VBAC (vaginal birth after caesarean) is big. A google search for ‘vbac’ results in ‘about 795,000’ results. Reviews, guidelines, policies and statements are being produced by every organisation with an interest in birth. Support groups and networks are growing. I am not going to add to this wealth of information. Others are doing a fantastic job and I will provide some links at the bottom of this post. This post is really aimed at putting VBAC into perspective risk-wise and discussing how we can best support women planning a vaginal birth after caesarean. I haven’t personally experienced the VBAC journey and would welcome some input from mothers who have via comments, suggestions and links. This is written from my perspective as a midwife.
With a c-section rate of around 1 in 3 (Australia) a significant proportion of women approach their subsequent birth with a scarred uterus. Of those women, 84% will have another caesarean. I can’t find the stats re. how many of these repeat c-sections are planned vs emergency. But, considering the 50-90% ‘success’ rate for VBACs, I am assuming that most repeat c-sections are planned. I wonder if more women would choose to experience a vaginal birth if they had adequate information and support from care providers who believed in them?
Guidelines suggest that women should be counselled about the risks of VBAC, and they should have additional monitoring and intervention during labour. The big concern is uterine rupture, and this is what I am going to focus on. By the way – unless I provide a reference/link you can assume I am getting my numbers from the NIH Consensus Statement (US) or Having a Baby in Queensland (Aus). Both of these resources are based on current research evidence. So, if you need the original research sources check out their reference lists.
What happens during a uterine rupture?
Considering this is the risk associated with VBAC is worth briefly describing what is involved. Uterine rupture can happen at any birth, even when no scar is present (particularly if syntocinon is used). There are two types of uterine rupture associated with VBAC (Pairman et al. 2014):
- Catastrophic (symptomatic) – the old scar separates long its length, the amniotic sac ruptures and the baby is pushed into the abdominal cavity. This results in significant bleeding, shock and the baby is in grave danger.
- Asymptomatic – the scar separates partway along its length, the amniotic sac stays intact and the baby remains in the uterus. Bleeding and shock is minimal and the baby usually survives. This is the most common type.
Here is a youtube clip of what happens during a catastrophic uterine rupture. For more information about uterine rupture (including symptoms) check out this article on BellyBelly.
Risk by numbers
Risk is a difficult concept. You can have odds of 1 in a million, but if you are the 1 it is 100% for you. It’s also impossible to eliminate all risk from life (or birth) and every option has risks attached. All women can do is choose the risk that feels right for them – there is no risk-free choice. There are many ways of presenting risk and some ways may mean more than others for individuals. For example, if we look at the overall risk of uterine rupture for a woman who has had 1 previous c-section. By overall, I mean without adding or subtracting factors which increase or decrease an individual’s risk (eg. syntocinon during labour, transverse scar). The risk can be presented like this:
- 50 out of 10,000 will rupture
- 9,950 out of 10,000 will not rupture
- 1 in 200 will rupture
- 199 out of 200 will not rupture
- 0.5% will rupture
- 99.5% will not rupture
Which of these versions would help you conceptualise risk? I know when I look at the picture versions of risk I assume I’m the ‘red person’. Personally I like the 99.5% intact uterus odds.
As stated above these figures are the taken from the NIH Consensus Statement (US) or Having a Baby in Queensland (Aus). A more recent UK study (Fitzpatrick et al. 2012) found an even lower overall risk of rupture – 0.2%.
The risk of rupture may be even lower in labours that are not induced or augmented (the stats above are a mixture of all labours). An Australian study (Dekker et al. 2010) found that the risk of uterine rupture during VBAC was 0.15% in spontaneous labour, 1.91% in augmented labour and 0.88% in labour induced using prostin and oxytocin. Fitzpatrick et al. (2012) also found an increase in rupture with induction and augmentation. In contrast a US study (Ouzouian et al. 2011) found no different in rupture rates between spontaneous and induced labours – but found a significantly greater vaginal birth rate following spontaneous labour. Another study (Harper et al. 2011) found an increased chance of rupture during induction when the woman has an ‘unfavourable’ cervix. There are also other risks associated with induction which need to be considered before heading down that pathway.
For women who have had multiple c-sections: Landon et al. (2006) suggest the risk of rupture rises to 0.9%. Fitzpatrick et al. (2012) also found a slight increase in risk for women how had had 2 or more previous c-sections. However Cahill et al. (2010) found that: “Women with three or more prior caesareans who attempt VBAC have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and as those delivered by elective repeat caesarean.”
The story looks a little different again when you look at the mortality and morbidity caused by uterine rupture. Guise et al (2004) conducted a systematic review of research relating to VBAC and uterine rupture. They found that uterine rupture resulted in: 0 maternal deaths; 5% perinatal deaths (baby); and 13% hysterectomy. They conclude that: ‘Although the literature on uterine rupture is imprecise and inconsistent, existing studies indicate that 370 (213 to 1370) elective caesarean deliveries would need to be performed to prevent one symptomatic uterine rupture.’
So, out of the small number of women who experience uterine rupture, an even smaller proportion will lose their baby or uterus because of it. When the uterus ruptures 94% of babies survive. The RCOG guidelines state that: “Women should be informed that the absolute risk of birth-related perinatal death associated with VBAC is extremely low and comparable to the risk for nulliparous [first baby/birth] women in labour.”
VBAC vs planned c-section: uterine rupture
Most resources and guidelines compare the risk of a VBAC with the risks of a repeat c-section. This can be a brain-twister because of the multiple and complex risks associated with c-section for mother and baby. Childbirth Connection cover them well, so I won’t. It is also important that women know a c-section increases the chance of stillbirth in subsequent pregnancies (Moraitis et al. 2015). Having a Baby in Queensland directly compares VBAC with planned repeat c-section for a number of complications.
I’m trying to stick to the risk of uterine rupture (the ‘big’ one). So, planned c-section wins with a 2:10,000 uterine rupture rate compared to 50:10,000 for a VBAC. That’s if you are happy to take all the (more frequently occurring) risks associated with c-section in exchange.
Uterine rupture vs other potential birth emergencies
A Woman’s Guide to VBAC: Navigating the NIH Consensus Recommendations compares uterine rupture with other potential complications. You are more likely to experience a placental abruption, a cord prolapse or a shoulder dystocia (not associated with previous c-section) during your vbac than a uterine rupture. Your baby is also more likely to die from the placental abruption or cord prolapse than from a uterine rupture.
Anecdotes
Anecdotes often hold more power than numbers. I can guarantee that I will get a comment telling me about a poor outcome associated with a VBAC. They do happen (see the stats above). Unfortunately when care providers have been involved in a traumatic situation, it can be hard not to let that experience colour their perspective and approach. The memory of one uterine rupture will be stronger than all of the uncomplicated VBACs they have seen. The only uterine rupture I have personally been involved with was an induction of labour – not a VBAC. So, I emotionally associate uterine rupture with induction rather than VBAC.
Obstetricians in particular have to deal with the fall out of major complications because this is their area of expertise. They also miss out on seeing physiological births which end well because this is the realm of the midwife (I know this is different in the US/private sector). This can lead to fear-based counselling and practice, and a general fear of normal birth. It is interesting that a poor outcome associated with a c-section does not seem to elicit quite the same response – ie. fear of c-section.
When parents find themselves the 1 in how ever many, it is even more devastating. Their stories are powerful and need to be heard. However, it can be difficult for other parents to contextualise the story without also hearing stories with good outcomes.
The real risks of VBAC (according to me)
I am a bit confused about why such a huge deal is made about the risk of uterine rupture during VBAC. Why are these women subjected to serious (and often biased) discussions with fearful practitioners about the dangers of attempting birth? Why are they categorised as ‘high risk’, limiting their care options and imposing additional monitoring and intervention during their labour? If we agree that this is the right approach, then we also need to treat all women like this because the risk of placental abruption or a cord prolapse is greater than the risk of a uterine rupture during a VBAC.
To be honest, as a midwife uterine rupture is the least of my worries when caring for a woman having a VBAC. I actually think the mountain that has been built out of the risk-molehill requires more energy and attention. These women do need special treatment, but not in the form of disempowering fear-based counselling or practice. They have often had a previous traumatic birth experience and are dealing with fear from family, friends, and the medical system, in addition to their own worries. They have been labelled ‘high risk’ and are constantly reminded of the potential disaster waiting to occur. They also risk ‘failing’ if they encounter any complications or end up having a repeat c-section. This impacts on their ability to trust their body, follow their intuition and allow the physiology of birth to unfold. Often these women need more nurturing, reassurance and support from those involved in their birth.
Suggestions
During pregnancy
It is important to not only help women to prepare but also their partners and/or other close family members who may be at the birth. Often the partner was present at the previous birth, which may have been traumatic to witness. For a partner their priority is the safety of the woman they love – not a particular birth experience. Winning them over may be difficult. In some cases the decision the mother makes may be that the partner should not be present. OK – some suggestions:
- Find out the details of her previous birth experience. If she needs debriefing help her do so, or refer to someone who can. Knowing about her previous experince and her fears can help you know what she needs during her labour.
- Offer to discuss ‘risk’ and present the statistics in a number of ways. Find out what they (mother and partner) find most useful and empowering. I could say ‘don’t mention risk’ but to be honest ,unless she is living in a cave she will already be aware that VBAC is ‘risky’ and will need to explore this. In addition, it is a legal requirement for midwives to provide evidence based information about risk.
- Make sure she is aware that she has a very good chance of having a vaginal birth – 72-75% if she has not previously had a vaginal birth, and 85-90% if she has (RCOG). Overall, she has a greater likelihood of a vaginal birth than a woman having her first baby and no previous c-section.
- The RCOG guidelines state that: “Women should be made aware that successful VBAC has the fewest complications and therefore the chance of VBAC success or failure is an important consideration when choosing the mode of delivery.” Therefore it is important to consider previous birth scenarios and contexts to evaluate the chance of success for the individual woman.
- The woman also needs information about factors that can increase her chance of VBAC eg. choosing supportive care providers (and setting) and not having her labour induced or augmented.
- Talk about the possibility of the pregnancy going beyond the prescribed ‘due date’. This is often a feature of VBAC pregnancy. Some hospitals or midwives consider this to be a risk factor because the chance of a repeat c-section is about 9% greater (Coassolo et al. 2005). However, the risk of uterine rupture is no greater.
- Make sure she knows that having a c-section after labour has started holds more health benefits than a planned c-section. Her baby will have had a chance to initiate labour and make the physiological changes needed for life outside the uterus. They will be less likely to suffer respiratory distress and end up in special care (Senturk et al. 2015). In addition, both mother and baby will have the important cocktail of hormones that assist with bonding. Even if she chooses a repeat c-section she can insist on going into labour first.
- Talk to her and her partner about what actually happens if the uterus ruptures. They may be imagining all kinds of horrific scenes such as the baby bursting out of an exploding abdomen.
- If she is worried about ‘failure’ reassure her that she doesn’t need to tell anyone she is planning a VBAC. She can say she’s not sure and will decide in labour.
- If she is planning to birth in hospital she needs to know what the hospital policies are and decide what she will or won’t go along with. This means talking about the risks of the usual interventions such as CTG monitoring. A very clear birth statement can help the staff to support her wishes. It might be helpful to find out the VBAC rates at the hospital to gain some idea about how supportive they are likely to be during labour.
- Encourage her to talk to other women about their experiences of VBAC, read positive birth stories and watch beautiful VBAC birth movies.
- Do not use disempowering language such a ‘trial of scar’ or constantly refer to her birth as a VBAC. She is a woman having a baby, not a disaster waiting to happen.
During labour
The physical care of a woman having a VBAC should be no different (although I know it often is in hospital). Yes, I’m watching for signs of a uterine rupture: unusual pain, unusual contraction pattern, fetal heart rate abnormalities, unusual bleeding, a change in maternal observations etc. But, those symptoms in any birthing woman would be concerning, so this is not different care. In addition, if a woman is unmedicated and connected to her body/baby she will usually be the first to notice a problem. I have found that women having a VBAC may have additional psychological needs. For example, they may request vaginal examinations, particularly if their c-section was for ‘failure to progress’ (aka failure to wait). Even with information about how poor VEs are at indicating progress they may want that dilatation number – some non-VBAC women do too. They may also want more frequent fetal heart rate auscultation to reassure them the baby is well. In general, these women, and even more so their partners need reassurance and a birth attendant who believes in them. Of course some women don’t need any of this and choose freebirth.
Is homebirth a safe option for VBAC?
No – birth is not ‘safe’ regardless of the setting. Different risks are associated with different options. In hospital there is greater risk of unnecessary intervention and associated complications. At home, if you are the 0.2% and need to transfer, there is the risk of complications due to a delay in medical intervention (including death of baby and/or mother). Bear in mind that this delay may also occur in a private hospital out of hours when theatre staff are not on site. Women also need to be aware that when it comes to homebirth, having a uterine scar places them in a ‘high risk’ category. The Australian College of Midwives classify a previous c-section as ‘B’ ie ‘Consult’ with a ‘midwife and/or medical practitioner or other health care provider’. This does not mean that a privately practising midwife cannot provide care. And the woman can decline a consultation if she wishes. Some midwives appear to be unaware of this, and tell women that they are not allowed to attend VBAC homebirths – this is not true. However, if you choose an eligible midwife, you may have problems securing a collaborative agreement from a medical practitioner so that you can claim medicare rebates for care. Likewise, homebirth services run from hospitals or birth centres may be unable to accept you as a client. Whilst VBAC homebirth is generally not supported in clinical recommendations, many women choose to birth at home. Keebler, et al. (2015) examined women’s reasons for choosing a homebirth after caesarean and the full text is available here.
VBACs are usually immensely healing and empowering for a woman and her partner. I wonder whether this aspect of birth is discussed at the ‘risk consultations’ along with the numbers.
You can read a birth story and watch the film here. I may be biased but this is a beautifully filmed/edited birth: Madeleine’s birth
Here is another couple’s VBAC journey (have a tissue handy). This is the most likely outcome of a VBAC – particularly a homebirth:
Further Reading/Resources
- Queensland Health VBAC guidelines (Australia)
- CARES
- ICAN
- Caesarean Birth and VBAC Information (UK)
- Birthrites
- Special Scars Special Women (unusual c-section scars)
- Tips and advice from VBAC mums – BellyBelly
- Gloria Lemay VBAC audio
- Documentary – Birthrights: the risk of choice
I just had an attempted vbac with my son on the 12th. While I did end up with another csection, my birth experience was completely healing from the traumatic experience I had before. I think that the psychological and physical prep I did for a hospital based vbac totally helped make the labor experience more empowering and healing than I would ever have hoped (esp. given the end result – which was a completely warranted and requested csection).
I think that this is an aspect of vbac education that is missed – the self care and prep one does pre and during labor really helps to make whatever birth outcome happens allows for healing and empowerment that a scheduled surgery is not likely to have.
Hi
I read this site and it inspired me to be more assertive with my midwife and consultant. My first baby was emergency C-section at 37 weeks he was breach, low amniotic fluid and potential pre-eclampsia brewing – I didn’t dare argue, my second was a v-bac, I was totally supported by the consultant and midwife and it was a lovely experience and healed the feelings of failure etc after my first C-section.
My third baby was again breach so a C-section, disappointing but acceptable. With baby number four I was keen for a natural birth if he was in the right position. My consultant however had other ideas and was completely against it, spouting risk of death to baby and hysterectomy and not even considering the 98.5% chance of everything being ok. He also wouldn’t consider the fact I had already had a normal birth between the 2 sections.
After reading this and other articles I asked for a 2nd opinion and was referred to a consultant who explained the risks but was happy for me to have a go as long as the baby was not breach! I had him naturally 2 weeks ago, however did have to hold my ground at the hospital when due to meconium in my water the consultant produced a c-section consent form and told me to sign it, suggesting the baby was in distress and this could be due to my womb not coping with labour. We asked for some time and they gave us 4 hours to see what happened, when the consultant came in four hours later his head was out and we were on the final push.
I’m chuffed that my last baby was delivered naturally and have learnt that being assertive when you believe you can do it is essential when faced with experts who have different ideas. The midwives were supportive and felt that being given a chance to progress was fair rather than rushing into a C-section. So learning is: always seek a 2nd opinion. If things had started to go wrong I would of course have reverted to a C-section, but needed to be assertive to ensure that my rights were taken into account to give my baby and me the best birth experience.
Hopefully this will provide support to other women out there considering the same thing. It can be done!
Believing in yourself can be powerful! Thanks for sharing your story Steph.
I am incredibly proud of my two VBACs! My first delivery was a difficult one mainly because I was young and uneducated. I was told afterward (by my “imposter” midwife) that I should never attempt to deliver a baby over 6 pounds again, my pelvis was simply too small. So when I got pregnant again I had a c-section. There really wasn’t a lot of discussion about it. I began to research vaccinations of all things when I learned the term “VBAC”. I knew that was definitely what I wanted the next time. My first VBAC was full of interventions BUT it was sucessful and he weighed 8.5 pounds! Just two weeks ago I had a completely intervention free supernatural VBAC to a 9 pound 7 ounce baby boy. My previous 2 vaginal deliveries had been 24 hours each and this second VBAC was with a very supportive midwife team and only 5 hours long!!! Knowing that I was SAFE and not going to have to FIGHT while in labor was a huge relief and I think really contributed to my ‘easy’ labor.
Had a beautiful natural VBAC 8 months ago.
I LOVE this:
“They have often had a previous traumatic birth experience and are dealing with fear from family, friends, and the medical system, in addition to their own worries. They have been labelled ‘high risk’ and are constantly reminded of the potential disaster waiting to occur. They also risk ‘failing’ if they encounter any complications or end up having a repeat c-section. This impacts on their ability to trust their body, follow their intuition and allow the physiology of birth to unfold. Often these women need more nurturing, reassurance and support from their care givers.”
You summed it up perfectly. I got so much grief from people about my birth plans, (“that’s too risky,” “what if something happens?” “why can’t you just do what your doctor wants?” “all that matters is a healthy baby.”) My natural birth was hands down the most amazing experience of my life and I am angry that there are people out there who would rob women of that experience, especially since the risk of rupture in an unmedicated VBAC is LESS than the risk of a pitocin-induced labor in a first time mom!
I also love this particular quote in the article. It is so true, that the very people seeking a VBAC are those that may have suffered from trauma from a previous birth, and are in desperate need for support and not negativity.
I have not yet attempted my VBAC, however I am constantly thinking and researching because I feel as though I need to be set up to fight every step of what I want. I do not want this but I know that in the current environment, it is likely to happen. The fact that I plan to start my next pregnancy ready to battle for my right is not exactly conducive to a healthy, natural pregnancy and birth however if I have to, I will.
Thank you for this very well presented article on the risk of VBAC. The video montage, “This Woman’s Work” was beautiful! I am a co-leader of a local ICAN Chapter in KY, USA and an HBA2C mother myself. My journey through 2 unnecessary cesareans with no trial of labor and a beautiful homebirth was long and difficult but oh-so-worth-it! 🙂 Giving birth to my youngest son was the most amazing experience of my life and has led me to enter the birth professions. I think it is so important that we VBAC moms share our story to encourage and bring hope to the mamas out thier who desire a VBAC and are fighting for it.
Thanks you so much for sharing your beautiful and inspiring story. Women need access to stories like this showing how strong women are and how amazing birth can be. Congratulations x
This was the most inspiring thing I have ever seen. I had a c-section in January 2011 and have been researching VBACs since my son was born. I want the experience, the natural birth. I want to nurse my child as soon as he/she is born. I feel cheated, I only held my son for 5 minutes after he was born until about 8 a.m. the next morning, that was 10 hours! I felt so drugged, I want to be able to know what is happening and to see my angel immediately! I want daddy to cut the cord.
this made me cry.. Thank you
Got the link for this post from a fellow ICAN group. 4 years after my cesarean I still find there is healing emotionally to be done. Elizabeth, today’s healing moment came as a surprise when I watched your video. What particularly stuck out was “as my baby cried for me I was powerless to help her.” You put words to a feeling I had not been able to pinpoint about being tied down & why it was so traumatic/sad/heart wrenching when I heard my son screaming across the operation room. Now I’ve recognized this I can add this bit to my son’s birth story sharing how I so badly wanted to help him, that at his first moments of birth I did have that instinctive mommy moment (which i had previously thought was absent).
This is why I write this blog 🙂
Hi my name is maya! I am a mother of 3 with 3c-sections, my first c-section was an emergency as I was induced and only progressed to 4cm and after that I started having a really strong urge to push and could not control my baby was in distress and ended up having an emergency c-section. My second was a planned c-section, I did not know about a vbac from the information I received from my hospital made me think once a c-section always a c-section. On my third pregnancy I felt like a failure and I wanted to have a vaginal birth. On an antenatal appointment I heard a woman talking to another pregnant woman that she will go for a vbac I found that word interesting and I wanted to know what it was and she told me that it means a vaginally birth after a c-section that’s she’ had 3 c-section and she is now going for a vbac. So I spoke to with the midwives and then later with a doctor who was not very keen on this and so I stayed firm the said I could not go beyond 40 and they booked a c-section still just in case I don’t end up not having a vbac. I went in to hospital 2 days before and one of the doctors done a membrane sweep, I went home my mucus plug started to come off and the day came for my appointment and so I went in and I said to my midwife that I still wanted a vbac and so they put me on a bed strapped with that continuous monitoring, that’s how I felt as they said I had to stay in bed the 2 doctors came in with two midwives talking a lot of rubbish that I didn’t understand and they made me feel like I had no choice and that I had to go for a c-section, they made feel frustrated and just said to them if they can wait until my husband came, after nearly 3 hours the doctor that was going to do the c-section came in to tell me they are preparing for the c-section to start and so another c-section was done. I am now pregnant again and this time no one will make me feel scared or force me into one. I have seen your blogs and I more encouraged now than before… I would love to have a midwife like you and I like to ask if you know any hospital with good vbac rates or where they have supportive midwives like you. Please help and thank you in advance
I am sorry that you have had such unsupportive care during your births. I am not sure where you live. There are hospitals and birth centres that support VBAC well. A good place to start is VBAC support groups online. Facebook has a number of groups. The women in those groups will be able to give you information about their experiences in different hospitals. You can also contact hospitals and ask them for their VBAC rates and other stats… they should have them and disclose them to you. It might be worth having a doula to support you too – she can advocate for you in the hospital. Good luck with your preparations for your next birth.
I live in newham, all my births was at newham general hospital
Is that the UK? Are there other local options?
Anderzoid, i now realise myself too that i had exactly the same feelings though i didnt realise it either. And my baby was born 10 and a half yrs ago. I remember her crying and i burst into tears but i couldnt see her or hold her and they wheeled me off to recovery for 6 hours.
Thank you so much for sharing your story. You’re an amazingly powerful woman. You’ve given me hope for my VBA2C… I made that decision today and even though it might be difficult finding someone who will deliver my baby, I will search for them until I do. Your story and the other stories on this website have given me the faith in myself to do so. I’m so anxious to see this pregnancy unfold and I cant believe I was told that it wasnt possible to have a natural delivery. Thanks again!
This has helped me so much! My doctor said I was a good canidate for a vbac but with all the horror stories on the internet I was scared. As I continued to search the subject all I found were definitions and more horror stories. I didn’t want to ask family because I didn’t want their opinion to weigh in on such a big decision I had to make. Thanks to this page and the honest info and the Alison and Jack video I feel like I can do this and experience labor and birth for the first time 3 kids later. Thanks for the facts without fear and THANK YOU for the empowerment I now feel
Great article! Putting risk into perspective is so important. What are your thoughts on some caregivers insistence on continuous monitoring?
I know it’s policy in most hospitals to use a CTG during VBACs because of the risk of rupture. However, it is not usually policy to use a CTG on ‘low risk’ women because it increases their chance of a c-section without improving out comes. The risk of a ‘low risk’ first time mother rupturing her uterus is the same as a VBAC woman. So why does one get a CTG and not the other? My thoughts are confused 🙂
” The risk of a ‘low risk’ first time mother rupturing her uterus is the same as a VBAC woman”
This is not accurate. The risk of a first time mother rupturing is much lower – like 1:16849 (Intrapartum rupture of the unscarred uterus -David A. Miller MD)
The risk of UR in a vbac is comparable to *other* risks of a first time labor, such as cord prolapse or placental abruption. But the risk of rupture is not. Continuous EFM can be an early indicator of rupture. I don’t believe it should be “insisted” upon though, it should be up to the mother to decide whether this specific benefit of EFM (detection of rupture) outweigh the risks (higher incidence of repeat cesarean for other reasons) and other limitations such as loss of mobility.
Telemetry (wireless) monitoring is available in some hospitals, which can be a good choice for moms who wish to have monitoring but still want to be able to walk the halls, take a bath or shower, etc. Unfortunately it is not available in all hospitals. 🙁
If you can give me the link to Miller’s research I will add it into the post. I have to be very careful to substantiate what I say with what is considered ‘good quality sources’ otherwise I get blasted by people. The source I use for that statement is the recent Rozen et al (2011) study which you can link to from the post.
EFM can be an early indicator but also increase the chance of a c-section by 30%. A woman labouring undisturbed and connected to her body, baby and instinct will be the first to know if anything is going wrong.
However, for women who need to be, or choose EFM the mobile ones are better although often don’t work too well.
Sure, here is the link – http://www.ncbi.nlm.nih.gov/pubmed/9166298
The Rosen study isn’t comparing actual uterine rupture rates in the two groups, they are comparing overall outcomes, which you would expect to be similar (because of reasons previously given – the overall RISK level is the same, it is just risk from different causes)
This study – http://www.ncbi.nlm.nih.gov/pubmed/18604081 – found a rate of rupture of primigravidas to be about 1:17256
Thanks Christine. I think the Rozen study is helpful for women because they want to know compared to first time mothers are they more likely to experience a uterine rupture. This research = no. The cause of the uterine rupture, if they have one is more likely to be because of the c-section scar. Anyhow, we are still talking tiny numbers and I think women need have choices around EFM knowing that they are being monitored for an extremely unlikely event. I appreciate you digging out the research for me 🙂
First off, I just want to say I am an avid reader of you blog. I love it!
