A reader asks, “Am I making the right choice?”

by | Oct 14, 2010 | Planning your vbac, Resources for unsupportive family members, VBAC | 13 comments

Isha recently left this comment:

I am pregnant and plan on having a VBAC. As my due date gets closer, I get more nervous about it. I hope I am making the right choice in having the VBAC.

Hi Isha!

I too wondered if it was unreasonable to plan a VBAC when I had my cesarean. And that is when I started researching.

After all, my obstetrician said I was a great candidate for VBAC. But when I talked to my friends and family they looked at me like I had two heads.

All they had heard was how dangerous VBAC was and how convenient, easy, and safe cesareans were.

So, the discrepancy between what my doctor said and what my friends and family said was enough to propel me on my journey to VBAC and then creating VBAC Facts.

For me, what makes me scared is the unknown, so I found that learning more about the risks and benefits of VBAC versus repeat cesarean gave me a lot of peace.

I wanted to know, how likely was uterine rupture.

How likely was it that my baby or I could die?

How likely was it that I would have a victorious, healing VBAC with my wet baby slipping into my fingers?

It was only until I learned all the good stuff and all the bad stuff could I make an educated decision.

Now I spent years learning how to evaluate medical research and then compiling it and distilling it for my own use. So, I don’t recommend starting from scratch and culling through all the literature yourself because it will take forever… believe me, I know.

If I could have attended a class like my “The Truth About VBAC for Families” and just had all the information given to me, I would have jumped at the chance.

Because it’s not just all the things that are floating around in your mind right now. The specific questions you know to ask.

It’s also all the questions you don’t even know to ask. It’s the whole, “You don’t know what you don’t know” kind of thing.

And what I learned during my journey is how much I didn’t know. How much my friends and family didn’t know. And frankly, how much my doctor didn’t know.

And that’s not a slam on him. He is a great guy.

But the reality is, many busy obstetricians don’t have the time to go through the research. They certainly read an abstract here or there.

But they don’t have the time to really dig in and read a whole study start to finish… and then do that for every relevant study out there.

They have a busy practice, family, friends, and they need downtime like everyone else.

So, what I’m saying is, if you want to get up to speed quick, check out my program because it’s the most comprehensive course out there on VBAC especially for families.

It weaves together not only the medical facts but the politics of VBAC including VBAC bans, home VBAC, the bait & switch, and so much more.

After the completing the course, you will be clear on what is right for you. And that might be a VBAC. Or it might be a repeat cesarean. There’s no judgement here. Just do what is right for you.

You will also be able to talk to anyone at anytime about VBAC and feel completely confident in that discussion. Because you will have the facts on the tip of your tongue ready to dispel any misinformation flying your way.

I wish you well on your journey and best of luck!

Warmly,

Jen

What do you think? Leave a comment.

13 Comments

  1. I want to urge any woman who is considering a VBAC to go for it! I successfully VBAC’d on 9/15/11 – a 7lb baby girl. My first child was posterior and almost 9lbs, resulting in an emergency c-section. It didn’t help that I had gained almost 75lbs through my pregnancy. I am 5’4″ and got pregnant when I was already overweight (165lbs). The docs said I had “a small pelvis.” Ladies, that is balony. Do not listen to them if they tell you that. There is no way they can tell how big your pelvis will get in labor.

    A few words of advice:
    1) Be as active as possible throughout your pregnancy. This keeps your weight down and also your baby’s weight (which helps to make sure the baby can fit through the birth canal). I walked several miles a day up until I delivered. Take the steps instead of the elevator, etc. You will thank yourself. Trust me. Plus it really speeds recovery. I was only in the hospital for 36 hours from the time I set foot in L&D. I was able to leave the hospital a full day early. As a bonus, my daughter is 5 months old today and I am 11 lbs lighter than I was when I got pregnant!
    2) Go to http://www.spinningbabies.com and follow the advice to make sure your baby is in the optimal position prior to labor. Just say NO to a posterior baby! 🙂
    3) Stick to your guns. They wanted to schedule me for a C because I was a week overdue. My OB said ok to VBAC with the stipulation that I didn’t get induced with Pitocin. If you are under Pit, the risks of uterine tear greatly increase (and so do the chances you will sue your doctor, which is why they don’t want to let you go VBAC in the first place). I put the C off and did lots of nipple stimulation, sex & pelvic exercises to get the labor hormones going so I would go into spontaneous labor. It worked. My water broke on its own.

