My Journey to VBAC

Ever since my first C-section in 2012 with my first daughter, I knew I wanted to try for a VBAC the next time around. So when I got pregnant for the second time, I thought it would be an easy thing to do.

Unfortunately, my doctors didn’t see it that way. At the time I didn’t realize I had choice – that I could go find a doctor supportive of my dream.

So I stuck with a doctor who was unsupportive. At best, they were wishy-washy and left me discouraged after appointments. At first they told me we would try for a VBAC, but began to change their tone the closer I got to delivery.

The week of my due date they completely changed their decision and said no, we are going to schedule a C-section. It left me crushed and made for an emotional last 3-4 weeks of pregnancy.

My first appointment in Iowa City!

My first appointment in Iowa City!

I tried “everything” (looking back I really didn’t but thought I had) to help induce myself naturally. It left me tense and too stressed to go into labor.

So another C-section and my dream of having a VBAC was crushed.

But then I got pregnant again with baby #3 and my older, wiser self realized I had a voice – that I could go find a doctor who would be supportive and allow me to try for a VBAC after two C-sections (VBA2C).

Yes, it’s rare and most women just opt for another C-section but I don’t want to. I have this deep desire to experience birth naturally.

So as soon as I found out I was pregnant I hopped on the phone and called nearly every OBGYN in the area to see if they were supportive of a VBAC (this time I was going to be more selective and interview the doctors to make sure they were truly supportive and not just saying the words).

Most offices said they’d allow for a VBAC after one C-section, but not after two. Finally after the 10th office had said “no” to a VBAC after two C-sections, I was told the only facility in central Iowa who would consider a VBAC after two C-sections was Iowa City (which is almost 2 hours away).

Honestly, I was a little crushed but wasn’t about to give up. So I called Iowa City and immediately knew this is where I was going to go.

The nurse was not only incredibly friendly but acted like a VBAC after two C-sections was no big deal. “We do them all the time,” she said. I cried after that initial phone call. I knew this was my last chance at a natural birth and I found a place that not only allowed it but has done them repeatedly.

I had found someone who would support my dream!

Shared care

Originally I was going to do shared care and started seeing a local doctor. From the beginning I was upfront and informed them that I would be doing shared care with them and Iowa City so that I could try for a VBA2C. They didn’t love the idea but let me come anyway.

I liked the idea of having a local doctor so I wouldn’t have to drive to Iowa City as much. And it was good to have someone nearby in case of an emergency. But that all changed when I was around 23 weeks pregnant.

My doctor dropped me as a patient

Yes, that is a thing.

When I was about 23 weeks pregnant we were discussing my glucose test. I didn’t want to drink the glucola because of the toxic chemicals, dyes, and artificial colors it contains.

Read this very informative article about glucola and learn what your options are.

It’s not something I want to put in my body when I’m not pregnant let alone when I’m growing a baby. I had drank orange juice with my second pregnancy so I knew there were other options. But this office wouldn’t allow it. I got a call saying that I needed to go somewhere else to find my care.

Apparently I had too many checks against me: I wanted to have a VBA2C, I didn’t want to drink glucola, and before that, the doctor tried to force me to get blood work for an unnecessary test that wasn’t even covered by insurance.

Honestly, it was for the better. My second appointment with this office and the doctor boorishly informed me I would most likely die if I tried to have a VBAC. I didn’t need that negativity this time around.

So Iowa City became my sole care provider and it truly was a blessing in disguise to be dropped by this OBGYN office. Iowa City has been nothing but amazing and so incredibly supportive.

The truth about VBAC vs C-sections

Most doctors don’t talk about this but with each C-section, there is much more risk. A C-section is MAJOR surgery and can lead to many complications. But instead, everyone just focuses on the few risks associated with a VBAC.

According to Mayo Clinic, “Research on women who attempt a trial of labor after cesarean (TOLAC) shows that about 60 to 80 percent have a successful vaginal delivery.”

What about uterine rupture?

I’m sure you’ve heard other women and medical providers proclaim the dangers of uterine rupture. But you’ll be comforted to know that uterine rupture is very rare. Research has shown the risk of uterine rupture to be between 0.1% and 0.2%.

My doctor spoke with me about the possibility of uterine rupture. She eased my concern by explaining just how rare it really is. She also said that there are plenty of indications that doctors see prior to uterine rupture. My doctor and her team monitor closely to make sure they’re ready to respond if they see any of these warning signs.

