Can I change mind over VBAC?

[SpanielFace]

I am 39+4 with my 3rd pregnancy. My first baby was an emergency C section due to being undiagnosed footling breech, missed until I was 5cm dilated. My second baby was lost to a late missed miscarriage - he died around 18 weeks but I found out at my 20 week scan, and I had to be induced, which was the worst experience of my life. (It was well managed physically, but emotionally I mean).

This pregnancy has not been routine. I came back as high risk for Downs Syndrome after the NT bloods, and chose to have an amniocentesis, which came back as all clear. However, the bloods at the time showed low PAPP-A, which is linked to placenta problems in the 3rd trimester, so I've had lots of extra scans, as well as bloods for clotting problems due to losing our baby last year. Everything has been fine but I have been so anxious all pregnancy - every time baby has a quiet moment, I just assume he has died.

The plan that I had discussed with the doctor at 35 weeks was that I would have my cervix checked and maybe a sweep at 39+3, then a check at 40+3 to see if they could rupture my membranes. If they couldn't, I would be booked for an elective CS. Obviously they can't induce with the drip etc, as its a VBAC.

I saw a different doctor yesterday who says there is no reason to intervene that early. My cervix yesterday was clearly not ready (3cm long, firm, 1cm dilated). I had a sweep but the midwife did say it was unlikely to work. I am booked in for another sweep on Monday (my due date). But then, they want to leave me to 41+5 to attempt to rupture the membranes.

I feel very strongly that I don't want to go that overdue. I'm not saying this because I'm tired and fed up of being pregnant, I know everyone is the same at this stage. But I'm waking multiple times a night stressing about movements, having nightmares about delivering another dead baby. With my history and especially the low PAPP-A, I'm supposed to be at increased risk of placental failure at this stage, and it's so heavy on my mind. I think if I get as far as 41+5 I am going to have some sort of breakdown.

I want to say to the midwife on Monday that I'd like another sweep, but I'd also like to change my mind about a VBAC if it doesn't work within 48hrs or so, and to book for an elective C section instead. And give my reasons, obviously.

Does that seem ok? I hate arguing with medical professionals, but I really think I need to. I was ok with the original plan but I feel so stressed now. Can I change my mind at this stage about a VBAC? Are they likeIy to argue?

Sorry this is long!

[QueenMolotov]

Oh my goodness, they'd have to have a heart of stone not to listen to you. I am so sorry to read about the loss of your second baby

You are not being unreasonable at all. You have been through hell and want to ensure the safe delivery of this baby. If you feel safer about having an ELCS, ask for an ELCS and be firm about it. As you have already had one CS, I think you should be more likely to secure another one.

They may or may not try to persuade you otherwise. If they try and deter you from ELCS, just repeat that you understand the risks and that this is what you want, after much consideration. I think talking about your fears/nightmares is worth it, if you feel you can. That must be huge psychological stress for you Anyway, they are not the ones who have to deal with the consequences of either mode of delivery, so you must choose the one that YOU prefer.

I'm sorry if this is an insensitive thing to say, but if you are planning to have more children, the risks of CS increase with each one. Current recommendations are up to and including 4 (I think). So just think about that. However, the significant issue here is this baby being born safely, and I think spy out should follow your instinct.

I wish you all the very best

[QueenMolotov]

*that you, not spy out

[SpanielFace]

Thank you, that's a really lovely reply. I am really not generally an anxious person but this last 18 months (since losing our baby) has been so difficult. I just want this baby here now, so badly! I'm just so much more aware of all the things that can go wrong now - with my 1st pregnancy, it never even crossed my mind to worry after the 12 week scan. We have no plans to have any more children - I'm 36 and I honestly don't think I can put myself through the stress of another pregnancy, after all the issues this time - DH is planning on having a vasectomy next year. I just need to get my thoughts straight before Monday - I hate arguing with medical staff, I just tend to smile and nod, which is what I did yesterday. I should have raised my concerns at the time, instead I came home and cried all over poor DH!

[QueenMolotov]

They're just people doing a job, and part of their training - part of their duty of care - is to support you. You need to give them a chance to help you, too, because if you smile and nod, they just think you're happy with a VBAC, which you are quite clearly and understandably not.

Your body is one thing; your mind is another. Your mental health is as important as your physical health and the better birth experience you have, the better for you and for your baby.

You might not even have to fight for it, but make sure your DH is with you at Monday's appointment (for support) and hold firm. Second ELCS are a routine procedure and as you are not planning any more children, that works in your favour, too.

Take care and hope it all goes well x

[LumpySpaceCow]

Hi,
So sorry for your loss OP and it's so understandable that you are anxious.
Did you explain to the doctor that you weren't happy with that plan and you want to stick to the original? Are you still happy with the original plan? If so then tell them that that is what you want to happen.
On the other hand, if you want to go straight to booking your elcs then tell them that is what you want to do- it is a completely reasonable plan of action given that you have had a previous section.
I too am planning a vbac but won't be having any induction intervention, so if I don't go into labour spontaneously then I will have a section (not decided when yet though as have a while!).

[SpanielFace]

Thanks Lunpy. I was happy with the plan, but I'd (naively) just assumed I would go into labour spontaneously, before or around my due date, because I did with my first pregnancy. If it's not happening, or at least showing signs of happening, I really don't want to wait as long as 41+5 to intervene.

I've calmed down a bit and been thinking - could I request daily or every other day monitoring, if we are waiting to see if I go into labour naturally? Is that something that they allow? I think it would help a lot with the anxiety.

[LumpySpaceCow]

I think that when you see the MW that you need to explain everything that you have on here and if daily monitoring is something that is going to reassure you then ask about it. They may have reasons why they don't think this is appropriate and suggest something else that would be equally reassuring to you. Either way you need to be confident in the plan and not be frightened /anxious as this will just inhibit labour anyway. As a pp has said, take someone with you to MW for support.
You are very near to meeting your baby earth side...I hope it happens soon