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.