Paige's VBAC Story

Again I want to thank Paige for sharing her VBAC story with us!

Paige's VBAC Story:

"Despite all my gentle attempts to naturally induce myself I was not going into labor. I had to really fight to get to 42 weeks, especially after I agreed to the US to check the baby's size and they estimated him at +9lbs. They scheduled a c-section for the day I hit 42 weeks. That was a Sunday. Here's the rest of the story...
Saturday morning at 6am I woke up and felt my first real contraction. It felt nothing like anything I'd felt before so I thought it was the real thing, but was afraid to get my hopes up again. They continued regularly every five minutes for over an hour so I knew something was really happening. I took a shower and they started coming one on top of the other so I called my doula. While she was on her way they evened back out a bit. My mom came and got DD and I settled in to what I thought would be a pretty quick labor- since they were already so close together and lasting about 45 seconds. Over the next few hours they got to every 2 minutes and stayed there. All. day. long. I should have tried to do other things to take my mind off of labor, but I was so afraid that if I stopped concentrating on the contractions they'd stop coming and I'd end up on that OR table the next day.

Around 6:30PM that night I called the oncall MW because my doula was afraid I was going to get too worn out and she wanted me to try to speed things up. I'm so glad I called the MW because she assured me that the surgery was definitely off since I was in labor. I didn't realize I'd been worrying about that all day- like i was trying to labor on a time clock. She told me to relax, make myself comfy, take a warm bath and let labor take its own course without trying to speed things up. I felt so much better. I sent my doula home- that was actually a big relief. She was starting to stress me with suggestions of how to speed things up and I was tired of being stared at.

So i took a hot bath, relaxed, laid down in bed, tried to watch SNL and dozed between contractions for a while. DH was so sweet and comforting. After a few more hours the contractions weren't getting closer together but they were getting harder to deal with and more intense so I decided to head to the hospital. I'd been in labor about 18 hours at that point, though I lied to the MW when I got there and said the contractions had started early afternoon sometime. I really didn't want to be on their clock.

The drive to the hospital sucked, but we got there Sunday morning at 1am. We got lost trying to get in to the maternity ward but a friendly security guard helped us out and let us in the door that was locked after hours. The nurses recognized my name from the surgery roll for the next morning and were really excited for me that I was in labor. I was 5 cm when I checked in and incredibly happy to hear it. I had a heplock for ABX (I was GBS+) and was on continuous monitoring because I was VBAC, but generally comfortable and able to move around. I decided not to worry about whether they were getting good monitor readings and that made things easier. I used my yoga ball to sit on, lean on, drape myself over. I squatted into contractions some, I laid on my side for a while. Basically I tried every position in the book and just tried to generally stay mobile.
By 4am I was 8 cm and 100%effaced. I heard that and cried with happiness. Then my body decided that it was done for a little while and I stopped progressing. It was probably good cause I was able to sleep a little bit, but after a few hours they started talking about internal monitors and pitocin so my body kicked back into gear. In another hour or so I got to 10cm with a cervical lip that just wouldn't go away. I was getting frustrated at that point because I felt like no one was telling me what to do to make it progress. The doula was useless at this point (im sure she was worn out) and I was getting so tired and just frustrated. The pain really wasn't much of an issue for me, I was just exhausted from lack of sleep and a long labor and just READY FOR THE BABY TO COME OUT.
Then shifts changed and this angel of a nurse came in and started quietly making suggestions about how to stand, where to put my feet, how to curl my back forward instead of backward to get the baby around my pelvis. I got to the point where they said i could try pushing past the lip but the baby kept slipping back. The midwife (the same one I had talked to the night before on the phone) assured me that at this point I WAS going to have a vaginal birth, but they thought a "whiff of pit" would strenghten my contractions and make them consistent enough to actually push the baby out. I was still falling asleep between them at this point. I didn't even notice the pitocin, but once they gave it to me it took about 45 minutes of pushing before the head came out (at 11:13am after 29 hours of labor). I was laboring on my back at this point holding my feet and pushing against my own hands with some help from my aunt on one side and the nurse on the other with my mom holding my head and helping me curl into a shrimp position. DH was waiting to catch the baby and my sister was watching over his shoulder. My eyes were mostly closed but I have a few mental images of seeing their faces as the baby was coming out. I thought it would be embarrassing but it was encouraging because they both looked so amazed and impressed. Then the head popped out and everyone cheered.

