Repeat C-Section: Understanding the Necessity & Risks

Question
I am 35 weeks pregnant. The first day of my LMP is September 22, 2005.  I have a 5 year old and 2 1/2 year old boys.  With both of them I had c-sections.  My oldest I had gestation diabetes and the Dr.'s were concerned because of shoulder distocia and they said he was getting big.  Birth weight being 8 lbs. 11 ozs.  With my second child I had a repeat c-section because of 2 cysts that needed taken care of while in surgery.  His Birth weight was 9 lbs. 9 ozs.  This time around I'm planning on getting my tubes tied and I didn't really talk about a VBAC with the Dr.'s.  What are your thoughts about having a VBAC this time around?  I had an ultrasound done at 32 weeks and she was weighing 6 lbs. 4 ozs. at that time.  But as I understand they could be 1 pound off either way.  I'm really torn about this decision because of going through a major surgery again and the recovery.  I greatly appreciate all of your input.  Thank you!  Nicole

Answer
You have three strikes against you already. You have a history of two cesarean sections, a history of large babies, and a history of gestational diabetes. You are at higher risk for shoulder dystocia and macrosomia and it may be  difficult to convince your doctor to allow labor to ensue. There is a 1% risk for rupture of the uterus if you go into labor. In addition, you want to tie  your tubes. I would opt for repeat cesarean section. Good Luck.