VBAC risks

Of course the main risk everyone hears about is the risk of uterine rupture. This is what most doctors bring attention to, unfortunately sometimes too much. Yes, this is a real and serious risk but as I have said before the risk is less than 1%. Since I want us all to be informed this is an important topic to discuss.

So what is uterine rupture anyways? There are different degrees of rupture. The least likely is a complete rupture. A complete uterine rupture is a tear through the full thickness of the uterine wall, usually at the sight of the previous c-section scar. A minor rupture is also known as a dehiscence or window. This is when the opening is very small or does not go through all the layers of the uterus.

If this occurs it is serious and potentially, though rarely, life threatening to the mother or the baby and needs to be taken care of right away. The rupture can take place during labor or even before. A rupture can also happen in women who have never had a previous c-section.

Usually there are warning signs before a rupture occurs but not always. Some warning signs include: vaginal bleeding; sharp pain between contractions; contractions that slow down, become less intense, or stop; abdominal or uterine pain; bulging under the pubic bone; sharp pain at sight of scar; low blood pressure; fetal distress; fundus may feel "boggy" or seem to be expanding; the baby can be clearly felt in the abdomen; woman in shock; extreme maternal heart beat.

Some of these warning signs occur anyways during birth but it is something to pay attention to and to be aware of. Also women might experience some, all, or none of these warning signs.

Though rare it can be serious and cause minor to major complications. When medical response is quick usually mother and baby do well. It is wise to have surgery available within 30 min for the best outcomes. In minor dehiscences there is usually no risk to the mother or the baby. For ruptures, they can happen in the lower segment of the uterus, the upper segment or where the two join. A rupture in the upper segment is the rarest but also the most serious because the baby could leave the uterus and move into the abdominal cavity and it has the most blood supply so the mother would lose the most blood and the baby would be deprived of oxygen. More likely the rupture would be in the lower segment where the baby still stays in the uterus and the mother loses less blood. Both of these would require an emergency c-section.

Fortunately if a rupture occurs mother and baby are usually fine. If a rupture occurs with excessive bleeding a clamp of an artery is needed and in some serious cases the woman might need a hysterectomy. In extreme cases when the bleeding can't be stopped a woman can go into cardiac arrest and death can occur. For the baby due to loss of oxygen brain damage can occur along with the rare risk of death.

Remember there are risks in any birth, c-section or vaginal. Although rare, death and serious complications can also happen during any birth. I found a website that put it all in perspective for me. The website is http://www.birthrites.org/uterinerupt.html. Here are some statistics from that site.
Risk of mother dying due to uterine rupture during VBAC---.0095%
Risk of mother dying in any vaginal birth---.0098%
Risk of mother dying during c-section---.0409%
Risk of mother dying during repeat c-section---.0184%
Risk of baby dying due to rupture during VBAC---.095%
Risk of baby dying during any VBAC---.2%
Risk of baby dying during any type of birth---.12%

So as you can see the likelihood of a fatal outcome of a uterine rupture is no higher than in any normal birth and actually a lot less than in c-sections. This is important to realize in case your doctor or anyone else stresses on the risks of uterine rupture in VBACs.

***Most of this info was taken from http://www.birthrites.org/uterinerupt.html

http://www.obgyn.net/displayarticle.asp?page=/pb/articles/uterine_scar_rup

http://www.drspock.com/article/0,1510,5926,00.html

Why not just schedule a C-section?

I realize this is a very personal choice and there are risks with both but after doing my research and learning about how there are more risks with a c-section I personally would never just schedule one. I explained before too that the only way for me to know if I could do it was to try.

Most women will be successful with the VBAC---80%. Even though my midwives never used a scoring system with me, I read that some doctors use a scoring system to try to figure out the likelihood of the patient ending up with a vaginal birth. The scoring goes from 0 (least likely) to 10 (most likely). This might be helpful but again I would be careful because of course it isn't always correct. Just because a doctor gives you a low likelihood score does not mean you can't succeed. The studies found that half the group that scored 0-2 still were able to have a VBAC.

So if the high success rate doesn't encourage you to try for a VBAC instead of just scheduling surgery there are a lot of other reasons I personally would not want a repeat c-section. Here is what the research shows:

• There are increased physical problems for mothers: Compared to a vaginal birth, c-sections have increased risks for many physical problems from mild to severe. These problems include hemorrhage (severe bleeding), need for transfusion, blood clots, injury to other organs, bowel obstruction (due to scarring and adhesions from the surgery), anesthesia complications, scar tissue, longer-lasting and more severe pain, infection, increased risk of hysterectomy, psychological complications and maternal mortality 2-4x greater than vaginal birth.
  
• Longer Hospital stays: Usually women need to stay longer in the hospital after a c-section and takes a lot longer to recover as well.
  
• More expensive: C-sections cost a lot more even with having insurance. Average cost is twice the amount of a vaginal birth.
  
