Repeat C-Section vs VBAC: Why I’m Opting for the Latter

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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.This is the question I am trying to figure out during my second pregnancy! I have to weigh the pros and cons of a Repeat C-Section vs VBAC. It's helpful to know why one mom's story of why she chose the way she did and to be informed.

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

VBAC Risks

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).Having a C-Section

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).

Groggy After C SectionThe 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.

Baby NICUCons 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.Holding Baby for First TimeThe 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:

*Read Michael’s Successful VBAC Birth Story!*
*Read Emily’s Succcessful inducted VBAC birth story here!*


Also Check Out:

26 VBAC Success Stories to Further Empower You to have a Success Trial of Labor!Great list of VBAC success stories! And it's broken down by whether or not they were induced, had an epidural, were home births, were after 40 weeks, and so on! So helpful for pregnant women who want to have a vaginal birth after a C-section!

8 Ways to Up Your Odds of Having a Successful VBAC Delivery

Great advice for all pregnant moms who want to have a successful VBAC birth!

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Comments

  1. Michelle says

    I have had three VBACs. My first two children were vaginal deliveries. With baby number three, I had a complete placenta previa. My doctor was very accommodating with my desire to VBAC my subsequent deliveries. I did not like being tethered to the monitor ALL the time or having Pitocin as the only option to either induce or augment labors, but I am not a person who would elect to have a c-section without a very good reason either. I hated that I needed a c-section with my third child. I did a lot of research beforehand and my doctor bent a ton of rules for me. The recovery wasn’t even as bad as I’d heard, but I really hated not being actively involved in the birth, the expectation to not eat real food afterward, the idea of keeping that catheter in a moment longer than necessary, etc. My doctor allowed me to eat, walk, use the bathroom w/o the catheter as soon as I wanted to do so. (I walked as soon as the nurses let me, immediately after getting out of recovery and into a real room.) For the VBACs, she had notes in my chart to allow me to eat, pee, walk, etc. untethered just as soon as I proved I could do so. I also skipped the morphine in c-section epidural. Knowing that plans for a worst case scenario were in place made me feel a lot more comfortable about the possibility. As for the VBACs, they went very smoothly, no drama at all. Good luck!

  2. says

    I can completely relate to this. I’ve had 2 c-sections and while my first was not by choice, but deemed necessary…my doctor wasn’t going to take a chance with the 2nd and so I’ve had 2. I could’ve went to find a doctor who would’ve let me try a VBAC..but I do have a close friend who did that and ended up with a hysterectomy. I did have some bleeding issues with my 2nd C-section anyway..due to scar tissue issues, and it wasn’t fun. That being said, I will probably never know the feeling of pushing and I still want to try for one more! Thanks for sharing your story!

  3. Annie says

    I’ve had one c-section, because my induction didn’t work. Now, I’m afraid to try another induction, c-section, or go for a v-bac, Every scenario sounds dangerous. So, what do I pick for my next pregnancy?

    • says

      Well, I can’t tell you for sure! But the risks are the lowest with a vbac. I was just induced for a vbac (breaking my water) and that went fine too. I have had 2 vbacs now and they are much better IMO than a c-section. Every situation has its own risks, so you just need to educate yourself and make the best decision for yourself.

  4. Alexandra says

    Both my children were scheduled c-sections and I wouldn’t have it any other way. To each her own. I follow the advice of my ob/gyn as to what is best for my health and the health of my children. We talked about any risks of me having another c-section should we decide we want another child, of course he told me the risks with the additional scar tissue but he knows my body and I responded very well to both surgeries so he does not feel like I shouldn’t have any more children. Every woman’s body is different and these decisions should be based on the recommendations of her ob/gyn.

  5. Alexandra says

    It was medically necessary if that’s what you mean. I don’t know any reputable doctor who will perform a c-section unless medically necessary….then again, I live in Kentucky, not Beverly Hills lol. (No offense to the 90210)

    • says

      It’s so posh to get cut in Beverly Hills. :p And I hope doctors wouldn’t perform unless necessary, but I think “necessary” is becoming more up to interpretation, and sometimes due to hospital/doctor convenience. 🙁

  6. Katrina says

    I struggled with this question for our 3rd full-term pregnancy.