I am a very proud 3x VBAC mum. My first was a induction at 40+10 followed a cascade of traumatic interventions, (sadly) a very unsupportive midwife and ending in an unwanted “emergency” caesarean. Totally shell shocked from this experience, I was determined to never let anyone cut me open like that again.
My journey since has involved a lot of soul searching, research and has resulted in each one of my VBACs being amazingly empowering and healing.
As a result of all this I am now a doula and I’m studying to be a childbirth mentor.
That is awesome Rani!~ good for you!~ I am attempting my first vbac and super nervous! I did hire a doula and am researching Drs who are supportive of VBACS 🙂
I had a VBAC 4 months ago after a very traumatic 1st birth. The VBAC was the best experience of my entire life! During labour I never for am moment felt at risk. My husband and I made a decision to labour at home for as long as possible to avoid the hospital protocols of monitoring VBAC’s etc. By the time I asked my husband to take us to the hospital I was 10cms dilated! They filled the bath for me, the (wise) midwife took the monitoring off me as quickly as she’d put it on, and let me hop in the full bath where I started pushing, broke my waters naturally, and pulled out my beautiful girl with my own hands while being held by my husband. The obstetrician never even walked into the bathroom. I couldn’t be more happy for everyone letting me do what I knew my body was designed to do.
I agree with your article 100%
That is beautiful! I hope to have a water birth too, and have been told it wont happen with having had a c-section, this now gives me evidence that it can be done!
Trish
Thank you so much for an amazing article, that has helped me to be even more determined about what I want. I am pregnant with my 2nd and had a hideous first labour and delivery in 09 with my first that resulted in an emergency c-section. This still traumatises me now and the thought of a theatre room fills me with fear. I am due in just over 3 weeks and have been fighting my consultant the whole way about my right to VBAC and his insistance that a c-section is the best way forward for me. My husband pointed out to him that for my mental state of mind a planned section by them was not the best thing for me and the damage it caused me last time is not something he can watch me go through again!
I would love to find a hospital, consultant and midwives who support this rather than sit and tell me how easy a planned section would be – easy for who?
i wonder where you are. my cousins all had c-sections and then repeat c-sections and they all live in the midwest of the USA. the last thing you need right now is to fight with someone about how you’ll give birth!! i wish you all the best and hope it goes smoothly. if…in the end…you HAVE to have a c-section…i hope you’ll be at peace and have a lovely baby.
I am in the UK, our hospital has a very high rate of c-sections anyway – the consultants seem a little knife happy for my liking! Right from the 1st appt with the consultant it has been ‘dear, with all the problems you had with your first you need to have a c-section’. I believe a lot of my problems happened because my midwife refused to believe that my baby was back to back (she didn’t check my belly at all) and then went and broke my waters without asking, this resulted in a whole list of traumas.
I have everything crossed this time will be easier – one way I am hoping to make this happen is by avoiding the hospital until I really have to go, I want to be in charge this time.
Where in the UK are you? I just had a VBAC in a UK hospital two months ago. It was amazing but I had to fight my entire pregnancy and even in the hours and minutes before I birthed my baby I had to fight for my VBAC. You have the right to be provided care by a provider who supports your decision for a VBAC. If your consultant isn’t supporting you, CHANGE! I changed in the third trimester – I didn’t even realise I was allowed to see a different consultant if I wanted to. Have you checked out the UK VBAC Yahoo group? It’s full of great information, espcially regarding how to deal with consultants who aren’t on board with your birth plan.
http://health.groups.yahoo.com/group/ukvbachbac/
Sorry to hijack this thread, but couldn’t help myself after reading how unsuuportive your consultant is being. Best of luck with your birth!
I only have 3 weeks to go now, he is still determined to cut me open if I have not delivered at 40weeks and when I approached the subject of finding another hospital I was told I would be hard pushed to find one that would let me go to 40wks after the complications I had etc. I did tell him that he could book what he liked but he couldn’t make me turn up.
I just feel so sad that I have had to fight since 14weeks when I had my first appt, they assigned me to the senior consultant at our hospital to ensure I was getting the ‘best’!
I shall check out theYahoo group thanks for the info.
Oh, I am in Suffolk.
Glad it all went well for you with your VBAC – I have everything crossed that I get the chance to experience a natural delivery. x
Christina, remember no one can cut you open without you signing a consent form. It would be considered assault. Have you considered an independant midwife and homebirth?
I still have 9 weeks to go for my now very planned and supported V-BAC and as I was in the same situation as you I decided to change doctors, since the Doctor was the only person that seems to give “valid” arguments to my husband, who was really worried and I really understand him and his reasons after our first experience. I could not stand the pressure of scheduling a c-section and joined the ICAN group and found a doctor and practice that delivers in the hospital that we wanted, but now I have the support of my team. Everybody is cheering on me and I needed this so much. I also decided on having a doula..I do not know how everything will end, but you never know, but I know that I needed to feel the decision I was making toward a V-BAC or C-section and now I finally, after struggling for so many appoinments I am happy to visit my OB every week…..
I had a doula for my VBAC and it was the best money I’ve ever sent. I chose a hospital that I thought was VBAC-friendly and in the end hospital ‘policy’ ended up being actually unfriendly! My doula helped us stay on course and provided amazing support.
My vbac at home, was the most healing experience for me. what a journey of self discover, trust and love. I decided to birth at home with the care of 2 beautiful midwives as I didn’t want the whole label/ risk stuff thrown at me. there was no way I wanted to be treated as high risk and be labeled a trial of scar. I was just a women who needed every chance to birth my baby naturally, something I saw as virtually impossible in hospital. I never thougth about the risks of rupture, my only focus was on allowing myself to relax as much as possible and let me body do what it had to. What an amazing but suprisingly normal ?? moment when I lifted my little boy out of the water. I DID IT!!! No way I could have had this experience in hospital, my irregular contractions would have meant synto for sure, something I was not prepared to accept due to the increased risks of such. It took lots of emotional preparation, facing fears (about my birthing abilities), and soul searching. I had to really believe in myself. I am so thankful for the lessons I learnt on this journey.
Thankyou for sharing your wisdom yet again, blessings in birth x
Hi had my 2nd VBAC 4 months ago. My first son was a caeser due to him being breech. It devastated me, I hated everything about it and never even went into labour. During my next 2 pregnancies and births (both unmedicated natural spontaneous labours 🙂 ) I never once worried about uterine rupture and the dr’s/ midwives I saw never dwelled on it either. My birth stories can be read at http://www.birthwithoutfearblog.com. They were my wonderful healing VBACS and tell anyone I can to try, it is the best thing ever 🙂
I wish this could be my story! I’ve had 2 breeched babies – the 2nd they tried to turn and was all about vbac. but now that I’ve had 2 – NO ONE wants to even talk to me about vba2c! no trial of labor – not even midwives want to try. 🙁 still praying/hoping for my chance to let my body do what it was meant to do!!
What area do you live in? Im from Ohio. Ive had 2 sections and am hoping and praying that I can have a VBAC. This is most likely my final pregnancy. Im determined to find someone who will deliver me. I plan to talk to my doctor about it at my first appointment with him in November.
I am grateful to the doctors and midwives at Glens Falls Hospital in upstate NY for insisting that I give birth via VBAC in 1997. I had no risk factors. I have a horizontal scar just above my pubic bone from my first birth and they told me that type of scar poses no extra risk for uterine rupture. I was healthy and so was my baby. I still would have elected for a C-section again simply because I thought that was what was done. Also, I doubted my ability to actually give birth.
In the end, I was elated beyond belief to find that I did just fine with VBAC and my baby was healthy. My recovery was amazingly easy compared to my first birth, and I can’t imagine now why anyone would opt for a C-section when VBAC was an option. I was horrified to think of how close I had come to doing that to myself and how I never would have known how easy and natural birth really is if I hadn’t had that experience.
I so wish Glens Falls Hospital was still taking the same approach. They’ve since banned VBACs at that facility. The tides do change, but women can insist on their own options. Thanks to this blog for helping women educate themselves and put the risks in perspective.
I just delivered my baby girl via a vba2c 8 weeks ago! I’d been planning a vbac with my second son, but he was a breech 30-weeker in distress, so no go. I just KNEW I had to try a vba2c when I discovered I was pregnant with my third child. Everything in me railed against an elective c/s. I think the #1 reason most women DO choose an elective cesarean is because that is what the vast majority of OBs recommend, and MANY are hostile to vbac. I didn’t realize just HOW strong this hostility can be until I broached the subject of a vba2c with the midwife at my obstetrical practice (BTW, I didn’t choose a MW for my delivery b/c in my state all MWs have to be backed by a supporting physician, and I couldn’t find any who would take me unless it were for a homebirth, and I was not comfortable with that). Long story short, I was told I’d have to have a c/s or I was fired. Fine – I was so thankful to find two amazing practices who were willing to take me for a vba2c and the docs were all SO supportive of me!
Supportive care is the most important thing. As you can imagine, when I presented at the hospital in labor, the nursing staff were all taken aback that I would WANT to try a vba2c. My OB set them in line though. She was so affirming and said to my nurse “Yep, we know she can do it! Its going to be a beautiful birth, you are lucky you will get to see it!” While I was pushing, the nurse kept making comments about my scar. My OB said to her “Let’s just focus on what we’re doing now, not what happened before.” I LOVED her. She had totally faith in me, and that gave me so much confidence during the birth! We had some issues with fetal heart decels b/c it turns out my daughter had a VERY tight nuchal cord, but she kept reassuring me that this isn’t what a rupture looks like, we’re doing fine. I am SO appreciative of that!!
And the #2 reason I think most women choose elective cesarean is b/c they either don’t have perspective/education about the risk, or they don’t want to take responsibility for that risk. If they follow the OB’s advice, then THEY aren’t responsible if something goes wrong, the OB is.
3 cheers for your OB!! we need so many more more like her
I have to say thank you for laying this out in this way. I have had 2 c-sections the first being unnecessary and the second being an HBAC transfer ending in c-section for malpositioning and being unable to engage the pelvis amongst some other things. I labored for quite a long time with an 11lbs. baby who was 22in. long and did not rupture. My placenta was quite big, and I had plenty of fluid, so if you could imagine stretched thin as a uterus I’m sure mine was, and it contracted and worked for me so hard. It was just fine, and I was not afraid.
If I am ever to find myself pregnant again, I will VBA2C without a question. Surgery is not necessary unless there is a problem requiring it. It is true for any surgery. Is elective surgery worth the risks involved? I suppose it depends on you. For me it is not after experiencing a very difficult healing period with my first and lasting issues for the both of us all because of c-section. So, coming from someone who has experienced both sides of this surgery – I can say without fear that VBAC to me seems much safer.
Thank you again. I will be adding this post to the resource list on my blog that accompanies a free public radio piece I did on c-section and VBAC, if that is ok.
Of course it’s OK 🙂
I think you did a great job explaining the “risks” of VBAC. In 2008, I had a VBA2C and as you described, it was very empowering and very healing. It gave me confidence that my body COULD do what it was created to do. I did have this experience in a hospital with my OB close by. He is actually the one that came to me about attempting a VBA2C. I had tried for a VBAC with my second child but would never progress past 9 cm dilated. It was after over 24 hours of labor that my dr. convinced me to have a repeat C before it did become on emergency. I will say that c-section was so much more….I hate to use the term pleasant but for lack of being able to think of a better term right now, pleasant than my previous one which was an emergency both to save my life as well as that of my daughters….thanks to some incompetent state provided health care workers. ( they had me trying to push my daughter out without checking her position first. She was transverse and started showing signs of distress. Her heart rate went passed 300 and I’m thankful and surprised she’s alive and well today and my BP was bottoming…) I also had problems during the c-section which I’ll not go into here but the point is, it was to save our lives and for that, I’m thankful. Needless to say when my OB asked me about attempting a VBA2C, I was shocked as I had asked him about it during the beginning of my pregnancy and he was pretty determined that it would be too risky so when HE came to me about it in the final weeks of my pregnancy ( I think the decision was made 2 weeks before I went into labor that if I went into labor on my own prior to my scheduled c-section, we would give it a try) I was surprised. Leary of failing once again but wanted that experience of a natural birth. He did do extra monitoring and it was a LONG labor. He (my OB) never left my bedside for very long and when he did, he was sitting at the nurses desk watching my monitors. I think that was his way of trying to allow me my privacy and feel like a “normal” birth experience but he truly gave me 100% of his attention…even when I didn’t realize it. There was a time when my baby started showing signs of distress but he would adjust the way I was positioned, it also required adding fluid back into my uterus after the bags had ruptured because she was laying on the cord and cutting off the blood flow to it causing her heart rate to go up..) I guess I said all that to say, I didn’t feel anymore at risk for something fatally happening to me or my child than I would have having my gut cut wide opened. Overall, it was a very pleasant experience…one in which I’m grateful to have had. I wouldn’t change a thing about that experience and I would highly encourage a woman considering a VBAC or a VBA2C to research it and if this is what you want to do, be sure your partner and your Dr./midwife are also on board. If you have a dr. or midwife that is against VBAC’s, it might be worth changing Dr.’s if you have that option.
Thank you for a wonderful article putting this into perspective. I have to agree that attending VBACs is such an amazing blessing. I did want to point out that your risk diagram is inaccurate (if I am reading it correctly). There are 100 little women so only a half of one should be red, right now it shows a 2% risk of rupture. It looks pretty little as is but in reality it is only a quarter of that. Blessings!
Thanks Sarah
The risk diagram was taken from the Having a Baby in Queensland book which states a 2:100 risk. Also this is the risk that mothers are given although it may be slightly less. I am guessing that in the literature and information given to parents they round it up to a whole. 🙂
Even “rounded up” it would be 1:100. The NIH panel statement put it at 778:100,000 so 0.77%
2:100 is more than double the generally accepted level of risk. I wonder why they have it so high in that book?
Christine you are right!
I’ve changed the picture to reflect this. Although I can’t un-shade a ‘person’. Thanks so much for pointing this out 🙂
Sarah and Christine
Thanks for your input. I had a bit of a brain cloud. The risk is 1:200 not 2:100! Duh. Anyhow picture changed.
I’ve just read this thread with excitement – I’m the author of the VBAC/repeat caesarean section chapter in the Having a Baby in Queensland Book, so was very happy to see this reference to the Having a Baby in Queensland book!
I thought I would just jump on to confirm that the risk of uterine rupture is 1 in 200. In the book we have published this risk as 50 in 10,000 which is equivilent to 1 in 200.
Any other questions about the book, please let me know,
Aimee
Thanks for ‘calling in’ Aimee and clarifying the stats. The book is a great resource – I only wish every pregnant woman was given a copy before making her birth choices! My student midwives had never seen the book before and they are in Qld hospitals. How is the resource being distributed? I hope we are not relying on GPs to hand it out!
Sorry this reply is in the wrong place – I couldn’t seem to get it to reply to your post.
The Having a Baby in Queensland Book is currently being given out as part of a trial to test its effectiveness. We wanted women to be given the book as early in pregnancy as possible. Our (Queensland Centre for Mothers & Babies) 2010 survey data suggested that women’s first point of contact in pregnancy was their GP. Therefore we chose to conduct the trial through GP clinics around Queensland.
If you would like, we can make a recommendation to Queensland Health to make the book available to women in antenatal clinics? We have received similar feedback to yours, so you wouldn’t be alone!
Not sure where you replied but it ended up in the right place!
The problem with distributing it at antenatal clinics is that mothers don’t get there until half way through their pregnancy and they have already made their choice re. care provider. If you can ensure GPs hand the books out – that’s good because they are the first contact. But generally GPs will ask ‘have you got private health cover’ and based on the answer refer them to a public or private hospital. I doubt they offer other options eg. independent midwifery care. Many GPs are blatantly against midwifery care, particularly homebirth. I’ve had clients given ‘danger’ lectures and one mother even had the RANZCOG ‘anti-homebirth’ statement stapled to her blood results when she went to collect them. Therefore, I’m not sure GPs offer unbiased ‘here are your options in this area’ information.
In the UK every mother had an appointment in her own home with a community midwife at around 10 weeks. At this appointment they would discuss the local options + risks/benefits etc. and the mother would choose where to birth based on her preferences and needs. I don’t know how we can get this information to mothers early enough in Qld. I don’t know how you get around the GP as gatekeeper to information and choice for women 🙁
Hopefully our trial will give us some idea about how the book was received by GPs and whether GPs gave out the book to women. Additionally, we will be asking women what their GP said (if anything) when they handed out the book and whether women brought the book along with them to subsequent visits when making decisions about their care.
We hope that our trial will highlight some of the barriers to using this book and to informed decision making in general.
We’d love to hear any other feedback or thoughts you have about this resource!
Wow That is a fabulous article. I am 31 weeks pregnant and hoping for a VBAC in April, I am following hypnobirthing and focusing on a lot of what you have written about. What advice would you have if/when I need to challenge my caregivers regarding thier timeframes, interventions etc ?
Firstly I would suggest finding care providers who you don’t need to challenge and who believe in your ability to birth. If you can’t then be assertive and take responsibility for your decisions. Write a statement about what you will and won’t accept. If you are birthing in hospital, have someone eg. a Doula with you who can fight for your wishes. You cannot fight in labour. You need to be undisturbed and able to follow your instincts.
Good luck! 🙂
Hi Everyone – I just started reading this blog because a friend posted it on facebook & I’m very interested in VBAC. My daughter is 7 months old & after a very long labor and getting to 9cm, I reversed and went back to 7cm. At that time (36 hours later) a c-section was needed for the safety of our baby. I’m very inspired to know so many women have had success after c-sections. My question to you may be a strange one – how do you have one “more traumatic” experience via c-section then have a successful natural birth mentally & emotionally? My fear is feeling like I failed with the first & succeeded with the second. Wondering how to be “fair” to both children when we try for #2. Any advice is greatly appreciated. Thank you all!
Sara
My advice would be to find support in your community. Are there any local groups or people who could help you work through your fears? Other women who have been through the VBAC journey?
Hi Sara,
Hi, I am a midwife and a mum with two children, one born by C/S, the other VBAC. I understand the feeling of failure after C/S but the truth is, which may take some time to get to, you did the best you could and for whatever reason, your beautiful child had her own unique birth – which probably had very little to do with her. You did not fail. Take some time to identify things that you might want different this time. Some things you can change such as choice of position, options for comfort in labour, some things are out of your control such as the position and size of the baby. I found it helped to tease these things out so that I could be clear about which things I could do to support natural birth, and those things which I had little or no control over I needed to just accept as part of life.
Good luck in your journey.
I read this article with interest. I had a planned c-section with my son due to him being breech. Fortunately my experience was faultless, my caesarean was calm and a very positive experience with excellent recovery.
However, my fear now is a VBAC after having such an excellent caesarean experience. I do want another baby one day but I’m scared that consultants may pressure me to have a VBAC when ideally I’d like to be one of those who opt for a subsequent caesarean. I know that my body is designed to have a vaginal birth but my caesarean was so straight forward and stress-free that I’m sure that a VBAC cannot match or better my caesarean experience.
People ask me if I feel ‘cheated’ that I never went into labour or had a ‘natural’ birth. My answer is no; my baby was delivered calmly and safely with the added bonus of being completely pain free, I had no invasive procedures and it took 11 minutes from incision to birth. I have friends who took far longer to recover both physically and mentally from traumatic ‘natural’ experiences.
I do know of people who have had successful VBACs but my personal choice would be to have a second c-section.
All women should be supported in the choices they make whether that is to have a VBAC or a repeat c-section. You need to do what is right for you.
Just wondering – have you seen a cesarean? Did you see your own? They are often not as “calm” as they seem to the mother. I recently saw a breech cesarean birth and was a bit surprised at how much pulling and tugging was going on. It didn’t seem very calm for the baby.
Awesome. Thank you. I will be passing this on to clients.
Hi, I am planning a VBA2C in May. I last ended in a repeat c/s after the ob on duty at the hospital didn’t wnat to do a VBAC, even though there were no medical reasons to do a c/s. So, I know that is a possibility.. OB’s in hospitals require a lot of interventions. I was confined to bed on my back with constant monitoring and practically forced to get an epidural… So I really don’t want to have to go back to the same hospital and deal with whatever ob happens to be on duty at the time…
I realy wnated a midwife, but that isn’t possible because there are none avaliable(they are not allowed to attend home births here, so hospital is the only option as there isn’t a birthing center with in a two hour drive, and I am the only liscended driver in the household)… So, I am seeing a Chiropractor and a Natropathic Doctor. I will also have a Doula with me again this time around… it can be an invaluable resourse and we are going to work on options to limit interventions and to get the most freedom of movement possible!!! I am planning on staying home as long as possible. I plan on waiting till about the transition stage to transfer if possible… I am comfortable with calling an ambulance if an emergancy does happen, but I feel from my research that it is unlikely. Catostriphic ruptures that risk the life of mother and/or baby are very rare. Personally I am more concerned about the risks of major abdominal surgery, which are in reality much more common and glossed over by the medical community…
Best of luck to the other momas planning for a VBAC!
Thank you for another really terrific blog. I have just one tiny quibble: the use of the word “rupture” which has dramatic and alarming connotations, rather than “dehiscence” or “partial separation of the scar” which better describes what is likely to be the more common risk. I feel the term “rupture” is deliberately used by clinicians to frighten women from choosing VBACs
Jean Robinson, President, Association for Improvements in the Maternity Services.
I agree Jean
I struggled with whether to use the word. Even whether I should use the word VBAC so often. But, I decided that ‘rupture’ is the word used when talking to women about VBAC so I wanted to match it so they are clear I am talking about the same thing as the OBs. I think ‘dehiscence’ may be a word that lay people are not familiar with and ‘partial separation of the scar’ only describes what is defined as an ‘asymptomatic rupture’. We need to re-think much of the language around birth… starting with the word ‘allowed’.
The word “allowed” drives me crazy too! 😉
I often hear women refer to what they are “allowed” to do in labor or how long and under what circumstances their care provider will “let them” go before induction. Those terms are so commonly used without due consideration for how disempowering and condescending they truly are. The way women just hand over their autonomy to another person in birth is so incredibly frustrating to me. You have the right AND the responsibility to make informed decisions. *sigh* <3
I hate the word “Labor Pains.” I’ve given birth to six babies (five pregnancies) and I never found contractions to be painful. What generally happens is I feel a hardening of my uterus as it contracts, sometimes with pressure in my back, sometimes without, but I have never felt a contraction that I would consider painful. I think the word contractions should be used instead of pains. If I waited until I was in pain to call my midwives, then they would never be called.
In Christchurch New Zealand we have just set up a midwifery led VBAC clinic and in writing our guideline had huge debates about the language to use . We ended up using ‘trial of labour’ prior to having a vaginal birth and only used VBAC if the woman had a vaginal birth after Caesarean section…. def did not use work ‘allowed’ !
Words are interesting… when I hear or read the word ‘trial’ I always think of the law and being accused of something… Did you ask women what they preferred their birth to be called? And I’m pleased the word ‘allowed’ was not allowed 🙂
Just wanted to say THANK YOU to everyone for sharing your experiences, suggestions and thoughts. 🙂 🙂
I had a VBAC in November 2010 and it went perfectly! The birth story is currently the latest post on my blog for anyone interested. 🙂
I love this post as it so very accurately puts the risk of VBAC into perspective! I’m sharing it. And thanks so much!
Thanks for this. I just had my daughter via c/s in April last year. I am not ready to have another child just yet, but my brain still insists on wrestling with this problem. My c/s was not planned, and I never went into labor. I went to the hospital for an induction and her HR was 170…I was told that she was in distress and I needed to have a c/s to get her out NOW. It turns out that the placenta had started to fail (her umbilical cord was already shriveling) and she had passed meconium in the womb quite some time before (she and her umbilical cord were stained yellow…it took us almost 2 weeks to get it all off). While I do not feel that my c/s was unwarranted, I do feel robbed of the birth experience. I am, however, unsure of my ability to have a natural birth because my baby never initiated the birth experience. She was still floating when I went in for my induction. This helps me with the risk factors, and hopefully I can find somebody as supportive as I need to get past the fear of failure.
My bubs is due in 3 weeks and i have booked in for a c sec only because I am terrified of a repeat performance of the birth of my first bubs 2 years ago.
I had fully intended to go natural for my first, but everything was against us (induced at 42.2 weeks, posterior, low amniotic fluid, fetal distress, plus I could only get to 8cm after a 25 hour labour!). To be honest, when the doc came in and said they were going to give me an emergency c I was relieved! At that stage I had done all that I could and was glad it was out of my hands.
It wasn’t till meeting with Midwives to plan my second birth that having a ceaser upset me – I was quite open minded to go vbac as they were all pushing me to go that way. Most of them were younger and did not have children of their own and it wasn’t until I met an older midwife who said that she had ended up with 3 ceasers (after aiming for a vbac with the second), that I got thinking.
I know my experience is limited compared to actual Midwives, but every person I know who had an emergency c sec for their first child has always ended with one for their second, despite trying for a vbac.
Having a ceaser is by no means failing – i am actually looking forward to having one as i see it as a much more positive birthing experience than my first one! This time there will be no crazy labour and i will be far more prepared both physically and emotionally!
Best of luck to all those who have to make the choice (one of the best parts of giving birth these days!) – go with your heart!
I’ve had 3 c-sections now. The first was very traumatic and I really grieved the loss of a “normal” birth. I wrestled with the decision on my 2nd pregnancy. I really wanted to try a VBAC b/c I felt cheated with my first delivery. I was going to go through with it, even though my Dr. recommended a repeat CS. I could have found another Dr. or midwife that “supported” me in that decision, but I really love and trust this Dr. and he has delivered babies for many years (including delivering my husband!). So, I sat down with him and told him I really wanted a VBAC and why (my husband was worried and opposed to VBAC, though, but let me make my own decision). He told me honestly that he did a VBAC on his own wife 20 years ago and he’s done plently of VBACs in his career. But, now, he said, based on the newest research, he would not counsel his own wife or daughter to do a VBAC. I took that knowledge and continued to pray about my decision and was still undecided 3 weeks before my due date. Then, that week, a woman had a VBAC at the hospital where I was planning on delivering and she ruptured and the baby died. I felt like that was the final answer I was looking for. I didn’t want to take that risk. Like this article said, if you’re the .5-1% that end up rupturing, that’s 100% for you and you can’t change it. But, I didn’t make my decision out of fear. I trusted my heart. And that’s really what it comes down to…only you can make that decision.
