Musings of a Marfan Mom

To VBAC or Not to VBAC?

| 15 Comments

Let me start this post off by saying if you’re in any way related to me or in any way unreasonably freaked out about me having a baby, just skip this post please. I’m going to discuss my personal risks and benefits for having a VBAC (vaginal birth after a cesarean) vs a 2nd cesarean section.

Possible risks of a VBAC:
organ prolapse
spinal headache from the epidural
epidural not working –> causing blood pressure problems
aortic dissection (1-2% risk)
uterine rupture (aprox. 2% risk but no data on Marfan patients so may be a bit higher)

Possible risks of a c-section:
organ prolapse
spinal headache from the epidural (I do not want to be put under again)
epidural not working –> needing general anesthesia
blood pressure complications (like last time)
aortic dissection (1-2% risk)
uterine rupture
scarring problems, including intestinal adhesions (which I have a history of)

Benefits of a VBAC:
get to experience labor
be present for the entire birthing process
have the opportunity to watch my child being born (yes, I want the mirror)
hear the first cries
be able to hold my child right after s/he is born
be able to breastfeed immediately
won’t need narcotic pain medications for as long
be able to walk a lot earlier than with a c-section

Benefits of a c-section:
ummm…I won’t have to worry about tearing I suppose.

Again, this is MY personal risk/benefit list. Many of these risks are universal, Marfan or not, but if my aorta were 4 cm or larger than a c-section would be a safer route. As I’ve written before, the literature says that for women with Marfan and an aorta of less than 4 cm, vaginal births with an epidural are recommended. I make my list because according to Drs. Reed Pyeritz and David Liang, there are no research papers on VBACs in Marfan syndrome (VBACs are not recommended for women with Loeys-Dietz syndrome due to the increased risk of uterine rupture that the syndrome presents).

Although my risks are somewhat similar between procedures (it’s hard to assign percentages of risks to someone with Marfan because of the dearth of research, but the blood pressure risks should be less with the VBAC if the epidural works), the benefits of a VBAC blow a c-section out of the water. I made the best decision I could at the time when it came to Menininho’s birth, but I still feel sad that I missed out on so much of his first day on this earth. I’m going to do everything possible to make sure that doesn’t happen again. I never again want to tell my baby that I don’t know what happened to him in the hours after he was born; I want to be able to say that he was with me.

My decision is to VBAC.

Post edit: I should clarify that I recognize there are a whole lot of reasons why I may end up with a c-section: my aorta could grow, I could have a prolapse in pregnancy, I could develop pre-eclampsia (again?) that would necessitate an early and quick delivery, baby could be breech, etc. And if any of those happens and a c-section really is necessary, I am ok with that. It won’t be fun being cut again, but I know the circumstances will be out of my control and what matters most is a healthy baby. But if the choice really is up to me, and I can have either delivery option work out, then I choose VBAC and the above is why. :-)

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15 Comments

  1. Wow, am I really first? Cool. I know my opinion might not be popular, but here it is :)

    While I applaud your research and desire to be well informed, I think you’re doing yourself a disservice in a few ways.

    First, you’re abt 14wks preggo, right? I think you’re setting youself up for a big dose of disappointment by deciding on a VBAC so early. Because of your Marfan’s the decision isn’t the same as it will be for me. I’d hate to check your blog 10mo from now and see a post about your disappointment with your body for failing you in your quest for a VBAC.

    Your son (and soon to be daughter 😉 ) will not feel slighted if you can’t describe in detail their first moments after birth. You’re putting too much pressure on yourself. You’re an experienced mom now; you know there are sooo many incredible moments with a new baby. So you don’t remember the first minutes…you’ll be there for many other firsts.

    Remember, your goal is a healthy, happy little sis for M.

    I’m not suggesting you should resign yourself to another section. I think your best bet would be to prepare for both. Be blissfully happy if your BP and aorta allow for a vag delivery. But if they don’t, it’s ok. You’ll still be a MOTHER.

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    marfmom Reply:

    Very good points, Natasha! I should have added that I completely understand that circumstances may necessitate another c-section (my aorta grows, the baby is breech, I develop pre-eclampsia that necessitates an early delivery, etc.) and if something like that happens, I really am ok with it. :-) Those things will remove any choice from me and as you said, the goal is a happy sibling for M, and that will be all I care about. But if I get a choice, which is what I was trying to address, if all the stars align that I can pick how I want to deliver the baby, then VBAC is what I choose :-)

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  2. I know this is a tough decision and I also know you take the risks and benefits seriously. Good for you. I went through the same decision-making process with my second pregnancy–first was a planned c-section b/c she was breech, unrelated to my connective tissue disorder. I pored over the med literature on VBACs (my husband is a medical librarian–very handy), and what eventually really helped was doing a long-distance consult with an ob-gyn who had lots of experience with women with OI. I, like you, MIGHT have had a higher chance of uterine rupture b/c of the disorder. But this doc felt that in my circumstances (e.g., no history of pelvic fracture and deformity) a VBAC would be reasonable. But best-laid plans and all that…I labored well for about 10 hours, but when I was at 8 cm a resident thought to check the baby’s position. What a novel concept. She too was breech! So I ended up with a second c-section, and then when I had a third baby, he was not breech but another VBAC really was out of the question (and I honestly didn’t care any more!). But I am glad to have had the experience of labor anyway and generally recovered quickly from my c-sections. All that to say–I am impressed with your diligence, I hear you, and I hope all goes very, very well!

