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VB or ELCS? What are the risks of repeat ELCS?

(12 Posts)
TooImmature2BDumbledore Thu 04-Aug-11 19:38:13

Hoping for a bit of advice. I'm in the very early stages of pregnancy no 2 and I wanted to explore my options so I can be armed with the relevant information when I see the consultant.

I had a stillbirth in March at 41+3. Labour was spontaneous - had been going on since 41 weeks exactly, intermittently, and although DD's heartbeat had seemed fine when I was admitted to Triage at 41+2 she died sometime between then and when, 3 hours later, I was allowed up to the labour ward at 3cm dilated. I went on to have a 'successful' hmm VB (had epidural), with no tearing, only mild graze and pushing stage of about half an hour. During labour I started to show some signs of pre-eclampsia but the diagnosis has never been made - I had proteinuria, v high pulse rate, almost no urine output despite catheter, bruising to bum that apparently is associated with kidney damage, and my BP was wavering, although it dropped after the epidural was sited and didn't rise again. I have changed hospital due to the series of errors that contributed to DD's death, but the last consultant suggested that in future pregnancies there would be no medical reason for an ELCS. She said I would be induced at 38 weeks.

My question is, if I were to push for an ELCS this time, what would the implications be for future pregnancies? Both DH and I want a big family - minimum of 3. I've heard that the more CS you have, the more risks, and I wondered if anyone had experience of having 2, 3 or even 4 sections, and if so, how it all went for them? VBAC will probably not be an option as I am likely to always be induced at 38 weeks and I have read a bit about increased chance of uterine rupture in these cases.

Thank you!

happywheezer Thu 04-Aug-11 21:42:58

I've had two ELCS, I don't know if it was me or my age(37) but I found the recovery more difficult.
I can't say about further risks, I'd like to know this myself, thinking of asking DR.
My first consultant asked me how many children I wanted and made a point of saying that it's difficult the more children you have. At the time I only wanted one!
I would personally change your consultant, given your history.If you want an ELCS ask your midwife who will refer you to the consultant, you can always ask for another opinion from another consultant.
There wasn't a particular question about me not having a section this time, only to say they wouldn't have agreed to it first time. Different hospital. first was much better!

TooImmature2BDumbledore Thu 04-Aug-11 22:25:23

Thanks for the reply!

Just to clarify, do you mean the recovery was harder the second time, or was it hard both times?

I have asked the MW to refer me to a different hospital and consultant - many, many issues around the first! She said she would make me an appointment at the new hospital and I would be able to discuss my care plan with the new consultant. She has also said that she doesn't think anyone will argue with me if I choose ELCS. I'm just not sure - it comes down to how fast they could intervene if this baby started to show signs of distress. I would never forgive myself if something went wrong during labour this time.

EsmeWeatherwax Thu 04-Aug-11 22:38:38

I have had an EMCS and and ELCS, and am currently pg with dc3, who will again be an ELCS. I didn't find either to be particularly difficult recovery wise, was up and about quickly, and felt fine within a couple of weeks. Also BF dd2 with no probs after elcs. But I did take it very slowly after both, and had lots of help from dh and family. So far everything is fine with no. 3, and I know there are women on here who have had four or more CS and been ok too.

FWIW, in your situation, I would also be pushing quite hard for an ELCS.

happywheezer Fri 05-Aug-11 22:24:47

Just to clarify, it was hard going second time around.
I'm not sure if it is my age (37), the fact I was having a second or bad pain management.
I was delivered both time at exactly 39 weeks. It's good to know there is that end date.
I'm really glad that you have got a new appointement. If it's what you want be clear about it.
I wrote it all down first time, but came away feeling foolish because I had asked for one, even though I was granted one.
I really enjoyed my first section BTW.
Second one was Ok too, but was in there ages!

TanyaBranning Fri 05-Aug-11 22:36:05

I had an emergency section with DC1 at 42+5. Recovery was OK, although felt quite weak and bruised for a bit. With DC2 I had an elective section at 37 weeks (due to obstetric cholestasis). Recovery was absolutely fine - better than the first time, actually. If we have any more I will also have elective sections and they will be be at 37-38 weeks, due to my medical history.

My consultant told me she routinely performed up to four sections on women, but would have to consider the individual woman's health and circumstances before agreeing to perform a fifth.

Subsequent sections are usually longer, as there is a build up of scar tissue. I believe there is an increased risk of placenta praevia with each section you have, plus an increased risk of surgical adhesions, fibroids and hysterectomy (I am not a doctor, this is just based on reading I have done). However, based on my two elective section, I have to say, it was a breeze.

RollingInTheAisles Fri 05-Aug-11 22:52:57

I don't have useful information but wanted to say how sorry I am to hear about your daughter. Wishing you well for number two x

drcrab Fri 05-Aug-11 23:35:01

We know someone who had a stillbirth too (started off way overdue, mw kept pushing her dates back, went to birthing centre, ended up being blue lighted to the maternity unit, emergency cs and baby had just died). 2nd birth was an elective cs because of what happened first time round.
I'm so sorry that this has happened to you.

TrinaLuciusMalfoy Sat 06-Aug-11 16:20:34

Firstly, sorry for your loss sad

Secondly: Under your circumstances I can't see any reason why anyone other than a sadist would push you to have a vb this time if an elcs was going to better for your mental wellbeing.
Risks of subsequent successive sections include risk of rupture and a placenta sited over scar tissue, or placenta previa, along with the risks of the surgery itself. HOWEVER, these are risks not likelihoods or certainties, as with any pregnancy. My mother had 4 sections without incident, and I know plenty of others who've had at least 2.

I think if you want to try again for a VB, they would want to keep a better eye on you anyway. If you wanted to ask for an elcs, I don't think you'd face much of a fight. Someone I know had decided she couldn't do a VB, got referred to a consultant and at her first appointment refused to leave until he agreed. I'm not saying it's the best solution, just that if you face resistance it might be worth trying wink

TooImmature2BDumbledore Sun 07-Aug-11 00:12:49

Thanks people. Didn't realise anyone else had posted! It's nice to hear of people having multiple sections without incident - gives me some ammo.

catsareevil Sun 07-Aug-11 00:25:29

I found my second CS harder than my first, in terms of the overalll experience.
The number of CS that your body will tolerate isnt something that you can know in advance, as a major factor is how your uterus looks to the surgeon doing the operation.
After my second CS I was told that because of the way my uterus was that if I did want to have one more pregnancy they would operate early (around 37 weeks), but that they wouldnt recommend another pregnancy after that.

Mitchell81 Sun 07-Aug-11 12:02:04

Sorry for your loss.

I have just had my 4th elcs all have been fine and last one 6 weeks ago was the best recovery. Although they told me this should be my last baby as my uterus was really thin and would of ruptured if I had gone into labour.

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