Second CS or VBAC?

(82 Posts)
2margarinesonthego Tue 21-May-13 10:53:19

Hi All,
My DD1 was planned CS due to being breech, and I initially decided to go for a VBAC for this baby (DD2). But now I'm having cold feet for lots of reasons I won't bore you with.

I wondered if anyone had any pros / cons of going for either option. I feel I don't get the full story from medical professionals, IYKWIM.

Many thanks smile

lisbapalea Wed 22-May-13 15:24:58

Really interesting to read all of this as I have been mulling over the very same question.

I think I am veering towards another ELCS (first one was because DD was breech), because, as someone said upthread it is the devil I know.

I also am thinking about my due date which is sometime around Christmas, and the effect that might have on my DD, who will be 3.9 and therefore really excited about her Christmas day. If I can't be there because I have gone into labour I would feel absolutely dreadful for her (and me!). But I don't know if that's too 'shallow' a reason to have asecond ELCS?

bigbuttons Wed 22-May-13 15:51:27

I had 4 vbacs after 2 sections, first one emcs and second elcs. I really wanted to have a vbac with my third. My consultant simply assumed I would opt for another section and was quite discouraging. I had hired a doula by that stage and she really buoyed me up.
All subsequent vbac births were completely uncomplicated with no or minimal pain relief (g&a). Recovery much quicker and dc's 5 and 6 were born at home.
I highly recommend hiring a doula, I believe it made all the difference for me. I had one during all my vbac pregnancies and births.

irregularegular Wed 22-May-13 15:52:40

As others have said, there is really no more reason for you to have a CS than for a first-timer. You had a CS for a very specific reason last time that won't apply this time - or if it does you'll know about it. A CS is a major operation and carries far more risks than labouring naturally.

I also had a planned CS because my first was breech. There was no question that I would have a VBAC with my second - I'm not sure a CS was really offered, but i wouldn't have wanted it anyway.

As you know, after a CS you can't move at first. You have to stay in hospital for a few days. You a physically weakened for a significant time afterwards. I hated it.

After my VBAC I felt fab, elated, and was ready to bounce out of the hospital a few hours later.

There was some extra monitoring, but it wasn't particularly intrustive. I was late so induced by a drip. It was all pretty quick and straightforward and I only had gas and air.

I know I'm only a sample of one, but for me there is no contest. And in general the likely outcome and possible risks of a CS are on average much worse than a VB when there are no anticipated problems that would make VB problematic.

PoohBearsHole Wed 22-May-13 15:52:42

Hi dd was a emcs due to pre eclampsia, ds was a vbac. I wavered constantly and my lovely consultant would not advise me in either direction, as it was I was thinking of an elcs as I was worrying. Ds had other plans and arrived 3hrs before my last consultation to book in elcs.
I can honestly say it was a much nicer experience as I was out of hospital by lunchtime and back with both my dc. Recovery was quick and easy and yes whilst painful doing it, I would happily do it again!

I had requested an early sweep (impo it was less invasive than a cs) which did nothing for a few days although had strong Brixton hicks for a couple of dayssmile.

I think it also very much depends on support you have at home, if you are going to be on your own soon afte the birth with two dc then I would try for a vbac possibly, but the I could be biased as I got an infection on my emcs scar which was unpleasant, the stitching (2) wasn't nearly as bad!

bigbuttons Wed 22-May-13 15:57:57

btw NEither of my 2 hospital vbacs required continuous monitoring, just the occasional listening in with a doppler ,infact I refused to get on the bed at all! With my first vbac I was 9cm by the time i got to hospital and I gave birth sitting on the floor!
I believed my best chance for success was to be able to remain mobile and calm. I was also three weeks over due with my first vbac because they couldn't induce and i refused to be hauled in for a section if the baby seemed ok.
The subsequent vabcs were also very late babies, 2 weeks and another 2 at 3 weeks over. i guess i am a slow cooker!

MrsMarigold Wed 22-May-13 17:15:03

I had an EMCS with DC1 it was a relatively stress free experience and recovery was faster than when I had an operation less than a year before.

I had VBAC with DC2 - it was very fast, I wanted an ELCS but suspected I would go into labour early and did so there was no chance they would give me an ELCS. The only good thing was I could lift my toddler straight away.

shelley72 Wed 22-May-13 17:26:29

i too am weighing this up in my mind, so this is a really useful thread. I am on DC3 - DC1 was VB after 14 hours but with 3 deg tear which took months to get over, DC2 was ELCS due to being footling breech and I am due at VBAC clinic soon @37 wks to discuss DC3 birth. however i have found out recently that this baby is also breech (allbeit complete).

at my first vbac appointment i also had the 'we will do this, you cannot do that' speech. i am guessing that if this one stays breech a VBAC wouldnt be advised? does anyone know? whist i am not enthralled at the prospect of another CS, would prefer an elective to an emergency. this will also be my last baby so not too worried from that pov.

