A while back, I blogged about how I’ve come to terms with the fact that my last birth, in 2007, ended in a c-section, and about how I’ve finally realized that despite my best intentions, I am not ever going to be someone who wants to give birth without drugs for pain. After four births and plenty of education and knowledge, I know now that I am always going to have the epidural, no matter how I give birth.
However, although I’ve had pain medication in all my births, each of which took place in a hospital, only the last one ended in a c-section. The three prior to the c-section were relatively easy affairs, with fast recoveries (my c-section recovery was also pretty easy). So while I’ve finally accepted the fact that I am just not a homebirth or even a birth center kind of girl, I have yet to decide whether I am the kind of girl who after one c-section just throws in the towel and has a repeat surgical birth instead of trying to give birth the old-fashioned way, as I did successfully three times in the past. And now that I am in the second trimester of this pregnancy, I’ve realized that I need to start thinking this through, so that I can make a decision. My last two babies came 4 weeks and 3 weeks early, so I can’t really wait until the very last minute to decide.
I have not yet discussed this issue at all with my doctor, but I feel relatively certain of what he will say. I think he will tell me that he’ll support whichever decision I make, but that I should not feel guilty if I decide to go for the repeat c-section. And I have to tell you that that’s how I am leaning at this point – my inclination is to just wait until the baby is fully cooked, and schedule the c-section on or around her due date (which also happens to be C’s 3rd birthday). If I go into labor earlier, I’m inclined to just tell them to go ahead and slice me open and get it over with. Because if I am likely to end up with a c-section anyway – and my specific variables indicate a high likelihood – wouldn’t it be easier to have some planning in place for childcare and my job, etc instead of having to do things on the fly? Plus, I honestly dread the idea of going through what I went through the last time again if I am going to end up in surgery anyway.
My last labor – the one that ended with the c-section – was absolute hell. Three days of terrible pain, TWO epidurals (one to relax the uterus to flip the baby, who went breech suddenly on the day contractions started and then a second one two days later when I decided I could no longer labor another hour without significant pain relief) and a lot of angst and exhaustion for both Jon and me. The c-section, when it finally came, was blessed relief. It was over in only ten minutes, and finally, we could rest and enjoy our baby and stop worrying about why nothing was going right, and wondering what would go wrong next.
When C was born in 2007, our total medical bills for several days of labor, numerous checks of my progress at both the birth center and later, at the hospital, a manual version (flipping the baby), two epidurals, two hospital admissions (admitted then sent home when labor slowed then admitted again when things picked back up), followed by a c-section was probably double what it would have been if we had just had the damn c-section the first time anyone suggested it. Yes, we had “good” health insurance, but even the best health insurance doesn’t pay for everything and when you are talking about days and days of various procedures and visits and admissions and medications, followed by major surgery, the out of pocket expense to us was in more than 4k. We were paying that baby off for more than a year! My insurance this time is still good by general standards, but it actually covers less than the insurance I had when C was born. So whether it’s right or wrong, we have to do whatever we can to keep our out of pocket costs down. If a scheduled c-section without trial of labor would minimize costs, that’s a factor I have to consider because it impacts our whole family, as well as my general stress level. We are currently paying off the more than 8K in out of pocket expenses that accrued on top of insurance coverage from my October virus + hospitalization, and I really don’t want to slap a few thousand more in money we owe on top of that.
So yeah, I am leaning strongly toward just having the c-section, even though I feel kind of conflicted about it. I don’t really care about missing out on a “regular” birth; been there, done that. My main concerns about a repeat c-section are the fact that it’s major surgery, and something can ALWAYS go very wrong in major surgery, and my dread of getting the epidural. I am petrified of epidurals, and I find getting them in my back one of the most unpleasant experiences I’ve ever had. Plus, the epidural I had when I gave birth to E went awry – I am pretty sure the dude hit a nerve in my back when he put it in – and I suffered debilitating back pain for several years following E’s birth.
I know I would have an epidural even if I DON’T have a c-section, but at least by that time in my labor I’d be so grateful for the pain relief that I’d be less freaked out about the thought of a needle being inserted into my back. With the c-section, the epidural would go in when I was fully aware of my fears and the discomfort. And that sounds hellish. I asked a good friend who is a high risk obstetrics nurse whether I could choose to be totally knocked out for a repeat c-section, and she informed me that doctors don’t do that anymore. Bummer. The idea of just getting an IV and drifting off to sleep and then waking up 20 minutes later to see Jon handing me our baby to nurse sounds really appealing, actually – at least compared to the apparent alternatives. (Go ahead and flog me for this backward opinion; I’m just being honest!)
