to Put Women and Children First,
* Ina May Gaskin’s Ina May’s Guide to Childbirth,
* Henci Goer’s The Thinking Woman’s Guide to a Better Birth, and
* Dr. Sarah Buckley’s Gentle Birth, Gentle Mothering: A Doctor’s Guide to Natural Childbirth and Gentle Early Parenting Choices…as well as these articles from vbacfacts.com…
* I’m pregnant and want a VBAC, what do I do?,
* The Three Types of Care Providers Amongst OBs and Midwives,
* Homebirth vs hospital birth for the number cruncher,
# VBACing against the odds, and
# Comparing fetal death and injury: VBAC vs. amniocentesis/CVS.Look for VBAC Classes presented by VBAC Facts in your area.
Find further information and support at http://www.childbirthconnection.com, http://www.ican-online.com, and http://www.midwiferytoday.com.
Also be sure to read this post. If VBAC is so safe, why does my OB say it is dangerous?
Here is a very inspiring video of a woman who suffered a miscarriage, had c section because ‘her pelvis was too small’ then had a successful VBAC. Watch Dana’s story here.
Often times women how had a cesarean the first time around are afraid of vaginal birth the second time around. More so that if they were first timers. The key to resolving these fears are to learn as much as possible. Research the facts. Read VBAC birth stories. Get inspired. Believe in yourself. Believe in your baby and your body. VBACs are not high risk, don’t let anyone tell you they are. ACOG (American College of OB/GYN) recommends VBAC over repeat cesarean and even says that it’s safer.
What are some of the risks of cesarean?
* Infection: Infection can occur at the incision site, in the uterus and in other pelvic organs such as the bladder.
* Hemorrhage or increased blood loss: There is more blood loss in a cesarean delivery than with a vaginal delivery. This can lead to anemia or a blood transfusion (1 to 6 women per 100 require a blood transfusion1).
* Injury to organs: Possible injury to organs such as the bowel or bladder (2 per 1002).
* Adhesions: Scar tissue may form inside the pelvic region causing blockage and pain. This can also lead to future pregnancy complication such as placenta previa or placental abruption3.
* Extended hospital stay: After a cesarean, the normal time in the hospital is 3-5 days after giving birth if there are no complications.
* Extended recovery time: The amount of time needed for recovery after a cesarean can extend from weeks to months, having an impact on bonding time with your baby (1 in 14 report incisional pain six months or more after surgery4).
* Reactions to medications: There can be a negative reaction to the anesthesia given during a cesarean or reaction to pain medication given after the procedure.
* Risk of additional surgeries: Such as hysterectomy, bladder repair or another cesarean.
* Maternal mortality: The maternal mortality rate for a cesarean is greater than with a vaginal birth.
* Emotional reactions: Women who have a cesarean report feeling negatively about their birth experience and may have trouble with initial bonding with their baby5.
Risks and Complications for the Baby:
* Premature birth: If gestational age was not calculated correctly, a baby delivered by cesarean could be delivered too early and be low birth weight6.
* Breathing problems: When delivered by cesarean, a baby is more likely to have breathing and respiratory difficulties. Some studies show an increased need for assistance with breathing and immediate care after a cesarean than with a vaginal delivery7.
* Low APGAR scores: Low APGAR scores can be the result of anesthesia, fetal distress before the delivery or lack of stimulation during delivery (vaginal birth provides natural stimulation to the baby while in the birth canal). Babies born by cesarean are 50% more likely to have lower APGAR scores than those born vaginally8.
* Fetal injury: Very rarely, the baby may be nicked or cut during the incision (1 to 2 babies per 100 will be cut during the surgery9).
What are some of the risks of VBAC?
• Rare major complication of uterine rupture, which can lead to emergency surgery, possible blood transfusions for mother or baby, possible hysterectomy, and even death of the baby or mother.
• Greater risk of uterine infection for mothers who have labor and then cesarean.
• Risk of repeating prior negative experience if cesarean becomes necessary.
• Risk of need for emergency cesarean, which is more frightening than a scheduled cesarean and has a somewhat greater risk of complications.
Why VBAC?
Because with every cesarean, risks are increased for subsequent pregnancies. Because the way we birth does matter. Maybe there are a few women out there that are completely unscathed by their previous cesareans but that’s not true for most of use. We deserve that sense of accomplishment. We deserve the immediate bonding period with out baby. We deserve to have the faster healing time. Our babies deserve a more gentle entrance into the world and deserve the chance to avoid the risks associated with cesarean. We should experience giving birth to our children. It matters.
You may have to work hard for a VBAC. You may have to change doctors. You may have to go to another state or go to another country. Which by the way, mamaseoul also has a very good post on planning a VBAC here. If you want a VBAC or you seriously do NOT want another cesarean, you have to commit. FULLY commit. Not a little but 100%. You have to be willing to do whatever it takes. For some people in some places, it doesn’t take much. For others, they have to fight tooth and nail or even hire a midwife and HBAC (homebirth after cesarean), which by the way, is not risky contrary to popular American belief.
If you are currently pregnant, please, go from here and learn. If you don’t know your options, you don’t have any. If you have a VBAC story, please comment and tell us!
Doula Momma 
This is so important:
“Often times women how had a cesarean the first time around are afraid of vaginal birth the second time around. More so that if they were first timers. The key to resolving these fears are to learn as much as possible.”
I find that it is so hard for women to move back toward a neutral point of vaginal birth once they’ve had a c-section. Many times, like you noted, it has been their first birth and they find that CS’s are “easier”. I. having had a Vbirth, would tell you that vaginal is easier. Of course there are people who swear that their personal first method was the hardest but for the most part, I think that what we first experience is what we know and it is what we promote.
iwriteinbooks
June 12, 2009
P.S. Obviously you are exempt from this as are most people hounding after VBAC info!!! BUT I find that my friends and clients er on the side of what they know.
iwriteinbooks
June 12, 2009
Thanks! I knew what you meant and you are so right. What you have done already fosters a sense of familiarity and security and venturing back into the unknown is nerve wracking. Why couldn’t I just say that in the post?
doulamama1
June 12, 2009
Hi I think this is a fantastic blog, keep up the good work…
Sarah
June 13, 2009
Great list of resources. I used some of those books and had a very successful vbac with my second
Kelly
June 14, 2009
Thanks Kelly. Congrats on your VBAC, that’s wonderful.
doulamama1
June 14, 2009
Thanks for this list. I find it helpful to have all in one spot. I am doing lots of reading in regards to HBAC. First experience (vaginal birth) in hospital was traumatic, 2nd cesarean birth was fine, what do you have to say about VBAC 12 mos after cesarean? I’m having trouble finding info on this…
Lauren
June 29, 2009
I have had a hard time finding this info as well. I have heard everything from 6 months to get pregnant again (which would make the VBAC about 15 months after prior c/s) to two full years. I searched ACOG and APA and couldn’t find a recommendation. I have read many a birth story of a successful VBAC one year later. As for HBAC, I am the HBACing type as well. If I hadn’t of had a t incision the first time, I would be HBACing for #2. I need one successful VBAC under my belt first. Here is a good article discussing HB vs hospital birth
http://vbacfacts.com/2008/09/06/homebirth-vs-hospital-birth-for-the-number-cruncher/
I have also read a good bit about proper nutrition to strengthen your uterus. Protein and vitamin C are very important. Ann Frye discusses this as well as HBAC here
http://www.gentlebirth.org/archives/vbacfrye.html
Good luck!
doulamama1
June 29, 2009