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I’m getting ready to deliver my 4th baby in just a couple weeks (or less!) and I shared via Instagram that I’m attempting my 3rd VBAC. I got a lot of questions – ranging from ‘what is a VBAC?’ to ‘how big were your babies?’ to ‘how can I stay positive and increase my chances of a successful VBAC?’ so I figured I’d write them all out, Q&A style, here 🙂
Before I start, it goes without saying that I’m by no means a medical professional or expert in women’s health, labor, delivery, or OBGYN. I’m just a mom who has experienced both a cesarean delivery and VBACs and I’m sharing my own opinion and experiences.
ALSO – let me just say that no matter how you bring your baby into the world, there is no ‘easy way out’. Delivering a child is difficult and magical and scary and awe-inspiring no matter how and where they exit your body.
What is a VBAC?
VBAC stands for ‘vaginal birth after cesarean’. TOLAC stands for ‘trial of labor after cesarean’. so technically, you’re a TOLAC until you actually deliver the baby vaginally :).
What was the reason for your first c-section?
I had my first baby via emergency c-section in 2012 at 40 weeks. I went into labor on my own and at about 5cm dilated, her heart rate dropped. After breaking my water to do internal monitoring, her heart rate kept dropping and the doctor decided we didn’t have time to wait for me to dilate 5 more centimeters and we needed to get baby out.
So we did an emergency c-section and when she was delivered, the umbilical cord was wrapped around her neck twice, ‘tightly’. She was 6lbs 4oz and perfectly healthy.
Do you still feel incision/nerve pain from your c-section?
I don’t, 7.5 years later. I’d say it took at least a year until my scar even started to fade or gain sensation back.
What made you want a VBAC?
We knew we wanted to have 4 kids, and although there are doctors who will certainly deliver multiple children via c-section, ‘each repeat C-section is generally more complicated than the last’ per the Mayo Clinic.
I also didn’t want to have to recover from a subsequent cesarean while parenting other children.
And I know that MANY c-section births are wonderful experiences, but mine was not. I barely remember the first day and was VERY out of it. I wanted to avoid that feeling again if possible.
Lastly, the reason for my c-section wasn’t anything that was necessarily going to likely repeat itself; aka the baby wasn’t huge and not fitting through my birth canal, and her small stature made me think that it was likely I could give birth vaginally. My doctor agreed that I was a good candidate for a VBAC…
Was your doctor on board for a VBAC or did it take some convincing? Did you have to find a new doctor?
My doctor was super supportive and I did not have to find someone new. I will say that towards the end of my 2nd pregnancy, he asked several times if I wanted to schedule a C or just wait… I kept reminding him that I wanted a VBAC. But, overall, he was on board and agreed that I was a good VBAC candidate.
How did you know you were a good candidate for a VBAC?
According to Mayo Clinic, here are some factors to consider (and how they applied to me in bold italics).
- Have you had previous vaginal deliveries? A vaginal delivery at least once before or after your prior C-section increases the probability of a successful VBAC. I hadn’t.
- What type of uterine incision was used for the prior C-section? Most C-sections use a low transverse incision. Women who have had a low transverse or low vertical incision are usually VBAC candidates. If you’ve had a prior high vertical (classical) incision, VBAC isn’t recommended because of the risk of uterine rupture. I had a low transverse incision.
- How many C-sections have you had? Some health care providers won’t offer VBAC if you have had more than two prior C-sections. I’d only had one.
- When was your last C-section? The risk of uterine rupture is higher if you attempt VBAC less than 18 months after having a C-section. Mine was outside that 18-month window.
- Do you have any health concerns that might affect a vaginal delivery? A C-section might be recommended if you have placental problems, your baby is in an abnormal position, or you’re carrying triplets or higher order multiples. I did not have any of these concerns.
- Where will you deliver the baby? Plan to deliver at a facility equipped to handle an emergency C-section. I planned to deliver at such a facility.
- Will you need to be induced? Having labor induced or augmented decreases the likelihood of a successful VBAC. I hoped not…
- Have you ever had a uterine rupture? If so, you’re not a candidate for VBAC. I had not.
What was the timeframe between your c-section and first VBAC?
My oldest two children are 22 months apart, so I got pregnant when my oldest was around 14 months – my doctor had recommended waiting a year to give my uterus time to recover.
How did you decide on attempting a VBAC vs scheduling a c-section?
I knew I was a good candidate for a successful VBAC and because we wanted 3 more babies, I wanted to at least go for it.
