What are some thoughts out there regarding VBAC, or Vaginal Birth After C-section? I had a c-section with my twins and am now pregnant with a singleton. I'll consult with my physicians, of course, but wanted to hear from the group.

I have heard some terrible stories about VBACs and am not sure if it's worth the risk. My sister's friend had to have an emergency hysterectamy at age 28 because of VBAC complications; my best friend is a physician and she's due in june with her second child (who was an emergency c-section) and although she wanted a vaginal delivery, she's going to have a c section because there are extremely high risks involved.  Obviously these things don't happen to everyone and you need to make an informed and the right decision for you. I had major complications with my c section as well so hey, there are risks to it all.

I can't say exactly what I'd do in your situation since I'm not pregnant, but I would say that my instinct would be to go for the VBAC -- a friend of mine just did so succesfully - she was induced a week or two early because they thought the baby would be too big for her -- and it was a wonderful (if complicated) experience.  I actually wrote a pregnancy book with a doctor (The Whole Pregnancy Handbook: An Obstetrician's Guide to the Wise Use of Conventional and Alternative Medicine Before, During and After Pregnancy) and interviewed a bunch of women about their birth experiences -- some had tried for a VBAC and couldn't have one, others had very positive experiences.  It's kind of the luck of the draw -- the one thing to remember about ruptures is the statistical likelihood of it happening is quite low, especially if you don't induce and don't use a specific medication to ripen the cervix (cervadil -- my friend who was induced had some kind of catheter instead). Of course if it happens to you, who cares about the statistics, but it remains most likely that a rupture won't happen.  If your doctor is a little c-section happy, then you might consider having a very frank discussion with him about your wishes and your thoughts about how much he likes to cut (I know this might be very hard) -- or you could consider changing doctors. It's just if you want to have a VBAC it's good to have a doctor really on board with your wishes.

I have a friend who had a truly awful, awful experience attempting a VBAC, ended in an emergency c-section and she had some real problems.  She did not feel that she was appropriately warned of the dangers of trying.  I did not have a c-section but there was an article in The New Yorker a month or 2 ago by Atul Gawande all about c-sections, I thought it was really good and made me very comfortable with the idea of having a c-section with my 3rd (due when my twins will be 2 yrs, 9 months) if that is what ends up happening.  Anyway, if you read it it may help you feel better about just going for a c-section if that’s what you decide to do – you can probably find it on their website.

Personally, I've only had a c-section.  However, a very good friend of mine had a c-section with her first baby and then had sucessful VBACs with babies two and three (all singletons). 

I am happy to share my experience with VBAC.  I had my first daughter C-section (I was induced and failed to progress) and my next two children via VBAC (I've had three babies in the last four years).   

First off, I am assuming you’d be delivering at a Level 1 hospital, able to assemble a surgery team in 15 minutes or less?

I think you have to go with your gut.  My (and my husband’s) feeling was, even though a C-section is no walk in the park, “if the baby is fine, we’re fine.”  That being said, I had a great relationship with my midwife who felt that the risks (1% chance of rupture) were mitigated by the 2% chance of infection or complication that comes with any surgery (I think C-sections are so common these days that no one thinks of it as the major surgery that it is).  However, that being said, my midwife was not in favor of inducing a vaginal delivery.  In short, if I didn’t go into labor naturally, she wouldn’t advice the VBAC.  For whatever reason, that helped create clarity for me and my husband.  If nature was taking its course and I went into labor naturally, then we’d try a vaginal birth.  If not, C-section it was. 

I had a c-section with my triplet boys.   When I delivered the boys, I lost 2 liters of blood because my uterus would not contract, but finally it did (just prior to my ob/gyn deciding to give me a hysterectomy).   My c-section delivery was less than straight-forward. When the boys were ~12 months old, we were surprised to find out that I was pregnant again.  I actually liked my c-section, and requested another one, but my ob/gyn was very much in favor of VBAC.  I did my research, I spoke to other doctors, and in the end I decided to let my doctor sway me away from my desire for a second c-section.  I knew that she was the expert, and she knew my body, having delivered the triplets.

My VBAC was incredibly easy and I didn't have any complications.   I was on my feet and back to normal much sooner after the VB than I had been after my c-section.   If I had chosen a c-section, I wouldn't have been able to lift the triplets when I got home, and my activities for the first few weeks would have been more restricted.

I realize you have already gotten various medical opinions, but I forwarded your message on to my sister-in-law who is an OB-GYN as well as the mother of two children (both delivered naturally.)  Since she is not definitely not in the pro-c-section camp, I figured she might give you a different view from your doctor...

"There are risks and benefits to everything.  One needs to personally weigh the risks and benefits for a repeat c-section vs. a trial of labor TOL/VBAC.  For the repeat section, there are all the inherent risks of surgery (which are NOT zero).  For a TOL, there is a 10% risk of rupture, which is also not zero.  We do TOL all the time and a doctor watches the mother and her baby very closely during labor and will have a low threshold for c-section if things start to look abnormal. We offer this choice to patients because there are risks both ways and we need them to decide which risks they are more comfortable taking.  We are comfortable either way.

I'm assuming that the first C-Section was because of the position of the babies.  If it was actually due to failure to dilate or inability of the baby to fit through her pelvis, then one has a high chance of that happening again and may want to just go with the repeat c-section...but most doctors would advise their patients of that anyway."

Congrats on having a third! I also had a c-section with my twin girls, but was fortunate to have a successful VBAC with my third daughter.  My doctor was strongly pushing a c-section, and I have a very good friend who lost her baby after an unsuccessful VBAC (that was 7 years ago, though, and my friend was not at a hospital on the level of Cornell and she was pregnant with a very large baby -- she should never have been a candidiate for a VBAC.  I felt my doctor wasn't really helping me understand what could make it possible for a VBAC to work.  While I was terrified to think of an outcome like my friend's, I also felt that if we were being careful I could avoid an emergency, and if I needed a section, Cornell is the kind of hospital that could handle it.  Nonetheless, I spoke to my cousin who is a family practitioner outside of NYC and he said that the main two things to consider are:  the approximate size of the baby (8 lbs or over I shouldn't have a VBAC) and whether I go into labor naturally (if I had to be induced I should have a c-section).  My baby was 6.1 and I went into labor naturally.

I was in your shoes just 11 days ago when I had my third child after twins 22 months ago.  I was so, so confused about which way to go. My doctor nudged me in the c-section direction, though his partners (both women) felt strongly I should try a VBAC.  I was terribly stressed about the decision and in the end felt that since I couldn't use the ripening agents, the prostaglandins, that I should go the safe route and do the c-section.  That's what I did.  And it was more stressful and a little more barbaric than I remembered the first time around.  But the good news is that five days later, when  you walk out of the hospital, you're almost recovered.  And now almost two weeks later, I'm like new.  Did not ever have much pain afterward and now am basically back up to speed. 

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