The amniotic sac was still intact and she had to burst it by poking her finger in his mouth. Then they told me to stop pushing because his shoulders were stuck. DH was not able to deliver him because the midwife had to manuever him a bit, which caused a pretty good tear, but when I felt his body slither out everyone in the room cheered. They put him up on my belly and I reached down and felt that he was a boy. They had to take him away pretty quick because he was in a little bit of shock from getting stuck, but they assured me that he was just fine and they kept him in the room to check him over. I delivered the placenta (that thing was huge!!!) and then they stitched me up. The stitching was the first time I said the word "epidural" the whole time I was in labor. OMG that was the worst part of the whole experience. I tried to hold the baby to distract myself, but I was yelling so loud I had to give him to DHuntil they were done. It took forever, but they finally finished and gave my baby back to me. I offered him my nipple and he immediately latched on and went to town. Like he'd been doing it forever. It was wonderful. It was the most healing, amazing experience of my life and I hope every woman can experience something like it."

Paige's Cesarean Story

I am part of a site called Circle of Moms where I came across Paige's birth stories. She was kind enough for me to repost her experiences on my blog.

Paige's Cesarean Story:
"I know when I was pregnant the second time I was desperate to read about other women's VBAC stories no matter what the outcome was. I want to share my stories because if my experiences can help another mother out there then I want to do it.

Here's my c-section story:

I went in on a Friday to see my midwife. I was a little more than a week overdue at that point so they strapped me to the monitor to check things. Everything looked fine except the baby wasn't moving as much as they wanted. My midwife said just to be safe to go to the hopital for a NST. She told me that if I wanted to, just tell them I'm ready to have the baby and they'd induce me. That should have been my first clue that things might not go the way I was hoping.

So I went to the hospital and they decided that I was low on fluid. Fortunately the midwife oncall at the hospital was really understanding about me NOT WANTING an induction. Despite the doctor's recommendation (and my mother, and my aunt, and my grandmother) that I induce, the midwife suggested I go home over the weekend, drink tons of water and come back for another NST on Monday. I was very relieved to have another option.

I showed up at the hospital Monday afternoon and had another NST. While my fluid had not gone down, it hadn't come up either so the doctor, midwife, nurses, and my entire family told me to just get the induction. I still felt like it was the wrong thing to do, but everyone else was telling me to do what the doctor said and they kept insinuating that by NOT doing that I was endangering my baby's life. So I agreed.

You have to be 4cm to start pitocin and I was nowhere close (about 1 cm) so they used a Foley bulb to dilate me further. It was painful, uncomfortable, and invasive. They basically insert a balloon inside your cervix, inflate it to 4 cm, and it puts pressure on your cervix. When your cervix dilates to 4cm it falls out. The thing is connected to a tube that runs down your leg, which is taped there to hold it in place. They did this later in the evening and told me to sleep with it in. Yeah. Right.

By this time everyone had gone home because it was clear I wouldn't be in labor any time soon. There was no bed for Jason to sleep in so he asked if he could go home too. I wanted to say no because I was so scared to be there by myself, but I knew that if I did go into labor the next day I'd need him to be well-rested so I said that if he wanted to go he could. I don't think I actually believed he would leave me there alone, but he did. I've never been so lonely and scared in my entire life and I just lay there crying for a while. I felt abandoned and then guilty for begrudging him sleep. To my surprise I actually fell asleep.

I woke up a couple of hours later and had to pee so I went to the bathroom. While I was there the bulb fell out of me. There was a lot of blood and it was sort of frightening. I called the nurse and she just told me over the intercom to leave it in the bathroom. I was disappointed she didn't come in because I was still feeling lonely and wanted to actually talk to someone. I fell back to sleep, much more comfortable now that I didn't have a contraption inside me.

The next day my family showed back up cheerful and well-rested. I was feeling a bit grumpy myself, but tried to be excited that I was going to have a baby today. I thought. I asked the midwife if I could go walk around outside for a while before they strapped me to all the IVs and monitors because at that point I'd been in that hospital room for almost 24 hours. So I got my last breath of fresh air for a while and walked around outside the hospital. It was a beautiful day.

I went back in feeling much better and settled in for a long wait. They started the pitocin and an IV antibiotic (that burned when it flowed in! I could feel it all the way up my arm and into my chest). The first anesthesiologist came in and offered me an epidural. That pissed me off because it specifically said in my birth plan NOT to offer me medications. I wasn't even in labor yet for crying out loud! It would have been waaaaay too soon for an epi even if I'd wanted one. I just said, "No. I'm not using medications." He laughed and said, "I bet I'll see you later" and walked out the door. I was pretty pissed off, but my mom and Jason said "oh he was just kidding, you're making too big a deal out of it" so I tried to let it go.

