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vbac v elective cs?

(27 Posts)
Cookie51 Wed 20-Jul-11 18:22:25

Unlike many others in this situation, my hospital and consultant seem to be equally happy for me to go either way (2nd pregnancy after emergency cs).

This can only be a good thing, but I don't feel sufficiently equipped with enough information to make the decision. Although in theory I have a 70% chance of a successful vbac, this doesn't take into consideration personal risk factors, i.e. age (43), long labour/failure to progress last time (got to 10cm dilation though), possible inadequate shaped pelvis, fear of experiencing long drawn out labour ending in emcs, lack of ability to move around in labour due to constant monitoring... In fact logic and an overwhelming desire to produce a health baby points me in the direction of elective cs... but somehow can't get the idea out of my head that I might just have a reasonably normal birth if I give my body a chance.

Has anyone else opted to let nature takes it's course until, say, the due date or shortly after, then if nothing happens go for an elective cs? This is the way I'm thinking at the moment...

Baileysismyfriend Wed 20-Jul-11 18:41:44

I am in the same position as you! I had a long and difficult labour which resulted in forceps with DD and then ECS with DS as he was stuck (weighed over 11 pounds!), this time they said I can decide which is good if you know what you want but a bit annoying when you really want a medical opinion and they are being vague.

I have decided to see if I go into spontaneoous labour and have an apt the day before my due date so the consultant can have a look at my cervix, if she thinks it will happen soon I will wait a few more days if not I will ask to have a section booked.

The hospital are not keen for me to go so far over in case the baby gains lots of weight, it already weighs about 8 pounds and I have two weeks to go....

CoteDAzur Wed 20-Jul-11 18:46:55

Going over your due date is irrelevant. You need to choose the option that you feel is better for you and your baby.

jnm175 Wed 20-Jul-11 19:08:37

I had my first child 14 years ago (9 days past due date) with an emergency c/s following induction, high blood pressure, all the drugs they could offer and a long and unsuccessful labour. I got to 8 cm and everything just stopped. My baby became distressed and off I went to theatre. I really felt very cheated that I had missed out on some kind of amazing birth experience and it really did upset me. I was so put off I didn't even go back to the hospital for a pelvic scan (to establish why my labour had not been straightorward)and decided I wouldnt have anymore children. However, 9 months ago I gave birth to my daughter. On finding out I was pregnant (which was a serious shock!) my first thought was THE BIRTH. I convinced myself I needed a c/section and wouldnt even consider anything else. I saw my GP and he wrote a letter for me and at about 16 weeks we saw a consultant. He went through my notes and told me that I had got to 8 cms dilated and the surgeon had to pull the baby back from the brth canal to be deliverd via c/section. I had no pelvic abnormalties and had my baby not got into distress I would have been left to get on with it.

I elected for a VBAC and had a sweep at 40 weeks. 3 days later I went into spontaneous labour and delivered 6 hours later from beginning to end with gas and air. The biggest problem was the speed of my labour which meant I needed an ambulance to get to hospital. The labour was so very diffierent from the first that I might as well have been another woman. I was at home for 5 hours of it so was not monitored. I was 41 when I delivered. My recovery was so different as well from the first time and instead of 5 days in hospital I was allowed home the following morning. I found the whole experience amazing and never thought I would be saying that. When they gave me my baby I finally got it and understood why people want to have babies! My baby weighed 6.15 oz, I needed an episiotomy and she was delivered by ventouse (hope that's how you spell it). If I had another baby I would go for a vaginal delivery over a c-section. I am happy I gave my body the chance to do it.

Hope this helps?

COCKadoodledooo Wed 20-Jul-11 19:24:34

I'd intended to, and certainly after the shambles that was ds1's arrival into the world 30+hour labour ending in crash section I wanted to have a go at giving birth 'properly' (my issue totally, before anyone feels the need to jump on me).

All the way through, I'd been dreading the thought of ending up with another emergency section. At my 38 week mw check mw said she thought there was a small possibility babe was breech, a scan the following day showed this was definitely the case. Had a chat with the consultant and discussed options - breech vaginal birth, ECV, elective section. Had heard horror stories re ECV, plus consultant didn't seem overly keen, so that was out, breech vbac out for me because ds1 got stuck and there was no way I would risk that happening with babe the 'wrong way up', so for me the only real option was an elective.

It was fine btw, more than fine - a really nice birth experience, so very different from ds1's arrival. The healing was so much quicker too.

Good luck, whatever you decide.

mrsaligee Thu 21-Jul-11 12:54:09

Hi, I am also 43 and had my consultant appointment yesterday where we talked through my birth options for daughter no. 2 following emergency c-section for an undiagnosed breech with daughter no. 1.

