Planned c-section vs. vbac - what would you do?

[Anonymous]

I am expecting my second child in a couple of months. I had my first one via a last minute c section, so for this one, I have a choice of trying VBAC or going with a planned c-section. I would like to give birth vaginally through VBAC but I am afraid that my chance of succeeding could be low. I have talked to my OB about my options, but wanted to get some thoughts from others.

I am in my late 20's, healthy both pregnancies without any complications. I have super small frame - 5'9" pre-pregnancy weight of 110lbs. I have a very small hip too (wears size 0). I went into my first labor naturally without induction (a day before my due date), and I progressed (dilated) fairly quickly without any problems. First contraction to labor was about 11 hrs. I did have epidural around 4-5cm and a boost once my water broke (I probably shouldn't have gotten that boost). I still progressed to 10cm quickly with no issue. Comes the time for pushing, I didn't have much sensation and was unsure if I am pushing correctly, although nurse/ob tells me I am doing it right. Pushing for 2.5 hours, I was not making much progress (I could see the tip of his head going in and out, but never made to crowning) at which point OB gives me an option to push further or going with csec. I chose c-section. My first one was 7.5lbs but with a large head 14.5 inches (around 80th percentile I believe).

My OB says I can try VBAC or scehdule a repeate c section, but estimates my chance of succeeding at around 10% given my last birth, also given the fact that the second one is likely to be bigger. Both my babies are boys. I did heal pretty well and fast from my c-section last time, so I am not worried too much about recovery/trauma, although I hear repeated c-section has higher risk.

I would love to experience vaginal delivery, but I am afraid that I am working with a very low chance of succeeding. Personally 10% sounds like way too low for me. If I go VBAC route, I would probably wait for the natural contractions (not getting induced) and get less epidural. I am not sure if I can go through without any pain med It's hard to know if the way my first labor went was because I got epidural or because my pelvis was too small for my baby's head size. My OB thinks it is the latter, but he could be biased because he is the one who suggested the c-section. It's been a difficult decision to make up my mind on what to do.

I am delivering in Inova Fairfax, which I am aware is not VBAC friendly. I LOVE my OB, and he is supportive of VBAC and suggests to me that I dont need to schedule a c-section and we can play it by ear, but of course he has nothing against csection either. He said he is fine to wait until that I go into labor to do csec either but I havent discussed with him how long he is willing to let me go. I would hate to switch provider because of this reason, but willing to hire a doula - I've heard a doula say on this forum that she's worked with my OB and he was very supportive of natural birth in that instance.

What would you do if you were me? Any kind of insight/thoughts would be appreciated!!!

[Anonymous]

Personally, I would try for a VBAC, hire a doula, and possibly transfer care to a different provider. I would also consider taking a childbirth class or home study that focused on self-empowerment.

Hey, you asked.

[Anonymous]

What did your OB say about the risks of a VBAC? My first boy got stuck and was only 7lbs. Needed a vacuum to get him out, and I had a lot of tearing. Second was a scheduled c....thank god bc he was nearly ten pounds (at 40 weeks). I would ask the OB to explain the risks of both options and go from there.

[Anonymous]

I made my decision based on whether or not I wanted a third child. Wanted to keep my options open, so I went for the VBAC. Successful too!

Maybe you could try to go for a vaginal delivery, but tell yourself after 1 hr of pushing, if no process is being made, then go for the c/s.

[Anonymous]

Fwiw, I had three c-sections without any complications, as did a number of my friends and relatives. Talk to your OB about your situation. Don't assume from the PP that a second section would prevent you from having another.

[Anonymous]

OP here!

Thank you for all your responses!!! I did not have a chance to talk to OB about VBAC seriously yet but I plan to next week during my next appointment. When I discussed in passing before, he did not see higher risk inVBAC vs. Repeat c section for me - just thought that I might have a big head stuck in small pelvis again. But now with more research I am more informed, so need to ask him again.

I think would want more kids but not more than three total. OB sees no issue with me having three c sections. That I already confirmed with him. He did explain to me with each one I have higher risk but said would be marginal for me.

My priority is a healthy baby of course! I am not married to no drug birth but if that had something to so with my previous labor ending with c section I will attempt to avoid it.

Do you think changing the provider and hospital is critical in outcome? If I go VBAC route I would hire a doula I think. I am hesitant to switch OB bc I love him!! I know he is and excellent diagnostician and surgeon and will take care of my baby.

[Anonymous]

I would absolutely have a scheduled c-section if I trusted my OB and he said you only have a 10 percent chance of a successful VBAC.

Why would you take the option with the bigger risk?

I can't even imagine leaving an OB mid-pregnancy for something like this. Not if you like him and he's an excellent diagnostician and surgeon. Who knows who you will get next? And I wouldn't switch from your hospital either.

