Advice sought over birth choice please

[LairyPoppins]

Hello,

I had twins nearly 5 years ago by c-section (breech and I had pre-eclampsia). I am now 38w1d with one baby, have been planning a VBAC all along as recovery from section last time was hard, I now have 4yo twins to run around after and we struggled to establish breastfeeding last time.

Pregnancy has mostly been OK, a couple of scares with blood pressure but has settled down now. I am 'high risk' because I am overweight and had a section last time, so either way it will be a hospital birth.

At 36 weeks I was measuring big, sent for a growth scan. Everything perfectly normal, except baby is on 95th centile (7 1/2 lbs extimated at 36 weeks). They said he's be growing at 1/2 - 3/4 lb a week, so somewhere between 8 1/2 and 9 1/2 lbs now.

At 37 weeks, he was breech. I went in for an ECV (where they turn the baby) which was successful. At my appointment 4 days later, MW was unsure whether he had turned breech again and is now saying he has 'unstable lie'. They have offered me the choice of a section again because of the possibility of him being breech as I go into labour. She did an internal and said my cervix is 'unfavourable' i.e. I am nowhere near going into labour.

At the moment I am going back to the MW on Monday to look at position again. Pros for a section seem to be : He might be huge (10+ lbs at delivery if I go to 40 weeks) and this is a first birth effectively; he might be breech (not keen on a vaginal breech delivery); either of these would probably lead to a section anyway. Cons are: It all might be OK. A section would leave me with weeks of recovery rather than days.

What do you think? I am tying myself in knots trying to decide what to do....

Many thanks for reading.

[lemonfolly]

I can see why your struggling to decide. Have you got much help on hand if you went for the section?

To be honest I'd probably opt for the c section as its less risky for the baby if its very large. However they are really rubbish at estimating birth weights though, they can be easily a pound or two off I believe.

Are you booked in for another scan to see presentation?

[LairyPoppins]

Thanks lemonfolly

My in-laws are here and my mum is also close at hand - DH works from home so is around lots too and is SAHD to the boys when I am at work. So yes, lots of help.

MW suggested another presentation scan but was doubtful they would do one so soon after the last one (only 5 days between them) so we decided to wait and see if things were any clearer when I go back on Monday.

My head says section makes more sense, my heart says I would like to give a vaginal birth a go (but maybe not with a 10lb baby...). Also I am only 38w1d now, so uncomfortable I can't really imagine managing another 2 weeks of this!

If vaginal birth is risky for the baby if he is large that would definitely swing me towards a section. I wonder whether I can ask for another set of growth measurements at the same time as the presentation scan?

[Hemlock2013]

What a tricky situation!!

From only anecdotal evidence, it seems that elective c sections are much easier to recover from than emergency... So I would err on the side of caution and book it in knowing it will be calm and recovery, although not easy will be better than if you had attempted vbac and ended up I'm surgery.

I hope this is of some help? X

Good luck though and congratulations!

[LegoCaltrops]

No idea about the VBAC angle, I only have 1 DD so far, had a vaginal birth. However she was 8.12 at birth & it was bloody awful. Very long labour & the works in terms of pain relief. Due to her size & my exhaustion towards end of labour, I nearly ended up with EMCS as DD was showing signs of distress. Got forceps instead & a massive episiotomy. Not fun. And I didn't have other kids to run around after when I got home.

I think I'd go for the planned CS, in your shoes, & organise lots of help for afterwards.

[LairyPoppins]

Thanks Hemlock2013. That is what I am thinking too. It would be a bad scenario if I went for VBAC and baby got into difficulties then we needed an emergency section - worst of both worlds. Maybe I just need to bite the bullet and go with another section. Feels like I am throwing in the towel though. Silly I know - it is so hard because there are so many unknowns!

[43percentburnt]

I have had a vbac but baby was 7ib 6 and not breech, he was back to back but turned after I bounced on a ball for 6 hours! I went into labour genuinely believing that I could give birth naturally and I think that helped me. If I had had any doubt I would have had a c-section and not gone through several hours of trying only to end up in theatre tired and stressed. Sorry if that hasn't helped!

[LairyPoppins]

x-post, Lego.

Yes, that would be really hard. I'm really not keen on forceps etc. We do have a lot of help for afterwards.

I think I will need to discuss with my MW on Monday.

I bet the little blighter will have turned head down again on Monday and it will be back to plan A :)

[LairyPoppins]

Hi 43 percent burnt. Oh yes, I forgot to mention he was also back to back (when he was head down).

I do feel shattered though - in late pregnancy I am certainly in no fit state to go into a long and exhausting labour (or to look after a newborn, for that matter). It all seems like very bad planning

[Hemlock2013]

It's definitely not throwing in the towel!!! C sections are often just as rewarding as vaginal births and can be calm satisfying experiences! Certainly when planned and elective. Take out the stress of not knowing and start planning and looking forward to your lovely new baby! X

[Panzee]

Have you been offered a scan to check the position? I was when mine was moving about. Turned out he was head down.

Have you been on the spinning babies site? It's worth a go! And a friend swore by moxibustion. But check the position first. :)

[gargalesis]

This is an interesting article about big babies. Apparently there is only 50% accuracy in predicting them.

[Panzee]

Oh and I have had two planned c sections despite my desire for lentil candles and a water birth. They were fine, and was only in 2 nights with the second one.

[LairyPoppins]

Thanks Panzee, yes, I have been trying some of the Spinning Babies manoeuvres - the MW thinks that because I had twins last time (they were nearly 7lbs each) that my uterus is very stretchy so he has a lot of room for turning around even at this late stage. I think they will probably give me another presentation scan next week.

Thanks for the article gargalesis, I will take a look. I am measuring 45 weeks now though (!) so I think he will be on the big side..... DH is 6 ft 4...

[lemonfolly]

Id push for another presentation and growth scan in your situation. Also bear in mind it may be another 4 weeks for VB as they don't induce until 41 +5! I went to that with both mine.

To get yourself favourable for labour, get bouncing on a birth ball, if head down it will pop pressure on cervix.

Good luck!

[weatherall]

Yes I think having twins last time might mean that the baby could change position frequently.

I'm a home birther but in this circumstance even I'd be leaning towards a planned section, especially since you have a sahd to look after the DCs whilst you recover.

[LairyPoppins]

Thank you all.

Well the update today is that baby is now head down, bump has dropped by 3cm (now measuring 42 rather than 45 weeks (!)) so I am guessing baby s somewhat engaged and he is no longer back to back.

MW has encouraged me to continue to try for a natural birth. I am going back in on Thursday, when I will be 39 weeks, and she is going to try a stretch and sweep.

She told me that if my waters break but labour doesn't start they would induce me, but I have told her that I would not have an induction in those circumstances, and instead opt for a section.

So everything crossed that I go into labour before this baby gets too big to push out!

[Hazchem]

Have read up on big babies Evidence based birth big babies in themselves aren't a problem in themselves and the evidence doesn't suggest it's more risky to give birth to a big baby. DS was born at 10 pound 2 oz as my first and while being hard work it was fine and recovery was good.
It sound like baby is getting into a good position and that is important to giving birth. If you want to try to help baby stay in good position goggle spinning babies and do some of their exercises.

[Panzee]

Good luck! :)

[lemonfolly]

Good luck, bounce on that birthing ba every day! :)

[LairyPoppins]

OK, so I have had backache all afternoon after a night of (what felt like constant) braxton hicks. BH have continued on and off all day and backache is at the base of my back - could this be the start???

WIll be bouncing like mad on the birthing ball this evening.....

And thank you Hazchem for the article. I will be keeping the size of the baby quiet from my birthing team