VBAC-worth the pelvic changes?

[Anonymous]

I had a C-section last year because I had a breech baby and am now pregnant again. My doctor says I have a great chance at a successful VBAC. I'm just vacillating between the longer recovery time of a C-section and having my pelvic floor muscles all stretched out with a vaginal birth. One part of me thinks that I already have to deal with the side effects of my C-section (scar, little pooch) so why take on the side effects of a vaginal birth and have both negatives. Any advice? How much does your pelvic floor/vagina really change (sorry if too detailed a question)?

[Anonymous]

Pregnancy does more damage to those muscles than birth. The penis expands and contracts, the vagina is meant to do the same to accommodate a child. I am NOT stretched out.

[Anonymous]

[Anonymous]

The pelvic floor refers to the support system suspending the uterus, vaginal wall, and bladder. My bladder and vaginal wall rest lower than before I had children. My vagina protrudes a little were the vaginal wall has "sagged". I have had 3 vaginal deliveries. It doesn't hurt or cause me problems with sex or urination but I guess could worsen and lead to incontinence in the future. It can be caused by vaginal birth, pregnancy, menopause, or all of these put together. I don't regret having a vaginal delivery though.

[Anonymous]

I think the health and tone of your pelvic floor has more to do with *how* you deliver than with a simple VBAC/no VBAC decision. When you push, how you push and in what position -- those things will make the difference.

[Anonymous]

There are many factors which contribute to pelvic floor health. Weight gain, poor nutrition, poor exercise, multiple pregnancies, breastfeeding, menopause, abdominal surgery, how you actually push the baby out, whether or not you get an episiotomy or large tear, sexual activity, etc. etc. The list really goes on and on. I don't think any one of these things alone is going to determine how strong your pelvic floor is. I think the first thing you need to do is determine whether or not you want to try for a vaginal birth, and then maybe afterwards implement some things to help keep it strong.

[Anonymous]

have you thought about what might be best for the baby too?
VBAC vs Csec is not only about you.

[Anonymous]

Interesting what we worry about. Had a VBAC and this was something I didn't even consider. I can only speak to my experience, but I didn't have these problems. Original c-section was for the same reason as you, baby was breech. Had an epidural with the VBAC but had a relatively easy delivery. A little tearing but did my daily soak and recovery was quick. Toddler DS could climb all over me and no worries about him injuring my scar and no worries about climbing up and down ours stairs. Am pregnant with #3 and am hoping to go vaginally again.

Good luck with whatever you decide.

[Anonymous]

i haven't had a cesarean so can't compare, but have had 2 vaginal births and don't feel that my pelvic muscles are stretched out at all. both times i've felt them gradually strengthen back to normal.

for a good comprehensive discussion of the risks/benefits of repeat cesarean and VBAC i'd recommend the recent NIH report on VBAC.
http://consensus.nih.gov/2010/vbacstatement.htm

good luck!

[Anonymous]

I have had 2 csections. I have to say that I am happy to not have to deal with any of the issues some of my friends have.

Personally, I decided that the risk of VBAC was not worth it. I knew the risk was so small, but for me that was still too much.

Recovery sucks, but I am healthy and have a healthy baby. Can't ask for too much more.

[Anonymous]

It's interesting to me that everyone talks about the risks of VBAC (i assume this means uterine rupture?) but doesn't mention that the risks associated with repeat cesarean are often more serious and more likely than the risk of a rupture with VBAC. i understand it is each person's choice to decide which risks they are willing to live with, but i feel like all the focus on rupture risk is misleading, as if VBAC = risky/rupture, and repeat cesarean = not risky. that report someone posted up there from the NIH shows that that is just not the case, and that repeat cesarean has some very significant risks that someone seem to never make it into the conversation.

[Anonymous]

It seems to me, from the limited research I've done (which included reading the latest NIH report) that the risk to the baby is higher in a VBAC, as opposed to the risk in a ERCD. Similarly, the risk a mother faces in a ERCD is less catastrophic than the risk faced by the baby in a VBAC.

Am I way off base?

I'm 15 weeks and still trying to decide.

[Anonymous]

my understanding (after attending the NIH conference where that report was developed, and also reading it) is that the risk to the baby and mother overall is the smallest with a successful VBAC.

[Anonymous]

Anonymous wrote:my understanding (after attending the NIH conference where that report was developed, and also reading it) is that the risk to the baby and mother overall is the smallest with a successful VBAC.

Insightful post, there, PP. Of course a SUCCESSFUL birth has the smallest risk. It's the ones that are not succesful that are the issue. Unsuccessful VBAC w/ uterine rupture - I'd say that's risky.

[Anonymous]

i don't see what's wrong with pointing out that successful VBAC has better outcomes than planned repeat cesarean.

unsuccessful VBAC with uterine rupture is very unlikely. i understand that for some women, any risk of that happening is too high, but i also think it is important for women to think of the risks of repeat cesarean, even elective ones, because they are significant as outlined in the NIH report.

Anonymous wrote:

Anonymous wrote:my understanding (after attending the NIH conference where that report was developed, and also reading it) is that the risk to the baby and mother overall is the smallest with a successful VBAC.

Insightful post, there, PP. Of course a SUCCESSFUL birth has the smallest risk. It's the ones that are not succesful that are the issue. Unsuccessful VBAC w/ uterine rupture - I'd say that's risky.