And if you do choose a CS, don’t feel less-than or like you’re doing something unnatural and unloving for you baby. It’s so disheartening how some people, including midwife forums, talk about c-sections as if they’re horrible. Yes, my first one was awful, but my 2nd and 3rd were wonderful and so fulfilling and happy. I had much less pain than I did with the first (after laboring and pushing so long). I was able to hold, nurse, snuggle and bond with those babies right away. And I nursed them for over a year. I didn’t feel that the medications had a huge negative impact on me or the baby. I wish midwives would also be just as supportive of those that choose c-sections or end up having a CS after a “failed” VBAC. Can’t they empower these same women to realize that a failed VBAC is not a failure b/c with a c-section, you’ve still been able to carry that baby in your womb for 9 months and bond and then deliver the baby in a way that brought him or her in the world, no matter how he or she came. The birth is just a few moments in your lifetime of motherhood. Yes, it’s a wonderful, important moment, but then you move on to feeding, diapering, discipling, refereeing with other sibings, schooling, parenting teens, and then grandparenting (hopefully)! Rejoice in the motherhood and the new baby, not in the way the baby came into the world!
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This is such an inspirational post. I had my first son last year after 57 hours of labor and several failed pitocin inductions- he did not react well to the increased rate and severity of the contractions (his heart rate dropped with each contraction under pitocin) and I was mostly tended to by residents for the last eleven hours of labor because the doctor at my hospital was busy with first a breech birth and then twins that both needed c-sections before me.
I’m glad to know that I can choose to start labor before having my c-section; I’m pretty sure that a VBAC wouldn’t work for me because my son was born with a large head that didn’t compress enough to fit through the birth canal- he had an elongated section of skull and then a prominent ridge above his eyes where the bones stayed in place. I think that if my pelvis were a bit bigger and my husband’s head a bit smaller (literally- but yes, my husband is where my son gets that particular trait) then I’d be able to deliver vaginally (and even naturally) just fine; I made it through about 36 hours of that labor without medication just fine; it was the extended labor that got to me- and got to my son. He was in the NICU for three days because his blood sugar was low and he couldn’t maintain it, likely from being a week overdue and working so hard to be born for several days.
Congratulations to everyone who has successfully had a child via HBAC, VBAC, or any variation thereof- you are so strong. And to those who have attempted vaginal births and been refuted- all is not lost. To those who think they will have to have another c-section in the future- keep as much control as you can in your hands- or in the hands of people you trust; I was so loopy because of my epidural that my stepmother was the one who accosted the resident to make sure the doctor came to see me, because I couldn’t summon up the determination to insist upon anything. Don’t let your birthing experience be robbed from you; just because you don’t have the idyllic ‘Natural Birth’ doesn’t mean that your birth experience is not, at least somewhat, in your hands.
Celebrate life.
I have just read this with such interest, my vbac was certainly healing and so fulfilling, although the level of monitoring felt so unnecessary. When my baby was born all I could say was ‘but I have to have a c-section, I was so sure it wouldn’t work! This has left me so empowered that I am now happy breastfeeding 6 months later, something that never happened after my c-section. It has been an incredible experience!
Thanks very much for this post; I’ll be filing it away for potential VBAC doula clients! I also have a hard time understanding why people make such a big deal of the possibility of uterine rupture when, in reality, many other dangerous things can happen during childbirth! As you say, life is really a big set of risks, and we must weigh the benefits and drawbacks of everything before we make decisions, especially those that will affect our children. As far as I am concerned, for me the benefits to the baby of a vaginal birth outweigh the risk to the mother, in the case of most women who have given birth previously by c-section. The medical community has a host of damaged women and babies to answer to because of their “banning” of VBACS and all-around fear-mongering of pregnant women.
I am a mother of 3 and all of my 3 children were born via emergency caesarian. After a very traumatic induction and close call with the birth of my first baby, I was devestated and took a long time to come to terms with my needing a Caesarean. I researched extensively and was geared up mentally and physically for a VBAC second time round. I was horrified when I arrived at the hospital afer my waters broke at 37 weeks and 6 days and I wasn’t progressing to be advised that I should have Syntocin to kickstart labour! From my reading I knew that it wasn’t recommended and I asked for a 2nd opinion and ended up with an emergency ceasar anyway. But I couldn’t believe that the doctor I saw didn’t know of the risks or research that I had read.
I think doctors need better education in this midwife dominated field as there are women out there who would not know the facts and are guided by doctors, and these women and babies are at risk.
As it turned out the labour would have killed my very sick baby, and I thank God for my motherly intuition that let me meet my little princess.
I am so thankful I read this tonight! My DH and I had a very tense discussion earlier about our friends who just don’t see value in our birth choices and are afraid for us. I am planning to birth my 4th baby at home. I’ve had two previous term pregnancies that both ended with cesareans. The first one wasn’t bad, but when I started to learn about this “uterine rupture craze,” I got angry. The second cesarean was stressful, and it took a big toll on my body. 18 months later . . . I can still remember that searing pain that lasted for weeks, being afraid to lift my newborn babies in their carriers, and the lingering pain in my abdomen.
I’ll be posting your blog post to my various groups. Thank you!!!
As a midwife of many years I have attended many many successful VBACs. One of my most recent unsuccessful ones was a woman who had not been given a chance to labour first time, second time she did all she could. When progress stalled she agreed to an epidural and eventually a CS when progress did not follow. As hers was not a real emergency she has to wait a while for a more emergent CS to be done. When she finally had the CS they found a little tear in the uterus but it was not where the scar was, the scar was ok. Looked like a true obstructed labour and a real need for the CS.
I had three caesareans, one emergency and two “elective”. I had hoped for VBAC with the 2nd in 2000 but was told I would only be allowed to labour for four hours and would then have to have a CS if I hadn’t delivered…. I opted for an elective.
I had a VBA3C in 2006 despite having been told my “uterus would explode and me and my baby would die”. I changed consultants after this (twice) but went on to have a natural birth, in an NHS hospital, after MONTHS of planning and preparation. I took the time to educate myself about VBAC and natural birth, read endless studies and research, made sure I had good support and most of all, I absolutely believed in my body’s ability to birth my baby.
I’m now the UK regional coordinator for ICAN and I’m a birth and postnatal doula. My VBA3C changed my life forever.
I’m running a VBAC workshop at the next Association of Radical Midwives conference late in 2011 and I’d love it if I could use a couple of quotes from this blog? I always used to assume that all MWs would support VBACs but many of them seem to have the same viewpoint as the doctors – you’re a rupture waiting to happen. I’ve lost count of the number of times I’ve been asked with incredulity: “they ALLOWED you to do that after 3 caesareans????”
Thanks for your blog, it’s very heartening to hear a bit of common sense 😉
“My VBA3C changed my life forever” – looks like it has/will also change other women’s lives too. You can use anything you want from this blog 🙂
I had a C-Section because my baby was breech and I apparently had a small pelvis. It was not a great experience. I never wanted to go down that path again. I went on to have 3 beautiful vaginal births …… no stitches, easy peeszy !!!!
i have been waiting to read of someone who has had a VBAC after 3 c-secs,
I have had 6 children, 3 born naturally in 02,03 and 04…after a few years we decided to try again and had another in 09, but whereas my previous labours had all started spontaneously, this time my waters went at 36 weeks and labour didn’t follow… i was put on the drip for a pro-longed period of time and then ended up with a emcs after failing to progress. I felt it was unnecessary, apart from the risk of infection due to ruptured membranes. any how, it was 16 months later i found myself pregnant again, and although i have had problem free pregnancies my waters went at 37 weeks and after being given the chance to VBAC i ended up with another c-sec as my sons heart rate was decelling and id caught an infection. i ended up being quite poorly afterwards so wasn’t in a hurry to have any more children. However after a fumble 9 months after my son was born i was pregnant again with number 6. My pregnancy was perfect no complications at all…. then at 37+5 my waters broke and again this time labour followed but..only this time the midwives wouldn’t use any prostin to get things going and i was only allowed a trial of labour for 4 hours with the drip… with my first and second c- sec i had only made it to 2- cms dilated but this time id made it to 3…however after being examined by the doc my uterus ruptured and i was rushed in for yet another c-sec. Thankfully myself and my baby were well and are ok.
However this brings us to now 19 months on, my husband and i are thinking of trying again. i feel like i have failed by not being able to birth my last 3 babies naturally although having both experiences i long for a natural birth… i have read a lot of the posts above and feel empowered and strong that i can birth a baby… what are your thoughts of a VBA3C and rupture???
Dear Sam, having 3 cesareans, plus a uterine rupture increases your risk of VBAC. Although you feel empowered and confident you can birth a baby, it does not mean that nothing negative will happen. I have been advocating VBAC all my life (I had one when it was ‘forbidden’ then in North America), wrote a book (last published in 2011) about it and encouraged almost all women who wrote or phoned me to go for a VBAC. But it would be foolish for me to say “go ahead, follow your instinct and nothing bad will happen’. Maybe it would go well, of course ! And the risk may vary, for you and your future baby, depending on the extent of the damage the uterine rupture may have done to your uterus. But research has shown that the risks increase with each cesarean (for instance increasing the risk of serious placental problems), and that a previous uterine rupture is a contra-indication to VBAC. In fact, in your situation, I am not even sure I would get pregnant another time. And may I add that no women fail because they have a cesarean. You may find difficult that your last babies were not born vaginally – believe me, I totally understand how that can be hard to heal emotionnally – but obstetrics has grown to be increasingly medicalized, and it’s very hard to birth a baby in these conditions. Even midwives are influenced by how birth is seen in North American since decades. If I may, I would suggest that you work on healing the emotional scar left by your cesareans, and if you wish, that you give some of your time and energy to help things become better for other women regarding birth.
Hi Sam
Only you can make this decision but you need to consider your individual situation. The research available (see the post) re. VBA3C is that it does not = an increased risk. However, there have not been sufficient studies to say this with any authority… probably because not many women have a VBA3C – so not enough numbers for a good study. As for a previous rupture…?? There are increasing changes of a number of complications associated with multiple c-sections as Héléne points out. Perhaps you can talk it through with someone?
Thank you Rachel, for this lovely blog post that provides valuable information for women exploring their options for birthing after a cesarean. I am a doula, doula trainer, CBE and co-leader of ICAN Seattle and teach a VBAC YOUR Way class in Seattle to women planning a vaginal birth after cesarean(s.) You sum it up beautifully, when you say:
“All women can do is choose the risk that feels right for them – there is no risk-free choice. There are many ways of presenting risk and some ways may mean more than others for individuals.”
This is the crux of the issue in my opinion. With information, families can make a decision that feels right for their family! From a place of information, not fear, not scare tactics, but true facts and informed choice. Women will make a choice that is right for them, when given that opportunity!
Thank you for all you do for birthing women everywhere! It means so much to so many!
Thanks so much for your article. I had a c-section delivery for the birth of our first daughter, who presented in breech positioning. We had been booked in to attempt ECV, however my waters broke the morning of our appointment, i went into spontaneous labour and Laura was born a few short hours later (i was about 4cm dilated when she was born). While a very different experience from what i had originally hoped for, my partner and i felt very calm, positive and excited to meet our baby – however that happened. When pregnant with my second child i did my research and prepared for a VBAC. I did a calmbirth course (which i have subsequently become a practitioner of) and went on to have a truly wonderful, pain free (not sensation free), drug free birth. I have had 2 wonderful birth experiences – one through c-section and another natural birth. I am so glad that i had the right support, knowledge and tools, which led to such a positive VBAC experience. My recovery was so much easier, as was breastfeeding, healing and bonding. It also went on to inspire my change in career of working with other couples to help them to create a joyful birth experiences. Living in a culture where fear is so prevalent and inherent in our beliefs, it is so important to be well informed, accurately informed and prepared to deal with or manage any of the curve balls that life throws at us – and birth is always going to be one of those unknowns. I feel blessed to have had an obs who spoke so positively of VBCA, who supported the choices we made and assisted us in having the best birth possible. If we ever decide to have any other children, my next challenge would be to decide our birth options as i found being on monitor in hospital to be very restrictive, irritating and distracting…
Thank you for putting things in perspective. It drives me nuts that VBAC can’t be discussed without rupture, when we so rarely discuss the equally likely complications for any birth. I just had a fabulous VBAC last week with my vertical scar and amazingly, the hospital imposed nothing on me that they wouldn’t for someone without a scar at all, much less a vertical one. I’m so grateful there is so much information available to those who look for it. All four of my births have been life-changing experiences, and I’m grateful for the journey.
what a wonderful video. i cried thru the whole thing and am still crying. i delivered my twins in nov 2010 via c/s that could have been avoided had the staff listened to me and stopped doing the epidural when i said it was making me dizzy and sick. it was my 4th c/s. i feel cheated. i was treated disrespectfully because i wanted to have a vaginal delivery. i hope that thru education, blogs, and research, that more women will have the beautiful birth like the one in the video.
I had to have an emergency c-section with my first and didn’t heal correctly from it, finding out later not many rules were adhered to but knowing I never wanted a repeat. My second son was born via Vbac with a lot of help and I loved it, very little pain after and I was up on my feet within the hour. My third son we tried a second vbac but I started getting a severe crap along my scar on top of the contractions which called a halt to pushing and ended in a repeat emergency c-section due to uterine rupture the worst my ob had ever seen in over 15yrs just to find out like my oldest my son was stuck anyway because he was too big. My opinion, I would never let anyone just opt for c-sections, I’d try another vbac if I knew my uterus could handle it. I had a much better c-section birth the 2nd time around than the first but take vbac over both for my own health and healing.
Thanks for sharing your experience of uterine rupture Tara. It is good for women to ‘hear’ the story from the mother’s side.
Thank you for this fabulous article.
My son was born via emergency cesarean due to being unexpectedly breech after laboring for over about 6 hours. The midwife found his feet coming first, and sent us to the hospital in an ambulance. My son was born perfectly healthy, but the OB had to do a horizontal and a vertical incision on my uterus in order to get him out. She said that his body was all in the vagina and head was trapped in the cervix by the time we got to her (probably because they told me to stop pushing and sent me away to the hospital and scared me, otherwise I think he’d have come out breech just fine.) The OB told me that the vertical incision goes very far up and down and even into the cervix a little bit. She adamantly stresses that I do NOT try for a VBAC if I get pregnant again due to the possibility of rupture.
I’m still unsure as to what the best options are for me due to the nature of the scars an it’s hard to find any information with such an unusual scar. I want a VBAC more than anything in the world. It’s the most important thing to me and I dream about it endlessly. I know that my risk factors are higher than those for women with a low transverse scar and that my uterus will be weaker as there is a point where the scars cross over each other and that makes a 4 corner section of possible rupture or separation. If anybody has any advice for me on this, I would love to hear your views.
Having experienced labor I KNOW that I can do it. I was already pushing when I got to the birth center. I am not afraid of the pain or the contractions. But whether my uterus can handle it the next time, I don’t know.
Again thank you for this excellent article!
Hi Christie
Because your situation/scar is unusual you will probably not find any good research regarding risk or uterine rupture. I do know that lots of women have birthed with a classical scar. I hope someone will see this and tell you their story.
What I do know is that the OB can adamantly stress whatever she wants, but it is your body and you can do what you want with it. You are the expert not her. Get in touch with ICAN (link at bottom of blog). I hope your birth dreams come true 🙂
See my comment above. 🙂 I had a vertical scar from a 26 week c-section.
http://health.groups.yahoo.com/group/Special_Scars-Special_Women/?yguid=347970953 Here’s a group for women just like you…
and my dear friend who had a VBA3C with an inverted T incision…
http://triumphantbirth.blogspot.com/2010_05_01_archive.html
She had lots of issues with the meds like you and will help you find resources in any way she can. Good luck!
My first birth was a c section without my EVER getting close to going into labor! I was having a few braxton hicks contractions and the dr came in and said “we can deliver today by c-section or we can wait 3 weeks and deliver by c section but your babies head is slightly out of position so either way you will end up with a c-section”. It was all over in less than an hour. The pain and feeling of guilt however, lasted for months!!! With my second child I asked for a vbac and my dr. said sure. But when I reached 37 weeks, he changed his tune and told me the only way I was having the baby was via c-section. It was the most horrific experience imaginable! There was scar tissue from things not done correctly in the first one and I was in surgery for over 5 hours! The spinal only lasted for the first 45 minutes. I FELT almost everything after that. They kept trying to get sedated and numb again but my body was rejecting everything. Violently! Then 2 weeks after, they discovered pulmonary embolisms in both of my lungs and traced them directly to the c-section. I was hospitalized for over a month and so over medicated that I can’t even remember most of it. I missed an entire month of my newborn baby and three year old daughter’s life. My husband and I decided we could not go through that again even though we wanted more children. Well it has been five years and we were very surprised a few weeks ago to find that I am pregnant. Just ten weeks. I mentioned vbac to the dr. And he immediately cut me off and said absolutely not after two c-sections. Now instead of focusing on the health of me and my baby, I am absolutely terrified of what I may have to go through again! I can’t sleep for the nightmares. I can hardly eat because of the stress. I can’t find any hospital or dr. who will even consider letting me try a vbac. There is so little information that I can find for my area. I cannot see having a healthy, happy pregnancy with all of this hanging over my head. I am healthy and active. I run (prior to becoming pregnant) several miles nearly every day. I am in the best physical shape of my life. I KNOW my body can do this if given the chance!!! HELP!!!
Pennie
I’ve added some links in the post to research re. multiple c-sections and vbac (see under ‘risk by numbers’).
You can birth! Contact ICAN and see if there is any support in your area. Are there any local homebirth midwives? I’m not sure where you are. You are early in your pregnancy and have time to find support. You don’t have to have another c-section.
Where are you located? Get in touch with your local ICAN group and find a new doctor…talk to your local midwives/doulas. (even if that means several hours away) I had a VBA3C with an OB…so you absolutely CAN birth…but you must find someone who will listen to you and point you in the right direction. Having a supportive provider is worth a long drive! Our wonderful VBAC doctor gets people from all over…some drive hours to birth with him and have zero regrets.
Fantastic article. I had a vbac 6 weeks ago. The support and encouragement I received from my midwives and partner and other mothers were essential. The obstetrician definitely talked up the risk of rupture. The registrar during the birth also came around fear mongering during my labour, but my partner and I stayed strong.
The idea of booking into hospital and keeping appointments, and simultaneously planning a home birth is pure genius! Wish we’d thought of that. Wish we could afford a home birth.
I had a VBA3C with a fused sacrum and a softball sized fibroid. Thank you! This is a wonderful article that I’m going to share with my ICAN group. My birth story is at http://www.cherryblossomdoula.blogspot.com. I write a blog for VBAMC mamas at http://www.victorybirth.blogspot.com.
Thanks for sharing your story and links. You are an inspiration!
I had my first as a c-section in Mass. It seems they are very c-section happy there and I was very uneducated. They also induce a ton there, as I too had been induced prior to eventually having the C-Section. Then we moved to Oregon. I had a fabulous VBAC all natural with my second and will do it again and again if I can! It was a wonderful experience.
I wonder if there is correlation of higher frequency of C-Sections with hospitals who frequently induce moms to be?
By the way, I have no complaints about my C-Section experience either, it was fabulous and so is my baby :). I found the recovery of each birth to be similar. All in all all natural is better though, thus my love for the VBAC.
Inducing labour increases the chance of a c-section for a number of reasons. See my post on inductions for more information.
I’m pleased you had good birth experiences and were supported to VBAC 🙂
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Thanks for the stats and perspective. I had never heard rupture uterine risk is the same for vbac as first time mom.
I have lots of information and stories about VBAMC (VBAC after multiple cesareans) on my website and blog. Stay tuned to the blog, because I will have a new post about VBAMC coming out pretty soon too.
In the meantime here are some links to things I’ve written before about it:
http://wellroundedmama.blogspot.com/2010/07/about-damn-time-good-news-for-vaginal.html
http://wellroundedmama.blogspot.com/2010/12/vbac-after-2-cesareans-distorted-risk.html
http://www.plus-size-pregnancy.org/CSANDVBAC/VBA2Cstories.htm
I am a labor and delivery nurse in a California hospital and have experienced a patient having a uterine rupture during a VBAC labor. Having had 2 cesareans myself, I am the biggest supporter of VBAC on my shift! My first was a cesarean after laboring with a face presentation and double nuchal cord. My second was a TOLAC with a baby who was a pound and a half bigger and had a tight nuchal cord. I purposely take VBAC patients and have a 90% success rate, my job is to keep patients out of the operating room! More information is needed so more people will try VBAC, so many are discouraged by MD’s to even try to have a vaginal delivery. Thank you for providing education!
Thank you for your posts…your blog is awesome! I couldn’t watch the VBAC HB video, it’s blocked in Saudi. Is there a way to send it to me?
Thanks Aisha. The video is embedded from a youtube and is not ‘mine’ so I don’t have it in any other format. It’s a shame you can’t access it.
I posted a comment on your blog but it disappeared. I’ve re-posted it so I hope you didn’t purposely remove it – otherwise you will need to remove it again 🙂
Do you have any numbers for VBAC after a classical incision? I’ve seen anything from 4% risk of rupture up to 10%. I can’t seem to find the mobidity/mortality associated with those, though. I’ve been having a debate about it on a pregnancy forum..
Landon et al 2004 reports 1.9% with classical, T- or J-shaped scars, and 2.0% with low vertical. As far as I can tell however, there isn’t differentiation between scar types when they discuss morbidity/mortality. HTH
Thanks Bronwyn 🙂
Thanks! A certain person in this forum is insisting to a mother that she must, for the safety of her baby, choose a repeat c-section, because uterine rupture is EXTREMELY likely and will be an emergency when it happens…yada yada. Very frustrating. Women need facts and encouragement, not fearmongering.
Good luck to her. She would not be the only one to do it. Most people define my scar as classical and it held up just fine for my recent VBAC. If this woman wants more support, direct her to http://www.specialscars.org/index.html
Thanks for sharing this link/resource 🙂
Hi Rachel,
I just read a very good article that clearly said what I felt but lacked medical knowledge to rationalize… my gynecologist planned my emergency c section.
This is not the reason I am writing this comment. I had a VBAC in February 2011 and during my 4 day long labor I realized (while nurses were telling me that my uterus is working differently than one that is not scarred) that my uterus is completely fine, never better, it is a great muscle and had a lot of exercise while I was breastfeeding my son (born previously via c section) and as every other muscle it got stronger and fitter while it was contracting (during breastfeeding) for 2 years and 3 months (that is how long I breastfed my first child).
Do you know about a study that supports my reasoning? It seems pretty obvious, I gather someone must have had this idea before me.
My biggest frustration in my recent pregnancy was that I could not find anybody that understood why natural birth was so important to me. I had a very strong and determined reaction to my c section, and a feeling of disbelief from my own body. It was like my body has a mind of its own, independent of my mind but there is an emotional connection on a very primal level. Anyway, my body did not understand what happened and who took the baby. I was obviously aware of what happened but my mind was always late in explaining it to my emotions and I had very deep sorrow to deal with… and this eventually resulted in my body becoming depressed, even my vagina was depressed. My life had lost its spark for some time
Anyway, my story has a happy ending. I am fine now and totally adore my precious little baby boy. Well not so little 🙂 he was born weighing more than 4.6kg
My first born was present when I gave birth and now I have an issue to explain that he was not born like his brother (which he saw from the first raw, actually my doctor had him on her lap while she was waiting to catch my new baby).
I don’t know a study that supports your reasoning – but it makes perfect sense… and you don’t need studies to ‘know’. I am pleased you had a healing birth experience with your second (not so little) son.
Thank you so much for your post! It is easy to read and follow with perfectly stated facts. I hope your blog reaches millions of people around the US and the World!
VBACs are not a disaster waiting to happen!!
I am very proud to have achieved 5 successful VBACs and hoping to add one more to that. I also run the ICAN chapter in Anchorage Alaska. I would not be here today if it were not for my first baby being born via c-section. I’ excited to see some changes coming about.
Thanks and I will be continuing to spread the word and sharing this blog with everyone I know.
I have had 2 VBACs, but had to fight for both. My first baby was born via cesarean because she was breech and my water broke. With my second baby, one physician was against me having a VBAC because he worried that his office was a 20 minute drive from the hospital and he felt that was too risky, but his partner was totally for it and they actually had a shouting match in front of me about it, ending with the senior partner getting his way and me getting my VBAC. He told him that if I were to go into labor, he would be happy to deliver the baby by VBAC even if he weren’t the doctor on call at the time. (The doctor who was against it actually delivered my baby and we ended with a good experience.) With my second VBAC, we had moved into a rural area of our state and the hospital near our home was not equipped to help me if my uterus ruptured, so they would not allow VBACs. I elected to live in a hotel with my family for the last month of my pregnancy so that I could deliver in a hospital that would allow VBACs. The doctor who fought for my first VBAC delivered my 10 pound baby with my second VBAC. I am now weeks away from my third VBAC in a different location and have had no resistance to VBAC at all this time around. I’m very happy that I have been able to VBAC because the recovery from a VBAC is so much easier than a cesarean recovery.
Does anyone know if you are at increased risk of uterine rupture if you have very quick labours ? During my first labour I was fully dilated 90 minutes after my waters broke (which was before contractions began). But due to breech baby with bradycardia I ended up with an emergency caesarian section (baby also low birthweight). I hope for a home birth next time (if there is a next time !)
Sarah – as far as I’m aware there has been no research looking at this. Probably because it is rare. I know the medics are concerned about long labours with VBAC. You may find that your next labour is very different (or not).
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Hi,
I’m 36 weeks pregnant my DS was C Section almost 2 years ago due to oblique position, all was fine. I’ve been given the very hard choice do I go for a VBAC or another Section? My concern is that I will have scar tissue from my previous Section also scar tissue from a septum that I had operated on 3 years ago and I’ve also had x3 miscarriages and had surgery with all 3. Will I have too much scar tissue to be able to have a VBAC or will it end in an emergency Section I would rather have a planned one.
At the end of the day I just want my baby here safe and well so I will do whatever us best for her. I can’t talk to my Consultant about this as he’s left and I’ve been told I can’t have an appointment to talk to anyone until the middle if July, which by then my baby will have been born .
