Can you have a VBAC after 2 sections? or 4 sections?

[debliz5]

Hi girls,

I'm pregnant (33 weeks) with my 3rd child. My 2 other births were c-sections due to breech babies. This time, my baby is not breech. I'm toying with the idea of having a VB, as the MW told me it could be possible, but need to talk to the doctors and talk about all the risks.

In 2 weeks, I'm meeting the doctor who is supposed to tell me all and decide on which birth. Of course, on the other hand, I'm scared to death to try a VB, after all, there are huge risks.

The main reason for me to consider it, apart from quicker healing, is that I might want a 4th child, and don't want to close this option. Has anyone had 4 sections? The hospital MW told me that in their hospital she hasn't heard of a 4th c-section (Amsterdam hospital).

Any information and personal experience will definitely help me!

Thanks

There are a couple of mumsnetters who have had VBACs after two or maybe even three c-sections.

I personally know a few women who have had four or more c-sections - it's very possible.

Keep this thread bumped , and I'm sure you'll get some good advice.

Yes, you can have a VB after 2, 3 or 4 sections. No doubt some MNetters will have, and also there is a fab yahoo group focussing on VBACs which will give you lots of advice (although they are a bit HB biased).

This is a link to the group

Obviously they're mainly UK ladies, but our bodies are the same anywhere I had a VBA1C, and although I was scared by the risks, I felt comfortable taking them once I'd done a lot of research.

HTH

I have had 2 vba2cs, you can do it but you have to want it as you will come up against opposition, I changed docs and hospitals but it was so worth it

go onto the ukvbachbac chat room on yahoo, loads of support and advice there as well as loads of ladies who have had vbacs.

A new book out called Vaginal birth after caesarean by Helen Churchill and Prof Wendy Savage - ISBN 978-1 904750 21-5 might be worth getting.

Loads of threads on here do a search for vbac, ask some of the doulas on here for advice as well.

Good Luck

Cross posts, I waffled on for too long

FourArms is right, they are quite HB biased but I had two hospital vba2cs which were on my terms and suited us

I have had two sections and if were to have another child I would definitely go for a section. I'm not comfotable with the possible catostrophic consequences of a uterine rupture. It is rare. But the consequences are too horrible to even contemplate.

www.emedicine.com/MED/topic3746.htm

You should talk to MNetter Lisalisa who I believe has had 5 sections. nd there are others, but I can't think of their names off hand.

Also, there is a yahoo support group you might want to check out: groups.yahoo.com/group/Auterinerupturesupportgroup/

I'm sure there was a case in the news of a women having 13 c-sections.

I had a VBA3C and tbh, initially my main reason for doing it was because I considered the risks of a VBAC to be statistically lower than a 4th CS.

On saying that, you can have as many caesareans as you want. No one can force you to stop having babies, and whilst the more CSs you have, the more risks there are of things going wrong, it's still up to you.

But wanting to make sure you are increasing your chances of having more children in the future is a pretty good reason for having a VBAC, if nothing else

Thanks for your answers. riven and vbacqueen, could you tell me more about your experiences? i.e. what did you do to higher the chances for a successful VBAC? how did you prepare for it? how long did it take? and vbacqueen, what did you consider when you say the risks of VBAC are lower than a 4th CS?
Thanks a lot!

I went for a VBA2C with DS2 but I had placental issues and wasn't willing to wait past 41weeks so had to have a CS (Induction is contraindicated with VBAC's)
However, I'm planning on ttc in about 12 months (ds2 is 14 weeks) and will be looking at going for a VBA3C.
The risk between a VBAC/VBA2C&VBA3C is pretty much the same.
Approx 1-2%(MAX) of uterine rupture. Interestingly cord prolapse has roughly the same risk but isn't used to make first time mothers not have VB's.....

YES YOU CAN!

take a look here for VBAC articles. their book on vbac is also worg buying

www.aims.org.uk/

For the comparison of risks between VBAC and repeat CS have a look here and here and here

Learn as much as you can about the processes involved in natural childbirth - I'm a big believer in letting nature do what it was designed to do. The balance of hormones and natural endorphins is pretty delicate and easy to interrupt - once you understand how it all works, it's a lot easier to see how medical interventions can disturb that balance. Have a look at this to see how.

