I am due dc4 in 4 weeks, first dc was 36 hour labour and delivered normally. Dc2 was emcs after not progressing past 5cm, dc3 was emcs after attempted and failed vbac as didn’t progress past 9cm.
So I meet with my consultant next week after a growth scan to discuss what I want to do this time around. Doctors have already said that they would only trial me for a vba2c for a really short period, mentioned labouring up to 4 hours only, and if no baby then straight for emcs due to the risk and pressure on previous scars.
NICE guidelines state there is no greater risk of uterine rupture with less that 4 previous sections so no reason to not try for vbac, but what puts me off is only being allowed to labour for 4 hours? That’s nothing with my history.
I had a planned after only one EMCS. I liked knowing what was going to happen and when, and did not want another EMCS. Recovery from my planned one was so much easier I have to say. I felt butchered after the EMCs.
I'm going for planned section (one previous emcs, one elcs). Planned section and recovery were fine so have no qualms about going for it even though it means I'll never have a natural birth. In my case my previous section was very recent so suspect I would have met resistance for a vbac anyway.
Risk of uterine rupture with vbac after 1 Caesar is around 0.5%. After 2 Caesars it increases to around 1.3%. The risk of needing a hysterectomy with vba2c is 0.5%, and of needing a blood transfusion is 2%. Success rates generally 71% vs 76% with vba1c.
Personally a rate of just over 1:100 ruptures is too much risk for me.
If you could be guaranteed to be in the success group then fine, but if you’re one of the 30% where labour doesn’t go so easily then you are risking more complications with having a third Caesar in labour than electively. It also depends on where your placenta is (front / back / high / low) as to your risk of blood loss.
I would be cautious, as your team sound like they are. I’d also be going for elective CS at 39 weeks (38 weeks if you have a history of going into labour earlier).
DC1 I had a planned section, which went very wrong. Second time I attempted a VBAC, which went even worse and ended in a crash section and a child who was born flat. Fortunately he was resuscitated but, after a lot of help that included being sent to a bigger hospital, he pulled through. In retrospect I should have gone for a section in the first place. So I guess I'd go for the section. I was told I wouldn't be allowed to attempt a VBAC for a 3rd child and DH skipped off to the urologist to get himself snipped.
He wasn't skipping on the way back and I treasure that memory 🤣