Second CS or VBAC?(82 Posts)
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.
The first CS was for reasons not at all connected to your ability to give birth. You did not labour.
If you choose to labour, this time will be the first time as far as your womb is concerned. The likelihood of needing intervention would be the same as any first timer. Spontaneous labour is most likely to end in a straightforward birth. Not being admitted until labour is well established is very helpful.
The existing scar on your womb is a consideration but a minor one in terms of risk.
main areas of consideration
: are you fearful of giving birth vaginally? Lots of women are but manage to overcome this and are pleased they did. Would something like hypnobirthing be helpful?
:are you thinking of having more children? Although an individual cs, especially elective, is a pretty safe option, repeat cs after 2 does start to multiply complications and can lead to difficulty in conceiving.
: recovery time, with a toddler. This is very variable. Some women think elcs is easier than a first vaginal birth, others the opposite!
: is it an issue around birth timing? In my unit, some women book an el cs if they have not laboured by eg 41 weeks. This gives them some control.
I had EMCS with DS1 and wanted VBAC with DS2, went into labour spontaneously at 41+4, was 7cm dilated by time I got to hospital. All seemed to be going well, got to 10cm within a couple of hours. Membranes had to be ruptured by MW. Baby's head had not descended into pelvis and evidently was not going to! Ended up with another EMCS
12 days on I can honestly say I feel fine. Wish I'd gone for ELCS all along. I guess what I'm saying is go with your gut instinct, I wish I had!!
Good luck OP
I had planned a 2nd c-section right up until 36 weeks then wavered, then went with a VBAC. I spent the whole pregnancy ready every single scrap of information I could about it for & against.
In the end I went into labour 11 days overdue, the night before I was scheduled for waters breaking then a c-section if that didn't work. It was horrendously painful, ended up with forceps which hurt ds2 then a pph where I just avoided a transfusion to their surprise.
But even with all that I was happy with the birth I had because it was my decision. If there's a next time I feel I've done the natural birth and will be asking for a c-section quite happily!
There is so much information out there for and against that I think the way to feel the best about the method is the one you feel strongly about. If I'd felt I had to have a VBAC for external pressure issues I would've been really unhappy at the way things turned out.
I'd go for vbac with a very low threshold to proceed to CS (ie if any need for induction/ augmentation ). That was my plan with DS2. unfortunately he needed to be delivered early, and induction was not going to be safe for either of us. It is unlikely now that i will ever have a vb.
It seems generally that recovery from an elective or early emergency CS is often easier than a vb (other than very straightforward ones with minimal tearing). 2nd time round my recovery was fab. Driving after about 2 weeks, lifting my 3 year old after about a week.
If this is likely to be your last baby i would have a section. If you're planning more give a vbac a shot. I've had three sections and the third pregnancy was complicated due to the previous two sections. My third section was also tough going recovery wise and I've been advised not to have any more children.
This will DEFINITELY be my last baby.
Birth timing is a massive issue due to childcare; basically if I don't go into labour at 39 or 40 weeks then I will be labouring on my own... I'm sure lots of people have similar issues though so it seems somehow mercenary to be planning the type of birth around this.
I have had high BP all way along controlled with labetalol but it is now going up and I have other signs of PET (which I had with DD1 also)... Would this affect the actual labour?
I desperately want to avoid an emergency CS especially if I am alone which is likely.
Yes I'm fearful of a VB but then so is everyone I guess. I put off pregnancy til 34 because of this I would probably opt for a water birth if an ELCS wasn't on the table but am told it is unlikely as baby needs to be continuously monitored and there is only one wireless monitor.
Thanks all for your feedback it is really useful in my decision making.
I had a straightforward and intervention-free home VBAC in February and found it much less painful and much faster to recover from than the EMCS I had with my first baby. Is it really necessary to have continuous monitoring? I had to be upright and mobile in labour and for delivery - I couldn't have been on the bed. I would be put off by this if it was 100% required - but I would get more information about why it is necessary and ask them to consider whether intermittent monitoring would be just as good.
A good friend of mine also had a VBAC in February a week after me, and also had a positive experience although a very different birth - she had a hospital birth with induction and an epidural, but overall was happy that her wishes were listened to and she was consulted at every stage. She also found the physical recovery much faster and easier with this birth than after her section.
PS I second the idea of looking into Hypnobirthing - I found it brilliant.
I had a VBAC after EmCS. I had pre-eclampsia the first time so was induced and it ended in the EmCS.
