What do you think of VBAC? Vaginal birth after c-section.?

Question

I am 27weeks and had c-section first time. I was told that I can have vbac but having a hard time deciding. I am going to a hospital that majors in these types of births and other alternatives. Please give me as much feed back as possible. thanks

Answer 1

Doctors and alot of others will tell you you have scar tissue that will make the birthing difficult after having a C-section. Its really up to you, If you want to try a natrual birth witht eh vbac go for it since they do these sort of things all the time, if you are worried go for the c-section. Theres alot of Birthing methods out there too. I just did the normal route cause my kids decieded when it was time and there was no telling them other wise...

Answer 2

I had a C-section with my child and if I had anymore I would definitely want to try VBAC. I would also talk to the Dr about my chances with a VBAC. I would hate to labor all day and then end up with a C-Section. Does he feel you can deliver vaginal?

Answer 3

I have never heard of having a vaginal birth after having a c-section .Once you have had a c-section most if not All Dr's insist on a C-section birth with all of your children.A 2nd opinion may not be a bad idea.

Answer 4

As you know VBACs has risks. I am sure I don't need to go over them, you have probably heard them a great many times. I will point out though that uterine rupture doesn't automatically mean mom or baby is going to die.

What may not have been well explained to you is the risks of a c-section. You need to carefully assess the risks of a VBAC vs a cesarean. And while people are generally more than happy to point out the risks of a VBAC the risks of a c-section are harder to find. Most stats are biased some list almost everything as a "minor complication" and some go the other way.


Firstly there are the risks of the epidural, many women have epidurals during regular child birth so these risks are not specific to c-section. But let's face it you're not going to have a c-section without an epidural unless they knock you out, which is even riskier.

Here are some stats on epidurals:
Block failure (about 1 in 20). Partial failure may still give satisfactory pain relief. However, if pain relief is inadequate, another epidural may have to be performed.
Bloody tap (about 1 in 30-50). It is easy to injure an epidural vein with the needle. In patients who have normal blood clotting, it is extremely rare (e.g. 1 in 100,000) for problems to develop. However, in a patient who has a coagulopathy, the patient may be at risk of epidural hematoma. If blood comes back down the needle, the anesthesiologist will normally site the epidural at another level.
Accidental dural puncture (about 1 in 100 insertions). The epidural space in the adult lumbar spine is only 3-5mm deep, which means it is comparatively easy to cross it and accidentally puncture the dura (and arachnoid) with the needle. This may cause cerebrospinal fluid (CSF) to leak out into the epidural space, which may in turn cause the post dural puncture headache (PDPH). This can be severe and last several days, and in some cases weeks or months. It is caused by a reduction in CSF pressure and is characterised by exacerbation when the patient raises their head above the lying position. If severe it may be successfully treated with a "blood patch" (a small amount of the patient's own blood given into the epidural space via another epidural needle). Most cases resolve spontaneously with time.
Catheter misplaced into a vein (uncommon, less than 1 in 300). Occasionally the catheter may be misplaced into an epidural vein, which results in all the anaesthetic being injected intravenously, where it can be toxic in large doses. This also results in block failure.
High block, as described above (uncommon, less than 1 in 500).
Catheter misplaced into the subarachnoid space (rare, less than 1 in 1000). If the catheter is accidentally misplaced into the subarachnoid space (e.g. after an unrecognised accidental dural puncture), normally cerebrospinal fluid can be freely aspirated from the catheter (which would usually prompt the anaesthetist to withdraw the catheter and resite it elsewhere). If, however, this is not recognised, large doses of anaesthetic may be delivered directly into the cerebrospinal fluid. This may result in a high block, or, more rarely, a total spinal, where anaesthetic is delivered directly to the brainstem, causing unconsciousness and sometimes seizures.
Significant damage to a single nerve (very rare, less than 1:10,000).
Epidural abscess formation (very rare, about 1 in 50,000-75,000). The risk increases greatly with catheters which are left in place longer than 72 hours.
Paraplegia (extremely rare, less than 1:100,000).
Death (extremely rare, less than 1:100,000).

Then there are the risks of the c-section itself:
Death is about 1 in 2,500 (vaginal is 1 in 10,000 - VBAC should be somewhere in the middle)

"Giving birth via a caesarean section raises your baby’s risk of death during the first month by as much as three times, even when all other factors are taken into account. The numbers are low, a vaginally born baby’s risk is 0.6/1,000 and a c-sections born baby’s risk is 1.8/1000."
http://www.prematureoptimism.com/blog/Index.php?s=section

Pain, debility, and a longer recovery period: In one study, one-quarter of the women reported pain when interviewed two weeks after their cesareans and 15 percent still reported pain at eight weeks (33). More than 15 percent reported difficulties with normal activities such as getting out of bed, walking, bending, lifting and tending the baby at two weeks. One in ten still reported problems at eight weeks.