Hi Java
Only you can make that decision. Physically the scar from your septum should not increase your risks as I am assuming there was no incision through your uterine wall. There will also be no scarring from your miscarriages – they only scrape the walls of the uterus and no scarring should result from that procedure. So, basically you are in the same situation as most women who have previously had a c-section in terms of risk. I can understand why you wouldn’t want to labour and then end up with a c-section. But, statistically you have around an 80% chance of a vaginal birth – higher than a first time mother. Also experiencing labour is important for your body and your baby – even if you do end up with a c-section. It allows baby to choose when they are ready to be born and labour prepares them for breathing = less respiratory distress and feeding problems due to mucous. Marsden Wagner (an obs) argues that all babies should experience labour whether they are a planned c-section or not. 🙂
Thank you so much for taking the time to reply to me, I wish you were my Midwife 🙂 You have explained what makes sense in my language. I just felt the no-one had the time to talk to me at my appointment and I felt rushed into making a choice. Also I have a high BMI which I didn’t have when I had DS so that’s a concern.
I’ve read that they don’t like to induce previous C Section ladies so now thinking should I ask for a Section if I go beyond my due date? I just really hope that the staff are more helpful and pleasant when I actually have my baby. I’m hoping it was just because the clinic was running late everyone was stressed.
Thanks.
Y
… or just wait until your baby and body are ready to labour?
They have no sound reason to insist that VBAC women don’t go post dates.
Do you have a local birth support group you can access for information and support?
I phoned them yesterday & told them my wishes for a VBAC I spoke to a much friendly Midwife who said about 80% ladies achieve a VBAC she said I’d be surprised.
I explained that I’d like a back up C Section as a sort of safety net which she said she could understand. She said in my notes it says review at 41 weeks so going to have a word with the Doctor on Friday then get back to me. I think they allow ladies to go over by 11 to 12 days here before intervention but I don’t want to be induced so would rather have the back up planned Section although I’m hoping that I won’t need it 🙂
Thanks again for your advice 🙂
http://birthnavigators.wordpress.com/2011/06/10/no_more_vbac/
I am a birth doula in Johannesburg, South Africa and whilst my own VBAC has been a healing experience I accompany and educate many clients on the risks and benefits of having a VBA and/or elective caesarean.
I agre wholeheartedly with you when you say that we need to move away from fear based information and a one sided look at VBAC’s. Birth is part of life and it has no guarantees, we all take our chances. It is imporant that more doctors here also get to know more about these facts as we are currently sitting with a 85-90% caesarean rate in our private medical sectors.
I love your writings and I will pass this info on.
Thank you.
I had my first baby boy by emergencyc-sec after failed induction and a labour of about 12 hours in 2006
My second son was born by successful vbac in 2008, after I had a false labour of more than 24 hours and then a real labour of another 24 hours, most of which I chose to spend at home. I felt so empowered through achieving what so many told me I never would – felt so strong and capable for ages thereafter, and loved holding my baby and being able to feed him immediately – but thanks to the hospital’s policies and procedures which left my husband and I reeling from the so-called “care” I received during delivery, I also felt disconnected and suddenly woke up to find my baby was 8 months old and I had felt like I missed most of it! The hospital birth was so traumatic that my husband adamantly said “no more babies!” (btw the nurses at the hospital told me that I was the first woman in about 5 years to have a totally natural drug-free birth at that facility)
When I found out that I was pregnant the third time we agreed that we would not return to the same hospital that had seen us through the c-sec and VBAC. Luckily here in Johannesburg, South Africa, there are a few (read 2) birthing centres using midwife care. We had baby Dylan there in January this year and it was the most peaceful, fulfilling and amazing experience for both my husband and I! Because of this we are happier as a couple, we are calmer parents with all our kids and we are both so in love with little Dylan. Even more so than the first two babies – if that makes sense.. 🙂 This despite another long labour (more than 24 hours again) and hard delivery due to the scar tissue caused by the “routine” episiotomy and forceps delivery used with my first VBAC by an on-duty OB/GYN who was totally anti natural births and in particular VBAC’s. But I had FANTASTIC midwives and they supported both my husband and I through the entire preparation and birthing experience and this was the single most defining and incredible event of my entire life!
Even my husband now is a huge fan of natural birth, midwife and doula care and empowering women (and men) to choose through knowledge.
To me, it’s not just about achieving the natural birth – it’s about empowering women with knowledge and the power to make a truly educated choice, one that enables them to be in control of their own body, their own labour and to be fully present – both body and mind and even in spirit at the birth of their child.
Thank you for this fantastic article – I will be passing it on to those I know planning a vbac!
“To me, it’s not just about achieving the natural birth – it’s about empowering women with knowledge and the power to make a truly educated choice, one that enables them to be in control of their own body, their own labour and to be fully present – both body and mind and even in spirit at the birth of their child.”
🙂
I am currently pregnant with my 10th baby. Scheduled for C-section on Aug 20. But I am very bothered by this. My mind tells me that I should opt for VBAC even after have 3 emergency C-sections, 2 due to breach, 3rd because already had 2.
Here is my story and I hope I can get some advice..
I had 5 normal deliveries with baby size ranging from 2.95 to 3.3. All born 2 weeks before due date with exception where the 1st child was born on the due date.
Not counting the first 24hour labor, the rest was relatively fast 3-4 hours. The last 2 natural birth, I had no epidural.
My recovery was excellent. I could be up and walking with no pain in 3 hours.
1st C-section-reason complete breach
2nd C-section -also breach, baby in sitting position with both feet extended
3rd C-section- reason because already had 2 C-section.
The 2nd last baby was 3.8kg -She was born 3 weeks early
The Last baby was 4.15kg-He was born supposely 4 weeks early base on ultrasound..but base on my first day of period, I would say it was his due date.
All labor was spontenous with the last natural birth dilation was not possible due to cord around the baby’s neck. Doctor request I go for emergency c-section but 5 minutes later, I couldn’t bare the pain so decided to push the baby anyway and found pain relieve when pushing. From 4cm I went to full dilation and efaced and gave birth naturally within 5 mins.
With all of my labors, I do not get regular contractions until my waterbag is broken by the doctor at the hospital but dilation progresses non the less without much contractions.
With my last 2 delivery, my water broke but felt no strong contraction yet dilation was at 5cm from the first examination by the nurses.
I have asked my doctor regarding the condition of my uterus and he told me that there was no sign of thinning when he performed the last C-section on me. Only thing he kept saying was that he had to give me 2 powerful jabs to help my uterus contract. Is this a big concern if I go for VBAC?
My doctor stitched me up with permanent non disolving stitches for my last C-section.
My last recovery from C-section was remarkably quick. I was up and walking in 12 hours and discharged 2 days after delivery.
I had specifically signed a document telling the Gyn that he can remove my uterus if he can’t stop the bleeding but at all cost do not perform ligation.
After my delivery, he told me that he thought of removing my uterus but changed his mind because the anestetic was wearing off.
I forgot to mention that the 1st 2 C-section I attempted using epidural. First attempt was a failure so they put me to sleep before they cut me open. The 2nd C-section, the doctor advice to wait a little longer for the epidural to work then cut..but that was a disaster as the drug was only 60% effective. I only realize it after they pulled the baby out then I was put to sleep for the rest of the procedures.
So with my last C-section I had general anesthia.
I don’t know why but something tells me that I should try going back to vaginal delivery.
I am concerned about going for a 4th C-section, where the chances of the doctor removing my perfectly good uterus regardless of what I signed, is quite high..considering what he told me the last time. He thinks I have had enough kids. 10 is unheard of in this part of the world and at this day and age. 2ndly i think that even if I should survive this C-section with my uterus still in place, no doctors would carry out a 5 C-section on me.
I feel that if I attempt and suceeds in going back to vaginal delivery, then the doctors can’t make any excuse to simply remove my uterus and for subsequent delivery, natural delivery can be a normal option. All the issue about thinning, rupturing uterus can be disregarded.
My current doctor refuse to delivery my baby if I insist on natural delivery. My husband thinks that it would be safer to do C-section. But somehow I am not convinced of that. If I insist on natural delivery I would be referred to government hospital where only they have the facility to acommodate an emergency c-section if in case natural delivery fails. That is what my GYN tells me.
I would like to know if I go back to natural delivery, is it certain that my uterus will need to be induce to contract like my previous c-section. Somehow I feel that the inability for my uterus to contract is partly due to the fact that I undergone C-section instead of natural delivery where the Uterus would be contracting gradually just to push the baby out and I don’t think that it would just stop contracting when the baby comes out. During the C-section I have yet to even start serious contraction yet and i think that the uterus just wouldn’t contract because the baby was just taken out and it was not given the time to be pushed out by the contracting uterus. I maybe wrong.
My husband’s concern is what if i have another 4 kg baby…surely I wouldn’t be able to push such a big baby and I would endup going for an emergency C-section put risk on the baby and myself
My last C-section was considered an emergency as my water bag broke at 36 weeks. So now my GYN is scheduling me for a C-section on Aug 20, when my due date is Sept 3. That is another worry for me. I really don’t think that I should take the baby out when he is not ready to come out. MY GYN will give me a jab to mature the baby’s lungs for this C-section.
I deeply feel that it is more save for me to attempt a natural birth then a c-section at this point in time. Everyone I have spoken to regarding my desire for VBAC has considered by insane.
Goodness – there is a lot in your post/experiences!
I can’t give advice, only information. You need to make your own choices – the right choice for you and no one else. You appear to have had c-sections for no real reason (breech is not a good reason)
I’ll try and address some of your questions:
– You are more likely to bleed heavily because you have had so many babies and this could happen at a vaginal birth or a c-section (so not really a reason for c-section)
– Your uterus will be able to contract regardless of previous c-sections and induction would be dangerous and increase your chance for uterine rupture
– The risks associated with c-section increase with every c-section. Most obs don’t like doing more than 2 on one woman
– A 4kg baby is a very normal size and not big. Your pelvis is designed to open and adjust to a ‘big’ baby.
– There are risks associated with taking a baby out before term and before labour.
Do you have a local support group like ICAN (see links in post) or an independent midwife you can talk to. I feel like you have a lot to work through and need a lot of information to do so.
I live in Malaysia so there is no such support group. I really am at my ends wit to see who I can convince to let me go for natural delivery. I really do not feel like going under general anesthesia for this as epidural doesn’t work on me. Let’s say i just don’t go in for surgery and wait until I go into labor naturally and when I go to the hospital I refuse to sign the forms for C-section…can the hospital or my doctor refuse to give me trial of labor..before going to C-section..? I will continue to nag my doctor for now..
I’m not sure what the law is in Malaysia. But I would imagine that your dr cannot do anything to you (ie. c-section) without your consent. If you don’t give it he/she will have no option but to leave you alone.
So if i am at the hospital, will they still have to go through with delivering my baby naturally…if he doesn’t do it, any doctor on duty must do it right? Or they can just refuse and I have to deliver it on my own..I don’t really know what you mean by leave me alone.
See my post on ‘information giving and the law’. I don’t know Malaysian law. If you decline a c- section I don’t know if a ‘duty of care’ exists or whether your dr can refuse to give care. Why don’t you ask them at your next appointment what they would do if you decline surgery?
hello,
i am planning a vbac, but was wondering if it is safe to do so as their will only be 12 mths between the c section and vbac?
i had a baby naturally 3 years ago, he was 6 weeks early.
2nd was breech and they didnt relise until i was ready too push so it was an emergancy c section and because i was doing the birth without drugs they knocked me out and i missed the whole thing. didnt get to hold my baby for 3 hours and i was so drugged i dont even remember my first cuddle.
i really want a vbac but am so worried that my scar wont have healed for long enough.
i really dont want a c section as i was so depressed after missing out on first cuddles first bath and the midwife had told me the sex of the baby an hour before i got to meet him.
so do many people have vbac so soon after a c section?
thanks, melody
What a fabulous blog! I have just come across it and shall be using it from here onwards for inspiration and informaton.
Just wanted to say I love the way you have presented the stats and I will try to utilise that for ladies that I see (I am a UK based midwife)
Thanks!
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Wow! I stumbled on this post…Im in Australia but i recently achieved my VBA2C in March of this year and it was such a healing experience. I had the full support of my husband (this time!) and hired an independant midwife and found a wonderful amazing OB and hospital. I will post my birth story soon on my blog…. but your website has a wealth of info that i would love to share with those who contact me etc!
Rachel,
Let me start out by saying that I am a home birth midwife, a huge VBAC supporter, and a fan of your generally thoughtful, thorough blog posts. Having said that, I also have to say that I’m somewhat horrified by this particular post, and by the many commenters who repeat over and over the misinformation you posted in it regarding the relative risk of uterine rupture in VBACs compared to first-time pregnancies. The commenter identified as “Christine” pointed this out back in February, but you continued to defend the assertion that the risk of rupture in these two groups is equal.
Rachel, you are absolutely wrong on this point. You are badly misunderstanding and misrepresenting the reference that you provide as a citation (Rozen et al), and you are disseminating seriously flawed information on a topic of great importance in the birth community. I’m sorry to sound so harsh about this, but there’s a great deal at stake. VBAC is a critical birthing right for women, and it’s also a complex and sometimes fraught decision for them. In the interests of truly informed choice and in the interests of a public debate in which midwives and other birth rights activists have credibility, it is critical that we read and present the data accurately.
To that end, please go back and look again at Rozen et al. You will find that they never make the claim that uterine rupture risk is equal between VBACs and first-time moms. Look closely at the sub-section titled “Uterine Rupture.” The first thing the authors say is that “During the study period there were five uterine ruptures/uterine dehiscences in our cohort (0.02% of cases overall). This relatively low number was insufficient to achieve statistical significance during analysis due to insufficient power.” What does this tell us? What are they telling us themselves? They’re telling us that they don’t have big enough numbers in their study to say anything about uterine rupture.
Now look more closely at the numbers they do have: the study looks at 21,389 consecutive deliveries in one hospital: 9481 of these were first-time moms (nullips), 9816 had previous births (multips) with no scar, and only 2,092 were women with a previous c-section.
Okay, now look at the ruptures they identify: there were 5 total. Four of the 5 were in women with previous c-sections, and the fifth was in a multip: none of the ruptures were in nullips.
Now look more closely at the numbers regarding the 2,092 Group 5 women (those with a previous c-section). There are some mysteries in this group. They never tell us, for example, how many of these women actually attempted a VBAC, compared to choosing elective repeat section. Keep in mind, Group 5 includes all women with a previous scar; that’s NOT the same as a VBAC, but the authors seem to conflate these two. Look at this: only 423 (20.2%) of the Group 5 women actually delivered vaginally. If all 2092 of them had a trial of labor/attempted to VBAC, then that’s an extraordinarily low success rate. Seems likely that at least some of them had elective repeat sections, right? This means that the actual number of VBAC attempts in this study gets lower and lower. No wonder they can’t say anything statistically significant about uterine rupture!
What these authors can say — and what they do say — is not that rupture rates are equal between primips and women with previous scars, but that the rates of postpartum hemorrhage, significant tears, and neonatal complications (defined as NICU admission) were similar between first-time mamas and women with a previous scar. That is an interesting and potentially useful piece of information, but it is a very very different claim from the one you are putting out there in your interpretation.
Regarding the rates of uterine rupture in first-time mamas, the data is actually very consistent across many population-based studies. Nullips have such vanishingly small rates of uterine rupture that the traditional obstetric teaching was that the primigravid uterus was nearly “immune” to rupture. Even in the setting of the Irish “active management” protocols, there were no ruptures in nullips in almost 60,000 labors. In the most recent and most thorough review of the subject, Walsh and Baxi conclude that uterine rupture in a first-time mother is so rare that the rate is unknown. They are able to identify only 35 cases reported in the literature over a period of 60 years. (Sorry, I can’t link it as it’s in a journal, but this is the reference: Rupture of the primigravid uterus: a review of the literature. Walsh CA, Baxi LV, Obstet Gynecol Surv. 2007;62(5):327.)
Here’s a link to the best summary of rupture rates that I’ve ever been able to find: http://emedicine.medscape.com/article/275854-overview#showall
Overall, this meta-analysis finds that the rate of uterine rupture in women without uterine scars (in the industrialized world) is about 1 per 7440 (0.013%). The overwhelming majority of these are multips.
So, where does that leave us in the comparison of rupture rates between women with and without scars? You cite a VBAC rupture rate of 1 per 200 (0.5%). If the basline rate for women without scars is 1 per 7440 (0.013%), then the VBAC mama has a rupture rate that’s more than 38 times higher than the rate of any woman without a scar (primips, multips, grand multips). Compared to first-time mamas without a scar, the VBAC mama has a rupture rate that is so much higher that it is literally impossible to calculate — because primip rupture is so rare. The Irish studies had not one primip rupture in nearly 60,000 primip labors. If we posit a rate of 1 per 200 for VBACs and a rate of 1 per 60,000 for nullips (it is probably even rarer than this), that makes the VBAC rupture rate at least 300 times higher than the rate for first-time mamas.
I realize that I’ve belabored this point for a rather long post here, but I really think it’s important. PLEASE go back and look at this material again. Women need to make their choices based on real information, and we midwives need to be really scrupulous.
Thanks for thinking.
Hi Mary – Thank you for taking the time to write this comment and point me in the right direction. You are right. I have re-read the research. The lesson is not to rely on other people’s interpretation of the data without fully reading the research paper yourself! The whole point of this blog is to provide good quality information and to encourage women to share their stories. I have edited the post and appreciate your input 🙂
Mary, thank you so much! I’m the Christine from February. Thanks for noting my comment and for your thorough breakdown of the research. midwife thinking, I’m glad the post has been edited appropriately 🙂
And I apologise for not changing it in response to your initial comment Christine. I have problems getting my head around numbers and didn’t take the time to go back and properly look. 🙂
I had my second son booked in for a c-section on the advice of my OB, But thankfully he arrived 2 weeks early and I was able to try a VBAC. Im so glad I did as it was an amazing experience.
Although Like your article mentioned about, I ended up with 3rd degree tears because of shoulder dystocia and he also had a true Knot. Im so thankful that he is a healthy beautiful boy and that I got to experience the natural labour.
I am curious about a few things…perhaps you can point me in the right direction to find some more information. Firstly, I would like to learn about uterine windows (i can’t seem to find any real, concrete evidence on this topic) to give you a history:
DD1 went to 41.5 weeks, induced because i didn’t know any better, 27 hour laboring (in bed, epidural, everything that you should not do in labor, i did) pushed 6 hours, wheeled off for csection (doctor said somewhere in the midst i was less likely to die from csection than car accident, isn’t that fabulous?) and baby was 10.7 lbs (roughly 4.9 kgs?, sorry i live in states) i also remember some uttering of cervical lip still being there when i was pushing. healing was awful, never been on pain meds before, zonked out to find baby rolling onto the floor (yea don’t judge, i had no idea i would be awake one second and fast asleep the next, rns neglected to inform me of this) suffered HORRIBLE PPD and i still feel a bit of detachment from my daughter from the experience (she’s 4 by the way)
DS1 i was afraid of failing, yet again, so ob sent me for a few ultrasounds near the end, was determined that baby would be big (they termed macrosomia) and ended up RCS at 39.4 weeks. the whole process was pretty straightforward. but again with the PPD. i think i cried over everything. (he is now 27 months, 8.12 lbs at birth, 3.6kg)
And so here is where i began the endless search of research.
DD2 Hired an awful doula who slept in the pull-out while i was in labor, and annoyed everyone every time she opened her big mouth. so, membranes ruptured 40w4d and i waited a good 2 days before seeking medical attention. i had little contractions, but nothing major. after 48+ hours of no labor, doula advised to go to hospital. got there, hooked up to all the bells and whistles, CNM could find pooling, but no ferning, then eventually found ferning after, ohh 5 or 6 tries. then things were looking good for a vba2c (especially after acog revised vbamc guidelines and hospital was abiding) until the ob came and said i had uterine windows between babies 1/2. apparently that makes my risk go up tenfold(i suspect not) but who was i to tell them they were wrong? the ONLY thing they threw at me i knew nothing about. disappointed would be an understatement. so i was sent to a LDRP room (please don’t ask what initials stand for i can’t remember) where labor started to really start. docs came in, wheeled me off for surgery and i delivered (or should i say they pried) a healthy 8.10lb baby girl, not much smaller than her brother. It was much more fullfilling, having gone into spontaneous labor, but still, i want that coveted birth.
So, back to my questions. how would windows correlate to the risk of uterine rupture? i read a blurb from nancy wainer (queen of vbacs) stating that windows are indicative of healing, not impending rupture. where can i learn some real solid facts? Also, how would a rupture rate be affected if babies are close together (mine are 21 and 18 months apart). how would this affact a vba3c success/rupture rate? how soon is too soon for a vba3c? i hear 18-24 mos for interdelivery period and unfortunately all the studies i’ve read do no specify how far apart births are. And lastly, what poses more risk, a 4th csection, or a vba3c?
sorry about the rambling.
Hi Leah
I am not really familiar with ‘uterine windows’ and have never heard it used before. There is a recommendation to wait 18-24 between c-section and labour to reduce the chance of rupture. Only you can decide what poses the more risk for you. I hope you find your answers and support for your next birth 🙂
why thank you : ) the term ‘uterine window’ seems to be something a lot of people have not heard of. they said they’re basically thin spots on a uterus (which i thought your uterus was pretty thin towards the end of pregnancy anyways) the comparison they used was like stretching silly putty, where there are some spots that stretch to be really thin. it’s a hard thing to find information on.
Window sometimes seems to be used interchangeably with dehesience, although they’re different. My understanding of windows is that they’re a result of poor suturing or some other issue which results in an opening in the scar when it’s healed. I have never heard anything about whether they increase risk. I suppose it’s possible, but it’s so rare, I doubt they could ever get enough evidence one way or another. The ridiculous thing about your situation is that if that is indeed what you had, they would have sewn it closed during the last cesarean, since most of the time they go through the same scar. So, unless they cut you in a different spot, or you developed one again, you don’t have it anymore, anyway.
I’ve had 3 c-sections and have been deeply traumatised by them. With the first I was induced because that’s what the doctor told me to do. Having not had other children I was too scared to doubt the doctor – they’re supposed to have our best interests at heart, right? Anyway, fetal monitoring showed heart rate not fluctuating “how they would have liked” so they dissected me open like a frog in high school biology class and a baby was placed into my hands a while later. Re-reading my words I can see that I obviously am still hurting deeply over this. By the way, AFTER he was removed the doctors found there was nothing wrong with him (of course) but we were “so lucky” that we had done something to avoid the risk.
With my second pregnancy, from the first antenatal appointment they wanted to book me in for my repeat c-section. I fought and fought the whole way (in the public system in Qld so couldn’t exactly chooose another doctor). By 42 weeks I hadn’t gone into labour, even after 4 stretch and sweeps so in I had to go in for another clinical, sterile, removal of my baby. The anaesthetic also did not work entireley and I felt part of the incision and stitching – of course terrifying me for future births. After the operation I was separated from my baby for hours because another lady had tragically lost her baby and they didn’t want to subject her to hearing a newborn. Why couldn’t they have moved either one of us to another room or further away!!! (Of course my problems are NOTHING compared to losing a baby – I can’t even begin to imagine the pain)
My third baby in March 2011 was supposed to be a VBA2C. I saw a variety of midwives and doctors over my pregnancy (public system again, different hospital) and some were terrific and supportive and others basically called me an idiot to my face and treated me like I wanted to murder my baby just to have a vaginal birth. I left most of my appointments in tears and had to fight the whole time. I went into labour a few days past my due date and wanted to stay at home basically until I needed to push (to avoid doctors and unneccessary monitoring etc) but there was merconium in the waters so just in case there was something wrong I went to hospital and of course it was all over and another c-section. After the event, again, nothing wrong with me or baby, although they did say my uterus was very ‘thin’.
I do think that the two babies who did get to experience at least partial labour were much more alert and ‘ready’ than my second who was plucked out of her happy, warm home without warning. So if I do get to a place where I’m ready to have another child I think I NEED to at least go into labour again so my baby knows it’s time to come out. How can I know whether the risk for me to try a VBA3C or a 4th c-section is riskier? I’ve always wanted a large family but it feels like the doctors who performed my first “unnecessarian” (a great word I saw on a forum somewhere) have robbed me of this. Is wanting a VBA3C selfish and too risky to the baby? Is a fourth c-section too risky? Should I just be ‘happy’ that I have three wonderful, beautiful children who mean the absolute world to me – am I selfish for wanting more children when some people can’t even have any?
You are not selfish at all. To tell women they should be grateful for a live baby is to deny that their experience and trauma is important. Lots of women have had vaginal births after multiple c-sections. Maybe link in with on of the organizations I’ve listed and find some birth stories and support. You ave every right to your feelings.
Thankyou for this blog. It has put some things in perspective for me. I do have some questions you may be able to shed some light on for me, though, if you could spare the time to trudge through what has turned out to be a rather long comment.
Brief history: 9 years ago, I had my first son. Normal pregnancy, normal labour. 41 weeks, 15 hours, 4kg and did it with gas, he was perfect and healthy and it was all a great experience.
Two and a half years ago, I had my second son. That pregnancy I had gestational diabetes, which I controlled with diet. At 40 weeks precisely, I presented to the hospital in labour to be told some hours later that he had died, then had it confirmed by an ultrasound. He also was born naturally. Initially just with gas, but later on, I’m fairly sure they drugged me up because I was obviously in no state of mind to be making any rational decisions. Cause of death? At the time, they told me they didn’t know.
16 months ago, I had my third son by emergency caesarean. I was considered high-risk, so was going for multiple ultrasounds to monitor growth and whatnot. At 37 weeks and one day after a scan, I got a phonecall from the hospital telling me I had to go in that very day, but she said she didn’t want to stress me by explaining why, as it was a long drive and she could hear I was little terrified and getting somewhat hysterical, that the doctor would discuss everything with me. Got there, got hooked up to many machines, spent hours freaking out, not knowing what was going on or why I was there with midwives who came on duty, then went off duty, to be replaced by other midwives who didn’t really know what was going on, either. All while the aforementioned doctor was in a meeting. He arrived to say my Braxton Hicks was causing my son’s heart rate to drop, which could be fatal and, after assessing me and deciding inducing was not possible, gave me the option of having an immediate caesarean. Given my terror at the possible outcome, I agreed without hesitation and about 20 minutes later, was chopped open and heard his first cry. The caesarean was calm and orderly. The attendants (all five billion of them) were smooth, experienced (it was a teaching hospital) and yes, calm. The big lights above the bed – they were positioned in such a way that if I had wanted to, I could have watched the entire operation by reflection. I had no desire to see myself, as described above, dissected like a hapless frog, so did not view it. There was meconium in the waters and he ended up having a week-long stay at the SCN for low blood sugar and fluid on the lungs, but came out good and healthy.