• Issues with emotional well-being: I already mentioned how this can take a toll on your overall mental health and how after a c-section women are more likely to experience depression and even post traumatic disorder. She is also more likely to rate a birth experience poorer than a woman who has had a vaginal birth.
• Mother-baby relationship: You usually don't get the chance to hold your baby until quite a while after surgery as compared to usually immediately after a vaginal birth. Even though I never experienced this many women have a harder time bonding with their baby.
  
• Breastfeeding: Many times the recovery from surgery can cause challenges with breastfeeding and delays immediate breastfeeding along with having your milk come in later. I remember being in so much pain it was difficult to even find a position that was bearable.
• Effects on babies: Studies have shown that many c-section babies experience added difficulties as well. Such as having breathing difficulties, greater chance of developing asthma and also being cut during the surgery, though usually mild. Also there is more chance that the baby is not ready to come out out yet when a c-section is done early and has issues concerning prematurity.
• Impact on any future pregnancies: Some research suggests babies born after multiple c-sections are more likely to be preterm, have low birth weight, along with more serious and deadly complications. With each surgery there is more scar tissue which makes things more difficult as well. There is also higher rates of infertility, miscarriages and ectopic pregnancy.

So many times women are told how dangerous VBACs are and are encouraged to just have another c-section making it seem like there are not risks involved. As you can see there are many risks concerning c-sections and I think all doctors should carefully go over these with their patients.
***Most of this information was found on the ican-online.org and vbac.com websites

Necessary C-sections

There are only a few medical reasons when a c-section would be medically necessary. These are having a prolapsed umbilical cord or placenta previa, the mother has an outbreak of genital herpes or the baby is lying in a transverse position.

According to childbirthconnection.org, almost all care providers, including those who usually encourage VBAC, would strongly recommend planned cesarean in the following situations:

• certain uterine scars from a cesarean that aren't the usual horizontal cut made at the bottom of the uterus (low transverse scar): In these rare situations, the concern is that the scar on the uterus may be weaker and more likely to give way (rupture) and cause serious problems than the usual cesarean scar.
  • a high cesarean scar that runs up-and-down (vertical or "classical" uterine incision): a vertical incision may have been used if you had a placenta that grew over the opening to your uterus (placenta previa), for some urgent cesareans, or in some cases previous baby was in a buttocks- or feet-first (breech) position. (It is possible to have a low horizontal scar on your skin but a vertical cut on your uterus.)
  • inverted T- or J-shaped incision
• mother had previous uterine surgery for gynecologic problems, such as for removal of fibroid tumors
• uterine scar opened and caused problems in a prior labor: The key point here is that the scar has caused problems before. Many times, scar openings are small, harmless "windows" (dehiscences). These windows are not thought to have any ill effects in future labors.
• uterus does not have the usual pear shape: Examples of this are a heart-shaped (bi-cornate) uterus or a uterus that is partly divided down the middle (septate uterus).
• ultrasound in late pregnancy finds that the area of the scarred uterus is unusually thin: There may be a concern if the scar is 2.5 millimeters thick (about the height of 2 stacked dimes) or less.

Birth Story

I love hearing everyone's birth story and I am finally getting around to writing about my successful VBAC. I hope after reading mine you will also take the time to share your birth story with us.

My due date for my baby girl was Oct. 16. I didn't dwell on that too much knowing my first baby was almost 3 weeks late. Although I was definitely hoping not to go that far over this time. My midwives suggested stimulating the cervix in hopes to not go so far past my due date this time. So at each appointment from the end of September she would do that. While at my 38 week appointment I asked her about checking me also and she said I was 50% effaced and about 3 cm. dilated and that the baby's head was very low. That was pretty exciting news even though I knew some people can be that dilated for a long time before giving birth. It just made me feel good to know progress was happening.

Oct. 16 came and went. I was feeling a lot of Braxton-hicks contractions and baby continued to be very active. I was actually pretty sick for about a week before the due date and a week after so it was a good thing I didn't go into labor. I think my body knew I didn't have the strength or energy to get through labor at that point. I was blessed to have grandma come over on Oct. 22 to watch Isaiah while I was able to stay in bed and rest all day, which was a good thing because that night I couldn't sleep well. I had heartburn a lot and then started to feel crampy. I thought maybe things were starting to happen and I might go into labor that next day. Around 3 am I started to feel more contractions and they seemed to be more regular so I started to time them and they were between 4-6 min. apart. I decided to get up and go downstairs and see if they continued. I started cleaning the kitchen (nesting instincts I guess) and the contractions started to come quicker and more intense anywhere between 2-6 min apart and between 45 seconds and 1 minute long. Since they seemed to be picking up we decided to make the phone calls. When I called my midwife she suggested getting in the tub for awhile and see how things were and check back with her in about an hour. When I checked back in and reported the contractions staying regular she told us to head to the birth center.

We left home about 6:30 and drove to Bella Vie and got there about 7:00. It was a beautiful morning with the sun coming out and the mountains in the background with all the farm land around...it was a gorgeous sight.

The wonderful assistant Caroline greeted us and led us to our room and brought us some breakfast, took vitals and brought me a ball to sit on to help open my pelvis. Everything was going well. After a while we decided to go outside and walk along the path outside our room. We would walk a few steps then stop and work through the contraction then walk a little more. The contractions continued to pick up and become more intense.

