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VBAC vs. C-section

Sarah Preston Gorenstein

I’ve started talking to my OB about having a VBAC—vaginal birth after cesarean section. I know this is a hot-button issue and I’m opening myself up to a lot of scrutiny by writing about it, but try to remember this doesn’t have a one-size-fits-all solution. I would love to hear from you about your experiences, so here goes…

I had a planned C-section with Preston due to marginal placenta previa. It was so marginal, I didn’t have any of the usual symptoms/bleeding, but the placenta was resting right up against my cervix throughout my pregnancy so it required I deliver via C-section. Up until the day before my surgery, we were checking to see if the placenta had corrected itself, hopeful to try for a vaginal delivery—alas, it didn’t.

This might sound strange to women who believe vaginal deliveries are the only way to go, but it wasn’t a big disappointment for me that I couldn’t have one. Somewhere in the back of my mind, I think I always had a hunch a C-section would be a possibility. Of course there’s a part of me that would like to experience a normal delivery—I never went into labor with Preston; my water never broke; I never had that spontaneous “Grab the suitcase, honey!” experience. But I’m totally okay with it (and yes, I know it doesn’t happen like the movies). My only concern was having the easiest delivery with the fewest risks.

Now, I would never call a C-section—even one that’s scheduled—anything resembling easy. I went into the surgery a little naive about the whole procedure. Despite how many episodes of TLC’s “A Baby Story” I watched, nothing quite prepared me for how difficult it would be. I don’t know what I expected exactly, but it wasn’t until the morning of my surgery that the real fear set in: I’m about to have major abdominal surgery while I’m awake—holy sh*t!

The entire procedure from beginning to end was pretty frightening, and my recovery was not smooth. My iron was so low beforehand, there was concern I’d need a blood transfusion—I didn’t thankfully. And though painful, it was nothing that overshadowed the awesome birth of my first child, which was the happiest moment of my life, hands down. But the fact that my then-self-employed husband was able to be home for my entire maternity leave—and carried most of the physical burden until I healed—made things so much easier. I was lucky—I had a safety net. But that won’t be the case this time.

I’ve had several big injuries in my life, and several major surgeries, but I’ve always had ample time to recover from them—the abdominal surgery doesn’t scare me half as much as the days and weeks (and maybe months) following it. My circumstances are much different this time—I’ll have a baby and a toddler to take care of, and my husband won’t be home for more than a week, at best.

The dilemma for me is this: After everything I’ve put my body through in the last year, I don’t want to have surgery again, or have another thing I’m recovering from. I want to be able to take care of my kids, and take my son to and from school every day, like usual. I want to change diapers, and be strong for the new baby—and just enjoy this amazing time in my life, without being wounded. Is that realistic after a second C-section?

This is the main reason I’m considering a VBAC, but I’m also apprehensive to try for a vaginal delivery because of all the risks involved. The stats say 60-80 percent of women who try to have a VBAC end up having a vaginal delivery—the rest end up with a C-section anyway. Not to mention the other, more serious risks—rupturing my uterus, infection, trauma to the baby, etc. Those are things I need to consider as well. They may only occur in 1% of women, but that’s all that matters if you’re the 1%.

I want the option with the least risks and best chance for an easy recovery—but I'm not sure that necessarily exists.

Of course there’s always the possibility I’ll have no complications with a vaginal delivery, and it all goes down relatively smoothly. But what’s the likelihood of that, with a first labor? At least a third, if not more, of the women I know who tried to have a vaginal delivery the first time, ended up having an emergency C-section, ultimately recovering from both. I know far fewer women whose deliveries went as planned the first time.

My OB is willing to consider a VBAC, assuming I haven’t developed placenta previa again, the baby isn’t breech, isn’t too big, etc. But his gut reaction when I brought this up was that I was a better candidate for another planned C-section—he was actually surprised I was even considering it. It'll all come down to how determined I am to do this.

For me, this decision is not about how I deliver—it’s about delivering the safest way possible for me and the baby. We have the 20-week ultrasound next week, so there won’t be any decisions made for a while, but I’d love to hear from women who’ve had both VBACs and second C-sections: How’d they go for you? Was the second C-section easier/harder/same as the first? How was the VBAC? Please don’t hold back!