How About a Do-Over?

January 15, 2009 12:00 AM by

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By Andy Garreffa-Orizotti

I could barely sleep during the last weeks of my second pregnancy. But this time, I had something new to worry about as I lay awake—shaking up my two-year-old son’s little world with a needy sibling. But my first child was, ultimately, why I decided to attempt a vaginal birth after Cesarean, or VBAC. I knew the physical limitations of recovering from a second C-section would exclude me even more from his daily life.
My endeavor was a success—and I’m not alone: According to the American College of Obstetricians and Gynecologists, statistics show that 60 to 80 percent of women who try for a VBAC do have a successful vaginal delivery. So, in spite of increase in the number of C-sections performed each year, women should know that having a Cesarean is not always necessary.

The Advantages
There are many positives to a VBAC: less risk of surgical complications and infection, shorter hospital stay, immediate contact with baby, and reduced recovery time. But the risks and benefits of a VBAC have to be weighed on a personal level.
“With family at a distance and unable to help me, it would have been nearly impossible to come home and be a mother to my toddler with the lifting restrictions and pain a second C-section would have imposed,” says Rachel Marvin of Flemington, NJ, who delivered by VBAC in August 2008.
For some, a VBAC provides what they feel they missed by having a surgical birth. Nadine Jensen of Tulsa, OK, says the main reason she chose to deliver her second baby by VBAC was for the “fairy-tale experience of ‘Here’s your baby!’ The instant skin-to-skin contact and immediate chance to breastfeed.”

The Concerns
Not all vaginal births after Cesarean follow this “fairy tale,” of course. There’s no guarantee that after a long labor, your delivery won’t result in another surgery.
One of the main things doctors look at when considering patients for a VBAC is the incision from the previous C-section. You must have a low transverse cut, one that crosses horizontally just above your pubic hair, because it creates a sturdy scar that has little likelihood of splitting. This incision is used in more than 90 percent of Cesareans.
The main risk of a VBAC, in fact, is the slight percentage increase in uterine rupture, compared to women who’ve never had a C-section. This percentage greatly increases with incisions other than low transverse. But for women who’ve had the proper incision, the risk percentage is “anywhere from .2 to 1.5 percent, depending on the resource,” according to Tyler Bradford, M.D., an ob/gyn in Bozeman, MT. You may still be a VBAC candidate if your incision is low and vertical, but your risks increase.

Other Issues
The controversy over VBACs and Cesareans has moms caught in the middle. In June 2008, The New York Times reported that some women who’ve had C-sections have actually been denied insurance coverage or were charged higher premiums because they’re considered a risk to insure. And hundreds of hospitals don’t offer VBACs because of the aforementioned risk of uterine rupture, so you may to have to change doctors if you want to avoid another Cesarean.
Bradford believes this issue will eventually come full circle, because the more C-sections a woman has, the higher her risk of future health complications. But until then, if the benefits greatly outweigh the risks for you, start a conversation with your ob/gyn now.

Read and Decide
Birth After Cesarean: The Medical Facts, by Bruce L. Flamm, M.D.
The VBAC Companion, by Diana Korte
Vaginal Birth After Cesarean: The Smart Woman’s Guide to VBAC, by Elizabeth Kaufman

Andy Garreffa-Orizotti loves using her experiences as a mom to write articles that inform other new moms. Her work has also appeared in Montana Parent.

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