Because I hadn't experience any labour pains (had epidural straightaway to bring BP down, which it didn't) I was determined to have a VBAC. I wanted to know what labour was like. I spoke to the consultant midwife beforehand about the monitoring and requested that they only use a doppler. In the end I had to have the other thing but it was up to the midwife to keep it on me as I crouched next to the bed. I also insisted on no canula at the beginning which they did comply with.
Unfortunately after only having had gas and air, I ended up having a spinal to sew the third degree tear. I was so pleased to have given birth naturally although the recovery was worse that for the EmCS.
I am having an ELCS this time round. And if my BP was going up, I would deffo have an ELCS. I think your BP goes up in labour anyway - but i could be wrong.
All the best, i hope that your BP behaves itself.
I did enquire about a home birth (because my experience staying in hospital with DD1 was pretty awful, even though the ElCS itself went really well) and was told it wasn't possible at all. 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.
I feel absolutely clueless tbh. I am definitely swaying towards an ElCS. I'm really not bothered about experiencing labour... I don't want to put the baby (or myself) at risk. The only bonding and BFing issue I had with DD1 was that my milk took a couple of days to come in properly but we got round it.
THere are so many pros and cons, it's hard to make a list. But my second emergency c sec (had planned for vbac) was a lot easier in terms of recovery than first one. It's so different from person to person, it's of no help at all to you...
Looking back I would have gone for planned c sec, but hindsight always comes too late!
Second emergency c sec was much easier for me. I knew what was going on and there was not so much emotional issues to deal with. I only laboured for 8 hours (it was 24 hours for previous emcs) and I was up on my feet very quickly. Breastfeeding went much better after second emcs. I had all the right things in my bag (ie LOTS of snacks and fruit juices!). It was a lot less stressful than first one.
I'm in the same position (although Induction/EMCS for first), and I'm going to have a frank conversation with the VBAC midwife in a few weeks as I'm not confident that I'm going to get the chance to have the birth I'd prefer if the consultant is involved (consultant was rubbish - explained nothing, didn't listen to my concerns, thrust a leaflet at me rather than answer questions etc).
IF the VBAC midwife says that it's likely that I can get what I want (no induction, no augmentation, mobile monitoring, no canula until I actually need it, minimal interference) then I'm happy to go for VBAC (with low bar for C-Section). If the consultant is going to be the one in charge, then no dice.
I don't want to spend my labour fighting to be left alone.
Oh, and despite having been induced for nearly 3 days, my EMCS was fine to recover from - on my feet and going to the toilet in the morning (had EMCS at 10:30pm), home 1.5 days later, and going on short walks within a week.
The EMCS itself was unpleasant, but I certainly wouldn't describe it as a horror story!
I planned to try VBAC after an emcs. Like spreadsheet I spent whole of 2nd and 3rd trimester researching it, had 3 appointments with consultant (so non committal and not that much help) Eventually agreed to try VBAC with quick intervention if it went wrong) .DC2 was 2 weeks late and they wouldn't induce due to previous placental abruption/ I didn't want a sweep as felt if baby wasn't ready why bother. Has an elcs at 42+3 weeks. DC2 was 10lbs and they said would never have descended through pelvis! Basically all that worrying and planning went out if the window! I'm expecting DC3. No probs conceiving and will be hacking an elcs this time. Whatever you decide, I know it's a hard decision (I wanted someone to just decide for me!) in the end what will be will be so try not to get too stressed. It ruined my pregnancy in a way. This time I can just relax (once i stop this hyperemesis malarky!) and think about meeting bubba rather than worrying about how I will meet him/ her!
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.
I don't think she can say 'have to be' and 'have to have' - treatment without consent is assault, as I understand it. You are still entitled to say no, even if they don't agree.
'Strongly advised' would be a better term, but that would require her to tell you why, and give a better answer that a tale of horror about what might go wrong, or 'protocol'.The hospital might be bound by protocols but the patient isn't.
LaVolcan - yes, in theory they're not supposed to speak like that, but in practise that's exactly how mine spoke too ('we will allow you to go to 41 weeks, then we will rupture your membranes and we will put you on a drip, you won't be allowed to do X') etc. No discussion, no explanation, very proscriptive (and ignoring my very firm, "No, you won't")
The VBAC midwife in contrast assured me that even if I was being continuously monitored with wired monitors then I wouldn't be nailed to the bed - that they knew that movement in labour was very important and that long wires, wheelie trollies and accommodating midwives
I had DS1 by CS due to breech position too. As CS go it was very straight forward and calm but going up stairs/pushing buggy was quite hard. Also didn't like taking lots of dugs which may have made BF'ing tricky initially. No real complaints though.
