VBAC Fear

[Monkeytoo]

I'm probably posting this a bit early as I'm TTC rather than pregnant but can't seem to stop thinking about this.

My first baby was born by EMCS due to a failed induction. He was pretty big (9lb 10oz), I didn't respond well to the pitocin (currently in US, not sure if called the same in UK) and did not progress. When he came out he had a cone on the side of his head as he was wedged in kind of sideways.

I've had a lot of the (what I think are common) feelings about the CS - basically really sad that I didn't get a natural birth (I had hoped for no drugs and ended up with an induction / EMCS). I'm so happy that DS is healthy and was fine but still sad aboout it. Anyway, I would really like to try a VBAC next time but am living in quite a negative place for this (very medicalised births).

To get to the point what I'm worried about is that during a VBAC I will be really scared that I might have a uterine rupture. I think partly this is because my current doctor has scared me by saying that there's a 1% chance (small I know) but that if it happens it 'catastrophic' and that I should have another section. Has anyone else had these fears and managed to get past them?

Sorry, totally went on there!

Hi there Monnkeytoo, I have a post on here on a very similar topic (all those who've had a vbac) and the ladies have offered some really great advice
You have my sympathies but I think its a lot to do with state of mind, Im trying to get myself in a good place before the birth but also do remember you do have choices, you don't have to do anything you don't want to.
I hope when you get pregnant you have as much support as I've had, the staff at the hospital have been fabulous!
Good luck

Hello Monkeytoo. I'm in a similiar situation, having had an EMCS with DS1 and now 27 weeks pregnant with DC2 and unsure whether to have a VBAC or elective CS.

Obviously I can't give you any advice on VBAC as I haven't had one but I wanted to just give you a different viewpoint to the one your Docs may have given you.

Our maternity hospital is very supportive of VBACs and when I met with my consultant recently she was explained that the risks of VBAC are actually far less than a major op like a CS. They are all for me trying for a VBAC - and that's with what'll be only 22 months between the births.

Also, I've heard that the risk of rupture is actually below 1% (last thing I read said it was .35%).

Do you have a VBAC clinic you can go to to get more info? I'm booked in for one run by my maternity hopsital. You'd then be able to get support and ask questions specific to your sitaution (eg the gap between your pregnancies etc)

Good luck with your decision.

RCOG guidlines.

Risk of uterine rupture is low. About the same risk as any other emergency type thing happening during labour.

Hi

I'm in a similar situation to you. I found reading up loads is helping as I feel I now know much more about what I want and how to ask for it.

Hope all goes well for you x

Thank you for all the advice, I appreciate it. Thanks EccentricaGallumbits for the guidelines. It's really interesting reading. I think I'll need to really prepare myself for this, maybe with hypnobirthing so I can get into a positive frame of mind. I'll need to do more research as they mention that the chance for a successful VBAC is reduced if you had a failed to progress due to positioning of the baby. This is what I had but logically I don't know why that would mean it would happen again.

I'm not living in a great location for VBAC and it's quite discouraged. I can find a doctor / hospital who will 'let' me but not exactly support it so think I will need to find a good doula!

The risk of uterine rupture is actually lower than 1%. The risk of it being catastrophic is even lower still. There's more chance of having a placental abruption (in any birth), yet you probably don't worry about that. There's a similar chance of cord prolapse. Plus several other complications we don't worry about.

I'm also in the US (California) and am training in childbirth education. I had a HBAC here. Most US doctors are /very/ anti-VBAC. Mostly because insurance companies are anti-VBAC based on outdated risk factors (based on old fashioned vertical scars) and because there have been some nasty lawsuits claiming doctors didn't perform caesareans when they should. So doctors generally in the US push for repeat caesareans. That's why I ended up with a home birth here (which was wonderful and very safe, btw).

Uterine rupture is cited again and again to scare women into repeat caesareans. Please don't let them get to you. There are risks in birth but the risk of rupture is no higher than the other risks. Try and find ways to build your confidence. Perhaps look at the book, "Birthing from Within"

Hi... Really interesting and useful thread...wonder if anyone can answer my question please - this seems like an appropriate place to ask... I had an emerg cs in 1998 and an elective in 09. Want to try for a third baby but would like to try vbac... does anyone know if I'd be 'allowed' to here in the uk or if the risks - after 2 cs will be considered too high? Thanks...

Hi ohsomuch

Current evidence shows the risks for VBACing don't rise significantly after two (or even three) caesareans. There's a strong if wordy article here.and a very recent article here.

No-one can actually stop you from having a VBAC and you're definitely allowed to, but some doctors may be uncomfortable about VBAC in general. Some doctors may be uncomfortable about VBAC after multiple caesareans. These feelings probably aren't evidence-based so it is important to do your own research and feel happy with your own decision and hopefully find a caregiver who is supportive of VBAC.

