Advice about VBAC needed(16 Posts)
Hi ladies, I'm 29+2 now and getting to the point where I need to make some decisions really. Last time round I had a horrific birth experience. I planned a home water birth and went into labour (ish) at 40+3. All well and good. I had sporadic contractions, always fairly regular and never a break of more than 15 min and strong for 22 hours (no pain relief) before my mw accepted I was in established labour. I then laboured at home for another 12 hours with gas and air. I went through it pretty quickly and the mw had to send to the hospital for more. After 12 hours I was still only at 4 cm and the gas and air wasn't dealing with the pain so I was transfered into the hospital. My waters went as I arrived, I couldn't pee so had to have a catheter fitted. After another 4 hours of labouring with g&a the anthatist turned up (had been in theatre). It took them 2 hours to get an epidural in, in the end they had to give me a spinal block to get it in as I was black and blue. They had to get the consultant anthatist out of bed to come in and do it. They couldn't find a top up button thing for the epidural so the anthatist had to keep coming back to put in her code to the machine thing, except she was in theatre a lot so it was often delayed. This went on for another 16 hours, by which time I was still only 7cm. They decided it was time for cs, no options of use of drip or anything, waited another 2 hours with the epidural completely worn off for the new shift to start before finally getting the cs. I was the first on the list for the day, so it must have been bad. Cs was quick and painless and it was finally over. It turned out ds was back to back and presented his forehead and not his crown. I ended up in hospital for 4 days as ds had to have antibiotics in case there was an infection as my waters went more that 24 hours before he was born. I didn't sleep much as ds decided to cluster feed to pull my milk through, the ward was constantly lit and loud and hot. By the time I went home I was a zombie. Zombie turned into pnd as I couldn't get breast feeding established and felt like a complete failure. It took me a long time to recover.
Fast-forward 5 years and I'm going to have another baby. It took over 2 years to conceive and I can't wait to meet her. But I've got to get her out first. I've seen my
useless mw who doesn't seem to have any advice for me. I've seen the consultant at the hospital who was more helpful. She said that given my history she would estimate I've got a 60-65% chance of successfully having a vbac. She also said that given my history I wouldn't be allowed to labour for so long and they would skip straight to a cs. She also said they wouldn't want to induce me. I would need continual monitoring, so probably would end up bed bound, although they do have some cordless monitors now. There is practically no chance of a water birth or even using the pool for pain relief.
So the question is should I try a vbac or just ask for a cs? I am feeling pressure from my mw to try, but I almost feel like I'm being set up to fail. I think if I make up my mind that I do want an elcs then it will happen, but part of me feels like I ought to try because everyone says it's better for the baby. But I would rather not start off as a zombie again. I'm planning on getting some private help with bf this time and feel like that is more important. Argh I just don't know! What do you think?
I'm in a similar position and I have been assured that (a) my chance of VBAC success is about the same as a first timer (so we could see it as starting from scratch) and (b) I can ask for a CS much more easily, eg if I've been labouring for ages and they want to put me on a drip I can ask to go straight to CS. I'm also opting for home birth and a doula, to avoid continuous monitoring though I will be okay with ending up at hospital if any concerns at all. My doula is there to remind them of my choices so if I am in hospital she should buy me some time off of the monitor. I found a good list the other day of things that impact the success rate of VBAC, will try to dig it out.
I should add that although I'm trying to see it as a clean slate I am having to work very hard to overcome the previous trauma and remain positive. Our mental health is absolutely the most important thing here, so if a CS will set you off on the right foot then please don't let a medical professional dictate a very personal decision.
Bullet points here are useful.
I ended up with emcs with my first & was desperate for vbac 2nd time round. Firstly, remember they cannot MAKE you do anything - you have choices about all of it. So I declined continuous monitoring & negotiated with consultant MW that I would be able to use the birth pool. Nice guidelines, Rcog green tops are all useful reads, along with your hospital's vbac policy. Much like you, my feeling was continuous monitoring, strict timelines etc world just set me up to fail & I wasn't prepared to try vbac without giving myself best possible chance of it working.
As it happened I ended up with another emcs but it was so much better than the first and a very healing experience - & I was so glad I had tried the vbac.
It is such a difficult decision, I wish you luck with it.
I had a fairly similar experience to you with my first and am now oddly 29 weeks with my second. I just got an infection in labour wasn't progressing and Baby became very distressed. I felt absolutely horrendous for about two months afterwards. Like I had been in a car crash. I found breastfeeding tough too but was lucky enough to have a good latch and supply eventually.
I went back and forth a bit with it what to do this time round but I always knew it my heart I wanted an ELCS. I appreciate VBAC is better for recovery and for baby etc but DD is under 2 and the thought of feeling that way again after labour is unbearable for me. I'm not looking forward to the pain and recovery but I hear it's better with an ELCS , plus we know to plan for it. So have plenty of family support get a short term cleaner etc.
