Make my decision for me. Please!

[redllamayellowllama]

Sorry, it's a long one.

Am currently 33 weeks pregnant with DC2. I've been posting in this section on and off for the last few months with my procrastinations, so apologies if I'm getting boring!

DS EMCS following long latent phase, long 1st stage, back-to-back labour, brow presentation etc. Born with a large haemotoma on his forehead which is still there. Bad experiences with VE's, communication between medical staff and me and lead to a mini-breakdown in my relationship with DH (on my part; found the idea of sex very traumatic, he was understanding but inevitably lead to drifting apart). Definitely suffered in the early months and can only know talk about it without crying.

I've been for a de-brief, which I found very hard and don't feel like I came away from it feeling exonerated (that's the wrong word entirely, but hopefully you get the gist).

Hospital definitely pushing for a VBAC and I understand all the reasons why, but I'm still filled with fear. My consultant is good and will listen to me should I decide to push for an ELCS. Pros and cons as I see them below, what do you reckon?

VBAC:

-Quicker recovery, able to look after 22 month old DS.
-Baby arrives when ready.
-Less risks associated with.

But:
-Massively afraid and know that fear will hold me back (reading lots of Ina May, doing lots of VBAC Hypnobirthing and still filled with dread).
-Very VE-phobic following first birth.
-Worry about how negatively affected DH will be.
-Will be very medicalised anyway - constant foetal monitoring a must (apparently at St T's this is non-negotiable).

ELCS:

-I can control the situation (obviously within reason - I understand the many risks).
-There will be no need for VE's.
-For some reason there is no fear attached to this option for me.

But:
-Slower to recover.
-Harder for me to be physical with DS.
-Baby arriving when not necessarily ready.

I know only I can really answer this, but some other experiences would be helpful!

TIA.

A Csection isn't necessarily a slower recovery than a VB.

I had a pretty routine vb with ds1 but big baby, tore, lots of stitches, lost lots of blood very anemic, felt shit & teary for weeks.

DS2 ECS, 1st day post op a bit sore, needed paracetamol, day 2 and 3 pain free & onwards and upwards from there on.

Physically i recovered so much faster after c sec. Emotionally its difficult to judge as ds2 was very prem & so had a roller coaster in scbu.

Mine is only one story & I'm sure there are others that can tell you about the opposite outcome.... But if i was to do it all again I would def opt for a C section!

Oh and its completely pain free!

llama, you had a horrendous first time, so no wonder you don't want to go through the same thing again. In your position I would have an ELCS - like Chynah says, recovery isn't necessarily slower than after a VB, especially if the VB was a difficult one. By the sounds of it you need to feel some degree of control over the birth, and an ELCS will give you that - plus no drama, no fuss, no anxiety.

I had an emergency planned C section with DS1 (I had pre-eclampsia so I had two days' notice that they were delivering him at 34+4 days), and an ELCS with DS2 after failure to progress. Both times I was up and about on the second day, and by the time I got home (after 8 days with DS1 and five with DS2) I was fully mobile and lifting even DS1 wasn't too much of a problem.

One thing I've learnt about C sections, though, is that the way that you are put back together makes a big difference. My obstetrician glued me back together, which is unusual, but led to a quicker recovery time and a neater scar. The next best is stitches - stapling leads to the most complications, so it's worth finding out what method is used at your hospital.

Good luck llama. I hope you reach a decision that means you can look forward to, and even enjoy, the birth of your baby.

I meant to say ECS with DS2!

Is there any way you could afford an independant midwife? They would be likely to be much more supportive, and you would know them before hand. I believe most "do" home births but some would do a hospital delivery. Failing this how about a doula, who would be your advicate at the hospital. Often you have to pay for this service but I do know that there are some (wonderful) people out there that do this for free.
I'm a bit puzzled by the "must have fetal monitoring" surely the hospital can't do anything you don't give consent for.
You can refuse to have any VEs, experienced midwives can tell a lot about the state of your labour without them!

why not delay making a decision about this until you are in labour - you can always have a section at this point, at least then you would know that the baby was ready to be born. And you might feel differently about the birth by that point and decide to continue with a VBAC, however if you still feel panicky etc then you can opt for the section at that point, there is usually plenty of time!
best of luck whatever you decide.

Do you have the support available that you'd need to cope with your LO and a baby after a CS? You might need it after a VB anyway, but you'll definitely need help with lifting, etc after a CS.