Oh, and get a doula

Hypnobirthing can be very effective too, especially if you have issues surrounding your previous births.

Hope that helps.

Yes you can have a VBAC after 2 sections, but equally (as others have said) there is no particular reason why you wouldn't be able to have 4 sections if you want to have another child, so don't feel you have to have a VBAC if you don't want to just because you want to have 4 children. After my second section I talked to the consultant about this and he said that the '3 sections' limit is a complete myth these days now that sections are all LSCS. There are rare cases where there can be problems, but my consultant said the cases where they would actually advise against having further babies are almost unheard of, if there is some thinning of the uterus or they think the pregnancy might be slightly higher risk then they tend just to monitor you much more closely. I was reading a discussion on the babyworld website the other day started by somone booked in to have her 5th section!! Good luck with whatever you decide

just one other thing to think about.

c/s can increase the risks of fertility problems in any future TTC attempt (obviously not a problem so far )

also c/s can increase the risk of placenta previa & placenta accreta (this can be life threatening for mum)

The risks aren't huge, but I'm not sure if there is an increased risk the more c/s you have - perhaps something to ask the consultant about.

Occasionally they do advise no more babies - this happened to the woman in the next bed to me after my c/s no 2 (failed VBAC, long story) - she'd had 4 c/s in 5 years - she was a m/w too, so I don't think the doctors would be saying that to her unless there really was a problem. They were concerned that her uterus was very thin in places & very scarred & would be best not to have any more (she told me no 4 was an accident anyway, so I don't think they were planning on any more!)

I was going for a vba3c but ended up in a real emergency situation at 34 weeks.I ended up having my son by emergency section due to my body going into labour and my baby bein in distress. I was so lucky as my scar was giving way and i was unaware of the fact that i was in labour due to the pain i had been suffering in the days leading up to his birth. All i would say is do all your research but do be aware of the risks. I cant have anymore babies now which im finding hard, not because i want more but because its been taken away from me. Do what is right for you.

Thanks again girls, for your answers and the information. I shall definitely look in to it. I keep on thinking of just going for the CS and not risking a difficult birth, where the baby could get into distress and so many things can go wrong. I've never given birth naturally - my body will treat this as a first birth where things go slower...
well, as you can see I'm quite confused about it all.
gemprincess, sorry to hear about your experience. I hope you and your son are OK now. I am 34 weeks now. What pain did you have? I have had a virus the last few days with vomitting and diarria and I'm all achy. I Was actually wondering perhaps I'm in labour and don't know it... Thanks for sharing it with me.

Hi I had a water birth at home after 3 caesareans, it was wonderful. I went on to write "Birth After Caesarean" which is available from www.aims.org.uk and its the book I wish I'd had when trying to find the evidence about VBAC.

we are doin well thanks. my little boy has a few health problems and is receiving good care from his consultant etc. he had his 2nd brain scan 3 weeks ago and all looks positive.i was huge in this pregnancy and it was not picked up till last min that i had excess fluid,this all put too much strain on the scar. i was havig strong braxton hicks for a few weeks and in the last week b4 his birth i could not get in and out of bed because severe pains. the consultant i was under said it ws just the scar pulling. i accepted that untill day he was delivered, i knew then something was wrong and listened to my body. i hope yoy get the birth you want and either way just enjoy it, isten to your body.

I heard my name mentioned.....

And I also know someone personally who's had 10 sections.

the docs reckon its a bit of a myth the magic 3 sections and you're out bit. It's old fashioned adbvice and the best way to check if yo ucan have another one is to ask the doc whilst he's attneding to you after baby is born. He can have a good look inside and let yhou know how much scar tissue and how strong your uterus is or is not.

I would love to have vbaced -even after one section ( back in 1998) they told me I'd have to be continually monitored meaning I could'nt move around etc . Eventually needed another one due to pre eclampsia as could'nt labour naturally . AFter 2 sections my fate was sealed ( then - I understand things are different now).

Umm, take issue a bit with the word "myth" being attached to 3+ LSCS. The major maternal risk is the increase in placenta praevia (where the placenta implants over the scar) rising from 3% where 3 prior LSCS to 10% where you have 4 or more prior LSCS.

