Planned Caesarean VS VBAC

15 Oct 2018

When I had an emergency caesarean with Willow back in 2016, I didn't know anything about caesareans, what the major abdominal surgery actually involved, what the healing and recovery process would be like, or the implications it may have for future pregnancies.

A photo of a newborn babygrow for a feature on choosing a planned caesarean or VBAC after an emergency caesarean

Having been classed as 'low risk' by my midwife during my pregnancy with Willow, I had missed any possible appointments I may have been invited to at my hospital to discuss the possibilities of a caesarean, how the surgery is carried out, how it might affect breastfeeding or the amount of time I'd need to spend in hospital, let alone the risks involved not just for that birth, but future pregnancies too.

As I have been 'high risk' during this pregnancy, not merely for my larger size and higher BMI, but also for the fact I have had a caesarean before, I have had to have consultant appointments at the hospital quite regularly, with the way I intend to give birth taking a more serious approach than if this were a simple pregnancy following a previous vaginal birth. Of course, having had an emergency caesarean with Willow, I know a lot more than I did about caesareans before. You can read more about the type of appointments I have had during this pregnancy in my recent feature Plus Size, Pregnant & High Risk.

Things I found out about whilst pregnant this time around include issues with the placenta growing abnormally, with the possibility of it embedding into my caesarean scar and, what worried me the most, having had scans to rule out issues with my placenta, was the risk of uterine rupture. This is where your previous caesarean scar(s) can tear or rupture entirely, during an attempted VBAC (vaginal birth after caesarean), which can be incredibly dangerous for both mother and baby.

Now, that's not to say that an attempted VBAC wouldn't be successful (although many do result in emergency caesareans), but there are factors which have to be considered, including the length of time between your previous caesarean and your current pregnancy, the type of caesarean scar you have, as well as your BMI; statistically, those with a higher BMI have shown to suffer more complications with uterine rupture than those of a lower BMI, and this is the bit that scared me. I have a very high BMI and so making this decision wasn't going to be simple, there are, statistically, more risks involved for me personally than say, someone half my size.

It was made very clear during my consultant appointments that although I could try for a VBAC, the decision was ultimately mine to make and I would be supported with whatever decision I came to, that my BMI did put me at higher risk for complications.

It's no secret I have struggled more with increased anxiety during this pregnancy, which I speak about regularly on Instagram @TattooedTealady and I also shared during a recent review of The Positive Birth Book, which has helped tremendously. So trying to make a decision between trying for a VBAC and opting for a planned caesarean, only served to increase my anxiety to a whole new level and I was consumed with going between the two, not knowing what to do. On the one hand, I would have liked to have a vaginal delivery, although it's certainly not something I feel I 'have to experience', but it would be nice to know what it feels like to traditionally give birth.

On the other hand, everyone I have spoken to, people who have contacted me on social media when I've discussed the decision, has told me how different a planned caesarean is to an emergency one, in fact, every single story shared with me has been positive and encouraging. Whilst trying for a VBAC would be wonderful if I was to be successful, the chances of ending up with an emergency caesarean or the increased risks associated if I needed to be induced, made the decision a very scary one for me; not to mention the PTSD I have experienced from the labour with my first birth.

Caesareans carry risks, huge risks, but vaginal births also carry risks which are very rarely discussed, especially if you have had a previous caesarean, and in my personal circumstance, the risks didn't seem to be better for either decision; If I opted for a VBAC I would be taking a risk on the off-chance that it might all pan out well, but could end up as traumatic as my first birth.

So I decided to take control, with the confidence I gained from reading The Positive Birth Book and realising there was no shame in choosing a birth that was best for me and my baby physically, mentally and emotionally, from speaking to other caesarean mamas and a lot of time spent sourcing research studies, reading scientifically backed up data and investigating the success rates for the hospital I am birthing at, I decided at my 28 week appointment to opt for a planned caesarean. I was given a date there and then to help my anxiety, rather than waiting until the usual 36 weeks for a caesarean date and since 28 weeks, having that date in mind, I can honestly say my anxiety dramatically decreased.

Do I wish I was going for a VBAC? Not really, but a part of me does wonder about how I will feel after the fact, especially if I struggle with the recovery like I did with my first caesarean, whether I will wish I tried, whether it could have been successful. Ultimately, I have to put the safety of my baby and myself first, not just physically but mentally, and for me, this feels like the right decision to make.

If you have been in a similar situation, I would love to know whether you decided to try for a VBAC or opted for a planned caesarean like me?