DS 2 - VBAC. Drip induced due to broken waters. Fast labor at only 4 hours. Straight forward otherwise. I was very frightened though (my first VB) and had relatively close monitoring. Very quick recovery though, much better then CS and I quietly felt a real sense of achievement.
DS 3/4 - VBAC. Both normal straight forward labors lasting about 4/5 hours oddly and using gas/air. Less monitoring, much less fearful and lots of fab birthing positions. Seemed really natural and instinctive. Easiest and least painful births. I wish all my births had been like this.
first child was cs because of breech position. dh nearly fainted when at first meeting with consultant after giving birth I was asking about vbac for next child!
decided on vbac for dd2. weighed up everything - healthy, didn't have narrow pelvis, family history of fairly easy deliveries (mum, sisters), didn't do too much reading up as I didn't want to get bogged down with too much information.
in the end laboured for about 4 hours, tore a bit but everything was fine. mid wife was fab though.
greenformica, that sounds interesting: my DC1 is still quite new and was emcs due to onset of labour and baby's position.
I'm desperate to actually give birth, so want a vbac next time, but have been told of the difficulties of vbac combined with induction (I would be induced due to pre-existing med. condition).
What happened with your DS2 and the induction? Were the drs. worried about inducing you? Was your scar ok? How long did you leave between pregnancies?
I haven't read all the replies but here is a brief synopsis of my history.
Horrid delivery with DC1.
DC2 - ELCS because of third/fourth degree tear from DC1's birth.
With my 3rd pregnancy, I went to see consultant who assumed I wanted another ELCS. I had been wavering but burst into tears at the thought of it. Said no thanks, hired a doula to make me feel brave and had a great VB on gas and air. 7 hours - 9lb 5.
DC4 had another VB - 4 hours. Gas and air. 10lb 14
I definitely recommend a doula. She helped me (and DH) approach it positively. I also felt confident that she wasn't anti CS and would talk me into having one if things got hairy.
If you're not bothered about experiencing labour, and you are worried about labouring on your own if you haven't had the baby by week 39-40, then what are your "for" reasons for a VBAC?
I had an ELCS after an EMCS and all was well for me and I was happy with my decision. I guess there is a tiny pang that I've never experienced a vaginal birth (I did experience labour/contractions/pushing etc but it ended in an EMCS) but that wasn't enough to make me want a VBAC after the EMCS. The recovery from the EMCS was fine but the ELCS was even better as I was far less tired and hungry than when I ended up having the EMCS.
Maybe have a chat with your consultant again and ask what the implications are if you do develop full PET.
I had an emcs for PET the first time and this time, have been told that if I develop PET again then I will need an elcs as they wouldn't induce me, due to previous section but if I labour naturally then I could have a vbac if I wanted, with low threshold for moving on to a section.
Not sure that much help, both options have pro and cons which in my mind almost cancel each other out, so part of me is just waiting to have the decision taken out of my hands.
I don't know if this helps. I dithered about VBAC and ELCS, saw three different registrars [consultants kept failing to show up] after having an EMCS for failure to progress. Eventually I contacted a family member who is a consultant obstetrician and got the following response:
Questions from me.
It's been indicated already to me by a registrar that notes from the first delivery re narrow pelvis/difficulty ascertaining dilation etc put my chances of a successful VBAC at 50:50 rather than 75%. My mind is nearly made up therefore to stick with the devil I know given those odds, rather than risk all the complications that a normal delivery brings or a repeat performance. I understand though that a failure to progress would be declared a lot earlier this time around if applicable.
My key concern is this - I am in my late 30's, while it is unlikely that we will go for a third child the risks of a 3rd C/S plus the recommended 2yr break between sections would pretty much rule it out entirely if I have a C/S now. A successful VBAC would possibly leave the option open if I were mad enough.
So the question is this - is a scheduled ELCS likely to result in less uterine damage (lower risk 3rd section) than an EMCS carried out on a contracting uterus for failure to progress? Or is it entirely irrelevant generally speaking? I appreciate that's entirely subject to the latter being a repeat scenario of my first C/S - no foetal or maternal distress and you have not seen my notes so I am asking for a theoretical response but I would appreciate your opinion.