    Our first baby was an induced (9 days late) but pain-med free vaginal birth – 9 lbs. 3 oz.

    Our second baby we lost at 9 weeks though we celebrate ‘his’ birthday every year. I had to have a D and C at the hospital after the baby was born at home.

    Our third baby was a scheduled c-section due to placenta previa. – a couple weeks early 6 lbs. 14 oz. – in the NICU for one week for breathing issues. I did not have morphine or anything like that in the epidural – talk about a TON of research going in!

    Our fourth baby, I wanted a VBAC but had an insanely hard time finding a doctor that would do one for me…we had moved to another state between the second and third. “There is too much risk” I was told over and over…it didn’t help that I choose to have a female doctor. I finally found one after about a dozen phone calls but the entire pregnancy she was leery of the baby getting to big. Well, she did and I had to be induced, but I still had her vaginally – 9 lbs. 4 oz. on her due date.

    Our middle child struggled for a while with getting colds/bronchitis/pneumonia easily and I believe, though she was born early, if she could have been born vaginally it would have helped (squeezing her and getting stuff out of her lungs and air passages on the way out). Obviously, that was not a choice for us for our second but I am thankful to have had a VBAC for our third

    We lost our fifth baby shortly into our pregnancy this past April but our insurance is limited and I chose to wait and see if my body got back to normal on it’s own – it took a while but everything seemed normal again when I get pregnant again with our sixth.

    And I will choose a natural labor if at all possible with this next one.

    By the way, I had a much more difficult recovery from the c-section than the natural deliveries.

    • says

      First, I am sorry to hear about your two losses. That is sooo hard. I am glad you were persistent and able to find a doctor that would allow you to VBAC, even a large baby. 🙂 My last baby was 9lbs 4oz and my second was 9lbs 8oz (born vaginally). But, aren’t you glad you were able to have a C-section when you had a placenta previa? Thank goodness for ultrasounds that discover such things before labor starts and there is serious risks to you and baby! I am also amazed at your natural labors. I’ve always had an epidural. ha ha.

      • Katrina says

        I was grateful to be able to have had the c-section.
        I often hear the comment, “If only we could live back then,” I often tell myself, if we lived ‘back then’ I would be dead twice over. From my first miscarriage and from the placenta previa.
        To be able to keep my baby and myself safe was a blessing. I had a cousin who was pregnant at the same time as I who had a partial previa but hers moved off to the side and she was able to have a normal delivery.

        By the way…my first was natural but the 3rd delivery, I did have an epidural. I have discovered that if I don’t keep up at the chiropractor things get really out of whack and I had incredible pain as the baby forced passed a bone that wasn’t in the right place (she came out with a bruise on her nose 🙂 )

  7. says

    I think something people tend to forget when they’re talking about the danger of VBACs is the fact that a uterine rupture usually happens during the early stages of labour. Unless your c-section took place before any labour began, your chances of rupture are about the same. Since vaginal birth is ultimately healthier and – at least in this regard – almost equally as safe, I think it makes a lot of sense. How a woman perceives risk can vary greatly (I, for instance, am a home-birther, but not everyone feels safe with that decision – totally okay!), and that is also a factor.

      • Karyn says

        I had an emergency C-section in 1994, in 1995 my doctor strongly encouraged me to have a VBAC. I did, it was awesome, I think I pushed three times after twelve hours of labor. I had another VBAC in 1999- it was hard- I was 41 weeks and they could not even break my water for six hours. Twelve hours total and I had my 9.3 lb bundle of joy. Fast forward to 2008, and I was FORCED to have a C-section. My doctor who did the two VBACs was no longer offering them! The scheduled C-section was horrible, they took my son early so I would not go into labor and he ended up in the NICU for having water in his lungs. I think lawyers are going to be the end of VBACs. As a side-note, I have a friend who is a labor and delivery nurse and she has only seen one uterus rupture and it was not a VBAC. Peace and joy!

        • says

          See, and that makes ZERO sense to me. Why would they have to do a C-section when you’ve already had two successful VBACs? Often it is a hospital policy, but it’s a stupid policy. I (half) joked with my husband that I just wouldn’t go in for a C-section if they scheduled one for me, and just go to the hospital after I went into labor. Also, I hate that doctors often push for early deliveries when they are C-sections. Let them babies cook!

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