After that it's a long, boring blur. Every few hours or so a new anesthesiologist would come in and ask if I was ready for an epi yet. I got irritated…then I thought it was funny. Especially since I still showed no signs of labor. They kept cranking up the pitocin, but nothing was happening. I dilated to about 6cm by early evening, the monitor showed regular contractions, but I felt nothing. The baby was perfectly happy and showed zero signs of distress. I laid there on my back and got up from the bed only to go use the bathroom. I started lying about needing to pee just so I could get up.

Sometime in the evening a nurse offered me a rocking chair. I was surprised. I asked if it was ok for me to get out of the bed and she said of course. Geez, I wish someone had told me that earlier!! I'd have been up moving around, squatting, rocking, kneeling on all fours, all the things I knew would help the baby move down. At that point I don't think I sat down again. I stayed on my feet except when they checked me for dilation.

I don't know what time it was when the midwives changed shift, maybe 8ish, but the new MW came in and it seemed like right away she decided she needed to know how strong my contractions were since I hadn't dilated past 6. She put an internal monitor on my cervix, which meant the end of my standing. I had to lay on my back and try not to move at all. It wasn't long before I felt the water trickling out. I let her know my water had broken and she removed the monitor. I’ve since learned that the water has to break when they use an internal monitor, but the midwife didn’t tell me that part when she said she was going to put it in.

But I got excited once my water broke because suddenly I could actually feel the contractions. I thought what I'd been waiting for for two days was finally happening- I was in labor!! I was thrilled.

Then the midwife came back. She said the monitor showed that I was having really strong contractions and that because I wasn't dilating despite the contractions she thought it was time to do a c-section. I felt like someone had literally punched me in the stomach and knocked the wind out of me. I started crying and said, "but I can feel the contractions now, I'm in labor." She told me I'd been in labor for a while and it wasn't progressing anything. I asked her if we could please just wait a little while to see if anything happened and she said she would give me one hour. If I hadn't dilated by then I had to have a c-section.

She put me in the "Pretzel"position, which apparently is supposed to encourage dilation (again, no one could have suggested that earlier??) but unfortunately makes the fetal monitor hard to keep in place. I spent the entire hour crying to myself, listening to my mother and Jason tell me it was for the best, and trying to ignore the friggin nurse who would not leave me alone and kept messing with the stupid monitor. I wanted to scream at her that surely after 13 hours of lying there with the damned monitor strapped to me and the baby had never once shown any signs of distress, surely it would be ok for the next hour. But of course I didn't. I just kept trying to help her get the monitor situated. She didn't try to hide her frustration and impatience with me at all. She clearly thought I should just go do the surgery and get it over with.

Then the MW came and checked my cervix again. Still 6 cm, so she said. I have my doubts about whether she would have actually told me if I had dilated, but maybe I'm just paranoid.

So that obnoxious nurse came in, much more cheerful now, and shaved the top few inches of my pubic hair. Someone came in and gave me a shot of something "to calm me down." I requested they wait to give me a catheter until after I'd been numbed and they said yes. It was the best decision I made all day, I think, but the nurse seemed to think it was weird.

They rolled me to the OR, which looked like a supply closet. They said Jason would join me in a minute. The anesthesiologist just happened to be the same one who'd been there 12 hours earlier. He said, "I told you I'd see you later." All I can say is that it was a damn good thing that they gave me that shot to calm me down because I remember being angry but just not caring. That stupid nurse who'd been badgering me for the last hour was there as well. While they are getting things ready they were gossiping about some guy who was "totally looking at" one of the nurses. I didn't understand how they could not realize that I was laying there having one of the worst moments of my life. I wanted to scream at them that I knew they probably did this everyday, but I didn't and it was really scary and emotional for me, but again that shot saved them from my wrath.

DH still hadn't shown up, but it was time for my spinal block. The thing I'd feared most throughout pregnancy- the reason I never wanted an epidural- a needle in my spine. I thanked the shot again. I leaned on the MW. Suddenly I thought someone had splattered boiling water down my left leg. I jumped and looked to see who'd dropped a cup but the MW just told me not to move. It was just the needle hitting a nerve. I laid back and they raised the curtain. I zoned out. The part of my brain not "calmed" by the shot wondered where Jason was.

Finally he came in. He seemed surprised they'd already started. Apparently he'd gone to get a cup of coffee and they couldn't find him.

It's all a blur from there until at 1 am I heard the doctor say, "Oh, what a beautiful baby." I remember wondering whether he said that about all the babies. I tried to look and see but the curtain was in the way. By the time they brought her to us she was clean and swaddled and had a little cap on, but she was the most beautiful thing I'd ever seen. Her face was so pink and her eyes were closed and she looked so peaceful. They handed her to Jason and I reached up and touched her cheek and said hello. I laid there with my hand on her cheek for god knows how long. It seemed like ages.