Hi, I'd just like to share my story with all u ladies frightened of a VBAC out there. I had a ECS with my first baby due to what they called "slow progress" - I had actually only been at 9 cms for about 2 hrs but had been in labour for about 23 hrs so by that point -I was so exhausted and what with it being our 1st we basically did as we were told cause we didn't know any better. All was fab when my son was born and he was 100% healthy. When I became pregnant 2 and a half yrs later I was detemined to have a natural birth. The about of red tape I encountered here was quite alot! I hired a doula which took a lot of pressure off my Hubby too, and we went for it. At 37 weeks the midwife looking after me got cold feet and decided that it was more than her jobs worth do not only do a VBAC but a home water birth which was what I really wanted. Luckily for me a friend of a friend who was on another team of midwives in my area took over my care. Her team were more experienced in water birth. I went into labour at 40+6 and have never felt so in control in my life. It was our home, our desicions, and mostly our choice. 6 hrs later my beautiful daughter was born in the birthing pool in our lounge. I only used a wee bit of gas and air and she was 9 lb 5 ozs! I understand that we are all so different and each situation varies from woman to woman. But I also strongly believe that if you want to achieve it you can. I kept as positive as I could and kept telling myself that I could do it. Also, I was told at the time by my gp that the risk of uterine rupture was 1 in 3000. Please don't be frightened, it's YOUR choice and as long as ur sensible , u have made informed desicions and your pregnancy progresses well there's no reason why it can't be achieved. Good luck and I can honestly say the desicions I made then have changed my life for the better. Xxx

Is it in the Ina May's Guide that she goes on about double stitched versus single stitched uterus scar? She thought that the new fangled single stitched scars were more likely (but still highly unlikely of course) to rupture. I've been told they only do double stitched in the UK, but some surgeons in the US were doing single. Have you any idea what yours was?

Did you see the vbac pages?

Thank you again everyone, this really helps. I need to ask my doctor what type of stitching she did. I should know and don't - scary how little I know about what happened to my own body! I read the Ina May book prior to my birth and thought it was brilliant. I think that was partly what upset me so much about what happened, I knew how it could have been! It also made me more mad when they wouldn't let me have anything to eat etc...

CarmenSanDiego - that's so great to hear you had a HBAC - ultimately I would love to try that. I don't know if I could find a midwife here to help me. I'm not even allowed to labor in a midwife led center because I've had a previous CS. I think that's one of the hardest things about it, it's like some choices have been taken away from me. Definitely need to assert myself next time (fingers crossed I have a next time soon ).

Given how your first labour went, and the fact that baby was rather big, if I was you I'd go for an elective c-section, no doubt about it! Don't play russian roulette with your and your baby's health. Listen to your doctor, they do know best.

Good luck

Monkey, where are you in the US?

I wasn't allowed in the midwife led center either which led me towards the home birth with a lovely, lovely midwife.

I honestly didn't feel safe in the hospital or feel that a VBAC was achievable there (especially when the doctor I saw mentioned using Pitocin during a VBAC which is not recommended by most bodies.)

I'm in Seattle so not far. I should look into the home birth thing for sure (can imagine my husbands face when I tell him that ).

Thanks Onestonetogo, I know what you mean and I have had a lot of thought about this. One of my problems is I don't fully trust doctors to do the best thing either. I don't think there was any malpractice with my experience and they meant the best but their view is incredibly medicalized and they don't necessarily know a huge amount about women giving birth naturally - so I ended up with a failed induction and c-section - they even made me sign a form before about how likely this was to occur. I think theres some horrendous statistics of 40% or above of csections in the hospital I was in. I read about one doctor saying 'I can't get sued for doing a c-section but I can for not doing one'. Unfortunately that's not based on what's best for me and my baby but other outside influences. A c-section is major surgery with high risks of it's own to the woman and baby.

There are some amazing midwifes out there that I think have a huge amount of experience about helping women to do what their bodies want to naturally (and probably a few doctors too!) and that's what I'm hoping for if I'm lucky enough to have a next time.

Carmen - I also meant to add that that's really scary about the pitocin. I found it really hard to even know what I was being given once I had the IV in - so many lines and quite complicated seeing as I wasn't ill!

OB/GYNs in the US are generally taught a very specific medicalised model of birth. ACOG's policies are not always evidence-based and are heavily influenced by political and social bias. It's not necessarily 'wrong' but it's not to everyone's taste.

I've only found one doctor in my city who is encouraging of VBACs and even then you're up against hospital policy. The hospital I studied in has a policy of strapping women to the table during a C Section and no skin to skin contact after birth. There's a lot of things that put me off trying for a VBAC in hospital.

Locally, I found several midwives who are VBAC specialists. They know the warning signs of a rupture or serious problem. My husband was reassured when our midwife team arrived and set up all the resus equipment before anything else. Then left it alone and concentrated on being positive

I'm so glad I did it that way.

Wishing you all the best!

Yes I was strapped down and no skin to skin contact until about half an hour later, quite sad

Really great to hear about a positive HBAC, thank you for sharing, has inspired me to try!

Oh Monkey, I'm sorry about that.

I hope the next one goes much better for you

Hi monkeytoo,
Just a quickie, I just got a book from Amazon "the VBAC handbook" its just a small book but its quite new and has some really good stats and case studies in, have already got halfway though it.
Puts a lot of things into perspective and discusses the various risks of repeated sections and also VBACS without ramming the "MUST try a vbac" mantra down your throat.
Might help you with your decision too? talks about the real risks of uterine rupture a lot, which actually seem to be extremely low
HTH
K