Do you have VBAC advice or references?

[ShanaMama]

Hi everyone. My friend is currently going thru a very difficult pregnancy (bed-rest & meds due to preterm labor starting all the way at the beg.) and debating a VBAC.
She comes from a very medical family who are (not so) sublty encouraging her to go for an elective C-section. Her DS was born thru an emergency CS. She has very little support other than her parents & myself, and she is close to my mom who is a midwife.
She is pretty well educated on the risks vs. benefits, but I don't feel like she's getting the entire story from her doctors. They say they'd support a VBAC if she chooses, but my feeling is that they are sublty pushing for a CS, due to the info she seems to be getting. (I am hearing everything they tell her second hand, so I can't be sure of that.)
I really want to encourage her to do what's best for her, & not push one option over the other. However, I have no research to back me up other than my own opinions & my mom's subconsious agenda.
Some of her main concerns are:
1. Opting for a VBAC & ending up with a repeat emergency CS. Per her OB, this is a worse option than an elective CS, presumably because her body will undergo the additional trauma of labor? I don't really see the logic there.
If she & I understand correctly, either a scheduled or emergency second CS leaves her no more option of VBAC with possible future DC.
2. Additional risk (of rupture, etc.) for a VBAC due to the preterm labor. I don't know if she discussed this with her OB - this was her own concern, not based on any actual knowledge of increased risk.

She is now at 33 weeks & very weary & worn out from all the meds, trips to the hosp, being homebound, etc. I think she's getting cold feet about the VBAC b/c she just doesn't have strength to think about labor. I am pro VBAC but as I said, I only want to arm her with info & encouragement - she needs to make the decision.
If any of you have BTDT or have advice on any of the points mentioned or VBAC in general, I'd really appreciate it. TIA

[BaileyBea]

My good friend had a CS w/her first child due to complications and the inability for her body to progress in dilation and the baby didn't want to move down the birth canal. She prepped and went for a VBAC with her second child.

Again another hard pregnancy and again her body in labor didn't progress. They decided to do an emergency c/s. Then due to the hours of labor and stress etc... she had a hemmorage, the next day another hemmorage, and the morning after that her last hemmorage. She had 3 blood transfusions and nearly died. They ended up doing an emergency hysterectomy. She's fine now and it's been nearly a year.

But it was scary. I was one of the few people who supported her VBAC. And looking back I would still do so but I would tell her that when the time came and if it seemed a c/s would be the best answer for her then I would support that too. She just needed someone to tell her that both options did not take anything away from her Motherhood or Womanhood.

I think the best thing is to provide some help for her. Maybe contact a Doula and Midwife to talk to her about a VBAC and listen to her situation. They will hopefully offer her support and give her the best answer given her situation.

I learned that some things are not worth risking. If her health isn't up for a vaginal delivery which can be very hard for some women then a C/S is the safest option for her overall health. I just wouldn't want anything like what happened to my friend to happen to anyone else.

You're a great friend for being there for her.

[kijip]

No advice but lots of good thoughts for your friend. Whatever happens and whatever she decides, I hope that it all ends well. That is the most important thing.

[Momof3Labs]

There is a VBAC board at mothering.com that should have a lot of the info that you are looking for. It is a tough decision, and insisting on a VBAC may leave her looking for another OB at this late stage - could she handle that along with bedrest?

[chlobo]

Wow, tough choice. I am all for VBAC but please urge your friend to not just consider possible complications but whether she'll actually have the stamina to go through labor. It sounds like her body just might not be up for a long labor & delivery. Just something to think about.

[KrisM]

D aI don't have any specific info, but I wanted a VBAC with DD and came close, but ended up with a c/s. At my 2 week check, the OB said I would have to schedule my next birth (if there is one) as a c-section. I asked if it wouldn't be possible to go into labor naturally and then go in for a c/s? She also seemed to think that any labor would be bad on my body, which goes to your first question.

Hiring a doula would help for a VBAC. I loved having mine and she even helped me through the c-s a bit, too.

Good luck to your friend.

[kellyotn]

Wow. She sounds EXHAUSTED. What jumps out at me is that "she doesn't have the strength to think about labor". She might not have the strength to *undergo* labor. That much bedrest really weakens the body - muscles, lung capacity, etc.

Given her weakened state, going thru an exhausting labor only to end up with major surgery would likely be worse than a planned c-section with regard to recovery. I've had two planned c-sections and recovery was very easy. My sister had an emergency c and had a slightly more difficult recovery. My friend had a VERY scary very emergency c and had a horrific recovery. (She had to "live" in the lower level of the house for a few weeks because she couldn't walk the stairs even. It took her far longer to be back to normal than it did for me.)

The ideal situation, obviously, would be an easy, fast, non-induced VBAC birth. But, any labor past that, her body and mind just might not be up for it. I think all you can do is support her and let her know she's a success either way. Surviving that much bed rest, she's already a hero.

If she attempts it, can your mom act as her doula? She'd probably need all the mental and physical VBAC support she could get at the hospital.

I'll be thinking about her!

[ShanaMama]

That is so frightening! I'm glad your friend was ok in the end, but wow- she really almost died!
I'm sure that was a unique case, but that's the type of thing my friend is scared of. Apparently her mother didn't dilate past 5 cm. I don't know if its hereditary but she hasn't ever gone thru labor & childbirth to be confident that her body *can* do it.

