thinking about options for birth - what else do i need to consider? and WWYD?(9 Posts)
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hi there i am currently in early stages of pregnancy (15 weeks) with DC3 and i am deemed a 'high risk' pregnancy due to my age, having had an ELCS for DC2 and for having high blood pressure with DC1 (which incidentally was fine all the way through second pg).
so i am now thinking about my birth options for this baby. i realise that things dont always work out the way you want them to and so i have said that i am not having a birth plan that i can fail at, but i do need to at least start thinking things through in my head.
so a bit of background - DC1 was breech until 36 weeks, then turned. had a failed home birth. i laboured for 10 hours perfectly well, then it took a total of 4 hours to push him out (eventually after being transferred to hospital, cons turning his head as he was stuck, and being threatened with ventouse). i had a third deg tear, spent two hours in theatre being stitched back up and was in pain for a long time after. also had PND which i am sure was influenced a bit by the traumatic end to the birth as well as the first time mum shock. i booked for a homebirth again with DC2, but DC2 was also breech - footling this time - and despite hanging upside down, using moxi sticks, being on all fours and finally an unsuccessful ECV she was delivered by ELCS @ 38wks, really what i did not want at all but we recovered well, and it was a lot less painful than the tear.
so now. dc3. obviously at this stage i do not know which way it will lie but the consultant has already mentioned at the 12 wk scan about the birth and said i would be fine health-wise for either a VBAC or ELCS. does anyone have any experience or thoughts that i should consider? i would particularly be interested in the views of any midwives - eg if i went for a VBAC would i have to be in hospital and i would have to be monitored / on a bed? would i be able to refuse induction if i went over 40 wks? i dont want to risk another horrible tear (and the consequences of that), or rupturing the section scar however i dont particularly fancy a section either!
thoughts and suggestions please!
depending on how old your youngest is and so how much time you body's had since to heal, but I'd say as you are high risk, go for a C-section.
midwives/doctors treat VBACSs as ticking time bombs, if the scar raptures they have a very short time to get baby out safely and it's one of those things that doesn't happen often, but the result can be catastrophic!
I wouldn't risk it if there will be less than 2.5 years between your youngest and the baby.
having said that I had a VBAC with DS5, but only because there's a 3 .5 years age gap between DS4 and DS5 there were no problems otherwise
(had ELCS with DS4, also footling breech)
also had normal birth with DD,but was in high dependency unit as I was over 35 and it was 6th birth, so they were watching me like a hawk anyway...
and yes for above reason you will have to be in hospital, and very likely you'd be fully monitored.
they can not induce you as the induced labour will cause stronger contractions which would risk the scar rapturing even more
(remember, when you had a C-section they had to cut through 7 layers of skin and so a scar tear could occur within the layers, internally, so to speak)
it is a difficult decision and one you can only make, but please listen to your care team,
Difficult one..although I chose to have DC1 and DC2 by section,I hate the recovery and the incapacity afterwards and now I have 2 DCs to look after (3 and nearly 2) the prospect of yet another section in a few weeks and the ensuing recovery is not something I am looking forward to at all.I think if I had the option of a successful VBAC I might be tempted,but after 2 sections I'm not even able to consider it.Because you've had a normal albeit complicated delivery once,although you've had a section since you must have a reasonable chance of successful VBAC?I would go for that,unless you are advised it is unsafe or unsuitable,but that is based purely on the fact that recovery might be quicker and make it easier to get on with looking after 3 DCs rather than any medical facts!
beatrix well said and sorry you are dreading another c-section, I sympathize!
OP - just wanted to add that although C-section was a drag with DS4 (4 kids under 6!) and was hanging over me with both DS5 and then DD, if I was advised to do it, I'd have gone for it in a heartbeat.
they discourage ELSC for a number of reasons and they really advised me against it with DS5, so if they advise you to have it that decision is not made lightly, they have good reason!
You're in a position of possibly having to make a difficult decision. Without a crystal ball, no-one call tell you exactly which choice would be best for you - there are risks involved with either!
