Thoughts on vbac vs. repeat C-section

Kirsten and I had an ob appointment this morning, and as promised the doctor was able to give us some research-based facts about vaginal birth after cesarean (vbac). While Kirsten likes to point out that any birth carries risk to both the carrier and the baby, I think being in a situation like gestational surrogacy where you have the life of someone else's child in your hands, it makes these decisions (whether or not to vbac or do a repeat C-section) so much more weighty.

I know that if this were my own pregnancy, I would choose a vbac for myself. But in this situation, I have more than my own family to think about; I have Kirsten and her family involved as well. Yes, I had a horrible first C-section experience (I'm sure not as horrible as some!), and I am not certain that I am done having kids of my own, so if I choose a C-section this time, it pretty much means I will always have a C-section in the hereafter. But a C-section would be worth it if it was the right thing for both Evan and I.

The problem with that logic is that no one can predict what the best thing for both Evan and I will be. The ob we are seeing now admits that there are risks to trying for a vbac, but he feels that it isn't "dangerous" and that the risks aren't significant enough for him to recommend a C-section.

The fact remains that there are risks. Today he gave me some paperwork on the risks of a vbac in women who have less than 24 months between deliveries (I have 20 months between). Some of the points that stuck out to me are as follows:

1) For women whose labors begin spontaneously, uterine rupture (the main concern with vbac) is reported to be less than 1% and the risks are similar to or less than the risk of any other unpredictable complication of labor and delivery (cord prolapse was 1.9 people out of 1000, fetal distress was 39 people out of 1000, placental abruption was 5.5 people out of 1000, and uterine rupture was from 0.9 to 8.0 people out of 1000).

2) With access to a rapid cesarean (18 minutes or less), babies and mothers usually do very well. If the cesarean is rapid, fetal death from uterine rupture is extremely rare.

3) Many facilities have recently determined that they don't have the capability to respond fast enough in the case of uterine rupture and are denying women the chance to vbac. Caregivers who support vbacs say that the focus should be on improving access to quality of care for women who want a vbac, not on discouraging them because of negative outcomes publicized in high profile malpractice law suits.

Kirsten and Chris appear to be on board with me trying a vbac, but I certainly have some things to think about before the big day.

In other news, my stomach is measuring a little behind so the doctor is sending me for an ultrasound to measure the baby. He thinks I am only measuring behind because the baby is lying sideways right now though, so he didn't seem too concerned. I'll go next Saturday for the u/s.