Only a couple of thoughts - constant monitoring is never non negotiable. They may strongly advise it, and you can choose yes or no. You give consent to it, or not.

I had a crash CS under general for a brow baby plus massively dropped heartrate with first baby.

I tried for VBAC at home after basically being refused an elective. Had another EMCS in the end, leisurely transfer for not progressing - but it was all on my terms and a MASSIVELY better experience.

I went for VBAC at home because their protocols for a hospital VBAC sounded like a disaster waiting to happen. Home vbac or section for me, just would not have a vbac in my local hospital (esp as first time they were so crap)

You really sound like you need an independent midwife or a doula to support you through all of this emotionally. Good luck xxx

I have no personal experience of this sort of decision, but I'll tell you what I do with decision making sometimes.

To take your case, I'd maybe decide to go for asking for the section in my head. Then I'd give it a few days to see what I felt about my decision. I tend to either feel happy and settled about it or unsettled, which helps to confirm the decision in my head.

I think you've kind of answered your own question? if you read your lists you sound a LOT more frightened of a VBAC than you do a ELCS.
I have just been in a very very similar situation. Very traumatic first birth brow presentation ending in EMCS. Im now 35 weeks with DC2 and have spent most of this pregnancy worrying about how this baby will come out. I have cried at 4 consultant appointments and just been generally terrified.

I have done tons and tons of research into VBACs, been to antenatal classes (again) talked to a therapist at the hospital but still could not get over the fear of the same thing happening again. So today I told my consultant and I have my ELCS booked in for next month and I cannot tell you what a huge weight off my mind it is.

I did what you did and made lists of pros and cons, and there were just too many variables with a VBAC for my liking, by choosing a section I feel like I've got a little bit of control back and although I know from experience a section isn't a walk in the park I would so much rather have that than the unknown of a VBAC and the potential to end up with ANOTHER EMCS.

I wish you all the luck in the world coming to a decision but in my honest opinion it sounds like you are already leaning one way,
Hope that helps! X

Wow, thank you so much for all of your replies. I thought I was being a bit OTT about it all, but your responses have made me look back at what I wrote and see how much this is affecting me.

My recovery from EMCS with DS was fairly good - I was exhausted, but that was from the labour, which I won't have with an ELCS. DH can only have 2 weeks off (is a teacher, so no chance of holiday), but have had very kind offers from friends willing to help out.

I can't have a home birth (this would be the massively preferable option) as I have a history of epilepsy and although I know I could fight for my right to have a home birth, I'm not convinced I would be doing the best thing for me and the baby if I did.

The constant monitoring bit. The midwife I had my de-brief with (who wrote a birth plan there and then for a VBAC as if it were all decided -it wasn't) made it sound like I would be putting the baby at risk by not having the constant monitoring and for that reason, I didn't feel like I could refuse consent for it.

This all adds to my worries about labouring in an environment that won't be optimal. I'm reading Gaskin and thinking it all sounds wonderful and am then reminded that actually, I'm going to be in a hospital that is a 30 minute drive away, surrounded by medical kit, haunted by the birth of DS in the same ward. It's not going to be orgasmic rushes for me. If I feel this way now, I'm sure I'm just going to panic in labour.

Kity - that does sound like a familiar situation. I've cried at many appts in the last while. I had an appt with a registrar (my consultant called away at last minute), who listened to me sobbing, offered no support and then told me that they didn't hand out ELCS' 'like sweeties' and she would recommend a VBAC. I'm due to see the consultant at 36 weeks and will demand to see only her. I feel like she'll listen and be receptive, but what if she's not? I know that the birth plan can't be set in stone, but now I've agreed to a VBAC, am I going to struggle with getting an ELCS?

Hi redllama, we've spoken on the ELCS after traumatic birth thread. Sorry to hear you're still struggling with your decision.

Thought I'd give you my perspective on recoveryfrom ELCS as I also have a 22 mo toddler. I'm 3 weeks post section and feel back to normal - driving and lifting (although try to avoid it as I feel I should, not as I feel I need to). DH had 3 weeks off but I could have managed with only 2.

Obviously every recovery is different but I felt pretty bad physically for a good few weeks after my forceps delivery so really couldn't say my ELCS recovery was any worse than that.

LOVED my ELCS, such a happy experience. It's a lottery really, at the end of the day, how any kind of birth will go. I think you just have to follow what your instinct tells you.

