Unscientific survey: What was your successful VBAC like?

[AllBoxedUp]

Hello. I am currently obsessing about VBACs and I am trying to find out more about the details behind the quoted success rates. I've been trying to find out how many of the successful VBACs involve an assisted delivery and how many result in significant tears and how this compares to non-VBACs. If anyone can link to any proper research that would be wonderful but I thought I would see what the anecdotal evidence was!

I had an ELCS because DS was breech so there is no good reason for me not to have a VBAC but I hate the fact that I have to start on the path of intervention (delivery unit and not midwife led unit, CFM, etc.) for a really low (though very serious) risk of uterine rupture. It seems intuitive to me that this is going to lead to more intervention but the only thing I can find is this site which has no references to the increased risk of intervention and this paper which basically says more trials need to be done to assess the risks and benefits. Any words of wisdom, personal experiences and data welcome . Thanks!

[MakesAMessWhenStressed]

Can highly recommend reading

Birth After Caesarean

Written by Jenny Lesley
Published 2004
ISBN 10: 1874413177
ISBN 13: 9781874413172

It's published by AIMS.

The risk of uterine rupture is lower with a VBAC than it is with a Syntocinon induction for a first birth. Funnily enough that information isn't as widely known

CFM is not very helpful as a) results can be misinterpreted and b) foetal dsitress is one of the last symptoms of uterine rupture. Maternal heartrate, for example, is far more reliable, but that requires much more work from the HCP than hooking you up to a CTG

[MakesAMessWhenStressed]

PS - Disclaimer - not a medical professional, just a mum who got a hideous cascade of intervention first time and has been reading as much as possible to prevent its happening ever again.

[Rummikub]

Hi I had an emergency c section, then vbac with dc2. No assisted delivery or epidural. But lots of gas & air as well as pethidene.
The hospital left it to me to decide what I wanted. I'm glad I opted for vbac.

[AllBoxedUp]

Thanks for the replies. I have been reading stuff as well that says that CFM is not actually that useful if it is not being monitored. I do think the hospital where I am going to be offers wireless monitoring but it still seems obtrusive.

My personal experience of an ELCS was pretty good and I don't have a strong desire to experience VB. I do think a straightforward VB would be the best option but I am terrified of going down a path of intervention and ending up with a traumatic delivery or EMCS.

It's good to hear positive stories Rummikub. Was there pressure on you to reach certain points by a certain time? I'm a bit worried that I will be slow as well as it is my first labour and don't want to be pushed into things as a result.

[Rummikub]

I didn't feel pressured with vbac. With dc1 I had a failed induction and the whole thing was v intrusive.

With dc2, the midwives listened to me and at one stage I did say I wanted a section and they all stopped to see if its what's I really wanted!

Talk to them about what you want and include that you don't want to be pushed into things. You maybe able to judge how supportive they would be and that may help you make the decision.

I thought I'd be slow too but dc2 was out in under ten hours!

[PacificDogwood]

I had VBACs x2 after induced VB and emCS.

They were great .
I delivered in hospital (no MLUs in Scotland) but all my care was by MWs (consultant popped in because she works with DH and to admire the baby).

I had been keen to at least labour and if possible deliver in water but both my VBACs were pretty fast and I never made it to the pool (seriously though I might deliver DS4 in the car park).

Scar rupture is v rare in 'Lower segment CS' (horizontal cut suprapubically) compared to 'Classic Caesar' (vertical midline cut) which is v rarely done today.

[ContinentalKat]

VBAC after emCS here, 2 years apart.

VBAC without pain relief and midwife led. Minimal tearing, no stitches needed. Turned down manual check for rupture, doctor was called in and did ultrasound straight after delivery. This was not in the UK, but in a country where VBAC is the norm.

[AllBoxedUp]

Thanks for both the replies - really good to hear about supportive good care.

I'm not particularly worried about uterine rupture as the risk seems low - I am worried about having complications from a 3rd degree tear and if this was more likely if you end up with lots of intervention. I can't find anything that proves or disproves this though. It's about the only thing I can focus on though when I think about VBs which is probably down to my own issues! I just want to know if there is anything I can do to avoid it.