Now I am 27 weeks pregnant and just last week was told the hospital would not allow me to go further than 38 weeks, maybe earlier if there were complications. It was also tossed at me in a somewhat offhand manner, that they did, in fact, know the reason for my second son’s stillbirth, even though none of this was discussed with me or my partner at the time we went in to talk about the autopsy two and a half years ago, nor at any time through my pregnancy or birth with our third son. Apparently the placenta had an infection synonymous with rubella (I’ve been immunised) or toxoplasmosis or some other long Latin names that I was simply too stunned to mentally note.
Sorry, even days later, I’m still a bit stunned that no one ever told me, and it has, in some way, made me lose faith with this hospital who has birthed two of my three babies.
Anyway, I have been given the option of, at or around 38 weeks, scheduling a repeat caesarean or being induced via Foley’s Catheter, which I understand is a technique which carries the lowest risk of Uterine Rupture. Needless to say, I have been on the internet almost constantly since then, trying to find good information. I start to lean the way of the VBAC, then I read something that makes me go, ‘No! Why are you doing this? Why should your baby be put at risk just because YOU want a vaginal delivery?’ , then getting cranky with righteous women who believe any inducing and all caesareans are completely unnecessary and we’re designed to pop babies out with little more effort than that exerted with a slight case of diarrhoea. It is good to have the actual risks all laid out in layman’s terms in a forum with no judgement.
Because I have had a full term loss, I absolutely do NOT want to put myself or my first girl in any unnecessary situation which could prove fatal to either of us. Uterine Rupture is something I have always been terrified of. Even during my first complication-free pregnancy, I obsessed over it.
Because I have had two natural births, I feel confident that this time it will all go through smoothly, even though I know every pregnancy and every birth is different. However, as this is my fourth pregnancy, I also think that I am more ‘stretched’ and this might logically carry a higher risk of rupture – I show early and carry big (I can’t even say if this is because I’m small and my partner, the father of all our babies, is tall and broad-shouldered, as are our sons, or if it’s genetic on my side – my mother and sister are obese, so it was difficult to tell when they were pregnant if they were big or just ‘big’, if you understand what I mean). Is this paranoia at its worst, or is there some substance to it?
I also fear not being able to distinguish the feeling of a rupture and it possibly going unnoticed. The reason for this is my thoughts on pain relief. I want to be prepared in case I need to go in for an emergency caesarean, so am thinking an epidural would prepare for the worst. Would this obliterate the knowledge of a rupture? If I didn’t have an epidural, would they put me under a general anaesthetic to conduct the surgery?
Also, I fear not being able to stand up for myself. I’m a public patient in the Queensland Health System, so we won’t know who will be my doctor until the day, and if that doctor says, ‘oh, we should probably just do a caesarean’, I know I will cave.
Not particularly relevant to this specific blog, but perhaps with your experience, you may have some information: if I choose to go the way of the VBAC, I would like the Foley’s Catheter to just work. If it doesn’t, they won’t apply hormonal inducement gels or fluids, I will be taken to surgery. That ‘early’ in the pregnancy, will completely natural forms of inducement help to, shall we say, loosen things up? Things like nipple stimulation, intercourse, walking and castor oil, to name a few? Or will it be too early for any of that to have any real effect?
So in my case, there is a 1% chance of Uterine Rupture with the Foley’s Catheter, but other complications that carry a higher risk of bad things happening (I am focussing on the rupture – as I said earlier, it’s something I do obsess over), but what are the chances of fatality during a scheduled caesarean? Because it’s a common surgery, it is sometimes forgotten that it is, nonetheless, a major surgery. How does having previous successful vaginal births and caesareans factor in, if at all?
I’m sorry this was so long. I have so many questions, and as I am an indecisive person by nature, I know that even when I make my ‘final decision’, I’ll still be thinking of how the other option would be better for whatever reason. I would appreciate any input you have to offer and once again thank you for the information you have collated and offered up here.
Bindi
Wow – you have a lot of thinking and processing to do! No one can make this decision for you. You must weigh up the risks of various options and listen to your intuition too. In answer to some of your questions… No you are not at more risk of rupture because your uterus has been ‘stretched’ by previous pregnancies. Yes there are risks involved with c-section, and for your baby there are risks related to not initiating labour and making the physiological changes needed for life outside (ie. elective c-section). The fact that you have laboured before and had vaginal births may make induction easier to achieve. However, you may be very unready to labour at 38wks and although nipple stimulation etc can help – if your body is not ready it may not work. If you lost your baby due to infection I am not sure what the rationale for early induction is. Your c-section sounded like it was necessary but I’m not sure why your baby was in trouble. Phew – there is a lot to work through. That probably hasn’t helped you. Good luck with your journey – I really hope you find the right answer for you 🙂
Thanks for your quick reply. You have given me some good info, which I have taken on board my teetering decision-making scale. I’m not sure why I’ll be going early this time around, either, but I’m just hoping the doctors are doing what’s best for me and this new little lady. I will try the natural inducement techniques and hope they work to move things along as naturally as can be in this situation, otherwise I guess all I can really do is take things as they come.
Thanks again for your reply. 😀
I have another question for you – does diastasis affect a successful outcome with VBACs? I have had it with all pregnancies.
No – I can’t imagine how it would.
I wanted to pop back on and thank you for this site and the information you have provided as well as your continuing attention to questions posed.
I went in for my induced VBAC on 10th November and our little girl was born at 11.48pm on 11th November, 2011 at 38 weeks and 4 days. They used a Foley’s Catheter to begin dilation and syntocinon to help along contractions. After 7 hours of intense labour, they suggested I have a repeat caesarean as dilation hadn’t progressed further than 2cm. The idea of doing this made me very sad, but I just wanted our girl to be healthy, so half an hour later, off the syntocinon but still contracting hard and fast and in the anaesthesiologist’s room, I got a spinal. Moments later, once I was paralysed from the chest down, the doctor performed one last vaginal examination and told me that in that half an hour I had progressed from 2cm to 9cm and she could feel the baby’s head. 20 minutes later, I pushed her out in the anaesthesiologist’s room. I was mere minutes from being sliced open again. In the end, there was no grazing, no tearing and no rupture. She was 7lbs, 5oz (3.3kg) and 51cm long, so while not a huge baby, neither was she small.
I am so pleased it all happened this way and once again, thankyou for the support and education you provide women facing this choice.
Congratulations! 🙂 🙂
You did amazingly well to push your daughter out with all of that going on! Just goes to show vaginal examination is not a very accurate assessment of what is going to happen in the future. I hope you feel as wonderful as you are. Enjoy your new daughter x
I personally have had three c sections in my career as a Mother 😉
The first one I was robbed… they did the whole push the epidural… pump up the pitocin and it stopped my labor.. after 21 hours a c section happened. I never progressed past 6cm lame.
With my second little guy.. I had totally planned on a VBAC. I got a new Obgyn she is great and was totally on board with me in this. Then the unthinkable happened. At 15 weeks I was rushed to the hospital we thought we had a miscarriage, there was so much blood the ER doc prepped me for it. But during the ultrasound he was discovered. There was his beautiful heart beating and it was discovered then I had a 12cm tear in my placenta. I was placed on complete and total bed rest till delivery. But it wasn’t expected the pregnancy would survive. My lovely doctor held my hand though it all. It ended up lasting till the 39th week. He ended up being taken by c section simple because of my complications. I am super glad he made this call because when examined internally I was for sure to experience a serious rupture. Glad to have it.
When my Third guy came around… the pregnancy went great all the way till my 35th week… then after going into the docs for a routine visit he was check for his heart rate.. it was low… dangerously low??? They rushed to monitor me and thankfully they did.. he was crashing.. dying. I was rushed and prepped for yet another c section and he was born a mer 10 minutes later. Glad to also they then discovered there was only 4 oz of fluid.. yikes.. That was too close for me.
So needless to say while she was in there I had her neatly tie off my tubes and close up shop.
It was time to enjoy the beautiful people I have and watch their journey.
I wish more than anything I could of birth my children.. but apparently the cards were not there. The first one I was robbed and I keep thinking if that first doctor hadn’t screwed me over then what if… But there are no what ifs. Thank God for able doctors and procedures like the c section other wise my kids wouldn’t be here. But that being said… I pray more and more woman try for a more natural birth experience. The statistics of ratio c sections vs vaginal births are mind blowing…
Sorry this is so long.. You have a ton of amazing information. I hope about to be new soon to be Moms are reading. So they are not railroaded into the early epidural, don’t do it lol and then the pitocin… It gets you flat on your back and on the fast track to a c section.
C-sections can and do save lives… as you have experienced. It is lovely to see that you support other women’s right to information and the avoidance of unnecessary c-section. 🙂
Thank you, I have made it part of my journey as a woman and a Mother to do just that. I pray Moms (new and experienced) are reading though all this and more information. Being informed is powerful. If I would of known then what I know now, who knows how different the out come could of been.
My experience doesn’t have to be theirs.
Blessings to all your sweet babies Ladies.
Dear Rachel,
You’ve received almost 150 comments on this post, so I’m not even sure if you’re still reading the comments, but I thought I’d try leaving one anyway. First of all, thank you for this amazing blog. I’m hugely impressed with it, and even more impressed, I have to say, with the way you dealt with the correction from Christine and from Mary Moore in the comments. I didn’t read your post before you edited it, but it speaks volumes in favour of your approach — entirely evidence-based and reasonable, contrary to what so many people think of the homebirth movement (of course, the strongest natural/home birth advocates, e.g. Ina May Gaskin, *are* evidence-based, but so many people don’t know that).
I’m leaving this comment because I recognise myself in your description of PTSD following a traumatic birth (in your post about PTSD), and also because I will be planning a VBAC in the future. I live in France, where I had my first child, and it was a horrendous experience, so all I can say for sure is that I won’t be giving birth in France again. I was, from the beginning, never listened to by my ob-gyn — who pushed me towards X-ray pelvimetry based purely on the fact that I am small. I refused the X-ray pelvimetry because I had been told (by local midwives) that my doctor could use the results to insist upon a scheduled Caesarean. On my due date, a routine check revealed a leak of amniotic fluid, so they kept me in hospital and induced after 24 hours when contractions were still weak and irregular. They tried every kind of induction, but I had strong contractions only after chemical induction, and by this time several midwives were saying, “Well, you should have had the pelvimetry, then we’d be more convinced to let you labour.” Towards the end, a check by one of the midwives showed that the baby was descending — and let me add that at no point was my baby *ever* in any kind of distress. But then the shift changed, and the new team of midwives insisted on a Caesarean because by then we had gone 48 hours since the amniotic sac had started leaking. My husband was not allowed in the OT, despite all our pleading and begging. My baby was born in perfect condition, had a 10 on the Apgar, and the shape of her head immediately after birth suggested that she’d been on her way out anyway, before the C-section.
I will probably have my second child in the UK. But after my first experience, I feel shaken and wary and unable to trust any healthcare professional. It’s been 2 years, but I still can’t think about my daughter’s birth without feeling like I’m about to cry. I wish I could find a midwife like you; I plan to try to find an independent midwife, but when I think about communicating how I feel about trying for a VBAC, the task feels insurmountable. I do have fears about uterine rupture, and I know I’ll be placed in a high-risk group not only because of the previous C-section but also because of my age (I’m over 35). All this means that I need a midwife who’ll be able to work through my fears with me, and to help me feel empowered again — and I don’t know if it’s fair to expect a midwife to be a therapist as well! I was never afraid of childbirth before I had my daughter — I was confident, and sure my body would know what to do. The experience I had took all that away from me. I don’t know if I’ll be able to find a midwife willing to try homebirth with me given the 2 “high-risk factors (previous C-section and age). If you have any advice at all, or contacts to suggest, I would be deeply grateful.
I so sorry that your first birth was sabotaged by your ‘care’givers. Pelvimetry went out with the ark as it provides no indication of how the baby or pelvis move/mold during labour. I am surprised to hear it is still being used anywhere.
As for your next birth. I would recommend finding yourself an independent midwife. Your age is not a risk factor! VBAC is a very slight risk factor (as you can see from the post). As for you midwife being a therapist… It is part of the midwives job to work through fears and concerns relating to previous births (and anything else). We care for the whole woman – mind, body, emotions, spirit. It will be important for you to have support in working through your awful experience and building trust in your body. I really hope you find the support you deserve.
Dear Rachel,
Thank you very much for your reply. Yes, pelvimetry is still regularly used in France; just two weeks ago I was visiting a friend and a friend of theirs who is a practising midwife was shocked and horrified that I had refused the pelvimetric scan. She also insisted that a woman’s shoe size is a reliable method of gauging the capacity of her pelvis (yes, I know that theory went out with the ark too). You can see why I don’t plan to give birth in France again. Thanks very much for the link to the independent midwives website. There are independent midwives here, but I think I might do better finding one who can understand my needs in the UK. Do you really think that my age is not an additional risk factor, even a small one?
Age is a number and we are all individuals. Some 20 year olds are less healthy than some 40 year olds. It is about your own personal health – not the number. At 35 you are statistically more likely to encounter difficulty getting pregnant and have more chance of congenital abnormalities. But, your age won’t affect your birth. Older women have statistically more intervention… but older women are also more likely to use private obstetricians because they have the means to afford it = intervention. I have cared for plenty of women over 35 and don’t see a difference with birth.
Even the restrictive Australian College of Midwives guidelines don’t consider age a risk until 45.
Thank you again, Rachel. I was asking partly because a woman I know was recently refused a homebirth by the NHS in the UK because she’s 38 — the last time she gave birth, at 36, they didn’t object to her age, but this time they are treating her as though her body must have magically aged 50 years in those 2 years. I’m in excellent health and shape and hope to find a midwife who will understand this.
Thankyou so much for this. After two c sections (one for failure to progress, the other a near crash section for scar dehicsence and fetal distress after augmentation of my attepted VBAC) this was just what I needed to hear. We would love to have more children but I hate knowing I will be instantly classed as high risk and be thought of as putting my life and the life of my unborn baby at risk for attempting a VBA2C and even *shock horror* a homebirth.
I work in maternity sevices as a support worker (In the UK) and I am saddened by how little is known about VBAC as a whole yet alone the relativley low risk of uternine rupture.
Even a year on I am still struggling daily with a barrage of emotions and my heart aches that I have not been able to give birth to my babies vaginally. Thankyou for seeing the woman behind the label and for giving me hope. Would you mind if I linked to this post from my blog?
Thankyou again,
Nim x
Oh and you weren’t joking when you said to keep the tissues handy for watching the video were you?! I cried bucketloads!
Thanks Nim – of course you can link to the post from your blog 🙂
My hospital has just changed to become a bit more pro-vbac (UK – it had a high c section rate and wanted to lower it).I went to a VBAC appointment and was wondering about the folowing policies.
However they do want to have cfm (although they claim it is 2 belts with long leads and you can still be mobile). I don’t want anything attached to me as I think I will feel inhibited and hated all the drips and leads with last time. Would I be putting the baby at risk if I refused? Surely there would be other signs of scar rupture?
Secondly they don’t want to allow me to use water (even a bath) in labour – I assume this is because they want to monitor though.
Finally – they “allow” you to push for an hour and then “if the doctor allows it and thinks the head is in a good positiion”. I didn’t like the language, but apart from that is there a Good Reason to restrict time allowed for pushing?
I think if I make enough fuss in advance and in my birth plan I can do my own thing, but I want to be sure I’m not doing anything risky. I’m also curious why they have these policies. The MW I saw just soouted normal party line and said it was all due to risk of scar rupture…
Not sure how to answer you questions… the hospital is preparing for the worst case scenario. The intervention suggested make it less likely that you will birth vaginally. The policies are there to protect the hospital from litigation. You have the right to do what you want in labour. Put it in writing, state the at you are willing to take responsibility for your choices, and insist that they are followed. If you are being coached to push hard for hours you are increasing the chance of a uterine rupture. If you are spontaneously and instinctively ‘pushing’ it will be gentle. As for risk… there is an element of risk with all birth. You cannot eliminate risk – only choose the risks you are happier to take.
hi there love this page and have been in tears both time watching the video clips of VBA2C/ HBA2C and reading everyones stories.
However i have some questions of my own as im am a mum of 2 boys both delivered via c-section and now expecting baby number 3!! and very excited as i have choose to have a home birth in hope to birth vaginally.
Question 1: As a doula do u check for dialation at home?
Q2: What are the diffidence between a midwife and a doula?
Q3: At a home birth is the vitamin K shot givin to bub after bub is delivered?
Q4: how is the baby monitored at home whilst in labor?
Q5: I thinking about a water birth, does anything need to be added to the water? eg prevent infection or anything.
thanks guys! 🙂
Hi Rebecca
The answers to your questions really depend on where you are and who you choose as your carer…
Q1: I’m not a doula but the doulas I know don’t do any clinical assessments during labour. They care for, and support the mother (and family). As a midwife I rarely do vaginal examinations – they are a very uncomfortable and inaccurate method of assessing progress (see http://midwifethinking.com/2011/09/14/the-assessment-of-progress/).
Q3: Yes – if you want it. Do some research and make an informed choice about this routine medication (http://www.aims.org.uk/Journal/Vol13No2/vitk.htm). Most of the parents I care for don’t want it for their baby. Depending on where you are and who your carer is you may have to get a prescription from a dr.
Q4: If you have a midwife you will be offered intermittent auscultation ie. the heart rate will be listened to regularly with either a doppler or pinnard. Again – your choice (see http://midwifethinking.com/2010/07/29/listening-to-baby-during-labour/)
Q5: You shouldn’t add anything to the water. Nothing. Bacteria from you, amniotic fluid, blood, faeces, urine etc will often end up in the water. The baby would encounter this ‘soup’ in an ‘out of water’ vaginal birth anyway. Being in contact with this helps the baby to colonise their skin with healthy and familiar bacteria which actually protects again infection.
Enjoy your homebirth 🙂
Hi Rachel,
Thank you so much for your post. I had a emcs with my first baby, for reasons I still do not really understand. Like Preeta I was 36, I am now 38 and due to have (fingers-crossed) an HWBAC with no 2 who is due in 4 weeks. I am in the UK. I changed from my first hospital, because they were so obsessed with me having continuous foetal monitoring and therefore being immobile, not allowed to use water, etc. When I said to the consultant that I did not consent to this as there are lots of other signs to look for, including my own sensations and feelings, my husband and I were subjected to a five minute lecture on how the midwives would not feel comfortable with this, it would be difficult and we would have to ring and specially tell them we did not want this when we went into labour so they could ‘try’ and sort a member of staff who would be happy to be with us!! I truly felt as if they were setting me up for another Cs. So, we moved to a different hospital 40 minutes away, who couldn’t be more different. I saw a different consultant who went through the risks but always in context of low risk, but potential high impact, but said they were happy to support us in OUR decision and genuinely hoped we were able to have a home water birth. I am hoping that works for us, but I feel this hospital really wants us to succeed. My only comments are I guess a) we CAN do this and it should be OUR choice whether we want VBAC or a planned c-section – I have friends who have chosen both ways and b) nhs staff play a massive part in influencing how confident women feel in their own bodies and I worry that protocol and policy mean that this really important emotional support is being forgotten about.
Enjoy your birth – come back and let us know what happens.
Could you make one little change in this sentence:
Interesting that a poor outcome associated with a c-section does not seem to illicit quite the same response – ie. fear of c-section.
The word you want is “elicit”, which means “draw out” . “illicit” means illegal or against the law.
illicit (adj.)
c.1500, from O.Fr. illicite (14c.) “unlawful, forbidden,” from L. illicitus “not allowed, unlawful, illegal,” from assimilated form of in- “not, opposite of” (see in- (1)) + licitus “lawful,” pp. of licere “to be allowed” (see licence). Related: Illicitly.
elicit (v.)
1640s, from L. elicitus, pp. of elicere “draw forth,” from ex- “out” (see ex-) + -licere, comb. form of lacere “to entice, lure, deceive” (related to laqueus “noose, snare;” see lace). Related: Elicited; eliciting; elicits; elicitation.
Otherwise, loved the article. Will give my experience in next post.
Susan Peterson
Done! Thanks for picking that one up 🙂
I had eight vaginal deliveries after my C section. The last 6 were at home. I almost forgot I had had a C section and stopped thinking of my uterus as wounded or imperfect. I want to give thanks here to the late OB Dr.James Brew who helped me have the first two VBACS-before that acronym was coined-in the hospital despite much resistance from his professional colleagues-and provided me with a CNM to monitor me 1:1 until he could do it rather than subjecting me to EFM, despite pressure from hospital staff. Thanks are also due to FP doc Herbert (Skeet) Muncie, who helped me every way he could with my home births, even though he could not attend the actual births. The ninth birth was attended by Patricia Chirumbolo CNM, backed up by a Dr. Dan Driscoll. (whom I also thank for stepping back and letting me catch my first grandchild, at Wilson Hospital some 20 years ago.)
Dr. Brew laid out the statistics for me, and said the same things about “if you are that 1%, it doesn’t matter”. (I think there were way fewer VBACs then to get any stats from.) But he gave me a lot of good reasons why he didn’t think I would be. After all the scary stories the previous doctors I had seen gave me, this was very refreshing.
When I was young, we thought all would be better with birth by now, and instead we have so many C sections, and the majority of labors being induced or augmented, so much less belief that babies really will get themselves born; it makes me very sad, when it doesn’t make me angry.
Susan Peterson
So I am in desperate need of your opinion. I had my son by c-section in 2008 b/c the ob/gyn told me he was to big(no labour), wish I’d known how stupid that was, then I had another with my daughter in 2010, labour for 28 hours she didn’t drop enough and they found a small tear in my uterus during this time. The insensitive woman who did the operation announced that I could never try a natural birth again and this is really haunting me (not my midwife she was amazing), so what I’m wondering are a few things. If I do get pregnant again is it more likely my uterus will rip again? can they force me into a c-section again or can I try labour, I really really want to have a baby naturally and am haunted all the time by this so any answers would be great
Rebecca – no one can force you to do anything and if you want to labour you can. It is difficult to comment on your specific circumstances without having been involved. Have you debriefed with your midwife? I don’t see how your uterus is at any greater risk than anyone else who has had 2 c-sections as the tear would have been repaired during the c-section? 28 hours of very strong, frequent contractions is a lot. However, 28 hours of irregular or contractions with a gentle build up is not… there are a lot of factors that influence what is going on and it is impossible for an ‘outsider’ to know. I really hope you can find a way to put your mind a rest and talking to your midwife who was there might help.
I did sort of debrief with her but at the time I wasn’t really ready to talk about it. The ob/gyn said I had to have c-sections but since it tore rather then ruptured I dont see why I can’t try for a vbac again. It was 28 hours of mild then increasing contractions, and it only lasted so long because she wouldn’t put her head down so she could come out (that was an addition 4 or so), can I use a midwife if I have to have a scheduled c-section? I do plan to see the midwife again if I decide to have another but I also do wonder if more interventions had happened earlier like the vacuum could she have been forced out vaginally sooner so part of me doesn’t really know what to think (I know she did what she thought was best but I still wonder)
I’m sorry I don’t even know which country you are in or what your local access to midwifery care is ie. for a scheduled c-section. You could not have had a vacuum if her head was high. It would need to be in your vagina and low for the use of a vacuum to be safe and effective. I think you would benefit from de-briefing with your midwife now. She may remember helpful information about what happened that would assist you to work through it.
I had a very traumatic first birth ending in a c-section. Not ever wanting to have that experience again I opted for a home water birth, even after a very un-sympatheic registrar at the hospital told me I would die and my baby would die. My birth went without a hitch and was the most amazing and healing experience of my life. I am now pregnant with my 3rd and thinking we will again try a hospital birth (due to building a new house) but after my 1st hospital visit they told me I would have to be monitored the entire time thus not being allowed to use water as my pain relief option. I refused and threatened to have another home birth. They don’t consider my scar which will be 9 yrs old or that I have had a sucessful trial of scar with a perfect baby. They also don’t consider montioring intervention – as I do. Does anyone know of any research done on risk of uterine rupture after a successful VBAC? I am sick of being bullied by hospitals, to me the risks involved in a c-section are far greater than uterine rupture and frankly I don’t want a doctor coming near me unless absolutely necessary. Thanks.
Lou – it doesn’t matter how much evidence you give them you will still be considered ‘high risk’ within the system. You really can’t change how the system thinks/works. All you can do is either opt out of it altogether or insist they follow your request regardless of the risks (they perceive). If you birth in hospital be prepared to fight the interventions all the way and/or take someone who can do it for you.
I am in a similar situation, years ago with my first vbac I was encouraged to try it. Now after 7 years and 3 successful natural births in hospital with midwives if I go to the hospital they are demanding IV upon admittance and fetal heart monitoring during active labour. With my fear of needles and the need to use water to assist with labour I know it will set things off to a bad start. Another difference is the midwifery practice has had to have a meeting to see if they are all on board for a homebirth even though mine is fine with it the ones on call have to be too. Luckily they have all agreed to let me but this has been very stressful.
Thank you for this! In a fairly anti-VBAC local climate here in the US, I have managed to find ONE provider willing to work with me toward a home VBAC. Still, she constantly refers to my birth as “VBAC” and has said I will probably be labor for days and days because VBAC labors are “always” longer because a scarred uterus doesn’t as work as well as a “normal” one. Not exactly encouraging! I am determined to give birth at home because I know it increases my chances for a healthy and successful vaginal birth, but I admit that the less than encouraging words from others get me down sometimes. I appreciate your post and your perspective and have shared it with my midwife and all of my Facebook friends. 🙂
In my experience a VBAC is just a birth. There is no difference in terms of how the body labours and birth. Your uterus works in just the same way as uterus without a scar (ie. labour can be minutes, hours or days). The only difference is that often women having a VBAC have less faith in their ability to do it – largely thanks to the attitude of others. It is vital to surround yourself with people who KNOW you can do it and who will be strong for you when you feel you cannot do it (which most women feel at some point in labour). I am a little worried about your ‘providers’ attitude. If she/he is approaching your birth with the belief that you have a second rate uterus you may not get the support you need and deserve. If you can’t get another provider can you get a doula or another support person to also be with you in labour?