So there you have it – my c-section dilemma. I know I will go back and forth on this in the next few months as Jon and I figure out what makes the most sense. I’d love to hear from any of you blog readers who have faced the same decision. What did you decide and how? Were you happy with your choice? Share your experiences in the comments below.
Thanks! – Katie
I think there is a lot of pressure by society to have a drug free natural birth. But, as you found out with C., that is just not always possible (or even desirable in the end). With this being your 5th baby, and your previous experiences, I believe you will make the decision that is best for the Baby Mr. Darcy and your family (and of course you!).
I hate that your decision has to be somewhat based on the cost and financial strain this could cause your family…we are in the same boat. Not with a c-section decision, but with the whole insurance coverage issue. Even with what I would consider pretty good coverage also, I still continually have to weigh whether or not we are sick enough to render a visit to the doctor, because our deductible is so costly. Unfortunately it seems like you can't live without insurance but it is almost too expensive to use!
A planned repeat c-section is actually quite nice. Withe my first like you the c-section came at the end of several days in the hospital, induction, failed attempt at natural birth. Due to complications from my first c-section I had to have a repeat and you know what it was great. I knew exact time and date which made plans for my older daughter easy to handle. I was showered, hair done. The c-section was quick and easy and recovery much easier then my first because I did not spend days in labor.
I had a c-section with my first and opted for a scheduled c-section with my second. I struggled with the whole vbac decision since I never had a natural birth, but in the end I decided that being able to plan when it was going to happen was what made sense. Do I regret it? Sometimes, but if I had tried a vbac and ended up with a c-section anyway I'd regret that decision as well.
At least my OB made me feel better about my decision by exclaiming that I had made the right decision when she pulled my big boy out!
Good luck with your decision. I'm sure you and Jon will make the right choice for your family.
I had a repeat c-section, mostly because if I had tried for a VBAC at my local hospital, the whole surgical team was on-call. They said if something went wrong, it might take 30 minutes before the baby was out. That sounded too scary to me. But in the end, various complications led to giving birth at a bigger hospital anyway–I never have had a normal childbirth, but I do have two healthy children.:) Good luck with whatever you decide!
If you're determined to get an epidural (and I'm not judging that – you're both educated and experienced and I know you are perfectly capable of making that choice), then a VBAC is really pretty much out of the question anyway. As I'm sure you know, epidural use more or less guarantees the use of Pitocin, which dramatically increases the risks of VBAC. So it sounds like this is your decision.
I know you're basically joking about the general, but do bear in mind that you wouldn't just be up & at 'em 20 minutes later. Recovery is much longer and more difficult, and will result in a longer separation from Mr. Darcy, which can impact breastfeeding, and I know that's very important to you.
I wish you the very best no matter what you decide!
You know my story (VBAC after going 10 days past EDD). I was very happy with my decision to VBAC.
You do seem to be focusing on the worst case scenario here. Since every birth is different there is also the possibility of the best case scenario (20 minutes of labor and two pushes!) and everything in between. So, it could go the other way just as well. Maybe you are focusing on the worst case scenario because it would be easier for you and your family to just have a scheduled birth? Which is okay but I think it would be good to be honest with yourself about this which is of course easier said than done.
One other thing. I wasn't sure from your post what your personal circumstances are that make you higher risk for a CS? More and more studies are coming out about how VBACs are safer than has been argued in the past years because of changes in the way most CS are done. I don't think your age alone coupled with the fact that you had a previous CS indicate you are at higher risk. There may be other factors that you are not talking about which I can totally understand. But many women read this blog who may be contemplating a VBAC in their future and I think it is important that you are clear that for many women VBACs are indicated and are very positive possibilities for them.
And Erin, it is interesting to me that this is what the doctors focused on when discussing VBAC with you. What happens if a woman goes into labor naturally and then needs a CS? It seems in the laboring process there would be PLENTY of time to get the team together if they see that you are going towards that direction (needing a repeat CS). And even in a hospital there is no guarantee that you could be immediately wisked in for surgery. When I had my first CS once we had decided with our OB we had to wait well over 30 minutes for a surgery room to open. I am not saying this to make you feel bad (I may have decided the same way if I was in your shoes!) but it does just seem like everything they talk about in The Business of Being Born.
I can totally sympathize with your decision – I'm a big chicken re: needles. My first c-section came after 33 hours of labor and failure to progress beyond 7 cm. No wonder – she was 9 lbs 2 oz and I'm only 5 feet tall! The epidural didn't work well with my daughter and I was put under general anesthesia for her birth (completely asleep).
