C-Section/VBAC? EpidurL and Episiotomy

Discussion in 'Pregnancy Help' started by Specky, Mar 29, 2014.

  1. Specky

    Specky Well-Known Member

    I need some information if anyone feels like sharing...I'll make this as short as possible.

    I'm 40 and almost 31wks pregnant and trying to make some decisions.
    I had my twin boys when I was 35.3wks. Induced labor due to pre-e after 'active' pushing for 4 hrs and baby b heart rate decals, and failure to progress, I ended up with a very UNcomplicated c-section. Honestly I had no comications with it before, during or after. Unlike my trial of labor which was a mess! Magnesium, pitocin had failed several times. I had NO idea what I was doing and had a nurse who didn't walk me through the process (and I didn't know to ask). In a nutshell, it was horrible so in comparrison the c-section was a breeze!

    Present time: when I first met with my dr who I love she didn't ask me the option of vbac or repeat, it was more of a statement...repeat c-section, right?
    I said yes because of the horrible circumstances around my labor.

    I do not have true hard feelings one way or the other...the only reason I am considering a VBAC is less recovery time and with it being summer, running a farm and two 5 yr olds, this momma's got sh!t to do!
    I don't feel cheated because I had a c-csection, if anything I feel grateful for it.
    My question to you is, pros and cons for either? How much do I need to worry about tearing/episiotomy?

    I can't find good information other than scar placement on why NOT to have a VBAC. And I have a low transverse scar. I am on the plus side of 5'11 and pre pregnancy wait of 200lbs, but as of now have only gained about 11 lbs.

    I'm nervous about the pain in labor. I have NO idea what my tolerance for pain is, but I do know I am highly scared of it!! I remember my labor being horrific, with an epidural, but looking back I think I was just scared. I wonder, knowing what I know now, if I did do an epidural if I could go natural.
    Don't even get me started on the horrors of trying to breastfeed or lack of support!

    I want the safest outcome possible for me and baby. I'll be delivery at the most advanced hospital in the state (a teaching hospital-yuck) but work here so know if push came to shove I'm in great hands.

    What are your thoughts?

    Sorry for the ramble, my mind goes in a thousand different directions, I'm guessing that's why I have insomnia, lol!
  2. miss_bossy18

    miss_bossy18 Well-Known Member TS Moderator

    I think one thing that it is really important to understand is that an induced labor, especially one in which you are also dosed with mag, is an entirely different beast than a spontaneous labor. It's comparing apples and oranges.
    Have you checked out VBACFacts.com? Lots of great info there.
    A couple of thoughts I had reading your post:
    - based on your care provider's approach to the VBAC/ERCS "discussion", she may not be supportive of VBAC. One of the most important ingredients in a succesful VBAC is a supportive care provider. I thnk your first step before anything else is to talk to your doc and see if she'd be willing to support a TOLAC (trial of labor after cesarean) and if her routine practices will be supportive of the process or interfere in it. If she IS supprotive, great - you have options. If she isn't supportive, you can still attempt a VBAC but are statistically less likely to end up with a vaginal birth. Or you can switch care providers, which may or may not be worthwhile to you.
    - if there is even the smallest, tiniest chance that you will be having more babies after this pregnancy, I would really encourage you to strongly consider a VBAC. The increased risks to moms and babies when you're looking at 3 or more cesarean births is a big deal.
    - avoiding episiotomy is pretty simple - you tell your doc not to do one. ;) There is NO evidence to support their routine use, and very little evidence to support their use under specific circumstances.
    - avoiding tearing is a trickier thing. The problem here is that many routine hospital practices increase the likelihood of a tear - these include epidural use for pain management, pushing flat on your back or in a semi-reclined position, "purple pushing" (this is when they instruct you to push as hard as you can while they count to 10, 3-4x/contraction), and doc "massaging" the perineum as baby is descending. Conversely, ways to avoid or minimize tearing include pain management techniques that allow you to be upright and mobile, pushing in up right positions (ex on hands and knees, sitting on a birthing stool, squatting, etc), pushing spontaneously and only as you feel the urge to, and doc keeping their hands off your perineum. A 1st or 2nd degree tear is usually not a big deal - they sometimes don't even require stitching and will usually heal just fine. 3rd and 4th degree tears are more concerning and healing from them can take a long time and can be complicated by poor stitching/repair.
    - if you want to attempt a VBAC, I would encourage you to hire a doula, even if you know you will be getting an epidural. They can still help with informational and emotional support, not to mention she can help with position changes after you've had the epi placed which in turn can help labor continue to progress on its own without the need for pitocin. I've even had some clients who still had enough sensation after getting an epi to be able to push in hands and knees position which is great but most nurses and doctors don't think to suggest it. If nothing else, a doula will help ease your fear which in turn will make labor less painful which is always a good thing. :)
    - safety is relative and there is no way to guarantee it. I know that sounds like a harsh thing to say but all it really means is that there isn't a "right" choice to make - there's just the best choice for you, considering the resources you have available to you. There are worst case scenarios for both VBAC and ERCS. There are best case scenarios for both VBAC and ERCS. You have choices that can increase/decrease the likelihood of certain outcomes, but in the end, some things are completely out of our control. In a way, it's a matter of choosing what is most likely to feel better to you after.
    1 person likes this.
  3. Katheros