Because I got to 10 cm dilated they are pushing me for VBAC. However I am worried about uterine rupture given the short time frame between having my daughter (March 10) and getting pregnant again in January 11. They said that the optimum time to give a previous scar time to heal would be 18 months - well I got pregnant 10 months after the first c-section and at 28 weeks as I am now the baby apparently weighs about 1kg, which will be weighing down on the scar.

I had pretty much set my sights on another c-section given that a) we live quite a way from the hospital and b) we have to drop DD off with her nana first before I can actually get there, which I'm not convinced I'll be able to cope with.

I would have loved to have given birth naturally but I do have a choice here and they are obviously hoping that at the 36-week appointment if a scan shows the baby lying head down I will opt for VBAC.

DH says it's my choice, which of course I guess it is, really still feel that I'm veering towards another c-section, but just wanted to hear what others have to say ...

Anyone in a similar position, with not much time between pregnancies?

Mrsaligee

AlpinePony Thu 21-Jul-11 13:14:54

mrsaligee I'm just 9+5 now and my son is just 12 months old.

I'm hoping for an elcs because I just don't think my body can do vb. I managed an entire 1cm dilation last time with induction. Obviously they're not going to be able to induce me this time and I am terrified of rupture etc., but given that my body doesn't seem to know to "open the door" it seems futile (to me) to put myself through a potentionally long and exhausting set of contractions which end in emcs anyway.

nunnie Thu 21-Jul-11 13:25:19

mrsaligee. I am in a similar situation I am currently 31 weeks with number 3 and DS is 9 months and was born via EMCS due to brow presentation.

I have had my 1st consultant appointment which was very pro VBAC due to me previously birthing naturally with DD even though I had a failed 3 rd stage. I also made it to 10cms and was pushing with DS, so they think I am ideal candidate because of these two factors and I progress quickly so shouldn't have the delay worry which increases the rupture risk.

Anyway my 20 weeks scan showed I have a low lying placenta so have to be rescanned at 34 weeks if it is still low then I will lose my VBAC option anyway.

However every appointment I have had since with midwife community and hospital have all consisted of so you WILL be having a VBAC won't you? I personally would prefer the ELCS but am not petrified of the idea of a VBAC, so am remaining open minded until the scan at least.

My gap will be just 11.5 months.

clairefromsteps Thu 21-Jul-11 22:06:53

Don't underestimate how different an elective CS can be from an emergency CS.

My consultant and midwife were equally happy for me to try a VBAC or to refer me for an ELCS, so I plumped for a VBAC on the basis that I would recover quicker. In the end though they realised that the baby had turned and was now transverse, so I was booked in for a CS the day before yesterday. Completely different from my first experience - so calm and relaxed (even though I was terrified and shaking like a leaf) and I had a lovely anaesthetist who talked me through the whole process during the op and told me what to expect before it happened. I've had virtually no pain afterwards and I was discharged from hospital after 20 hours and I'm sure this is partly due to the fact that the whole process was so calm.

MarkStretch Thu 21-Jul-11 22:15:01

I have to agree with clairefromsteps- I had a emer CS with DD 9 yrs ago (24hrs labour, 1.5hrs pushing, she was back to back, 8lb 15oz and stuck), when I got pregnant with DS (now 2.5yrs) I was given the option of VBAC or Elective. I said to my consultant to book me in for an elective, and if I went into labour naturally before that date then I would try for a VBAC.

They were happy for me to do this, and I didn't go into labour and had an elective CS. It was TOTALLY different from DD's birth, it was calm, relaxed (apart from me shitting my pants with nerves obviously grin) and it made me feel a lot better about DD's more traumatic birth. It laid some ghosts to rest for me if you like. My recovery was brilliant, off all pain relief within 10 days of the op and pretty much back to normal.

I am now 16 weeks pregnant with DC3 and I will be going through it all again!

blueshoes Thu 21-Jul-11 23:13:18

Elective cs. Safe and calm. Did what it said on the tin. I already had the sun roof (emcs first time), so why risk mangling my bits? I also got the surgeon to stitch up the incision properly, so the scar is now almost invisible.

If you don't want a big family, an elcs is something I would seriously consider. Once I got the green light from the consultant to have my elcs, all my worries about the birth went away. I felt so relieved and much more relaxed.

MerylStrop Thu 21-Jul-11 23:22:32

There are lots of threads on here about this - definitely do a search and you will find lots of great advice and perspectives.

