Question of the Month...
Dear Cindy-
My last baby was born by c/section after a long and complicated labor. I had been induced because I passed my due date and ended up getting an epidural because of the Pitocin. My baby's heart rate dropped and I had an emergency c/section as a result. I really want to have a natural birth this time but my doctor says I should probably schedule another c/section for the safety of the baby. What should I do?
-A.G.
Dear A.G.-
Obviously there are many factors which can effect the safety and chances of success for any VBAC (vaginal birth after cesarean). Typically though, in a woman who has a documented low transverse uterine scar and is otherwise low risk, there is a really excellent chance a VBAC will be successful. The reason the original c/section was done also matters, since certain things predispose a woman to need a repeat c/section (such as physiologic conditions) while others were done for reasons that are not necessarily likely to repeat (such as the baby's heart rate dropping). Some OB/GYNs (and midwives for that matter) do not feel comfortable attending VBAC births, but it would be fairly easy to find someone agreeable to this on Oahu. Generally, it is common practice to offer patients the choice of VBAC or repeat c/section. One of the biggest reasons providers fear women with uterine scars is the risk of uterine rupture during labor (or, in rare cases, during pregnancy). The risk is very small (less than 1% in women with a low transverse scar) but when it happens, it is catastrophic. I think the most important thing is to find a provider you trust and knows what your desires are. Providers who schedule a lot of cesareans and/or inductions, have rules about wanting patients to deliver by their due date or within the first week after, or those who are uncomfortable with your choice to VBAC will probably not be your best bet. Good luck!
-Cindy
Cindy Stein Urbanc CNM, MSN, MPH is a certified nurse-midwife on Oahu that has been attending births at home, in birth centers, and in hospitals on 3 continents since 1994.
My last baby was born by c/section after a long and complicated labor. I had been induced because I passed my due date and ended up getting an epidural because of the Pitocin. My baby's heart rate dropped and I had an emergency c/section as a result. I really want to have a natural birth this time but my doctor says I should probably schedule another c/section for the safety of the baby. What should I do?
-A.G.
Dear A.G.-
Obviously there are many factors which can effect the safety and chances of success for any VBAC (vaginal birth after cesarean). Typically though, in a woman who has a documented low transverse uterine scar and is otherwise low risk, there is a really excellent chance a VBAC will be successful. The reason the original c/section was done also matters, since certain things predispose a woman to need a repeat c/section (such as physiologic conditions) while others were done for reasons that are not necessarily likely to repeat (such as the baby's heart rate dropping). Some OB/GYNs (and midwives for that matter) do not feel comfortable attending VBAC births, but it would be fairly easy to find someone agreeable to this on Oahu. Generally, it is common practice to offer patients the choice of VBAC or repeat c/section. One of the biggest reasons providers fear women with uterine scars is the risk of uterine rupture during labor (or, in rare cases, during pregnancy). The risk is very small (less than 1% in women with a low transverse scar) but when it happens, it is catastrophic. I think the most important thing is to find a provider you trust and knows what your desires are. Providers who schedule a lot of cesareans and/or inductions, have rules about wanting patients to deliver by their due date or within the first week after, or those who are uncomfortable with your choice to VBAC will probably not be your best bet. Good luck!
-Cindy
Cindy Stein Urbanc CNM, MSN, MPH is a certified nurse-midwife on Oahu that has been attending births at home, in birth centers, and in hospitals on 3 continents since 1994.