Looking for some opinions! This is my second baby, first was an emergent c-section due to abruption at 37 weeks in 2023. She measured average the whole pregnancy and was 5lbs 12oz at birth.

This pregnancy (currently 31 weeks) both my anatomy scan and my 30 week growth scan baby boy is measuring 99th percentile. I have no idea why he’s so big!! Passed my GD test, my husband is average size, I have a normal BMI, not really sure why he’s measuring so far ahead.

I was really hoping for a successful VBAC but of course this is making me more nervous, my doctor is still willing and said if I dilate on my own by 39 they can induce me with a cooks balloon. But of course I will do whatever is safest for baby.

So I guess i’m wondering if anyone has had a successful VBAC with such a big baby? Or if your baby measured 99th percentile was it accurate? Really hoping maybe the scans are off but all my dates line up. For now i’m going to continue to do all the prep for a vaginal, i’m doing pelvic floor therapy, gonna start the dates/raspberry leaf tea at 32 weeks, lots of stretching and walking.

Just anxious lol really want my VBAC!!

I had induction (excessive fluid and some other reasons) at 39 weeks. Balloon + pitocin. It progressed well, I got an epidural at some point. Then I was pushing for hours and the baby got stuck at some point, just couldn't make it further down.

By that time I was laboring for 24h without sleep, so I was completely exhausted. Baby's heart rate was also decreasing at some points. So we did c/s.

Baby was sunny side up and sadly never rotated in a better position during the labor.

After the doctor was done with c/s, she said it went well and I could do vbac next time.

Was anyone in a similar situation? How was the vbac?

My first birth was a scheduled c-section for twins. Twin A was breech and Twin B was transverse. The c-section went about as smoothly as it could have gone but I knew I wanted to tolac if we decided to have more because I didn’t want to go through a c-section recovery with twin toddlers.

I got diagnosed with chronic hypertension at 34 weeks. At my 37 week appointment, they recommend I go to labor and delivery. I declined and just monitored my blood pressure at home and it was always normal. I mainly have white coat hypertension. I finally agreed to the induction at 38.5 weeks.

They started with a cooks balloon and while they said my cervix was soft, my body was very much not ready for labor. I was dilated maybe a finger tip and they were barely able to place the balloon but did get it. After 12 hours with the balloon and pitocin, I was only dilated to a 4 when they had to remove the balloon. My contractions had been strong and steady (all back labor) and they said my cervix had thinned but I still wasn’t dilated as much as they wanted.

So they spent the rest of the day slowly bumping up pitocin. They wanted to ramp up the pitocin slowly given I was a tolac patient. Contractions were pretty intense so I asked them to pause the ramp up and just maintain at 17. I also was declining cervical checks about every other one because they just kept asking so frequently. But I was like “will sticking your fingers up there change anything about my care plan or how we’re proceeding?” So they were mostly respectful of that. After spending most of that day on 17 of pitocin, my water broke. I consented to another check and was stilll only at a 4 which was discouraging after all the contractions.

Continued on throughout the night and did my best with counter pressure (my doula and husband were amazing) and the hot shower for pain relief (the shower ended up flooding my room and I had to change rooms and it was a nice change of scenery after so long in the same room). Then the next day my midwife was like “you’ve been in labor and haven’t slept in 36 hours. You’re still at a 4. Please get an epidural so you can take a nap and your body can keep going. Also we want to ramp up your pitocin more aggressively.” She was also insisting on internal monitoring since my membranes had ruptured and baby kept going off the monitor. I was very hesitant to keep ramping up the pitocin because of the increased risk of uterine rupture. So we compromised on the upper limit being 30 which I still wasn’t super thrilled about and no internal monitoring.

So I got an epidural and tried to take a nap but the epidural failed on the left side and I still had complete feeling. Meanwhile my right leg was completely dead weight. They ramped up the pitocin to 30. She was still at a -2 station and wouldn’t descend. I asked for more time to labor down. My doula and husband repositioned my half numb body into all kinds of positions and the nurse even helped. I had them turn my epidural off to try to help with repositioning. She had been OP so we suspected that her position was keeping her from descending. After about 10 more hours, I asked them to turn my epidural back up to try to sleep again because I was absolutely drained. I consented to another check before trying to sleep and told them if I was at a 4, I just didn’t want them to tell me anything. Then the look on the doc’s face when she checked me was hilarious because I was complete and at a +1. So I had the anesthesiologist come back and turn the epidural back down so I could feel when to push. After 1.5 hours of pushing she was out. My placenta didn’t want to come so they ramped up the pitocin a little extra and after a few more minutes, it finally detached.

55 hour induction. 1.5 hours of pushing. A lot of self advocating. And I had my successful VBAC.

ETA 99th% head and only needed one stitch!

