I'm thinking myself into circles and I'm wondering if anyone has some insight that can nudge me in a concrete direction.
I was induced at 41+1 with LO1 for high BP. At that point I was less than 1cm dilated and had had no contractions. I dilated well, but she got stuck, there had been meconium, I had a fever, and she had heart decels--- so I ended up with a somewhat urgent c-section after 18 hours of labor. I'd been with a midwife practice so I'm confident that both the induction and the decision to cut were necessary and I wasn't just with a slice n' dice type doc.
I'm 26 weeks with #2. I'm on my second OB. Neither has been very encouraging about my chance to vbac. Mostly because I hadn't gone into labor on my own by 41+1, was less than 1cm at that time, and had stopped dilating at 8cm when my daughter got stuck. My current doc has said he'll allow me to try to VBAC if I want, and I can go to 42 weeks if I want.
The DOWNSIDE of VBAC is both docs have told me that doing a RCS on a failed vbac is much harder for them and a much harder recovery for me than just doing a planned RCS. So it feels like it's not a "might as well try" situation, because the outcome would very likely be worse than if I just planned a RCS.
The UPSIDE of a VBAC is if it's successful it's a much easier recovery. Which would be amazing because I have a 3 year old and a lot of stairs in my home.
I feel like if I want to try to VBAC I should hire a doula. But none of them work on a "if you go into labor" basis. You hire them and spend the money and even if I never went into labor and ended up having to have a RCS, I still have to pay. I just can't decide.
Part of me feels like I should schedule a RCS for 41-42 weeks and plan to try to VBAC if I go into labor before that. Going into labor seems like a really good sign things would be different the second time around...?
But I'm still scared of failing. And I'm scared of wasting a ton of money on a doula and then never even going into labor and it's all just wasted.
But I'm also scared of planning a RCS and doing that recovery again.
Sorry this is a novel... but anyone with thoughts.. I'd love to hear them.
apricot / 315 posts
I chose a RCS myself because I wasn't a good VBAC candidate and recovery is much easier this time. That said, if you are quite keen to try then could you hire a doula who does other things besides vaginal birth? Like help out post partum? Or assist at the hospital just after a RCS? That way it might not feel like such a waste if she's prepared to be flexible about her role.
coconut / 8472 posts
Considering you seem somewhat ambivalent about VBAC vs RCS, I'd say skip the doula and schedule an RCS around 41w. That way you can go for the vbac if you go into labor, but you aren't potentially wasting money on the doula.
I was in a similar position - semi emergent CS after failed induction due to stalled dilation. According to what I've read, if you don't dilate on your own you'll likely have that problem in future labors and therefore not be a good vbac candidate.
I chose a RCS and don't regret it. I knew what to expect in terms of recovery and the second time was much easier. But I had plenty of support, DH took 6 weeks of leave, and our 2 year old continued to go to daycare.
cantaloupe / 6730 posts
My daughter was born via c-section at 42 weeks. I did go into labour on my own, but stalled at 7 cm, was augmented with pitocin, pushed 2 hr to no effwct and ended up with a c-section (best reason I got, was labour stalled because Baby was "cockeyed"). For my second, I wanted a VBAC, but was given all the same pros and cons as you. I decided that I would so a repeat C-section if I didn't go into labour by 40+6. I decided to hire a doula even though it
might be a waste of money. I considered it my insurance policy. I wanted the VBAC to work if there was a chance. At 39+5, I was still not dialated, or effaced, Baby was high and OB was confident that I would make it to my c-section date. I went into labour at 40+1, and after 31 hours I was fully dialated, but Baby was still really high and the OB talked c-section again if breaking my waters didn't help bring Baby down. My doula had me try different positions which brought Baby down and I got my VBAC. One thing that was important was that my doula was the most committed of anyone (including myself) about getting the VBAC. Everyone talked C-section at every step and I think it would have gone there if it hadn't been for my doula.