Around 9:00 they checked me and said I was between an 8-9. That was exciting news! As labor progressed I continued changing positions from sitting on the toilet, to squatting while holding on to the bed post, to sitting on the ball while being in the shower. I really encourage all that movement, it really helps. During it all they kept reminding me to keep my noises low and deep. Everyone from my husband, sister, and midwives were there giving me support, helping me any way they could, taking care of me, rubbing my legs and my back...they were all wonderful.

Just before 12:00 pm they asked if I wanted to get in the tub---I'd been waiting for that! I was really looking forward to having a water birth. Before getting me in the tub they had me lie on my side on the bed and checked me again. They said I was about 9 1/2 cm! Soon after I had the urge to push and began pushing. It came on so suddenly I didn't get the chance to get to the tub and just stayed on my side on the bed. After about an hour of pushing my baby girl was here! It was an amazing and wonderful birth.

My baby girl, Kylah, was born on Oct. 23 at 1:06 pm. She was 20" long and weighed 8 lbs. 7 oz. The birth was definitely intense but so beautiful at the same time. It was so empowering to be able to have an all natural vaginal delivery. It was an awesome experience, and a beautiful baby girl. I was truly blessed!

Advice From Midwives

Along with researching on my own, my midwives also had some advice for me to better my chances of a successful VBAC.

One thing they had me take was magnesium. It has to be the Magnesium aspartate or Orotate because any other form of magnesium is not helpful. They have done their own informal "studies" that showed this type of magnesium helped women have a better and shorter labor. I was all for that after 30 hours with my first one!

As for my diet, they of course wanted me to eat healthy, but they really wanted me to go off sugar, milk, and wheat. The sugar wasn't too bad---I wish I still had the will power to be off of it entirely now. :) The milk I substituted unsweetened Almond milk, which I didn't mind at all. I prefer the Blue Diamond Brand though. For the wheat, I didn't totally eliminate, but I did cut down. Some of the reasons they asked me to make these changes were, for one, they are healthier but also to not have my baby's growth on these empty calories that could tend to grow a bigger baby. Not to say you can't give birth naturally to a big baby but to just help me in maybe having a little bit of a smaller baby this time. They also suggested eating lots of protein to keep muscle integrity as strong as possible. Also to cut carbs as much as I could, suggested goat protein powder, spiralina, lots of good veggies, and drinking kefir.

They of course wanted me to keep my body strong and ready for labor so encouraged exercises like walking, pelvic tilts, squatting and being on my hands and knees.

So I don't know if all these things really did help, but as for the shorter labor I went from 30 hours to 10 hours. I gained a lot less weight from 40 pounds to 17 pounds, and my baby was smaller from 9 lbs. 6 oz. to 8 lbs. 7 oz. Who knows if these things had any contributing factors to any of these outcomes, but I was wanting to try anything that might potentially help increase my success in having the VBAC I wanted, so I thought I would pass it along to you in case you might benefit from these changes as well.

Resources

I wanted to list some books, movies, websites, midwives, etc... that I found helpful or have had recommended to me. If you have any other recommendations please leave a comment.

Books
The Birth Book--Dr. William Sear
Pushed--Jennifer Block
Silent Knife: Cesarean Prevention and VBAC--Nancy Wainer Cohen

Movies
Business of Being Born

Websites
www.vbac.com
www.ican-online.org
www.childbirthconnection.org
www.childbirth.org/section/VBACFAQ.html
http://nursingbirth.wordpress.com
www.pushedbirth.com
http://yourbirthright.info
www.mothering.com

Midwives (Oregon--Willamette Valley)
Bella Vie Birth Center---www.gentlebirthcenter.com

Blessed With Support

As I said before I was well informed about VBAC. The number one thing I can tell you helped besides my supportive family and faith was having wonderful midwives who were 100% supportive and encouraging of my decision and who really believed I could do it. I have heard of many who had a doctor who said they could try but you knew deep down they weren't supportive and any chance they got to go ahead with another c-section they would. I encourage you to find another doctor/midwife if you feel they aren't supportive 100%. They should be telling you they believe you can do this instead of giving you excuses as to why you won't be successful. That will make a huge impact on the success of the VBAC.

So as my pregnancy went on I was getting more and more excited. I was still nervous and anxious at times but I was able to deal with those emotions and overpower them with positive ones. I realized it was best for me to deal with these emotions instead of just try to ignore them. My midwife asked me one day what would be the worst thing about having to be transferred and told me to think that over but then to realize that if by chance that were to happen it wouldn't be the worse thing because I would know 100% that I had done everything to try to have a VBAC and I would know it was completely necessary.

Talking to others really helped. I even found two others from my mom's group at church who were trying for VBAC's as well. It was great getting to know them and be able to share with others who were going through the same thing and feeling many of the same emotions. That is partially why I wanted to start this blog because for me having the support of someone who had gone through it too was really a blessing. I hope sharing my story will be a blessing, support and encouragement to you.