I went to see my Obstetrician on Thursday for my sixteen week prenatal visit and we ended up talking for about an hour about the upcoming birth! We discussed my low platelets and what my options will be if they are at or below 100,000 by the time I’m 30-something weeks, and what my numbers will mean for my delivery. More on platelets in another post. We also talked about several possible birth scenarios.
I’ve been thinking for a number of weeks now that I’m going to have an elective cesarean no matter what, but much of what she was saying about VBAC made me feel like it might be a better choice. She absolutely wasn’t trying to sway me, and she said the decision is 100% in my hands, but I wanted to know about both, and that’s what she gave me. The four reasons I was thinking c-section are as follows, in order of their importance (in my mind):
- My other cesarean will have only occurred 19 months before this birth so…increased uterine rupture risk. O_O
- I thought I wanted a tubal ligation so why not have it while they’re already doing surgery?
- I was pretty much traumatized by my last birth and I really, really didn’t want to experience labor again.
- It is so nice to think about the convenience of just walking in there on a set date and having them deliver the baby because my husband can plan it with work, etc.
BUT, most of the reasons seem a little less valid after our discussion.
- For one thing, I found out that “uterine rupture” is a really scary way of describing a condition that can range in severity. It sounds like your dang uterus explodes, right?! But it’s actually about tearing, which can be minor or major. And the risk for a woman who’s had a previous cesarean is about 1 in 10,000. Because my babies will be less than two years apart, that risk doubles for me, but that still only means 1 in 5,000. Not terrible.
- The tubal ligation thing might not happen now. Or ever. The effectiveness is not what I was hoping it would be. It’s something like 1 in 300/400 women can still get pregnant after having it. Considering my husband and I 100% don’t want to have any more children after our fifth one, those odds don’t seem so great. And if I were to have a successful VBAC, it would mean an outpatient surgery at six weeks postpartum, not a procedure done at the hospital following the birth like I’ve read some doctors do. I know myself and I’m not going to want to go through another procedure with a six week old.
- I’m still traumatized by my birth experience with Elizabeth, but we discussed a few scenarios that made me feel a little better. One is that I could go into labor earlier than 39 weeks, and show up at the hospital already quite dilated, with not much more to go. If I’m 8cm when I get there, am I really going to want to pass on the VBAC option? I don’t think I would. My chances of having a repeat of what happened with her (essentially getting stuck) after having had three babies just fine are probably pretty low. Another scenario would be that I get there at 5 or 6cm and they start prepping me for surgery but by the time they’re ready to take me back, I’m at 8cm. Again, would I still go in the operating room at that point? Probably not.
- While there’s no denying the convenience of having a set date and time, I’m still not totally free of the spontaneity factor because it will mean I have to make it to 39 weeks. I could certainly go into labor before that point.
So, as it is now, I’m looking at two possibilities. My view could certainly change but here’s what I’m comfortable with currently:
If I go all the way to 39 weeks (Jan 31, 2017), I will have a scheduled c-section. I absolutely do not want an induction, which would significantly increase the risk of uterine rupture and/or could end with me in the O.R. anyway, and I don’t want to go beyond 39 weeks because of my age and the incidences of still birth, as well as the size of baby (for me) after that point.
If I go into labor before that, I am feeling like I want to play it by ear and see how labor progresses. With my last two pregnancies, I got to 4cm before labor even started so I arrived at the hospital at 8cm and 6cm respectively, without a whole lotta laboring going on to get me there in the second case and only some in the first. It sure would be nice to recover from a vaginal birth instead of surgery.
Honestly, I’m just still really (really) scared of the pain. It’s still fresh in my mind. The pushing stage with Elizabeth, in particular, was frightening because of her position. I can’t even describe how bad it hurt my ribs and diaphragm. I’m trying to think positively about it and not focus on that because I really do think a VBAC sounds better.