Tuesday, September 29, 2009

To VBAC or not to VBAC?

I wish I was one of those women who felt the act of giving birth was wonderful, beautiful, spiritual. Yes, there is certainly something of a miracle about it, I understand. But I was dreading the experience for the entire 8 1/2 months I knew I was pregnant. The horror stories you hear... and the excrutiating pain! I am not a big fan of pain, even when it's only moderate. Although I was excited to meet the small person growing inside of me, I constantly wished there could be a more pleasant way to make that meeting occur. I'm picturing myself laying down on a table and being draped with a magic black cape... now you see a women with a baby tucked away on the INSIDE of her stomach... abra cadabra... now you see a women holding her baby in her arms on the OUTSIDE of her stomach! Thank you! Try the veal and don't forget to tip your waiter. I'll be here all week.

Perhaps a self-fulfilling prophesy, my labor and delivery (more the delivery part, actually) with Bean was a nightmare. When I go back and read the birth story, while all the relevant details are included, I think it's really missing the trauma that I still carry with me from the long and trying process. The 24+ hours of labor and three hours of pushing were insufficient to deliver my 9 lb 14 oz blessing, and a C-section was performed at 10:30 pm. By then, DH and I had been up for something like 40 straight hours. When we met our son, we were beyond exhausted. Even the adrenaline that comes with your child's first few hours of life couldn't entirely overshadow the fact that we were recovering from more than a full day of labor followed by major surgery.

Knowing what I know now, I have many regrets. I took the childbirth class at our birthing center, but I really thought everything would just happen naturally. Now I wish I had paid more attention instead of singing "La la la la la! I can't hear you!" in my head, and done more research on my own. My nurse was way too young and inexperienced to be much help, and my OB, whom I loved during our prenatal care, was next to useless until it was time for the C-section. I think hiring a doula would have been a wise decision.

The hardest part is wondering: Could I have delivered him myself, if I had been smarter about it? Less mediciation when I started pushing, more effective positions, etc.? He was a large baby, true, but many women deliver larger. Heck, my friend just gave birth to a 10 lb 4 oz bundle of joy without so much as an aspirin! But pelvis size also comes into play, and I've never had what you might call "child bearing hips." The woman who altered my wedding dress wrapped the measuring tape around me and said, "Hmmm, you really don't have a waist, do you?" (Now I do, but sadly, it goes outward instead of inward.)

Anyway, one of the first things that came into my mind when I got pregnant again was: Oh God, how am I going to deliver this baby? I could schedule a repeat C-section... or did I want to try for a VBAC (vaginal birth after Cesarian)? Niether one really appeals to me.

To be completely honest, when I found out it was twins, I felt a sense of relief that I could certainly count on a repeat C-section. It's hard enough to find a doctor and a hospital willing to let you try a VBAC these days, because it is risky and they don't want the liability. (In fact, the birthing center where I delivered Bean does not allow VBACs, although the new hospital we chose does. Lucky me.) I figured it would be next to impossible to find a doctor who would let me try a VBAC with TWINS -- as I have to guess it's slightly more risky than trying with a singleton.

Imagine my complete shock and horror when my new OB asked, "So would you like to try a VBAC this time?" After I found my voice again, I let her know that I had considered it at first, but was more hesitant with twins. She was very laid back about it, and suggested that I play it by ear. "If you go into labor and want to give it a shot, no problem! You don't have to decide until the last minute."

Personally, I can't imagine waiting until the last minute to decide whether I'm going to try a VBAC. As I said, there are many things I want to learn before going into that situation again... I won't be flying blind this time. And she did point out that the decision still may be made for me, if Twin A is breech we will have to do another C-section.

I haven't done much (read: any) research on VBACs at this point. I obviously have a lot of time to make the decision. And I'm still wading through When You're Expecting Twins, Triplets, or Quads that Carrie recommended. Obviously gotta finish the pregnancy book first, one step at a time. And I'm really crawling through the pages, because I don't want to get to the nutrition section. I'm guessing that the butter sandwich, loaded baked potato Pringles, and assorted Jelly Beans that I ate for lunch won't really fit into the guidelines. But damn, it was yummy.

