My Repeat C-Section- Why Opt For One, and What To Expect

VBAC or Repeat Cesarean? 

You Have An Important Decision To Make

For whatever reason you did, you had a child by cesarean section, just like me. You went to your OB and she's asked you what you are doing this time; VBAC (Vaginal Birth After Cesarean) or Elective Surgery, another C-Section. Perhaps, like me, you have had conflicting emotions regarding your first cesarean. I had desperately wanted to have a natural childbirth, but fate would have it otherwise, and it was an emergency C for me.

Trying to decide what is safest for you and for baby is a difficult job that only you can make. I opted for the Repeat, myself, and want to share with you the reasons why. There is a lot to weigh and consider, and I was surprised at how little I had been informed on the subject prior to some investigation. Hopefully this overview saves you some trouble.

My First Born

A Not So Natural Childbirth

When I was pregnant with my first born, we attended prenatal classes with all the anticipatory excitement warranted and more. During the instructors overview on Cesareans, I recall hearing the odds or likelihood of having to have one, and at the same instant dismissing the possibility all together. So naturally by the time she got to discussing VBAC, I was hardly present. More than likely, I was day dreaming of the fabulous new natural child birth positions I'd been reading up on. I do however, remember one thing precisely regarding VBAC. She said, "not to worry if you have to have a c-section, now you can still have a chance to try vaginal birth with your next pregnancy! Its called VBAC."
When I did my first born's birthing plan, I had no doubt that what I desperately wanted was natural childbirth, but by the same token, my husband and I agreed that given anything at all should go wrong, I would listen to the doctors. If they had told me I needed to hula dance on my head to get my baby out safely, it would have happened, balance issues and all. So the story goes, that when the odds were against my delivering vaginally, we listened to the medical advice bestowed upon us and "got that baby out of there".
I've never been sad exactly about my son's helped entry into this world, but perhaps I harbored some feelings of inadequacy, and even confusion. I wondered if I'd done things differently, worked less, stressed less, etc., maybe he would have come out on his own. Overall I was way over the moon in love with my little man and hubby, and pushed it to the back of my mind. It was only years later that I recognized what I pushed the upset away with, and that was the hope that when I had another baby, things would be different.

Nursing After A Cesarean

Just a few things that I learned. Life is much easier with these few items when trying to breastfeed your newborn. One of the pitfalls of C-Sections is that it is a great deal more difficult to have your milk come. This is because the stages of a a normal delivery induce your milk to arrive. PS. Dpo get some near beer or light beer to help the milk come in. It works. And if you are worried about the alcohol, just remember that it's not as bad for baby as the milk inhibiting pain relievers (which I don't blame you at all for taking) they offer in hospital.

Carex Bed Buddy Hot/Cold Pack

A rice sock is very helpful on engorged breasts. Some people will advise a shower, but if you let your milk supply run down the drain, it will replenish itself to feed baby thus causing a vicious cycle of engorgement. Instead, use the rice sock while baby feeds. the warmth will help the ducts unclog and baby wont mind the warmth :)

Lansinoh 20265 Disposable Nursing Pads, 60-Count Boxes (Pack of 4)

These are the only nursing pads I will buy after having bought every other brand. They are worth it even if you could only buy them for 10 times the cost of other brands. These are much larger, and absorbent, and use a material that doesn't break down and shred, or release a gooey gel all over your breast for baby to potentially ingest if you were say, half asleep.

Lansinoh HPA Lanolin, 2 oz.

Even if it's your second time nursing, even if you nursed your first born for two years, you will likely need this nipple cream, because a baby born by cesarean has a lot of work to do to get that milk in and believe me, though worth it in the long run , it chafes and hurts.

My Research and Experience

The 'Facts' That Came To Me

After my 1st appointment with my OB, I came home shaky. I was 6 months pregnant, and on top of the common feelings of guilt about having a 2nd child (which I was drowning in), it suddenly came to light that this whole thing, having another baby, no matter which way the baby came, was potentially dangerous. I am not a fan of danger, and that might be the biggest understatement ever. Ever since I was pregnant with my 1st, I've become a bit of a health and safety nut actually. I just love my little family so much, that I've become like a protective mama raccoon.

It should come as no surprise that my defenses went up when my OB told me some of the hard facts. She said that 1 in 100 VBAC deliveries result in ovarian rupture, which results in a wide range of consequences: from both mom and baby are perfectly fine, to both dying instantly. Babies, and/or moms can suffer all types of injury, even mild to severe brain damage. More commonly, mom has to a have a hysterectomy, and this of course means no more kids. Then she told me that the choice was mine for the making. I asked her what she would do. She told me she wouldn't comment and would not try to sway me one way or another. Well Gee Thanks. I was so confused I wasn't sure we had just had the same conversation anymore because VBAC suddenly sounded absolutely terrifying. She told me to think about it and give my answer at our next appointment.,

Now, I know what you're thinking... and it's true that c-sections are not without risk. But interestingly, repeat c-sections are far lower risk than first time procedures, according to the anesthesiologist who did my pre-op at McMaster Hospital. He told me that this is because most of the risk for c-sections stems from the administering of anaesthetic. Once you have been through the procedure successfully, the surgeons and anaesthesiologists know that it worked for you the way it was once done, thus eliminating some risk when they do it the same way again. Plus, the repeat is planned, and therefore you are properly prepped; you have an empty stomach, you are not in labour etc. (By the way, having contractions makes holding still for a spinal tap very, very, very difficult - I do not recommend it at all.) He added that a patient will most likely not suffer the same bloating as the first time, nor should a spinal tap headache occur if there wasn't one the first time.