40+ weeks and oh so ready to meet this sweet babe!

40+ weeks and oh so ready to meet this sweet babe!

The benefits of a VBAC

Unlike a C-section, vaginal delivery doesn’t involve surgery or the possible complications of surgery and leads to a shorter hospital stay and a quicker return to normal daily activities. A VBAC also helps prevent placental problems during future pregnancies.

The risks of VBAC

There are fewer risks associated with a VBAC than a C-section. The most common risk is uterine supture. But as we’ve already noted, this risk is less than 1%. In the event of uterine rupture, an emergency C-section is performed to protect the mother and baby. If the bleeding is severe, the uterus may need to be removed.

The risks of C-section

Here are the risks for mom and baby associated with a C-section as provided by the American Pregnancy Association.

Risks and Complications for the Mom

  • Infection: Infection can occur at the incision site, in the uterus and in other pelvic organs such as the bladder.

  • Hemorrhage or increased blood loss: There is more blood loss in a cesarean delivery than with a vaginal delivery. This can lead to anemia or a blood transfusion (1 to 6 women per 100 require a blood transfusion1).

  • Injury to organs: Possible injury to organs such as the bowel or bladder (2 per 1002).

  • Adhesions: Scar tissue may form inside the pelvic region causing blockage and pain. Adhesions can also lead to future pregnancy complications such as placenta previa or placental abruption3.

  • Extended hospital stay: After a cesarean, the normal stay in the hospital is 3-5 days after the birth, if there are no complications.

  • Extended recovery time: The amount of time needed for recovery after a cesarean can range from weeks to months. Extended recovery can have an impact on bonding time with your baby (1 in 14 report incisional pain six months or more after surgery4).

  • Reactions to medications: There can be a negative reaction to the anesthesia given during a cesarean or negative reaction to pain medication given after the procedure.

  • Risk of additional surgeries: Includes possible hysterectomy, bladder repair or another cesarean.

  • Maternal mortality: The maternal mortality rate for a cesarean is higher than with a vaginal birth.

  • Emotional reactions: Some women who have had a cesarean report feeling negatively about their birth experience and may have trouble with initial bonding with their baby.

Risks and Complications for the Baby

  • Premature birth: If gestational age was not calculated correctly, a baby delivered by cesarean could be delivered too early and have low birth weight.

  • Breathing problems: When delivered by cesarean, a baby is more likely to have breathing and respiratory problems. Some studies show the existence of greater need for assistance with breathing and immediate care after a cesarean than with a vaginal delivery.

  • Low APGAR scores: Low APGAR scores can be the result of anesthesia, fetal distress before the delivery or lack of stimulation during delivery (Vaginal birth provides natural stimulation to the baby while in the birth canal). Babies born by cesarean are 50% more likely to have lower APGAR scores than those born vaginally.

  • Fetal injury: Very rarely, the baby may be nicked or cut during the incision (on average, 1 or 2 babies per 100 will be cut during the surgery).

Are you considering a VBAC?

First off, I’m so happy for you! Next you need to become your own advocate and find a doctor who will support your decision. Then discuss your desire to VBAC with your doctor, talk about any concerns you may have and the expectations you should be aware of.

Make sure your doctor gets your complete medical history, including the records from your previous C-section(s). You’ll want to continue talking about your desire to VBAC throughout your pregnancy.

One of the many weekly trips we took to Iowa City to monitor baby.

One of the many weekly trips we took to Iowa City to monitor baby.

Iowa City is a dream come true

I’ve told everyone I can how much I love going to Iowa City for my care. I immediately fell in love with my doctor, Dr. Sarah Shaffer, and felt at home there. Dr. Shaffer was incredible from Day 1. I can’t explain it to you but I felt listened to, supported, and truly could tell she was on my side and wanted me to succeed with my dream of having a VBA2C.

Dr. Shaffer never once talked down to me or thought my desire for a VBA2C was dumb. She answered every question and was excited to tell me of other women who recently had a VBA2C. I will never forget one of the stories Dr. Shaffer shared with me at one of my earlier visits.

“Kara, I was thinking of you because we had a woman come in who was in labor but had a scheduled C-Section. She had already had two C-sections prior but since she was in labor we told her that this was her only chance to try for a natural birth. So, we asked her if she wanted to try for a VBA2C. And she did it!”

I seriously could have cried there because never had I heard of a doctor OFFERING to allow a woman a VBAC let alone a VBAC after two C-sections when she already had a C-section scheduled.

