VBAC

This is very possibly one of the most difficult decisions I've ever had to make - to try for a VBAC (vaginal birth after c-section) or have a RCS (repeat c-section).

Isaac was born via c-section when, after 20 hours of labor, I hadn't dilated past a four. They even gave me pitocin after about 10 hours of little to no progress. My contractions were very strong and very close together, but did nothing. Was this due to the fact that my water broke at 37 weeks 5 days? Maybe. Or did my epidural, which only worked on half of my body, making it impossible for me to relax during contractions, play a role? Possibly. But who knows? I don't, and I probably never will.

Before I went into labor, I had a pretty open mind about my birth experience. I didn't have a birth plan, I was ready to roll with the punches. If I ended up with a c-section, oh well. If that's what needed to be done, then I'd be fine with it. Or so I thought.

Here's why I was not so ok with it.

First of all, J couldn't be in the OR with me until I was totally prepped. I was scared and emotional and I just wanted my husband to be with me. I kept asking when he could come in, and they kept saying "soon". Then there's the fact that I was puking for the entire surgery. Or at least I was trying to. Everything below my arms (including most of my arms) was completely numb because of my spinal (since my epidural didn't work), even my muscles. I felt the urge to vomit, and was trying to, but nothing would come up because my stomach muscles didn't work. It was awful.

Then when Isaac was finally born, they quickly showed him to us, then took  him over to the side to be checked over. That was fine, I could still see him (sort of, I couldn't have my glasses on, and without them I'm as blind as a bat). J went over and was able to cut the umbilical cord. Then he was able to bring Isaac over to me once he was all wrapped up in a blanket. I held him for a moment, but I could hardly feel my arms because of the spinal, and I was terrified that I would drop him. So I gave him back to J. It was hard for me to not be able to hold my newborn baby. Then they had J whisk him off to the nursery, where my parents and brother got to know my little boy before I did. And I wasn't even able to be there to introduce him. That was the hardest part for me. Luckily, my wonderful husband had the foresight to take lots and lots of pictures for me because he knew I'd want to be there for that. But it's still not the same.

Then of course, there's the recovery aspect. I hated the feeling that my insides were going to fall out every time I stood up. There were a lot of tears for the first few days when I'd have to get out of bed. Oh, and the most painful part was when I swollowed some water wrong and had a coughing fit. I thought I was going to die. I can't imagine trying to take care of a toddler AND a newborn while recovering from a c-section. I know I'll have help. I know J will be awesome. My parents will probably be around a lot, and J's parents will probably spend at least a weekend with us. Last time, I needed my mom to help me shower because when I lifted my hands above my head to wash my hair, it felt like my incision was going to burst open. And I couldn't bend over enough to wash my legs/feet. I just felt like I should have been doing more, but I just couldn't. Isaac will want his Mommy, and I'll want to be there for him too. I also can't help but wonder if the c-section was part of the reason that I couldn't breastfeed. Maybe, maybe not.

Emotionally, the c-section was very difficult for me. This was something I hadn't predicted. To be honest, I felt terrible that I wasn't able to do this very basic thing that my body was made to do. It wasn't that I needed the c-section because the baby was in distress. He wasn't. My body just couldn't do it, and that thought hurt me. Why can other women deliver their babies vaginally, but I couldn't? It wasn't fair. I had no idea it meant so much to me. Looking back, I do believe that my c-section played a role in my post-partum depression.

So knowing what an effect the c-section had on me, you probably think that trying for a VBAC would be a no-brainer, right? Wrong. According to my doctor, there is a 30% chance that I'll be able to have a successful VBAC. This number is mainly based on the reason for my last c-section - failure to progress. Women who failed to progress have a lower chance of successful VBAC. If I fall into the 70% category (failed VBAC), there is a chance that the results could be catastrophic. In any given VBAC, there is a 1% chance that the uterus could rupture along the incision site. The kind of incision that I had (low transverse) is the least likely to rupture, but it still happens. 1% odds might not scare some people, but it scares me. When I went in for my gallbaldder surgery a few months after Isaac was born, I was told there was a 1% chance that they wouldn't be able to do it laproscopically and would have to open me up. They kind of glossed over the details since it was rare, but told me that would include much more pain, about a week long hospital stay, blah blah blah. Well, guess what folks, I was one of the lucky 1%. So I am one of the few that understands that somebody has to be on the wrong side of those statistics. It could be me.

What would a uterine rupture mean? Well, it depends on how quickly the signs were recognized and how fast they'd be able to get the baby out and control the bleeding. I could lose my uterus. Or even worse, it is almost certain that there would be some sort of permanent damage done to the baby. Mental or physical damage, or even death. I just don't know how I could live with myself if that happened.

So that makes me question myself. Why do I have such a strong desire to try a VBAC? Is it because of how I might feel, emotionally and physically? Are my reasons totally and completely selfish?

I don't think they are. There are risks with a RCS, too. I haven't been able to find any concrete numbers on this, but I'm gathering that the risks are similar. Also, c-section babies are more likely to have respiratory problems because the fluid isn't squeezed from their lungs during their passage through the birth canal.

So, J and I have discussed it, and I have agonized over the decision for months. We've come to the conclusion that if we're given the opportunity for a trial of labor (TOL), we'll do it. There are various reasons why I wouldn't be allowed to VBAC. For example, pre-eclampsia, gestational diabetes, past my due date  (maybe), etc. But none of these things were an issue with Isaac. Also, if there was a need for me to be put on pitocin or any other labor inducing drug, I think I would opt for the c-section, as labor inducers are known to increase the risk of uterine rupture. My doctor will do it, but she said "we need to be very careful with that."

We discussed our questions and concerns with our doctor at our last appointment. I asked how supportive and willing the other doctors in the practice are with VBACs. She said they are all very comfortable doing them. She further put my mind at ease by informing us that when they have VBAC mom in active labor, the OB on call or at the clinic during that time is required to be at the hospital the entire time in case things were to go south. That really made me feel better, because I was less than thrilled with the resident who handled most of my labor with Isaac, and I sincerely don't think he could have properly handled VBAC complications.

When we told our doctor that we were leaning toward VBAC, she said she thinks that it's very reasonable for me to try for one. She was very supportive, and indicated that the other doctors are, too. That was the clincher for us.

So, long story (not so) short, we'll be attempting a VBAC when Sequel comes. Assuming the stars align and I'm allowed to, of course.

Sometimes I really hate grown-up decisions.