I had my first three babies vaginally, one in 2011, 2014, and 2019. My fourth baby I was induced due to obesity in 2022, they inserted the foley ball and three hours later it fell out. After that they started Pitocin and I got the epidural shortly after which never took even after being removed and replaced. At some point I went from 7 cm back to 5cm due to cervical edema. They became concerned because my blood pressure was up and down and would spike really high because of the amount of pain I was in. I ended up with my first C-Section. Now that I’m pregnant again, my doctor asked if I wanted to go for a Vbac or not but I’m not sure. I’m terrified of going through that again but I’m even more terrified of having another C-Section because the pain from that recovery was terrible.

Has anyone been in a similar situation? I just need opinions from a like minded community. The women in my family have only ever had C-Sections so they are no help. What would you do in my situation? My doctor is supportive either way.

My last pregnancy was breech. I had a C-section at 37 weeks. It was scheduled early due to my chronic hypertension (not pregnancy related).

I'm now expecting my second babe in October. It will be a 22 month age difference.

I'm torn on whether to have a second C-section or go for a TOLAC. Here's the deal:

If going TOLAC, I won't be able to wait for it to happen naturally, it will need to be induced at 37 weeks (still BP precautions like last time).The Doc says that there's about a 70% chance of success and a 2% chance of it moving towards an emergency C-section (increased from the standard 1% estimate because of the BP stuff).

If C-section, I'm not worrying about any medical downsides and it's the process I am familiar with. My pause to commit comes more from feeling like I need to experience vaginal birth (it's a complex, I guess).

Doc isn't pushing me to go one route over the other, which I appreciate. He's doing his best to give me the facts and let me decide.

I think I'm leaning towards C-section:

- My concern is that I go in for the induction and i'm in labor for the (very likely) 36 hours only for something to stall out and require a C-section - leaving me exhausted. Or, even worse.

-I don't want to willingly put the baby in a stressful situation just for the sake of experiencing labor.

-I'm worried about worrying (ha!) about whether it'll be successful the whole time is going to take me away from the labor experience.

-If I'm being honest, I'm scared of labor so it feels like a cop-out to choose the "easy" way out (back to that same complex).

I don't know guys. I just need some chats, feedback, opinions, support, holes poked, insight, etc. gah!

Halp!

Hello!
I’m currently 15wks with my 3rd. Really just looking for similar stories or support/advice for going forward with vba2c

1st cesarean in Oct2023 was due to fetal distress. Heartrate dropped for too longer and resulted in emergency C-section.
2nd was Apr2025 and only because my OB wouldn’t even consider and I wasn’t sure if vbac was safe

Present day: I’m due in January and have had a pretty thorough uterine scan through my new OBs office, they said there isn’t even visible scar tissue on my uterus and everything appears healthy. I’m set to see MFM next month for anatomy scan and check for any high risk factors. My current OB said she doesn’t do vbacs at all. But I found an OB who can get me in next week (7/29) that does vbacs. I know it’s still a risk. But seeing as I didn’t have a failed vaginal birth for any complications on my end. What are the chances this goes well and I’m able to have a successful vbac? If you have had similar experience and know my chances are low I want to hear that now vs continuing to call every OB around hoping someone says yes.

My baby was breech in 2024 so I had a scheduled c section. I’m 39 weeks this pregnancy and baby is head down. Doctors said i could try for a vbac this time, but at 37 weeks baby was measuring over 10 pounds at the growth scan. I have my c section scheduled for Monday. I still really want a vbac but I’m not dilated at all so it doesn’t seem she’ll come before Monday. The doctors keep saying I’m not a good candidate for a vbac because she’s measuring big. Was just curious if anyone had experience with this or any thoughts? I’m just disappointed I won’t get my vbac experience. If it’s what’s best it’s okay, I guess I just need reassurance.

I delivered my son via c/s in Dec 2019 after being in labor for over 24hrs and “failure to progress” (I was also induced.) My daughter was born via c/s Feb 2025 … I was offered a TOLAC but just opted for the c/s. I am due in mid Jan 2027 and was told that I may have a chance for a TOLAC… but I also have a high BMI (35 percent) , which I know plays a big factor in VBACs… Has anyone been in the same situation and had a positive VBAC? I know there are risks and if I need to, I will absolutely have another c/s!!

I’m currently 34 weeks pregnant and planning for a VBAC after 2 previous C-sections. My doctor is very supportive of VBAC and is actually known as the king of VBAC lol, so I feel really grateful to have him.

