QuestionHello,
I am wondering if you could give me some advice about my situation. I am scheduled for a c-section in a few days. I have had a c-section in the past with my son ( he was almost 10 pounds), due to how big he was, and the fact that my cervix is tilted. My doctor is giving me the option to try and have a vbac. however she is strongly recommending a c section due to my history. I think she is worried about a uterine rupture because she has had that happen with a couple of patients and the babies died because of this. Although I am worried about the complications due to a vbac, I am also very concerned about the ones due to a c section as well. I am TERRIFIED of getting an infection or a blood clot. Although I know that neither of these are common, I am a nervous wreck about it. Could you please give me some advice. What your experiences with these complications are, who is at risk, and what can be done to prevent them....Thank you
AnswerMegan,
This is a complex issue. You are correct that both options do carry some risks. However, the rate of developing complications to either are very similar. The biggest difference lies in that once you've had a VBAC, your risks of complications decrease whereas with every c-section you have, your risks increase significantly, especially after the second c-section.
The American College of Obstetricians and Gynecologists does not recommend cesarean section for babies that are expected to be big. This is because it doesn't improve outcomes - the rates of complications don't go down with a c-section vs. a VBAC. This is because weight is not a predictor of which babies will fit through a woman's pelvis. It has more to do with the circumference of the baby's head and its position rather than its weight. A baby could be 10lbs because it is very tall but have a tiny head and shoulders where a 6lb baby may get stuck because although it doesn't weigh much, it has a large head. In the absence of complications such as gestational diabetes or pelvic problems, it's quite rare to grow a baby that won't fit.
It also doesn't recommend an automatic c-section once you've had one already. Again, because the more c-sections you have, the more your risks of complications increase.
The research on VBAC vs. repeat c-section has shown that they have similar rates of both uterine rupture and other such complications. Even if a uterine rupture were to occur, it is very rare for it to be catastrophic. In most cases, everyone is fine. However, the risk of uterine rupture is increased if you allow any means of induction, which is why they are not recommended for VBAC patients. This means no pitocin, no broken water, no cervical gel, etc. The safest way to VBAC is to let labor start on its own.
To answer your question about blood clots and infection, there is no predictor of which patients will develop them. I wouldn't worry too much about developing a blood clot as it's quite rare but infection is a real concern. Hospitals are full of infections - that's where sick people go. So, when you must have your baby in a hospital, there is an increased chance of infection, especially after a c-section. A postpartum infection occurs in about 3.1% to 6.7% of patients where the risk of a uterine rupture is 1-2%. Statistically, there is a much greater chance of developing a surgical site infection than having a uterine rupture.
Unfortunately, there is little you can do to limit the risk of an infection or blood clot. These are usually factors out of your control because of the surgical environment.
In all honesty, I would have the VBAC. The risk of uterine rupture is very similar for both c-section and VBAC. One is not safer than the other. Babies delivered via c-section are also twice as likely to have respiratory problems and feeding difficulties than those born vaginally. A VBAC also carries a much shorter recovery period so you can devote your time and energy to your children.
Best,
Catherine
