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. 🙂