VBAC-worth the pelvic changes?

[Anonymous]

"risky" is a misleading word -- everything has risks. it's a matter of each individual woman understanding those risks, weighing them, and making her own decision. when people come on here and say that "VBAC" is risky, i think it's misleading and unhelpful ... everything is risky, we all take risks when we give birth, and we all need to look into what those risks are and how likely they are, rather than just labeling one choice as risky and another as not risky.

[Anonymous]

i actually think it IS helpful for women to know that of the possibilities after a cesarean (successful VBAC, elective repeat cesarean, attempted VBAC ending in cesarean), the successful VBAC has the best outcomes. that way women who want a successful VBAC have some evidence-based support for their choice, and can focus on how to increase the chances of having a successful VBAC (for example by picking a provider who acknowledges that successful VBAC has the best outcomes and whose practices and protocols encourage VBAC success).

I know lots of mamas who had VBACs all with great outcomes. I think when we tend to focus on the rupture risk, we forget that almost 100% of the time, rupture does not occur.

[Anonymous]

worth reading on this topic:
http://birthingbeautifulideas.com/?cat=15

[Anonymous]

a friend of mine wrote what i think is a great blog post about the issue of pelvic floor damage and VBAC/cesarean. i'm sure it's not everyone's experience/perspective but as someone who has not had a cesarean i found it interesting.

http://thefeministbreeder.com/mominatrix-says-consider-yourself-lucky-you-c-section-bitches/

[Anonymous]

I had a VBAC and it is so different from c. Now about 1.5 years later, I can't tell you if one from a pain perspective was worse than the other.

My muscule went back, especially after I started to run.

[Anonymous]

Anonymous wrote: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.

Amen to this. The list of risks associated with repeat cesarean (as well as any future pregnancies that follow the cesarean) are many and well-documented. Unfortunately, most women simply think in terms of the risk of uterine rupture - without considering how rare that is, and the things which can be done in pregnancy and labor to avoid having a rupture at all. Doctors also tend to encourage repeat c/s and diminish the risks of this choice, simply because there is less liability for c/s than there is for vaginal birth - despite the fact that both options have unique and occasionally significant negative outcomes. Spontaneous labor and vaginal delivery are better for the baby. Why not try for a VBAC which will optimize your chances for success?

[Anonymous]

My reading of the NIH studies and other research was the ranking of risks for mothers and babies was the following: least risky was a trial of labor leading to a VBAC, followed by an elective repeat c-section, and most risky was a trial of labor that ends with a c-section.

The challenge for the medical profession and for women is then to try to determine whether a trial of labor can succeed or not. And there is not good research on this. But there is some evidence to suggest that spontaneous labor before 39 weeks with a baby under 9 pounds will more likely lead to a vaginal birth. As a pregnancy goes beyond full term, the likelihood of a trial of labor leading to a vbac decreases.

I am currently expecting my second and had a c-section with my first. For me a safe delivery is the most important and I do try to keep that into perspective. If I go into labor before my due date by myself, and am doing well otherwise, I will do a trial of labor and hope for the best. Between 39 and 41 weeks, I will talk to my OB about how things are doing. If my baby is in a good position, not measuring huge, and I am starting to dilate, I will wait and see what happens. If I do not deliver by 41 weeks, I will schedule a c-section. My OB agrees with this approach and expressed that she was happy to have a flexible discussion - she meets many women who absolutely want one approach or another - good candidates for a VBAC opting for an elective c-section and women that she has concerns about insisting on a VBAC.

[Anonymous]

Dear PP, I am in your position and the above may be the most sensible, measured, research-grounded approach I have read. Thank you.

[Anonymous]

There is a well-known study (don't have the citation, but you could probably google it) regarding pelvic floor and incontinence problems in elderly Catholic nuns. There is no scientific evidence that would support the claim that c-section is protective of pelvic floor muscles or that vaginal birth is a greater risk to later urinary incontinence. This was just one of those "obstetric myths" (as Henci Goer terms them) that a president of ACOG speculated about in public. Apparently, the greatest risk to pelvic floor muscle problems is episiotomy, which makes sense.