    My water broke around 7pm. I ate a big bowl of cereal for strength and waited a bit longer. Went to the hospital around 8:00pm and by 2:00am I was pushing. At 4:30, Natalie was born. I pushed for a long time, but that was because she was turning and trying to find her way out. Once she got into optimal position, she was out 10 minutes later.

    I can’t stress enough how physical activity will help you successfully VBAC. It will also give you the strength & stamina you will need to push if your baby is not in optimal position.

    Good luck to you all! And trust in yourself & your body. Women were made to have babies and anyone who tells you a C is necessary because of a small pelvis should only say that if you have had Polio. Otherwise, I guarantee you are big enough to vaginally deliver. Even if you are only 4ft tall!

    Reply
  2. I am looking for the risks to fetus if a uterine rupture occurs, i have found data that suggests the risk of rupture if the first csection is less than 18 months jumps to almost 5%
    But even if that occurs what are the risks to the baby? My ob said baby could suffocate, is that true, how long do you have etc? I can’t find info on fetal survival after rupture and what would be the cause of death or injury to baby if it does occur?

    Reply
    • Hi Colleen,

      I’m sorry it has taken me so long to reply to your comment. It is frankly really hard to keep on top of all the comments I receive!

      The studies on uterine rupture by birth interval are small and don’t control for important factors like induction and augmentation which we know increases the rate of rupture. So in studies like this that have reported high rates of rupture, we don’t know if that rate is due to short birth intervals or induction/augmentation or simply due to the wonky numbers that small population samples occasionally yield. Read more here.

      As a result of this inconclusive evidence, some OBs require 18 -24 months from cesarean to subsequent delivery whereas others don’t. So, if you have a small birth interval, it might be worth your while to interview other care providers in your area.

      As your OB said, uterine rupture impacts baby by interrupting the blood flow to and through the placenta, and thus oxygen supply. The evidence strength on rupture-related perinatal mortality (infant death within 28 days of birth) is low and you can read more about this here. The evidence on the rate of rupture-related oxygen deprivation and brain damage is even more inconclusive as reported by the 2010 National Institutes of Health VBAC Conference. You can review all the documents and presentations related to that conference here.

      I do cover this topic and so much more in the 6 hour class I teach which is offer via an on-line webinar and in a city near you.

      Hope this helps!

      Best,

      Jen

      Reply
  3. Hello Ladies! I am a Certified Professional Midwife in southern Calif. My birth center, AquaNatal, specializes in assisting women to have safe VBACs in our deep warm built-in tubs from Waterbirth International. If you are in the area I hope you will stop by.

    Reply
  4. I was wondering if you have any statistics on VBAC risks with 2 prior c-sections. I had a c-section the first time because of concerns related to high blood pressure and gestational diabetes. My dr told me that my incision was low and transverse, and that a vbac would be an option for the next delivery, but I moved out of state and the dr I had last time would not allow it and actually told me that there wasn’t one in the region that would. (I did not have HBP or GD) That was a little over 3 years ago. My dr did tell me after the c-section that she was able to make the incision along my previous scar so that I would still only have one scar.

    This time, I was able to find a dr (in the same city) that will let me try a VBAC as long as everything continues to go well. Apparently even the clinic I used last time has started allowing some VBACs as well. My current dr said that he would not induce labor under any circumstances and doesn’t want me to go past 41 weeks. I think that’s wise and am agreeable to that. No HBP or GD this time either!! But I did hit the magic age of 35 at the end of April which immediately bumped my pregnancy into a high risk category. I’m currently 36 weeks (due July 9) and feel like a VBAC is the right option for me. But I have some family and friends that are concerned and I know I would benefit from their support. So if you have some information that could help me help them feel better about it, I’d appreciate it.

    Reply
    • Cheryl,

      Please check out KMom’s website on vbac after multiple cesareans. She has a lot of great information.

      Jen

      Reply
  5. I am strongly considering a VBAC. Everyone else is saying once a cesarean always a cesarean but I want to challenge my gynae next week when I see him for my appointment. My son did not engage at 39 weeks that was the reason for the first cesarean. I will be giving birth in October 2011. I am doing all the research that I can possibly do and I want to thank everyone for the wonderful support that you are giving us mothers who are considering a VBAC.

    My mom is a midwife and she says as long as this baby engage she does not see any reason why I wont be able to deliver vaginally.

    Thank you again and I will let you know how it went.

