I was dumbfounded to find out I was pregnant this past April fool's day. It had been a little over five years since my last pregnancy and I wasn't planning on any more. But it was a pleasant surprise none the less!

My first child was, to be modest... REALLY BIG! At 11lbs plus, his head and shoulders were respectively, 38 and 35 cm. The DR. suggested I have a C-section. I did and all turned out well.
The second one was a bit different. He was well within normal range as I headed into labor. But 17 hrs latter, I had only dilated 4 cm. The contractions were unbearable and amniotic fluids were slowly draining. I was told that a c-section under controlled circumstances, would be preferable than waiting and more than likely having an emergency operation latter on.
Obviously I agreed to it.

I asked my current OBGYN about a possible natural birth, for my third and final child. I was told that no doctor would agree to it. That the possibility of my scars rupturing during the birthing process are just too high.
So I guess my question is...
Is the only way to have a "safe" delivery, in this situation, another Cesarean?

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Hi Laura! VBA2Cs are a bit rarer than VBACs, but they are possible with the right provider...that will be your biggest obstacle, I'm afraid. What state are you in? I definitely think you should contact your local ICAN: www.ican-online.com ... they will be familiar with specific providers in your area. Good luck and many blessings!
I have had 2 c-sections and just delivered at home with a midwife. The chance of your scar rupturing is less than 1%. And that is usually due to augnmented labors. I had absolutely no complications with my daughter.
I would recomend going through as many dr's or midwives that you can find till you find one that is willing to give you the birth you want. Good luck
I have been searching medical databases on this one and I haven't found anything. I would say the risk may be slightly greater, but I would ask for hard research that says that you shouldn't be having a vba2c. By guess is, your physician isn't basing his decision on any research but just his own thoughts or feelings. Most doctors won't do a vba2c, some home birth midwifes will. I'm going to keep checking for you on the research and see if anything shows that a vba2c is riskier than a vbac. My guess is that if you are giving birth in a hospital with all the monitoring that they do, it wouldn't be any riskier. I'll let you know what I find out.
ok I found some...you can show them to your doc if you like and see what he/she thinks...at least you can see if it is something you find reasonable.

Journal De Gynécologie, Obstétrique Et Biologie De La Reproduction [J Gynecol Obstet Biol Reprod (Paris)] 1998 Dec; Vol. 27 (8), pp. 806-10.
Publication Type:
Clinical Trial; English Abstract; Journal Article
Journal Information:
Country of Publication: FRANCE NLM ID: 0322206 Publication Model: Print Cited Medium: Print ISSN: 0368-2315 (Print) Subsets: MEDLINE
MeSH Terms:
Cesarean Section, Repeat*
Trial of Labor*
Vaginal Birth after Cesarean*
Female; Humans; Pregnancy; Prospective Studies
Abstract:
The mode of delivery in the parturient women with two prior cesarean is controversial. Based on a prospective analysis of 130 cases, we tried to assess the outcome of trial of labor after two cesarean sections. Among 167 patients with two uterine scars, 130 (77.8%) were selected for a trial of labor that was successful in 65 cases (50%). The overall rate of vaginal birth and cesarean section was 39% and 61%, respectively. There were 4 scar dehiscences and 2 uterine ruptures among the women who underwent trial of labor, but no case of perinatal death or morbidity related to these complications was observed. In the majority of the cases, these scar separations were due to poor obstetrical conditions. Trial of vaginal delivery after two prior cesarean sections seems to us a reasonable attitude if it is well indicated and supervised correctly.



Boabang P; Bogesits-Aufschneider R; Hug K
Author's Address:
Abt. für Geburtshilfe u. Gynäkologie, Maria-Hilf-Krankenhaus Bergheim/Erftkreis.
Source:
Zentralblatt Für Gynäkologie [Zentralbl Gynakol] 1999; Vol. 121 (9), pp. 449-53.
Publication Type:
Case Reports; English Abstract; Journal Article
Journal Information:
Country of Publication: GERMANY NLM ID: 21820100R Publication Model: Print Cited Medium: Print ISSN: 0044-4197 (Print) NLM ISO Abbreviation: Zentralbl Gynakol Subsets: MEDLINE
MeSH Terms:
Vaginal Birth after Cesarean*/methods
Adult; Cesarean Section; Female; Humans; Infant, Newborn; Pregnancy
Abstract:
We report on a patient, who, after two previous caesarean sections, normally delivered vaginally without complications. The obstetric approach to, or better, the management of a vaginal delivery after caesarean section, our experience in other vaginal deliveries after previous caesarean section is discussed. This case report shows that, after two previous caesarean sections, the next child can normally be delivered vaginally without complications.

Lazarov L
Source:
Akusherstvo I Ginekologii͡a [Akush Ginekol (Sofiia)] 1992; Vol. 31 (1), pp. 7-8.
Publication Type:
Comparative Study; English Abstract; Journal Article
Journal Information:
Country of Publication: BULGARIA NLM ID: 0370455 Publication Model: Print Cited Medium: Print ISSN: 0324-0959 (Print) Subsets: MEDLINE
MeSH Terms:
Cesarean Section*/statistics & numerical data
Vaginal Birth after Cesarean*/statistics & numerical data
Infant, Newborn/*physiology
Apgar Score; Bulgaria/epidemiology; Female; Humans; Infant Mortality; Pregnancy; Reoperation/statistics & numerical data
Abstract:
The author has set himself the task of studying the state of the fetus delivered vaginally after a previous caesarean operation and the state of the fetus delivered by a second caesarean operation. He has studied the state of 304 children vaginally delivered after a previous caesarean operation and 436 children delivered by a second caesarean operation as well as early neonatal death rate over a period of ten years (1980-1989). He has come to in the conclusion that the early neonatal death rate in the former group is not greater than that in the latter group.