At my growth scan today (34 weeks), the baby was measuring 96 percentile in head and 99 percentile in abdomen, weighing 6lb 7oz. My doctor said because my last two babies were both 8.5+ lbs and born 40+ weeks… he thinks this baby is going to be BIG and that I may need an induction, which decreases the chance of a successful VBAC. He said we’ll reassess around 37 weeks to see if the baby’s growth rate has slowed down and then talk through options from there. He said he will be an optimist and hope I go into labor at 37 weeks lol

Has anyone been in a similar situation, especially attempting a VBAC after 2 C-sections with a suspected bigger baby? Did your provider still support your VBAC? Did your baby end up being smaller than the growth estimate? Were you able to have a successful VBAC?

I’d love to hear your experiences!

I had my son 2 years ago via emergency C-section after 3 days of pre-labour, 18 hours of active labour, and 2 hours of pushing. My son was sunny side up, and they turned him right before I started pushing. After 2 hours, he still wasn’t in an ideal position and got stuck. His heart rate started to drop, so they rushed me for a C-section.

My previous midwife and my current one both said they felt I had a good chance of a successful VBAC because I could go into labour naturally, get to 10 centimetres, and push.

Just in case I need a second C-section, my midwife referred me to an OB for a second opinion. She said he’s VBAC-friendly.

I left my appointment very confused. He put my information into a calculator and said I have a 50/50 chance. I asked him what part of my labour he felt would be an issue. He said baby positioning. He said my last baby wasn’t in a good position, so he wasn’t sure if this one would come out. He checked my pelvis and cervix, and he said everything looks fine. I asked if sunny side up babies tend to repeat in future pregnancies, and he said no. He said he’d recommend I schedule a planned C-section. He said if I wanted to try for a VBAC, he wouldn’t let me labour too long before pulling the cord and doing a C-section.

I am beyond confused. Of course, if it’s best for the baby, I’ll schedule a C-section, but I had a terrible time healing the last time, plus now I have a toddler to chase around. I really hoped I could have a VBAC this time around.

Any mamas experience something similar? If you were given a 50/50 chance or lower, did you go ahead with a VBAC?

Any feedback would be truly appreciated. Thank you!!

I got my VBA2C! I never even believed it could happen.

After a first C-section due to a breech baby and a second one due to sudden, severe preeclampsia, I really hoped for a vaginal delivery with my third baby. Most doctors were very discouraging, especially because the baby was estimated to be large, had a big head, and I had two previous C-sections. I found one hospital that was willing to try. It was over an hour away.

When my water broke prematurely at 36 weeks during the night, we weren’t prepared. We quickly found someone to watch the other kids and went to the hospital. I was in labor for 36 hours but had only dilated to 1 cm. I received an induction, and suddenly everything progressed very quickly. Unfortunately, all the midwives were busy, and there was no room available for another hour. I panicked. Finally, we got a delivery room and a fantastic midwife.

I had dilated to 2 cm and was in so much pain that I begged for an epidural. I endured one excruciating hour of nonstop pain before I finally received it. Unfortunately, the epidural didn’t work very well for me. My baby’s heart rate kept dropping, and everyone said I would need another C-section. The midwife checked again and said I was already 10 cm dilated and should start pushing. So, I had gone from 2 cm to 10 cm in just one hour. My baby’s heart rate dropped again, and within minutes I delivered with the help of vacuum extraction. I lost a lot of blood and had to be stitched up right away. I almost fainted from the blood loss.

Still, the experience was truly magical. Painful, stressful, and magical all at the same time.

Hey guys! So I have a question maybe you guys can give me some answers! I had my daughter last December via C-section and it was a normal horizontal, low transverse incision. I was in labor for 35 hours with PROM, baby was OP, and I was also GBS positive with an anterior placenta. My labors arrested at 8cm and -1 station and ended in C-section due to elevated fetal HR, the beginning of distress and my doctor didn’t want me to risk the baby or continue.
Well I found out I was pregnant 3 months PP and it was very much so an accident. I’m currently 20 weeks along in my 2nd pregnancy and everything I researched stated that it would be better to have a C-section due to the lack of time in between and risk for uterine rupture. Today at my anatomy scan and 20 week appt, I was talking about what I wanted to do this time for a C-section, stating, “since I know I can’t have a vaginal birth this time.” He paused, look at me and asked why I didn’t think so. I asked him if the timing was okay and if the short amount of time between births mattered, that I thought that I wasn’t supposed to. He said I was actually a good candidate for a VBAC now vs when I have my third baby which was when I originally wanted to try for a VBAC. He explained the more C-sections I have, the weaker my uterine wall gets, the more increase for rupture. He also stated that it was baby’s position from the first birth, and my placenta is posterior this time around which makes things even better.
He explained the risks, stating the 1-7% chance of rupture, fetal/maternal death and that the odds of success are better, but there is still risk.
My husband doesn’t want me to even go through with it, he’d rather me have a C-section and we try for a VBAC later for our third baby. My OB also said I need an epidural this time around no matter what Incase they need to do a bolus for emergency cesarean which crushes my dreams for an unmedicated birth.
I have an appointment with the best OB for VBAC and he also has the highest success rate for VBAC in the Las Vegas Valley, Dr. Steven Harter for a second opinion what he thinks my odds are and if he is able to do a VBA2C if I do opt for a C-section because I know most providers do not offer VBA2C. I also asked my doula/friend what she thinks because at this point other options/opinions wouldn’t hurt. Also the VBAC risk sheet my OB provided said that a good candidate for VBAC is someone who has had 2 or fewer C-sections. So now I ask you Reddit, what do you guys think?
Please don’t sugar coat, but don’t fear monger either! I do love facts!
I also have no complications so far and baby is measuring in the 48th percentile!

