VBAC (vaginal birth after cesarean) or repeat elective cesarean section? That is the question. One that, to be quite honest, I’m sort of annoyed that I have to make that choice for my next birth. One that, had I had the knowledge I have now, the assertiveness, the willingness to speak up for myself and the knowledge that actually I have rights and options, I might not have had to make. My pregnancy with Evie was really relatively easy with no real issues apart from a higher BMI. I planned a home birth actually after changing my mind quite close to the last minute. I went overdue, I was booked in for an induction and I kind of felt well that was it. However, I was progressing in labour getting to 3cm and having regular contractions on my own. I was told to walk around a bit and try and break my waters. There’s only so many times you can walk around the same hospital though to be honest. I reckon, had my waters been broken for me, maybe things would have progressed on their own, if I hadn’t had the epidural I had I probably would have done it all myself and I wouldn’t be feeling this extreme guilt over not being able to do something my body is built to be able to do. I am now faced with another high risk pregnancy due to higher BMI and having had a previous c-section.
Even with the Syntocinon hormone drip and epidural, having my waters broken got me to 10cm between 1am and 7am. I tried pushing for two hours with unsupportive midwives who weren’t telling me when I should be pushing. I couldn’t really feel when I should push with the epidural. I was 21, tired and didn’t know what I was doing. I couldn’t respond to my bodies natural urges and I feel really let down like no one wanted to help. In fact I remember the midwives standing off to the side for most of the pushing until it got to 9am and I met an obstetrician who said let’s prep for surgery, try ventouse and then go with the c-section. I cried. I was scared. I felt I’d already failed. It was horrible to be honest. I have no fond memories of my birth and so now I am doing all I can, that is in my power to ensure I have a really positive birth. The birth I actually want to have, that to be honest I am craving.
I think this is why I really want to push for a VBAC and I have a lovely supportive Midwife who is happy with my choice. I just want to try. I want to feel it. I want to do things my way, something that was taken away from me last time. For starters, I am refusing induction this time around. I just don’t see the point really when I know that induction can include so many more medical interventions and the last thing I want is another emergency c-section. If I’m going to have the section I would rather have an elective. Now I know things might go beyond what I plan and having an emergency c-section for a different reason might happen but I really want to try and do everything I can to avoid that from happening.
What I want from a VBAC
I want the chance to feel labour. I want a chance to try. I want to be at home with my new baby and family as soon as it’s healthy for me to do so without spending a good few nights in hospital. I really want to try and have a more active labour rather than being restricted to lay on my back. I just want a positive birth experience really. Something that will make me appreciate all that I know my body is completely capable of doing so. Having a c-section was rough. I’ve dealt with many skin infections on the wound since. Movement was restricted. Breastfeeding was hard. I couldn’t walk right away without shakey legs. On the other hand, I have heard that having an elective is a much more positive experience and if my labour does go that way then I do feel more prepared for what’s to come after the c-section. I feel a lot more in control for this pregnancy including deciding on things I want to make my pregnancy easier.
To help make me informed I’ve read the VBAC book By AIMS which I really recommend as it gives you all the facts about both.
What are the benefits of VBAC?
Shorter recovery time and less time in hopsital
Greater chance of successful VBAC births in the future
Not having surgery
Less abdominal pain
VBAC: What are the risks?
I’m taking my information from Hampshire Hospitals VBAC leaflet (29/03/18)
Scar Weakening and Rupture – but it’s really rare. We’re talking 0.5% – 2% of all the women having VBAC births. This could then lead to another emergency c-section and happens in around 25% of VBAC births. However, there’s still a 70% chance that a woman having a VBAC will successfully have one. I think that’s a pretty good chance! Induction of labour can also increase this because the contractions can come on really strong and intense.
Risk of infection – around 1 in 100 women might need a blood transfusion or will have an infection.
The risks to your baby are, to be honest, incredibly similar to that if this was a regular vaginal birth. There’s nothing there that concerns me.
If you are planning a VBAC and get to 41 weeks without labour happening you will speak with your consultant and midwife and decide on the best course of action. Remember, this is up to you. Even at this point you are well within your rights to continue to wait for labour.
Elective C-Section: What are the risks?
A longer operation which is sometimes more difficult
Chance of blood clot which is very rare.
Longer recovery period and more time spent in hospital. Not ideal if you’ve got kids at home already.
Breathing problems in the baby – this is reduced by planning an elective at 39 weeks however, you can ask to plan an elective later if you want to. There is always a choice.
More chance of having another elective c-section in the future. This is the big thing for me as I’m not sure I am ready to stop at just two children.
Successful VBAC: Can I Increase My Chances?
Nothing is guaranteed but there are a few things you might want to talk to your midwife or doctor about to help increase your chance of a successful VBAC. The most important thing is you do what is best for you and that you make your birth a positive experience. This is your body, your birth and your baby. The best thing you can do is make yourself informed and discuss these choices openly with supportive healthcare providers.
- Hire A Doula – Having continuous support throughout pregnancy, labour and birth. It’s not always possible to see the same midwife throughout your pregnancy and because of this some women decide to hire a Doula. Whilst this can’t stop you needing medical intervention Doulas are there to support you and your choices. From a study in 2013 there were some really encouraging results that showed having a Doula was a positive choice. This included 12.5% having ended in a c-section as opposed to the national average of 25.5% – apparently, questions where limited and it was not always stressed if the section was elective or emergency. 26.3% of women opted for a home birth with Doula support as opposed to the 2.4% national rate. 22.5% more women initiated breastfeeding with 31.3% more women still feeding at six weeks. This for me is really encouraging when I only lasted 2 weeks of exclusive breastfeeding before being told I wasn’t good enough to do it. Epidural uptake was less than 15% compared to a 62.9% national average rate. You can read the full study here.
- Allowing time between pregnancies for your scar to fully heal. The risk of rupture is slightly smaller. The recommended wait time between births is 18 months. My scar will be around 8 years old by the time I’m full term.
- A consultant supportive of VBAC. If they are not, you can ask to be referred to one that is. It’s worth doing some research. Asking friends that have given birth at the same hospital or trust that may know the consultant. I asked a friend, the lovely Emma who had her beautiful son by VBAC under consultant care.
- Avoid induction. Some women decide to try VBAC but plan an elective c-section after 41 weeks to avoid this. I don’t want to be induced. I hated having so many drips and being stuck on my back.
- Arrange a birth reflections meeting so you can go over your previous birth. This can help you gain any closure, understand why your previous section happened and help plan your next birth effectively.
- Be in good health. Even with a high BMI, like myself, you can still have a healthy pregnancy without putting on lots of weight. Regular, gentle exercise and eating a balanced diet will help your body be in the best condition it can be for childbirth.
- Avoid an epidural if you can. Epidurals can increase the risk of further medical interventions. However, it is your choice, if you want one at that time then go for it!
- Get yourself informed. Read books, watch VBAC birth videos and read VBAC birth stories, speak to other mums that have had VBACS. Being informed will help you prepare for every situation and having a good birth plan that you are confident in will help make those choices easier.
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For more pregnancy content please head to my hub post which contains links to all my relevant pregnancy based blog posts. My second High Bmi Pregnancy.