I have tried not to let her comments get to me on a deep level as annoying as it hearing those things can be. I never went into labor with my first, it was an early (36 week) c-section due to pre-e. This pregnancy has been so healthy and I know my body will do the work when given the opportunity. 🙂 I do have an awesome doula – she is actually a naturopathic doctor who did homebirths for 25 years. Although she no longer delivers babies she is a great doula and resource, and is very supportive of my goal. My husband is also amazingly supportive. My only other provider option is a CNM or OB for a hospital birth, and I really am trying to avoid the hospital! 😉 Thanks for your comment and your advice and encouragement! 🙂
I have never heard of vbacs being any longer, my first was 6 hours and got shorter the last was born 20 minutes after arriving at the hospital. Everyone is different, hope that helps a bit.
I agree with everyone else that a VBAC is not necessarily longer. I had lots of early labour, but my midwife classified active labour as being 1 1/2 hrs and then pushing for 50 mins before my VBAC baby was born at home! My scarred uterus worked beautifully well. Read and watch as many HBAC stories as you can! There is no reason you won’t be another one of those when it’s time. Sending plenty of good birthing vibes your way!
I have always stated I would have another cesarean. Always. My first in 2004 was incredibly easy. My daughter was breech, ECV didn’t help and I was told I had to go cesarean. My scheduled surgery was at 10:30 on a Friday morning and I started having contractions about 5:30, water broke while getting out of the shower, contractions were long and close together. Got to the hospital at 8:00, 7 cm dilated, had her a 8:32. Saw her at 11:05. I have to admit, the laboring I did get to endure was great, and had she not been breech, I truly feel it would have been quick and mostly painless. I also admit my healing from surgery was perfect, no complications, no issues, minor numbness right at scar location, but it doesn’t bother me.
FF 7 years and I am pregnant again. I just, tonight, decided to look into VBAC, even after telling someone today I am all repeat. I know every pg is different, and I was just told by my husband that he firmly believes I can do this, and I should. I watched the videos and cried. Never realized the instant bond vaginal births get. Prior to that first video, it never phased me that I didn’t see her for 2.5 hours while I recovered.
I am very interested now and want to find some local women, information to talk about this to. I’m really hoping that because my firs seemed to happen so easily and labour wasn’t horrendous that a VBAC would be a wonderful option for me! I am actually a little excited!
Thank you for this article…
It sounds like your body works perfectly and there is no reason that you won’t have a beautiful birth with this baby. Come back and let us know how it goes 🙂
I just had a HBAC 12 days ago. And my only comment is “Why the fuss?” It was the most ordinary and uncomplicated of births. To me and those with me it was exhilirating and empowering – the most fantastic experience of my life so far! My daughter was born after a few hours of labour, in the water and straight into my arms. It was an absolutely textbook birth and both of us (mother and baby) did wonderfully. My midwife did not treat our birth as anything extraordinary. I can’t believe had I gone to the hospital I would have faced intervention just by showing up, when the only monitoring I received was regular doppler checks of baby’s heartrate. I was in control and supported throughout the four hours of the labour and birth. I had no labour for my c/s almost six years ago and no expectations for this labour – other than we be left alone as much as possible to let my body do what it was made to do.. I wish every woman could experience birth the way I did – let alone every VBAC!
Congratulations… and you are right. A VBAC is ‘just’ a birth and the less fuss the better.
This post gives me hope, thank you so much! It is so refreshing, comforting and reassuring to read your words, especially as you are a professional! I’m 33 weeks pregnant with our fourth baby and am trying to obtain the right to try a VBA3C… not an easy task here in Switzerland. I understand I might not “manage” to give birth vaginally, and I can accept that if it happens again… but I get really down when doctors say things like “the question is, do you have the right to put yourself and your family at such a risk?” – by that they mean uterine rupture and potential death. It makes me feel as though I’m selfish and wanting to try a VBAC for personal development. But then surely this isn’t the case… I don’t feel selfish or crazy, but I can’t explain why I want to try a VBAC either – it’s just a gut instinct, something so strong that I can’t ignore…
Anyway, whatever my birth is like, thank you for speaking out, it makes me feel less of an alien!
i expercience VBAC but in up to truamatic ruptured of symphysis pubis.
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This website, your Voice, wisdom, and perspectives, are among my very favorites. I am so grateful to you. I write today to thank you for your excellent work. I personally had a VBAC years ago…. and have helped women on this journey. I will refer women to your site.
I am trying to gather enough info as I can to make an informed decision. 3 years ago my son was born by csection. At 39 weeks he was found to be frank breech, I had low fluid, and slightly elevated blood pressure. So we had a csection. The experience was great, recovered quickly and I had a perfect beautiful baby. Now, 3 years later, at 34 weeks, I am given the choice. I have gestational diabetes. I felt sad first time around not experiencing Labour. My regular doctor says vbac, the obgyn says schedule a csection. My husband wants me to have a csection. I want a healthy baby, with minimal risk. What to do!?!
Only you can make this decision. There is no ‘risk free’ option. What risks are preferable to you? You need to take responsibility for your own decisions because ultimately the outcome will be your responsibility. I hope you can get some support to work through your options and make the right choice for you.
I had a C-section 14 years ago due to placenta abruption, 6 years later I gave birth naturally with a midwife in hospital. After 2 more natural births in hospital I am now planning to birth my 5th child at home. With the previous births I felt safer in the hospital but now with all the hype about vbacs the hospital insists on IV upon admittance and fetal heart monitoring during active labour. From what I gather there is greater risk in repeat c-section then a vbac. My midwife in 40 years has only seen one rupture in a woman who had never had a section. I believe that as with all things government regulated there are trend causes that they later realize were wrong and the latest one for birthing is vbac. With my first pregnancy after c-section I was encouraged to try it naturally now there is all this concern after having 3 vbacs with no complications, I don’t get it. All I can think is how the medical community and mainstream society is so ignorant and trust myself in this instance as I do in all other aspects of my life ie. homeschooling and not vaccinating. As long as you are making an informed decision and not just listening to others opinions you will feel confidant in your choice.
9 years ago , I went through 18 hours of natural labor that ended in a c-section (The OB showed up then and said the baby was in distress) It was very difficult as we dealt with breastfeeding difficulties and surgery recovery for a month afterwards. Two years after that, I had a wonderful VBAC which was 5 hours start to finish and just perfect. (We had a midwife attending that time) I am about a month away from another VBAC and plan on having another great experience. To all of you out there planning to VBAC-you can do it and don’ t let them bully you!
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I loved this information. I am a doula in Utah and have my first VBAC client. I hope I can use some of this information to empower her in her choice. Thanks!
Hi everyone,
Have a lot of questions regarding vbac,n not getting any support.i had my first child with c-section,bec of failed induction
n meconium,after 2 years again i got pregnant n decided to have vbac,i m from india,vbac in india is very rare,once a c-
section,always a c-section,is the attitude here.consulted many doctors.i dont have any problem throughout my both the
pregnancies,but at the end,there is always pain.for second decided to have vbac,search alot n got a midwife,planned a home
birth,but lost my child.when the child came out,she was not alive,i dont know what went wrong,midwife showed me her
nails,which were purolen d cord was turning black in colour,she told me that the child had died earlier only not now,i had done a
checkup,3 days prior to my delivery
Now after 7 months again i m pregnant,n in my third month,but no one is supporting me for vbac.according to them,since
my child died bec of vbac,so no more taking of any risks.
So really need ur help n suggestions,whether i can go for vbac or not.
I am sorry that you lost your precious baby. Did your midwife listen to the baby’s heart rate during labour? Had you felt the baby move?. Considering the description you gave, it seems that your baby died before labour started and therefore nothing to do with the VBAC. The death of a baby during pregnancy is more common after c-section because the uterus is scarred and if the placenta implants on scar tissue there can be problems with the placental blood vessels. The more c-sections the higher the risk. This may or may not be relevant in your situation. Often there is no reason to be found which can even more difficult for parents. You can ‘go for vbac’ again – no one can stop you if this is what you want to do. You must do what feels best for you. You are the one that has to go through the experience.
I scrolled all the way to the bottom to see if anybody had posted recently bc I didn’t want to comment to a “left behind” post. This article is so informative and encouraging to women like me. I had an emer. Cs in 2005 for prolapse cord. I was 19 years old and very uneducated and I feel strongly that had I had a doctor that didn’t rush me and push me into breaking my waters to ” move things along”, I wouldn’t have needed on.I was awake for this section, nobody got to come to surgery with me, I was terrified. They took my son, I got to touch his check as he was moved to be cleaned, we didn’t reunite until 2 & 1/2 hours ltr after everyone else got to hold him. Alas baby number 2 was due Jan.2010 , and I found a midwife who would “allow” me to try for a VBAc, only to fail at 5 cm bc baby’s heartrate was flucutating and did emer. Cs again, to find baby’s cord “loosely” around her neck. I was asleep for this one bc I didn’t have an epi. My husband made sure noone held her and I got her on my belly first thing when I woke up while still in recovery. That was so helpful and i’ve always been grateful to him for that. Now I.m expecting a baby due Sept 2012 and trying for a VBAC 2. I have a doctor with a very high vbac success rate and hospital will let me labor. I’ve decided against a doula, but I’m still confident that I can do it this time. I’m a little worried about the pain but it’s worth it to feel that I’ve been able to “have ” a baby. Any advice on pain mgmt or anything? I’ll post after my (crosses fingers) successguk VBAC 2
I’m sorry about the spelling, I’m using my tablet and It’s not easy to scroll and reread on 🙂
Nicole – there are lots of techniques and approaches you can take to ‘manage’ pain. It really depends on what you feel would work best for you. To be honest worrying about pain it totally normal. Feeling that you can’t manage pain is also totally normal… you can. No one ever died from pain in childbirth. You are strong and you can do it – even when you think you can’t (and the chances are you will feel you can’t at some point). Surround yourself with people who believe in you and will not push analgesia that will interfere with the physiology of birth (epidural, opiates) – unless you really want them.
Remember you are just a woman having a baby 🙂
Come back and let us know how it goes.
Thank you so much for the encouragement:)
So I have never had a VBAC but i have wanted to try it with my next pregnancy. My first pregnancy i had to have a C-Section after pushing for two and a half hours. My doctor said that the bony part of my sons head was stuck on my pelvis and he wasn’t coming. So she opted for me to try the vacuum and then if that didn’t work then i would have the C-section. So I chose the Vacuum and she told me that she wasn’t going to try very hard with the vacuum and she didn’t so that is how i wound up with my first c-section. I really want to try a VBAC but i guess I Don’t know where to find a doctor or midwife that is willing to do it.
Search for local birth groups, doulas or midwives. They may be able to point you in the right direction. Two and a half hours is not long for a first baby and maybe a position change or a rest would have helped you. I hope you find the support you are looking for.
Thank you for this great article. I had a very traumatic birth experience my first time in 2010 with my son. I was given intervention after intervention from an OB that beforehand had seemed accepting of my plan for natural birth. Once I was fully dilated I was given only 30 minutes to push before my OB unsatisfied that he hadn’t came down enough told me I wouldn’t be able to push him out because he likely just “didn’t fit” so I needed a c-section. I felt completely robbed of my chance to birth my son. When I found out I was pregnant again I thought I was just stuck having c-sections. It wasn’t until recently I found support and realized I don’t have to settle for another c-section and trying for a VBAC is actually the safer option for me. I have since switched to a midwife at a birth center that has many years experience and will deliver VBACs. I am now very hopeful that in December I will get the birth I always wanted. I will follow my body and do what it was made for and I, not someone else, will be the first person to hold my baby and soothe him or her when they cry. I am also hopeful this will help me heal from my traumatic first birth experience. And even on the chance that it doesn’t work out and I still end up with another c-section then I will feel better that I gave it my best and tried.
Hello! I am so happy I came across this website. 🙂 I am 35 weeks pregnant with my second son and I had a crash c-section performed with my first son. My OB is encouraging a VBAC as he says I am 5x safer attempting a VBAC vs. a repeat c-section. I have been a nervous rec since I got pregnant thinking about all the risks and things that can go wrong with both a VBAC or repeat c-section. My main concern is that I got pregnant 7.5 months after the birth of my first son and I fear I have not given my body enough time to heal and strengthen after my surgery. Am I at greater risk for UR because of the short duration between births? I feel a lot of pressure and pain at times near my incision (which my OB says is the pressure of baby on scar tissue and says it is normal)…but I am fearful that this may be a sign that my lining is thin and that I may be at greater risk for UR????
Yes – statistically you are at a greater risk of UR. However we are talking small numbers and you are significantly more likely to have a wonderful VBAC with no complications. It is very common to get pain and discomfort across your scar during pregnancy and this is not related to the chance of rupture. The scar tissue needs to stretch and the pressure and pain is most likely to be the skin layer of scar – not the uterus. Birth is not risk free – however you do it. There are risks involved with every possible choice and scenario. You just need to take the risk that feels best for you. Come back and give us an update 🙂
I will definitely give you an update after my delivery. 🙂 I have one more question….if I choose to have an epidural will that increase my chances of UR during an attempted VBAC??? Also, do you recommend a VBAC if the doctor is not present the entire time? MY OB said due to the length of labor he will not be able to be present the entire time but will be on call for any emergency. He said if an emergency (UR) occured he would most likely be able to respond within 10 minutes but there is no guarantee. Knowing this, do you think a VBAC is still a better choice given that the risks are low??? Sorry for all the questions! I just really appreciate getting a second opinion from someone other than an OB. lol!
That’s strange that the doc won’t be there. Where I live they have to be at the hospital the entire time with a VBAC which is why most doctors won’t allow you to try for it. My research says that in the case of a UR there is a 17-30 minute window before brain damage can occur with the baby, why would your doctor risk that?
My OB just said that there is no possibility that he can remain present during the entire duration…i believe due to scheduling (appt, other deliveries, etc.)…I plan to talk to him in more detail this week during my appointment. I know I have to sign a waver explaining all my risks for both VBAC or C-sec…and the waver specifies that he will not be present the entire time. :/
I would ask if he plans on coming right when you get to the hospital or wait until a specific time, like cm dilated or what not. Has he told you when to come to the hospital? I am going to have a successful VBAC after 2 around Sept. 5th(hopefully) And my doc is a huge advocate of VBAC. She told me not to come to the hospital until I can’t talk thru my contractions, bc once I get there I’ll be hooked to a bed. I pray that the doc will do what’s best for you and baby, not most convienent for him.
An epidural will not increase your chance of UR. However it will increase your chance of needing pitocin which increases your chance of UR. It will also mask any early warning pain which may result in a later detections of UR.
I find it really interesting that OBs insist that VBAC is risky yet plan to not be there until the whole thing is almost over.
Nicole – how sad that your OBs has to advise you to stay at home without anyone there to observe for any signs of UR until late on in labour. It doesn’t make sense to consider VBAC so dangerous that you need medical monitoring and access to instant intervention yet it is OK to do it alone at home for hours and hours.
Jennifer (reply below) – You had continuous care throughout your labour from a person who knew you and could assess your labour without unnecessary interventions. No need to try and decide (alone) when to transfer to hospital for care by strangers… and OBs think hospital is the safest option!
Marisa – I worry that you are heading into your birth experience focussing on a tiny chance that one particular thing may happen (UR) and that an external expert will prevent or manage this. Perhaps you need to surround yourself with stories from women such as Jennifer who have birthed after c-section. It really is just birth. An OBs cannot attend entire labours of any type due to the way in which their working is organised. They rely on obstetric nurses to do all of the ‘caring’ and monitoring during labour and they attend with their medical/surgical skills for the birth. If you really want your care provider with you throughout you need to employ a care provider who can do this (midwife, doula).
those are great questions and i will definitely ask those this week…thanks! 🙂 you are also having a VBAC (for first time) after 2 past c-secs or you have had 2 successfull VBACS after a c-sec??? I love to hear success stories…it calms my nerves! 🙂
I had a successful HBAC earlier this year, so no dramas about obs and hospital policies. My midwife arrived when I asked her to and our baby was born a few short hours later. I had no vaginal examinations, not sure how they could have helped at all. There was no cause for alarm or concern, just an ordinary and wonderful birth. Do your research, there really is nothing to be overly concerned about. Honestly, the less fuss the better!
so happy to hear you had a great peaceful birth! 🙂 how many months/years apart was your c-sec from your HBAC? not sure where you live…i am near LA area (about 20 miles east)…do you know of any good midwives out this way? i am considering hiring one to assist me when at home prior to going to hospital…i want to labor as long as possible at home.
Very much recommend hiring a midwife, regardless of where you’ll give birth. They can give you excellent support at home and then as birth support at the hospital. It will help you get your VBAC. I’m all the way over in Sydney, Australia, so can’t recommend anyone out your way, but I’m sure if you ask around on your local homebirth groups you’ll find someone. Wishing you the best!
Oh and my c/s was nearly six years earlier, but I don’t believe it was necessary to have quite so long a gap. A friend of mine also had a beautiful HBAC three days after mine and her c/s was less than two years before.
I will be having a VBAC for the first time after two emergency c sections. You can read my comment on this page from a few months ago to hear my story.
here Ivana from Rome again today. I had a cs afetr which I decided to become a midwife and then a VBAC, I wanted to have an unassisted VBAC at home but I ended in the hospital 🙁 but it was fine with a good male midwife there. I agree on everything you wrote. In Italy this is my subject since I wrote a book on the issue called “After a cesarean”. In Italy there so much to be done still. thanks for your posts I like them
ivana
I am 40…they call me high risk.
I am overweight…they call me high risk.
I have had two c-sections, one almost 12 years ago due to a breech presentation and one 9 months ago for the same type of breech presentation….they call me high risk.
I had a vbac in 2010…it was SUCCESSFUL! …they call me high risk.
I am 24 weeks along and had the second c-section 9 months ago. I will be just over 12 months out from a c-section when my son is due, Feb. 4th 2013. I am nervous about it being only a year out. I fear a breech presentation again. But I am going to University of Washington and they are WONDERFUL there. At this point they have not said “NO” just stated how “VERY HIGH RISK” I would be for a VBAC. I will push to have one. I feel GREAT! I have a very large uterus as I have been told so large that it took an extra 30 minutes to put it in place after my last c-section. I do have hesitation but I really think a VBAC is safer. I may not be done having children. I do not want to have section after section after section. If I am given the gift of more children.
Has anyone experienced a VBAC so close to a section? It will be between 12 and 13 months from having one.
Thank You for this wonderful site!
Vanessa
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Hello!
This is a great post. I haven’t read all of the comments, but I am wondering where women who have experienced UR can find support. I had a UR during my VBAC attempt in March; my son and I survived. Thank you.
I’m not sure where you live but this organisation may be able to help: http://www.specialscars.org/tag/rupture/ 🙂
Thank you!
I had my daughter by c/ section back in 1999. My son was born by VBAC in 2005. I am currently pregnant with my 3 rd child and want to deliver naturally again, but it’s hard to find a Gynae in South Africa who will allow this. Reading all these posts really made me feel empowered again, and I will be fighting for another VBAC. Thank you for a great blog! If I could do it once, surely, 8 years later, my uterus should be able to cope, this time around again 😀
I’m sure your uterus will do a great job 🙂
Hi Christelle I am not sure where in SA you are, but I suggest you find a birthing centre and rather use a midwife as your main support. If you are anywhere in or around JHB have a look at the Genesis Clinic. I had my 3rd boy there (second VBAC birth) and it was an incredible experience – so different and so much better than my VBAC at the hospital! also look at vbac.co.za for more wonderful stories based in SA. 🙂 all the best for this thrilling experience!
Hi Lauryan, thank you for replying. I know of Genesis, and I have been contemplating to check it out. We are indeed in the JHB area. Did your med aid cover some of the costs? Thank you for that link as well, I am eager to see home-based success stories 😀 as our doctors really instill fear in us unneccessarily.
Dear Christelle, congratulations on your latest pregnancy. There is absolutely no reason why you shouldn’t have a second VBAC… I’m in SA too and I got a midwife and a gynea to back up my VBA3C!!! Please feel free to contact me for care provider details my email is bethsimes@gmail.com
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Thank you so much for posting this. I am currently pregnant with my 2nd, and am hoping for a VBAC. I left my OB’s the last 2 visits so confused though… first the OB spent several minutes discussing all of the terrifying risks, then handed me paperwork I would need to sign acknowledging all of these risks, only to conclude by saying the practice really supports women in considering VBAC. In not quite sure what “support” she was referring to at that point. As I stared at this sheet, I felt like I was signing away on something that essentially served as an “I told you so” should something go wrong. My first pregnancy resulted in a csection due to poor fetal growth and fetal distress, leading to a preterm csection. So far this pregnancy has no problems, and today they again reiterated that VBAC might be an option, but still haven’t really addressed the GOOD things about VBAC. I am so appreciative of you addressing the psychological part of this decision. At this point I’m well aware that I may not have a choice when the time comes should things go the way they had with my first, but if all continues to go well I want to know that my OB will educate, support, and reassure me the best they can in my choice.
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This post has been fascinating to read. I have had one ECS because my waters broke and I was given the full 24 hours to go into labour at home by myself which did not happen; I was then induced with pita in for about 10 hours and only dilated to 1cm so it ended in an emergency c section.
I am now pregnant with baby no 2 and am currently 40 + 3. I had been planning all along on a VBAC but in the back of my mind I think I have major insecurities about my body not being able to labour efficiently esp after my first and only birth experience! Last week at my check up my consultant told me that the baby is OP which makes a lot of sense because I feel like I’ve been in prodromal labour torture for weeks. I panicked researching the OP position especially combined with only ever having delivered by section. I called my consultant and asked about scheduling an elective section and he was quite dismissive and told me to wait till this week (tomorrow) to decide. I feel like a bit of a failure for choosing the elective section but with my history and the babies position I am thinking the vbac has a strong chance of ending in a c section. I have to decide before tomorrow because if its a section I am going for I have to be definite about my decision and push for it otherwise I will just be fobbed off until the following week.
It is your decision – you have to live through it and live with any consequences. In relation to an OP position you may find this post helpful: http://sexybacksummit.com/jane-bennett/. I have attended VBACs with the baby in an OP position and the babies rotated and came out of their mother’s vaginas. The OP position is no different for a woman who has previously had a c-section than it is for a woman who has not – ie. rarely a problem. Let us know how your birth goes 🙂
This is such an inspiring blog. I am due 27 May and doing my second VBAC and I am super excited about the birth. My first was caesarean and my second was an induced VBAC. I am going to my doctor today to see how things are progressing, but will not allow him to induce me again. This time will be 100% naturally induced labour without any medical intervention 🙂
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Keep up the great work , I read few blog posts on this site and I believe that your websiteis very interesting and has a lot of good info.
Great article, thanks! I am hoping for a VBAC with my second Bub and am wondering whether the fact I have a 7.5cm cyst on/near the ovary and a fibroid (not sure where or what size, but its smaller than the cyst I’m told) are likely to impact on my chances of having a VBAC?
Hi Jo – I don’t see why. You should ask your care provider who will have more information about your situation. Lots of women have fibroids.
My second child was a VBAC, it was an instant cure to the emotional upheaval of my first birth. My VBAC was actually in the private system and my OB needs to be cloned, she was fantastic. She gave me all the risks at my first appointment and actually downplayed them. When she came the 1 in 200 chance of rupture she also pointed out that because most women do not attempt a VBAC the statistics are skewed and it would actually be more like 1 in thousands. She was relived I wanted a VBAC and treated me like any other birthing mother not a “high risk” mother. There were times when I actually forgot I was having a VBAC.
One big tip I have for a lady wanting a VBAC is do not accept a time limit. From the time my Braxton hicks became something I had to work through I was in labour for 36 hours. At 30 hours I finally gave up going drug free and took gas. At 32 hours I found out I had not progressed at all in 4 hours, I gave up I wanted the consent forms for another c/s but my OB made me keep trying. She said she wanted to wait a few more hours to see what happened now my waters were broken. I had MSL, this was the reason for my first c/s however it was really me falling victim to scare tactics and failure to wait.) I had an epidural for the 2 and a bit hours, which is really my only regret as I found the gas much more effective for me. When I hear of time limits I get so cranky because if there was one on me I would have had an unnecessary c/s.
I cannot put into words how it felt to push my baby out, something I found so strange but so amazing was to actually feel my little boys arms, hands and fingers wiggling inside me as I waited for the next contraction. Aside from having a successful VBAC that was my favourite moment of birth, it was the very last movements I felt of my little boy on the inside and I will never forget them!
Yes yes yes!! As a person who has had a HBAC I want to jump through the screen and hug you! I also heard you speak at the Homebirth Conference in Hobart last year and I found your talk fascinating (I spoke the morning before).
Thanks 🙂 Are you going to the Homebirth Conference next year? Now I am trying to work out who you are 🙂
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Hi there I’m wondering if anyone has experienced uterine rupture during first labour, I did at 42 weeks, I cat seem to find any solid information out there regarding a subsequent pregnancy, I would like to try again but a, very scared.
Ps both bub and I were fine but were very lucky, I’m just wondering if it would be selfish to try again in case of a bad outcome. This happened almost two years ago and I am still very upset by this, but would like to know what my options are, have been told I would have to have a scheduled caection at 38 weeks
Emma – I am sorry that you experience this rare event. I’d be interested to know the circumstances surrounding the rupture. Were you induced or having your labour speeding up with medication? How long were you in labour? Did your uterus rupture in labour, or were you told after a c-section that it had? You probably need to discuss your following birth with someone who has access to your medical notes. You have a scar on your uterus – so your ‘risks’ are similar to a woman having a vbac… but you need to look at your individual situation.
