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Massive Fibroids: ELCS or VBAC?

(11 Posts)
eversomuch Mon 27-Aug-12 21:32:53

I'll be having a 34-week scan in a few weeks, followed by a meeting with a consultant to determine the best option for the arrival of DC2.

DH and I suspect they will pretty much leave it up to me/us as to whether I want an ELCS or to try for a VBAC. I'm curious if anyone has been in a situation similar to mine and might be willing to share their experience.

In summary:

Even before TTC DC1, I knew my massive fibroids might be an issue. I have three significantly sized ones, the largest being 12cm. They're intramural, so didn't conflict with TTC but I did go into my first pg with the understanding that I would likely need a c-section. However, when the time came, I was encouraged to try for a regular delivery.

My waters broke on a Friday evening; twenty-four hours later I had barely dilated, so began induction. Four hours after that I was still barely dilated and was given (after about six tries) an epidural. Four hours later I was about 4cm dilated. From what I can make of my hospital notes and one of the doctors' drawings, the baby and the biggest fibroid were sort of level with each other. Baby may also have been back-to-back. In any case, she had hardly engaged at all and one of the doctors wrote in my notes: "vaginal delivery unlikely; probably needs cs". So about 36 hours after my waters broke, DD was delivered via EMCS. I lost 1.4L of blood (PPH is common with fibroids) and had to have a transfusion.

As we were leaving the theatre, one of the doctors said that if I had another baby, I would need another c-section. However, there is no reference to this advice in my hospital notes and neither DH nor I was clever enough to ask at the time why they thought this.

Early in pg2, I met with a consultant who seemed to think it unlikely that the fibroids caused the slow progress or the need for the CS. He said first babies often turn back-to-back and that it's less common in subsequent pregnancies. However, he did admit that he would need to review my notes from pg1 before making any decision or advising us on the best option for delivery of DC2. So we suspect that unless he sees something in the notes that I've been unable to decipher, he'll probably encourage me to try for a VBAC. Except I'm not sure I want to. I still have that "you'll need another CS" in my head, making me think there must have been a reason for the doctor saying that.

OTOH, I had complications after my last CS -- the wound reopened, I spent four miserable days over a weekend in our understaffed local maternity ward (though I delivered at UCLH) and couldn't exercise or do much physical activity for twelve weeks as a result. I sort of think it would be good to avoid voluntarily undergoing major surgery if I don't need it.

I hated the whole induction thing and have made it clear that I will not consent to that again. The consultant I spoke with a few months ago was fine with that and said I could either schedule an ELCS (probably able to go to my EDD even) or wait to go into spontaneous labour and if I don't progress, then have the section. But I have no idea how long they would expect me to wait before deciding I'm not progressing. This is something we'll discuss in our appointment in a few weeks, when we also intend to look closely with the consultant at the notes from pg1, but if anyone cares to share their experience/advice in the meantime, I would be very grateful.

Part of me (and DH's gut instinct on the subject) suspects that they may encourage me to go for a VBAC even if they think I'll eventually need a section. I sort of feel like they got my hopes up for a regular delivery last time when they may very well have suspected early on that I would eventually need a CS. And if that's the case, I'd rather just have had the section to begin with, rather than go through 36 hours of misery. And now, we also have DC1 to consider (who will look after her while we're in hospital, how long will I be away, what will my recovery time be, etc).

Hopefully, reviewing my pg1 notes and 34-week scan report with the consultant will clear things up and there will be an obvious best option, but I'm preparing for that not to be the case and for the decision to be in my hands. I just wish I knew what I should do. I guess I'm leaning towards an ELCS, but part of me feels like if there is a chance for successful VBAC I should take it.

A very long post, I realise, so thank you in advance to anyone who takes the time to read and comment.

dikkertjedap Mon 27-Aug-12 22:27:30

I would go for ELCS if I were you. In that way you can make sure you have the right team available when you need it.

Yes, with large fibroids the risk of a PPH is much greater. You already have a child to look after and with a baby, you will need all your energy. A PPH saps energy, although a CS also takes some time to recover from. However, at least you can plan for an ELCS and ensure you get help from others when you need it.

Good luck with whatever you decide.

eversomuch Tue 28-Aug-12 22:11:47

Thanks, dikkertjedap. I am leaning that way, but it still feels like such a hard decision, and I suppose part of me feels like I should give normal labour a try. Although, honestly? Even though the MW last time said I wasn't experiencing real contractions, they felt pretty darn real to me and I wasn't enjoying them!

But then I wonder, what if I chose to try for a VBAC and it went beautifully smoothly and was over before I knew it? Problem is, of course, that you can't know in advance how it will turn out. And I do suspect that with such large fibroids, my chances of a normal delivery are pretty low.

eversomuch Thu 30-Aug-12 10:31:31

If anyone else has any words of wisdom, advice or similar experience, I would be very grateful to hear it!

TuttiFrutti Thu 30-Aug-12 22:12:03

I had a very similar experience to yours in my first birth and chose an elcs for my second. I have never regretted it. It was an amazing experience, no pain at all and really calm and serene.

Like you, I was told verbally straight after my first birth (elcs after a long labour following induction) "you could never have given birth naturally because of your fibroids", but during my second pregnancy it became clear that this hadn't been put in my notes and the doctors I saw tried to persuade me towards vbac.

I recovered much quicker second time around. Like you, I had a big haemorrhage during my first birth and felt weak for months afterwards.

