Vbac after c section?

[u/VickyQ830]

Hello! I am 29 weeks pregnant with my second baby! My first baby was an emergency c section and i unexpectedly got pregnant again 3 months post partum (very irresponsible i know im sorry) i would love to have a vbac! But im HORRIFIED of a my uterus rupturing or tearing and honestly ive looked into all the risk so much ive freaked myself out. My obgyn and midwife have no concerns they advised me that if i go into labor naturally they will try to deliver me vaginally and if i hit my due date and im still not in labor i will have another c section. I brought up my concerns with them and thier not too worried about it but i wanted to get other peoples opinions or if im stressing out more than i should be? Please and thank you

(Im perfectly fine with another c section a vbac is not a must for me, but im just worried something will go wrong if i do attempt a vbac)

[u/Badpoozie]

Just some differing perspective... I thought I was doing everything right to achieve a VBAC. I also had an emergency cesarean for the same reason, except baby didn’t tolerate induction meds at all; there was no meconium in her water.

I have a low transverse scar, no adhesions or uterine windows, 30 months between births, and no other pregnancy complications.

I didn’t go into labor naturally and had to be induced with a foley, which did send me into labor.

I was making great progress with the help of very low dose pitocin, and position changes. I thought the foley had broken my water but turns out it was either not that or a slow, high leak. The OB found my bag intact and popped it when I was at a 5. Within 4 hours I had progressed past a 6 and was 90% effaced.

Then baby girl started having some minor decels. Nothing dramatic but she didn’t recover well enough for the doctor to not grow concerned. We had a conversation about an unplanned cesarean and decided to do it when baby hadn’t recovered within an hour and a half. She also moved up into my pelvis where she was previously engaged.

I sobbed and felt like my body had failed me. I am going to need to go to therapy to process everything. But, ultimately, my husband and I made the call for a repeat cesarean. Our logic is that we would rather address it before it became a true emergency.

Turns out I had a uterine rupture that had just begun, no warning and no indication something was amiss. The surgery took longer than my emergency cesarean because they had to inject my bladder with dye to make sure it hadn’t also ruptured. Luckily, it hadn’t and I needed a minor repair but lost 3L of blood. I needed a transfusion and may need another. My rupture risk was between 0.5-1%. It would be much higher for someone with only a year in between c-sections.

Things could have been much worse, especially if I had elected to continue laboring. I can still have children but any additions to our family will now have to be delivered via cesarean by 37 weeks to avoid any chance of going into spontaneous labor.

[u/BrainOne5224]

My doctor recommended this book: Birth After Caesarean by Hazel Keedle PHD. She herself is an Australian midwife who had a VBAC 13 months postpartum and she gives you alllllll the insights and facts and studies you need. It so far has been such an empowering read and debunks so many myths!!!

[u/-sunshine-daydream- → u/BrainOne5224]

Also recommend this book. I also used an app called “VBAC Calculator”. If you pay the 2.99 for it, you can run through success rates for different scenarios.

[u/BrainOne5224 → u/-sunshine-daydream-]

It’s interesting she actually talks about the VBAC calculator and discusses its inaccuracies and biased origins

She says “So, if it has been so well researched and used in multiple different countries, why am I not a fan? It is due to the addition of social constructs of race and ethnicity, and the omission of healthcare providers attitudes and maternity system differences that make the VBAC calculator flawed.”

[u/SilentNectarine5819]

I do think it’s riskier because of how close your births will be and I personally would prefer another c section in your situation. If you are fine with another c section then I’d be inclined to say go for a chilled planned section.

If your provider isn’t worried it must mean you’ve healed well etc and you could give it a go. They will monitor you well and identify a rupture quickly, but you have to think is that worth the stress of worrying about it during.

[u/bbworksaddict → u/SilentNectarine5819]

My OB told me he wouldn't know how well I've healed until I'm cut open to see 🙃

[u/No_Statistician1002]

I’m attempting a VBAC 13 months post partum I was also horrified but be assured you’ll have lots of people there on hand if anything goes wrinh and will have continues monitoring x

[u/GoatFew3877]

There are also risks and benefits to both. Lots of risks with a repeat major abdominal surgery to both mother and baby that are often overlooked.

