VBA2C - Have now been told the hospital I am having my anti-natal wont support me!!!

Please I need some help in getting any and all information I can to help support my decision to have a VBA2C. I will try and give as much relevant information as I can and the information as to why the dr's at the hospital I have been going to say why they will not support me in trying for a VBA2C. xx Please bear with me!!! xxx

I come from a small country town on the border of NSW/Vic. I am currently 27+2 weeks pregnant! As soon as I found out I was pregnant I straight away wanted to have a VBAC. So my husband and I started reading information about risks etc. I rang the hospital where I gave birth via "elective" CS to my daughter, (I wanted to have a VBAC with my daughter, however the Ob told me that the risk of uterine rupture was too risky, especially as my daughter was going to be at least 9 pounds minimum!! She was born 6 pounds 5 ounces!!!!! And I regret not doing my homework and insisting on seeing another dr who was pro VBAC!!) and a couple of local dr's and asked if there was someone who was a supporter of VBA2C. I was told straight away that as I have had 2 CS I will have to have another CS.

So I began looking at other hospitals that were in the "local area", the closet being 30 minutes away the furtherest nearly 2 hours. I found that 2 of the hospitals told me that I would be supported in my decision. One of them being the 30 mins away hospital and the other the 2 hours. Of course I chose the closet one.

So I have been going for my anti-natal check-ups to the hospital for the past 10 weeks only to be told by the dr during my first registrar appointment that they are not going to support me in my wanting a VBAC, telling me again that the risk of uterine tearing is too high. One of the doctors said that I have a 1 in 20 chance of dying if I decide to proceed with my trial of labour. Mind you I have had my 2 children at different hospitals and they havent seen my surgical reports to know whether there is notes about the strength of my uterine wall. They have asked me to get the notes faxed to them from the other hospitals.

My question is (to anyone that can help me find out statistics and facts), what is the risk of uterine tearing after 2 CS? The dr today wouldnt give me a statistic but would only keep telling me that she is just trying to keep me alive by suggesting a CS. The only real statistic I could find was a US study that out of 3 million VBAC, 1580 mothers died due to complications after having (or during) a VABC attempt. Thats makes the percentage 0.07%. Does it being a US study make a difference. I cant find any Australian studies or percentages. And yet when I asked the dr to back his statement of the 1 in 20 chance of dying with evidence he couldnt.

Just so that you have all the information about me that I think would help in seeing the full picture, I will give you a little info about my previous pregnancies etc.....
My first birth was emergency CS due to "failure to progress", I hate that phrase. I dilated 3 cm's in total, 2 by myself at home and 1 after being induced and connect up to oxytocin for 12 hours. I was in labour for a total of 48 hours before they decided to give me a CS due to my sin's heart rate dropping.

My second was "elective" CS as I touched on previously, but do regret not pushing for a VBAC or seeing another more supportive Dr.

All 3 of my pregnancies have been complication free and other then having a high BMI, put so nicely by the Dr today. I have had no problems throughout any of them. In actual fact with this pregnancy I lost 10 kilos in the first 13 weeks and my weight has not changed since. My BP is never far from 110/70. The baby's heart beat has always been very strong and both my previous children scored apgar scores of 10/10 and 8/10.

I feel that having a VBA2C is the best option for myself and my baby, however they are starting to scare me a little and yet in saying that I dont want my decision to be based on scare tactics. I am the kind of person who understands facts and has little belief in someone who cant back it up!! I am also one listen to a mother's opinion due to her experience over a dr who admits to me that they enjoy and prefer to perform CS over a natural birth!!!

I have been booked in to see the anesthetist on Friday so he can discuss the dangers of an emergency CS with me due to my BMI, more scare tactics???? And the dr today booked me into a GP (my first visit) as well on Friday (I dont have a regular GP) but now Im wondering if she is going to tell him to try and convince me to have a CS as well!?!??!!