I started to realize that I felt a vague burning sensation in my abdomen. I told the anesthesiologist that I felt something. He asked me what it felt like and I thought for a second and said, "it feels like fingers in my belly." He said, "Let's get you a shot of morphine." They don't tell you this, but morphine makes you itch. It was terrible, it started in my nose, then my face...neck...chest. I was trying to focus on the baby but I was so itchy and I'd been laying there for so long.

Finally they finished and I was able to hold my baby for the first time as they rolled me back to my room. For a few moments all was right with the world. It wasn't so bad. My baby was healthy and I was OK. As soon as they parked my bed I put Nora to my breast and she latched right on. I was so happy. I slept with her all night in my bed with me, nursing and snuggling.

The next day I was in the bathroom when I heard my usual midwife come in my room. It was the first time I'd seen her since that Friday she'd sent me for the NST. I sat there in the bathroom afraid to come out and started crying. I couldn't face her. The last time I'd seen her I was pregnant and happy and confident and now I'd failed. She was going to be disappointed in me and I was scared to look her in the eye. I tried to clean off my face and look like I wasn't crying and walked out to see her. That was the first time I pretended like it didn't matter but it definitely wasn't the last."

Finding the Right Practitioner

If you are hoping to attempt a VBAC it is crucial to find a caregiver who is supportive, encouraging, and trusting of VBAC's. They should also be knowledgeable and experienced in VBAC deliveries. It is important that your caregiver be comfortable and confident in order for you to feel safe and trusting in them and their judgement. Unfortunately it is becoming more difficult to find a caregiver who will offer the choice of a VBAC. I feel this is because of the fear of lawsuits and the high cost of insurance doctors and hospitals have to pay if they are doing VBAC's, not to mention the money they make by preforming surgery instead of allowing VBAC. I of course personally prefer midwives but there are good VBAC doctors out there as well. I suggest taking the time to interview a few different practitioners to compare their responses and attitudes to really have a better feeling as to which one is really going to help you the best to achieve the birth you desire.. Discuss with them your desire to have a VBAC, your goals and preferences and find out their philosophies, experience, success rates, and how they will work with you to have the birth you desire. If their responses don't satisfy you, or they don't seem like they would be supportive of your decision, if they have too many protocols to follow, etc..I would suggest finding someone who is a better fit. Also if you have different hospital choices or birth centers I encourage you to visit them and find a place you would be most comfortable in.

Sometimes doctors seem supportive but as time goes on they change their tune. I have heard many stories of this happening. Hopefully if you get that feeling you will be able to change and find someone who truly is supportive. I had a friend who did that in her last trimester and was so grateful she did. So how do you go about finding one who is truly pro-vbac? Here are some things to keep in mind when first meeting your caregiver:

• They should believe that women should labor unless there is a medical reason not to, and talk about the benefits of labor for the mom and baby.

• They should respect the woman's right to make the ultimate decisions about their birth.

• They should view pregnancy and birth as a natural process, not treated or viewed as a medical condition.

• They do not have policies that discourage VBAC such as having a "big baby", gestational diabetes, pregnancy going past 40 weeks.

• They should have a high success VBAC rate of 70%.

• They should show acceptance of your choice to have a doula present if that is what you want.

• They should not routinely use interventions during labor.
  

To understand their views on the above subjects here are some good interview questions to ask:
I got most of these off of the ICAN website.

1. What are your beliefs about birth and prenatal care in general?
2. What are your beliefs about VBAC births and prenatal care?
3. How do you feel about VBAC delivery? Do you support VBAC?
   
4. Do you feel a VBAC is a safe option for women?
5. Approximately how many VBACs have you attended?
6. Of those patients in your practice who wanted a VBAC, how many were successful?
7. What do you think my chances are of a VBAC success, given my childbirth history?
8. What is your rate of cesarean sections and under what circumstances do you usually advise them?
9. Are VBAC patients treated any differently than patients who have never had a c section?
10. Who is your back-up? Is he/she VBAC friendly? Would he/she support my birth plan?
11. What hospital(s) do you have privileges at? (Which would you recommend for a VBAC?) (Natural birth?)
12. What book(s) would you recommend that I read?
13. Are you familiar with ICAN?
14. What prenatal tests/procedures do you usually require? Recommend?
15. What do you think of Birth Plans/ Preferences?
16. How do you usually manage a postdate pregnancy? Or a suspected Cephalopelvic Disproportion (CPD)?
17. Do you have a vacation scheduled near my estimated due date?