This can mean vaginal birth is not possible, as the placenta obstructs the cervix, and means that the surgeon has to cut through the placenta to access the uterine cavity to extract baby. Not a fantastic manouvere I'm sure you can imagine, and one that rather increases the risk of significant bleeding.

And if you have a placenta praevia, there is a risk that not only is it in the wrong place, it invades the uterine wall abnormally, and goes too far, making it very very adherent, and difficult to get out, making you bleed. If you have a praevia, and you are on your 2-3rd section it is actually accreta in 40-50% of cases. If you have a praevia and you are on your 4th section, it is actually acreta in 65% of cases.

Stats from a review article in clinical obstetrics and gynaecology 2002, vol 35 (2) page 330, author Dildy.

So although it is not impossible (obviously given the testamonies on here) to continue having LSCS, there are real increases in the risks at delivery. Blood transfusion, blood product transfusion,and all the risks associated, critical care admission, and radical surgical salvage (hysterectomy) become more likely.

Apologies for doom mongering. I am an anaesthetist, and it is pant-wettingly frightening to have a young woman bleeding out in front of you, especially one that has a new baby waiting for her.

Thanks again for you replies.

I think apart from having a lot of information, I need to speak to the doctor at the hospital I will be giving birth at. The big questions is how many VBACS the hospital has successfully performed and what they think my chances are.
Thanks Pinkveto for the more medical/personal side. It is another important issue to ask the doctor. What is your recommendation? is VBAC2 safer than a 4th c-section?
As far as I know, I don't have scar tissue (nearly at all) and never had any problems with either of my births (still have a month to go though, hope nothing can go wrong now...). Does this higher my chances to a healthy 3rd CS and concequesntly a 4th, or perhaps this can also higher my chances of having a successful VBAC?

A lot of questions...

Thanks again!

I have had 2 sections. I was told that my uterine wall is very thin. After the second section they said that if I wanted a 3rd section then that was probably OK, but they would do it at 37 weeks to try to reduce the risk of rupture.
I was advised to have no more than 1 more section (so that would be 3)
So, as people have said, not everyone can go on indefinitly either.
For me there is no way that a VBAC would be a safe option, but that was something they were able to tell me on the basis of the condition of my uterus at my first section.

Sorry, can't comment on the relative safety of each, like you say, you need to speak to the people caring for you, particularly as I understand this is in the Netherlands so they may do lots of things differently.

There are lots of things that staff do to mitigate risk, so as an anaesthetist caring for a lady on her 3rd section I would cross match blood rather than just group, have it available, make sure my support staff know I might need it in a hurry, have a syntocinon infusion ready before starting etc etc.

So risk is managed as far as possible, as it would be if you did go on to vbac. You need to feel comfortable with your decisions, thats the main thing, because no one can tell you what will happen to you as an individual, and only you know how important to you it is to have a 4th child. And of course people change their minds, so you have to remember the circumstances prevailing at the time when you made that decision (as I keep on reminding myself as to why we moved house....)

Good luck! Hope all goes well.

Sorry, can't comment on the relative safety of each, like you say, you need to speak to the people caring for you, particularly as I understand this is in the Netherlands so they may do lots of things differently.

There are lots of things that staff do to mitigate risk, so as an anaesthetist caring for a lady on her 3rd section I would cross match blood rather than just group, have it available, make sure my support staff know I might need it in a hurry, have a syntocinon infusion ready before starting etc etc.

So risk is managed as far as possible, as it would be if you did go on to vbac. You need to feel comfortable with your decisions, thats the main thing, because no one can tell you what will happen to you as an individual, and only you know how important to you it is to have a 4th child. And of course people change their minds, so you have to remember the circumstances prevailing at the time when you made that decision (as I keep on reminding myself as to why we moved house....)

Good luck! Hope all goes well.

Pinkveto - that was interesting. My consulatant ( private at Portland - 40 odd years experience never mentioned any of that). However, was a bit confused at your mention of placenta praveia meaning tghat cervix is obscurred so that doctor can;t get to uterine cavity to get baby out. I thought that the cervix was at the top of ########## so that placenta praveia meant that vaginal bith was not possible not that it impacted on c section birth as dcotros make cut directly at uterine cavity from outside not through or near cervix . In fact i thought that th eonly safe wasy to give bitht with placenta praviea is by section.