Maternity and Children's Hospital, Riyadh, Saudi Arabia.
Source:
British Journal Of Obstetrics And Gynaecology [Br J Obstet Gynaecol] 1994 Jun; Vol. 101 (6), pp. 498-500.
Publication Type:
Journal Article
Journal Information:
Country of Publication: ENGLAND NLM ID: 7503752 Publication Model: Print Cited Medium: Print ISSN: 0306-5456 (Print) Subsets: Core Clinical (AIM); MEDLINE
MeSH Terms:
Trial of Labor*
Vaginal Birth after Cesarean*
Adult; Cicatrix/complications; Female; Humans; Labor, Induced; Obstetric Labor Complications/etiology; Obstetric Labor Complications/mortality; Pregnancy; Prospective Studies; Uterine Prolapse/etiology
Abstract:
OBJECTIVE: To determine the outcome of trial of labour after two caesarean sections. DESIGN: Prospective observational study. SETTING: Maternity and Children's Hospital, Riyadh, Saudi Arabia. SUBJECTS: Women with two previous caesarean sections considered suitable for a trial of vaginal delivery. MAIN OUTCOME MEASURES: The rates of vaginal delivery, scar dehiscence, uterine rupture and associated complications among 115 women with two previous sections who underwent trial of labour were compared with 1006 women with two previous sections who did not have a trial of labour. RESULTS: Trial of vaginal delivery was requested by 230 out of 1136 women (20%) who had two previous caesarean sections. Of the 115 women accepted for the trial, 103 (89%) were delivered vaginally. Labour started spontaneously in 78 (68%) of the 115 women and was induced with prostaglandin (PGE2) in the remaining 37. Augmentation of labour with oxytocin was required in 32 (28%) of the trial labour group. There were no scar dehiscences among the women delivered vaginally. There was one scar dehiscence and one woman required hysterectomy after failed trial of labour, a frequency comparable to the occurrence of these complications in women who did not have a trial of labour. CONCLUSION: A trial of labour in selected patients with two previous caesarean sections appears a reasonable option.




Anyways, it appears that while there is some risk for uterine rupture, it is not any more than with a first c-section. Plus you have to take in the risks of the c-section also. It is riskier to have a major abdominal surgery. Let me know if you have any questions about these studies. I would be happy to help out.
I've too wondered on this? It was apparent to me that an acquaintance of mine who's going in for her second c-section will not likely have a natural birth should she have a third either. I wonder if she will feel differently with that birth and then be in the same situation as you? Our one hospital here locally doesn't perform Vbacs in general, so I'm guessing a Vba2c wouldn't happen either. I'm sad for her on her decision to not make the travel somewhere else and have a natural birth. I am proud of you for looking! It is hard for me to see moms just take the one route when the other seems too distant. I wish you the best either way!
There are doctors and midwives that will do VBA2C (vaginal birth after 2 csections) you have to call around, and know your rights! Also, contact ICAN and get some research briefs from them about multiple csections and the dangers vs. vaginal birth. http//www.ican-online.org
Find a doc/midwife that practices EVIDENCE BASED CARE!!!!

Margarett the Oklahoma Midwife
No that is not your final answer. I would ask other women in your community if they have had successful VBAC and who they chose as a care provider. Midwives are always a good option if you can.
Yes you can have a vaginal birth!! :O)
I wish you ALL the best on having a vaginal birth/
You can have a vaginal birth after 2 c-sections I had a home birth 6 months ago with my fifth child and after 3 c-sections and it was the best birth I could have ever asked for you just have to do as much research as possible for yourself. Go with what is best for you and your baby. It can be done I know it may be a challenge to find someone willing to do this. Midwives are so much more open to that. in the hospital I don't know of a hospital yet that is willing to do vbacs. All the best for you and may you have a wonderful birth and healthy baby.
Yes, it is harder to find someone willing to support you in a VBA2c. However, you must consent before you have any type of surgery. You have to do research and be committed. It is not the norm to try for a Vaginal Birth after one cesarean let alone two or more. Join ICAN-ONLINE and your local chapter if there is one. Good luck in your journey.
Your best chance will be with a midwife at home ... I am currently in the process of setting up my birth team for my next child. I am not pregnant yet but I want to get it all set up before hand. I know that OB's will not do a VBA2C but you can have a HBA2C. Here is a list of Midwives in LA good luck.

http://californiamidwives.net/zc-90066.aspx


also check out

http://midwiferytoday.com/articles/homebirthaftercesarean.asp
I definitely agree with what others have said - look into your local ICAN chapter for help. There are lots of resources out there, you just need to do your research. I had a c/s with my first baby (typical cascade of interventions scenario) and then was planning on a hospital VBAC for my 2nd baby - who decided to remain breech, which led to my 2nd c/s. That labor, however, was fast and furious and I *know* if he had been in position I would have had my VBAC. So I'm definitely thinking VBA2C should we decide to have a 3rd baby in the future! :) good luck - you can do it!

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