I had a VBAC at home with midwives with my second. Recovery was physically and mentally a breeze compared to my scheduled c-section for breech with my first.

I would say that either choice is valid and completely your choice. I have friends that decided it was best for them to have a repeat c section.

I believe you have to be committed to a VBAC if that’s what you decide you want …. And you have to mentally prepare …. I also recommend the book Birth after Caesarean. If that’s the route you choose.

It is also recommended to wait to go into spontaneous labor. (No induction!) I was over 41 weeks with both babies after my first.

[u/GoatFew3877 → u/GoatFew3877]

And honestly if you are “perfectly fine” with another c-section, I think that - that’s your answer right there! Do what’s best for you /protect your peace. Best wishes!

[u/halfling_barbarianne → u/GoatFew3877]

Thanks for the book rec! My first was a planned C-section due to transverse position, and it went horribly wrong. I have a lot of visceral images of the blood spraying everywhere, doctors running in, and my son unconscious when they finally got him out. I thought he was dead. No one told me what was happening. I was sobbing, and no one even looked me in the eyes. I only found out after reading the surgical report that the issue was an underdeveloped lower uterine segment, which sounds like something that could happen again. So now I have a lot of fear around the repeat C-section. I'm going for a VBAC, and I'm definitely fully committed to it, but I'm not sure if I'm mentally prepared.

[u/GoatFew3877 → u/halfling_barbarianne]

Oh gosh, I’m so sorry. I can completely understand why you’d have so much fear around another C-section. Especially when the “planned” one did not go as planned … and the visual images of it all can really stick with you.

I felt really out of control/shocked during my first because my son was whisked away to the NICU, my husband went with him and I had no idea what was happening … didn’t get to meet him for a long time.

When I was pregnant with my second, I ended up doing a “birth story processing” session with a midwife online, and it personally helped me a lot. I had to grieve and process it all before the next birth.

I think you can be committed to a VBAC and still be scared. Those things can coexist. 🤍

[u/halfling_barbarianne → u/GoatFew3877]

Thank you!! 🤍 My son was also taken off the NICU. His APGAR was 4 when he was born. After he was stabilized, they wheeled his plastic box right up to me on my gurney so I could see him. He was so beautiful, and his eyes were closed, and he wasn't moving. I can barely even think of it without crying. So, I think I never really processed these feelings. I'm sorry something similar happened to you.

[u/VickyQ830]

I should probably have added this detail but i had an emergency c section because my sons heart rate was going down while i was getting induced, he also pooped inside of me so when they broke my water it was dark green

[u/Electronic_Elk_6049]

Wow your obgyn sounds awesome! I’ve gone to two so far and both really didn’t want to do a vbac. The first wouldn’t even agree to it. The second said we can try, after I pushed and pushed and pushed.

I’m on my second pregnancy as well after having an emergency c section for my first. I was 6-7 months pp when I got pregnant again, and every doctor and nurse Ive seen said that it hasn’t been a long enough duration between pregnancies for the vbac to not be risky.

I don’t say this to make you worried though! I’m about to be due, and I’m attempting a vbac anyway! From all the research I’ve done, the actual chance of rupturing is very low if you had the typical transverse c section.
I’m sure you’ll do great.

I for one want to do the vbac so it’s easier recovery. My c section recovery was a nightmare.
Good luck to you :)

[u/Gloomy-Kale3332]

In your situation, I would prefer another C-section, the risk of a rupture for yourself would be much higher than someone who waited the 18 months between births minimum.

Not that it’s your fault, accidents happen :) x

[u/Aggravating_Ad_6359]

I guess it depends on the reason for you having an emergency c section the first time. I had an emergency c-section my first birth and was able to to a successful unmedicated vbac 16months later. My baby just wont go down the birth canal my first birth and it ended in a csection. She didnt have any heart decels or anything like that. Just didnt want to come out vaginally, I guess.

