VBAC or Repeat C-Section?

I am slightly in denial that my daughter is turning one year old in a short 4 days. Has time really passed this fast?

While pregnant with Daphne, I spent my time studying and researching all sorts of information concerning birthing methods, parenting tips, and logistics of coming home with a screaming baby human.

I remember afternoons and evenings where I would walk outside and walk (and yes, even jog) laps around the quarter mile track my husband mowed for me. I remember walking with my diving knife and my binder of birthing affirmations. The diving knife was for my own safety, of course. Who knows what kind of beasts might have jumped out at me from the woods!

I would walk in circles and listen to my favorite calming music to get myself in the right frame of mind for labor and delivery. I would read the affirmations aloud and with each passing step, my resolve to have a non-medicated vaginal birth was solidified.

I just knew in my heart that I could do it. I could have a great birthing experience.

The ladies at the Charleston Birth Place were a major part of my holistic frame of mind; I knew that with the support of my husband and local birth center, I could achieve a great natural birth.

My birth story was quite different than I had expected. You can read about it here.

This past year has afforded many opportunities for reflection. I often think back to my birth experience and am filled with torn feelings.

I remember feeling empowered while I was in the birthing pool and bearing down with each contraction in the water. I remember the unending support my husband gave me.

I remember the disconnected frustration I felt lying in that hospital bed after we were transferred from the birth center. I remember feeling so upset and confused. I rhetorically asked myself “Why did this turn out this way? Is everything going to be okay?”

I had not planned to give birth to my daughter by cesarean section. I hadn’t intended on having to delay breastfeeding and skin to skin time. I look back and mourn those little things. I wonder what difference those things would have made had I been given them.

Just as the past in unalterable, so the future is flexible.

Sam and I have discussed our desire for a large family since having Daphne. We have debated about baby names and thought about what it would be like to go through the process of pregnancy and delivery again.

In late July of this year, I found out I was pregnant. While visiting family and friends in Kansas in mid August, I miscarried.  My reaction to miscarriage, upon reflection, was a bit distant and cold. Perhaps the pregnancy was too early for me to become attached. All the same, my heart has been wrenched with that experience and it gives me power to reach others who have experienced the same thing.

Three months have passed since my miscarriage. Our desire for more children has not waned.

I remember when we we visited my doctor for the first time with my second pregnancy that the nurse asked if I was going to attempt a VBAC (Vaginal Birth After Cesarean). My mind was made up to have a repeat c-section. She neither clapped nor booed; she supported my decision either way.

I look forward to the moment Sam and I find out we are pregnant again. I look forward to actually being pregnant again, holding a newborn in my hand, and rocking that baby while singing my favorite songs. I feel phantom flutters in my belly that remind me of my pregnancy with Daphne and the feeling of her kicking me. I see newborns out in public with their tired but proud mommas and smile, thinking “You’ve been blessed. Cherish each moment, each hour they keep you up during the night, each time they look up into your eyes, each moment you share bonding while feeding. Remember that this is temporary and you’ve got an awesome little human. Smile, momma!” 

With thoughts fresh in my mind of desiring another baby, my first instinct is to jump to this question: “How in the heck is this second baby gonna get out of my body?”

Each mom with whom I come in contact has a different birth story. Some have had only c-sections, others a mix of vaginal and c-section, and others with one to three vaginal births in a row. No formula fits every woman. There is no blanket statement that tells expecting mothers what decisions should be the right ones.

I have had a c-section. What next?

Why am I scared of both options for delivery of a second baby?

Another c-section would mean another 3-5 days in the hospital, delayed breastfeeding and skin to skin time with baby, and the 1-2 month recovery time of slow moving/non-laughing and coughing/avoiding hunching over.

But… c-section is what I know. I like knowing what’s ahead.

I know the feeling of the shin squishers to keep clots in my legs at bay. I know the feeling of the catheter, the spinal block, the shave, and being rolled down the hall to the operating room.

I know the light blue glare of the overhead lights and the bustle of doctors and nurses in the surgery room.