My son was born via repeat c-section. My OB wanted me to have the repeat c to reduce any additional risk to the baby since he has a birth defect. Granted – I likely would have opted for it anyway. Although the recovery was more or less the same with both, it was quite difficult to submit to the needle without the comfort of knowing it was being done to stop the pain you are in. And with the 2nd c-section, I had a spinal rather than an epidural. That's a question to ask your OB. I've heard some dr's prefer to have the spinal for repeat c-sections or for scheduled c-sections. The sensation is very different and it blissfully wears off much quicker and without the shakes. I had a lot fewer issues with the spinal.
I regretted my decision to get a repeat c-section, but mainly because I wasn't aware of the risks involved in getting pregnant later. If I had known how risky it gets after two c-sections I would've pushed harder for a VBAC, but other than that I really don't feel like I missed out. I think it's good to be prepared for either way and to not get too wedded to either plan, but I never had a vaginal birth, so what do I know?
I can tell you, though, if you do end up with a c-section, do ask for the spinal. MUCH better than an epidural. My first c-section was spinal (emergency) the second was epidural, and the third was spinal. The difference in the amount of pressure felt during the surgery and the ease of recovery was incredible. That second c-section was horrible compared to the other two. Also, ask about stitches instead of staples. Staples SUCK.
I've already posted my thoughts and story before but I would ask you to not only look at the benifits to you but the risks to baby if you choose to have a c-section. C-sections aren't like vag births when it comes to the health of the baby. There are plenty of complications to go along with c-section including the baby being cut when you are opened up.
I've had clients that are in your situation.
They seem happiest with their decision for a planed c/sec when they wait for labor to start, then go in to have their planed c/sec.
The baby gets to have the advantage of the good effects of labor, and you get the advantage of not suffering, and all the other logical reasons you are thinking about to want another c/sec.
I'm still not quite sure how I stumbled across your blog. Maybe something to do with Webb? I graduated in '99. Anyway, I just read this post and thought I'd offer my two cents. I had my second c-section in March of last year. My first was an emergency (in 2006), done after hours of labor and no progression past 7cm. Baby girl was stuck and her heart rate dropped, so they wheeled me into the OR and she was born before I had much time to even think about it. For that delivery, I had an epidural because it had already been administered during labor. I had a planned c-section with my baby boy after consulting both my doctor and one of my best friends who is an OB, who has witnessed several VBACs go bad and rush into surgery. For the second, I opted for a spinal. It was MUCH better than the epidural. By that, I mean that I could not feel nearly as much pressure or pain during the surgery. I was in recovery for about an hour. The feeling came back slowly (just like with the epidural), and it did feel quite funny. But in the end, I'd say a spinal is the way to go if you know you're going to have a c-section.
mamatried,
My doctors really left the decision up to me, and one of my doctors (trained in the UK) pushed for me to do a VBAC. I am in Canada and most women are given the choice.
At the time, there was a woman on Babycenter.com and in the signature line of all her posts was a picture of her deceased baby son, along with his name, and an explanation that he died due to a uterine rupture in a VBAC attempt. So despite knowing the risks were small, it loomed large in my mind, and the idea of the surgeon and team needing to drive to me in the middle of a Canadian January really made me nervous. In the end, water broke at 35 weeks anyway, and I never went into labor–since you can't be induced with a VBAC, it probably wouldn't have happened even if that's what I'd chosen.
I think if I was a monitor on Babycenter.com I would have that signature removed! I mean even if it is not a VBAC issue it is kind of a downer in general (not like pregnant women aren't scared enough as it is). There are just so many issues in pregnancy. I taught with a woman who tested negative for group B strep but her baby was born with it and died 10 days later which is virtually unheard of. I was 30 weeks pregnant and had tested positive for GBS and was so freaked out that I almost had a CS just to make sure the antibiotics would be issued in time. Luckily, a friend talked me down who is a L&D nurse.
And like I said I may have made the same decision as you did especially living in a snowy region. I just think there are a lot of OBs that really are looking at their own schedules and not necessarily at what is best for momma and baby (or because they are trained as surgeons they see it as the easiest solution). And honestly there is a LOT more research coming out on the relative safety of the VBAC. Ultimately, there are no guarantees so all the risks and all the benefits should be presented so that the choice a woman make is her own.
Oh, and my OB wanted to induce me with a VBAC??!! I knew the pitocin would lead to another CS so I had to really fight to go past my EDD. And she wanted to give me pitocin once I went into labor to 'move things along' and I had to say no once again.