apricot / 488 posts
I had a similar labor and delivery as you. I progressed to 9cm and he got stuck (maybe due to being sunny side up) but officially was failure to progress. I had a horrible recovery. When I got pregnant again I was so torn as to what to do for all those reasons you mentioned. I really wanted a vbac but REALLY didn't want to try and end up with another csection. I can post my birth story or more info if you want but I ended with having a vbac and I am so so glad I did. Recovery was a million times better. I wish you all the luck on whatever you decide is best for you!
pear / 1703 posts
@Mae: I was an excellent candidate for vbac and wanted the extra support of a doula - at the cost of $1300! When baby was ready to come they discovered on ultrasound that almost all my amniotic fluid had leaked out. Ob told me baby would have a hard time in labour and due to the lack of fluid he/she needed to come sooner rather than later. In the end it was, "it will be best for baby to come now via an rcs", what choice did I have after that?
The doula was there with us at hosp for a few hours before surgery and then she insisted on coming in the operating room with us but I said no thanks. There's already a million ppl in there plus, I'd done it before and knew exactly what to expect.
In the end it was a lot of money but didn't really feel wasted Bc it allowed me to feel prepared and supported in the plans to have a vbac.
Next time (if there's a number 3) I will try again for a vbac but won't hire a doula, the nurses are really so amazing that will be all the support I need.
grapefruit / 4455 posts
Just as someone who has had two vaginal births, I can't say about the RCS but I wouldn't plan it based on the doula as L&D nurses tend to be really good at supporting patients! Especially if you're having an epidural and don't need to be coached through every contraction. Just my two cents. And for what it's worth I wouldn't consider a RCS, planned or not, to be "failing." I know what you meant but I think either way you're doing the best you are physically able to to provide the best for your baby and family and that's great!
cherry / 194 posts
I also had an unplanned C-section with my first. I went into labor on my own and dilated fully fairly quickly for a first time mom, but she got stuck at +2 station. My OB practice has been pretty supportive of a VBAC although a couple of the OBs have been pretty frank that a repeat C-section was at least a 40-50% outcome considering my first got "stuck" during pushing. However, unless I get really nervous or something occurs during pregnancy which makes a repeat C-section the best option (like baby going breach) then my plan is to VBAC. I just booked a doula a couple weeks ago, although I was also nervous that I could lose out on money if I decided to suddenly do a C-section or a C-section became necessary despite my plans. However, one point my husband made that struck a cord with me was that if I decide to have a repeat C-section, I have 0 % shot at a successful vaginal birth and a hopefully easier vaginal recovery, while if I try to VBAC, I have at least a 50% chance. And having a doula does statistically raise your chances of having a VBAC. I had hoped that my nurses would play that role last time I labored, but I honestly had the worst cast of nurses who spent their time complaining about personal issues and barely answering my questions, so I didn't want to risk a repeat of that situation. I chose a doula who has a lot of experience with VBACs, and if I decide to have a C-section, the cost lost toward the delivery assistance goes toward her spending a couple nights with me at the hospital while my husband goes home to be with our first. Also, as much as I hate the risk of laboring just to have another C-section, barring any unforeseen complications that I just can't plan for, I know I'll be monitored closely and they will be proactive with telling me that the VBAC will not happen. I'm hoping that since I was able to recover well from an unplanned surgery last time, that would be the case this time, should that be necessary. While a scheduled C-section is typically an easier recovery (and I imagine much better emotionally/mentally than an unplanned one), I also know women who had rough recoveries with each planned repeat C-section, so it's hard to say that a planned C-section recovery will be any easier than what I faced last time.