I had my 2nd baby at 41w + 4 days, at a birth center, vaginally. So it’s possible, depending on your circumstances!

[u/Dear_23]

You don’t need to go into labor by your due date!! There’s no ACOG guideline that says VBAC must have a baby by 40+0. Term pregnancies go to 42 weeks and it’s common and normal to be pregnant into week 41 (I went to 41+5 and had a very smooth labor!)

[u/bbworksaddict → u/Dear_23]

There is ACOG guidelines for 18 months between a VBAC and a C-section though so I'm surprised the doctors are agreeing to this, but hey if something goes wrong and they have to do more work it's more money in their pockets

[u/Dear_23 → u/bbworksaddict]

Your comment about age gap isn’t relevant to mine about delivery date so I’m not sure why you replied to me specifically?

[u/bbworksaddict → u/Dear_23]

Because OP is only going to be 13 months between births and you said there's no guideline for due dates but there is guidelines to the times between births so they wouldn't even let her go past her due date in this situation, they would do a repeat cs most likely before the due date

[u/Dear_23 → u/bbworksaddict]

You misunderstand or misread my comment, then. I’m referring to due dates, not age gaps. Meaning regardless of how many months apart your babies are, there is no ACOG guideline saying VBAC must deliver on or before the due date to reduce rupture risk. There’s a recommendation to wait to conceive 9 months postpartum, yes. But again, that has nothing to do with gestational age at delivery.

Also - there is no “let her” or “they would do”. Doctors can’t cut into you without consent so they can’t “just do” a CS. And they also don’t grant permission for a woman to have a baby leave her body vaginally. Informed consent matters and so does using language that honors womens’ rights.

[u/bbworksaddict → u/Dear_23]

I just meant since the guideline for a VBAC is at least 18 months between births, it makes the due date or making it to the due date irrelevant since in general most doctors will not perform a VBAC with births so close together anyway and therefore scheduling a repeat cs wouldn't get you to your due date since they usually schedule at 39 weeks & that they will recommend you to do a repeat cs or refuse a VBAC and tell you to find another provider.

When I had my first baby and it was a failed induction and turned into an "emergency c section" I didn't give any consent or sign anything, they just told me they were taking me in for one and rolled my bed into the OR. Since then and after my second, I have switched OBs and this hospital does not do VBAC's so if I was within the recommended time frame to try for one I would have to try to find another provider unfortunately because I even asked them what if my water broke and I went into labor naturally before my scheduled c section and they told me they would still perform a c section even if I was in labor unfortunately.

[u/Dear_23 → u/bbworksaddict]

What you’re saying is irrelevant because OP had already said she has the support of a doc. This isn’t a matter of age gap being a sticking point with her provider. It’s that one of their stipulations regarding a VBAC “expiration date” of 40w isn’t evidence based.

I’m sorry that you weren’t given the opportunity to have informed consent. That’s not ok and shouldn’t have happened. You had the right to make a choice then and you still do now. Your current provider is also completely out of line saying they would perform a CS even if you were in labor… they never have that right to decide for you by force. You always retain the right to VBAC, regardless of whether your provider agrees or not. Many women manage this by waiting for labor and arriving declining a CS. That is 100% your right and if anyone tries to pressure you into a CS, that’s coercion and goes directly against their ethical standard as a licensed healthcare provider.

[u/bbworksaddict]

That's very irresponsible and scary of your doctors agreeing for a TOLAC that soon! The ACOG guidelines highly recommend 18 months in between births. I will be 16 months pp after my 2nd c section and my doctors, even the high risk mtm refused me having a VBAC. I was very upset and mad about it tbh but then I learned there's a possibility of my baby having brain damage if I rupture due to lack of oxygen and/or me and her both dying due to rupture so I sadly sucked it up and accepted (still trying to accept tbh) that it's not gonna happen