Disclaimer: I never intended to publish this post, I wrote it to help sort out my feelings; however, in doing so, I realized there are so many women making this very same decision. I felt it was important to share. The opinions expressed in this post are a reflection of my experience, no judgements!
If you have never had a c-section you probably have never heard the terms RCS or VBAC. However, I seem to be spending my days obsessing over these two things. You see, I am faced with a massive decision, one that I am really quite mad about. Should I schedule a repeat c-section (RCS) or go for a VBAC (vaginal birth after Cesarean )? In many ways I feel like I am here because of my actions. With my first pregnancy I pushed to be induced. My doctor definitely played a role in my decision by instilling a lack of confidence suggesting my “tiny body” would not be able to deliver a baby who was expected to be “pretty big” considering I had gestational diabetes. I so wanted to have a vaginal delivery, I thought early induction would actually help me to stay on track with my goals for labor and delivery. Turns out, I was very wrong.
Being induced actually heightens your chances for c-sections, significantly heightens. Yet, in my mind, induction sounded like a perfect scenario; I could plan the day my son would be born, my mom could book a plane ticket in advance to be there for the delivery and help us afterwards, and there would be no surprises. Well, we ended up with one huge surprise, an emergency c-section after only 20 minutes of pushing.
Was it my fault there were fetal decelerations? No. Was it my fault my doctor did not help me make an informed decision? No. Did my body fail me? No. I know all of these things were out of my control, but I still feel sad about the way in which my son was born. Now that I have had a c-section, I have 2 options for this delivery. Both of these options are complicated, carry risk, and contain their own set of pros and cons. I am feeling incredibly torn, scared and frustrated.
Here are some of the factors I need to consider…
Before I became pregnant with my second I was more than confident I would have a VBAC delivery. Now, at 20 weeks in, it is time to fully commit to this plan and I am just not ready to. Since VBAC is still considered “controversial” there are few providers who actually perform them in my area. I am lucky to have been working with a VBAC provider since I found out I was pregnant; however, he does not have extensive experience in VBAC deliveries and does not have an established VBAC reputation. Not only do I feel a lack of confidence in him, I have a lack of confidence at the hospital where he delivers.
For the past few weeks, I have been working with a doula who has been helping mothers with their deliveries for many years and has focused her efforts in helping VBAC moms achieve their goals. My doula has given me names of a few additional doctors who regularly perform VBACs, and whom she has worked with in the past; however, these doctors are at hospitals over 45 minutes from where I live. Plus, switching doctors mid-pregnancy is not an ideal scenario.
If I am going to have a VBAC I want to be in the best hands. Should an emergency occur (like the scar opening up, or uterine rupture) I want to be at a hospital best equipped to handle these emergencies. Yes, while rare, those are some of the risks of VBAC, and if they happen I could require an emergency hysterectomy, a blood transfusion, and there could be injury to the baby. While all of this sounds scary, the same risks are associated with c-sections and repeat c-sections. Without going into numbers and statistics, from all I have read, I feel VBAC is only slightly “riskier” than a c-section. But, nonetheless, the risks for both are very real and very scary.
Going back to hospital location. If I chose to switch providers and deliver at the hospital located over 45 minutes from our home, I worry about my son. My husband will need to be in and out of the hospital to help care for him, and having a long distance to travel really complicates things. Then there is this big question, what if I go into labor during rush hour? What if there is a bad accident? In those cases, it could take us close to 2 hours to get to the hospital, is that a safe decision?
Again, in considering my son, a VBAC has a shorter hospital stay and shorter recovery time, which means I can get back home and be with him sooner. The recovery from my first c-section was quite long and painful. I can’t imagine going through that while having a toddler and a newborn who need me.
Is my desire to have a vaginal birth selfish? Looking back on the birth of my son, the most difficult part was seeing him for literally 1 minute and then being left alone in a recovery room for over 4 hours. I want that skin to skin contact, I want to breastfeed immediately. This is likely my last pregnancy and I want to experience my water breaking spontaneously, I want to really feel what labor is (as crazy as that sounds). I feel like my body is made to do this.
As you can see this is a heavy decision, one I have no idea how to make. I feel like I spend my days considering all my options, and still end up confused. Just today I read an article stating that the way in which my uterus was sutured has been linked to increased risk of uterine rupture, and another article stating most studies on this topic are inconclusive. There are countless articles for either side and reassuring stories of hope and inspiration. I know I need to follow my instincts and do what I feel is best and safest, considering all factors. I am hoping to make my final decision by the end of March, wish me luck!
If you are considering your options here are some helpful websites: