Friday, June 15, 2012

Repeat c-section vs a VBAC

I had a cardiologist appointment today and am happy to report that my heart looks great. Everything is functioning normally!

Most of my appointment was spent talking to my doctor about the debate I've been having with myself over my impending delivery method. My high risk OB has said that she would leave the decision up to me. She is extremely pro VBAC (vaginal birth after a cesarean) and has even written articles against c-sections. She understands their necessity in some situations and agreed that it might be best for me, but she wanted me to discuss it with my cardiologist before making any decisions. I, of course, being the librarian that I am, have researched both methods to death. I know the risk factors and statistics of each. But I still couldn't fully decide which would be best.

A little quick background for new readers, in October of 2011, I experienced stress induced cardiomyapathy (also called Takotsubo or Broken Heart syndrome) during a standard lathroscopic gallbladder removal. My heart stopped functioning properly and my blood pressure plummeted to extremely dangerous levels. I was quickly stabilized and spent 2 days in the ICU. I am now fully recovered but am being closely monitored by a high risk OB. Read more info here if you are interested!

Fast forward to today. There is no info on Takotsubo and pregnancy. The research simply hasn't been done because it is so uncommon for people my age to be diagnosed with it. I will most likely be a published research study following Connor's birth! So my cardiologist, one of the only leading experts in Takotsubo in the world, is making his best educated guess. He believes my episode was caused by a combination of emotional stress, the death of a good friend and attending her funeral the night before, and physical stress, the surgery.

So we went through each procedure in regards to their stress levels. With a scheduled c-section I will be under the physical stress of surgery. I will be closely monitored by both anesthesiology and the cardiology departments. Emotionally, I will be worried about the surgery and it's risks.

With a VBAC, I will be under the physical stress of labor. My chances for a successful VBAC are about 60% due to my previous labor experience.  Emotionally, I will be worried about the small risk of uterine rupture. Mostly, I will be worried about a failed attempt and the possibilities of needing an emergency c-section. The idea of going through an entire day of labor again with a failed epidural and then needing a c-section again scares me a ton. Even worse is the thought of needing to be put under for an emergency c-section.

Overall, my cardiologist believes that the emotional stress is what generally causes Takotsubo incidents and thinks that a scheduled c-section is in my best interest. I am a worrier and not knowing what will happen with a VBAC will cause me more stress than I need. I can prepare myself mentally for a scheduled c-section and it will be over extremely quickly. I remember during my c-section with Grace asking the nurse when they were going to start and she smiled at me and said "honey, your baby is almost out" and sure enough Grace was born about a minute later. After Connor is born, I know that my stress will be out the window and I will be too focused on him to think about anything else.

So, a scheduled c-section at 39 weeks is the plan. Sorry if this was long, but I know many people struggle with this question. It is an extremely personal choice and I know not everyone will agree with mine. But we think it's the best decision for us! I can't wait to meet our little guy! 

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4 comments:

  1. I've been so behind reading blogs lately.. Congrats on having a boy! I hope your c-section and recovery goes smoothly. I bet this was a tough decision to make.

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  2. I've been following your blog for a long time now. I too am debating about having another c section or doing a vbac. I've Ben researching both and couldn't make a decision. I think my mind is set on another c section. I have horrible anxiety which causes y blood pressure to rise and I think for myself and the baby a c section is the best choice. It def isn't an easy decision and it's certainly a personal one. I'm glad I wasn't the only one struggling with this decision. Good luck on your c section

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  3. C-sections arent as bad as people make them look. I personally loved mine, after 26h of labor it was the best thing ever.
    Congratulations on having a boy!!! Boys are the best!
    You're looking great. btw - I love your shower curtains hehe

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  4. Just catching up on blog reading... I can't imagine how difficult this decision would be. Have you read about Family Centered Cesareans? http://www.ican-online.org/pregnancy/family-centered-cesarean

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