    Katheros Well-Known Member

    Ditto everything Rachel said, especially finding a care provider that is supportive and knowledgeable about VBAC's.
    The only thing I can really add is about tearing.  I tore pretty badly with my first singleton (he had a huge head) and had a lot of stitches.  But the recovery was no worse than the twins (one stitch) or my daughter (no stitches).   The only difference was it took longer for me to heal well enough for sex.   But as far as pain after the birth because of it, there was very little difference.  I was slightly more sore afterward but it was totally manageable with cold packs and low dose pain killers for the first day.
    The difference between an episiotomy and tearing was explained to me this way:  Think of your perineum like a piece of fabric.  If it's cut, as in an episiotomy, just like fabric it will just keep ripping with pressure.  Whereas if you tear naturally, just like fabric you'll only tear as much as needed. 
  4. Specky

    Specky Well-Known Member

    Thank you both so much for the amazing information and taking the time to share it! You've given me a lot to think about. I feel like I'm starting with a blank slate, assuming I don't get pre-e again I may have more options than I ever allowed myself to acknowledge.

    Thanks again, I really appreciate it!
  5. babyhopes09

    babyhopes09 Well-Known Member

    I'm pro repeat c-section here, though i do very much agree with pp's about dangers increasing with the more csections you have. I was exactly in the same situation when we delivered my Ds after our girls were born. For me, I was just too dang tired by the end of that pregnancy I just didn't think I had it in me to do a vbac with the labor and delivery (which was offered bc I was a good candidate). I scheduled a csection and ended up going into full blown labor before they were able to do the csection.. I guess I did do the trial of labor after csection just out of sheer circumstance. I had my mind set against vbac completely and was caught off guard by it. In the end I did not progress and they would not give me an epidural bc I was still planning on having a c section (ours was delayed bc of an emergency c section had to go into the OR before me). They still checked me to see if I could just do the vbac even though i had my mind set on a repeat c. I honestly had a fairly easy time recovering from my csections and I will scheduling another csection with this pregnancy. This will be our third csection and our dr is not worried.

    I guess my two cents from my past experience: just make sure you have your mind completely made up as to what you want prior to the end of your pregnancy, whether its vbac, trial of labor after c, or scheduled c. Make sure you are clear with your significant other and dr about your wishes. This time with #4 I will be telling my dr under no circumstances do I want to advance that far into labor this time. Good luck to you in your decision, whichever you choose!
  6. gina_leigh

    gina_leigh Well-Known Member

    I recently had a successful VBAC with our third. And, I'll be honest, I don't remember the recovery from my c-section being all that bad. I know I didn't take any of the hardcore pain meds past leaving the hospital. But then there was the recovery from the VBAC. Oh my goodness! It was so very easy! I did have a small tear that my doctor said was minimal. (I don't remember how many stitches were  used.) And I did have to push for 2.5 hours, which was exhausting since I went into labor in the evening and labored through the night. I tried to rest, but my nerves and just everything going on made sleep impossible. So when it came to pushing at 3:30 in the morning, I was exhausted. I was sore for a day or so, but not nearly as bad as I was thinking it might be. And by a few days out, I felt mostly back to normal.
    Now, the only reason I had a section with the twins was because of baby B's position (transverse). So my doctor was very supportive of me having a VBAC. And, honestly, she was one of my biggest cheerleaders when I was pushing. There were a few times when I said I couldn't do it and she was right there saying that I could and would.
    She did have a few stipulations for a VBAC. She had to have my OR report from my section to confirm where I was cut on my uterus and that I was in active labor when I went in. And she said she would not do an induction with full-blown pitocin with a VBAC. (I did have a small amount in a drip to help me progress, but it was a fraction of the amount they use to do an induction.)  
    I do agree that having a very supportive doctor is a must. 
  7. rrodman

    rrodman Well-Known Member

    I chose a repeat section. For me, that was the more comfortable, less stressful option. Both of my sections were easy. I didn't even take Percocet this time. Just 800mg Advil.
  8. FGMH

    FGMH Well-Known Member

    I am 33 weeks and I am hoping for a VBAC. I was induced for the twins, had a long labour but ended up with a c-section when baby B's heart rate showed she was not doing too well once I started pushing for baby A - we all decided that she would have to deal with the stress for too long and we did not want to take any risks. I am thankful for the option of a c-section in these situations and am happy with my birth but I found the recovery after the c-section hard: not so much the pain but it took so long before lifting, bending over, walking at a normal pace etc. felt ok again. I can't really imagine doing that again with two active pre-schoolers as well as the baby to take care of if I don't have to.
    Plus, with this singleton I am enjoying a much more natural pregnancy, letting my body tell me what it needs, feeling a lot more energy than with the twins that it just feels right to let my body do the work of birth too, if that is possible with acceptable risks.
    So far my doctor is supportive of attempting a VBAC and I have a meeting planned in the hospital where I plan to deliver to discuss their policies and views on a VBAC too. This hospital has midwives in charge of L&D but doctors (OBs, pedis and anesthetists) on call on the premises 24/7 and they cooperate with a large teaching hospital which is 5-10 minutes away should things become complicated, so I feel that the environment is helpful for a natural birth too.

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