VBACs (Vaginal Birth After Cesarean)
Q. I had my first daughter in September 2002. Two days before my due date, I went for a checkup and my blood pressure was high and I had some protein in my urine. The doctors decided to perform a C-section. I was a little shocked at the outcome to not even try to deliver vaginally, but my daughter and I turned out fine. I became pregnant again last April and informed the doctors that I desperately wanted to try for a vaginal birth. I am now about 32 weeks pregnant and the doctors recently told me I am measuring "large" and if I continue they will give me a sonogram one week before my due date to determine the baby’s size. They said at that point they will probably try to talk me into a C-section. Isn’t a vaginal birth better for everyone around? Why are the doctors so eager to do C-sections? I am not scared of a C-section itself– it’s the recovery that is the killer, especially with a 16-month old child. I am very frustrated but want to do the right thing. Should I switch doctors at this late date?
-Mary, New York
A. It sounds as if your doctor decided to do your first C-section because of the protein in your urine. High levels of protein could be related to toxemia and they probably wanted to get the baby out ASAP.
As far as your second pregnancy, twenty years ago, having a Cesarean automatically meant that all succeeding births would be done the same way. Today's doctors have learned that this doesn't have to be the case, nor is it always most beneficial. But, if you do have a C the first time, your chances for having another do increase.
I, too, had a C-section with my first child and was desperate to have a V-back the next time. During labor with my second child when my doctor was urging me to get the C-section, I considered, just for a moment, telling him that another C would be anti-climactic for my book. Did he really want to be the cause of my publishing downfall?
But seriously, if you can do it without risk to the baby, I would recommend the vaginal birth over a C-section. It is usually less pain and for a shorter period of time. Not only that, but you are right about the recovery– what a difference!
I'm not here to doctor-bash, but you should be aware that some obstetricians are more scalpel-happy than others. Believe it or not, there are doctors who would rather be on the golf course than doing overtime to deliver your baby vaginally. Nervy, huh?!
It may be wise to ask your doctor the rate of Cesareans in his or her practice. The World Health Organization (WHO) states that no region in the world is justified in having a Cesarean rate greater than 10 to 15 percent.
If you find that the practice has a large number of C-sections or your doctor is unwilling to discuss a plan for a V-back, then yes, you may want to consider changing doctors.
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Q. During my first pregnancy I gained 40 lbs., was a week late, and had an almost 10lb. baby boy via C-section. I am petite and my husband is six feet tall and 280lbs. Everyone said my son's weight was due to what I ate while I was pregnant. Is this true? I am now 19 weeks pregnant with my second child and my husband and I are afraid that this baby will be just as big, if not bigger. We want a vaginal birth this time but fear I will need to have another C-section.
-Anonymous, New York
A. There are a lot of factors that play a role in whether or not you are a candidate for a C-section. (See the other C-section question for more details.) Weight gain is one of them. Unless you are extremely tiny, a 40lb. weight gain is not excessive, so I don't think "what you ate" has anything to do with the reason you had a Cesarean the first time around.
I, too, had a C-section the first time and wanted to try for the V-back the next time. In my opinion, the vag birth is much better all around than the C-birth. Less pain, shorter recovery, better experience. I recommend it if you can deliver vaginally without posing any danger to you or the baby.
Q. I just found out that I am five weeks pregnant with my second child. I had a C-section delivery with my son only seven months ago. Will my scar be strong enough to hold up to a VBAC or should I go for the C-section again?
A. It's amazing how quickly the human body can repair itself. By the time you are ready for delivery, your scar will be over 15 months old. Having given birth both ways, I recommend going for the VBAC (Vaginal Birth After Cesarean) if you can. For me, it was a much better experience all around—I experienced less pain and for a shorter period of time, and after giving birth I was much more coherent and able to hold my baby right away.
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Q. I am currently pregnant with my third baby and would like to know if it is possible to have a vaginal birth after having two Cesareans.
A. Of course it's possible, but your chances of achieving a VBAC (Vaginal Birth After Cesarean) depend on many factors particular to your medical history. (See the other VBAC questions for more details.) You should discuss your desire to have a VBAC with your OB/GYN now to determine if this is a viable plan for you.
Q. On your site I noticed that you had a big baby the first time and had a VBAC the second time. I am pregnant with my third child. I had my first child delivered vaginally and my second child was an emergency C-section after 36 hours of induced labor and two hours of pushing. My second child was 9lbs. 4oz. and 21 inches long. Given that I am only 5'2” and usually 115lbs., I can see why I couldn't push the little fatty out. My doctor said that I HAVE to have a scheduled C now. With both my other boys I did not go into labor on my own. What do you think? Should I fight to have a VBAC or should I just give in and realize it is just not in my cards to have another vaginal birth?
-Jennifer, New York
A. Certain conditions should be met to achieve a VBAC. Here are a few that apply to your situation:
- Your baby should not be too big. Since your last baby was over 9lbs., your chances for having another large baby are very high.
- You should go into labor without being induced. Again, since you were induced with both of your prior pregnancies, the chances for that happening again are very high. If you are induced, you are more at risk for your former C-section scar opening.
I have to agree with your doctor on this one. The only way you can safely have a VBAC is if you have a very small baby and you go into labor on your own and early. You can always hope, but in the meantime I think you should plan for a C-section.
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Q. I am 36 years old, healthy and pregnant with my third child. My first two were born C-section because they were both breech. From the beginning of this pregnancy I told my doctor that I wanted to have a VBAC. He said it would be determined by the baby's position and weight. My first two were just over 6lbs. I'm now 36 weeks and my doctor just told me he no longer recommends that I try the VBAC due to the risk of uterine rupture. The baby is still under 7lbs. and head-down. He told me it was my decision. I don't want another C-section. I've done some reading and I'm having a hard time finding anything about a VBAC after two C-sections. Is the risk too high? I know if this was my second child and not my third I would be able to do the VBAC with very low risk of a uterine rupture. I want to do the right thing for both me and the baby.
A. I've been unable to find any information stating that more than one Cesarean birth increases the risk of the former scar rupturing during a VBAC any more than a one time C-birth. There's a possibility that the risk factor may increase slightly, but that should not deter you from having a VBAC if you feel strongly about having one. If other factors come into play, such as non-productive labor, excessive growth of the baby, the umbilical cord around the neck or fetal distress, I'm confident your doctor will try his best to convince you to have a C-section. Barring any complications, the decision is yours. Do what you feel comfortable with. I think the mother (being you) knows what's best.