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  3. I see no problem with planning for the best-case scenario. Of course, if things go differently you must be prepared for that too, but seems to me that you already realize that possibility and are ready to deal with it. I agree that your child probably won’t care later if you were there for the first few hours of their life, but you care. You should be able to get what you want out of this too.

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  4. I agree with your decision! Also, I was thinking (and this may be WAYYYYY overboard), but you said there are no case studies of VBAC with Marfan’s… is there any chance you could find someone to follow your pregnancy and delivery (with the intent of researching it), not only to benefit future women in your situation, but also maybe to defray the cost of delivery? I betcha you could find a doctor who would pay for your hospital stay (and then some) in exchange for your cooperation!

    [Reply]

    marfmom Reply:

    To defray the cost? No, because this would be a case study so they don’t pay for that sort of thing as far as I understand (as opposed to an actual formal research study with other participants, where sometimes they do pay for medical costs). But I did tell the fellow (who told the OB) that they have my permission to do a case-study on me and that I thought it would be a good idea. I’m going to bring it up now and then throughout the pregnancy. We can’t move forward if doctors aren’t doing the research, after all!

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  5. I’m sure you’ll pick what’s right for you! Birth choices and planning is always so intensive!

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  6. forget whomever that doesnt support you and your decision for you family. attempting vbac i think is so much safer, and better for you and the baby. if a 2nd cesarean is necessary ten so be it. butvits jst like what my medical team sugested, a vbac(or vaginal birth in general) is something that should always be attempted until/unless there medical indications stating it would be dangerous to procede with a vaginal birth. i was lucky i suppose to be able to birth both my children vaginally without the need of medical intervention. good for you to research both out looks and be prepared. i did the same.

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  7. Just yesterday a good friend of mine gave birth via C-section. For months she planned for a vag delivery, talking with friends, weighing natural vs epidural… She even hired a doula (which will be great for the next few weeks). She was also able to labour before finding out the baby was breech. But she’s not upset about “missing out” on her birth experience. All that matters is the good health of mama and baby.

    Whatever choice you make will be the best for you and your family. It sounds like you’re weighing all of the possible outcomes, and are hopefully prepared for whatever comes. You certainly sound confident even with the risks involved. I once watched a vid on YouTube about a sucessful VBAC. The mother could not be happier with her birth experience. I hope your pregnancy continues to be healthy and that you get to experience the same.

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  8. Hey Maya! I hope you get your VBAC. Giving birth is so hard (something I was reminded of recently, lol) that I wish every woman everything she wants when she goes through the process!

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  9. Yes, I say try! I tried with my second, and it didn’t work, but a VBAC would have been good. Best of luck!

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  10. You sound like me– research, research and more research! It’s a good thing to be well-informed! I tried for a VBAC a few months ago and after my water breaking and getting to 5 cm, we discovered he was breech. I will say too that the C-section recovery was 1000% easier the second time around. Like amazingly easier.
    I don’t regret trying for a VBAC though. Not one bit.

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  11. Good for you :) My SIL had a C-Section with baby #2 and baby #3 and #4 were VBACs.

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  12. I delivered my 3rd baby in January as a VBAC and it was the most amazing of all of my deliveries. Like you, I poured through every pc of info on the subject, most of which repeated the same thing. My first child was a natural delivery, so that helped my decision. In the end, I just really believed in my body’s ability to do what it was made to do and in my doctors. The recovery is SO much better than even the best of csection recoveries….really, I wish you all of the best.
    Feel free to visit any time an my mama blogg :)
    http://monkednfifed.blogspot.com
    alison

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  13. I totally agree with your decision, Maya! Of anyone, you are the most clear thinking and thourough person I know so I’m certain you’ve looked at the situation from every possible stand point and if it’s VBAC you want, then that’s what you should have!! Personally, having gone through a spinal headache after having Savanna, I wouldn’t wish it on anyone, but it’s a risk either way!! I agree with you wanting to be awake for the baby’s arrival and I could understand you being willing to risk a spinal headache to experience that. And at least you know to look for it – I had the raging headache for 24 hours before the nurse told me what it was… I had never heard of it before! Plus, because of the headache I feel I didn’t get to participate in Savanna’s first week on earth much because I couldn’t move (family took care of her and would just bring her to me when she was hungry), but at least I was awake when she was born and could breast feed immediatelly. It was worth that I would think!

    Best of luck to you Maya! I respect you for putting it all out there and giving us all alittle insight on your life! You are amazing! Much love!

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