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.
Answers
- 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.
- 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).
- 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.
- 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.
- 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.