Questionam 21/22 weeks pregnant and due August 20, 2011. I had (2) previous c/s one 7/07 and one 5/09. I labored with my daughter for 9 hours (after water breaking and no contractions so being induced) and stopped at 5 cm; then I had a 2nd c/s with my son b/c it was highly recommended since they weren't 2 years apart. Now I am wondering if I should try for a VBA2C? What would you tell your patient? Is it riskier to try and fail, then to just have the repeat c/s? I would never do anything to intentionally put my daughter in harm's way. I just feel that a VBAC would be better overall because of all the recovery time that a c.s requires. Please help. I feel like I can't get any unbiased information.
The American College of Obstetricians and Gynecologists (ACOG) changed their guidelines in July 2010 stating:
"The College guidelines now clearly say that women with two previous low-transverse cesarean incisions, women carrying twins, and women with an unknown type of uterine scar are considered appropriate candidates for a TOLAC," said Jeffrey L. Ecker, MD, from Massachusetts General Hospital in Boston and immediate past vice chair of the Committee on Practice Bulletins-Obstetrics who co-wrote the document with William A. Grobman, MD, from Northwestern University in Chicago."
http://www.acog.org/from_home/publications/press_releases/nr07-21-10-1.cfm
I have read the report and the press statement; basically they saw that a woman should be given the option to do a TOLAC (trial of labor after a cesasaran) even after 2 c/s if they want. If the OB is uncomfortable; he can refer to another OB. The hospital were the attempt is made should be equipped with the staff to do an emergency c/s if needed; due to the risk of uterine rupture.
The risk is stated at between 0.5% and 0.9% during a TOLAC but is an "emergency situation."
VBAC stats:
60-80% of appropriate candidates who attempt VBAC will be successful
avoids major abdominal surgery,
lowers a woman's risk of hemorrhage and infection
shortens postpartum recovery.
It may also help women avoid the possible future risks of having multiple cesareans such as hysterectomy, bowel and bladder injury, transfusion, infection, and abnormal placenta conditions.
Most maternal injury that occurs during a TOLAC happens when a repeat cesarean becomes necessary after the TOLAC fails. A successful VBAC has fewer complications than an elective repeat cesarean while a failed TOLAC has more complications than an elective repeat cesarean.
What should I do?
AnswerDear Jessica
I would never recommend a tolac for any of my patients who had 2 previous C.S. regardless of what the literature say or the recommendations are.
The situation differes between countries and the level of practice and the best one to make a decision is your caring obstetrician. The ACOG recommendations, i believe, is made with ideal situations. Furthermore, scientific facts are liable to changes based on new evidence. Years ago we followed the priniple "once Cesarean always Cesarean". Years after we changes to "Once Cesarean always a trial of labor" ..now TOLAC is being promoted for those with previous 2 and who knows what would be tommorrow.
Therefore, the decision in cases like yours should be made by your doctor based on the place where u plan to deliver, the adequacy and excellence of the nursing services, level of neonatal care services and other factors. This decision should be made with proper counseling and explanation to you.
Good Luck