VBAC - the hospital policy is likely to involve continuous monitoring, and being on the bed - you can refuse either and you may like to investigate the debate that there is about whether CFM would actually detect a scar rupture - many people believe that changes in mother's pulse rate and pain would be earlier indications of problems before getting to the point where lives are at risk. Many consultants will not recommend induction of labour but there are some that do if the mother goes overdue so again you could do your own research and come to your own conclusions.
A repeat c-sections carries all the attendant risks of surgery and a potentially longer recovery.
Points for you in favour of a VBAC - you've had one vaginal birth (and remember, one birth experience is no indicator of how your next will go!) so you know you can "do" birth. Points in favour of another c-section - you've had one before, you know exactly what the recovery can be like (again though, each experience is likely to be different!)
Personally, I wouldn't worry too much at the moment. I would start planning at around 34/35 weeks when I know (a) how well I am and (b) what position the baby is in as both these things could affect my decision making.
Good luck whatever you decide and congratulations on this pregnancy!
Just thought I'd add my two pence in ...
I'm having DC3 and planning a VBAC. I was induced with DC1 (for postdates) and had a ventouse delivery and a third degree tear. I then had an ELCS with DC2 due to excess fluid (and some bad advice which scared me a lot!).
This time I am planning a VBAC at home. Personally I am refusing CEM because the outcomes for both mums and babies are no better than with IA (regular listening of the fetal heartrate). I really do not want to labour in a static position, which CEM usually necessitates) - it's more painful and more likely to slow progression of labour - given that the hospital policy is 1cm per hour dilation something I don't think I can afford to have!
I don't want an ELCS because of the recovery afterwards, although it was fairly straightforward last time I will have 2 older DCs to look after this time and could do without the added discomfort/disruption.
I have also read research that suggests that maternal heart rate, maternal temperature and pain are better indicators of uterine rupture than fetal heartrate. Plus, the actually chances of having a serious uterine rupture are very small.
I have made the decision to plan my birth at home because I feel that it will give me a much less greater risk of procedural intervention and that it is likely to give me 1:1 midwifery care, which hospital births cannot provide. I have managed to talk to the obstetricians about being called 'high risk'. Yes I am slightly higher risk than someone who doesn't have a scar on their uterus but with THIS pregnancy it is largely straightforward and uncomplicated so I disagree that my risk is 'high'. I am, therefore, now classified as 'moderate' risk!
It might be worth contacting your supervisor of midwives to explain your concerns/ask for advice. I have found that I get very different advice from obstetricians and from midwives but I much prefer midwifery-led care. Obviously no-one on MN can tell you what would be best. I have found, however, that I feel much more in control of this birth than I did with my others because I am more informed and being more assertive
challenging with HCPs to explain their position and provide evidence. Because of this I feel that if things don't go as I would ideally like them to I will still have been in control of the decision making process and this to me is more important than the way I end up giving birth. Good luck OP.
Thank you all for your thoughts. You see, if it was completely up to me, i would like a VBAC at home. I dont mind going through labour again, but I absolutely do not want to do it lying flat on a hospital bed, wired up. To me that is not that much better than a ELCS. Though I admit the thought of the recovery from CS this time with three children to consider is a bit scary!
I am due to be booked into the VBAC clinic to discuss my options, though I am not sure how useful they will be - or whether they will push me into a decision one way or another. I am not good at making decisions! I had the CS last time, when i really didnt want to and i felt bullied into it by the hospital midwife. thankfully i had fab CMWs who helped me sort a CS birth plan and even attended the delivery with me to make sure that some of my wishes (eg i get the first hold of baby, skin to skin) were carried out. i know that will probably not happen this time though .
i think that i will wait for my appt to come through and then until i am a bit further along to see what the baby's up to!
Sounds like you'd actually like to have a VBAC at home! It's certainly not unheard of and many mothers do it.
You are entitled to have a midwife present at your birth regardless of what their advice is. If you need support in this, you can contact AIMS.
You can also speak to the Supervisor of Midwives and negotiate your hospital birth, as in, state beforehand that you are declining CFM, and that you'd like to labour in the pool. (for example)
Have a Look at the AIMS website, as well as http://homebirthersandhopefuls.com/vbac-vaginal-birth-after-cesearean/
Have you considered hiring a doula? Some have lots of experience in supporting women with VBACs.
Good luck in your decision making!