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Re-Planning the Boy's Birth

So I had that whole post about how I was leaning towards trying for a repeat C-section over my original intention of trying for a Vaginal Birth After Caesarean (VBAC). I thank you all for the wonderful responses I received, and I want to especially thank Ruta who gave me some good research which was really helpful and sent me down the right path for looking into both sides of the choice. I'll just say upfront, that we are going back to the original plan of trying for a VBAC if I go into labor prior to my due date. In fact, we will schedule a C-section for 3 days after my due date just to give us a window for trying for the VBAC.

Because the thing about looking into and asking about the risks associated with a VBAC is that you learn the risks associated with a VBAC. If you don't also look into and ask about the risks associated with repeat C-sections, you won't learn the risks associated with those. (This article Time magazine did on repeat Caesareans was really interesting (and spoke in layman's terms), if you are interested in some history behind VBAC vs. repeat C-sections.) Now, I've actually been able to look into both, and I truly feel that the risks are comparable. Let me talk about some of them.

The risk of uterine rupture is not to be ignored when trying for a VBAC. However, my research has now made me pretty aware of what the signs would be, and I do think the doctors and nurses would be able to tell that something unusual is going on. The window for reaction, as Jan commented about, is not a long one. Apparently, this is why the American College of Obstetricians and Gynecologists (ACOG) changed their recommendation from having doctors and anesthesiologists "readily available" to "immediately available." Where I live and the hospital where I will labor and deliver has a doctor from my practice there 24/7 and anesthesiologists there round the clock as well. So they are immediately available, which should cut the risk down.

In addition, there is apparently no conclusive evidence that a larger baby makes the risk of a uterine rupture greater. Although there is evidence that inducing labor can make the risk greater.

The risk of a maternal infection is always higher with a C-section. Although I know stories on both sides of the infection from family members and close friends, the stats show that it's higher with C-section.

The risk of hysterectomy is the same with both. How about that? I never really thought about that risk as something with a vaginal birth, but apparently it is.

Um, that's all I've got off the top of my head (and my memory of a goldfish). But overall, I just feel that there are risks on either side and the risks mostly are comparable based on my eligibility for a VBAC, my going into labor naturally (not induced) and my general health.

So then, it boils down to choice.

Londo is a big planner and wants to minimize serious risks to me and the baby, as well as any discomfort to either of us. He does feel that a repeat C-section would do this. He also feels that the doctors we've talked to and the research he has done supports this. BUT he has said this whole time that it is my choice. I know he will support me in the thick of things even if he would prefer I deliver another way.

So then, it really boils down to MY choice.

It's not just the research that leads me to want to try a VBAC. It is partly what the birth advisor we met at the hospital said: For me, it's less about wanting to try to deliver vaginally than it is my not wanting to go through another C-section if possible. That's absolutely true. Sure, I think the experience of a vaginal birth would be pretty cool, as well as really hard and exhausting. The idea of having my baby right there immediately after birth is so appealing that I just melt thinking of it. Being able to fully experience what my body was built to do also sounds fulfilling to me.

But even more, if I have the opportunity to avoid major abdominal surgery, it's direct recovery, it's mid-term recovery and it's sucky long-term recovery... Well, I'd like to try to avoid it. I've been comparing it to if you had to have major knee surgery, but a couple years later the knee is acting up again. The doctor says that you could try physical therapy and there is a 60-80% that it will be successful, or you could go directly to major surgery again. I think that most people would opt to at least give the physical therapy a try, right?*

Finally, my gut, my instincts, that tell me to try for the VBAC. If it doesn't happen, at least I tried. But I really feel like it's the right thing to do for me.

So the final plan is back to the original plan. We will schedule a C-section for June 22, the day my primary OB is at the hospital. If we go into labor prior to then, we will try for a VBAC. All our family and friends are in on the plan and will move on a dime when we give them the word that I'm in labor, or we tell them that we're heading in on the 22nd for the planned C-section. Either way, we'll get that baby out and have a beautiful boy within the month. Yikes!!!

I doubt anyone read this whole post, but I think this post is more for me to get all these thoughts and feelings on the matter written out more than anything else. I haven't been able to write much lately, and I think it's because I've been holding all this in... Okay, that's not exactly true, because I've been talking about it a lot. But the writer in me needs to write it out. So there it is, and now hopefully I'll be able to write about all the cute Pumpkin things that are going on and how much fun I had at the DC area May meet up!

*I gave this example to my dad, who jokingly said just hop using the other knee. I responded, "Well, I've got only one uterus!" We laughed, but we have the same sense of humor.


HeatherY said…
I can't believe you are so close to having your little man! Yay! I think going with your gut is the best thing to do.
Trannyhead said…
I had a vaginal with my son, but due to his size it was a horrible experience. 3rd and 4th degree tearing, massive blood loss, a longer recovery time than for a C-Section. My son had to be vacuumed out, and I was in terrible pain (I won't even discuss my bathroom issues) for months. A year, probably. I had 4 epidurals, all of which failed.

Why do I tell you this? I don't want you to think the vaginal is necessarily easier or better. My OB thinks I should have a C this time due to the misery last time around. I'm 90% sure I'm going to do it. Anyway, the vaginal is not necessarily a walk in the park. Be prepared.
Ruta said…
Yay! It sounds like you've come to a decision based on the evidence available in the research, while also honoring your feelings and wishes... win on both accounts. :) Glad that article was useful. I think sometimes the risks of VBAC, while real, are over-stated, while the risks of c-section (particularly repeat c-sections) are minimized because OBs are essentially surgeons at heart and the c-section route provides the illusion of more control over the situation. They, of course, are not having to recover from the procedure while caring for a newborn and preschooler!
I hope your L&D experience goes smoothly and safely. Your little guy will be here soon! How exciting!!
ImpostorMom said…
I've thought about this very thing myself when and if we have a second. I'm almost positive that I'll have another c-section. Not so much because of the research but because several other reasons.

1. my recovery from my first c-section was a walk in the park. I know I have no guarantee of that the second time around but it really was much easier for me.

2. Labor SUCKED big time. Compared to my C-section recovery especially. I still haven't forgotten that so whatever hormones are supposed to kick in to make me forget that part just ain't workin' in my case.

3. I know someone personally that had the worst possible outcome from a VBAC and I have no desire to attempt it. She actually didn't tell this story to try and dissuade someone from trying actually, quite the opposite. However, that is the affect it has had on me.

My only reservations are that I almost feel like I would want labor to start naturally. I didn't have that with Boog and although there were no adverse outcomes I do sort of feel like I'd want the second baby to decide when he/she is ready. I still have time to think about these things seeing as we aren't even trying for another year or so.

Oh, ask your doc about Derma-bond to close the incision just in case you end up with the C. That's what I had. It's like glue. So no stitches, no staples, no bandage even. I swear it made all the difference in my recovery.

Good Luck!!!

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