The main three reasons I would like to consider a VBAC:

1. It is healthier for the babies travel through the birth canal. Although why they can't just give the babies a good squeeze when they get pulled out of my abdomen, I don't know. Doctors can create an artificial heart, but they can't simulate what it's like to crawl through a very narrow tunnel? I highly doubt it.

2. Recovery time is (supposedly) shorter with a vag birth. I will have two hungry munchkins to feed and one very sore belly if I get a C-section. Yeouch.

3. I will have the opportunity to sort of "rewrite" my own perceived failure of birthing the Bean. These two babies will be smaller (God help me if they both weigh nearly 10 lbs) and perhaps easier to fit through. I don't feel the need to be a hero, but it would be a nice personal accomplishment if I can pull it off.

The reasons I would like a repeat C-section:

1. No risk of going through the ENTIRE labor/pushing process, only to end up on the operating table once again. Recovery from a C-section might not be a walk in the park, but it's better than going through almost the entire vag delivery process first. I don't think it's good for me or the babies to have that experience repeated.

2. There are dangers of my uterus rupturing from the previous C-section. Still need to research the stats on this. I've heard it's not as common as some doctors make it out to sound. But still... concerned about this possibility.

3. They can tie your tubes and give you a tummy tuck while they have you open. So I probably wouldn't do either of those things, but it's nice to have the option. I wonder if they'd do a boob job too?

4. We would know the delivery date and could plan accordingly. We can have family fly in to help with Bean and then with the care of the newborns. This actually isn't as strong of an argument in the case of twins, because the chance of me making it to the actual date of the 38-week planned C-section would be somewhere around 40%. If I go into labor early and need to hop quickly to the hospital for my C-section, we will still have the problem of needing help with Bean and the newborns, just as we would if I try a VBAC.

I think those are my main concerns at this point. Like I said, much research still to be done. But I'm definitely curious in hearing from any of you who have done a VBAC. I've actually found from women who have BTDT (been there, done that) that the VBAC recovery is actually not any better than a C-section for many of them. I'm open to any advice or thoughts on the situation.

Or maybe someone knows a really good magician?

17 comments:

Kristina P. said...

I had no idea you could do vaginal after cesarean. All I know is that I will be taking drugs when I have a little one.

Kate said...

Wow, the pros and cons are both compelling to me. I know most people I know who have had C-sections do not try vaginal deliveries afterwards. I personally think I'd go for a C-section but I've never been there so I don't know. Good luck with your research and decision.

Jen said...

I love the idea of you just winging it going into labor with twins, a two year old at home and no family in the area. It would be nice to have a plan A at least right???

A Mom in Jacksonville, FL said...

Impressed that you've so completely thought out both options at this stage of the game and that you're STILL thinking it out. I am a thinker/planner too!

Definite pros and cons to both. Hope your choice eventually hits you and DH as being "THE ONE," so that you don't have to fret over it anymore. :)

Stephanie Faris said...

My sister was trying to but ended up getting another Cesarean. It's up to you. Although I have to say there's something about going in and having that baby without hours of labor...but I've never had a child so I don't know much!

joyce said...

Hi, I'm Hollyween's sister. I didn't have VBAC (dr. wouldn't allow it), but I just thought I'd let you know that my second experience with a C-section recovery was SO much easier. I knew what to expect as far as pain was concerned, plus I wasn't all tired when my whopping 10lb. 5oz. baby was pulled out. It was great! My 4 day stay in the hospital was amazing and extremely relaxing (I had 2 wild boys at home that I needed a break from anyway:)) Just thought I'd share that with you. Good luck with your decision!!

Michelle said...

I don't know personally but my sister had a VBAC after an emergency c section the first time. Things went VERY smoothly (besides the 27 hrs of labor after rushing to the hospital because they said she would have the baby fast because she went so FAST the 1st time). She was home within 24 hrs and doing really well. She did not have any complications and she said it was SO much better then the c section and was very happy she did it!