1. I would disagree your odds are 50%. If your next child was facing right way next time then your odds would be closer to 70/75% if you labour spontaneously. No one will know that until you labour so even if she was OP (back to back) before labour they often turn once labour starts. As doctors we are terrible at diagnosing narrow pelvises etc so I would ignore that comment. it is subjective and not helpful.
2. You are correct. if you laboured again you would be given usually upto 4 hours. if you hadn't progressed then usually a section would be done so no long delays like people often have with the first because of the risk of scar rupture (approx 1 in 250 but I believe its rarer than this because we tend to bail out early).
3. I wouldn't blame you for wanting an elective section. A first delivery like that is traumatic but the odds for a successful vaginal delivery would still be in your favour should you chose to wait and see.
4. No one will ever tell you 1/2/3/4/5 sections is safe but the reality is every day I operate on women with 1/2/3 and often 4 sections. They can be difficult (from my point of view) but the risk of a serious complication or bad outcome is very low. I would say less than 1% in women with 2/3 sections so to have upto 3 sections first of all is very common nowadays and generally quite safe.
5. a section is a section is a section so elective or emergency/ urgent would have no real difference from altering risks of a subsequent 3rd section. Emergency sections do carry with them increased blood loss etc but overall still I would say would are generally very safe.
6 Similarly the 2 year wait is an ideal and we see it broken the whole time without consequence. Section or no section if you ask doctors will probably say even if you have a vaginal delivery for number 2 you probably should wait but again we really don't know that ideal time. 6 months for sure but probably 1 year is ideal before trying again regardless of what the mode of delivery for number 2 is. I don't think a 2 year wait is based on very scientific evidence so I would be happy with 1.
So overall I would reassure you, whatever you opt for is safe and I would opt for whatever you're comfortable doing. If a vaginal delivery is important to you then go for it. Odds of success are still in your favour. if the worry of a vaginal delivery is killing you then opt for elective section. Either option is generally the majority of the time very safe and an excellant outcome is what I would expect either way.
In the end I opted for the ELCS as it was the devil I knew and I wasn't too fussed abour experiencing natural labour. Waters broke early, had a fast labour and a VBAC with forceps delivery in the end. Some "minor 2nd degree tears". The recovery from my first EMCS was much faster so I wish I had been able to have my planned ELCS.
These are questions I prepared for my meetings.
1.Pain management during VBAC are my pain mgmt. options more limited due to link between pain in scar area and rupture, or is monitoring a sufficient indicator should I require an epidural?
2.Among women who attempt a trial of labor after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it?
3.What are the short- and long-term benefits and harms to the mother of attempting a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
4.What are the short- and long-term benefits and harms to the baby of maternal attempt at a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
5.What are the non-medical factors that influence the patterns and utilization of VBAC after prior cesarean delivery?
6.Is continuous monitoring mandatory and if it is, or I prefer to have it, are their facilities to be monitored in a birthing pool at this hospital?
8.Should I plan for early hospitalisation ie if waters break or contractions start naturally to allow for monitoring. What is the general practise in this hospital?
9.Who will be my surgeon? Can I request the same surgeon as I had before? Are trainee surgeons allowed to carry out ELCS's? Presumably not allowed to carry out EMCS's?
10.What are the risks of repeat caesarians? What would be an optimum number of children to stop at in order to statistically avoid a high risk pregnancy eg: placenta previa, or post op complications eg: hysterectomy
1.My first CS was entirely complication free but what are the key maternal risks I should be aware of with an ELCS and at what rate do the incidences of these types of injuries rise with multiple caesarians. eg bowel injury, ICU admissions, post-operative ventilator use, cystotomy and more?
2.What are the key risks to the infant I should be aware of with an ELCS?
3.Under what circumstances are forceps used during a CS and am I at higher risk of this use as part of an ELCS if the baby has/has not descended?
4.Will my post op recovery period be longer with a second CS? Internally due to repeat surgery or shorter due to fewer drugs, lack of labour etc?
5.Will the incision be in the same spot or will I have two scars?
6.If I go into spontaneous labour, and there is no medical reason not to try for a VBAC, what are the decision criteria for recommending I progress to a CS? My BP or Fetal distress is an obvious one, is there a time period after which Failure to Progress status is conferred?
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?
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.
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.
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 days.
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!
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!
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.
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.
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...
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)
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.
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.
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
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.
Lots of people 'told' me what to do. Do what's best for you.
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.
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!