[Rummikub]

I worried about hit too and did the perineum massage itch vitamin e oil. Don't know if it helped or not. I did tear, but not much.

[PacificDogwood]

Why are you particularly worried about a 3rd degree tear? Sorry if I missed something (if happens. A lot ).

If you are allowed to labour in your own time, don't have your labour augmented, can be as active/change position as much as you want, your risk of any tear is reduced IMO. Labouring in water is v good to prevent tears btw.

Fwiw, I had minor labial grazing with both VBAC and a small tear with my first VB which was sutured and has not left me with any problems.

Discuss your concerns with whoever looks after you - whether it's the midwife or a consultant. You'd not be the first woman to opt for a VBAC with the stipulation that you would prefer to proceed straight to CS rather than augmentation of labour or instrumental delivery.

[ladydepp]

VBAC 5 years after emCS. Labour never really got going after my waters broke naturally day after my due date. Induced 48hrs after waters broke and had epidural (heaven!), dd had a clip on her head to monitor progress. Had episiotomy which healed very well. I may have seen a consultant briefly but the rest was all mw led.

Probably sounds really bad but 'twas brilliant. Had a shower 2 hours after the birth and went home next day. Such a relief after my first experience (pre-eclampsia, premature birth of twins, long stay in hospital etc....)

[AllBoxedUp]

You haven't missed anything - I just seem to know so many people who have had tears it is on my mind. I also know it is more likely if you are being made to push to meet some time limit or are not mobile which seems more likely in a vbac situation (though could be wrong). I have always been very scared of the idea of a VB and almost csn't imagine that contractions are the worst bit as all I can think of is the final stages (though have been assured you are numb by then anyway). Sorry if I seem irrational! Just really interested as well in what the reality of a vbac is like - I would love a water birth but I think there is only one pool in the delivery unit whereas there are lots in the midwife led unit. Just wish I could go there instead - they are right next door so it seems mad that I can't when you can have a home vbac.

[PacificDogwood]

I was never pressurised to meet any kind of expected 'rate of progress' - I think the '1cm/hr' is pretty outdated and a MW worth her salt should go by other parameters as well to assess whether this is 'effective' labour or not.

And. O. M. G. - the 'urge to push' - it is fecking amazing !! It is not 'urge' (such a wimpy word) - it is your body taking over and getting this baby born. It is the most amazing feeling ever. Really. Honestly. IME.
I felt really silly because it took me to DS3 to experience it (had epidural with induced first VB and spinal for emCS).
Contractions are sore, no denying it, but without synto really manageable and it helped me to think with every one 'well, that one is never coming back and has done it's job'. I had only Gas and Air with my VBACs.

Re water birth: it depends how strongly you feel about a water birth and how much you are prepared to fight for it. You can speak to the head of midwifery and your consultant.

[BelleOfTheBorstal]

How far are you from the hospital? Less than twenty minutes and I would be say have a home birth with a pool.
I had a vbac with a boderline 2nd degree tear. I have no ramifications from that five years later, unlike my c-section scar, which is eight years old and still gets painful if I'm tired or rundown.
Have the vbac, lots of gas and air, you'll be fine!

[backinthebox]

I had an accidental HBAC. 2nd baby was in a hurry (unlike first baby!) I had a second and a third degree tear, had to transfer into hospital for a bit of repairing. I had excellent advice from my midwife, who recommended lavender oil and tea tree oil baths twice a day, and the human body is an amazing thing. I was riding a horse (yes, really!) 5 weeks later. Tears are all very different, and my friend had a 2nd degree tear that took much more time to heal than my 3rd degree tear. Of all the things to be concerned about, tearing is one thing I would put a long way down the list.

Wrt to CFM, I would agree with the poster who says they are useless unless you have someone paying attention to it all the time, and if they are paying attention to the CFM machine, they could monitor you with a Doppler instead. There is a suggestion that in restricting your movement a CFM actually has a negative effect in comparison to a correctly used Doppler and one to one attention from a qualified midwife. When I was in your position, my biggest argument was for a midwife to look after me rather than being strapped to a piece of machinery so they could tell in hindsight what went wrong. As it was, my baby decided they were not interested in any bit of the hospital, and popped out quite unexpectedly at home.