[ShanaMama]

Thanks- I'll check it out.
No way will she switch OB's. I sometimes wonder who she loves more, her DH or her OB. Just joking but she swears by them.
Also, she is definitely not insisting on a VBAC. She's really just exploring it, & I'm trying to search out some facts to give her to counter the emotions.

[ShanaMama]

That's an excellent point. AS a few of the pp have said- she may just not be up to the physical *labor*.
She is also feeling very demoralized & doesn't have confidence that her body can do this. So that of course adds to the mix.
I keep telling her that there's a reason she lives in this century, & all the technology we have is there to be used. There is no reason to feel like a failure for not birthing her child naturally.
A large part of her uncertainty comes from the feeling that her body just 'isn't cut out for this'. (In her words:) It couldn't handle birth #1, it couldn't handle bf, it couldn't handle pregnancy. Why should anything change now?
I feel bad that she is so unconfident (is that a word?), but I can just try to encourage her. The main thing is to do what's safest for her & her baby.
She had a very difficult recovery from the first CS. Can you give me a little more details on why you felt that your recovery was easier?
I think if she was convinced that the recovery wouldn't be so bad, she'd go with a planned CS.
Thanks for all your help!

[ellies mom]

I had a scheduled C-section with an easy recovery so I'll jump in here as well. I think having the c-section without out labor is a big part of what makes for an easier recovery. When you have an emergancy C-section after hours of labor your body is not only exhausted from labor but now it has to recover from surgery as well. It is like the worst of both worlds. Another aspect of a planned C-section that I think makes a difference is the emotional/mental part of it. When you are geared up for a vaginal birth, especially if you planned on a meds-free one, and then have to have a c-section, I think the emotional recovery can hamper the physical recovery.

[KBecks]

I have never had an emergency c/s, but have had 2 planned c/s and one major uterine surgery.

I think the difference is that the planned c/s is controlled and less frantic than an emergency c/s. The process is fairly relaxed, and you get to stay awake (not always the case with emergency c/s).

All my uterine surgeries have had easy recoveries. I was feeling really good by the 3rd day.

For me, planned c/s was about minimizing risk and choosing the safest delivery option, and my experiences were good.

Anyway, you can search here for VBAC info too.

[kellyotn]

Mine were both planned. My first was stuck breech in my very heart-shaped uterus. I initially wanted a hypnobirth (in large part to avoid a needle in my spine)! I chose a repeat after much thought. I had many friends who had wonderful VBAC experiences and I wanted that BADLY, but for me a repeat c-section was the right choice.

For ME, my recoveries were easy. Key things that helped were just the casual nature of things. Yes, I know a c-section isn't casual, but it was calming to me when my mind was racing and I was FREAKING out to listen to the docs talk about random chit chat during the surgery. At first I was ticked, then I'm like, "Well, if they can talk about the doc's baby's sleeping habits while I'm laying here, things must be going well." ;)

I walked as soon as humanly possible. A bit sooner with my second, actually (had to get to the NICU). I walked the halls, the room, just got up and got moving - slowly and carefully, but up. I allowed my daughter to sleep in the nursery for three hours on the third night. She'd been rooming-in and didn't sleep a bit at night. Before being discharged the next day, I took the opporunity to have her in the nursery so my husband and I could catch up on some sleep before going home. If the baby rooms-in, the dad needs to be there all night. If not, no shame in using the nursery if the hospital has that option. (Of course, she slept like an angel there according to the nurses! She never slept in the room at night, just during the day!)

I took all the pain meds offered in the hospital, so I could sleep, etc. At home, I didn't fill out the prescription. Just didn't need them, but would have taken them had I needed them.

In an ideal world, and easy, fast, non-induced VBAC would be best. But, given her emotional state, her lack of confidence in her own body, her physical state after enduring bedrest for so long I just wonder how they'd decide how far to go in getting a VBAC? If things get rough, how much energy does she burn before either finally having the baby vaginally, or deciding for the section. It would be hard to balance, the more energy gone, the more I'd want to "succeed" to make it "worth it", but there may not be enough energy to make it, so the potential c-section recovery is getting harder and harder, etc. Its a HARD choice.

I think she also needs to understand that she's not superwoman. ;) I hope she takes any and all help offered. She's been on bed-rest, and while its helped her baby, its hurt her. Gosh, just this week I had a 24 hour bug. I went to bed at 6 pm and wasn't feeling better until noon the next day. I was sore from just that short amount of time in bed.

(edited for typo)

[JTsMom]

I have no knowledge about VBACs whatsoever, but I just wanted to give another POV regarding emergency C's, just in case she does decide to go VBAC and it doesn't work out....

My much planned out hypnobirth with Jason turned into an emergency C-section after 11 hours of labor. Now I may be the exception to the rule, but I had a really easy recovery. The only pain med I took was Ibuprofin. I walked A LOT, which I think helped. Several nurses told me that mindset has everything to do with how quickly/well you recover. I was HIGHLY motivated to recover b/c I knew if I could show my Dr that I was doing well I could leave, and I wanted to be with the baby (he was air-lifted to a Children's Hospital b/c of his heart condition). I left the hospital about 46 hours after surgery.

For the first 24 hours or so after birth, I didn't do much, but after that, it really wasn't that bad. My hospital doesn't even have a nursery, so all of the babies room in- you have no choice. DH had to do all of the diaper changing, and hand the baby to me to nurse. The only really bad part was trying to roll over in bed.

Anyway, just wanted to say that an emergency C doesn't necesarily equal a nightmare recovery. Of course mine wasn't a REPEAT C, so that might make a difference too.