Just curious - My first baby was born at 29 weeks, emergency classical/vertical c-section (both lives in jeopardy and had thought they had lost her). I had a c-section with my second (and last!) baby because of course all the research I did said no VBAC. However would a midwife attempt it?
...nope - not pregnant! Just reading MIDWIVES and there had been a few questions/answers on here about/from midwives that made me think and wonder if I should have looked into it more. But I as scared to death anyways and thought it was the only option because of my incisions (yes both vertical - they had lost all fetal movement/heartbeat and she was stuck feet behind ears between my pelvic bones so had to get her out the fastest way so couldn't bikini cut) and because I already knew how quickly things can go wrong....just went with the VBAC not an option. Never questioned it until now. And I don't know if it would have been presented as a possibility that I would have felt comfortable trying. I've never felt like I missed something not having a vaginal birth and I was still able to bond with my babies - even the one in the NICU for almost 2 months that I was knocked out to have and didn't even meet until about 12 hours later! but that makes me wonder....
My experience with VBACs (not that i had one - but my midwife was willing to do so since the births were done in at the hospital anyways) is that a midwife might try it, but only with the newer/safer bikini cuts. The vertical cut is too dangerous for a VBAC.
However I would recommend that you call around and ask. They worst they can say is no.
If a midwife agreed to try a VBAC with your history of a vertical scar on the uterus for a preterm delivery, she's probably not one you would want to trust to deliver your next baby. The risks of VBAC are MUCH higher with these two conditions. A home birth should be out of the question due to the lack of ability for immediate surgery should uterine rupture occur or placenta acreta (when the placenta has grown into the muscular layer of the uterus and causes massive hemorrhage after delivery). A woman can die in less than 5 minutes from profuse bleeding from the uterus. The guidelines established by ACOG were meant to help save lives rather than prevent women from experiencing vaginal delivery when it was safe fro them to do so. Although C-sections are over utilized today, I'm thankful that they still save lives that would otherwise be lost. Certified Nurse Midwife and Mom of 3
My sister is a nurse and worked in the mother baby unit for over 10 years when she had her first... she ended up having all 3 kids c-section, she was thinking about having #2 VBAC, but a month before she was due, while she was helping out in a delivery a mother who already had 2 c-sections tried to do a VBAC and her incision opened up and they ended up losing the baby and almost the mother... When my sister told me I cried for that mother, and she said there is no way she would even try to have her's vaginal...
I had an older sister too that was very upset, she only had one child, and had her c-section and she told me once she felt cheated during birthing that she didn't get to try to have her daughter vaginal. I told her she didn't miss out on anything, there is a lot of pain and stretching she missed out, that's it... she felt better after we talked. Please don't feel like you are really missing something by not delivering vaginal... You are giving birth to your child, you are not missing out on anything... Keep the birthing process safe and do a c-section, not vaginal....
Generally, most health practitioners (CNMs, certified midwives, OB/GYNs) would not agree to a trial of labor (to attempt a VBAC) because of the vertical scar. The vertical scar is so much weaker than a horizontal "bikini cut" scar, and the risks of serious, possibly deadly complications during the TOL for a VBAC are not something that most conscientious health care people would condone.
If I had had a vertical c-section, there's no way I'd feel comfortable trying a VBAC. The risks wouldn't be worth it for me, and I'd stay far away from a health care provider who suggested it as a realistic option.
If you are seriously considering a VBAC, plan to deliver at a hospital in your area that has the best surgical staff and the labor & delivery nurses, and hire a montrice.
And all that being said, I'm a big proponent of VBACs and avoid c-sections & midwifery....
This is a regional thing. In Fort Myers, Florida, there was only 1 doctor that allowed for a VBAC. Local laws stated that the doctor had to be IN THE ROOM from the time of admission to delivery for a VBAC. He didn't take insurance either, you paid out of pocket. In some parts of California, you can get a midwife to give you a water birth at home even with your history... so regional.
Dear D.,
You are very lucky. You have an ICAN (Internaational Cesarean Awareness Network) in your area. You should really contact them and they will help you sort through your options. They will be able to tell you who the good midwives are, who the good OBs are, which hospitals are most birth / baby friendly. If nothing else, you will have a great support network to help you process your previous c-sections.
Best wishes,
C.
ICAN of Lincoln
Contact: Nicole Jacobs
eMail Address: ____@____.com
Telephone: ###-###-####
Website: www.wix.com/icanlincoln/home
American Congress of Obstetricians and Gynecologists has changed much of their 'requirements' to VBAC in 2010. The last c-section seems to be due to "once a c-section, always a c-section" and for no other reason. Depending on your pregnancy history... a Midwife would be able to let you know if you are a good candidate for a VBAC. I am having one in July with #2 - - and I'm looking to get my Nursing Masters in Midwifery also.
Two of the really HUGE improvements in their list of requirements that changed are the following:
VBAC can be attempted after 2 previous cesareans - before 2010 it was only after ONE cesarean.
No longer does the scar placement matter... Vertical, bikini, low transverse... now anything is acceptable as long as a certain layering of stitches was done.
http://blog.ican-online.org/2010/07/21/ican-responds-to-n...
http://www.acog.org/from_home/publications/press_releases...
http://www.midwife.org/documents/ACNMResponseACOGVBACReco...
http://vbacfacts.com/2010/07/21/acog-issues-less-restrict...
****ADDED after 2 flowers****
I had an OB tell me how happy she was about this particular change in the ACOG's 'mandates':
"VBAC is no longer contraindicated in women at higher risk for complications (previous classical or T‐incision, prior uterine rupture or uterine surgery); rather, such women are now considered “not generally candidates for planned TOLAC”
Uterine rupture - even when the deadly drug cytotec (this drug caused a lot of uterine ruptures even in women without previous cesareans) was being used like candy - was still under 3%. Without the use of that drug, it's gone down to 0.02%.
Alot of midwives and some doctors will do VBACs. You will have to do your research of the hospital also. Find out what the percentage of successfull VBACs are at the hospitals near by and talk to a few different birth professionals to see who you mix well with. I'm a doula and I know there can be wonderful VBACs!
Good luck on your birth :)
If you truly have a vertical incision on the uterus, not just on the outside, no doc or midwife will attempt a c-section. I'm actually surprised that's what they did, I was a labor and delivery nurse (before having twins at 27 weeks and being a SAHM) and I never saw any docs do that type of incision in any situation. Most docs don't use it as much anymore because of later problems you can have.
I am a midwife. Unfortunately with the type of c-section you had you should not have a vaginal birth. Midwives would probably not take you either. If you had a low transverse incision you could do a VBAC. The risk of rupture with this type of incision is extremely low but with your type it is much higher. The type of incision you have is much weaker.
Your outside cut might be vertical and the inside one a bikini cut. If both are vertical it's not wise to attempt it.
The successful outcome of a pregnancy is a healthy baby and a healthy mother.
I don't think with your type of c-section, that they will consider you a candidate for VBAC. Especially, after 2 births. It doesn't hurt to call a midwife and ask, but I don't think so...as far as I know.
No. If you have a classic vertical cesarean scar, then no one will attempt a VBAC, and for good reason. However, when you say vertical, are you talking about the actual incision to your uterus, or just the abdominal incision that you can see? It's the uterine scar that matters, not the abdominal, and they don't always match.
The midwives here in Texas would have allowed an attempted vbac. I have friends that actually got their vbac with their midwives.
Usually after 2 c-sections especially with your history of premature labor and delivery, they wouldn't go for a VBAC. Too many problems could come from this. GL!
M