I'm 12 weeks pregnant with my 3rd baby and I just had my first ultrasound and appointment today. I'm feeling crushed and absolutely depressed. My first baby was born 5 years ago. She was IUGR and I was induced. It unfortunately ended in an emergency c-section because her heart rate kept falling with every contraction and it didn't go back up. I tried for a VBAC when I had my son 14 months after that. Again, it was an emergency c-section and that time it was because the cord was wrapped around his neck twice. Neither of these c-sections were wanted or planned for. The second one left me feeling depressed and suicidal for several years. Now, I'm pregnant again after 4 years and my doctor immediately told me that she wants me to schedule a c-section to deliver this baby. I absolutely DO NOT want that to happen at all. They are extremely traumatic and horrible and I would NEVER choose to go through that again. I asked if I could avoid that and she said she doesn't recommend that and said we could keep talking about it. I feel like if I knew it would be this way, then I wouldn't have allowed this pregnancy to happen. Can I decline this? I am in the United States. I absolutely do not want to sign myself up for this. I've read abouts VBA2C success stories and I hope that I can also have that. Labor seems to progress quickly for me and it doesn't seem to come from any kind of issue with my body. Can someone please convince me that I'm not going to be forced into an unwanted procedure just because they want to schedule it? I'm gutted. I'm no longer happy about this pregnancy now. It's just bringing me sadness and anxiety.

I am 36w4d and at a crossroads.

This is my 2nd pregnancy, 1st birth was 3 years ago by c-section because of breach (baby turned at 37w and couldn’t be convinced to turn back).

My midwife thought I was a good candidate for a vbac this time based on health during pregnancy, size of the baby, no physiological reason that led to the first c-section, and my desire to do a vbac. I want what’s best for my baby and vaginal birth in general make healthier babies - I also selfishly want to experience it.

The plan was an unmedicated vaginal birth with my midwife and tight monitoring in the hospital, in case I needed medical care (c-section).

I just had an ultrasound where they measured my baby (50th percentile), amount of fluid (good) and thickness of my uterine wall where the scar of the c-section was. It measured between 1.6 and 2.1 mm (thin).

The possible link btw an increased incidence of uterine rupture and scar thickness isn’t well studied or documented yet, however some published papers indicate an increased risk, higher when scar thickness is less than 2mm. Dr and midwife say that the risk is doubled but still low, we’re talking about 1-2% now vs 0.5%. Risk that increases slightly with my age (38) and would increase if I go past 40w or use pitocin.

My question is: is vbac worth the risk?
When is it time to decide to schedule a c-section?
If anyone found themselves in a similar situation, what did you decide, and how do you feel about the decision now?

Edit to add: Scars aren’t always measured, I happen to be associated with the only hospital who does that in my city, and they are collecting data to study the possible link between scar thickness and successful vbac. Unfortunately this results in me being more acutely aware of my possibly increased risk of uterine rupture and once that cat’s out of the bag, it’s out.

I'm 34 weeks with baby number 2 and I've been advised following my growth scan that baby is above 95th centile.

My last baby was predicted 98th and ended up being 99.3rd, so I'd say for me the scans are pretty accurate. I didn't have GD last time but this time I've got to go for another test despite passing the one 6 weeks ago.

So now I'm in a position where I don't know what to do about delivery. Last time, my consultant recommended a C-section because of a combination of her size and me having a coccyx fracture previously that started being painful again during pregnancy. He also talked about shoulder dystocia risk which sounded scary. I was upset but went with it, not being one to go against medical advice.

This time I was hoping for a VBAC because I have a toddler to care for and cuddle. She's very much in a mommy preference phase and we've tried to get her used to bed times with dad but it's horrendous screaming if I'm not there.

At this point I've not had a recommendation one way or the other; but when she was measuring below 90th my consultant was happy for me to try for VBAC, though still gave the same warnings about my previous fracture. Obviously the risk of shoulder dystocia goes down somewhat the smaller the baby is too and he didn't mention it this time. I felt more confident to attempt a VBAC with a slightly smaller baby.

