Would you choose a vbac or elcs in this situation? Having a wobble!

[MissusWrex]

Hello,

I'm 35+1 and have started completely shitting myself!

I have an elcs already signed off and an agreement that if I go into labour before then then I will be having an emcs.

Well I'm having a huge wobble and wondering if I've made the right decision.

I have had multiple miscarriages due to a bicornulate uterus with a full septum (it goes all the way to my cervix apparently) You might have seen my posts on here before!

Dd was born via emcs at 35 weeks when my waters broke spectacularly. She was breech (sp?)

This little guy is head down and in position and I'm starting to wonder if I should try a vbac but a few things are holding me back.

1. A higher risk of scar rupture due to the dodgy womb shape.
   

1. When we lost our little boy to a late miscarriage in 2014 I had a large bleed behind my placenta which refused to budge afterwards and needed a d&c for. I was quite ill afterwards and the surgeon said I was lucky I was on the operating table at the time! Apparently (again due to the dodgy womb) I am quite likely to have a problem with retained placenta etc.
   

1. I have heard some horror stories about our local hospital (which is extremely busy) about women being left in rooms on their own despite being high risk a and early warning signs of distress being missed.
   

What would you do if you were in my position?

On the one hand I am anxious about the csection even though my last one was fine. I would like to have a go at a 'normal' birth but only if it was going to involve no forceps etc. (😂 I know, I know)

On the other hand I'm aware I've a higher chance of things going wrong and would rather have a team of professionals all there in the room with me! I feel selfish and like I might be risking our son it I don't have an elcs. All my family, friends and partner say they would prefer me to have an elcs.

Sorry for the ramble. I can feel the time slipping away and I'm really starting to doubt myself.

[SoftSheen]

Having an ELCS for DC2 (after a scary EMCS with DC1) was one of the best decisions I have ever made. So calm and civilised, and plenty of professionals on hand. Whilst it is very much your decision what birth you opt for, from what you say, attempting a VBAC would carry significant risks. Personally I would stick with the ELCS.

[MissusWrex]

Thanks, it's probably just because I'm getting anxious leading up to it I guess.

My consultant just agreed with me. I went in and said why I wanted an elcs (I miss the decisive me!) and she didn't really say much about the decision, just started putting plans in place.

[Annarose2014]

I'd have the section. Even with low risk births they often involve forceps or ventouse.

And they'd be watching you pretty closely so possibly if it started to go off course they'd have you down to theatre anyway. Double the drama.

[BettyBi0]

I'm in the same position of deciding but I have none of your risk factors.

In your shoes I'd go for an ELCS. Scar rupture is a very real but small risk in a standard uterus but the probability (1 in 200??) was something I definitely took very seriously. With your personal history there is no data on the probability of rupture so you are kind of making a decision in the dark.

I guess one other issue is whether you are planning further children in the future as with each c section the risk for future pregnancies increases.

Wishing you lots of luck whatever you decide x

[MissusWrex]

Thank you

No this is definitely our last child! I will be deliriously grateful to have two (never thought it would happen)

Well this has helped me get over the wobble, seeing it all written down it does seem pretty clear doesn't it.

[Junosmum]

Section, without a doubt. It's horrible having had a natural birth all the way to the end, no pain relief but then forceps delivery (no pain relief) and THEN having a spinal block and surgery for a retained placenta. It was awful. At least with a ELCS you'll feel more in control.

[MissusWrex]

Yes Juno, I do think I'd rather be already numbed and ready for the surgeons if a placenta problem happened again.

Right, will completely ignore wobble and stuck to original plan. It always gets a bit more terrifying when you know it's near though doesn't it

Just wish I had a working crystal ball...

[Cuppachaplz]

Can you talk to s birth choices me it consultant me about how you are feeling.
Even if ELCS is right for you, I think it might help you to talk through his your feeling, and try to deal with any anxiety.
I've also had multiple mc (due to acquired uterine abnormalities from scarring), 3 of which were late, and 2 previous sections-if you'd like yo pm me, please do xxx

[Birthgeek]

I'd honestly give it a go, as your boy is head down, in the perfect position.... But you're not me

I'd ideally meet with a senior supervisor of midwives / consultant midwife / head of midwifery and have a meeting together with a senior consultant... and unless there were compelling reasons not to, I'd choose to give birth in hospital, under midwifery-led care, preferably in a pool with the telemetry external (continuous) monitoring, so they can keep a close eye on baby. I'd consent to more regular pulse and BP checks too, as this can be the first sign that a scar is opening.

Uterine rupture is usually partial, not complete. Caregivers can tell from your observations that it may be beginning to happen and get to theatre if that's the case. Likewise with retained placenta.

But I totally get that a lovely calm caesarean might also be very appealing!

[Birthgeek]

But I'd only give it a try with a plan to revert to c/s if all of the following was ok:-

Head well engaged
Progress was good, i.e. cervix was opening and baby was moving down well
I felt confident and positive, and trusted my body

Otherwise I'd have a c/s

[HarlotBronte]

With that obstetric history and knowing you don't want any more, I'd have the section every time. You've been told you have an elevated risk of rupture and of placental retention, neither of which you want to fuck about with. To the best of your knowledge, your hospital has a history of not giving high risk women the care they need. And even if this actually isn't true, you think it is, so that's going to worry you. Being worried in labour is not what you want.

I understand the desire to 'have a go' at normal birth but from what you're saying, you have a rather lower chance than average of having one. Nothing wrong with VBAC, especially if you're low risk and know you want more. But if your circumstances make it such that a complex VB is a more likely outcome than average and you're not going to have any more kids, the main reasons for attempting one don't seem to apply in your case.