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.
'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.
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!
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.
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!
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)!
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.
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
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 reason
sorry, the second bit was meant for * OP*
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.
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 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". which is basically what she was promising . That was my take on the meeting anyway.
amazing love that story, that made me laugh!
pinkbeans it was hilarious!
I essentially behaved like a toddler....
Fantastic birth story amazingmumof6! Staring contest with the midwife Midwives must see it all!
Good for you pinkbeans for holding out.
I kept on saying " I'm not doing it" in a tone of "and what you gonna do about it?"
she and DH were going " oh but you've been doing so well, let's get this baby out! "
me: ok, call the surgeon then, I'm having a C-section
dh: come on darling
me: you fuck off
mw: well you need to push blah blah blah
me: I want a C-section. I'm not pushing, I don't know how to.
DH: but you've done it before. FOUR TIMES!
me: I know. not today....
seriously, it was surreal.
Hi 2marge I had an EMCS with dd - got to 9cm but she was back to back and had turned her head the wrong way and by then it was 14 hours since I'd turned up to the hospital at 7cm so we had to stop. Had a PPH during the surgery due to clots forming which wasn't great.
Also dd started crying before he was born and inhaled a load of mucus that she spent the first 3 days of her life coughing up.
I have decided to go down the VBAC route. I'm due in 8 days (and dd was 4 days early) so it really is any second now. I'll try and come back on this thread after and let you know what happened.
I won't list my reasons as they are already up there given by others. I did have a complete choice although my instinct (VBAC) matched the doctor and midwife's advice.
A few things I will say about how it is right before:-
I do feel (and I hate this word but please bear with it) very empowered that this labour is my choice. I do not have to do it. I can change my mind. But I have made the decision that it is right for my baby and my body and that does take some of the fear out.
Childcare for labour is stressing me out slightly. We have lovely friends who are keeping their phones on. We have in laws who are chomping at the bit to race down the motorway and take over. But I don't know when it will happen and that is a bit scary. If I had a ELCS I would have a date nd we could plan.
Finding it hard to go to sleep and not know if I will wake up in labour. Didn't really happen with dd as she was a few days early and first babies are usually late so not really expecting it.
But it would be even more scary (I think) to just turn up at hospital for the operation. The best (and worst) thing about labour is that once you start you can't stop so you just cope!
If I had had an ELCS I would probably have the baby now which is really really weird. There is a little bit of me that is thinking "if I turned up at the hospital today and said "changed my mind - want my baby" would I get it"????
LOL @ amazingmumof6
I can't give you statistics OP but I will tell you what happened to me.
DS1 was a breech baby, which was not discovered until 41wks. The consultant recommended a section because it was a first baby, etc, so that's what happened. Recovery was fine, no complications with me. BF was a total and utter nightmare though and it made the first weeks really rotten. I don't know if that was connected to the section, the quite rubbish care on the ward or the fact I was a total noob at babies!!
With DS2 I was in a different hospital and they were hugely encouraging of VBAC. I went to hospital when things kicked off at 3am and delivered DS2 6.5hrs later. I had a canula put in my hand and a monitor on my belly so i was quite confined to the bed but I think that was mostly because it never occured to me to move around. I tried a bit of G&A but everything made me sick so I had no pain relief whatsoever. Baby was born fine and, since I had been intervention-free throughout, I had a physiological last stage and got the placenta out with the help of baby BF. The only damage done was a 2nd degree tear, due to shoving DS2's fat head out in one big pop! Few stitches and that was that! Showered, had breakfast and spent a few hours in delivery room waiting for them to process my stuff and discharge me and was home at lunchtime.
My second experience was so much better than my first. Despite not exactly appreciating it at the time, having a VBAC was brilliant. Obviously my nethers were worse off afterwards than with DS1 but it passed, BF was excellent and everything was just really easy and straightforward.
I'm now expecting DC3 and will be having a homebirth this time.
No one can tell you what to do - it is your body and your decision.
I had an EMCS for failure to progress with DD and was really keen to avoid another CS with DS as I found the recovery hard and the thought of recovering, not being able to drive etc, with a 3 yr old and a newborn was awful.
After doing a lot of research, i decided to try a home VBAC in a birthing pool. I weighed up the risks and made my own informed decision. This is in accordance with NICE guidelines, which state the doctors and midwives must respect the pregnant woman's decision, no matter what they believe she should do.