Now, back to that statistic 1 in 100. It sounds pretty good to say 99% of VBAC deliveries go according to plan. But this is what I'd figured: if there was a lottery where 100 people were putting in $100 for a chance to win $10 000..... would I want in? And the answer was 'heck yes', in fact I'm thinking of rounding up 99 like-minded people if you're interested ;).

An important note. The aforementioned 1% is a Canadian statistic as I am Canadian. The American version is 20%. Yes 2 of every 10 American women who attempt vaginal birth after cesarean will be unsuccessful. This isn't because the medical science is insufficient or of lesser quality, it has nothing to do with HMO's, and American citizenship certainly doesn't make a woman more susceptible. (Good to know for all you American readers, I'm sure!) This 80% success rate is the reason that there are over 300 hospitals in the US that will not perform VBAC, FYI. And why is that number so much less attractive you may wonder? It is simply because it is from a far larger database and is therefore, sadly, more accurate. The States has over 313 million people, Canada has a mere 34.3 million. The larger the data group the more accurate the results, plain and simple.

I Chose The Cesarean

And I Do Not Regret It

My research was done. I needed the lowest risk scenario far more than I needed to see if I could deliver vaginally or naturally. Though important to me, in comparison to being okay for my son and husband as well as our new addition, the experience became about as necessary as a spa day. As much as I would love to know how labour would feel, I never will. I could say "no fair" and all, but in the end I care not, for I have my beautiful family. Now, I am eternally thankful for modern medicine and cesarean sections, and believe it or not, both my husband and I embraced the experience a lot differently this time.

My recovery time for my repeat was cut in half (no pun intended) from the first time. I had my surgery on a Friday morning and Saturday morning they took out the catheter, and by the time I was checked on again I was washed up, bathed, and had tidied my room to get ready for visitors. (I couldn't wait to see my son and husband!) I left the hospital that Sunday afternoon. Monday morning, my husband and our 2 kids went to Toronto via public transit to see our family doctor. One way, that's 2 buses, 1 train, 1 subway and so round trip is about an 8 hr day. Believe me, I'm not saying I recommend doing anything this active on day 3, but you do what you have to, and that's what we had to do. The point is, that recovering the 2nd time was far, far easier.

Just to clarify this does not mean that c-sections are easy on a woman, by any stretch of the imagination. The fact that Hollywood celebrities opt to have them for their first born with no medical reasoning for the procedure is so very extremely confusing for me. Although 'up and at em' again quickly, it will be quite a long time yet before I have anywhere close to my previous core strength back. I have just recently started back at the Pilates and yoga, and like last time, I know that eventually it won't hurt like a son-of-a-you-know-what to do a v-sit. Not to mention the scar itself. Yes, I was fortunate to get a low "smiley", but still, a scar isn't exactly a fetching adornment for that area. Even when I got into my best shape again last time, it was challenging to find cute neglige and swimwear that didn't let on more history than I care to express when wearing it. Fortunately, they simply reopened the old scar this time so I don't have two (I find it strangely convenient they can actually do that). So there is no adjustment to a scar this time... like the rest of your body, you just wait for it to look like it used to.

Extra Reading

More "Facts"

Playing a bit of devils advocate here, but it is important to make your own informed decision on this one.

VBAC Facts

There is quite a bit of controversy within this website. See article titled "Response to OB: Scare tactics vs. informed consent aka why I started this website"

ICAN Canada

ICAN stands for the International Cesarean Awareness Network. They do promote VBAC while informing about C-Sections

The Disclaimer

With Love

The reason I subtitled My Research and Experience as The Facts that Came to be is because a woman could spend all 40 weeks of her pregnancy searching and researching for the ultimate truth, and truthfully, I'm not sure there is a definitive truth out there as yet. There is a lot of debate and controversy over this topic, and so I just want to say, that I have found all this information from sources that I respect and trust. I am not a member of any medical organisation of any kind. I made my decision based upon these 'facts', and that is a fact. Mom to mom: you all know what an endorsement that is. I wrote this for any moms out there who are having a hard time with the lack of clear evidence of what they should do. My humble opinion is this. Attempt the VBAC or opt for the c-section, in your heart you know that you are leaning one way or another. Just decide and then believe in your choice and it will be the best option for you. My best wishes for you and your baby!!