I know the feeling of my arms outstretched and my upper body covered with warm blankets while the blue protection screen is put up to shield my eyes from the surgery and to shield the doctor’s eyes from mine.

A c-section is familiar. I know what to expect. I know what to expect in recovery.

Soft foods. Trouble tooting and the overpowering joy of being able to poop for the first time after surgery. Walking the halls and pretending there is a board up my back to strengthen my core as I heal.

While I know what to expect with a c-section, I am unsure of a vaginal birth.

 

Is it a matter of fear or convenience? 

 

As I sort through my feelings regarding my delivery options, I ask myself if this is a matter of fear or of convenience.

Am I rejecting the thought of a vbac because of legitimate reasons or because I am scared of something that may have a slight chance of happening? Am I gravitating more towards a repeat c-section because it is what I know and in my mind I am making it more convenient than a vaginal birth? Some could argue the issue of comfort in recovery from a vaginal birth versus a c-section.

You don’t know what it’s like unless you’ve gone through it. People can try to explain it to you, but you’ll never really know.

I fear not being able to progress in my labor just as I did with my first labor. I labored for 12 hours with gradual dilation and was pushing to break my waters. I retracted and my dilation closed a few centimeters.

I fear laboring and experiencing complications with delivering vaginally: uterine rupture, lack of dilation, that sort of thing.

Accoridng to Medscape, the chance of a uterine rupture is 1 out of 1,146 (.07% of total pregnancies).

Similarily, VBACfacts.com  lists important information regarding length of gestation and induction techniques.

The following information is regarding gestation length and uterine rupture. 

Coassolo (2005) is a nice sized study including over 11,000 women that concluded: uterine rupture was “not significantly increased… beyond estimated due date.”

6,907 labors before 40 weeks:
– 29% of those labors were induced/augmented
– 1% rupture rate

4,680 labors greater than or equal to 40 weeks:
– 33% of those labors were induced/augmented
– 1.1% rupture rate

1,643 labors greater than or equal to 41 weeks:
– No info on the % induced or augmented
– 1.5% rupture rate

In addition, VBACfacts.com lists this information regarding induction vs non induction.

Zelop (2001) is a smaller study, but it reported rupture rates for non-induced/augmented labors versus induced labors. Zelop found that uterine rupture “does not increase substantially after 40 weeks but is increased with induction of labor.”

Non-induced/augmented labors:
1,214 labors 37-40 weeks: 0.5%
1,001 labors greater than 40 weeks: 1%

Induced labors:
290 labors 37 – 40 weeks: 2.1%
270 labors greater than 40 weeks: 2.6%

While Zelop is great because it gives us the rate of non-induced/augmented rupture, Coassolo has the strength of numbers. The rate of rupture Zelop reports for its induced labors is likely not incredibly accurate as we have less than 300 labors in each group.

I discuss uterine rupture (complete separation and opening) as opposed to a uterine dehiscence (not a complete opening and separation). VBACfacts.com offers a good contrast article here as well. 
I spend a bit of time collecting this information as a way to understand and sort through my feelings on the choice of VBAC. I’m fearful of an event that is not heavily chanced on happening.

My own selfish reasons for not wanting a vbac include an intact cervix and vaginal area (no tearing or stretching).

Is it a matter of vanity or a necessary sacrifice?

There’s also the issue of body image.

If I’ve learned anything about myself in this year of having Daphne in my life, it is this: I want more children.

More children = more pregnancies (God willing) which of course means more deliveries. I’ve heard of women having upwards of 8 c-sections safely. I also wonder what health concerns those women maintain. I wonder also how those women view their postpartum bodies.

In the big picture of things, children cause a women to sacrifice many things including some aspects of body shape and image. I’ve noticed my body is not the same shape as it was before becoming pregnant and giving birth to Daphne. 

Is it worth it? A thousand times YES.

My body is aging. I am dying. We all are. I can take care of myself by working out, eating right, staying hydrated, and maintaining a positive perspective on life.

There is plenty of time to decide how our next baby should be delivered (God willing that we get pregnant again). More time to research and devote to reflection.

 

 

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