There’s not a lot of research out there for VBA3C’s (Vaginal Birth after 3 C-sections). Why? Because in the medical community it’s not supported to do a vaginal birth or trial of labor after 3 c-sections, they don’t know exactly what the risks go up to other than the risks increase.
According to americanpregnancy.org “If you desire to try a vaginal delivery after having had a cesarean, you should be encouraged by knowing that 90% of women who have undergone cesarean deliveries are candidates for VBAC. Statistically, the highest rate of VBAC involves women who have experienced both vaginal and cesarean births and given the choice, have decided to deliver vaginally.In most published studies, 60-80%–roughly 3 to 4 out of 5–women who have previously undergone cesarean birth can successfully give birth vaginally.”
What are the risks? Uterine rupture is the main concern which can cause death to the baby, to the mother or both. Yikes! Hearing that sounds extremely scary and some may wonder why in the world would you take a risk like that?!
“The greatest concern for women who have had a previous cesarean is the risk of uterine rupture during a vaginal birth. According to the American College of Obstetricians and Gynecologists (ACOG), if you had a previous cesarean with a low transverse incision, the risk of uterine rupture in a vaginal delivery is .2 to 1.5%, which is approximately 1 chance in 5001. Some studies have documented increased rates of uterine rupture in women who undergo labor induction or augmentation.”
Okay, so yes, uterine rupture is scary but check out that percentage, it’s pretty low. There are factors though that can increase that percentage. But first let’s get a little history on me. First baby was a vaginal delivery. Second delivery was an emergency c-section due to breech baby. I didn’t have the doctor try to turn my baby but I wish that I would have after talking to my most recent OBGYN. But at the time, I lived by Sun Valley Idaho, actually I moved there at 36 weeks. And at 37 weeks the doctor informed me baby was breech. They said they could try to turn the baby, but informed me that if anything went wrong with me or baby and I needed a transfusion or baby needed NICU then we would have to be life-flighted to Boise. So that scared me out of trying. We waited as long as possible for baby to turn – meaning I went into labor but he was still breech so emergency c-section.
Unfortunately I had complications after my c-section. A spinal headache for a week that was so severe I needed a blood patch to help me. Think of the worst migraine you could have an multiply it by 10 – that’s a spinal headache. Unfortunately that wasn’t my only problem and I needed to have a colonoscopy too. Not fun.
It took us 3 years to get pregnant the first time, then 15 months the second time. We thought it would take over a year to get pregnant again and wanted our kids to be 18 months to two years apart so we started trying for another baby – we got pregnant that month. Palm to face. I was hoping for a VBAC, even though it would only be 15 months between the two but I had partial placenta previa. So 15 months after my first c-section I had another c-section. Fortunately I didn’t have physical health issue after this one, but had an emotional upheaval which caused me to spiral into severe postpartum within the first 2 weeks. Then my baby was hospitalized at 4 weeks with RSV for 5 days.
I did not want to get pregnant anytime soon. But unfortunately (or so I thought at the time), the one time we didn’t protect I got pregnant. Go figure. Boy did I cry and cry and cry. And my husband just told me he was excited for another child which helped. In the middle of my pregnancy we ended up moving to Utah and I got a new OBGYN. She was encouraging me to have a VBA2C (vaginal delivery after 2 csections). I was shocked but super excited. And then she gave me paperwork that I needed to sign basically it was informing me of the increased risks. As I read the paperwork it said that a minimum of 18 months should be between the last csection and the attempted VBAC. I would only have 13 months between the two. When I asked my doctor about this she told me there were studies that showed 12 months was the absolute minimum. But then my risks were double. After reading all the paperwork and the risks I had a bad feeling about attempting a VBAC because not only had it been 13 months since my csection, it had been 15 months before that one since my other c-section. I did not feel like it was safe for me to try for a VBAC so I had an elective c-section.
The c-section went great, but the day I was to be released I couldn’t even walk. I felt like I was going to pass out even just talking. My blood pressure was high but the nurse wasn’t worried and sent me home. I ended up in the ER 3 times with heart issues and was on bed rest for 10 weeks after having my baby. I had to see a cardiologist after my 10 weeks, by then my heart was functioning normally, it just had a low but safe ejection fraction rate. It was a scary recovery.