Surgical complications: A ten-year review at one hospital reported a 4.5 percent incidence of major complications, that is, severe hemorrhage, need for repeat surgery (generally to investigate bleeding), pelvic infection, blood clots, pneumonia, blood poisoning (septicemia), or clotting dysfunction (a result of severe hemorrhage) (56). Nearly one-third of cesarean mothers experienced minor complications, including fever; hemorrhage; blood-filled swelling (hematoma); urinary tract, wound or uterine infection; blood clots in the legs (phlebitis); paralyzed bowel (ileus); or bladder paralysis. An analysis of women in Washington State, found that women having cesareans were nearly twice as likely to be readmitted to the hospital as women having normal vaginal births (30).

A review of the medical literature reported these specific incidences (53):

Surgical injury to bowel, bladder, uterus, or uterine blood vessels: two percent.
Hemorrhage: Between one and six percent of women needed a transfusion. Hemorrhage may sometimes require a hysterectomy.
Infection: 8 to 27 percent. Antibiotic resistant infections are starting to be a problem as well (10).
Paralyzed bowel: one percent.
Blood clots: 6 to 18 women per 1,000 experienced leg-vein clots; 1 to 2 per 1,000 threw a clot into the lung (pulmonary embolism).
Maternal death: An analysis in Great Britain revealed that women were 5.5 times more likely to die of an elective cesarean, than a vaginal birth (9 versus 2 per 100,000) (25). A Dutch study found that c-sections caused seven times more deaths than vaginal births (28 versus 4 per 100,000) (50). Obviously some factors that lead to c-section also threaten the mother’s life. However, the British study used elective cesarean to minimize that possibility and the Dutch study investigated the exact cause of death. The numbers in the British study may also be low. Data culled from vital statistics undercount cesarean death rates by 40 to 50 percent (43, 46).
Cutting the baby: This complication occurred in a little over one percent of head down babies and six percent of breech babies in one hospital and in one percent of babies overall in another (54, 56).
Baby born in poor condition: Several studies get at the effect of cesarean section on the baby by looking at outcomes when the cesarean was not done for the baby's sake. One study concluded that newborns with low Apgar scores (a measure of the baby’s condition at birth) after healthy pregnancies are nearly half again as likely to be delivered by elective cesareans as born vaginally (11). Another study compared babies born by cesarean for reasons unrelated to the baby’s condition with low-risk vaginal births (6). Babies born by cesarean were nearly five times as likely to be admitted to intermediate or intensive care and five times more likely to need assistance with breathing. A third study reported that persistent pulmonary hypertension, a life threatening respiratory complication, occurred 4.5 times more often in babies delivered by elective cesarean than in vaginally born babies (29).
Long-term risks can include:

Psychological problems: Regardless of whether women feel satisfied with the decision to perform a cesarean, many women have negative feelings afterwards (34). Some of those feelings are the expected emotional aftermath of any major surgery (34). Others originate specifically in having a cesarean, including such issues as the loss of the expected birth experience or needing an operation to have a baby. Postpartum depression is more likely after a cesarean (8). A few women experience posttraumatic stress reactions such as nightmares, flashbacks, or an overwhelming fear of pregnancy (47). Psychological problems can also lead to marital stress or difficulties forming an attachment to the baby (34).
Scar tissue adhesions: Adhesions can cause pelvic pain, bowel problems, and pain during sexual intercourse. They also make subsequent cesareans more technically difficult and injury to other organs more likely.
Complications that could affect future pregnancies and births can include:

Infertility: According to one survey, women whose first birth was a cesarean were 13 percent less likely to have had a second child five years later than women whose first birth was vaginal (28). Women are also slightly but significantly more likely to miscarry (27).
Ectopic pregnancy: A life-threatening condition in which the embryo implants outside of the uterus, usually in the Fallopian tube leading to the ovary. 25 percent more likely (27).
Placental abruption: Placenta detaches before the birth. Two to four times the risk compared with an unscarred uterus depending on whether the woman’s first birth was a cesarean, or she has more than one prior birth and at least one cesarean (27).
Placenta previa: Placenta overlays the cervix. 4.5 times the risk with one prior cesarean, 7 times the risk with 2 to 3 and 45 times the risk with 4 (5).
Placenta accreta or percreta: Placenta grows into, or through, the muscular wall of the uterus. 11 times the risk with multiple prior cesareans compared with one prior cesarean -- nearly 1 per 100 versus 1 per 1,000 (7). This complication is particularly deadly. In a study of 109 cases of placenta percreta, 40 percent of women required transfusion of more than 10 units of blood, nearly all had hysterectomies, and 10 babies and 8 mothers died (36).
Uterine rupture (symptomatic scar separation): Planned repeat cesarean does not eliminate this risk. One study of nearly 67,000 California women reported that the scar gave way in 3 per 1,000 women having elective repeat cesareans, not much less than the 5 per 1,000 rate with trial of labor (23). Similarly, in a study of 29,000 Swiss women with prior cesareans, the rate of symptomatic scar separation was 4 per 1,000 in VBAC labors, but it was still 2 per 1,000 in repeat cesareans (41). All of these cesarean-related problems are rare. Nonetheless, in a series of 711 women with one or more prior cesareans, 1 in 42 women had a catastrophic complication, defined as maternal or fetal death, severe hemorrhage, hysterectomy, the need to tie off a major artery, or a uterine rupture requiring emergency surgery or resulting in a baby born in poor condition (12).