Like PP, I had three easy, successful c-sections. The first one was an emergency c-section. Now I have three happy, healthy children.

[Anonymous]

Ask your OB that question. If you prefer a VBAC, then ask your OB if he feels constrained by any hospital policies. And please report back.

Fwiw, there's not a lot anyone can do about your small pelvis. I was in the same boat (I'm the pp whose first one got stuck and needed to be sucked out....not fun). Then I had three scheduled sections after that.

[Anonymous]

Personally, I would likely go with the planned c-section. I ended up with one for my first and likely will do so with my second.

If you decide to go VBAC, your doctor sounds wonderful and balanced and very supportive. I would stick with him and hire a doula.

[Anonymous]

personally, I would scrap thinking about all of that and just schedule the c-section and forget about it.

[Anonymous]

OP here again!

Yes once I have the convo with the OB I will report back! I will have to ask about 10% chance that he suggested again. When I used the online "VBAC success rate calculators" based on age, height, weight and others I get greater than 70% chance. But my OB knows my specific circumstances. I know I'd I have repeat c section I will be ok. But I will always wonder if I could have given birth vaginally. Just something that is important to me personally... I feel that i havent done my 100% with my first. As long as it is not riskier than repeat cs based on OB opinion, I feel like I should try...

I will also ask about how he feels about the general perception that FFX is not VBAC friendly etc! He seems to have excellent reviews per this board as well so I would be interested in his take!

[Anonymous]

Since you have a desire for a vaginal birth, i would make the commitment to go that route now and give it everything I've got because once you're in the VBA2C situation, it's a lot more difficult to find a supportive provider and the risks are higher.

It sounds like you click well with your OB on a personality level but he doesn't sound like a VBAC expert, to be honest. 10% based on the baby not being out after 2.5 hours of pushing? I don't think that's fair - the pelvis is much more flexible after the first child, you were a FTM and pushing for 2+ hours is within the realm of normal, and there are things you can do to try to not have a bigger baby next time (similar diet to the GD one).

I'd say find a practice with the highest VBAC success rate in your area. Fairfax is not the place to deliver for a VBAC. VHC is supposedly the most VBAC friendly place in NoVA but I didn't find them to be very natural friendly. Personally, I'd make the commute to GW.

[Anonymous]

I'd ask the OB how he came up with 10%. Sounds like he just pulled that out of thin air. There is that VBAC success calculator, not that I would rely heavily on that, but if that thing is saying 70% based on a reasonable study, what is your OB basing his calculations on? I'd definitely try for a VBAC if my chances were 70%.

[Anonymous]

Have you asked him what percentage of moms with prior cesareans attempt VBAC with his practice and what percentage of those have a VBAC? If very few women are attempting or having VBAC id consider switching providers. If he doesn't see or facilitate VBAC often, how much confidence can you have in his estimate of your likelihood of success? VBAC rates among hospitals and providers vary widely, because the protocols providers apply in attempted VBACs vary widely...so success rate may depend more on your providers skill level with VBAC than on your pelvis. A provider who wants to do a cesarean at 40 weeks if you havent gone into labor yet will have a much different VBAC rate than a provider open to continuing to 42 weeks. As a doula I've had clients told by one provider that their chance for VBAC succes is very low, but when they talk to or switch to a provider who specializes in VBAC they're given a much better chance and are often successful in having a VBAC. I second the above recommendation for GW. I'd also ask your doctor how he came up with the 10% figure. There are so many variables that go into each birth that figures like this seem so arbitrary. This baby could be a different size or in a different position, you could get epidural later and/or retain more sensation, you could try different pushing positions....there are many things that could increase your chance of a vaginal birth this time. I think the number one factor that will influence your chance of success is choosing a provider with a high VBAC rate. If you stay with your current provider it seems likely that you'll end up with another cesarean -- they don't seem to have confidence that it could happen or skills to facilitate it.

[Anonymous]

I assume if you had an epidural you were pushing on your back? Or were other positions tried? Other positions can open up the pelvis more and allow more effective pushing, as I understand it.
I don't know. It sounds to me like you want to try for the vbac. And yet most of the circumstances surrounding the birth (same doc, who would be going into this expecting it would not work, epidural that may limit feeling/mobility,etc).

I think you'd have greater chance of vbac if you switched to a provider who was enthusiastic and who had ideas about how to change things to make chances of success greater. Even just having a provider who was expecting a vbac to work might make it more of a self fulfilling prophesy.
I had a doc that I liked personally but I left her because I did not think her mode of care was going to optimize my chances of avoiding stuff I did not want. I know it's hard. Maybe call and see another provider or two to see what they say and their ideas for how to approach things, before you make a decision to switch.....that's what I did and I was glad I did because I did end up switching and was very happy. Tho the conversation 'breaking up' with my doc was hard, I reminded myself that docs have tons of patients and probably didn't care as much as I did....good luck!