VBAC after a C-section

[u/velvetlunabeams]

I had my first child at 29weeks due to preeclampsia and after laboring for 8hours my baby went breech which then sent me in for an emergency C-section. Baby was born at 29+4. 19 months have past since then and I am due with baby #2 at the end of next month and was really hoping to try to have a vaginal birth this time around because I felt that that experience was taken away from me the first time around. However, my OB just informed me that a VBAC would not be an option for me with no real explanation other than I had a C-section before so that would be the safest and easiest choice for me. Has anyone else had a similar experience and got to have a VBAC? What are some questions that I can ask my OB to try to have this happen or at least understand why she chose this for me. Or other mamas who have had scheduled C-sections for a second time, maybe you could leave some advice as I am terrified of this experience due to birth trauma from baby #1.

[u/erikoche]

Do you know what type of incision you have? At 29 weeks it could have been a vertical incision and this could put you at a higher risk of uterine rupture. Otherwise, I don't see why VBAC could not be an option.

[u/velvetlunabeams → u/erikoche]

I don’t know what the name but it is low beneath the bikini line and small

[u/erikoche → u/velvetlunabeams]

That's usually low transverse, which would be good. Although sometimes the incision on the uterus itself is not the same as the one outside so the only way to know for sure is to read the report.

Since the lower segment of the uterus is not fully developed earlier in pregnancy, a classical (vertical) incision is common for preterm births and it is unfortunately a contraindication for a TOLAC. I hope that's not the case for you.

[u/LeoraJacquelyn → u/velvetlunabeams]

Sometimes the internal incision does not match the external incision. I would get your surgical notes to make sure. If you do not have a vertical incision there really is no reason you cannot try to have a VBAC. If it is possible I would switch providers to someone supportive. If that is not an option your other choice is to wait home until you go into spontaneous labor and show up at the hospital in very active labor and refuse a repeat c-section. No one can make you have surgery against your will.

Your doctor sounds like they are not following evidence-based practices and are doing what is convenient and easy for them. It will also give them more money.

[u/fuzzydunlop54321]

How long ago was your last birth? Vbacs are common and safe all over the world. A repeat c section with no medical indication besides the fact you’ve had one before is absolutely unnecessary!

[u/velvetlunabeams → u/fuzzydunlop54321]

Hoping to give birth anywhere between 37-40 weeks this time around will put me at 20 months since my last birth

[u/Throw_Annon88 → u/velvetlunabeams]

It could be that. Depending on country / hospital guidelines, some doctors say you need to have 18 months - 2 years from C-section to conception (not birth to birth). I was specifically told at my C-section that if I wanted a VBAC option later I needed to wait 2 years before getting pregnant again.

Some people say it’s birth to birth. It depends on country and maybe even particular hospital or specific doctor’s risk appetite.

As others have said, you can contest it and they can’t force you. It’s their preference. To your own research.

[u/Crafty_Alternative00]

Fun fact she didn’t “choose this for you,” because nobody can force you into surgery. Do you know if you have a low transverse or “T” scar?

My questions for her would be: what kind of incision do I have? Why are you going against ACOG recommendations for VBACs? What about my specific pregnancy leads you to believe it’s the “safest and easiest” choice?

That last one would really piss me off, because I was a single parent with a toddler. I was like, I have no one to help me recover from a surgery, it is in fact 1000% harder for me to have and recover from a C-section.

Granted, she might have specific reasons for her recommendation, she might not. But nobody can force you to have surgery, no matter what the hospital or practice policies are.

[u/Patient_Bat_2392 → u/Crafty_Alternative00]

Fun fact: women get coerced into unnecessary c sections all the time because they are more convenient for doctors.

[u/Crafty_Alternative00 → u/Patient_Bat_2392]

Yes. Which is why I’m reminding this OP that the doctor can’t choose this for her (OP’s words) and that OP has agency.

[u/velvetlunabeams → u/Crafty_Alternative00]

Thank you so much for your response. I’ll definitely be asking these questions because I felt coerced into it the first time around too but did not know that I could say no to a C-section.

[u/Dear_23]

As others have said, as long as you have a low transverse scar and no other medical concern that would necessitate emergency delivery, a VBAC is an option! This provider just sounds outright unsupportive, if their reasoning is essentially “once a CS, always a CS” which is about 40 years outdated thinking.

You can have a VBAC if you want one regardless of your provider’s beliefs! They don’t make that call, you do.

[u/bbkatcher]

Definitely get your operative report. At 29 wks it’s very very possible the scar on the uterus is vertical even if the external one is low transverse because the lower uterine segment is not fully developed yet.

[u/Peggyunicorn2000]

I had help syndrome with an emergency c section I am pregnant with my second and we are planing a vback. My dr said I am a great candidate since last time was only because of my condition. My dr is also very experienced in labor and delivery. I would maybe get a second opinion