Kristi said...

I have no advice here, as I had two c-sections, but I will admit to being really surprised that you even have the option of a VBAC with a twin pregnancy. That's great. Personally, I would probably opt for the c-section, only because I am way too much of a Type A to wing it. Planning is my middle name, and the ability to know the date (should you go full term) would be huge factors for me. Good luck with your decision!

Coffeegrl said...

I think the key might be to just focus on what the goal is and thinking about how to make it happen. Are you thinking you might go in the direction of a doula this time around? That might be a big help either way. I had a friend who ended up having a c-section and didn't need her doula's help in the way that she thought she would. However, in the end, my friend felt really good about the decision she and her husband had made to go ahead with the last minute c-section b/c they'd had some support and validation from the doula and had decided that they went to the hospital to have a baby, not a vag. delivery. Maybe if you're not really "committed" to a vag. delivery you won't feel like it's such a letdown not to have one?

Red said...

Wow - it's great that they offer you the choice to VBAC given the twin factor.

I like you idea of deciding whoch outcome you could least live with - could you apply that to this situation?

Re: your experience with Bean, I have heard that having a c-section AFTER labouring is like getting hit by a car and THEN a bus. If you could just guarantee that that wouldn't happen this time...

Maybe you *could* call the magician?

WiseGuy said...

Laughing at 'I wonder if they'd do a boob job too?'...

..This is a decision that you can best take....If I had been in your shoes, I would have possibly gone for a C-Section again...my OB is also a plastic surgeon! ;-)

Nicky said...

I'm going to be watching your comments and decision VERY closely on this one. I'm not pregnant again, but hope to be someday, and my first labor experience was awfully close to yours (23 hours, several hours of pushing, followed by c-section, for a ~9 lb baby with an awfully big head).

I have no regrets, mainly because I believe 100% that nothing could have been done differently (his head did not fit through my pelvic bone, but there was no way to know that for sure until I was pushing), so the ONLY thing that makes me sad about the experience is the thought of needing repeat c-sections. As soon as I could walk again, I was reading up on VBACs, and I *still* don't know if I'll want to try it someday....

Martha said...

I wish you the best for both your health and that of your babies of course, I also hope they and the Docs will guide you as to the safest option. ((Hugs))
Thanks for your sweet Birthday Greetings, You Rock!!!

bbrsbaby said...

I don't have any firsthand experience either but I can see both sides of the situation. I was terrifed to vaginally deliver the twinnies and it ended up being easier than I thought thx to the epi. I say go with your gut and prepare yourself for both scenarios as best you can as you never know what will happen. The size difference between baby A and B makes a difference too, I think its more favorable if A is bigger to 'pave the path' so to speak. On the plus side at least you won't be having to give birth to two 10 pound babes, or at least I hope you won't ;).

Furrow said...

I would normally be all for a VBAC, for the pros that you listed, but the odds of delivering naturally with twins is so small these days, even with a previous vag birth, I'm not sure I'd even try it. That said, even a small trial of labor is said to be beneficial. But you're very likely to end up with a C-section anyway.

Sarah said...

Thanks for the shout out, :). I have a friend who had a successful VBAC. She linked up with a mom in DC who started a non-profit or something about VBACs. I'll see if I can get you the website to check out. It may help you with your decision. My friend felt motivated, but she was NOT carrying twins! She also didn't have a history of carrying large babies. No matter what you decide, you are amazing for bringing these new lives into the world - regardless if it is a magician, a big push, or a surgeon.

Chad and Gena said...

Best of luck to you in the decision that you make. I too have had a friend that had a successful VBAC. I personally delivered twins vaginally. They were my first babies and I had a long labor. Twin A (out first) was smaller than Twin B and he was transverse but my doctor still let me go for it and it all worked out wonderfully. I did have a doula and did my first 24 hours of labor naturally.