Hello and Thankyou for the reply. I was induced and the rupture occurred during the caection I was told this occurred due to being over due in labour for too long and having a large baby 5kg. Laboured 3days two rounds of cervidil gel and then full chemical induction and epidural. Have booked into see a private obgyn as this occurred in the public system I am really unsure of what way to go
Hi, I am the author of a recent book on VBAC : Birthing Normally After A Caesarean or Two (Fresh Heart Publishing, 2011). I cannot believe the unfounded conditions and requirements women institutions and caregivers increasingly impose on women who want to have a VBAC. The last one ? A woman under the care of a midwife saw the consultant require an induction at 38 weeks because she had ‘too much fluid’ and rupturing the membranes should happen in a controlled environment ! The consultant suggested that a repeat caesarean would even be preferable, and the midwife thought so also. This along with the evaluation of a ‘big’ baby (estimated weight at 38 weeks : 7 and a half pounds, previous baby : 5 and a half pounds). The woman said she was scared of what would happen with this ‘big’ baby, shoulder dystocia, etc. although she longed to have a VBAC. Although I have been researching this topic for more than 25 years, some doctors (and, alas, some midwives) end up saying to some women this or that in order to increase their fears about VBAC, and discourage them to have one, because they are themselves scared. Quite sad. So thanks for informing midwives – and women – about VBAC. Hélène Vadeboncoeur, Ph.D. Childbirth researcher.
It is sad. Women are so open to comments and influence from care providers. It is understandable that many avoid them to avoid this coercion.
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I really hate this article! I’ve had 2 uterine ruptures they can happen and can easily kill you and your baby! Be aware and listen to your doctors advice, that’s why you choose them to be your doctor!
I am attempting a VBAC after a failed attempt at a home-birth with my son. Even though my son was posterior and was stuck, my midwife doesn’t think its a good idea to attempt another home birth and highly urging me to have the vbac in the hospital because its safer and easier to monitor… so I’m confused… Is there any studies done about HBACs? I really feel comfortable at home and she also said that attempting a VBAC and ending up with c-sec, was higher risk, than just a repeat c-sec, which isn’t what I read in this article. I’m so torn as to what to do… even though I want my natural home birth <3
Hi Brittany
There are still relatively few women having HBAC – so there is very little research. There is a small US study: http://www.sciencedirect.com/science/article/pii/S1526952305001091
However, in general vaginal birth rates are higher at homebirth (to some extent reflecting a ‘low risk’ population). Women tend to labour better when they are comfortable and feel safe. The risks involved with hospital birth are associated with the increased monitoring and routine intervention. The risks involved with HBAC are that if the small risk (less than 1%) of uterine rupture eventuates you are further away (time and distance) from medical intervention. The result of waiting could be the difference between life and death. Only you can evaluate your own threshold for risk. There is no risk free option.
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I just want to say thank you for linking my experience on your post! Such a well-written blog!
Thank you for sharing your experience 🙂
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hi,2yrs,3mnths ago, i had an emergency c-sec @ 42wks,3days cos baby was in sitting position & there was no labor pains. d doc set a balloon 4me 2 make me dilate. wt my water broken & 12hrs labor 3cm gone,there was no other way. i couldn’t bond wt my son 4almost 8hrs cos i slept all through d procedure. i was told my cervix is small. i had vacuum aspiration last yr April cos there was no fetal beats @8wks old. I’m planning 2get pg again but afraid of another c-sec. i really want a vbac. I’m 32 & a Nigerian.
Hi Peggy. I am sorry that your first experience of birth involved a lot of intervention. There seems to be no reason that you wouldn’t be able to birth your next baby vaginally. Is there any support available locally? A midwife or birth worker who can support you with your next baby?
I really need some encouragement. It’s been 13 months since my first birth, which wound up being an emergency c-section after 29 hours. I researched months before my birth, and thought I was totally prepared. My sister, a pediatrician, had come to visit me; she had had pneumonia 2 weeks prior, and I think I got sick from her. We walked around the mall at 41 weeks, and I went into labor. I labored at home for 12 hours, and my contractions fit the transition level description in terms of timing (and to me, intensity). We left for the hospital at that point, because I assumed I was on the verge of delivery. When we got to the hospital, the pain was excruciating, and they wouldn’t admit me, because, apparently, I was not dilated AT ALL. They left me collapsing in the hallway, suggesting I walk around, but I couldn’t walk more than a step because each contraction made it so all I could do was curl up in a ball on the floor. My sister begged the doctors on my behalf to give me a shot of morphine, because at the time I was talking about ending my life just to get out of the pain. Within an hour after the morphine I was at 3cm. I felt the intense pain returning – nothing helped, not massage, I couldn’t stand from it, I couldn’t bear touch, water was out of the question – I caved and got the epidural. I dilated to 10cm while sleeping (which they recommended I do). My midwife left for another labor because I was not at the pushing stage, so my doctor’s service pretty much abandoned me. My duala was not not much help at this point either. Suddenly they announced that the baby was in fetal destress and that I only had 15 minutes before a c-section would be done; the baby’s head first they said was pointing to the side, and then they said, after it had positioned itself right, that it wouldn’t descend. The midwife had returned from her other labor and both she and the OB who came in in her place “begged” me to consider the child, and urged me that this was a real emergency. My contractions had gotten weaker and I was told that not even pitocin would help me at that point. I got the c-section which was terrible with the cough I had. Baby was born with an APGAR of 1, and was kept from me in the NICU for 4 days because he couldn’t maintain his temperature. Now he’s doing great. His head is a standard of deviation about 99%, he’s ahead on every milestone, and doing wonderful. My main reason for wanting to avoid a C-section is because I want to have 3 kids and I don’t want to use more than just condoms and the calendar method, so if I accidentally get pregnant with a 4th child, I want to be able to safely have him or her just in case – without risk of hysterectomy or bladder cutting, etc,. I cannot find a good VBAC doctor. I’m supposedly with one of the better ones; he’ll “let me try” but he felt my pelvis and said something to the effect that my pelvis is narrow. He also told me about the three women who died that year trying to give birth, one from uterine rupture (out of 450 women). But he seems pliant. He said he would be willing to do 2 morphine shots instead of the epidural (one after another), if it came to that. Really, it’s not him I have a problem with. It’s me. I don’t know how to deal with that pain. My doula commented that my pain seemed “worse than anything I’ve seen” – but that still leaves me no way to deal with it. I don’t care about epidural or not – I don’t want to have my uterus cut so I can have 4 babies more safely if it comes to that. How can I manage extreme pain? I feel i have so much resolve NOW but, I thought that too – before the pain. What can I do to feel hopeful? We had tried acupressure and everything; I feel like there is something wrong with me. I have massive depression over this.
Alice – I hope that your doula and midwife are helping you process your birth experience. It does not sound like ‘normal’ physiological pain, but something beyond that. The fact that your contractions weakened and your baby had an APGAR of 1 suggest that this was a complicated labour… perhaps because you were ill… or another reason. Your next labour and birth are likely to be very different. Maybe plan for another painful birth ie. accept you may want an epidural, then take it as it comes… you might be surprised.
Thank you for your encouragement and support. I have switched to the doctor my doula went to before deciding to have a home-birth herself (she successfully did so); I haven’t much spoken with the midwife from the other service; l did leave her and the OB a gift for helping to deliver my child, but, somewhere inside me I still harbor a resentment for having been left alone at 10cm by them. I am nervous about the doctor I have switched to because he seemed only abstractly encouraging of a VBAC – saying that I could “try” and “we’ll see how it goes” and the whole mentioning the three people that died this year (unrelated to VBAC – they died before even getting to the operating room), and the whole “your pelvis is on the narrow side” thing; I’m not sure whether this just means he is honest, or whether my chances would have been better with the original doctors I was seeing. I just have it imprinted in my mind the “you have 15 minutes left before we have to deliver this child by c-section” – and this coming from an OB who delivered 5 children naturally. The thing that makes it hardest is questioning whether I could have done things differently; I know a lot of women say that their OB rushed them into a c-section – I’m not sure whether that applies to me or not; they said something about the heart rate declining at the wrong period in the contraction, and about the weakening contractions, and the risk to the baby – but I know a lot of other people hear these things and they aren’t actually accurate. So I always wonder if I should have “fought back” more at that point – whether they wanted to do a c-section for profit – or whether it was actually necessary. I was wearing an oxygen mask towards the end of it, which was difficult because I could hardly breathe because of the pneumonia. I think about how ill I was but, I’m still never sure if perhaps the heart rate was from either my initially accepting the shot of morphine or the epidural. It’s the overwhelming fear and guilt of thinking because I accepted pain relief that that’s why I wound up with a c-section – that somehow I should have stuck it out – I mean, so many women seemingly gracefully do. I go back every moment to that day and try to think my way over the pain but I am never successful doing so. Just yesterday I had a menstrual cramp and it vaguely (on the order of a 100th or less) reminded me of the pain I had at time I requested the morphine and this was after I spent the whole day envisioning how I would this time – well, not refuse – but, not request – any medication – but that just vividly brought the memory back and I find I am still too weak to handle it and I still don’t know what to do. I am deeply hoping the next pregnancy entails less pain. I marvel over how so many women seem to primarily just struggle with a doctor that bullies them along or, with the hospital – I feel like I’m the only woman who is struggling with myself. That makes it isolating. I’m trying to be less depressed about it, but, I feel like more than other women who harbor feelings of being taken advantage of by their doctor and hospital, I harbor an even worse sentiment – of having taken advantage of my own self. Sorry for rambling. I’m not sure why I can’t let go of this.
It is OK to struggle and find it difficult to ‘let go’ of your experience. You really need to talk about it and work through what happened and how your feel about it. Are there any counsellors, midwives, doulas local to you who can help?
Well, I’ve been trying to find a doula in my area (the one I used last time just had her home birth). But in the meantime I’ve been talking with my Church group; it helps.
Just wanted to update this. I had a failed VBAC for my 2nd birth as well – 24 hours of pre-labor with contractions 6-9 minutes apart. They were going to send me home again to “tough it out” for up to 3 days – but, nobody was hopeful as the baby hadn’t descended and was at an extremely high station – even after I passed the mucous plug. Pain was horrific. Would not progress past 2 cm. I basically elected a C section this time around because there was no pain medication – they gave me a shot of morphine as I requested and I was devastated to see it totally wiped out my contractions. So now I know not to do that in the future. But still. The C-section sucked, and the scar got infected and opened up a bit, so the recovery was very slow BUT my baby was healthy this time around (his head was only 80% – versus his brother’s had been two standard of deviations above normal) .He was a cute, tiny baby that was really calm, happy, and an excellent feeder (everyone remarked what a good feeder he was). He has been virtually attached to the boob ever since and just smiles at everyone peaceful as a clam. No horrific NICU stay with this one. I did puke twice all over myself because I had dinner before the C-section, and I passed a lot of blood clots – so it was no easy going – and I had to actually take Percoset because Norco wasn’t cutting it this time but – I’m happy that this baby was doing so much better. My older son continues to be a poor sleeper, and, though a very intelligent kid, hugely headstrong; I always wonder if it’s because of the longer labor or NICU stay, or because we got him circumcised. Maybe it’s just that he’s 2 1/2. Either way, I will try one more time for a VBAC but, of course, am not holding my breath. I may stop at 3 kids. I originally wanted 4 but, I don’t know if I can tough out 2 more c-sections. I guess we’ll see!
Thank you for the update. You did not have a ‘failed VBAC’! You allowed your baby/body to initiate labour and make all of those important physiological changes that happen during labour to prepare for baby’s transition to breathing. There is no failure in birthing a baby regardless of how that baby arrives into the world. Congratulations – and enjoy your new baby 🙂
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I just wanted to share my experience here. I had a very traumatic first birth that ended in an emergency C-section after 48 hours of labor and 4 hours of pushing. Unfortunately my son had a very short umbilical cord and it was wrapped around his neck. It may well be that a C-section what the only way he could have been born. I had planned for a natural birth, I had a midwife, I had a doula and I felt like all my supports failed. My midwife was very unsupportive and openly complained about how long labor was taking, bullied me, told me I wasn’t in enough pain and that I also wasn’t relaxed enough? I got to 5cm dilated and stalled. She suggested introducing Pitocin and then when Pitocin was ineffective after 5 hours she suggested we introduce an epidural. At any rate, it took 12 hours of epidural and Pitocin to get me to 8cm and then I pushed for 4 hours. My son was crowning but I just couldn’t get him further down (in retrospect, thank goodness since the chord was so short and around his neck). The labor nurse yelled at me?! almost the entire time, and my midwife was conspicuously absent. When we made the decision to have a C-section I was devastated but also terrified that something might be wrong with my son. When they finally pulled him out, everyone in the operating room gasped because it was suddenly clear why he couldn’t descend. Even worse, his lungs weren’t adjusting and he was rushed to the NICU. I didn’t get to see him or hold him for another 20 hours. The whole experience was incredibly traumatizing and I didn’t really realize how messed up I was until months later. My labor nurse actually apologized to me in the recovery room for being to hard on me. I never got an apology from my midwife.
When my son was 6 months old, I realized that I was really traumatized and having a very difficult time. I was angry and alone and felt really deserted and felt that there was no one I could relate to. I still had pain from the C-section, I was still struggling with feeling like I had deserted my son and I was desperately trying to make up for those first 20 hours. I went and spoke to a new midwife practice about my options – could I have a VBAC? They felt that since my body had been ready to give birth vaginally and was only unable to because of a short umbilical cord, I was actually a very good candidate. My pregnancy with my second son was great, and I was embracing having a VBAC and what that could mean. And then I was diagnosed with gestational diabetes. To my midwives’ credit, they were incredibly supportive and just… let me go. I gave birth to my second son at 41wks 3days after 3.5 hours of labor .It was the most healing and incredible experience for both myself and my husband (who was with me every second). That second birth magically healed all those terrible, powerless feelings from my first birth. It gave me back a part of myself and a strength I was terrified I had lost. I encourage women I know who are having a second child after a C-section to attempt a VBAC, especially if they had a traumatic birth. I was VERY fortunate to have an INCREDIBLE group of midwives who were so loving and support.
Although we ‘think’ we are done having children, I can’t pretend I’m not tempted to have a third as my second son enters toddlerhood and is clearly not a baby anymore. VBAC number 2? Do women do this?
Hi Emily
Thanks for sharing your experience… please put this story into the survey so we can use it as data.
Praise the LORD! What a great testimony! Thank you for sharing it. I had 2 sections then a failed v-bac ending in a section. If they would allow me to try for another I would but no one will. I do not regret the 46 hours of labor and the hours on end of pushing.
My little guy had the same problem, no descent due to the umbilical wrapped tightly 2 times around his neck. He was 10 lbs to boot but I believe with time I could have birthed him, except for the heart rate dropping so far with every push. I said let’s get him out. My first son was complete breech and I was told I could not go naturally. In hindsight I wish I had tried harder but I had little to no support and did not know what to do nor where to go. I believe if I would have had that first baby naturally, even breech I would have had no problem with the other births. I am so glad to hear your beautiful story, your heartbreak and your healing. God Bless You!
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I have had 3 c-sections. 2008 I went for 30hrs of labor then they took me to have a c-section because for 4hrs I didn’t dilate. January 2013 I had a planned but ended up being emergency because I had cholestasis of pregnancy. The last one was a year ago in Feb(2014). My uterus is cut classical once because my daughter was born early due to a placental abruption. I have dreamed of a natural birth…is it possible to try and how safe would it be?
Hi Amber
It is possible to try, and women have done this. It is impossible to say ‘how safe’ it would be as no birth is ‘safe’. You would need to look at the general risks (see information blog) and then at your individual risks. One of the problems is that not many women choose to VBAC after a number of c-sections + a classical scar – so the research is not there. However, you may find some information about women’s experiences and some support on this site: http://www.specialscars.org
It also seems that your last two pregnancies were complicated i.e. ICP and premature/placental abruption. This would also need to be taken into consideration with another pregnancy. Can you discuss your situation with a potential care provider?
At this point I would not. I have had 3 as you have and one v-bac that was my 2nd child. The risks do increase and I would be too afraid of the outcome. Even though there are cases that everything was fine. It is walking a fine line and I could not risk my child for it. I pray you will find what is best for your baby and you and your spouse.
I recently attempted a VBAC and ended up with Uterine Rupture and Placental Abruption. I wrote about it on my blog today. I don’t regret trying but I’m so pleased I was in the hospital when it happened as otherwise neither my child or myself would be here today xxx You can read/follow my blog here: http://lifehathchanged.blogspot.co.uk
Thanks for sharing your story. I am also pleased you were in hospital when your uterus ruptured. However, your birth scenario is not comparable to a homebirth… at home you would not have had an epidural or an ARM – and did you have a syntocinon infusion to speed up labour? If there had been concerns about labour progress at a homebirth – which there clearly were – a midwife would have mostly likely transferred you to hospital for medical assessment and assistance. I am not saying that uterine rupture does not happen at home… only that your scenario is not a homebirth scenario.
Hi, Thanks for the reply, I didn’t have syntocinon as they didn’t want to risk harder contractions because of the VBAC. I did wonder about the ARM, as it wasn’t that long after that I ruptured. However with the strength and pain of the contractions from the onset of labour I think something was starting to go wrong from the start. I know I’m one of the minority, I’ve just seen so many stories of mothers who have lost their babies due to Uterine Rupture and no immediate access to critical care that I worry more babies will lose their lives or be born still. It’s a delicate subject from whatever angle you look at it x
It is a delicate subject and every woman needs to make her own individual assessment of ‘risk’. Many women choose to have a VBAC at home because they feel the environment decreases risk. They are able to relax and tune into their intuitive knowledge when things ‘feel wrong’. They are attended by a midwife who knows them and is with them every minute of the labour watching and assessing for signs of an abnormal contraction pattern or level of pain. It really is about what you feel comfortable with as the birthing mother. 🙂
Thank you for this article. I am pregnant with my third and have had two emergency cesareans with a failed VBAC. I am determined to try this one last time and no-one around me understands why i break down in tears still at the thought of never getting this opportunity or suffering yet another major surgery.
Just the sheer fact that I was at least able to have a ‘normal’ “oh honney we need to go to the hospital i think im in labour” moment for my second after an induction and csec for the first was somewhat healing. People dont seem to understand the depth of the psychological side of having cesareans when unwanted or to have your entire entry into parenthood planned by a professional as opposed to the excitement of waiting for that surprise day and moment.
I am yet to have ‘discussions’ with the doctors (am 15wks) but I just secretly pray with everything i have that we can enjoy a successful VBAC for my last time at becoming a mother again.
Hello Julie, I am all for you trying with this one. I said a prayer for you just now. I truly do understand as I have my story above as well. I longed for a natural delivery and never got one but I did labor many hours until I knew it was not going to happen safely that amount of trying helped so very much. God Bless you, Vanessa
Allowing your baby to initiate labour when he/she is ready and for you both to experience the hormonal cocktail of labour is so beneficial even if baby is not born vaginally. The birth experience is so powerful and is a rite of passage however it occurs. I hope your doctor respects your wishes for a VBAC and supports you. It is OK to love your baby but not your birth and to want something else. You may find this post helpful: http://midwifethinking.com/2011/04/09/judging-birth/
I hear you Julie! I had a 2nd C-section as well. My first I labored 29 hours, was fully dilated, but had pnemonia and his head was 2 standard of deviations above normal – he started showing signs of fetal distress so – emergency C-section PLUS NICU for 3 days. My 2nd I was moderately hopeful but again 24 hours of “pre-labor” – this time stalled at 2 cm – and I just caved and got a C-section because I had no alternative for pain relief – they would not give me an epidural because I was not 3 cm, and the thought of trying to “tough” out the 9 minutes apart contraction for DAYS more was….I can’t put it in words – it was like sentencing me to hell. This C-section was harder on my body than the first, and my wound got infected so it took me longer to heal, plus I still have 18 lbs left now at 3 months (versus the first time I lost all the weight all at once). HOWEVER, I have to say, I almost feel better about going into the C-section earlier with this one because my 2nd baby was born 100% healthy, was super calm (everyone was commenting how calm he was), and was an outrageously good feeder. Smiled early, hit his developmental milestones even earlier than his brother. His head is 80% but was 50% at birth so – theoretically I could have had a natural birth except, he wasn’t descending at all – and they kept telling me if he doesn’t descend at the start of labor there’s only a 10% chance of delivering him naturally. I too hope to have a VBA2C – mostly because I hope for 4 kids and as you know there are complication risks with each additional C-section – but, I too have little hope. Twice now my babies have failed to descend – one after 10cm dilation (the first). So I have no idea what is wrong with my body, or how I keep doing this wrong. But, I take heart that the babies turned out OK anyway, even if, as you know, C-section totally sucks for the Mom. Hang in there you’re doing great!
As the 1% I must point out that my midwife was incapable of noticing any warning signs that my uterus was rupturing & when you’re labouring without any pain medication there are no warning signs that it is happening because you’re already used to dealing with the pain of the contractions. If I had not stopped my vbac and demanded a cesarean against her pushy guidance I could very well have lost my uterus and my son. I’m not sure what my point is here but this is a very real thing that women should be worried about because the warning signs are almost nill.
I happened upon your site when I was pregnant with my second and thinking about how to achieve a VBAC. I want to say how thankful I am. Reading your post armed me with the information and perspective I needed to have the confidence to strive for a VBAC. All throughout my pregnancy I was confronted with people’s assumption that I would automatically have a c-section because that’s what I had with my first (and my first c-section was not planned, and in hindsight, I feel that it could have been avoided if I had had a different care provider). It’s amazing how ingrained this assumption is in our culture, and I’ve since shared your post with many friends and just at random in parenting forums so that others moms can read it and be encouraged, or at the very least, well informed. From the bottom of my heart, thank you. My second birth was such a healing experience. I remember when they passed my baby to me, I held him up and kissed him on the lips. Such a joy!
Thank you for taking the time to give me such lovely feedback. This is why I write my blog 🙂 Congratulations on your healing birth and new baby!
Hi everyone,
I had at VBAC 42 weeks 2 days and my labor started naturally. I suggest to let’s your labor start on its own and don’t give into he hospital or doctors telling you to get induced as that increases the chance of a uterine scar rupture or other complications.
I actually fell pregnant 4 months after my c section but still things went normally. I just really suggest a Spontaneously starting labor as a better precursor to a complication free VBAC. Thanks.
I’d like to share an encouraging story. Apologies for the volume.
Our first born was an emergency C-sect 21 months before, due to pre-eclampsia on g. week #34. My wife (35) preferred a VBAC for baby #2 (also a girl) due January 2016.
Towards the end uninterrupted pregnancy, at the very end of g. week #39 the amnion must have ruptured somewhere high and the fluid broke. Contractions only began 5-6 hours later. From then on, with a frequency of 5 minutes, contractions repeated for 12 hours. In the last 2-3 hours of labor the amniotic sac was broken behind the cervix manually with a use of an artery forceps to let the remainder of the amniotic fluid leave and help the baby slide closer to the birth canal. Also, my wife was given an infusion of oxytocin to help the contractions be stronger and longer lasting. Also, the frequency of the contractions got higher.
In the meantime, taking a shower, surviving the pain of a contraction on an giant inflated ball or taking a shower on that ball was allowed, in fact encouraged despite of previous warnings that a TOLAC can strictly only happen in a lying position, for its entire duration in that very hospital – the reasons behind I think was the need for constant baby heart rate monitoring – but anyway, this rule was not that strict for us on this occasion. Warm water – not sitting in a bath which can be harmful to the baby but having a long shower proved to be a good pain killer.
All went well, the baby heart rate was normal. My wife was asked several times as she stared to train for the pushing phase, the movements during the peak of the contractions on whether she can feel any unusual pain on that area where the scar is – which could be hard to tell from the whole pain women experience – since the whole pelvic area: bones, muscles were dilating that time, causing a pain which could be felt even at the waist area. The main thing was to be able to concentrate on if it hurt specifically between the contraction caused pains.
The unpleasant part was not to be allowed to consume any food or drinks, even a quarter of a gulp was allowed seldom. All due to the risk of a potential emergency caesarian and the inevitable narcosis after birth which was needed to let the doctor touch the scar on the uterus from the inside to check for any ruptures.
At the end, all went okay and our second daughter was born the VBAC way. She and her mother are both healthy.
The team around her was obviously a key to the success – the doctor who allowed the use of oxytocin – he would tell us monitoring was okay and he could have intervened and fixed the damage in time if needed. If there is a higher risk for a uterine rupture during a VBAC, an operation always carries more risk alone, specially if it’s a repeated caesarian. 10 days before the birth, the scar was examined via ultrasound and was found to be thick enough (5mm) to let my wife a TOLAC.
The success of VBAC mainly because of the rules was not for granted. We tried to gather as much information as we could previously. It only added to the confusion that each doctor had a slightly different opinion and attitude. Exceeding the terminus, inducing the birth was not going to be allowed, my wife would have been forced in the hospital right before the due date for up to a week and it would have ended with a programmed caesarean had nothing started the natural way. The induction was disallowed even by the first team (night shift) which before the one which actually was on site when the baby was born. Reasons were that oxytocin could cause a lot more tension on the scar of the previous c-sect.
Narcosis was not a real factor jeopardizing initial breast-feeding. A couple of hours later mother was allowed to feed the baby. The real hazard is if the narcosis took longer or the baby could suck down the milk to 0 – which is not an issue since a newborn has a stomach as big as a cherry’s core. Officially, you should not breast-feed the baby for 4-6 hours, but since the colostrum already collects long before birth in the breast, for a newborn who can sip only a bit then fall asleep, materials used for anesthesia is not problem. Half an hour after the examination in narcosis, the mother was already awake and was allowed to be with the baby.
Three days later, they were out of hospital.
Lessons learned: we should have studied which doctor would enable the VBAC the most flexible way – of course not at any cost but to a reasonable extent. Since we only started to look for a pre-arranged doctor who would be on hand when it was needed regardless of hospital schedules. We were lucky to have the best doctor around on his schedule that time.
So you’ve got to learn the hospital protocol beforehand and choose a doctor or even another hospital if you can to make sure your desire on a VBAC is supported. Worst case scenario would have been a programmed caesarean, when the mother cannot even start the labor which is told to be needed for both mother and baby, physically and emotionally in a healthy way. If you can choose at least let the contractions start and you can still opt for a c-sect if needed.
All of this happened in a hospital of a small town just outside of Budapest, Hungary, Central Europe.