Y'all have given me a lot of great food for thought. It's funny – before this last labor and delivery with Charlotte, and before all the miscarriages in recent years, I was just never worried or anxious at all before giving birth. I figured it would go fine, and mostly it did. I did sense DURING my labor with Elliot that something was wrong, even though the doctor kept assuring me everything was fine. And it turned out he was born with persistent pulmonary hypertension of the newborn. He was in the NICU for 3 weeks and almost died. My mama spidey senses just knew something wasn't right with the baby while I was in labor. But nothing about my pregnancy or labor could have predicted that he would be sick when he was born. It was just a weird fluke (He's 12 years old now and super healthy).
A logistical issue: you can schedule a c-section for your EDD, but if you go into labor weeks before that, then what? If I were you, I would talk with your doctor about what your options will be when you know that you are really in labor, and also about how that might change at 36 vs 37 vs 38 weeks. From reading your story and the comments (so compassionate and helpful!), I think that I would wait for natural labor onset, and then try to go for the spinal and the c-section as soon as possible. Of course, if you do make it to 40 weeks, head in for your scheduled appointment.
The glitch with wanting general anaesthesia, most hospitals will not let you wait for natural labor to start and then use GA in a non emergency situation, they use the epidural. There are too many liability issues to administer GA when it's not an "emergency" and you have food in your stomach. They take this risk only in emergencies.
However, it's a good question to ask your OB about the hospital policies if they could use GA if you show up in labor.
Since your dates giving birth are early and unpredictable anyway it might be the way you can have a planed cesarean is to wait for labor, call and show up.
The irony of all this planing is that baby will slip out on the way to the hospital
to get your c/sec.
Maybe someone has already pointed this out, so I'm sorry if I'm repeating anything!
It seems your main issue with a VBAC is worry about repeating the suffering you went through with your last labour. If you knew you would have a straightforward vaginal birth this time, would that change your thinking at all?
Perhaps you + your doctor could agree beforehand on something like this: you wait to go into labour. If things are progressing, with an epidural, fantastic. If not, you agree that after e.g.: 12/24 hours you are happy to have a repeat c-section. This way, you give yourself and the baby a good chance for the health benefits and quicker recovery of a vaginal birth, but you do not have to anticipate the days-long suffering you went through last time.
Hope that makes sense, and good luck with whatever you decide.
^^I actually think QoB's suggestion above is well worth considering! I would add that this way you're reducing the chances that Mr. Darcy might be extracted before being fully cooked, too.
My first was c/s was due to breech. It was scheduled just before the due date, no labor. He was breech from 6 months on and never moved and I tried everything I knew how to do , but nothing worked. I was talked out of an ECV. In retrospect I wish I had tried that or waited to go into labor, but my husband had to come from far away. My c/s and recovery were good, but I didn't want another c-section because of the risks of major surgery and the problems a c/s can cause in future pregnancies and increased risk of hysterectomy, etc. Also, I did want to experience giving birth. The more I read about the true risks involved with VBAC and ERC, the choice was clear for me to VBAC.
For my second, I changed providers 3 times including flying to the US from Korea to have a better chance at VBAC. My daughter was breech as well. This time, I had a successful ECV and then went into labor on my own. I was 2 hours from my hospital. By the time I got to the hospital I was 8cm. 2.5 hours later she was born. I used Hypnobabies and it really worked. I did not have any pain medications. I also had a doula. It was definitely the right decision for me.
With 3 vaginal births before your c-section, it would seem that you are a very good candidate for VBAC. Long labors are usually a sign of malpositioning. Trying to help baby get into a good position can help: http://doulamomma.wordpress.com/2009/06/10/optima…
But that doesn't mean that this baby would be in a bad position. Waiting until the baby is well-engaged to get the epidural can help things as well. I know many people that had a c/s with their first after a long, labor for Posterior baby and then a very quick VBAC with their second babies.
Even if you get an epidural, you can be helped to change positions or even labor/push in a supported squat. That can really make a difference.
There are also benefits to mom and baby from laboring even if you have a c-section. There is no comparison between a c-section recovery and a vaginal birth. Both my recoveries were good, but with a vaginal birth I was up right away to take a shower. I had no separation from the baby and most importantly, I could walk upright, right away! If you go into labor before you c-section date, I would go for it and see what happens.
You can induce a VBAC, you just have to be more careful. You can use a foley bulb or AROM. You can also use Pitocin, though most will only augment with Pit, instead of inducing with Pit. Still, your best chances for VBAC are to go into labor on your own and we allowed to go to term (42 weeks). Since you tend to go early, this probably won't be an issue. The fewer interventions, the higher your chances, but you do have options.
If you do decide to try VBAC, I highly recommend Hypnobabies and a doula. It will help you keep relaxed and focused while you practice during pregnancy and also throughout the labor and delivery. Even if you have a c-section, you can use the techniques to relax yourself for the anesthesia.
Anyway, good luck with your decision!