Cesareans and Vaginal Birth after Cesarean (VBAC) Frequently Asked Questions Index

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CONTENTS

• Information About Cesarean Sections
  • Cesarean Birth Stories
  • Possible Causes of Cesareans
  • After the Cesarean: Physical Recovery and Breastfeeding
  • Emotional Impact of Cesareans
  • Health Risks and Future Implications of Cesareans
  • Large Women and Cesareans: Important Issues To Know About
  • Making a Cesarean More Birth-Friendly
• Information About Vaginal Birth After Cesarean

  • VBAC Resources and Stories

  • VBAC After Multiple Cesareans FAQs

  • Important Issues for VBAC Moms 

  • Choosing Between Repeat Cesarean and VBAC

Information About Cesarean Sections

• BBW Birth Stories: Cesarean Stories - Birth stories of Big Beautiful Women who have had c-sections, representing a wide variety of experiences, both good and bad     Updated January 2007
• Cesarean Section: Anatomy of a Choice - Article (with graphic photos) of what is really involved in a cesarean, and the risks associated with cesareans for both mothers and babies  This link not currently working, try again later

• Baby Malpositions: Implications for Birth - Babies that are head-down but subtly malpositioned often cause long, hard labors, and many of these labors end in c-sections.  Find out what position your baby should be in for birth, how you can encourage that position, signs that indicate a possible malpositioned baby, techniques for helping a baby resolve its position, etc.  If you have had a cesarean because your 'baby was too big', 'your pelvis was too small' or because you had a hard time dilating all the way, be sure to read this important FAQ
• BBW Birth Stories: Malpositions - Birth Stories of Big Beautiful Women who have had cesareans or otherwise difficult births because their babies were not optimally positioned for birth
• Pelvic Pain (Symphysis Pubis Dysfunction) Pubic pain, low back pain, sciatica, pain turning over in bed or while putting on clothes, etc. all are symptoms of SPD.  Pubic pain may also be associated with a higher rate of baby malpositions or a more difficult birth/cesarean.  Information about causes, precautions, and treatments. Very important information!  Updated

After the Cesarean: Physical Recovery and Breastfeeding

• Breastfeeding After a Cesarean - Studies show that breastfeeding rates are lower in cesarean moms, as many factors combine to discourage cesarean moms from breastfeeding.  This FAQ examines these factors, analyzes the research, and summarizes ideas that may help women preserve breastfeeding despite cesarean challenges.  Numerous stories from cesarean moms about their bfing experiences, too.  

• "You Should Be Grateful" - Many women find cesareans traumatic but are often told, "You should be grateful, at least you have a healthy baby."  People mean well, but this disempowers women and takes away their right to grieve a difficult birth. Guest Columnist Gretchen Humphries wrote this essay in response to hearing these remarks again and again
• Emotional Recovery From a Cesarean - For some women, a c/s is no big deal, but for others, it can be difficult physically and emotionally.  Women who experience a cesarean often find that they struggle for emotional healing afterwards.  This FAQ shares ideas on how to start the healing process

Health Risks and Future Implications of Cesareans

• Placenta Accreta by Elphie Hosler - One risk of cesarean surgery is an abnormal attachment of the placenta (called Placenta Accreta) in future pregnancies.  This is a very serious complication, one that puts both the mother and baby at risk for death, and its occurrence is on the rise because of the rising cesarean rate. Read this article by guest author Elphie Hosler (originally published in "The Birthkit" from Midwifery Today).  Elphie knows about this subject firsthand, having experienced it herself
• Choosing Cesarean Section - Article by Marsden Wagner, MD, MSPH about the risks and issues behind elective cesareans  The original link is not working, but the article is reproduced at this other site
• Vaginal Birth and Cesarean Birth: How Do The Risks Compare? - quick reference comparison chart from the Childbirth Connection, as part of its evidence-based consumer booklet, What Every Woman Should Know About Cesarean Section

• NEW!!!  Avoiding Surgery: Lowering The Cesarean Rate in Big Moms - Article by Kmom for the Without Measure blog.  Obese women have some of the highest cesarean rates around, but it does NOT have to be that way.  Learn how to lower your risk for a surgical birth and raise your chances for an empowered birth experience
• Preventing An Unnecessary Cesarean - Research indicates that about half the cesareans performed in the United States are unnecessary.  This FAQ reviews ways to lower your chances for an unnecessary c/s. 
• Cesarean Incisions In Larger Women: Up-Down vs. Side-to-Side - Although most doctors use a transverse (side-to-side, or 'bikini') incision, a few doctors regularly still use an up-down ('classical') incision in larger women, despite its risks.  This FAQ discusses the relative merits and the implications for future pregnancies with each.  EVERY big woman should clarify this issue with her doctor before birth.  A MUST_READ FAQ. COMING SOON!