Good luck

Thanks withoriwthoutyou, glad to hear your ELCS went well. I feel like my instinct is telling me that I want an ELCS - I'm so uptight and afraid and that can't be conducive to a postive birthing experience if I have a VBAC.

My big concern now is getting the ELCS - how do I put my points across? What do I do if I am refused one? The idea of going for a VBAC that is completely against my will is devastating - at least making the decision to have one would make me feel a little bit in control!

redllama, It's very clear that you aren't considering an ELCS lightly, or because you can't be faffed with a VB. You have genuine and legitimate reasons for not wanting to put yourself and your baby through what you fear might be another traumatic experience. And if anybody else gives you patronising guff about not handing out an ELCS like sweeties, remind them in graphic detail about what you went through first time round, and how long it took you to get over it.

You put all your points across extremely clearly in your OP, and you can do that on the day with the consultant if you write them down beforehand and read each one out so that you don't get distracted or sidetracked. Can you take your DH with you for moral support?

Thank you ttalloo - I'm glad that's how it appears.

DH is very supportive and is booked in to come along and fight my corner if necessary.

Hello again!
When I went for my 20 week appointment I said that I wanted a VBAC so had a big yellow VBAC sticker put on my notes! so in my case it didnt matter at all that I had already said I wanted to try a VBAC. Things do change the closer you get to your due date and at the end of the day Im sure all they want is a mum in a good frame of mind.

As I pointed out so many times at my meetings, if Im in this much of a state now how on earth will I be when the real contractions start!!

The support thread for the ELCS has such great advice on, I think you may have already been on there. But I think it just goes to prove, that even though some poor women don't get an easy ride getting to their ELCS, I DO think that most consultants will allow the go ahead in the end.

I may be wrong but I am pretty sure they cannot force someone who has had a previous section to try a VBAC, if something goes wrong, and you had expressed strong wishes to have a ELCS they would be liable? (i think?) It seems from other threads that the women who have had traumatic vaginal births first time round struggle more to get their ELCS's than those that have had a previous section.

I got myself in more of a state trying to just MAKE the decision in the first place, but once I had I did find it easier to sit and say this is why I would like a section again.

Keep us all posted, Im sure you will get the outcome you want in the end, you just may have to shed a few more tears before you get there.

X
ps having finally got my date yesterday, I cannot tell you how much better I feel this morning, I slept reasonably well (for a 35week preggers woman) and feel calm today. Don't underestimate how much this will be affecting you and how much better you will feel when its sorted

tribunalgoer "You will hold him/her personally responsible"

There is just bullying and manipulative behaviour and actually means nothing. The consultant will want to do what the evidence shows is best and this will not affect the choice. There is also no way that they can be 'held' to this.

red If, however, you go to your (nice sounding) consultant and say your thoughts and fears all round, I would hope he would listen.

The idea of a letter is often a good one though as it is easy to forget to say or ask something at any medical appointment, never mind one that might be more emotionally charged for you.

tribunalgoer, yes, I can guess that you have issues with anyone who does not do exactly what YOU think to be best and blame someone else for anything bad that happens otherwise. Statistics need to be considered, because that's the only evidence we have, and then applied to an individual situation. There is also no evidence that the consultant is not listening, so you are taking a very antagonistic approach which is just not necessary.

However, red has obviously thought through the issues (neither option being an 'easy' choice). Hopefully this will allow you and your DH to put forward your thoughts and for your consultant to discuss these with you before coming to the best decision for you both overall.

I wonder if the midwife has assumed that you'd want to go for a VBAC, but I'd find it hard to see you being 'forced' to have one after a completely uncomplicated EMCS, never mind after the rough time you've had with things. My SIL is having an elective section after a section for failure to progress, timed to fit in with her husband going away unavoidably with work.

JMO, but from reading everything you've written think you should opt and push for an ELCS, as you know exactly what you are dealing with and can plan for it. And it sounds right for your emotional equilibrium.

I have just had an elective for dc3 after a traumatic delivery with dc1 and am pretty much recovered in 2 weeks. Was changing dc3 on the floor the day I came home. The pain of delivering dc1 'normally' and the problems afterwards were just so much worse than major abdominal surgery! With an ELCS pain meds keep everything well controlled even once at home. I have also had a vb for dc2 that was fabulous but that was only because I had a guaranteed epidural topped up at source so felt no pain whatsoever, so I speak from varied experience!

You can also request through your consultant a referral to Women's Health or the Pelvic Floor Clinic after birth so you get good post-natal advice and support, whether you have a vbac or an ELCS.