Repeat C-Section vs VBAC – It’s a very real choice I had to make once I became pregnant again. I had a Cesarean section with my first pregnancy, but this pregnancy I have decided to elect for a Trail of Labor After Cesarean (TOLAC) or Vaginal Birth After Cesarean (VBAC) instead of opting for a repeat C-section. And there are many reasons why.
The reason I had a C-Section with my first pregnancy is because I had breech twins. A valid and reasonable reason to have a C-section.
That’s really the only reason. I didn’t have high blood pressure. I didn’t have gestational diabetes. I didn’t have toxemia/preeclamsia. My pelvis wasn’t too small. My labor didn’t stall. My babies weren’t in distress. The placentas weren’t covering the cervix. There was no emergency. I wasn’t even in labor yet.
I had a planned, scheduled C-section because Obstetricians don’t deliver breech babies anymore (at least none that I’ve worked with or have heard of) and with a twin pregnancy two breech babies provided the possibility of added complications. But, we did wait until my girls were full-term, meaning there were born at 37 weeks 6 days gestation. And they were a healthy size: one was 6lbs 14oz, the other 6lbs 15oz. That’s almost 14lbs of baby! While Baby A, Lisa, did have to spend two days in the NICU with a partially collapsed lung, there’s no knowing if waiting a week would have made a difference.
So, as I approach my new pregnancy, with a singleton baby boy in my belly, I know there is no medical reason for me to have a repeat C-section.
C-Section VS VBAC
I have great, healthy pregnancies. I am a prime or ideal candidate for a VBAC for all of the above reasons that I mentioned that I didn’t undergo. Also, my uterus received a two-layer suture, and it was a regular, low-lying cut that wasn’t extended. This new baby’s placenta isn’t low-lying, or covering any of the scar or cervix. This means that my chance of having a complication from electing for a VBAC are very low. Like a 0.5% chance of having my uterus rupture, the major concern for those having a vaginal birth after cesarean.
Now, let me be clear – uterine rupture is a scary business. It can cause internal bleeding for me, an emergency hysterectomy, or even death. And it can cause problems for the baby which can invovle neurological complications and even death. Seriously, bad stuff! But, I feel confident in my chances. About 5 in 1000 women have this happen, and my doctor told me that they aren’t often super severe when they do occur (aka if your uterus does rupture, they treat it quick before anything serious – death or hysterectomy – happens).
Pros and Cons of a Repeat C-Section
Pros of a Repeat C-Section
Now, I recognize that there are some advantages with choosing a repeat section. With a repeat C-section you can schedule your baby’s birthday and be able to plan more accordingly for help and meals. You wouldn’t have to go through labor, or at least not for very long. You would already know what to expect as you’ve done it before (as pictured below).
The Risk of a C-Section
On the other hand, a repeat C-section would put me at a higher risk for complications. First I have to have an epidural which poses its own set of risks and side-effects (read more about them HERE). While I didn’t have an allergic reactions to my previous epidural or problems associated with my epidural the first time around, I do remember being extremely sleepy and groggy during and after the operation. In fact, I slept while they were stitching me up, and then while I was in the recovery room (pictured below all groggy-like).
The epidural and the C-section aren’t very good on the baby either – there’s the possibility of injury during delivery (I know someone who’s face was cut when his mother had a C-section), immature lungs and time in the NICU (like Lisa experienced below – going through the birth canal helps get any fluids out of lungs), poor sucking reflexes, and general sleepiness as well.Then the operation itself poses risks as it is a major surgery. There’s the increased risk of infection, heavy blood loss, blood clots, bowel problems, and even death.
Cons of a Repeat C-Section
Then there’s also the logistics about delivering via a C-section vs VBAC.
A major disadvantage of a repeat C-Section is if you plan on having more children, which I do (I’ve always wanted five – we’ll see). Because, according to Childbirth Connection “Each additional cesarean operation increases the amount of internal scar tissue. Increasing scar tissue makes it more and more difficult for the placenta that nourishes the baby to grow and attach normally. This can pose life-threatening risks to babies and mothers. Increasing scar tissue also increases the chance of adhesions, where nearby tissue or organs grow together. Adhesions make cesarean surgery more difficult and risky in future pregnancies.”