Once the hcps found out I was planning a home birth, they seemed to go a bit doolally and not once did anyone point out the risks of having a c-section. They go on and on about risks of vbac, scar splitting but don't tell you the risk of a uterine rupture are only slightly higher for a vbac than with a first timer (first timer can and do have a rupture with no previous scar). There is a higher risk of PPH with a c-section and it can affect bf.
My first cs definitely affected my ability to bf DD.
In the end, i ended up with a second cs but I feel OK as I let DS choose his own birthday (41+6!) as I declined induction. I laboured for a good couple of days at home, the last 9 hrs in the birthing pool which was calm and wonderful.
I transferred in after the hb midwives suspected DS might have turned transverse and carried on labouring in hospital for another 12 hrs as he was head down after all. It ended up with a crash c-section, and it turned out my bladder had become attached to my uterus and if DS had come out vaginally, he would have burst my bladder. My body must have known this as DS did not descend properly during the labour.
But mentally, I am so glad i stood up for my choices and attempted a home birth.
Whatever you decide, it's up to you. CS recovery is harder, as you know but if you do decide surgery, I'd go for an elcs rather than an em or crash. VBAC is very very empowering.
As with Pinkbeans I had to "fight" for my second CS - first with the midwife at the ANC and then the Consultant at my 36 week booking.
I think what swung it for me was that I asked for my request for a CS to be written in my notes so that if anything happened during my delivery I could refer back to my original request. He then agreed to a section straight away.
Don't be bullied - it's your body and your right to choose!
I've had 3 C/S and 2 VBACs. One of my C/S had life threatening complications but it was twins which is higher risk...The elective C/S was pretty good though compared with the crash/emergency sections I had prior. But my first VBAC was amazing. I was euphoric to have actually 'done' it. Given a choice I would go for VBAC if you are low risk. Because the recovery etc is so much better even if you are unlucky and get a bad tear (I did). Plus less time in hospital. Also if you want a big family c/s will limit the number you can have although I know a few people that have had 4.
I had wavered about whether to go for a VBAC with my 2nd ds. In the end, my feelings were that however small the risk of rupture, the results can be catastrophic and I was just not willing to expose myself to that risk, however small. Yes, I understand there are many other risks associated with a cs, it was just what made me feel more comfortable in the end. Plus, you will generally not be able to labour as long when you have already had a cs, so I preferred to go with odds and just book in an elective cs, which is so much less stressful on your body than an emcs. You can also book in childcare, prepare your dc, and feel calm and control about everything. Just how I felt!
Sorry one more thing, and probably quite controversial: I think feeling empowered or sticking to a birth plan for your own reasons, should always come second to the health and safety of the baby.
I had an EmCS with DC1 as the cord was wrapped round her and she did not engage during labour. Was going to attempt VBAC for DC2, until I discovered with a late scan that he would be at least 9lbs, which would have made complications i.e scar ripping or non-textbook 8-10hr labour much more likely. The main thing I wanted to avoid was another EmCS, so the least worst option for me was to go for an elective ceasarian.
DC2 came out at 39 weeks weighing 9lbs5oz, so I think it would have been a tough call to push him out textbook stylee for first VB. Especially if it had gone to 40 or 41 weeks.
I had lots of good (as it turned out) advice from my obstetrician. He was in favour of an elective. Who knows if he was one of these that likes to 'medicalise' birth, or maybe he liked to be able to put it in his diary beforehand rather than let nature take its course. Or maybe he just believed, on the evidence and with the weight of his experience that this was the best option. He said he would be completely happy if I wanted to try for a VBAC also, but gave me the contingencies. I trusted him, went with his advice and I was happy with my decision.
I am also glad I have my pelvic floor intact. This is a side issue I know, but I like to run to keep myself sane and there are any number of women I know who cannot run because of pelvic floor issues. I felt that I already had a CS scar, I didn't particularly want a ruined pelvic floor as well. Again, who knows whether I would have suffered that if I had gone through with a VBAC. I will never know. But I am grateful that I've only got one lot of scars.
Good luck with it.
Heather baby's and mum's safety is always paramount. that's common knowledge.
I had an EMCS with DS1 as he was an undiagnosed breech. As that was the only complicating factor I decided to go for a VBAC with DS2 after having a scan at 36 weeks just to check he was head down.
My recovery from the VBAC was much better than from the EMCS.
There is no right answer, I felt comfortable that the risks of a VBAC were low for me because I had successfully gone into spontaneous labour with DS1 etc and the only reason I had had a CS was that he was breech and showing some limited signs of distress. I did agree to continuous monitoring even though I am not convinced it was strictly necessary.