It honestly felt that I was meant to be there and that Dr. Shaffer was meant to be my doctor. Which is another reason why I love going to Iowa City: I get to see the same doctor every time and she’ll be able to deliver me! That’s one thing I didn’t love about other offices. Typically you have to rotate different doctors and never know who would be on call.

Noah and I are always amazed after each appointment how friendly EVERYONE is. Because of complications with baby for about 5-6 weeks we were going to Iowa City every single week. Because of this we got to know other nurses and staff, but it didn’t matter who we saw – they were kind, happy, and great to work with.

Will your doctor induce you since you’ve had 2 prior C-sections?

This was a big question and concern for me because I knew if I didn’t go into labor naturally then I’d end up with another C-Section – unless they were willing to induce. I think this is one of the first questions I asked Dr. Shaffer when I first met her.

Again, I nearly cried when she said yes, they could induce me. However, to prevent uterine rupture, there are only a couple things they can do to get labor going due to my uterine scar.

What they are willing to do to induce me

We’re left with basically two options for induction because of my two previous C-sections.

Pitocin—given at a very low dose and then gradually increasing while being monitored to see how baby and I are handling labor.

Cook Catheter—The Cook Cervical Ripening Balloon catheter is comprised of two silicone balloons and uniquely engineered to allow the cervix to naturally and gradually dilate.

Why do I want a VBA2C?

Someone asked me this on one of my Facebook posts:

“I just have a question... why is a vaginal birth so meaningful to you? As a postpartum nurse I see births both ways- and both are special. And a healthy baby and mom is the most important thing.”

I’m surprised I wasn’t asked more often, but I I think I only got this question once or twice during my pregnancy. It’s a fair question and I’d love to answer it.

I do agree births are beautiful and special whether you have a C-Section or a vaginal birth. However, my first birth was a horrible experience and did not feel special at all. It was an emergency C-section, I got to see my baby for maybe 5 minutes, and then Noah left with London as they took her away for monitoring.

I remember feeling alone... like I had lost those precious moments I dream of after my baby is born. I am forever grateful that London was born healthy and everything worked out but it definitely wasn’t how I envisioned my birth story.

Then there’s recovery, which was no joke. And on top of recovery I got an infection that no one could figure out (even after going to the emergency room twice). Because of it I was sick for weeks and lost a lot of time with London because I couldn’t function normally. Finally, they discovered my severe infection and hospitalized me for over a week. So let’s just say my first experience with a C-Section was not ideal.

After going through that, it was a no brainer for me to try for a VBAC with my second pregnancy because honestly, I was scared of another C-section with all I went through.

All seemed like I was on track to have a VBAC but the doctors changed their tune the week I was due and we scheduled C-Section #2. Inducing me was out of the questions so I tried what I thought  was everything to go into labor but knowing what I know now and everything that I have been doing to go into labor naturally to ensure I have a better chance of a VBA2C, I wasn’t even touching the surface! I even made an appointment the day before the C-Section to BEG them to let me go a little longer or to induce me but they wouldn’t. So another C-Section and a dream was crushed again.

I will say, my second C-Section was much more peaceful and I got to hold Iylee (eye-lee) right away and do skin to skin. I also requested that they not cut the cord until the blood stopped pulsing and they were able to do that. It definitely was a better experience – and recovery was still so hard. Having major surgery is no joke!

Looking back I realize my previous doctors weren’t supportive. That’s why I share my story – to show that you do have a voice and it’s okay to go against the grain. It’s so important to find doctors who support you, listen to you, and will talk with you not just at you.

So why is vaginal birth so meaningful to me?

For some reason, this is hard for me to put into words. And it seems unimportant for some reason when I put it into words. But I have this deep desire to experience birth naturally. To have that experience that I have dreamed about before I was ever pregnant with my first baby. I think vaginal birth is magical, truly a miracle and I want that experience too. I know it’s not for everyone. And maybe it doesn’t even make sense to you why I would fight so hard for this. But it’s my dream that’s deep within me.

Last bump picture before we met our sweet baby boy!

Last bump picture before we met our sweet baby boy!

Read Shepherd’s Birth Story

I’m thrilled to be able to share Shepherd’s birth story. You can read all about his birth story here and find out whether or not I got my VBAC after 2 C-Sections!

About the author:

Kara Swanson is a certified nutritionist and founder of Life Well Lived. She is married to her best friend and the proud mother of three. Her passion is to make nutrition simple+easy+delicious!