Making A Cesarean More Birth Friendly

• Sample Cesarean Birth Plans - If a cesarean became medically necessary, there are ways to make it a more birth-friendly experience.  This FAQ discusses c/s choices to discuss with your providers.  In Process

Information about Vaginal Birth After Cesarean (VBAC)

VBAC Resources and Stories

• Great VBAC Books and Resources - Lists and descriptions of terrific books, audiotapes, videotapes, and online resources that may help in the quest for a VBAC.  Includes ideas on how to find these resources, plus a list of Kmom's Top Ten VBAC books!
• BBW Birth Stories: Vaginal Birth After Cesarean Stories - Birth stories of Big Beautiful Women who have had previous cesareans but gone on to have VBACs as well   Updated January 2007
• Fighting VBAC-Lash: Critiquing Current Research - Article by Jill McCorkle for Mothering Magazine on the backlash against VBAC in this country and discussing what the research really says about VBAC and repeat cesareans

• Vaginal Birth After 2 or More Cesareans  - Is it possible to have a VBAC after multiple cesareans (VBAMC)?  An analysis of research on VBAMCs, average success rates, rupture rates, risk factors, factors that increase chance of VBAC and lower the risk for rupture, etc.  Extensive references!   New Revision with Updated Research Coming Soon!!
• NEW!   Newest Research on VBAMC - Kmom article discussing the change in ACOG guidelines discouraging VBAMC; also discusses the most recent research on VBAMC since the above VBA2C FAQ was written.   
•  NEWLY UPDATED!!  VBAMC Stories - Where to find VBAMC stories in books, online, etc. Also has personal stories of VBAMC mothers, including Kmom's VBA2C story, and stories of VBA2C, VBA3C, VBA4C, and VBA7C.  

• Baby Malpositions: Implications for Birth - Babies that are head-down but subtly malpositioned often cause long, hard labors, and many of these labors end in c-sections.  Find out what position your baby should be in for birth, how you can encourage that position, signs that indicate a possible malpositioned baby, techniques for helping a baby resolve its position, etc.  If you have had a cesarean because your 'baby was too big', 'your pelvis was too small' or because you had a hard time dilating all the way, be sure to read this important FAQ
• Pelvic Pain (Symphysis Pubis Dysfunction) Pubic pain, low back pain, sciatica, pain turning over in bed or while putting on clothes, etc. all are symptoms of SPD.  Pubic pain may also be associated with a higher rate of baby malpositions or a more difficult birth/cesarean.  Information about causes, precautions, and treatments. If you experienced these symptoms, then had a cesarean for "CPD," 'too small pelvis', or had a malpositioned baby, be sure to read this FAQ!  Lots of important information!
• Emotional Recovery From a Cesarean - For some women, a c/s is no big deal, but for others, it can be difficult.  Many women find that they struggle for emotional healing afterwards.  This FAQ discusses the healing process. Grieving and emotionally processing a cesarean is especially important for VBAC moms
• Pelvises I Have Known And Loved - Is there really such a thing as a pelvis that is "too small" to birth vaginally?  Article by Gloria Lemay on the Midwifery Today website

Choosing Between Repeat Cesarean and VBAC

• The Risks of Elective Repeat Cesarean - ICAN's concise summary of the research describing the risks of Elective Repeat Cesareans, many of which are not discussed with mothers making the VBAC vs. ERCS choice
• Vaginal Birth and Cesarean Birth: How Do The Risks Compare? - quick reference comparison chart from the Childbirth Connection, as part of its evidence-based consumer booklet, What Every Woman Should Know About Cesarean Section

Note: These web sections are very time-consuming to research and write, so many parts are still under construction. New FAQs will be added on a regular basis, so be sure to check back periodically for new additions.  New sections due to be added as time allows:

• Why Do Larger Women Have Higher Cesarean Rates - Do large women have higher rates of c-sections? Why? How much is due to size problems and how much to provider bias? What can big moms do to lower their risk for a cesarean?
• Physical Recovery From a Cesarean - What to expect after a cesarean, how to minimize the risk for infection (very important for larger women), watching for anemia, and other recovery issues
• The Risks of Cesareans in Larger Women and How To Minimize Them - A c/s is a riskier operation in larger women.  This discusses the risks and how to minimize problems
• The Truth About Cesareans - Many people feel that a cesarean is 'no big deal' and 'just another way to give birth'.  This FAQ addresses the risks associated with cesareans, how they can impact mother and baby, future health implications for the mother, and implications for future pregnancies. 
• VBAC and Inductions - What are the relative risks and success rates associated with induction and VBAC?  What types of drugs and procedures are the most risky and the least risky? 
• VBAC After Prior Cesarean for CPD/FTP - If you had a cesarean because 'your pelvis was too small' or 'your baby was too big', you had a cesarean for "CPD".  If you had a cesarean because you stopped dilating partway through, you had a cesarean for "FTP".  Find out what these terms mean, how meaningful they are, what your odds for VBAC are, issues to consider that may be important in improving your VBAC chances, etc.
• Maximizing VBAC Chances - What can you do to increase the likelihood of a VBAC?  
• Elective Repeat C-Section or VBAC: Issues to Consider - A comparative analysis of risks of both repeat cesareans and VBACs, with lots of study references and discussion to help women understand the issues.  
• Repeat Cesarean or VBAC:  Emotional Issues - Are you torn between VBAC and repeat cesarean?  Do you want a VBAC but are afraid of 'failing'?  Does the idea of 'not knowing' the outcome ahead of time bother you? Do you have specific fears that seem overwhelming?  Many women who face VBAC decisions are torn by similar emotions.  How other women have tamed the emotional rollercoaster and clarified their decision-making process
• The Courage To Try Again - If you have had a cesarean after a trial of labor (what doctors call a "failed" VBAC, what we call a "CBAC" or Cesarean Birth After Cesarean), can you choose to go for a VBAC again?  What are the odds of a VBAC in this situation?  What are the risks?  What can you do to increase your chances of a VBAC?

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