FWIW I have done both! After EmC/S at 10cm for malpresentation with DS I wavered throughout pregnancy with DD and ended up with elective at 40+7. Hated the experience, found it very stressful recovery much harder. With DS2 I thought I wouldn't have the choice of VBA2C but my consultant suggested that I "give it a whirl" and the consultant midwife was all for it - was offered a water birth on MLU, no CFM. Was lucky enough to have a really great birth. Still a bit high about it 15 months later.

Cookie51 Fri 22-Jul-11 09:35:52

Thanks for all the fantastic feedback - forgot to mention one major factor though, my baby was pretty large at 34 week scan so this is also a bit of a worry!

The positive vbac comments have encouraged me to "give it a whirl" with elective cs booked for just over 41 weeks - my gut feeling is that the longer it goes the more likely it'll go the same way as last time, emcs at 41+3 after very slow progression, baby in distress etc.

Consultant says can change my mind at any time which is great. Have also opted for a sweep just before my due date - can anyone give me more detail/experiences of what this involves, please?

mrsaligee etc - I can totally understand your concerns about closeness of pregnancies, my personal view, if it's any help, is that with a small gap I would definately go for elective c-section. The risk of scar rupture seems quite high generally and the increased risk in this situation would make the decision between vbac and elcs a lot easier. For me there's 3 years in between, that's the only reason I'm considering vbac.

emsies Fri 22-Jul-11 09:49:53

Wow - I'm amazed about the waterbirth VBAC on mlu ! Here they want to continously monitor. I want a HBAC which they are dead agains tnad MIGHT let me on the mlu in order to prevent me HBACing. Still wn't let me in water sad

Scar rupture risk is really not at all high - less than 2% (and many of those are over 42 weeks or due to induction - if you take that out its less than 1%) THere is a much higher risk of all the other things that could go wrong, and indeed a much higher risk (but still very low overall) of complications with c section. It is major surgery don't forget and so does carry a risk to both mother and child and not to be taken lightly.

I have a low lying placenta so if it doesn't move I will have another c section but I can't really see why anyone would choose to put yourself through major surgery when a vbac is a viable option.

ThePrincessRoyalFiggyrolls Fri 22-Jul-11 10:20:41

Hi, wanted to give you my experience as in your situation am not sure what I would do.

1st baby emcs. Failed to progress then dip in heart rate blah blah blah resulting in the emcs (after long long labour), was induced because of pre-eclampsia

2nd baby - was in two minds about what to do as another csec would mean longer in hospital when I knew I would just want to come home (hospital great facilities pants grin) however never having had a vaginal birth I wasn't sure! Consultant didn't want to induce again so we came up with a plan for trying to get the baby to arrive earlier vaginally. I had a sweep at 38 weeks to get things moving but nothing happened then. I then a week later went into labour and ended up having a vbac the morning I was seeing my consultant to book a cs at due date! It was liberating and fantastic and I was incredibly suprised at the difference in experience! I am by no means a spring chicken (late 30's). Infact I think my choice was taken out of my hands by my baby! I had him in the early hours of the morning and was home at lunch time grin

One thing I did find was that I got the hospital 6/7cm dilated but because of the monitoring I did slow down a bit so perhaps if I were to do it again I might just leave it a little bit longer iyswim but then I very much doubt I would be monitored in the same way for a 3rd. I know I was lucky as I had a pushing time of about 5 mins, labour was a bit longer but that last cm was included in that 5 mins pushing! I'll admit it did hurt and I did have an epidural that didn't really work (low down baby!) however my recovery was almost instantaneous. I was worried about tearing and did but it was very small and I really didn't notice it at all being stitched or at any point afterward.

Good luck, if you can I would be tempted to try the vbac as if you choose the elcs you will probably be in hospital for a night anyway. Hope all the information helps you make a decision, I like you felt that my consultant was happy with either choice and it really didn't feel like a push in either direction. I really wanted them to make the decision for me too! However am glad we didn't get pushed at all.

ThePrincessRoyalFiggyrolls Fri 22-Jul-11 10:22:45

sweep - sorry didn't see that

MW finger, you know where wink slightly uncomfortable but bearable. A little bit like a smear but slightly more uncomfortable. I took my dd and she didn't seem bothered so it can't have been totally horrific!

mrsaligee Fri 22-Jul-11 12:56:19

Cookies51, this has certainly been a helpful thread and I hope you didn't mind me hijacking it for my own purposes, but as we're the same age and similar labour pattern thought imy penny's worth might help us both.

I think I am veering towards elective CS at 39 weeks. I know of a recent tragic case of rupture which I mentioned to the consultant and midwife and the lady had the same distance between the two pregnancies as I do. I realise that this is such a rare occurence but I have been worrying about it throughout this pregnancy.

Good luck ladies!