How many times have you heard women talk about their doctors warning them against having another baby because they’ve had too many C-sections already? I have multiple, multiple times. My sister-in-law had five C-Sections and I knew another woman who had six and both were told it was very risky to have so many, because each subsequent C-Section is more complicated than the last as they present concerns regarding weakened uterine walls, bladder injuries, heavy bleeding (and possible hysterectomies to fix that), and problems with the placenta. (Source – Mayo Clinic).
While I know many doctors will let you choose a trial of labor after one C-Section, most won’t after two or more. With a vaginal delivery after C-Section, I won’t be told by a doctor how many children I should or shouldn’t have (at least from a medical standpoint – some might still give their opinions….). I love that. I want to be in control of my reproduction and have the least amount of increased risk to myself and my future children.
Another disadvantage of a repeat C-section would be the lack of mother-child bonding after birth. Though I watched the doctors pull my twins from my abdomen during my first C-section, I didn’t get to hold them for two or more hours after birth (although I have been told this is not the norm). Since Lisa was in the NICU, I really didn’t get much bonding time with her at all and did feel distant from her. I felt like I had had only one child born to me and I hated it.The extended stay at the hospital for a repeat section may also be harder to manage (I stayed four days when I had the twins) since I already have multiple young children at home, a husband who can’t really miss school/work right now, and no immediate family in town. I also would have an extended recovery period and soreness, which again, with two kids and a newborn would make life more difficult once I’m home. I’d also be on pain medicines for a while as I recovered which would limit my functioning abilities, milk supply, and more.
Looking Forward to my VBAC
The advantages of having a VBAC would be instant mother/baby bonding time! I wouldn’t have to wait to hold and nurse my child for the first time. And I am greatly looking forward to that! I also would have a much shorter stay at the hospital, have a shorter recovery period, and feel better sooner, all good things when responsible for three young children. (See my birth story to see if these were true!)
As I draw nearer to my due date, I am so glad that my baby boy has decided to be head down. I’m also very glad that I chose the midwife practice that I have as they are very supportive of my decision to have a VBAC. However, there are some things that still may come up which would prevent me from having a VBAC.
I cannot be chemically induced for labor, meaning I cannot receive Pitocin to start labor (at least at my hospital/practice). I can, however, upon going into labor, receive Pitocin if my labor were to stall or slow down, under careful monitoring. The reason being that Pitocin increases my risk of uterine rupture. So, this means if I go too far over my due date (approaching that 2 week mark), I will more than likely have a repeat section. They can however, try other more “natural” methods of inducing my labor, like stripping my membrane.
But, assuming that this boy doesn’t take forever to come, I will be able to have a trial of labor. And I really hope everything goes well! I am planning on going unmedicated, partially because I fear that with an epidural, if anything were to slow or stall or what have you, they’d be more likely to want to “just” do a C-section since I already had an epidural in. Now, I do fully understand that I have never experienced the pain and discomfort of labor and I don’t really know how fully prepared I am for it. But, I have read a lot on natural birthing and feel like I will be in the right hands at the hospital to get the support I need to do my very best. They are very experienced midwives. Apparently, even midwives who almost never ever use episotomies too! And I will only have midwives working with me assuming no complications or concerns arise during labor.
I am very excited about meeting our little boy and just pray and hope I will have the birth I desire! Josh and I just hope that this little guy will wait until his due date to come or at least the day after as then Josh will have a week long spring break from work and school and be able to be with me as much as I need him! Whatever happens, you bet we’ll share our birth story with you!
Did you have a previous C-section? Do you want to have a repeat section (or did you) and why? Did you have a successful VBAC? I would love to hear about it all. I’ve very curious as to why people choose each as they had to consider having a repeat C-section vs VBAC.
*UPDATE: I’ve now had TWO successful VBACs. You can read about them here:
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