VBAC after 2 c/s?

[Portia]

Hi,

Just wondering whether anyone has had a successful VBAC after 2 c/s? I have had two both due to IUGR - my OB wanted the babies out at 37 -38 weeks and we decided this was the best way to go. If we do decide to go for number 3 I would like to try for a VBAC but not sure what my chances would be. I obviously carry small babies so would this help my chances? Any advice or experience would be great. Also any tips on OB's who would give this a go - SE suburbs?

Thanks,

[Astrolady]

Hi Portia.

I have had IUGR babies and never had to have a c-sect for any of them. I was induced with 2 and went into labour naturally with my last born. How big were your 2 babies born ??

Love

[Portia]

Hi,

They were 2.5 and 2.4 kg.

[Berry]

I have had one natural birth (baby's weight 3.5kgs) and one c-section (baby's weight 1.174kgs). For my third I was given the choice of natural or c-section, but statistically it is without a doubt safer for the next baby to be delivered by c-section. So I have opted to have a c-section. My ob has told me that once I have had two c-sections, I will never be able to give birth naturally again (but would be fine to have further caesarians).
Don't mean to be cynical, sorry, but please make sure you get the statistics etc.

[Trish]

Portia, do your research hun. There is every reason possible for you to be able to birth your babies vaginally. You don't have to become a statistic, it is always your choice.

[Edensmumma]

My ob has told me that once I have had two c-sections, I will never be able to give birth naturally again (but would be fine to have further caesarians).
Don't mean to be cynical, sorry, but please make sure you get the statistics etc.

What statistics? From an Ob?
I believe there is every oppurtunity if you prepare and research for you to have a vaginal birth Portia. There are people out there with knowledge and experience that will help you if this is what you want...

[BellyBelly]

Your risks increase with each c/s but this jumps significantly after 4 (I am pretty sure it's 4), but I know someone who has had a VBA6C at Canberra hospital I think it was... if my Ob told me no VBA2C I would be changing Obs, because thats ridiculous. I have heaps of info/studies I will find it.

[BellyBelly]

Vaginal Birth Safe After Multiple Caesareans

Vaginal Delivery Can Be Safe After Multiple Cesareans

By David Douglas

NEW YORK (Reuters Health) Jul 11 - In women attempting vaginal birth after multiple previous cesarean deliveries, the risk of uterine rupture is no greater than in women who have had only one previous cesarean delivery, researchers report in the July issue of Obstetrics and Gynecology.

The author of an accompanying editorial, Dr. Vern L. Katz, from the Center for Genetics and Maternal-Fetal Medicine in Eugene, Oregon, told Reuters Health that this "is exactly the type of evaluation we need to help advise women on the relative safety and relative risks of both repeat cesarean delivery and trials of labor after cesarean. Each woman's situation is specific and advice should be individualized for those specifics."

In the study, Dr. Mark B. Landon of Ohio State University College of Medicine and Public Health, Columbus, and colleagues prospectively examined data for women attempting vaginal birth after a single or multiple cesareans.

Uterine rupture occurred in 9 of 975 women who had had multiple prior cesareans (0.9%) and in 115 of 16,915 women with a single previous cesarean (0.7%), a nonsignificant difference.

However, the rates of hysterectomy were significantly increased in the multiple cesarean group (0.6% versus 0.2%), as were transfusion rates (3.2% versus 1.6%).

Similarly, a composite of maternal morbidity, including endometritis and operative injury, was significantly increased in women who had had multiple cesareans.

Despite this increased risk of complications, the absolute risk is small, the researchers conclude, and "vaginal birth after multiple cesarean deliveries should remain an option."

Dr. Katz added that there is a "shifting paradigm of cesarean, not as an adverse outcome -- a complication -- but as one tool towards achieving the goal of a healthy mother and baby."

"Thus," he concluded, "the studies that we need, like Mark Landon's, help provide guidelines in the best use of the tool."

Obstet Gynecol 2006;108:2-3,12-20.

[BellyBelly]

From another study

The rate of placenta accreta ranged from 0.24% in first-time c-section patients to 6.74% in women with six or more c-sections. In women with previa, the rates were much higher, ranging from 3% in first-time c-section patients to 67% in women with at least five c-sections.