If you are not comfortable with the risks of a VBAC for you or fear of a VBAC will leave you unsettled for the rest of your pregnancy then don't have one. How you give birth really doesn't matter.
Had emcs with my first, vbac was encouraged for my second.. all started well on due date but... they were worried for baby so ended up in emcs again... done hypnobirthing which helped but... I wish I eliminated the emergency part!
I also had a CS with my first due to breech and had a very successful VBAC with my second. I felt that all the obsessive reading up I'd done about VBACs on mumsnet and elsewhere really helped me. I was in a very positive and determined frame of mind and was very fortunate that everything went very smoothly.
This next bit is based purely on conjecture rather than medical opinion - I think that the fact that your CS was because of breech also goes in your favour, ie you didn't have a CS because your labour failed to proceed which might be more likely to happen again. At least with breech you will know whether it is happening again or not rather than going a long way into labout and then having an ECS which must be harder on your body. With my first I spent the whole of my pregnancy chained to my desk 12+ hours a day and I think this is probably why he ended up upside down. With my second I made sure I did lots of exercise and he was the right way round.
Good luck whatever you decide!
birdyarms don't youmean DOWNSIDE down?
I'm not convinced about the whole babies will turn if only you were on all fours etc. or whatever.
they tried to turn DS4 with external manipulation, but it didn't work because his foot was stuck. had to be ELSC.
for what it's worth I've been told by a few different people (and books) that you should sleep on your left side as that is a position both you and baby benefit from.
can't really remember why, something to do with internal organs?
dd1 - ELCS for macrosomia. They told me she was giant. Se was 8lb 6oz.
Ds1 - vbac1. They prepped me for emcs for failure to progress (he was back to back, tried external and internal rotation - it was like James bleeding Herriot) but I managed to squeeze him out just as they arrived to wheel me to theatre.
Dd2 - vbac2. She has cerebral palsy as a result of birth hypoxia.
I absolutely support all you ladies who are against CFM in a vbac scenario. But for me, thanks all the same, I prefer the NICE guidelines to be followed. If they had been, there's a pretty good chance dd2 would have escaped serious brain damage.
(Never offered ELCS, btw. No clinical reason)
oh prissy sorry to hear about your DD2!
when was this? (and where?)
I was told that once you have CS, EL or EM you pretty much "qualify" for another one.
sorry, not meaning to add insult to injury, just can't believe that the information/policies can varies so greatly depending on where you live/who's your MW etc!
it's sickening that, in your case this oversight or lack of information caused your DD2 to suffer unnecessarily (most probably as a result of the birth as you say)
I no nothing about the condition she has, I hope she is ok. and you.
I am 36 weeks pregnant.
I had EMCS with first baby. This was due to the stopping and starting of the induction process due to a busy hospital. Eventually after messing about for 4 days I got to 8 cms. Bby was back to back and did not progress from here. Very painful!!! After baby became distressed was admitted for EMCS.
With second baby I opted for planned CS due to expecting a very large baby.This went smoother but it was a very long op and I lost blood and had a big scar.
Now i am expecting third baby and I dont know how to have it:
1. Consultant says there is no reason why I cant have VBAC but I have to bear in mind the risk of scar rupturing.
2. The baby could be big. I am waiting for another growth scan.Does this really affect your chances of having a successfull VBAC? Can doctors tell the position of the baby before I get going?
3. I will be continually monitored. I dont like the idea of not being able to move around.
4. I do not want to end up with and EMCS but I also dont want to end up with a forceps delivery and stitches etc.
5. If I have another c section I have heard that a third one can be complicated ie hysterectomy, bleeding etc. There is a chance we may want another baby.
HELP!!! I need some answers!!!!
DC1 was ELCS due to developing pre-eclampsia plus DD was breech.
DS was VBAC, but I don't think I was ever given the proper info, it was assumed that was how I'd proceed. Which was okay by me anyway. It went really fast for a first labour which is something that seems to run in my mum's family (ie fast labour and birth). Midwife still had to break the waters though, and things went from 0 to 60 so quickly I felt a bit shocked after the birth.