I just need someone to either give me hard evidence of the success rate of VBA2C or to point me in the right direction to finding it so I can go into these appointments with facts and not be persuaded into something that is not necessarily the best and only option!!! Thank you for reading my long winded story and any help you could give me would honestly be greatly appreciated!!! thanks in advance xxxx

How are you going leisha?i can't believe no one replies to this. It must have been missed! Have you had your baby yet? If so I hope you got the birth you wanted

Sorry that i missed this post earlier on too! Not sure where you're at or whether you've had the baby yet??
I'm planning on a VBA2C at the moment and live about an hour north of Melb. The first hospital that was meant to have a good rep for supporting VBAC's, weren't too supportive of VBA2C, so I then rang about 8 or 9 private obs (a lot of receptionists told me I'd HAVE to have a repeat C/S). I did find a lovely obs who is supportive and the back up obs that she works with, also support it (all women, of course!). PM me if you haven't had bubs yet, as I've got some research articles that I can send you. I hope you've managed to locate somebody who will support (or has supported) your birth wishes. The stats from the Dr were pretty impressive indeed! No wonder he couldn't back it up with any research.

Leisha would be around 34 weeks pregnant now. Hope she comes back.

Leisha, there are care providers who support VBA2C and we have members on here who've successfully achieved this. You may have to ask around to find one in your area.

The risks of uterine rupture are not high. I'd encourage you to read Vaginal Birth after Caesarean by Wendy Savage and Helen Churchill - it breaks down the risks from different studies in an easy to read manner. Your chances of a successful vaginal birth without incident are much better than the chance of anything going wrong!

GL and let us know how you're going.

Leisha,

I found this study on the US national Liabrary of Medicine website.

It is an interresting read. Especially the finding that hysterectomy rate for a 3rd CS is higher than the hysterectomy rate for vba2c.


Vaginal birth after two caesarean sections (VBAC-2)-a systematic review with meta-analysis of success rate and adverse outcomes of VBAC-2 versus VBAC-1 and repeat (third) caesarean sections.
Tahseen S, Griffiths M.
Abstract

BACKGROUND:

Trial of vaginal birth after Caesarean (VBAC) is considered acceptable after one caesarean section (CS), however, women wishing to have trial after two CS are generally not allowed or counselled appropriately of efficacy and complications.

OBJECTIVE:

To perform a systematic review of literature on success rate of vaginal birth after two caesarean sections (VBAC-2) and associated adverse maternal and fetal outcomes; and compare with commonly accepted VBAC-1 and the alternative option of repeat third CS (RCS).

SEARCH STRATEGY:

We searched MEDLINE, EMBASE, CINAHL, Cochrane Library, Current Controlled Trials, HMIC Database, Grey Literature Databases (SIGLE, Biomed Central), using search terms Caesarean section, caesarian, C*rean, C*rian, and MeSH headings 'Vaginal birth after caesarean section', combined with second search string two, twice, second, multiple.

SELECTION CRITERIA:

No randomised studies were available, case series or cohort studies were assessed for quality (STROBE), 20/23 available studies included.

DATA COLLECTION AND ANALYSIS:

Two independent reviewers selected studies and abstracted and tabulated data and pooled estimates were obtained on success rate, uterine rupture and other adverse maternal and fetal outcomes. Meta-analyses were performed using RevMan-5 to compare VBAC-1 versus VBAC-2 and VBAC-2 versus RCS.

MAIN RESULTS:

VBAC-2 success rate was 71.1%, uterine rupture rate 1.36%, hysterectomy rate 0.55%, blood transfusion 2.01%, neonatal unit admission rate 7.78% and perinatal asphyxial injury/death 0.09%. VBAC-2 versus VBAC-1 success rates were 4064/5666 (71.1%) versus 38 814/50 685 (76.5%) (P < 0.001); associated uterine rupture rate 1.59% versus 0.72% (P < 0.001) and hysterectomy rates were 0.56% versus 0.19% (P = 0.001) respectively. Comparing VBAC-2 versus RCS, the hysterectomy rates were 0.40% versus 0.63% (P = 0.63), transfusion 1.68% versus 1.67% (P = 0.86) and febrile morbidity 6.03% versus 6.39%, respectively (P = 0.27). Maternal morbidity of VBAC-2 was comparable to RCS. Neonatal morbidity data were too limited to draw valid conclusions, however, no significant differences were indicated in VBAC-2, VBAC-1 and RCS groups in NNU admission rates and asphyxial injury/neonatal death rates (Mantel-Haenszel).

CONCLUSIONS:

Women requesting for a trial of vaginal delivery after two caesarean sections should be counselled appropriately considering available data of success rate 71.1%, uterine rupture rate 1.36% and of a comparative maternal morbidity with repeat CS option.