Bah! Such tough decisions! But at the end, all we can do is make the best call we can with the info we currently have and hope/try for the best. Good luck!
pomelo / 5509 posts
The one thing I'll say, as a doula, is that a write a contingency plan for c-sections into my contract. It includes that I will go with the client into the OR if she wants me to, otherwise I will go and set up her recovery room while she's in surgery. I will still remain with her for a few hours after the birth to help with any recovery/breastfeeding, etc. And then I include a # of postpartum hours. Postpartum help can include coming to the home to watch a sibling, do light housework, hold the baby while mom naps, run errands, bring meals, etc. That way hopefully no one feels as though the money was "wasted." I know a lot of other doulas do the same so you could ask around!
cantaloupe / 6146 posts
@Mae: A doula is an amazing help for the whole process including the mental processing, no matter if you have a VBAC or belly birth (planned or unplanned).
I had a doula for my VBAC and would have her again if I have another, and I wish she was around to calm me down for my first c-section!
cantaloupe / 6146 posts
@Grace: Thanks for sharing!
papaya / 10343 posts
Sorry to post and disappear-- it's hard for me to be online during the work day. Thank you all so much for your thoughts!
@ShootingStar: It's not that I'm ambivalent, I actually desperately want a VBAC. I'm just really scared. A failed VBAC seems way worse than a RCS to me, and I'm not generally a risk-taker. So I'm just feeling really stuck about it.
@Grace: This is exactly why I want a doula if I try to VBAC. I feel like it greatly increases my chances of success.
@justjules: This is why I want this. The recovery seems SO much better.
@Autumnmama79: yea... I am talking to one doula and she said she still comes even if I end up having to have a RCS if I don't go into labor... but like... I don't really need help with that lol. I'm sort of private and I don't want to share those moments with anyone, I only want her there if I NEED her there to help me succeed.
@2littlepumpkins: that was not my experience last time. The nurses were really unsupportive of my labor efforts
@castilrm: I'll keep my fingers crossed for you. I did have some complications post c-section last time that I"m hoping would be less likely if I did a scheduled one... but I just don't know. I do like the idea of having her overnight... maybe I could talk to her about that. Like if I end up with a RCS for some reason, if she could just be there the first night to help me when I can't get out of bed and hubby is home with LO1...
@pastemoo: i don't really feel like I have a lot to mentally process. I'm not scared of the surgery, and I'm not sad about the experience. 100% my whole deal about wanting a vbac is about the recovery. I have a 3 year old. She loves laying and climbing all over me. It just breaks my heart to think it will be WEEKS after I have LO2 before I can pick up or let LO1 crawl on me... so I don't really feel like I need mental preparedness so much as just... I want the easy recovery if I can get it lol.
cantaloupe / 6146 posts
@Mae: Having gone through #1 with the CS after a very long labor, that cs wasn't even that bad. Yes, the VBAC recovery was easier, but a post-labor cs is just not all that much worse, so I wouldn't use that as a reason to schedule an RCS. That's just what I would do for me, everyone is different.
Also re: processing, I had a lot of stuff going on at the same time, and it was very hard for me to even process "I am pregnant" let alone "I am going to have a baby" so it was great to have a doula!
If you feel like you had a great experience last time, but just want the VBAC recovery, you could totally go without the doula.
cherry / 100 posts
My emergency section with DD was due to fetal distress. My midwife thinks I'm a good candidate for VBAC because baby was so small, she just didn't tolerate labor well. Currently 30 weeks with DD2. That said, I will eventually schedule a section for 41 weeks if nothing has happened or before then if DD2 shows the same growth issues as DD. No one has pressed me to make an appointment yet. I personally couldn't spend the money on a doula with all the what ifs swirling around my head (many sound like yours!) I really wish it was something I could have done but I figure I will do the best I can with my husband and midwives.
nectarine / 2987 posts
Postpartum doulas are great after RCSs because you have baby and big sibling and you need care also. I'd ask around and see if someone would take you as a VBAC client and if you don't go into labor roll it over into only postpartum hours instead.
grapefruit / 4455 posts
@Mae: aw I'm sorry, that really sucks. Any chance of going to a different hospital? Or maybe having your DH sort of prepared with the right words/birth plan? I dunno. I think if I really really wanted a VBAC I would just pay the money and try to make the most of the services and if it were a loss because an emergency section had to be done, so be it.