VBAC

Vaginal births after cesarean section seem to be pretty rare, if not looked-down on today.  In my experience, talking to friends, once you've had a cesarean surgery you will always have a cesarean.  It seems to be the way most women think.

If you prefer a repeat cesarean, that is just fine -- again, this is your baby, your birth, your family.  But make sure you have done your research before deciding one way or another.  This is important no matter what you choose; preparing to welcome a second baby into the world after your first was delivered surgically tends to heighten the emotion and tension already present.  You must be confident in what you are deciding to do.

I have a wonderful pamphlet bursting with information that you can order at www.choicesinchildbirth.com, and one article by Nicette Jukelevics MA ICCE deals directly with VBAC.  She says that as recently as 1995, one out of four women with a prior cesarean had a vaginal birth.  Today that has jumped to one in ten.  Why the change?  A frustrating but realistic truth is that obstetricians do meet a lot of resistance with their malpractice insurers to cover a VBAC, and cesareans are quite a bit more profitable.  They must also consider that repeat cesareans are a far simpler procedure than initial cesareans.  For us, there are many fears that have been widely publicized and blown out of proportion.

Probably the most well-known fear with VBAC is that of a uterine rupture.  This actually only happens in 0.01% of women.  Many of us also think that the more children we have or the longer we wait, the weaker and weaker that scar becomes.  This is not true.  If you deliver a child vaginally after a cesarean, your likelihood of delivering vaginally greatly increases with any subsequent children.  This could partially be due to the confidence in your own body's abilities finally won.  When deciding, it would be a good idea to ask what kind of stitching your doctor used when repairing the cut.  My trainer, Ellie Shea, R.N., told us that most doctors do a double-layered suture, but today more and more are doing a single layer to save time.

There are many pros and cons to having a VBAC or a repeat cesarean, and it is important to list them out and rate what matters most to you.  If I were in the situation, this is a list I might make:

VBAC
pros

• Gain confidence in yourself and your body.
• Number of children you want will not depend on the number of times your uterus can be cut and healed
• Time required to heal decreases.
• Opportunity to breastfeed immediately, have skin-to-skin contact, and be able to care for your baby immediately is more likely.
• Fewer visible scars.
• Be an active participant in the birth of your child.

cons

• Fear of a cesarean could slow labor, making cesarean more likely.
• An epidural might be necessary should a quick cesarean be needed (this could be a pro, depending on your point of view).
• Feelings of failure/inadequacy should the labor end with a cesarean.
• If the uterus ruptures, there is a 5% chance the baby will suffer loss of oxygen or death.
• Pitocin and cytotec should not be used, as they can increase the risk of a uterine rupture.  A natural labor decreases the risk of uterine rupture far far below 0.01%.  (Could be a pro, depending on your point of view.)
• Limits your option of hospitals; many refuse to do a VBAC.  A hospital that has access to quick cesarean surgery will be your best option.

REPEAT CESAREAN
pros

• Will not feel labor pains.
• Emotional stability -- when you plan on a cesarean, you will not feel cheated out of a vaginal birth.
• Guaranteed your doctor will be available.
• Can schedule your time around the birth.

cons (taken from the article by Nickette Jukelevics)

• Higher risk of infection, adhesions, intestinal obstruction, chronic pain, ectopic pregnancy and placental problems compared to mothers who have a successful VBAC.
• Increased risk for hemorrhage severe enough to require a blood transfusion due to placental problems from accumulating cesareans.
• Higher likelihood of being re-hospitalized for complications related to the surgury
• Decreased fertility and increased risk of miscarriage in future pregnancies
• Greater likelihood of difficulty with mother-infant attachment as well as establishing and continuing breastfeeding.
• Elevated risk for prematurity and serious neonatal respiratory problems in baby.

There is a lot to contemplate when deciding on a VBAC or repeat cesarean.  Once again, I cannot stress enough the importance of doing your own research so you can feel confident in the choice you made.  However your baby enters the world, there will always be risks.  Should something happen, more than anything, the baby will need you.  Be sure that you are emotionally and physically taken care of, so you can take care of that little one.

Websites with more information:
http://www.pregnancytoday.com/articles/complications-cesareans/the-pros-and-cons-of-vbac-4853/
http://www.dangersofcesareanbirth.com
http://www.vbac.com
http://www.childbirthconnection.com