The thing is… both a VBAC and a repeat c-section have risks. Both the worst-case scenarios are truly terrifying.
The worst-case for a VBAC is a uterine rupture. A previous cesarean creates scar tissue, which can weaken the uterus and increase the risk of a uterine rupture. But some – not all – uterine ruptures result in the death of the baby and/or the mother. That’s a pretty terrifying possibility, albeit incredibly rare.
According to this, for women with a prior cesarean, the risk of uterine rupture is between 0.1% and 0.2%. Although these two articles do not provide sufficient data to evaluate rupture-related fetal loss rates, previous work indicates a 6% perinatal death rate from uterine rupture ; thus, the perinatal loss rate from uterine rupture is 0.006%. Overall, that is a “generally accepted level of risk compared to other pregnancy complications.”
I knew I was delivering at a hospital equipped to handle a worst-case medical emergency (aka they have staff for 24/7 c-sections and emergency surgery) and trusted that my doctor would recommend what was safest for myself and my baby.
One of your VBACs was induced… I thought that was a no-go?
I thought the same… until I had an induced VBAC at 39 weeks with Emmy (my third baby).
Basically… she was measuring small at 39 weeks. I was already 3cm dilated, thinned out cervix… ready to roll. So, the doctor suggested inducing me with Pitocin, which I also thought was a no-go… I thought it increased the risk of uterine rupture.
And, generally, inducing a VBAC is not preferred. But because there was a medical reason to induce, my doctor assured me that a small dose of Pitocin along with a favorable cervix would NOT increase my risk of rupture. Here’s info on a study but there are no great controlled studies that take all factors into account, which makes it tricky.
Apparently, using a cervical ripening agent is the most potentially risky induction method, as it weakens the cervix and thus (possibly) the scar on your uterus. If your cervix is ‘not favorable’, using a Foley bulb is still considered an acceptable option – source here.
Do you have your VBACs in the hospital? Do you get epidurals?
YES AND YES – I know everyone has a different experience and preferences and all that but, personally, I will always opt for a hospital delivery and an epidural.
Are you glad you opted for a VBAC?
I am – I have LOVED the 2 vaginal deliveries I’ve been able to have thus far and am hoping for a 3rd.
Recovery experience: c-section vs VBAC? Which was ‘easier’?
I know everyone – and every birth – is different, but for me, recovery from a vaginal delivery is MUCH easier than my c-section recovery was.
It’s worth noting that I had an unplanned c-section after laboring for about 12 hours, which I’ve heard is like ‘running a marathon before having a major abdominal surgery’. AKA that’s some tough shit on your body.
I’m not saying a scheduled c-section is easier but I have heard it’s generally a better experience than an unplanned c-section.
Mobility was difficult for me after my c-section and I ended up with mastitis, which is a breast infection (unrelated to a c-section). And it could’ve been the whole ‘first time nursing’ thing, but I honestly think my body was so busy healing from the surgery that I was more susceptible to infection. Again, don’t call me Dr. Val ;).
How big were your babies?
Valid question… I’m 5’2 and my husband is 5’10. We were both average-sized babies.
- My first – a girl – was born via cesarean at 40 weeks weighing 6lbs 4oz
- My second – a boy – was born via VBAC at 39 weeks, 4 days weighing 6lbs, 14 oz
- My third – a girl – was born via induced VBAC at 39 weeks weighing 6lbs 1 oz
Basically… we don’t make big babies.
How do you stay positive about having a VBAC? Did you have anxiety? The what-ifs are scary!
I HEAR YOU on this!
I tried to read encouraging, successful VBAC birth stories.
I reminded myself of statistics and read fact-based articles about VBACs. Here’s a list of encouraging VBAC resources:
- VBAC stats from the American Pregnancy Association
- Anything from the International Cesarean Awareness Network is very pro-VBAC
- This VBAC success calculator – I cannot even tell you how many times I’ve entered the same info into this calculator. The numbers made me feel better :).
Anything special you did to prep your body for a successful VBAC? Exercises?
I didn’t really have a specific plan or routine, aside from prenatal yoga with Cooper (my second). I quit working out around my 3rd trimester with Emmy (my third). So, in short… not really.
How long will they let you wait before scheduling an induction or a C-section with this baby?
My doctor told me he ‘wouldn’t let me go past 41 weeks’ which I’m really hoping isn’t the case. My other 3 came on time or a couple of days early, so TBD :).