Cookie51 Sun 24-Jul-11 00:08:15

mrsaligee no problem with hijacking! I think elective CS wise, I would in your circumstances esp with your knowledge of a rupture case, in fact I keep waking up in the middle of the night, deciding to have elective cs before my due date, then going back to vbac option in the morning........

My mum just reminded me her total labour was 6 hours (1st and only baby) and when the mw went to fetch pethidine she progressed so quickly it was too late by the time she came back - why can't it be that simple for all of us?!

Cookie51 Sun 24-Jul-11 00:14:06

Stupidly I'm really worried about the sweep, all the examinations I had during my last labour were SO painful, and although I never found a smear test painful in the past, the one I had a year after my first baby I was screaming in agony. MW thinks just down to being tense...

Cookie51 Sun 24-Jul-11 00:16:10

ThePrincessRoyalFiggyrolls and everyone else - many thanks v helpful!

drcrab Sun 24-Jul-11 23:28:31

Fwiw i had an elective cs the first time as I had a low lying placenta (stage 4) and early contractions etc. I had DS at 39 weeks and he was 8 lb 1. 2.5 years later I had DD vbac. I plumped for vbac because I thought I'd have a faster recovery, shorter stay at hospital etc. Quite far from the truth really.

I had a sweep at 40 weeks (at that point not a single niggle). Started contractions a few days later. Which didn't end till 4 days later. When baby was born w episiotomy and ventouse. It took me ages to get to 5cm (the magic number when my mw would agree to get me an epidural). I saw my consultant from the previous birth and begged for a cs but he said I could do a vbac (how???).

Because of previous scar I was given 1 HR to push (by the time I reached 10 cm). By the time I got to 10, I had the syntocinon, epidural everything.

We had to stay 5 days in hospital as not only did baby have to start on antibiotics as she swallowed some muconium, I had to stay because I needed a 3bag blood transfusion (which they didn't realize till I fainted the next day when I went to visit baby in scbu).

So... The recovery was fine. I was on my feet pretty quickly ish. But it was traumatic. I'm not sure whether it was me, baby size (8 lb 10) or my size (5ft 3, Asian frame).

Having said that I've had plenty of friends in the uk who've had successful vbacs. My friends outside of the uk however all suggested that I go for a cs as that's what they'd been told by their consultants. So whether it's a safety issue or a money making one I don't know!!

ThePrincessRoyalFiggyrolls Mon 25-Jul-11 12:05:35

I know I was lucky with my vbac, but if its of any help I have heard (and found it to be true with friends) that if your mother had a relatively short labour it can also happen to you. A friend has recently had her second and the labour was quite short (3 hours!!) and the birth very clean (no stitching etc) however the baby did have meconium in the waters so they did have to stay in the night. I think OP it is good to go with your gut on the whole thing, perhaps try for a sweep before your due date and also book in a elcs to give you the options? Good luck with your decision, I do feel that my decision was slightly taken out of my hands by ds wanting to come earlier than expected and I know there has been recent news of ruptures in scars but I don't think they are the norm (I really hope!) and I have some friends who have had cs and then had successful vbacs. I genuinely think this is a very personal decision and whatever we say about our own births that is exactly what they were and no two were alike smile I am sure there are many people who have had success vb who have then had to have emcs. Your baby is the most important factor and you know your own body best smile but it is always good to hear other peoples experiences to help you make an informed choice. Sweeps aren't the nicest thing about having a baby but then equally they aren't the worst either, and stitches aren't great but they aren't horrendous either for a small tear as usually done insitu with you in the euphoria of having given birth. And although I didn't believe it the euphoria of having achieved it for me was so very different from the euphoria first time round of having a dd grin. As I say good luck with your choices and let us know how it goes.

Gooddie Mon 25-Jul-11 23:30:21

I'm interested in this too. Sorry for hijacking.
I'm 38 + 4 at the moment and also had ECS on DD. This was due to waters breaking, nothing happening so was induced. Got to 1cm in 6 hrs and she got into distress, so had a section. She didn't breath for 4 mins and was given CPR and ended up in ICU for a few days. All brilliant after that!!

Anyway, my consultant wants me to try for a VBAC so I'm willing, but so nervous that it might end up in ECS again. Going for a sweep Wed so we'll see what happens!! At this stage, I think i'd like him to insist on CS!! Don't think he will though!

Good luck Cookie51!!

Cookie51 Thu 28-Jul-11 23:53:34

Thanks very much everyone - had sweep today, a bit painful but fine once it was over, let's see what happens...!

BadRoly Thu 28-Jul-11 23:57:57

I had elcs with dc1 for breech and then a vbac with dc2 21mths later. No scar rupture or any other problems. Went on to have 2 more vbacs. Good luck Cookie51 smile

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