[mercibucket]

you can refuse cfm if you don't want it

I had a vbac 17 months after em c section. it was a short labour and I stayed at home for most of it. delivered in hospital with episiotomy
an episiotomy is absolutely no trouble at all. I have had worse pain from bad bruises

[CointreauVersial]

VBAC after one normal vaginal delivery and one EMCS.

It was fully supported by the consultant at the maternity unit, especially as I had laboured successfully once before.

Apart from the extra monitoring (I wasn't keen, but went along with it), and the fact that no chemical induction was permitted (fast labour more likely to cause ruptures, I believe), I was treated no differently from anyone else. In fact, it was pretty quick, 10 minute second stage, just G&A, and a small tear that has given me no bother since.

It's all about the support IMHO.

[CocktailQueen]

Hi. I had a vbac after a cs for breech baby. I wanted a natural birth, keeping active etc., but my waters broke then I didn't go into labour so was induced.

It did lead to a cycle of intervention, sadly - continuous foetal monitoring - though I had said I didn't want it - pethedine, epidural, episiotomy, ventouse. Crap, really. But, although I had done research, I wasn't confident enough to say I didn't want CFM - who would?

Anyway, safely delivered a lovely baby boy, so that was fine. Still loved my vbac much much more than my cs!! And the episiotomy healed vv quickly - much better than my cs, which still hurts or is numb on and off 10 years later.

Have a look at www.vbac.org.uk for more info. Good luck!

[WeeTeaJenny]

I had VBAC after an EMCS last time for undiagnosed breech baby.
No tears , very quick labour and delivery and was home the same day . Much better afterwards as I could drive myself and pick up and bath my toddler which I would have struggled with if I had another section
Had no pain relief other than gas and air as it was all too quick and it was great afterwards as not woozy or full of painkillers and could remember every part of the birth
Not everyone tears , my baby was over 8lb .
Im glad I had a VBAC now

[nameuschangeus]

I had an emcs with ds1 as I had failure to progress
Ds2 was a vbac and I was bloody determined and slightly obsessed that it would all go well. Waters broke naturally at home, into hospital where they monitored me (monitor on tummy which fell off more often than it was on!) 0cm dilated at 6pm. 10cm by 8pm. Baby born at 9.22pm as I was a bit dim and not a very good pusher.
Only gas and air and lots of noise! Monitor on tummy throughout.
Incredibly lucky that my gp practice midwife was with me for the first part and when I faltered and went a bit of a wuss, saying i couldnt do it, she told me 'you've been mithering me about this vbac, you'll blooming well have it'. She was brilliant
So glad that I did it. Best of luck.

[backinthebox]

I forgot to add that I would have a VBAC a thousand times over than have another CS!

[insanityscatching]

I've had three VBACs after my second birth was ELCS due too breech.
VBAC 1 dd was 9 days overdue and back to back, half dose of prostaglandin, epidural as consultant would have liked me to have another ELCS (small pelvis) dd delivered in three pushes, lovely birth didn't have any pain from start to finish.
VBAC 2 went to hospital 4cm dilated, another epidural (same consultant) ds born 4 hours after arriving at hospital and 15 minutes of pushing.
VBAC 3 PROM 48 hours earlier, syntocin drip, gas and air (no epidural as different consultant who declared I had proved myself able to deliver vaginally) dd delivered six hours after drip started.
I had a monitor on throughout for each birth to check for rupture of scar and a clip on VBAC 3's head as her trace was a bit flat.

[AllBoxedUp]

Thanks so much again for sharing your experience. I only know one person in RL who has had a VBAC and she had a lot of problems which is maybe making me more nervous. I think I need to find out more about hospital policy as it may be I am worrying about things that no longer go on. Thanks again.

[mayhew]

A vbac following an elective cs for first baby is like any person having a first labour. It might be straightforward or more difficult. Just like anyone having a first.

Its different where a woman has laboured before, even if she didn't deliver vaginally. The body has now learnt how to labour and becomes more efficient.