My consultant and midwife both said I shouldn't even really consider VBAC unless I was really determined too. So I didn't have to fight and it reassured me. I made peace with the fact I won't give birth naturally and I'm fine with it! In the grand scheme of things it doesn't matter. You don't sound hugely bothered about VBAC?
Hello, first of all congratulations!
Wow I had a very similar experience. I think a couple of things in what happened makes a vbac a good option for you. I have been ttc no2 for awhile now and have given it liads of thought.
1. The peeing thing is key. The chances are he was presenting forehead first as a very full bladder was blocking his exit, this is exactly what happened to me.
2. First labours can be very slow. It takes an age for the cervix to thin first time around. 2nd time around your cervix will be thinner to start with and that initial phase is short.
3. You did amazing without pain relief or just gas and air for a very long time.
3. Hypnobirthing! I had the same experience as you but i has attended hypnobirthing. Honestly i was so calm throughout it did not really feel very traumatic. I cannot recommend it highly enough.
In your shoes I would go for the vbac knowing that an emcs is there as your back up.
Good luck! Would love to know how you get on.
Not dissimilar to you. I had a long and difficult first birth and ended up with an EMCS because baby was back to back and big. I was determined to have a VBAC the second time and was successful, despite no. 2 also being back to back. It was an entirely different experience the second time. Much calmer. Good luck.
Your experience sounds horrendous.I also had a back to back baby and emergency csection. Similar to you I think the medical team were negligent in letting the labour go on for so long. After 30 plus hours of horrific contractions and pain in my spine I asked for an epidural. It took 2 hours and 20 minutes to site during which time I was wishing for death. I was terribly scarred by the experience. When I have dc2 I will ask for a consultation with an anaesthetist to see if they forsee any problems if I do attempt a vbac and want an epidural. The things that scare me about another csection are the recovery and not being able to hold the baby straight away (I couldn't move my arms last tiime).
Thanks for your answers, I'm going away on holiday on Friday so I'll be able to have a good think about it. I think part of my problem with committing mentally to a vbac is that my community mw is so bloody crap I can't actually find out what's possible and what isn't before I get there. That makes it very difficult to come up with any kind of plan and know that it's actually feasible. I wonder if I can ask fir one of the hospital midwives to review my last birth experience with me and help me come up with a plan? I think feeling in control of the situation will be key for me and as things stand I don't think I can do that with a vbac at the moment.
Pickle my hospital has an afterbirth thoughts team that runs you through what happened to help you deal with it. I decided I didn't need it as have made peace with it but I would def ask if you have something similar where you are.
Good idea to think about it. You just have to weigh it up and decide what's best for you. Have a nice break
At the moment it sounds like a csection would be the best choice for you. I think a vbac is only worth pursuing if it is something you feel strongly about so don't feel pressured into it. After your first experience you deserve a calm, peaceful experience.
The birth afterthoughts session sounds like a good idea.
I've had a lovely relaxing week, well as relaxing as it can be at 30 weeks with a 5 yo desperate to play every second . Before we came away I had a meeting with a private lactation consultant and health visitor (also a qualified mw but doesn't practice) I explained about what happened last time and that abiryh that went wildly off plan followed by a failure to get bf established left me feeling awful. She said bf issues were probably due to a huge lack of sleep and exhaustion from such a long and traumatic birth (her words, I wouldn't have put it that strongly, but apparently mine qualified as traumatic!). We talked about it for a good hour and came to the decision it was the bf that I felt most let down about last time and that in order to concentrate on that it would be best for me to have an elective section. That way I won't end up so tired or (potentially) have to stay in hospital so long afterwards. She advised me to look into skin to skin sections, where baby is placed on your chest unwrapped and not taken away for immediate weighing and measuring. She made the point that with vbac births (which are often more traumatic for babies) that isn't routine so really there is no reason for it to be done with a planned section routinely. I guess will have to speak to the consultant and see what they say about it. But I'm happy to have made a decision.
Really glad you've come to a decision that works for you but just wanted to make the point for anyone who comes to read this thread at a later date that it's not accurate to say that VBAC births are often more traumatic. That could be quite misleading for someone to read - if a VBAC ends up going doing the forceps/ventouse/EMCS route then obviously that's more traumatic but no more traumatic than anyone having a VB who's not had a previous section.
I'm glad you've reached a decision and you can now look forward to meeting your little one! Hopefully the recovery from a planned section will be easier than from an emergency one. I love the idea of immediate skin-to-skin. Good luck PickleBot, hopefully it will be a healing experience and replace the bad memories from last time.
I think ELCS could be the right decision for you. FWIW I had EMCS the first time, also due to a baby presenting brow first. I did go on to have a successful vbac but I had a different labour to you and got to fully dilated quite easily, just couldn't push her out. It sounds like your labour progressed very slowly and it is understandable you don't want to put yourself through that again.
The royal college of obstetricians and gynaecology has useful guidance on this. For example, when agreeing to try VBAC I wasn't informed by the hospital, for example, that not having got far with dilation in the earlier birth and being induced for VBAC reduce the odds of success.
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