MadeOfStarDust Wed 22-May-13 17:40:37

I had EMCS due to undiagnosed breech with first - with an epidural - seemed just fine - no complications seemed to recover quickly - 2 days in hospital - thought it was great....
Then VBAC for second -recovery from VBAC was a complete walk in the park even though I had had no problems with EMCS recovery... just went home after a couple of hours and got on with life...

amazingmumof6 Wed 22-May-13 18:16:47

shelley breech babies can turn head down in the last few days before birth, so if no other reason I'd book ELSC as late as possible.

at 37 weeks you have heaps of time.

they will/should scan you nearer the time anyway, so hard as it is not to prepare one way or the other, I'd just wait.

(even if you book an ELSC, if you go into labour before that you still might end up with an EMSC, so I wouldn't worry about that...if that makes sense)

AWimbaWay Wed 22-May-13 18:27:59

I've had VBAC after an EMCS, I was given the choice of an ELCS with my 2nd but opted for the VBAC. I was also given the choice with my 3rd and after having experienced both went for the VBAC again.

Personally I found the VBAC a far better experience, obviously it hurt like hell but in generally I found it far less traumatic and recovered so much faster. However my EMCS was particularly horrific and has probably skewed my opinion , so I guess it's really all down to personal experience and an ELCS is going to be far more straight forward than an EMCS.

amazingmumof6 Wed 22-May-13 18:29:14

OP what will be the age difference between you children?

DS4 was footling breech, ELSC.
DS5 3.5 years later VBAC
2 years after DD was VBAC too.

all good

But I was on a high dependency labour ward, just in case and they were very twitchy, especially with DD.

A midwife friend of mine said (and since I read other threads where people agreed), that VBACs are treated like ticking time bombs, because although things don't often go wrong, if they do the results can be catastrophic.

not too scare you, but you should know

Thatsinteresting Wed 22-May-13 18:45:02

I haven't read all the replies but still wanted to add my story. I had emcs with Dc1 as it became clear that baby was't going to budge. I made a good recovery and had no regrets about how baby came into the world.
When I was expecting dc2 my consultant suggested a planned cs as dc1 was 9lb 7. The idea of going into surgery 'cold' terrified me and dc1 was starting nursery 4 days before cs was booked. I had always been a sahm mum so this was a massive thing for both of us and I knew I'd be away from home at least 3 nights. I spent many, many evenings trying to go through my options. My consultant said that I couldn't be induced due to previous scar.
In the end I was 41 +2 and had my waters broken and given a tiny amount of hormone drip. Baby was monitored constantly but I was free to move around the room and bounced on one of those balls like a crazed woman as by this point I really wanted a vb. Natural labour started and I eventually requested an epidural and dc2 needed forceps but it was a great experience and if I was ever to have a 3rd I would defiantly vbac. I was ready to come home in a couple of hours and my milk seemed to come in much quicker but I don't know if that's related.

Thatsinteresting Wed 22-May-13 18:46:15

Lots of people 'told' me what to do. Do what's best for you.

amazingmumof6 Wed 22-May-13 19:48:21

DS5 was my biggest at 9lb 14 in case that helps

DD (6th) was smallest at 8lb 3. I had no stitches with her (not bad, eh?) and I was bouncing around with no pain straight away (well not regarding the after pains).
if we had more, I'd opt for VBAC again - if all good otherwise.

HTH

MakeHayNotStraw Wed 22-May-13 19:54:23

One thing to consider is long term effects of cs. I have had 2 emcs, both for failure to progress, and it is since the second that I have developed probable endometriosis. There are some forms that can be caused by surgery that cuts through the uterine wall - ie a cs. It is causing pain, discomfort and problems conceiving dc3. I am sure this is unusual, but it is a risk I knew nothing about.

Ultimately the HCPs cannot say you have to / can't do something, they can only advise. Oh, and if you decide on vbac and need induction, see if your hospital is using Propess - a much longer-acting version f the pessary that mimics the slow progress of real labour rather than the wham action of the pessary, thereby putting less strain on scars. 'Tis newish I believe, but effective!

teacherwith2kids Wed 22-May-13 20:28:24

DS was EmCS (big head, got v. stuck).

DD was a textbvook VBAC with gas and air.

My decision was affected by

a) the fact that we seem to combine childbirth with house-moving. Having moved house and country 6 weeks after an EmCS first time round, no way was I going to try to settle into the house we had moved into literally days before the second birth after another EmCS. DH had no paternity leave, nearest relative hundreds of miles away, 2 year old DS only just recovering from life-threatening croup and needing me to be up and around to care for him - all those things weighed in the balance against an operation unless in a dire emergency.

b) they gave me a late (36 week) scan for DD's head size. Instead of 'as far above the top line of the centile scales as the span of the centile scales between 2nd and 98th centile', her head was a bijou 50th centile circumference.