    Alverna

    Reply
  6. I really learnt a lot from your research. i had my first daughter vaginally, it was a long labour lasting 48 hours,i was induced ,she weighed 8.3lbs.
    my second daughters labour was different, her water broke, and i went to the hospital early, after 11 hours i was only 4 cm and the nurse said my baby had turned to a breech position. i had to have an emergency Caesarean .
    My third baby, had no problems, but the hospital wont let me have a VBAC, even though i changed hospitals. They all said the same thing, i eventually had to have an over medicated elective Caesarean, my son suffered a lot in the hospital. he was placed on i.v and was given so many injections that i knew nothing of. i eventually left the hospital after i realized they had read a false blood level on a faulty machine, and caused my little boy a lot of distress.
    Now am pregnant for my fourth child, i live in Nigeria, i do not know what kind of care i can recieve. we do not have an active midwifery organisation, and most hospitals would not allow a VBAC. Am secretly planning an home birth, your research gave me plenty comfort.

    Reply
  7. Hi,
    What is your definition of spontaneous labor? For example, my water broke, but I didn’t go into active labor right away and was given patocin, which allowed me to get to 9.5cm dilation with in hours. Would this still be considered spontaneous?

    My little man was face up and wouldn’t turn, at the end of the day we did c-section. At the time my doctor said I should be able to go natural in future births, but receiving all of the facts now, it doesn’t seem that way.

    Thanks for all your information. I feel so much more informed and able to discuss it better w/ my doctor and husband going forward.

    Thanks,
    Kari

    Reply
    • Hi Kari!

      I’m not a medical professional, but my understanding is that when your water breaks it can take several hours for contractions to start. How long a medical provider waits until they use pitocin, if at all, varies from practice to practice.

      When a labor starts spontaneously (without being induced), but then something like pitocin is administered, that is called augmenting a labor.

      Warmly,

      Jen

      Reply
  8. I was wondering about the statistic you mentioned at the top of your reply. “There is about a 0.4% risk of having a uterine rupture with one prior low transverse cesarean in a spontaneous labor (meaning you weren’t induced or given pitocin or other similar drugs during your labor) (Landon, 2004).”

    With my first delivery, I was determined to have a natural, no drugs birth but it ended up being the complete opposite. After 20 hrs of labor I was only 2 cm dilated, the baby hadn’t dropped and also about 10 hrs before delivery my water broke and there was meconium. I still wanted a natural birth so we waited as much as possible and I was even put on a drip to strengthen contractions. I remained at the same dilation and we had to have a cesarean. The baby was getting stressed and the heart rate was rising.

    So we did, I did ask my doc whether I could have a VBAC and he said if no complications in next birth yes.

    In your quote you say that the risk of rupture is 0.4% if there was no other intervention (so I guess if it was immediate emergency to get the baby out or selective Cesarean). Which means in my case the risk would be higher. Is that right?

    Reply
    • Hi Vanja,

      The 0.4% statistic is based on your VBAC labor starting spontaneously.

      Warmly,

      Jen

      Reply
  9. Isha-
    Interestingly enough, I am due only a couple days ahead of you. I am due on January 28th, 2011. I too am concerned about VBAC – but after reading Jen’s response, I quickly realized that in order for me to feel more confident, I just need to do more research. I am also going to attend one of the ICAN support groups in my area. I hope that you continue to take the steps you need to feel comfortable with your decision.

    Take care-
    Zsuzsi

    Reply

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Jen Kamel

Jen Kamel is the founder of VBAC Facts, an educational, training and consulting firm. As a nationally recognized VBAC strategist and consumer advocate, she has been invited to present Grand Rounds at hospitals, served as an expert witness in a legal proceeding, and has traveled the country educating hundreds of professionals and highly motivated parents. She speaks at national conferences and has worked as a legislative consultant in various states focusing on midwifery legislation and regulations. She has testified multiple times in front of the California Medical Board and legislative committees on the importance of VBAC access and is a board member for the California Association of Midwives.

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Free Report Reveals...

Parents pregnant after a cesarean face so much misinformation about VBAC. As a result, many who are good VBAC candidates are coerced into repeat cesareans. This free report provides quick clarity on 5 uterine rupture myths so you can tell fact from fiction and avoid the bait & switch.

VBAC Facts does not provide any medical advice and the information provided should not be so construed or used. Nothing provided by VBAC Facts is intended to replace the services of a qualified physician or midwife or to be a substitute for medical advice of a qualified physician or midwife. You should not rely on anything provided by VBAC Facts and you should consult a qualified health care professional in all matters relating to your health.