This brings us to today: three years later we got pregnant again. I went back to my previous OBGYN and was hopeful that maybe she would let me try for a VBA3C since it had been so long. I was told in no uncertain terms that I could NOT try for a VBA3C. To say I was disappointed would be an understatement. Dejectedly I would go to my appointments each week, and I was also extremely concerned with what happened after my last delivery. My OBGYN was concerned too and I had to go see the cardiologist just to see how my heart was doing early on. My heart was fine – thank goodness. But I had a bad feeling about trying for a csection.
I started having sharp abdominal pains in the beginning of my second trimester. I called and spoke with the nurse at my OBGYN’s office and she told me I needed to go to the ER and get it checked out. After many tests they couldn’t see what was wrong other than my potassium was extremely low and I needed to increase it’s levels. Which could have been causing the pain. So it cost me $3500 to find out my potassium was low and causing constipation – that’s some expensive poop! Grrrrrr. We could not afford that bill on top of my husbands medical bill that was over $1700 for his diabetes that we had just gotten earlier that week. And paying for the pregnancy and delivery. I was sooooooo stressed. I started googling financial help for medical bills when I came across a website that shared little known facts concerning medical bills.
The one that stood out to me was that there are hospitals that have a charitable care act that based on your income is essentially financial aid from the hospital and you could qualify for help. The hospital I had the ER visit at had the charitable care act and we qualified for it! So hallelujah – such a tender mercy. I checked at the hospital I was going to be delivering at and saw they didn’t have this program. So we decided to find an OBGYN at the hospital that was closest to us that had the charitable care act.
I called their office and just got a random OB that was a female because I didn’t want a male doctor. The next day someone told me about a group called ICAN that is a VBAC support group on facebook for Utah. I joined it and asked if anyone knew of a doctor that was VBA3C friendly in the valley. I had little hope that I’d find someone. I was shocked when a had multiple people recommend two doctors! I couldn’t believe it. I was disappointed that they were both male, but I was willing to have a male OB if it meant that I could have a VBA3C. What was even better is one of them was at the hospital I had switched to! I called up the office and switched to see him at 22 weeks.
I was extremely nervous and excited for my first appointment with him. He immediately put me at ease, and we talked about my pregnancy history. After he was done with all his questions he said that he’d have to get it approved by the hospital board but he felt I was a good candidate for it! I did an internal scream, I couldn’t believe it. I was all for it. He had to inform me of the risks, and the fact that there’s not enough research – as in any- that shows how safe a VBA3C is since it’s frowned upon and not really allowed by a majority of doctors. I felt that I was at more risk for a csection than a VBAC so I was all for it.
As the weeks passed I would have moments of insecurity with my decision. My husband was extremely supportive and wasn’t worried at all about doing a VBA3C – he really didn’t want me having a C-section. My OBGYN would tell me at my appointments that if I were to go into labor and he was away on vacation that the doctors on call would insist I have a csection. None of his associates agreed with him allowing me to do a VBA3C. But he told me he wasn’t going on vacation during October so I should be fine. I would repeatedly ask him if he was still okay with me doing a VBA3C and he would say yes. At one appointment I asked about exercising because my husband thought I was doing too much. He told me that he wanted me working out, it would actually increase my chances for a successful delivery. So I worked out 6 days a week for an hour a day – either biking 11-12 miles on the mountain path with my stationary bike or doing a prenatal barre workout. Towards the end of the pregnancy I started walking 3 miles a day too.
At 39 weeks we decided to try stripping my membranes because I’d been at 1cm since 36 weeks and I wasn’t dilating. We were hoping that I’d go into labor, but a week later I was back for my 40 week appointment and I was still at a 1 and only 20% effaced. We stripped my membranes again and made an appointment for 40 weeks a 4 days. But hoped that I’d go into labor over the weekend. Unfortunately I made it to my appointment. And nothing had changed. We stripped my membranes again and set an appointment for the next morning but hoped that I’d go into labor. Alas, I came to my appointment the next day. I had dilated to a tight 2 cm and was 50% effaced. My husband asked the doctor if he was worried and thinking about a csection or an induction and the doctor said he was. There has been research showing that after 41 weeks the chance of stillborn increases and the risks increase for a VBAC. But there are risks with an induction too. So the question was, do I wait and wait to see if I go into labor or do I induce?