You can't ever know what might happen if you did try for a vbac, it might all go very smoothly, but for me the risks were too great. Good luck with whatever you decide.

idlevice Thu 30-Aug-12 23:22:08

I've got 2 fibroids, biggest one was about 10cm. DS1 was naturally born but with syntocinon due to (I now reckon) him being back-to-back as your consultant told you about your first. (Fibroid was quite near baby's shoulder & neck too, initially looked like it would block vaginal exit). I think I probably should have had a CS as I had 48hrs labour with no progress then very agressive syntocinon with no pain relief which was pure hell-on-earth. I also had retained placenta & 3litre PPH so a CS seems more attrative than that option. Like you I was also told I would need a CS next birth, not only that but a cesearean-hysterectomy! Just what I wanted to hear when I was in intensive care recovering!

Anyway with DS2 I eventually decided I would try for a VB with guaranteed epridural option unless it looked like the baby was in an awkward position. I was advised not to have a CS as risk of PPH is actually greater with a CS over vaginal delivery. The fibroids seemed to not get as big during pregnancy this time but DS2 turned out to be nearly 10lb. I decided to be induced as I got overdue & had severe anaemia so felt terrible. I needed syntocinon again as my body does not appear to do contractions (possibly due to fibroids disrupting the muscle action?) so had an epidural & although it wasn't as carefree as I thought from watching American One Born Every Minute, DS2 was delivered vaginally with no tears. I had a smaller PPH of 1 litre this time & subsequently felt nowhere near as bad recovering after the first time.

I really think baby's position's is a strong influence of how the delivery goes, as I'm sure most midwives would agree. Overall though I would take on board your dr's advice & particularly note what they say about PPH as it's really rubbish, as you know! It's tough trying to evaluate all the factors when your first experience has not been particularly straightforward - I really empathise with that! Hope all goes well!

eversomuch Sun 02-Sep-12 21:04:18

tuttifrutti I think I actually recovered pretty quickly from the PPH and transfusion; the hardest part for me was the wound reopening and having to take it easy for six extra weeks, waiting for that to heal. That would be really difficult to go through now with a toddler who will be demanding and needing my attention, too. But I suppose the odds of that happening again are pretty low.

I have heard ELCS referred to as serene and civilized, just as you've described, and TBH it's not sounding like the worst option. smile

idlevice Sounds like you had two very rough experiences. When we talk with the consultant in a few weeks, one of the things I've been planning to discuss is PPH with a CS vs with a VBAC, because I wasn't sure if there was a greater risk with one or the other. I think the baby's position in relation to the fibroids is a huge factor, so FX that my scan later this month will yield some concrete results to judge by.

Thank you both for sharing your experiences.

lottiebean Sun 09-Sep-12 20:16:37

I have 3 fibroids - 1 intra mural which is the biggest (7 - 8 cm) and grew in pregnancy both times. On first PG, the intramural fibroid was blocking the birth canal for a time but apparently they can move, so I was still hoping for a vaginal delivery. As it turned out, by week 28 I felt huge pressure and was trying to urinate all the time. Then some horrendous pain in rhs followed by a threatened premature labour, some steroids + other drugs to stop labour and then 48hours later when the drugs wore off I went into prem labour again and had a crash section at 30 + 6 giving birth very traumatically to a baby boy 9who is now a lovely healthy 7 year old). Consultants all thought it was the fibroids but no-one could say definitively. He was breech and I think trying to turn but couldn't get round and my poor uterus was so irritated it just wanted the whole thing done with. I also never stopped for a minute during pregnancy being a workaholic, high maintenance kind of girl.

Second time around I was terrified. I didn't want another prem labour but I did want a vaginal delivery if I could have one. The fibroid this time was in a slightly different place. Still had pressure problems and worse on urinating - even went to hospital and was catheterised. HOWEVER, I did a lot less and rested alot more. Did pregnancy yoga and learnt how to breathe and be calmer. Then I finally made it to 37 weeks (I still believe mind over matter and all the rest), and I gave birth naturally in 6 hours. I was walking around within an hour of the birth. So the fibroids gave me no issues during this birth. So my advise would be - that every pregnancy is completely different. And the second pregnancy is often a lot easier than the first.

However, everyone is different and as long as the baby is delivered safely and you are safe then they are the single most important factors. There is no medal or prize for giving birth naturally - its just a quicker recovery. Go with your gut feel - you will know what is right as the time draws nearer. Listen to your body.

eversomuch Thu 13-Sep-12 10:21:43

lottiebean Thanks for sharing your experience. Every pregnancy and situation is so different. Glad to hear you were able to have the vaginal delivery you wanted and that it went so quickly the second time. And very happy to hear that DC1 is doing so well despite such a traumatic birth.

We're moving house in a few weeks and I haven't made it to pg yoga this time, so I'm not exactly putting my feet up much this time around, but hopefully that won't cause any problems.

I've got my scan in about ten days and then the consultant appointment, so will see what the situation is then with the fibroids and baby's position, etc before deciding anything.

eversomuch Tue 25-Sep-12 11:15:19

Just popping back in to say I had my 34wk scan yesterday and both radiologists I saw agreed that I should have an ELCS because of the location of two of my fibroids (one near the cervix). Confirms what my gut instinct was telling me all along, and was a huge relief to get a definitive opinion.

Have an appointment with the consultant next Monday and should get a date then. Hoping they'll let me go to term (back in June, the consultant said this was a possibility).

Has anyone here ever had an ELCS at 40wks or were you advised to go earlier?

charlienash25 Tue 25-Sep-12 11:22:57

I would go for an ELCS. Only because as you have fibroids this may cause extra strain on your scar during labour which could lead to it rupturing. Also inductions after a CS they dont normally like to do - as with inductions it forces the stomach to contract harder than normal which may also lead to rupture of the scar.

I had a VBAC and was out the hospital in 12 hours, however with my current pregnancy (although things are very different this time and I dont have fibroids) i have decided against another VBAC and am going to have an ELCS.

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