But apart from stitches for some very deep scratches caused by DS and his sharp nails on the way out, I had no problems and would have a natural birth if I ever had another child.
the hysterectomy thing is very rare, and only needed if womb is not starting to contract to shrink itself back down - mum could literally bleed to death.
if I understand correctly that is generally not a concern until you've had at least 4, but I don't know.
as you had PPH they might worry that you are a higher risk, but I had forceps with DD1 and PPH and I thought those two things were connected!
the injection in the thigh that helps deliver the placenta helps the womb to contract down
so hard to know what to do.
do you have pregnancy diabetes?
that could cause baby to grow too big.
so perhaps ( and I know it might sound silly) but if baby's a good size and you have a good nutritious diet cutting down on sugar could help not to "overgrow" baby?
that might make a successful VBAC more likely?
I'm clutching at straws and might be talking utter rubbish so check this theory with MW.
position of baby - yes, they can, reqiest a scan or two if needed
and re the hysterectomy, I told DH before going into labour with DS1 that I'd rather have that to save my life and have no more babies, so he knew what to decide if needed.
had 6 so far, DS4 ELSC, then 2 VBACs, feel very blessed.
I had ELCS with DS1 because he was footling breech and desperately wanted a VBAC second time around. Then for a long time DS2 was breech as well so I was just coming round to the idea of 2 CSs. Finally DS2 did turn though and I did have a VBAC with him.
I didn't want continual monitoring but agreed to put it on at the start, the idea being that it would then be turned off. In the end, everything happened so fast that we all forgot about it! I did manage to avoid a canula though - hated that with DS1.
For me, I wanted to experience labour, despite being scared by it. Also, I really didn't want to be recovering from major surgery with a newborn and a two-year-old to look after. Whether it was related to the CS or not I don't know, but BF was much easier with DS2. Mind you, he was also a much bigger and generally hungrier baby!
I had massive PPH with my 2nd c/s which was the second baby of twins. But it was in recovery I ruptured-lost many litres of blood and had multiple transfusions-was lucky to make it. Thankfully another op sorted it out. I went on to have a 3rd planned c/s and was so scared of PPH and had no PPH. So it doesn't always happen again especially if they take measures to prevent it. Eg I had a senior consultant (last one was a junior early hours of morning) etc.
My first birth sounds nearly identical to Marbles. I don't have a clue what to do next time. I didn't progress past 6cm, so I assume that could happen again with a VBAC, but I don't know how big a family I want so the thought of having to stick to two due to cs scars worries me. Its such a minefield. I wish there was one "correct" answer to it.
Pros and cons are really subjective as we can see on the thread.
My logic was this:
Did hypnobirthing with DC1, came late to hospital (10 cm dilated and ready to go), and got the news that baby was breech... So straight onto EMCS. That moment I was very relieved that the docs could take care of the labour for me. Recovery time was a couple of days - almost!
Was told that women who progressed easily with their first labour would be great VBAC candidates so I got lured into a VBAC with DC2. Well, I didn't even do one breathing exercise before labour and baby was back to back. I was in agony this time around and got an epidural at 8 cms dilated (should have had a better prepared birthing partner..) so this epidural stalled the whole labour.. Basically I couldn't push and DC2 was born via forceps. It took me about a month to recover and I was depressed about that because I expected a speedy and easy recovery...
I had a nice ELCS planned with DC3. But labour started before the date and luckily I vowed to get to the hospital in good time after my experience with DC1. Again I made it just in time to the hospital (almost fully dilated when I arrived) and a midwife asked me to just try a vaginal birth. But I wanted my cesarean. Then I had to have a crash cesarean due to placental abruption, under general anaesthetic. They had DC3 out in 12 minutes.
It is nice reading about all the births on here :-) brings me right back.
My advice would be: if you go for a VBAC I'd do some hypnobirthing and get a great birth partner. But IMO VBAC isn't all it is cracked up to be.
Oh, recovery time with my crash cesarean was a week maybe. But the scar is very lopsided.
cinema if that makes you feel better, my scar is lopsided a bit, despite CS being Elective.
surgeon couldn't be bothered? she had the time! makes me cross.
or more likely that it is just very difficult to get it straight....
Thanks for thoughts - she's doing pretty well these days, considering. We were told that being offered a subsequent CS was largely dependant on the reason for the first one, and as the issue with dd1 wasn't likely to recur, we couldn't opt for ELCS. And then, with dd2, because I had already had one vbac (however horrific) with a live baby, that there was definitely no need for ELCS.
Needless to say, I now have a letter from the consultant which states for any subsequent pg, I am to have an ELCS.
I'm just generally a bit crap at childbirth, I think!
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