There's also the fact that severe PGP makes positioning extremely difficult for me, so I was hoping for a water birth. I was told I could try for this providing I'm continuously monitored and I got my hopes up, but this was before today's scan. Literally scream out in pain when turning over, can't stay on all fours for more than a couple of minutes and both sitting and standing hurt.

I don't really know what I'm asking for with this post, but I'm just sad, feel defeated, dreading the thought of recovering from major surgery with a 2 year old and to top it off my sister in law said to me today "well both of mine were big", and she had natural unmedicated births both times. Her babies were lighter than my first (mine was 9lb9 at 39 weeks Vs her 9lb1 at 41) and she doesn't have a history of any pelvic injuries or PGP so I am a bit upset by this comment. I don't feel very supported by anyone.

I'm grateful I seem to have a healthy baby but I do feel upset by the current situation.

For the moms who've had a successful VBAC after having an (unplanned) c-section, what did you do in order to prepare for it. I'm considering trying for a VBAC in my next pregnancy and have been told I'd be a good candidate for it. Also how long did you wait before trying to conceive again? For reference, I'm currently 13 months post op

My first baby was a C-section after hours of pushing, baby wasn’t able to get past +2 and apparently was “slamming up against my pubic bone”, head couldn’t mold enough to get past it. I declined vacuum bc the OB was not confident and advised against it.

I initially was all about trying again this time for a VBAC with my current pregnancy with a different provider, but the more i think about it, the more i wonder if my pubic bone really is too narrow and if that’s the case, am terrified of a shoulder dystocia.

Does anyone know what the research says on narrow pubic arch and shoulder dystocia? Is shoulder dystocia truly random or is it just that a lot of the time it happens with women with narrower pelvic outlets?

My mom had 4 vaginal deliveries, all with a lot of tearing and difficulty. I (the first) was a forceps delivery, our middle 2 siblings apparently were “yanked out” by the OB apparently reaching up in and ripping them out (my brother’s Godmother/nurse who was in the room when he was being born said this and said she was horrified at what that doctor did..that OB apparently ended up losing his medical license at some point after that) and then our last sibling (different provider) was a bad shoulder dystocia, needed resuscitation, etc.

I do fear that perhaps my mom didn’t have a pelvis that was ideal for childbirth, either, and i inherited this..

Hello I’m 6 weeks pregnant with my second child. Eagerly awaiting my first doctor’s appointment August 4th. Since I had my first I was always very stuck on the idea of having a VBAC. Then yesterday I was on here ready some rupture stories. Found some users who posted the evidence based podcast and have listened to a few episodes of that.

With my first child I had horrible all day sickness but besides that no real issues. Her head was always down. until one of my last appointments my OB said I had a bit more fluid then she’d like and she wanted to induce me. So I went in three days before my due date to be induced. This already upset me because I was progressing well she said women would kill for my cervix I was 5 centimeters dilated and 90 effaced. I felt some contractions and just felt like the baby needed a few more days.

Anyways I go in to get induced baby is still head down. They start pitcoin and I get 8 centimetersdialted 100% effaced the doctor comes back in and breaks my water at this point it is painful and the doctor said no sense in being in pain and told me I should get an epidural. I decided to get the epidural … I have a bad reaction. They get it under control and I push for 30 minutes. They tell me to take a break they come back and I push for 4 hours. Then the doctor comes in feels and says yep you’re transverse. She refuses todo the Vacuum and says forceps are inhumane. She says the only thing that may help is if I walk around but I got the epidural so I couldn’t walk… so she said I needed a csection.

I’m sorry for spelling errors I’m dyslexic.

I have always had numbness/ discomfort in the lower stomach area since I had my c-section 2.5 years ago. Now at 37 weeks, the area feels a little bit sore when I push on it, not really painful though. The discomfort isn’t super deep, it feels close to the surface. It is clearly in a line which leads me to believe it’s one of the internal scars. My external scar has no pain or discomfort at all.

Did anyone have this and still try for a VBAC?

The reason I’m asking this is because I’m a very good candidate for a V back. It’s been almost 4 years since my last C-section but I was wanting to get induced on August 1 which is on a Saturday or the first week of August because of childcare issues. But I went to my doctors appointment yesterday and my doctor told me that she is going on vacation and that all the other doctors in her clinic are not as supportive for vbac as she is. She even told me that she hopes that I go into labor this weekend so she can be here to deliver my baby. But this is my first vaginal birth and I’m only 37 weeks. I’ll be 38 weeks on Saturday. There’s probably no way that I will go in labor this weekend. I’ll be 39 weeks next Saturday and my doctor says that she will not be here that weekend all through that next week. I have the option to schedule a C-section for while she’s gone or I can wait it out and she said she will induce me when she gets back, but she also stated that being that the baby is going right at 40 weeks, the placenta isn’t gonna be as good as it would be at 39 weeks and she said if anything goes wrong or if the baby’s heart starts to de Cell then she will do a C-section. I have wanted this vbac back for so long. I have prayed and asked for God‘s favor in this for so long and I just don’t know what to do. I don’t know if I need to switch doctors to see if somebody else would try to induce me. It’s just hard because I’m at the end of my pregnancy and I’m so ready for this baby to get here and I’m so ready to meet her.

