I'm sorry, but your question is outside of my sphere of expertise
as it is a clinical question specific to your obstetric history,
not one that would be addressed in a study. I think your best bet
would be to consult an obstetrician who encourages VBACs and see
what he or she says about it. That way, if the ob recommends a
planned c/sec, you will know it isn't because the ob would rather
just do repeat c/secs. The trick these days is finding such a
person. The local home birth midwives, doulas, and childbirth
educators are likely to know if such a person exists in your
community. If there is no one who fits this bill close by, it might
be well worth while to travel for this consultation, seeing as your
situation is complex, and a major decision is riding on it.
If you can find someone satisfactory, here is what you need to know
in order to make an informed choice:
* What this practitioner recommends and why.
* The pros and cons of planned cesarean delivery vs. planned
vaginal birth, including how likely problems are to occur.
You also aren't looking at an "all or nothing" issue. There are
choices within choices you may wish to discuss. For example, it is
likely that the torn cervix happened during the failed forceps
attempt. You might decide to plan a vaginal birth, but if it comes
to a vaginal instrumental delivery or a c/sec, you will take the
c/sec. Or you might decide to plan a c/sec, but you want to wait
until labor starts before having it to ensure that your baby is
ready to be born.
I suggest you go with your partner to the consultation appointment
because your partner is also likely to have questions and concerns.
In any case, go with someone who can debrief with you afterward.
Write down a list of questions ahead of time and take notes on the
answers. That way you won't forget to ask something important, and
you won't have to count on your memory to recall what was said.
A good source of general information on the planned VBAC vs.
planned c/sec decision is
VBAC or repeat c-section?
on the Childbirth Connection
Of course, there is more to this decision than information. Your
personal values and feelings enter into it as well. Along those
lines, it is not uncommon for women who have had a birth as
difficult and frightening as yours must have been to have symptoms
of post traumatic stress. These include flashbacks, nighmares, high
anxiety, hypervigilance (feelings of being on "high alert" all the
time), strong avoidance of anything that reminds you of the
experience (ex.: inability to walk into a hospital). If you are
nodding your head at any of these, getting some help at working
through the trauma will help you make a clearer decision freer of
subconscious pressures. Working with the right mental health
professional can be of great value. Again, the locals may know who
is knowledgeable about birth trauma.
If you decide to plan a vaginal birth, I strongly recommend hiring
a doula. Both you and your partner will benefit from having
continuous support from a skilled and experienced labor companion.
If you want to know more about this option, Who
can give me support during labor and birth?
on the Childbirth
Connection site is a good place to start, and here is some
additional information on the research
supporting doula care on the DONA website.
-- Henci By: Henci Goer