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VBAC or C Section: The Question We've Been Dreading

The million dollar question.

Caroline turns 29 weeks tomorrow. That, of course, leaves just 11, assuming she goes the distance. Believe it or not, thanks to what can best be described as some pathologically aggressive nesting tactics, we’re pretty much all set when it comes to the nursery. We’re good to go on baby-proofing as well.

So that leaves 11 weeks to ponder a very important matter: to VBAC or not to VBAC. That is the question.

Caroline’s first child, my beautiful stepdaughter, was born vaginally. And when we first found out Caroline was pregnant the time before this, there was no doubt in either of our minds. Vaginal birth was the way to go. But that all changed when we learned she was carrying triplets. At that point, Caroline’s doctor all but told her she’d be having a C-section.

Carrying triplets already put her in a high risk category. Her age (38 at the time) would have done the trick as well. Then you take into account my wife’s petite 5’2 frame? Yeah. C-section.

Caroline learned first hand with that C-section that major abdominal surgeries are nothing to sneeze at. They’re hardcore, invasive processes. Despite being in excellent physical condition, it took her quite some time to recuperate. Frankly, it wasn’t pleasant.

Neither, however, are VBACs gone wrong. The chances, no matter how remote, of uterine rupture? They can be frightening.

So what to do? There are compelling arguments on both sides, which, at least initially, surprised Caroline. After all, it wasn’t very long ago that “once a C-section, always a C-section” was the common thought. But as pointed out yesterday in an excellent feature slide show on Babble, that’s nothing more than a myth. (Learn about 10 other pregnancy myths that Babble debunked by visiting the slide show now!)

Last July, Ceridwen wrote an excellent post in the wake of an announcement made by the American College of Obstetricians and Gynecologists (ACOG). The College was softening its original and cautious stance on VBACs and were encouraging doctors support a woman’s choice to try for such a birth.

Ceridwen correctly points out that the question of VBAC vs. repeat C is an incredibly hard one to answer. In trying to do so, risk must be assessed. Yet even when you do just that, it’s still hard to find a clear-cut answer. Consider this stat, again, courtesy of Ceridwen’s post:

According to the numbers ACOG is using, if you try for a VBAC, you have about a 99.2 percent chance of no uterine rupture (lower without induction). If you have a c-section, you have about a 99.5 percent chance of no uterine rupture. That would make the chance of a uterine rupture with a repeat c-section and VBAC without induction about the same. But with a c-section, you have the added risks of surgery.

I would counter Ceridwen’s last point with this one. Along with the added risk of the c-section surgery would come one significant benefit: opting for a repeat C would take a lot of mental anguish off of Caroline’s plate now. And that has to be considered, as well.

We were hoping to lean on Caroline’s OB/GYN to more or less make the decision for us, but he made it clear from the get go that he would do no such thing. (Which is a sign that he’s a true pro. He recognizes it’s not his decision to make.) However, he has been more than willing to discuss pros and cons with us and, like Ceridwen, he could argue all day long for both sides.

At the end of that day, however, we get the sense that he just as soon see Caroline opt for the repeat C. And I’m pretty sure I know why. Last pregnancy was a grueling one for her. It proved to be quite heady as well. And by the end of it she was spent, both emotionally and physically. This pregnancy wasn’t exactly a piece of cake either, thanks in large part to the psychological elements which accompany an unexpected pregnancy as well as the fact that while pregnant, Caroline’s been constantly bombarded by three fussy toddlers every step of the way. Don’t forget our 9-year-old, either.

So it’s been more trying than either one of us could have ever imagined. And Caroline’s constantly exhausted. And while I’m not suggesting that she’s too tired to research the matter (for anyone who knows her would tell you just the opposite—this is something she’s been taking very seriously), I am suggesting this: the last thing either of us want to see is for my wife to agonize over this for 10 weeks, finally opt for a VBAC, only to then fall into the category of the 20 to 40% of women who try for VBACs, but are ultimately forced to have a C-section.

And, again, I get the sense that her OB/GYN feels the same way. But he’d never come right out and say it. For I’m certain he’s 100% with Ceridwen when she writes this:

I think the decision about whether or not to VBAC is something we have to leave up to each woman. She should be well-informed rather than freaked out and/or pressured by various agendas, and she should find a doctor or midwife who supports her decision, whatever it is.

One comforting thing about the decision Caroline has to make? She’s got an incredible OB/GYN (even if he does have the hots for her—don’t worry, I’m cool with it…) and he’d support either decision 100%. As, obviously, would I. And through this process she’s become quite informed.

And for all of those reasons, whatever she chooses will most definitely be the right decision, indeed.

Image: stock.xchng

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