We decided to strip my membranes for the 4th time and then come back two days later at 41 weeks. If I hadn’t gone into labor then I would get induce that night by a Foley Balloon Catheter and then an extremely low dose of Pitocin. My husband asked which option was the higher risk – the induction or going past 41 weeks. The doctor said he thought the induction was the higher risk but hopefully this membrane sweep would work. This one was more painful and by the time I got home I was actually bleeding which worried me. I called the office and the nurse recommended that I go on a walk and see if it would start contractions. I went on a 3 mile walk but it just increased the bleeding. That night I got a phone call from my doctor checking on me. He said I needed to take it easy. If the bleeding increased at all I needed to go into labor and delivery. Oh, did I mention that I still wasn’t having any contractions? Talk about frustrating.
The bleeding lessened that night but the next morning it started back up. I finished packing my bag and we headed to labor and delivery. My doctor came and checked me. I was dilated to a 3 and only 50% effaced. He recommended that we should go ahead and induce me since I was already there and I agreed with him. At 11:30 am we inserted the foley balloon catheter which was going to stay in for 2-4 hours. After they took it out, I would get an epidural and then they’d start the pitocin drip and break my water. I started having contractions but didn’t want an epidural yet so I got some pain killers which made the contractions bearable but made me drowsy. Baby was being monitored continuously and was doing fabulous. I was grateful I’d eaten breakfast that morning because I wasn’t allowed to have anything, including ice chips. Ugh, that made for a long day. I was so hungry.
I got the epidural and had shooting pain into my hip when he gave it to me. I instantly thought something was wrong. I even asked him if for some reason it wasn’t working fully would there be an issue if I had to have an emergency c-section. He said no, I’d be fine, it was working. But while we waited for it to start kicking in it didn’t seem to be working on both sides so the anesthesiologist injected something into my line and I felt it start working on both sides finally and didn’t think anything else. Eventually they put a monitor in me to monitor how strong my contractions actually were so they could judge my contractions more accurately. Unfortunately, by 6pm I was at 7cm and I started feeling my contractions. Boy was it painful! I’d push my button but I was getting no relief. The nurse called the anesthesiologist back but he didn’t come until almost 7pm. He gave me another injection saying it should kick in in 5 minutes and he left. He didn’t come back to check on me and the injection didn’t work. Turns out he was off at 7 and the new anesthesiologist was in the ER and would come up as soon as possible. Turns out I was numb from my privates down to my toes. I was so numb I couldn’t move my legs at all but I could feel all the pain of the contractions. Apparently the epidural was done too low. Talk about frustrating…and painful. At one point I had the thought it’d be better to have the c-section. When was the pain going to end?!
I felt all this pressure right at my rib cage – it hurt soooooo bad. The nurse told me that at some point I’ll feel pressure down low and that means I’m ready to push. I didn’t feel anything down there! Just all the pressure by my ribs. At one point I looked down at my stomach and thought, “Where did my big belly go? Why is it flat now?” Just a side note, my baby had not dropped at all before being induced. The nurse kept coming in asking if I felt pressure down there and I kept responding no. Shortly after that, and sometime after 8pm the nurse decided to just check me to see where I was. And I was at a 10!!!! Hallelujah! There was an end in sight to this pain! Unfortunately we had to wait for the doctor to get there. The nurse kept telling me the pain would go away when I could start pushing. I didn’t believe her but just prayed for the doctor to hurry up and come!
He arrived and everything happened pretty quick. I was told to hold my breath and push for a certain amount of time during the contractions. I was determined to get the baby out ASAP. The first two contractions came and I held my breath and pushed when I was told. The nurse would say I was doing so well and that the baby would be there quickly. And I just thought, “Really? Cuz I feel like I’m doing nothing and I don’t see anything yet.” I thought she was just trying to be nice. Oh, and yes, I could see everything cuz they had this cook mirror that let me see everything. After the next contraction I saw something that looked like intestines or some kind of organ that I was like “where is the head?!” And then I realized it was my babies head! He had me stop for a minute while he tried to stretch me a little to prevent tearing at my episiotomy from my first pregnancy. Then the next contraction he had me hold my breath and push at shorter increments and she was out! That was so fast for me, 4 contractions and she came! I was so happy and excited that she was out, and healthy and we were both safe.
I couldn’t believe it. I had a successful VBA3C! Now, just because I had a successful VBA3C doesn’t mean that everyone will. I was a good candidate for it and not everyone may be a good candidate. It’s been so amazing to be able to function after delivery. To be able to care for myself and my family instead of being in bed for weeks on end recovering from a csection. I’m forever grateful for my OBGYN. I know he took a lot of flack from his associates, I’m so grateful he didn’t cave under their pressure and did what was best for me. BEST. Doctor. EVER.