Questions regarding Labor & Delivery

1. What’s a reasonable length of time for a VBAC labor if I’m healthy and my baby appears to be healthy?
2. Do you know any kind of restriction I should expect from the hospital on a VBAC? (Who do I need to have policy exceptions approved through?)
3. How many people can I have with me during the labor and birth?
4. How do you feel about doulas?
5. What is your usual recommendation for IVs? Pitocin? Confinement to bed?
6. What’s your approach if the bag of waters has broken at full term but the mothers feels no contractions?
7. How often do women in your care give birth un-medicated? How many with minimal medication? In what percentage of your patients do you induce labor?
8. Approximately how many of your patients have un-medicated births?
9. Do you do breech deliveries?
10. What would you suggest if I had another breech baby? (Before labor? During?)
11. At what point do you arrive at the hospital during labor/delivery?
12. What labor positions do you recommend to your patients? Do you encourage movement during labor?
13. How much fetal monitoring do you routinely use during labor? Intermittent?
14. Do you allow light eating/ drinking during labor? Does the hospital?
    
15. Are you OK with No IV – but a Hep Lock?

Increase your VBAC chance--Decrease Cesareans

Even though about 80% of women have successful VBACs I think it is important to be proactive to help increase your chance for VBAC and decrease your chance for a repeat c-section. We shouldn't just sit back and hope for the best, but seek out ways to improve our chances and be prepared.

I think the most important way to increase your chance for a successful VBAC is to find a doctor or midwife that 100% supports and encourages your decision. They should be offering advice on how to be successful and not focus on what would cause you to not be successful. Some doctors might be tolerant of your decision or say "well, you can try" while others help you realize that you can do it! Those that are "tolerant" are usually either looking for reasons/excuses to end up with a c-section or if anything seems at all "abnormal" might just end up saying you need to have the c-section. I have even heard of some that seem supportive, only in the last couple weeks of pregnancy totally change their tune and recommend a c-section. When that happens many women feel it is too late to change doctors so end up with the c-section they were trying to avoid and often times was not necessary. It is important to take the time to interview a few different people and to ask the right questions so you can really see what their philosophy is. Don't just end up with someone because you used them before or your sister/friend uses them and says they are good, or they are the closest, etc. To increase your chances it is necessary to find just the right person. I highly recommend midwives but also know there are some great very pro-VBAC doctors as well. You might even consider hiring a doula to help and support you through your delivery.

In my research I found these other tips to also better your chances of having a successful VBAC.

• Wait at least 9 months before trying to conceive again, even longer is better: I think I was actually told wait a year before trying to get pregnant again while others say even 18 months. I know the longer you wait allows your scar to heal better and become stronger, which is what you want to help decrease any chances for problems with the scar that could lead to complications and a c-section.
• Avoid induction of labor, whenever possible: My research said that induction agents can increase the risk of uterine rupture. Along with that though is that inductions significantly increase the likelihood that you will end up with a c-section---this is true in any vaginal birth, not just VBAC. Because you don't want to be induced you need to find someone who will not pressure you to be induced due to being "overdue" or for having a "big baby". If for some necessary medical reason you need to have labor induced you should avoid the cervical ripening agents such as prostaglandin found in Prepidil, Cervidil, Cytotec.
• Avoid use of synthetic oxytocin (Pitocin or "Pit") early in labor:
• Avoid interventions: Some of these were listed above but the more interventions that happen during any birth have greater likelihood for ending up with a c-section.
• Wait until your cervix is beginning to open to be admitted: You are less likely to have a VBAC if you are admitted before your contractions are well-established. If you go to the hospital before labor is under way the more interventions are usually pushed on you as well. Also some hospitals have time limits for how long they allow VBACers to labor.
• Avoid epidurals and spinals: A common side effect of these pain relievers is that they slow down the baby's heart rate. This is also a symptom of uterine rupture so even though it most likely would be the side effect of the drug most doctors would push for a c-section whenever the heart rate drops even when they are unsure of the cause. I had my baby naturally and there are many techniques, positions, etc. that can ease the pain. I will talk more about these in another post.
• Work on a healthy diet and exercise: The stronger our body is will help during the hard work of delivery. I already talked about the diet changes my midwives suggested but I will list them again: going off sugar, limiting wheat and carbs, no milk, lots of protein, taking magnesium.
• Healthy mental well-being: Take the time to process and work through whatever emotions you went through after your c-section. Don't ignore or suppress them. Visualize the whole labor, pushing, and delivery with the beautiful outcome of a precious baby and a successful VBAC. Positive outlook can do wonders for the mind and body.

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.