Thank your for sharing your wife’s birth experience. I have to be honest and say I was rather shocked by the content. I’m not sure if this is normal in Hungary but it is very concerning practice from my perspective.
Wow – I’m surprised they would do this. Both procedure carry risks… and even higher risks with VBAC (http://midwifethinking.com/2010/08/20/in-defence-of-the-amniotic-sac/ and http://midwifethinking.com/2011/07/17/induction-a-step-by-step-guide/) I assume your wife was warned of the potential danger in order to obtain consent?
Sitting in warm water is not harmful to the baby… syntocinon infusions can be.
Women need to have adequate nutrition – lack of food can result in inefficient contraction and then c-section. It is not evidence based to starve a woman in labour. Anaesthetists are used to dealing with women in theatre who have eaten. And I am very confused and worried about the ‘narcosis’ after birth and doctors putting hands into the uterus!!!! Never heard of this – unnecessary and abusive.
Wow… would you thank a fire fighter for putting out a fire if he was the one that lit the fire?
I am so pleased your wife managed to birth vaginally and had a healthy baby DESPITE all that was done to her during her labour. Congratulations on your new baby! 🙂
The birth of my first child was via emergency Caesarian and I had to fight tooth and nail to have a vaginal birth the second time around. The first obstetrician that I saw tried to book me in for a Caesar when I was only four months along. Needless to say that he didn’t remain my obstetrician! I’m happy to say that the birth was free from intervention but it saddens me that I was not supported by our medical system to aim for a vbac and that because I was so high risk that my birth choices were very limited. No water births etc. Our medical system is failing women and their babies 😕
I want to email who ever wrothe this i have had 3c and the last one My tubes were tied without consent. Im having a reversal soon. Could I try to vbac even with this. Im so desperate births have being horrible on My husband we wanted many children he also wanted many children.. I want many children. But I think he has to much psicological damage going trough first c and then the néxt 2 trying to have a vbac and now the tl and soon the tr. I would love to ear some hope from you
Yes you could try to VBAC if you want to. Your tubal ligation reversal will not increase the chance of uterine rupture any further. You are essentially in the same situation as any other woman who has had 3 previous c-sections. If you are on Facebook do a search for VBAC support groups. There are lots of women who have experience VBAC after multiple c-sections who may be able to offer you support.
In 2014 I had a successful vba3c. It’s totally doable! I went 12 days past my due date and had to be induced using a catheter inserted into the cervix and inflated and then a low pictosin drip. It took 37 hours of labor but I was successful. I’m now due in September with the next baby and fully plan on a repeat performance in the vbac arena.
Hi great article. Can you provide any details of why continuous monitoring is recommended by hospital during vbac?
Thanks
Yes – because of the risk of uterine rupture. If the uterus ruptures the baby’s heart rate is likely to become abnormal and would be seen more readily by continuous monitoring than intermittent listening. Hospital recommendations also usually recommend that women having a VBAC have a cannula inserted during labour in case they end up going to theatre.
That’s great to know thanks. Any reason a cannula would prevent a water birth?
In theory no… in reality many hospitals do not support waterbirth for VBAC or have waterproof continuous monitoring equipment.
I’m working with consultant midwife to push for a better experience this time. Thankfully the hospital do have waterproof monitoring.
Good luck! 🙂
It’s to watch for signs of fetal distress during labour that could be a cause of a rupturing uterus.
Fetal distress can be caused by a ruptured uterus rather than the other way around.
Hi – I’m not sure if my message worked. Is this the same as with classical VBAC? I have been unable to find a provider that is pro VBAC with a classical vertical scar (even though they are pro-VBAC with a horizontal incision? As soon as they hear I have a vertical scar, it is immediate “you’ll require another c-section”. Looking for some support to encourage my pursuit for a VBAC next birth. Thanks, Louise
There is no good research into classical scars because they are relatively uncommon. Theoretically there is increase chance of uterine rupture because of the location and size of the scar. Women have birthed vaginally with a classical scar (see the Special Scars link at the bottom of the post). However, I would imagine providers are reticent to take on a client with this history due to legal and professional concerns (if you are Australia or US based).
– you last message worked I just needed to approve it 🙂
Yes it would seem like I may be facing a very steep uphill battle for a VBAC. I am a member of the special scars group on FB. Thank you. X
Hello.
I had an emergency Caesar with my first baby and was pregnant 6 months later. This was in Berlin though I am
Australian. The doctor I first saw was alarmist about uterine rupture and judgmental in general. But when I went to the birth clinic I wanted to birth at and asked a midwife there if the Caesar meant I couldn’t be accepted at the clinic (like a birthing house on the grounds of a hospital) she looked at me funny and said, no, why should it? Luke she didn’t understand my question.
From that time on, no big deal was made of it. There is no such term as VBAC in Germany, at least not that I knew. When I asked my midwife about this risk she said well yes, but it’s tiny, and probably smaller than many other things that are risks. It was her manner that mostly helped me to put it in perspective and focus on having the healing experience of a vaginal birth that I longed for.
The birth was brilliant. Very “easy” and empowered and I put that partly down to my own process work of removing fears and limiting beliefs, my support team’s attitude and then that big part of life that is uncontrollable – it just happened that way.
I teach pregnancy yoga and I tell this story. I wish the term VBAC didn’t exist. It’s very unhelpful. But it does, so I coach women to see it as just another chance to learn how clear their minds and hearts of outer voices and messages (which are culturally biased and can create trouble where there isn’t any) and to listen to and trust their own feelings, common sense and I instincts.
Best wishes
Jai Ram
Thanks for sharing your experience. I wish there was no such term as VBAC worldwide! 🙂
As a midwife I have seen vbac numbers significantly rise in the last few years. I have also seen more # and wounds dihiss than ever in my 25 year career. The new stats ( once collected ) will most certainly be different and not reflect the current risk ratios. I totally support vbac in the right environment with appropriate trained staff but it does carry higher risks than previously thought.
Thanks for sharing your insights. I would be interested to see these stats when they are published. I wonder if you are seeing an increase in rupture during physiological birth or with syntocinon? I would expect a rise in wound issues along with the rise in VBAC numbers just because there are bigger numbers – whether it alters the stats i.e. increases the % rate of adverse outcomes is the issue. It will feel like more because e.g. 1% of 500 is more than 1% of 100 if you know what I mean. I wonder if anyone is keeping track of other stats related to an increase in VBAC incidence ie. reductions in adverse outcomes associated with repeat c-section.
Our fifth child was born on the 20th of June 2018 here at Stellenbosch Medi-Clnic (not planned to be there) after our second home alone attempt to have a normal birth. She was born normal with no complicatioins, my first natural birth. I carried her up to 41weeks6days, my first ‘due date’ was for the 7th of June. I am 37 years old.
Our first child (January 2005) was born six weeks premature due to my waters breaking, I was 23 years old. My water broke the Tuesday morning before work, on the Thursday morning contractions started but by what I know today its was not contractions and by the evening at 18h00 I was only one centimeter dilated so they performed an emergency c-section.
After her birth December 2008 I had a spinal back fusion operation at Panaroma by Professor Vlok. The recommendation afterwards was that for a next pregnancy I have to be on my back for the last 6 weeks before the operation the chiropractitioner said I will never be able to have more children again.
With our second pregnancy five and a half years (born September 2010) later we asked for a VBAC here at our gyne in Stellenbosch. I was refused, just a plain “no” regarding my history and that was it. I did not ask any other questions as the answer was given with no other options. So we had a second c-section.
Four years later our second daughter was born December 2014, I did not dare ask for a VBAC and she was another c-section.
Meanwhile our lives changed dramatically from where we thought we were and how we knew God to a big awakening. I am mentioning it because our oldest son prayed for a brother the one evening with our greatest shock especially while we were teaching them that if you ask in faith you will receive so take note of what you are asking. Also I’ve always planned my pregnancy far apart as I want to spend as much time with the little one as possible. So with a daugther that was just over one years old this was not taken lightly from my side. It was not four weeks later when we discovered that I am pregnant and its a boy.
With Micah we knew that we could not have another c-section. We got a different gyne but her advice a natural birth not an option. We started reading as much as possible regarding VBAC but because the midwifes that we’ve contacted then was a bit sceptical to help we were left alone. His due date according to the gyne was 21 February 2017, his scheduled c-section date was set for the 8th of February. By lots of prayers we asked the gyne if we can wait longer and give it time. By the 15th of February our parents started phoning the gyne out of concern because of everything that we are so used to hearing. By then we’ve decided to have an unassisted home birth. We had our last appointment scheduled with the gyne for the 27th after discussions and concerns from her side that she does not approve our decision, but it was scheduled for the 27th of February at 08h00. We cancelled the appointment as I was still walking with no complications regarding the pregnancy.
Sunday afternoon my muscus plug came out an awesome experience for a first time. My water broke at 05h00 on the Monday morning of the 27th of February. I was 40weeks6days. I tried not to push with every contraction and my body ache like I have never experienced before. The contractions was hard and fast and by 12h00 I said to my husband in tears I am done. I was alone did not know what was happening and if I was dilating at all? He just kept on saying lets wait…by 17h00 I was really done and started to walk to the car…forgetting about traffic. I broke my shoes in the car on our way to Medi-Clinic and came there just before 18h00. Stellenbosch traffic at 17h00 is not good even if Medi-Clinic is less than 5km away from our house. When we arrived our gyne was waiting and I was 8cm dilated! They gave me pain meds so the extreme abdomen pain was gone but I could still feel every contraction coming. At 18h15 they said they are going to give me an additional epidural just for recovery during the evening, after that I could not even feel the contractions – nothing. At 18h30 I was fully dilated at 10cm and so they said push….I did…but the only thing that happened was my face getting red and nothing else….
I was pushed into the theatre and he, Micah (meaning There is no one like God) was born (27 February 2017) again c-section at 21h05 but at 4.21kg!! My biggest baby yet and at the age of 35.
October 2017 we went away to celebrate the Feast of Shelters, the Monday morning I had a dream, just white back ground with a very loud and clear voice saying you are pregnant with a daughter and her name is Amelia. I woke up and said to God no its impossible!! We returned the Friday and after several times that He told me to do a pregnancy test and me refusing as I kept on saying to Him no I am not pregnant, the third time He told me to do it I did it. And I was three weeks pregnant – digital pregnancy test. We immediately searched the name Amelia and it means Work of the Lord. So we said to Him okay You show us because we do not know.
We found a midwife here in Somerset West and went to see her. After everything she was willing to go with us all the way. By the second appointment the doubts started after she spoke to other doctors, what about a rupture, her name, losing her practice etc.
I know and see the absolute hand of God behind all midwifes, whether they believe or not. I know He loves each and every one of them and that the reason why I truly believe that they experience so many different experiences than what we see and hear of. So with this I could not go against her own decision so after the third appointment and our last scan at 26 weeks we left there – alone again at home.
Sunday the 17th of June my muscus plug came out 17h55 (I tried to record everything) but after that nothing happened. I had no complications once again and we kept on asking for God’s help in this. I would wake up in the morning with a full night rest and dreams, upset because not even one braxton hicks and the time passing with nothing starting. My first due date was the 7th of June, the second date the 10th of June. This time we did not tell family members what was going on so by the 18th of June I was in tears at God’s feet, what was happening.
Wednesday morning on the 20th of June I woke up at 04h30 with my first contraction, I woke my husband and asked him to lit the fires as I was cold. We got up, put on the music, the kids was still asleep and went down stairs. The contractions was fast but this time I kept on holding on to who God is. I was on and off the ball. My stomach emptied and I tried to take in as much fluids this time not trying to go against my body at all with every contraction. Just before 08h30 my muscus plug came out again!! I was shocked, its impossible we can’t be this far in with contractions and now have my plug again and my waters not breaking yet? Litterally 5 minutes later the whole ball game started to change. I vomited a lot and then my body started to push by itself. I did not experience this before and it was a shock and painfull. I wanted to go to the clinic but my husband phoned Ruth Ehrhardt out of emergency and asked for advice, she asked if my water broke yet? My husband no, her answer and I completely understand it, we are still in the beginning fase. I did not agree and sat in the car waiting for my husband in order for us to leave. With a lot of debate we left the house at 08h45 and he wanted to go to the midwife in Somerset West, I said that I am going to get out of the car at the traffic light beside Medi-Clinic if he won’t take me there. I am telling you this as its really the reality of being alone. He stopped at Medi-Clinic just past 09h00 and when I went inside they checked me. I was fully dilated and she was crowning!!!
They rushed me to the labour room, me pushing and the doctor screaming at me don’t push!! We just got inside and our previous gyne with Micah came in shocked because remember she does not even know that I am pregnant again! Her words, you feel the contraction, push! First push she was out to her shoulders, second push completely out. I did tear. Amelia was born normal at 41weeks6days and shock from everyone around me after four c-sections and at the age of 37! A big stamp of High Risk written all over regarding what we know. I stayed overnight and was at home by 10h00 the next morning.
Thank you for sharing your story! 🙂
Just wondering, according to research does a longer or stalled labour increase the chances of rupture for a vbac patient? It seems plausible that more contractions = more stress on the scar, but does research bear that out? What about contractions that aren’t dilating the cervix? Do they place more stress on the scar? I heard these two things today.
Longer and/or stalled labour can be caused by the uterine scar starting to tear as this disrupts the functioning of the muscle fibres. This means that the cervix is not ‘held’ open by the uterus becoming ‘smaller’. When a rupture happens it is difficult to know if the long/stalled labour caused the rupture or was a result of it.
In terms of ‘stress’ on the scar. That is more to do with the strength of contractions. So a long slow, spaced out contraction pattern would be less stress on the scar than a strong (eg. synt) short labour.
A long labour and a successful vbac is what I ended up with! It started on a Sunday night and varied in intensity (but never stopped completely) until Tuesday night. Was 4.5cm when I arrived at hospital at 1am Wednesday morning. Baby was born at 2.31pm Wednesday, with only gas for pain relief (though I was asking for an epidural or c-section when I hit transition). Half an hour of pushing. More intervention than I’d like because they picked up a drop in baby’s heart rate with intermittent monitoring. PROM, episiotomy, and stuck on my back to push, but I DID IT. Had to get him out quickly in the end because of his heart rate and they threatened forceps/ ventouse. Didn’t need it and he was placed straight on my chest – bliss! Mild postpartum hemorrhage. The birth wasn’t perfect but I felt respected, supported and was happy at the outcome. This was in a public hospital, with the support of a doula and a student midwife in addition to my husband and Mum. Looking forward to doing it again someday, but hoping It will be more relaxed because I’ve proven I can do it. Sadly that may not be the case – once you are a vbac there are always extra concerns, but I can go on hoping :). Thank you for this article (and the others on the blog) as they greatly influenced my birth plan. The doctor who stitched me up told me that mine was the most informed birth plan she’d ever seen!
Congratulations! 🙂
What a great article! Summed up what I had to dig out of lots of studies, guidelines and articles. Puts things in perspective without leaving anything out. I have two remaining questions and would love your view on these:
1. Continuous Fetal monitoring
2. Early admission to hospital due to vbac
TIA
1. CTG… the individual woman needs to weigh up the risks of routine CTG (which increases the chance of a c-section by 30%) with the risks of a uterine rupture with no symptoms except FH changes.
2. Again… need to weigh up the risks of early admission re. increased interventions https://midwifethinking.com/2013/11/13/early-labour-and-mixed-messages/ and possibly early CTG with the risks of labouring away from that intervention.
Hi,
thank you so much for your reply!
1. How many % of uterine ruptures show FH changes? Can these not be detected with intermittent monitoring?
2. what does labouring away from that intervention mean, plesase?
Very grateful for your help! Thanks again!!
1. I don’t know, and there are no stats on % of uterine rupture for women without an epidural (ie. won’t feel pain). There are other signs. And yes you would pick up changes with IA.
2. labouring in a setting without immediate and direct access to medical intervention (some women consider this a risk… other women do not).
This is how my hospital reasons regarding constant Fetal monitoring:
Signs and Symptoms of Uterine Rupture
*Abnormalities in the fetal heart trace, such as variable or late decelerations, prolonged fetal bradycardia, warrant immediate review by senior registrar or consultant. These abnormalities may be the first signs of scar rupture/dehiscence.
Be vigilant for the symptoms and signs of scar rupture, which may include1:
Abnormal fetal heart rate or cardiotocograph (present in 55-87% of cases)1.
Birth After Previous Caesarean Section
Obstetrics and Midwifery
Page 7 of 10
Several VBAC studies have reported that in over 70 % of cases of uterine rupture, the first signs or symptoms presented as prolonged fetal bradycardia. Of these cases, only 8 % presented with pain and 3 % with bleeding9, 31, 32.
https://www.kemh.health.wa.gov.au/~/media/Files/Hospitals/WNHS/For%20health%20professionals/Clinical%20guidelines/OG/WNHS.OG.BirthAfterPreviousCaesareanSection.pdf
… and were those studies on women having spontaneous unmedicated labours… or women with epidurals?
From my experience of rupture stories occurring outside of routine medical intervention… the first sign is usually changes to the contraction pattern.
And I think it is important to remember that we are talking about a less than 1% chance… hence why women need to weigh up the risks of routine interventions (such as CTG) with the rare incidence of rupture.
Very insightful blog. We can see the research that went behind in publish this blog. We would definitely recommend this blog to our patients. Keep posting blogs like this.
I just wanted to give a testimony, in case it should encourage someone. I felt very invalidated by my first two C-sections, and I am wary to mention the reasons lest they should exacerbate some other poor woman’s fears. However, I will give the details in case they could encourage someone who has had similar C sections, and believes there is no chance of a vaginal birth.My first pregnancy was with my son at 26 years old. My husband is 6’3, I am 5’5. I had an OB friend of mine say she never saw a baby with the head size of my baby come out of a woman my size, because, in her impression, larger husbands and smaller wives produce babies that are too big to come out naturally (that was the inference made there). My children all had 90% head sizes…I think the first was close to 99%. My last pregnancy, a girl, was also 99% head size. My first child was 7 lbs 6 ounces at birth; I think my daughter was 7lbs 8 ounces, I don’t recall.With the first pregnancy I was determined to do a vaginal birth with no pain medication. All my pregnancies, I am very grateful to God for, went to 41 weeks. I tried to “walk” out my eldest son by going to the mall in December and walking briskly, and this may have worked (I tried to climb stairs vigorously there), but I also, either from that or from my sister, caught pneumonia. The contractions were agonizing – I am not a good birther, and I was making no progress as well, or little. I “stalled out” at 2-3cm and per hospital policies they would not admit me for pain relief. After screaming in the hallway on my hands and knees they finally believed I was not exaggerating and I got a shot of morphine. I don’t know if that was the right thing or not. I also got an epidural so terrified of the pregnancy pains was I (all I recall is thinking that I would hurl myself out the window if the pain continued, I had lost all perspective). I am still ashamed I couldn’t handle the pain better, despite all “practice”. During the epidural I didn’t sit up or anything, they said I could sleep because things were progressing, and I just didn’t realize anything could go wrong. I got to 10cm but the baby hadn’t fully descended and my water bag was still in tact. They said they were going to pop it because it was in the way, and I didn’t know any better, so I let them do that. But the baby didn’t come down past a certain point, and then they said there was tachycardia – or the heartbeat was falling off. I demanded to see it in the printouts but, apparently it was there, and, despite trying to get up to squat position and meet their 15 minute more time limit (because the OB and midwife were in hysterics saying to get over myself and get a C-section for the sake of the baby) – I didn’t manage it and opted for the emergency C-section. The baby, my eldest and a child whom I was blessed to have early learning capacities, was born with an APGAR of 1 and had to be resuscitated. I was left to hobble over to the NICU Level II nursery to breastfeed him after pumping, and he was tied up to wires there for failure to hold temperature. After 3 days, praise God, I got him back, and things were sort of OK but he couldn’t breastfeed past 4 weeks (oversupply I think?) He also was my only child to develop night terrors. Thank God those are over with. In the eyes of the world though, he is my most academically gifted child from tests anyway.So, that is what happened with my first child. My second one, I really wanted to have a VBAC, but I gave in too early. I hadn’t passed my mucus plug (again) after something like 30 hours of contractions, I again was only 2-3cm, and the therapeutic morphine rest seemed to knock out my contractions. They started to come again slowly but, I was foolish and I thought – since things are progressing so slowly, and since it might be all this pain for nothing, why not just opt for a 2nd C-section. It was the only way I could stay at the hospital, and again I feared the pain. Thank God it was an uncomplicated C-section, outside of puking on myself twice, and the baby was an excellent breastfeeder. However, he has had a couple of problems. Intermittent exotropia (though my daughter had this a little bit as well). He had enamel hypoplasia – maldistributed enamel. He was at one point only at 3-8% on the growth chart. He may have recovered, I don’t know – but, he’s very short. He is much slower to learn number names than my elder son was, and, though I don’t believe it to be accurate, he has a lower IQ based on whatever tests can be reliably given to a 5 year old. But he builds beautiful, perfectly symmetrical towers, is very inventive in story telling, and periodically can add a little; I think he will turn out OK in the end – but I do always wonder if all these strange issues he had with growth stemmed from that therapeutic rest or the epidural or “something”.My last child I was determined to do a VBA2C or die trying. I am not kidding about this. Perhaps you could view it as a mental illness, but I honestly felt that if I didn’t have the VBA2C I wouldn’t know whether God had blessed our marriage with the child, or whether I should have rather died earlier and that the marriage was cursed by God or something of this nature. Maybe that sounds puerile to other people. I also didn’t want to go through the dehumanizing C-section pain, and the comments people ultimately made about my body just not being made to birth, or something. I regret how poorly I treated my midwife during my first labor. Perhaps that is why she said this thing about me. I was a complete jerk during labor and in the pain lashed out at everyone, and I regret this. I was not a pleasant hospital patient.Anyway, back to my last pregnancy, I was fortunate enough to live 3 hours away from UNC Chapel Hill hospital. They allowed me to try for a VBA2C. I tried to take a percoset because it helped with the pain before in recovery, but it was not helpful. The pain came on just as before. Sadly, that thing they say about the pain getting less and less with each pregnancy never happened for me – maybe because they weren’t full births? But anyway, after 40 hours I went to the hospital. Same story, only 2-3cm dilated. I tried to stick to our birth plan by doing the “gas” method of pain relief but they indicated that that wouldn’t work at the last minute. The nurse was really nice but they sent me out of there, and I got a therapeutic rest later, but I was stunned to see that this did not help almost at all. The doctor, bless his soul, was factually stating that he was confused about me – saying I was like a broken lawnmower – that I wouldn’t quite start but I wouldn’t stop either. He felt if I got an epidural I would totally stall out and he only wanted to do that if I would sign off on a C-section or that is my recollection of it. I left and just hobbled around the parking lot. I remember crawling on my hands and knees on the couches feeling like I was literally going to die. The next time my husband got me back there, I was screaming for pain relief and they had to call security. I think I was also pulling my hair out – the order of events blurs. Another doctor came in there and felt things and said I was at 5 cm. A perfect person would have been like “great, I’m at 5cm, I’m going without pain relief to ensure this thing works!” but if possible, I was in even more pain at that point than even with the first pregnancy. I don’t know – I cannot quite compare the pain levels. I remember just ripping out my hair unable to be cordial to anyone even though they were working as fast as they could on getting me the epidural. I knew I was being a major jerk but I just snapped at all the anesthesiologists to go faster, and I felt like they just didn’t care how much pain I was in but, I know now retrospectively I was behaving like an animal and I don’t blame them for their reactions. I finally got the epidural and 15 hours later I was able to have my daughter vaginally. You’d think this would have been a great victory but, two days later my husband was hospitalized for pancreatitis so I didn’t quite get to relish it in its full splendor. The splendor included my vagina being so extremely swollen it looked unrecognizable – literally like I had two swollen vaginas instead of one. Also I had a hernia. They sent in the psych team to give me a pamphlet on how to handle emotions because I had screamed so viciously during the 40-45th hour of labor before the epidural, and, I think they felt that I should have handled that better despite the pain. And I should have but I don’t know how to describe the pain to you – I really feel for some reason my pregnancy pain level was higher than others but maybe I am just a jerk to assume that still.Anyway, I am very grateful to the doctor that got me through. I think his name was Dr. Brimager? He moved to Wake in NC. He’s an excellent doctor. I am more grateful to God of course for allowing me the opportunity to have this VBA2C, despite how horrific it felt, because finally my insecurity about our marriage on that level stopped. So I guess it was “healing”. I do think even with everything the VBA2C was much better than any of the C-sections. I do not mean to be one of those insufferable jerks who thinks that God has specially blessed them, but, I think God allowed me to have the third one naturally because I stood up to the doctors and told them that God would see me through the VBA2C or I would accept death. I think when you want something badly enough that you are willing to die for it somehow it works out.Anyway, I wanted to share this because, if you are a woman who stalls out at 2-3cm, and your labor goes beyond 40 hours, perhaps by not giving up, and letting it go the full 60 or whatever it is, it will still work naturally even though other people supposedly birth in 8-12 hours. Just wanted to add that data point in there – it could be your body just takes 60 hours to deliver a baby.Hope everything goes well for everyone,
Thanks,
Alice
im wondering if there is any newer studies on vbamc? Specifically vba4c and vba5c? Also can you link the risks of a 6th csection? (not just accreta but also hemorrhaging ect thanks!
Not that I know of. There is unlikely to be any statistically significant studies on this because so few women do it. There is evidence on the increasing chance of PPH with subsequent c-section surgeries ie. a haemorrhage during surgery is more likely the more surgeries you have.
Hi there, my daughter was born at 25 weeks dues to severe preeclampsia and HELLP. I’m currently due Dec 24 and my daughter will be almost 3 by then. I had a classical cesarean with her. I am really really struggling to find any research on risk associated with a VBAC after a classical cesarean perhaps because it’s so uncommon? I really want to VBAC but I want to be super confident in my decision so that I can advocate for myself. My cesarean experience and healing afterward was positive and straight forward so I am not against a c section if it is truly necessary. Anything you know of? Have you personally assisted a woman with a VBAC after a classical cesarean?
Dear Rachel, When you do your next update could you please comment on wound healing time frames as many women are now be intimidated about getting pregnant and thinking VBAC in a year after C/S, !
Yes – however I’m not aware of any research into this.
There are some references in Hazel K’s book.