I've had three C-sections and now I want to try VBAC (vaginal birth after C-section.) What do I tell my doctor who feels, "Once a C-section, always a C-section"?
The problem with trying for VBAC after three cesareans is that we don't have confidence that it is as safe for the baby as a repeat cesarean. VBAC is most likely to be successful and free of complications when it is after just one (or maybe two) cesareans, when the uterine incision was "low transverse" (crossways), if the mom has had vaginal births, and when the original reason for the cesarean was something unlikely to repeat, like breech. In that case, the chance of uterine rupture is fairly low and the chance of success is quite high. Uterine rupture, while uncommon, can be a disaster. The baby may lose oxygen supply, and the mom requires emergency surgery. The chances of uterine rupture after one or two cesareans is about 1 in 200 labors, with about 1 in 5 of those leading to significant serious problems or death for the baby, for an overall risk of poor fetal outcome of about 1 in 1000. I don't know the odds of uterine rupture for three prior cesareans but it is believed to be higher than after one or two, so most hospitals don't offer it.
As for what to tell your doctor, you can't force your doctor to do something that he or she thinks is poor care, but you can always decline the care that is offered. I suppose you can refuse cesarean when you arrive in the hospital in labor, but I don't recommend forcing the hand of a doctor who clearly doesn't share your views. It is much better to get your care from someone with whom you have a good relationship—with open and honest two-way communication and mutual respect. If you feel strongly that you want to pursue VBAC despite the risks, you should try to find a care provider who can support your plans, or who can convince you of his/her view with a better explanation than "once a cesarean, always a cesarean". Good luck to you!