3 cs then VBAC?

Archived User

3 cs then VBAC?

 Is a VBAC nuts if...

1. csection : failure to progress

2. vbac 8.8 lbs

3.vbac 9.6 lbs

4. vbac 8.6

5. csection: fetal distress

6. vbac 9.3

7. vbac 9.15

8. csection: breech

9. Vbac?

Am i crazy? or irresponsible?

Karen

Henci Goer

RE: 3 cs then VBAC?
(in response to Archived User)

Absolutely not! The fact that you have had VBACs means that you will almost certainly have another uneventful VBAC. By contrast, each cesarean comes with risks attached to having surgery, including greater likelihood of injuring internal organs because of internal scar tissue (adhesions), and accumulating additional cesareans escalates your risk of life-threatening placental attachment complications* in future pregnancies. Not to mention the easier recovery with vaginal birth, which is no small thing with your large family. Since you already have three prior cesareans, though, I would recommend VBAC in a hospital staffed and equipped to handle urgent cesareans 24/7 because you are at higher risk for those placental attachment problems. 

* placenta previa: placenta covers the cervix partially or completely; placenta accreta: placenta grows into the uterine muscular wall and sometimes through it; placenta previa and accreta in combination

~ Henci

Archived User

RE: 3 cs then VBAC?
(in response to Archived User)

Henci, apologies for another question: What hospital will let me VBAC after 3 c sections? It was a nightmare to VBAC after 2. They told me the "climate" had changed since my previous VBAC, which was the previous year and the hospital wouldn't allow it. (This was with #7.) I fought to be allowed and was successful, but it was awful. Do you have a suggestion? I am trying not to freak out. My recoveries from the natural births were nothing. The c section recoveries were very difficult and I'm pretty tough. Thanks for your time.

Karen

mom to : Wesley 16, Shaw 14, Julian 13, Cheyenne 11, Vaughn 6, Kade 4, Rafe 3, Brooklyn 2 and baby due 10/11

Henci Goer

RE: 3 cs then VBAC?
(in response to Archived User)

 I was hoping VBAC access wasn't going to be a problem for you since you have managed to obtain VBACs despite multiple cesareans. Fortunately, you've got some time to see what can be done. The International Cesarean Awareness Network has a page with recommendations on what to do if a hospital refuses VBAC. Here is a quotation from the Joint Commission's consumer pamphlet "Speak Up: Know Your Rights" that should be helpful.  (The Joint Commission accredits hospitals.)

• You have the right to be informed about the care you will receive. . . .

• You have the right to make decisions about your care, including refusing care. . . .

• You have the right to be listened to.

• You have the right to be treated with courtesy and respect.

Finally, here is a quotation from the current (2010) VBAC guidelines put out by the American Congress of Obstetricians and Gynecologists:

Respect for patient autonomy also argues that even if a center does not offer TOLAC [trial of labor after cesarean], such a policy cannot be  used  to  force  women  to  have  cesarean  delivery  or to deny care to women in labor who decline to have a repeat cesarean delivery.

This statement is followed by:

 When conflicts arise between patient wishes and health care provider or facility policy or both, careful explanation and, if appropriate, transfer of care to facilities supporting TOLAC should be used rather than coercion.

Nonetheless, the language is there, and you can use it to politely but firmly insist on them either providing you VBAC services or find you a facility that will that is nearby enough that it will not create undue safety (distance to drive in labor) hazards or financial barriers (won't take your insurance).

Please let me know how things work out for you.

~ Henci

Archived User

RE: 3 cs then VBAC?
(in response to Archived User)

Thanks for your help so long ago. I am going in tomorrow to get an amniotomy at 39 weeks because of PIH. My Dr is letting me do a ToL. I hope this VBAC is successful! I will let you know.

Karen

Henci Goer

RE: 3 cs then VBAC?
(in response to Archived User)

I hope all goes as you would wish, and I look forward to hearing from you. If you will forgive the liberty, I'm going to suggest reframing the language around VBAC you have picked up as it may help you feel more empowered. "Letting" you do a "trial of labor" implants that the decision is your doctors', when, in fact, the choice to agree or refuse surgery is yours, and "trial of labor" implies that this is an "iffy" proposition and not the norm, when, in fact, labor is what happens at the end of pregnancy and with optimal care, the vast majority of women will birth vaginally. "Successful" VBAC is problematic because it suggests that a labor that ends in a cesarean is a failure. I think you would be better off thinking that you have chosen to plan a VBAC that will probably end in a vaginal birth but may end in an unplanned cesarean.

~ Henci

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