VBAC after multiple caesareans. Possible at all?

[TwoCupcakes]

I?ve had 2 C-sections, both for emergency reasons. (fetal distress etc) but have always wanted a vaginal birth. Expecting DS3 in Oct and hosp told me yesterday that it was very unusual for women to ask for VBAC after multiple CS. (VBAC after one CS is quite common but not after 2 CS). Now DH and I consider ourselves fairly informed on the pros/cons of both VBAC and repeat CS, having done tons of research on it. The hosp have also been very good ? the consultant willingly debated for nearly an hour with us yesterday on both pros and cons, and even brought in a second medical opinion. So we do understand why most women do not go for VBAC after multiple CS given the medical risks.

BUT, I would really like to know if anyone out there did manage to have a VBAC after multiple CS and if so, would be grateful for your stories on how it went. Thanks!

Although it is not common, many women do have VBAC's after 2, 3 or even 4 CS.
Some sites with info here-
www.homebirth.org.uk/vba2c.htm
www.vbac.co.uk/stories/story.php?s=zoe
empoweredbirth.typepad.com/empowering_birth_blog/2009/08/vba2c-this-video-will-bring-tears.html
health.groups.yahoo.com/group/ukvbachbac/

Selina x

Also great videos-
www.youtube.com/watch?v=roFVkDV45MM
www.youtube.com/results?search_query=vba2c&aq=f
Selina

Oh brilliant, this is such useful stuff - thanks Selina!

any other stories, do keep them coming.

The ukvbac/hbac group that selina linked to is fab, lots of women who have had VBAC after 2 x CS, and a couple of women who had VBAC after 4 sections, yes after 4 sections.

AFAIK there is no proven increased risk after 2 compared to after 1 caesarean, but there has not been loads of research either.

Hi I had 2 emergency sections aswell as 2 VBACS (both after my 1st section). So with DC5 it would have been VBAC2. I got the impression that they would have 'allowed' it had I been low risk but my obstetric history is terrible (inc several losses) and I already was injecting heparin and had a cervical stitch in situ and was classed as very high risk.

For those reasons i agreed to have a planned section since they said my chances of emergency section were over 50% and I needed a consultant and it was easier to plan it. If i had the choice, though, and was low risk, I would go for the VBAC. I believe it is not that much more risk than 1 section. I think but not sure on 3+.

Found this for you-

What does the best available evidence tell us about vaginal birth after two cesareans?

Tahseen S, Griffiths M. Vaginal birth after two caesarean sections (VBAC-2) - A systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections. BJOG 2010;117(1):5 -19.

The practice of vaginal birth after cesarean (VBAC) has swung widely over the past two decades, declining considerably since 1997 due in large part to concern about increased risk of uterine rupture. A recent consensus conference convened by the National Institutes of Health to study the evidence and provide guidance on VBAC concluded that ?trial of labor is a reasonable option for many pregnant women with one prior low transverse uterine incision.?

In this study, the authors conducted a careful meta-analysis to pool all available observational data on the success rate and risks associated with vaginal birth after two cesareans, comparing this to vaginal birth after only one cesarean and also with elective repeat cesarean. The pooled successful VBAC rate among 5666 women who had a trial of labor after two or more cesareans was 71.7% (compared to 76.5% after one cesarean). The pooled uterine rupture rate after more than one cesarean was 1.36%, which represents a statistically significant increase in relative risk, but a very small increase in absolute risk for this rare complication. Importantly, the study did not indicate a significant difference in risk of neonatal death, asphyxia, or admission to the neonatal intensive care unit among VBAC after one cesarean, VBAC after more than one cesarean, or elective repeat cesarean. In addition, the rate of other serious maternal complications such as hysterectomy, blood transfusion, or fever was not significantly greater for VBAC after more than one cesarean than for elective repeat surgery.

The take-away: The authors conclude that this analysis of best available data does not suggest excessive risk associated with VBAC after two prior cesarean births, and therefore eligible women should be appropriately counseled and offered the option to undergo a trial of labor.

Selina

thanks everyone. Minnie - to hear about women who managed VBAC after 4 CS! Jellybeans, you are right - it does depend on high/low risk as well. Because i dilated very very slowly in previous labours, i wasnt considered low risk and there is more chance of the scar rupturing the longer the labour proceeds.

I saw that Tahseen research on the internet too Selina and I think that everything that i've seen and heard so far leads me to conclude that i would like to try for a vaginal birth but open to the fact that i may end up wt a CS after all! now just have to persuade the consultant (although to be fair, he was open to vaginal birth but did warn that if it progressed slowly, the hosp would seriously recommend CS).

thanks for all the info, food for thought indeed.

I loved trying for a vbac after 2 sections.

didnt manage as only got to 8cm and baby twisted up unnaturally but I dont regret trying one bit xxx

Any labour is goog for your baby. To start labour naturally when baby is ready to be born and have contractions which prepare baby for life outside the womb.
A long slow labour (in my experience) i often down to baby position.
You should look at the Spinning babies websites for techniqus to help baby get into a good position in labour.
Selina