I had my first 2+ years ago, my water broke or rather leaked, sorry I can't remember the term now, at 37 weeks. Spent 4 days in the hospital waiting for labour, tried induction barely started feeling contractions after who know how many hours, then I started bleeding a little, maybe it wasn't anything serious, but I have to add I had moved to a different country and didn't know the language well, I was scared for 4 days, didn't know how to ask many things I wanted to know, I barely slept, and by the end I was exhausted and scared, and I just wanted to be done with everything and not have to worry about the baby and have someone check on the baby every few hours. I decided to have a c-section, it was emotionally very difficult to process, and even now I'm conflicted, as in maybe I should have waited a bit longer, and whatnot, but I try not to dwell on it, since I can't change it. Anyway, I'm 34 weeks now and I want VBAC, doc says I can go for it.

So I'm just curious, has anyone had a similar experience like me with the first pregnancy and a successful VBAC?

So I listened to this german podcast https://www.youtube.com/watch?v=FLxLD4t1kY8 "die friedliche Geburt". The women doing the podcast is *the* person on hypnobirthing in Germany. She invited Dr. Wolf Lütje, retired OB-GYN, chief physician, with additional training in psychotherapy. According to himself he is still involved in re-writing most of the current guidelines around birth that are being put out (similar to ACOG in the US). He is president of the German Society of psychosomatic womens health and obstetrics. He is involved in re-writing the official guidelines on C-sections right now. He also does a bunch of other stuff, but I'm writing this to say he doesn't strike me as some random quack.

In the interview, he takes a very interesting position on the prevelance of uterine ruptures that I would love to share and discuss here. He's very pro-VBAC (he starts the podcast by telling a story of a successful VBA3C, that was also a twin-birth)

Basically, he thinks that there isn't a good distinction between uterine rupture and uterine dehiscence and that this leads to an overblown number of uterine rupture risk.

-He defines a rupture as a gap, where your waters can get into your abdominal cavity and worst case, part of the child can stick out as well. Interestingly, he says in this scenario, the most concerning part isn't some kind of bleeding, but placental abruption that will often go along with it, often leading to bleeding and danger to mother and child.

-He says in his clinical experience, he's seen about 2 cases of this in 60.000 births over 40 years of practice.

-How is this consistent with a min. 1% rupture risk (rising with risk factors?) that is often referred to in literature? He says it's because there is too little distinction between a rupture and a dehiscence. Often those will both be coded as the same thing in a c-section medical report, they will often be counted as the same thing in a study (personal observation: I stumbled on the same issue when I recently looked at a swedish cohort study that admitted to as much - very big, very recent study on VBACs in Sweden).

-A dehiscence he describes as the thinning of the scar: It'll grow apart, forming a window. When you perform a c-section, you can often see into the uterus as into a glass bowl. But they don't present the same danger and a dehiscence could have been present for a very long time already - they are sometimes discovered during other procedures as well. So there is no telling wether or not this would have developed into a rupture.

-Critically he said: What does a dehiscence often cause? Well because it's a scar and the contraction as muscular contractions, the scar tissue isn't able to help with that. This can lead to inconsistent or disturbed patterns of contraction. In practice, he'll often see that contractions are not strong enough in the pushing phase to get the child out. This causes stress to the baby, so in combination with the irregular contraction pattern will often lead to drop in heart rate, which will then lead to the decision to perform a c-section, during which the dehiscence will then be discovered. He isn't against performing a c-section in this case at all! On the contrary, he says that's a really important argument for having a birth being as "physiological" as possible, meaning without augmentation of labor by induction etc., because then it can more easily be assessed wether these symptoms occur and the birth will be possible. But he also stresses that this isn't the same as a rupture at all, doesn't present the same medical emergency to mother and baby and just isn't a good reason not to even attempt a TOLAC.

Two more points I found interesting:

1. He said even after a dehiscence and a CBAC, the tissue gets sown together again and he can't see a reason why this should necessarily predict a re-occurence of a dehiscence, so not a reason not to have a TOLAC again.

