Thoughts on Birth: VBAC vs. C-section

I'm doing a lot more thinking about the birth. (FYI: This is going to be a LONG post and I've been writing and adding stuff to it for a while!) This is a huge place of anxiety and worry for me. I am so torn about the decision of what kind of birth to have and all the little decisions that go into that. Because Lila arrived by emergency c-section, it's my choice if I want to do a repeat c-section (RCS) or vaginal birth after c-section (VBAC). I'm apparently great candidate for VBAC because I went into labor on my own, got to 5 cm and because my c-section was due to cord and heart-rate issues and isn't something that should happen again with this baby.

Most people in my situation opt for a RCS and I don't blame them. If you've had a traumatic delivery experience where you were told your baby's life was in danger - a planned, calm surgical procedure sounds pretty good. It's not an easy choice by any means though, because even if your first c-section recovery (like mine) was fine, it's still surgery! A c-section means at least 2 nights in the hospital but likely 3 or more, longer recovery with restrictions on lifting, stair-climbing and driving, greater chances of complications for the mom during surgery (as compared to a vaginal birth), and some studies have shown more breathing and breastfeeding issues in newborns born via c-section. 

The concern with VBAC is uterine rupture. Because I have a scar on my uterus, there is a small chance that the scar could come apart during labor or really anytime during pregnancy which could be fatal for the baby. This is very scary but a rupture happens in only .6% - 1% of VBAC attempts. A smaller percentage of that percentage actually have a catastrophic outcome for baby or mom. 

I truly believe VBAC is the best choice for me and that is what I'm leaning toward now, even though I'm pretty sure I would have a perfectly fine c-section with an okay recovery. I am mainly concerned about the affect that a longer hospital stay and recovery would have on Lila and her adjustment to the baby. I also had a lot of difficulty nursing Lila in the first 3 months which might have been related her birth, but could also be due to other things. I really want to do everything I can to make breastfeeding easier this time around.

The other issue with a second c-section is that with each subsequent c-section the risks grow greater. So if I was planning on more babies, I should really think hard about doing another c-section because it would make my 3^rd birth a much riskier proposition. We are planning on this being my last pregnancy, so it doesn’t really play much into my decision.

So with all of that considered, I think I want to try to have a VBAC. Neil's biggest concern with me attempting the VBAC is that I will feel like a failure if I end up having to have a c-section anyway and that an emergency c-section will be a lot harder to recover from than a planned one. I think I'd be no more disappointed than I was last time. I actually think I'd be more disappointed if I didn’t try at all and just elected to have the surgery. Giving baby and me a chance at a vaginal birth is what I really want.

Earlier on in my pregnancy I was considering switching hospitals and doctors to increase my chances of successful VBAC. I sought out advice from the International Caesarean Awareness Network (ICAN) group here in Cincinnati, and many of those ladies encouraged me to look at a more supportive provider, specifically Dr. Daniel Bowen, and a potentially more VBAC-friendly hospital (Bethesda North).

In the end, I’ve decided that sticking with my original doctors and delivering at Mercy Fairfield will ease my anxiety about actually going into labor: Not driving to a different hospital, worrying about whether my solo practitioner doctor will make it to my birth, etc. I am sticking with what I know, and hopefully that works out okay! They seem very supportive of VBAC and I like knowing that if something bad does happen I'd have skilled doctors right there at the hospital.

Enter the next complication. My due date (40 weeks) is December 25. With Lila, I didn't have her until 9 days after my due date, or 41 weeks and 2 days. There is a good chance I will go "overdue" with this one as well, although usually not as long as the first time. Most of the OBs in my practice have been fine with letting me go 7-10 days over my due date. But they will not induce me if I go that long, I will just go in for a c-section. Induction can cause more stress on the uterus and is more likely to cause a rupture. I haven't asked about other non-chemical induction/augmentation like Foley catheter, membrane sweep or even low dose Pitocin. All of those I've read are the safest options for getting labor going in VBAC births.

Now, personally I'm fine with going over my due date and waiting until baby girl is ready to come out. I've done it before I can do it again. I'm not all that concerned with Christmas because Lila doesn't know any different and we can celebrate on any day. My parents will be around during the holidays anyway, so it will be fine if I go into labor during that time. The real issue is insurance and the costs of the birth. It’s pretty unfortunate that this has to be a consideration for us and what type of birth I will have.

If I go much past my due date, there is a chance that even if baby is born in 2013 that my hospital stay could extend into 2014. I’ve checked with my insurance company and if my birth and hospital stay spans into 2014 I will likely have to pay two out-of-pocket maximums. So instead of a $4000 cost for birth (which we have saved up for), we could be looking at $8000. I am already going to have to take 2 months unpaid leave to take off as much time as I want, and I’m afraid this cost will cause me to have to go back before baby and me are ready.

So “worst case” scenario, I go into labor on Dec 30, am not released until Jan 1, and have to pay two deductibles and two out of pocket max amounts. If I make it to Jan 1 without going into labor, no problem I just go overdue into 2014 and have the baby vaginally or end up with a RSC. But is it worth the financial risk to possibly go into labor between Dec 28-31? It’s not like it’s easy to keep a baby IN if it wants to get out, and vice versa.

I know this is SO much information, but it’s actually really helpful for me to type it all out instead of having all of it just spinning in my head.

So after thinking it through I think I will try some natural induction techniques (which probably won’t work) starting at 38 weeks. Nothing crazy, just staying active, lots of walking etc. As it gets closer to my due date I may try more drastic induction techniques and ask my doctor to sweep my membranes (which put me into labor last time) or if there is anything else they can do to augment my labor or induce.

I'm also looking into some other things that can make my labor better/easier/quicker, such as taking Evening Primrose Oil (EPO), drinking Red Raspberry Leaf Tea, doing Spinning Babies techniques for good positioning and possibly even Hypnobabies, chiropractic care or acupuncture which I've heard and read can help.

I think what I may have to do is schedule the c-section for Dec 27, which will likely have me out of the hospital by Dec 31, but hope to go into labor before then. I just don't think I want to risk it otherwise. Neil suggested complete bedrest from Dec 28-31 to try to not go into labor and try to make it until the new year. I don't think either of us are really comfortable with that idea. 

The decision is tough. Birth is unpredictable and scary, especially when you have had a traumatic birth in your past and a giant scar on your uterus. I know another c-section is not the end of the world, and as it gets closer and things change, I may even opt to do the RCS. But right now, I think I need to put my energy into having a successful vaginal birth if that is in the cards for me. It's MY decision and I am going to do my best to listen to myself and what I think is right for me and my family.