The hysterectomy rate was lowest in second-time c-section patients and highest in those with at least six c-sections, ranging from 0.42% to 8.99%.

"Women planning large families should consider the risks of repeat cesarean deliveries when contemplating elective cesarean delivery or attempted vaginal birth after cesarean delivery," the authors conclude.

Obstet Gynecol 2006.

[BellyBelly]

I also strongly encourage you to read this article: VBAC - On Whose Terms?

Despite evidence supporting the safety and desirability of VBAC (vaginal birth after caesarean), mothers who have undergone one or more caesarean sections are frequently led to believe that VBAC is a risky choice that may well turn out to be hazardous, especially for the baby. This impression is further emphasized by ‘hospital policies,’ which dictate the ‘management’ of women who are in labour following a previous caesarean section.

[Berry]

What statistics? From an Ob?
I believe there is every oppurtunity if you prepare and research for you to have a vaginal birth Portia. There are people out there with knowledge and experience that will help you if this is what you want...

I agree its always an option to have a vaginal birth after c-section, but it has to be managed very carefully, especially if there had been more than one c-section. My ob advised me that attempting VBAC after one c-section would present a small risk of the previous c-section scar rupturing, and should this happen the outcome could be catastrophic, ie baby dies and hysterectomy needed. I did lots of reading to check what she had told me and various sources seemed to indicate about a 1% chance of the scar rupturing. On the other hand, having a c-section would present the usual surgical risks to me as a mother but would be the safer option for the baby. My ob is FANTASTIC, extremely thorough and professional and she did offer me every opportunity to have a VBAC and discussed all the ways she would ensure the outcome would be safe, particularly by ensuring that labour would not go beyond 4 hours. I was worried that, as my vaginal birth involved a very long labour over a day needing arificial induction to get things moving, that I wouldn't be a good candidate for VBAC. So it was my decision completely, not my ob's - she gave me impartial info and didn't encourage me in either direction but supported my decision.

So this is my long-winded way of saying consider your own circumstances and if you do go VBAC then make sure you have a fantastic ob who can manage it safely and put safeguards in place to make sure nothing goes wrong.

I am not against VBAC at all and can understand why people would prefer it, but not me.

So hope my views aren't offensive as they are just my own....

[BellyBelly]

Not offensive at all Berry - we all need to factor in our own circumstances. I just get concerned about medical professionals making outrageous statements which others may read and believe to be gospel in every case, I like to respond so people know it's not the only way for everyone iykwim? Just to get a balanced view.

[Edensmumma]

yeh sorry Berry- my post may have seemed a little abrupt... the bad thing about not hearing my voice- sorry.
I just get cranky sometimes when woman think one c-section, always a c- section...
I guess too i was trying to encourage Portia...
Like Kelly said- many women know the ob's side of the story and not the other way round.

[BellyBelly]

And it's important to remember, first births can typically be long and drawn out, and many women are in less than ideal birthing environments which hinder labour, so they often slow and stall. Second labours are quicker the vast majority of the time, and with induction also comes risk of rupture, which can also happen with a c/s, along with increased risk of hysterectomy and many other things, so if you are planning a large family experts recommend you consider mode of birth.

[bailey99]

Thats interesting Kelly. Can I just ask, does anyonr know if the amount of time passed since your last c-section matters when trying for a vba2c? Just that I was exploring this a little while ago, and couldn't find any info on that. I had my 2nd cesarean in November and will have this baby in Jan 2008 so it's not alot of time between for healing.
Thanks

[Alan]

Hi Bailey
As far as I know the length of time makes no difference. As Kelly pointed out the chances of your scar rupturing for VBAC1 is 0.7% after VBAC2 it raises to 0.9%. The same percentages also apply to CS. So don't be fooled into thinking that a CS is necessarily the safer option.

[bailey99]

Thanks Alan, It really gives me something to think about. Not sure if I am brave enough to do it, but I have a few months to research it anyway. Thanks again.

[Julie Doula]

Bailey and Portia, if you haven't already seen it, this is pretty inspiring: a montage from a woman who had a homebirth after THREE ceasarians, earlier this year , in USA. Get tissues ready!

Birth Montage General Discussion #1

(it's the first one)

You can do it, I trust all the confidence, knowledge and support you'll need will come to you. You can do it.