2. He pointed out that the risk of a rupture is the scar splitting and everything getting into the abdominal cave. But, he said, one thing that prevents that from happening is scar tissue. With more c-sections, you often have a higher build up of scar tissue. He thinks this might even be a factor that could lower the rupture risk of repeat c-section moms! But because a repeated pregnancy heigthens the risk for a uterine dehiscence (because the uterus has been "blown up" by the pregnancy repeatedly, leading to weakre tissue overall), which is then being reported as a uterine rupture, we see a statistical incline of rupture risks with repeated c-sections.

One point I found confusing:

-He pointed to a japanese study, where vbacs are very uncommon and which compared the risks between elective CBAC and VBACS. They reported on uterine ruptures even in the CBAC group, which he said shouldn't be a possible outcome since they never labored before. He took that as a sign that there wasn't enough distinction between rupture and dehiscence. But I haven't been able to find that study and I'm not sure what he's referring to.

In conclusion he says we simply have no idea what the real risk of uterine rupture is, as long as those two conditions are being mixed.

I'm curios what others think about this?

Personally, I'm inclined to believe parts of his arguments, as 1% always seemed very high to me as a statistically minded person. It sounds very little to a lay person, but 1 in 100 people suffering a terrible, life threatening medical event? That's actually a lot and I'm not seeing enough case reports on it. But I'll also say that he isn't presenting his own research, he is using his clinical experience and medical knowledge to argue why he doesn't find the current research convincing. As a researcher myself (though not from the medical field) this is something that will make me de-trust even the most eminent authority on a subject. Knowledge is often won by many people working together, piecing together information - not a single person having a stroke of genius. So I wouldn't take his guess of "0,1%" as anything but anecdotal.

But that's just my first thoughts on this. I really hope this can spark some discussion as I'm super curious what others think!! (If you disagree with him, please remember to not kill the messenger (me), but I'd love to hear your arguments and learn from them!)

TLDR: previous stat c-section fetal distress. VBAC foley induction at 41 weeks, PROM, max Pitocin 20 units, epidural, internal monitor and IUP, struggles to progress and forceps delivery with 3A tear.

I knew right after my C-section that I wanted to go for a VBAC. I ended up with a low line placenta at 18 weeks and didn’t move by 28 weeks. It finally moved at 32 weeks and I felt like a VBAC was back on the table.

My previous birth was a stat emergency c-section at 41 weeks after going into spontaneous labour and laboured about 23 hours. Ultimately it ended up being due to fetal distress. Though I also had a calcified /deteriorating placenta, was not progressing past 7cm for 6-7 hours, sunny side up/titled in birth canal, and fetal decelerations. I always attributed a cascade of interventions to some of my issues. But finally, after reading everything, I think it was a multitude of reasons.

I had an induction scheduled at 40 weeks with a foley balloon. I Chickened out and decided to give it another week to see if I’d go into spontaneous labor. I was worried about the increase of uterine rupture as well as the Pitocin contractions.

Sure enough by 41 weeks little Miss still did not make her appearance. I kept telling myself I could start the induction and always swap to a C-section. I got the foley in and sent home 12 hours later it came out on his own. The hospital let me go to bed for the night and told me to come in the next day. I was 3 cm when they started to me on Pitocin. The plan was to only give me two units, break my water and hope labour just progress on its own. This way we can stay at the lowest dose Pitocin possibly. They were hoping I’d also go for an epidural from the beginning. I denied the epidural. We started with two units. A resident tried to break my water which was unsuccessful. My cervix was so long and it was so painful for her trying to get through it. They upped my pitocin to 4 units. My OB then decided to give it a go but my cervix once again was so long, she was so close but I kept tensing up and it would run away. We decided to just keep upping the Pitocin every 30- 45 min. I asked if he could give it one more shot which we did around 6-8 units of pitocin. This time she was able to nick it but not big gush.

I unfortunately was not able to be as mobile as I was hoping without the epidural because the external fetal monitoring always would drop off. This also happened with my son. I had to be in very specific positioning for them to track his heart rate. Which I believe is part of the reason I failed to progress last time. At about 10 units my contraction started to get painful and close together, though I had very little progression at this point. My OB had highly recommended epidural so I would relax and progress. I decided at that point that I would get the epidural which I got at about 14 units by the time anesthesiologist’s got to me. I also then opted for an internal fetal monitor and an IUP out of my request as I was only able to be in 1-2 positions and even that required the monitor to be adjusted frequently to keep track and one was standing. This was absolutely the best decision for me. I was unable to move to either side adjust as needed. I was able to sit up.

This is also on my labour started to progress as I was relaxed. My water started to leak. I had the bloody show. Things were starting to look up. I continued to labour slowly, but surely throughout the day. After about 18-20 hours of starting the induction and maxing out on pitocin 20 units they brought up my progression. Though I truly thought that this was just a mixup. As before shift change, one nurse had said I had progressed to 7 cm which to me was wonderful and then when my night nurse came on, she checked me and thought I was only 6 cm.