CocktailQueen Wed 22-May-13 20:52:57

'The VBAC consultant I have seen told me the baby has to be continuously monitored all the way through, and I will also have to have canula in in case it turns into an EmCS. She also told me some horror stories about what will happen if it turns into an EmCS.'

There are no 'has to's - this is YOUR body and YOU are in charge. they cannot do anything to you without your permission.

I had a VBAc after dd was breech and I had a ELCS with her. I really wanted a VBAC for various reasons.

Have a read of www.vbac.co.uk/ as this has all the info, pros and cons, and will help you make an informed choice.

Dozer Wed 22-May-13 21:04:03

I tried for VBAC with DC2, mainly because I felt pressure from midwives and the hospital, but after my waters went at 36 weeks I was admitted but nothing happened for days, had the syntocin drip induction with close supervision (which found reassurring), contractions were v painful around the scar, felt like burning, and it began to split, so ended up with another C -section, which was OK, was an amazing feeling when the spinal stopped the pain!

I do feel that the hospital should have explained the lower chances of a successful VBAC in the particular circumstances and offered choice: the odds were lower because I needed to be induced and because I hadn't got far with dilation with DC1. Because I was listed as wanting to try for VBAC (although in fact I had always been ambivalent and made this clear) they didn't give the impression that I had any other option than VBAC, when what I really wanted was a C-section. I am normally really bossy assertive, but felt like I had to do what I was told!

In retrospect I wish I'd had the C-section.

So even if you choose VBAC, or indeed C-section, please tell people if you change your mind!

WalterandWinifred Wed 22-May-13 21:19:15

DS1 was ELCS for breech.

After much discussion/studying the statistics/debate about what to do, DS2's birth was a 2 hour VBAC with no pain relief other than a Maggie Howell VBAC Natal Hypnotherapy CD which was brilliant. I would highly recommend her CDs whatever you decide. I do feel like my pelvic floor has suffered more from the VBAC but recovery generally was quicker. Good luck.

izzywotnot Wed 22-May-13 21:21:34

I've had 4 children, first 2 the normal route, second 2 by ELCS. My first CS was because breech baby, second CS was my choice because having done 'normal' birth twice (both of which ended up with episiotomy and forceps) and therefore experienced both types of delivery, would EVERY time choose a CS. And having spoken in some depth to the Obgyn about this, stats are that safety-wise it's slightly higher risk for the mother, lower risk for the baby.

My advice as someone who's done it - HAVE A CS!

amazingmumof6 Wed 22-May-13 21:44:49

Dozer the complications of the scar splitting is the only downside I was warned about, what a shame you weren't informed about it.
It must have been really scary.
hope you recovered well

I know what it's like to get cold feet as the birth approaches, I went all weird while BEING in labour with DD ( 2nd VBAC)!grin
Just as I was told that I was fully dilated and can push all the pain stopped and I panicked and requested a C-section.
everyone was shock hmm confused hmm shock
I kid you not, I folded my arms, shook my head and refused to do anything. I would've stomped my feet if not lying in bed.
I just didn't want go through it again and was so scared allnof a sudden.
DH was utterly blush
I had a 5 minute staring competition with midwife who got really worried. I thought she'd end up slapping me, so decided I'd better start pushing.
just bizarre, no idea what came over me!
best birth though, no stitches needed!

so I really understand that you keep changing your mind, it is a difficult decision to make, but you are allowed to change your mind!

well, within reasongrin

amazingmumof6 Wed 22-May-13 21:46:52

sorry, the second bit was meant for * OP*
stupid phone

Pinkbeans Wed 22-May-13 22:12:01

Dozer I was also put under pressure to try for a VBAC after my EMCS again and again, and when by 36 weeks I had still not been persuaded to try for a VBAC, I had to attend a meeting at 36 weeks with... I'm not sure what her title was, but she was some sort of patient liason officer attached to the maternity unit.

The Battle Meeting lasted around 40 mins during which she wanted full details and reasons as to why I felt an ELCS was better for me, and for every reason she had a counter-argument why I should have a VBAC. I was really quite exhausted by the end of this meeting. I did get an ELCS as nothing she said could persuade me to try a VBAC but I really had to work for it as such.

She suggested I try a VBAC and then choose a CS whenever I wanted in the process hmm but I felt that she was maybe being a bit misleading ambitious there, given that I know CSs are either planned or emergency not "lady in room 4 has been labouring for 2 hours but she wants a CS now, thanks". hmm which is basically what she was promising hmm hmm. That was my take on the meeting anyway.

Pinkbeans Wed 22-May-13 22:17:55

amazing love that story, that made me laugh!

amazingmumof6 Wed 22-May-13 22:22:00

pinkbeans it was hilarious!grin
I essentially behaved like a toddler....

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