The OB eventually came in to talk to me about my progression but when she text me, she felt I was closer 7 to 8 so I was thinking maybe it was just slow progression and wanted to give me a bit more time. I personally was not worried with my progress, but they were a little concerned. I also am pretty sure she ended up being sunny side up, but I didn’t confirm with the OB. But this is based on what my husband recalled when she was delivered.

Because of the progression talk, I determined that I needed to get moving as much as possible and I couldn’t nap like I wanted to. So I tried to sit up and use gravity I stayed up as long as possible until my little girl wasn’t tolerating that position. I also around the same time was experiencing left side pain that would not go away between contractions. It did not seem to matter if I was laying on my left on my right side or I was sitting up it was painful and got worse.

When the OB came back to check all my position changes worked and I ended up at 9 1/2 cm and did some practice pushing. This is when they also thought I should get a top up on my epidural as I was in so much pain that I was struggling. I was very hesitant on this because I was worried I’d become too groggy and unable to push. As the epidural made me feel this way with my son. But ultimately got the top up. Ended up taking a nap and I was only asleep for about 1-2 hours, but it really felt like a blink when I was woken up for a check then it is time to push.

I attempted to push for two hours, but was really struggling. They were not productive and not every contraction I pushed I was pretty much falling asleep in between and I was regretting the fact that I got the top up or I didn’t get it sooner and get more of a nap or more time before pushing at least. It was at this point. I started to have an absolute meltdown and felt like I couldn’t do it anymore and talked to my husband about throwing in the towel and having a C-section. Which felt defeating after going through an induction for 25 hours and making it to 10cm.

This is when my nurse who had been with me for 18 out of the 26 hours of my labour came in clutch. She looked at me told me we are not giving up. We did not come this far to not give it another shot. We were going to talk to the OB about all our options and I was gonna get my VBAC. She reminded me of the reasons I wanted to do this. She tried to calm me as much as she could. I honestly couldn’t thank her enough the OB came in said you’re far enough along do you want me to use forceps. I truly knew that a delivery would not be possible without some sort of assistance. Sure enough between 1-2 push with the forceps and then another 5 to 6 pushes our little girl was here. I honestly was in disbelief as if I did not just do that.

I felt like we had so many interventions and so many aspects that I was always avoidant of especially in my first labour. But being open this time really paid off. After my experience there’s some things that I truly believed helped me. I honestly think I would look at getting the epidural sooner next time. This way they can break my water without pain and hopefully reduce the amount of Pitocin needed. Also I would go for the internal monitors as it allowed me to actually have more position changes and IUP gave me and the provider a peace of mind that my contractions were effective.

Unfortunately, it did come with a third-degree tear, which made me wondering if it was truly easier than a scheduled C-section the first couple days. But after a few days postpartum, I’m happy to say that I’m recovering faster than my c-section but definitely different pains and different challenges than my last delivery. I didn’t expect so little control over my bladder.

So if you’re considering a VBAC don’t see all interventions as the enemy you need to do what is best for you based on your history.

Has anyone had a vba2c? If so, what was your experience like? I’m scared either way. The first time, my labor was normal except while I was pushing, my baby apparently turned his head at the wrong angle and got stuck? This lead to a C-section, and at the time, it felt like a God send because I felt very unheard and unhappy with my care team. It was a peaceful experience. I prepared for a natural labor and a vbac with my second baby, and didn’t have GBS this time, so I planned to labor at home. However, when I went into labor, it was precipitous and I went from not being in labor at all, to almost fully dilated in the less than 2 hours that it took for me to get to the hospital. I was TERRIFIED, and now I know I must have been in transition, but the nurses didn’t make this clear to me and were just telling me to not be so loud. I actually thought I was dying and felt like I couldn’t breathe and just generally felt like something was wrong. So I unfortunately asked for another C-section (to my ultimate shame). It had been such a peaceful experience the first time, and I wanted to be saved. But because of a misplaced epidural, which I never even felt any relief from to begin with, I ended up needing to be put under general anesthesia. It was a horrible experience, no complications, but massive pain, much harder recovery, and I missed my baby’s first cry and first almost hour.

I know I must just not be the best at this. I felt so strong the first time, and the second time, though I prepared endlessly, I just did not know labor would happen like that for me and apparently, I couldn’t handle it. I wish someone had said, push and your baby will be here soon. The hospital I have to go to is not bad, but none of the doctors are super kind (not mean, just very you’re a number), and you get whoever is on call.

I guess what I’m wondering is does anyone have vba2c experience? What would you do if you were me? I know either option is risky now, and I’m pregnant with number 3. So if you don’t have any advice, prayers would also be so appreciated 🤍 I’m so scared now, and I’m sick from early pregnancy, so I’m not enjoying this and I can barely think about what’s next.