Planned CS first time around - what can I expect if I were to have another baby?

[Harry2007]

Just a bit of general advice needed really.

I had a planned CS in January of this year due to severe SPD - long story.

What is the protocol for second pregnancies? I know that if my SPD should return as bad as the first time, and I've been told that it probably will, I'll obviously have another CS.

But what would happen if it wasn't to return - wishful thinking I know! Would I be forced to have a VBAC or would it be my right to request another CS?

XXX

[NotQuiteCockney]

Generally, if you've had a CS, you can have another, if that's what you want.

A friend of mine who had v severe SPD with her first pregnancy (was in a wheelchair after the birth, on and off, for years), got it sorted out using physiotherapy. When she got pregnant again, she was able to use physio to keep the SPD from happening.

[lulumama]

you cannot be forced to have a VBAC, but if there are no medical issues, then you should consider it....and as NQC said, there are things to help with SPD

[Harry2007]

Thanks for the advice.

I was in a wheelchair whilst I was pregnant and was having daily pethidine and morphine to deal with the pain. I've been having regular physio since the birth, but the physiotherapist has stopped the treatment as the pain seems to be worsening.

I have been told by the dr that the spd will inevitably return in a 2nd pregnancy but I think I now have a fear of giving birth by vbac because the thought of parting my knees after months of such extreme pain horrifies me IYKWIM.

[lulumama]

oh that sounds awful, very extreme pain...

i guess the sensible thing to do is to see how things go in second pregnancy..i;ve no doubt if things are that severe again, you can elect for c,s

[Harry2007]

thanks lulumama - it helps just to tell someone about it

xxx

[Eleusis]

I think you are an obvious candidate for a repeat CS. You might run into some resistance upon requesting it. But if you are string, determined, and persistant, you can get one.

But, your SPD experience sounds horrible. I don't think I'd have another child if I'd had to go through that. And you are not recovered yet? Poor you.

[NotQuiteCockney]

The friend who had SPD was fixed via some rather specific physio, it was all about core stability work, some Canadian technique or something. I don't know if this is what you've been having. Maybe it doesn't work for everyone.

[TuttiFrutti]

Getting another planned CS will be no problem.

I recently had my second CS, and I was automatically offered an elective CS because I'd had an emergency one with my first. In fact there was another medical reason, but each time I saw a new doctor, they said "What's the reason for a caesarean, is it previous caesarean?" all ready to tick the box on their forms.

Your SPD sounds a nightmare. I really admire women like you who go through so much to have a baby.

[withwomanmidwife]

Hi,
It would be interesting to know why you had the c/s. Was it specifically because of spd or another reason eg malposition, failure to progress, fetal distress? There are many things that might influence the sucess of future vbac. My daughter had spd first time round. However baby was stuck in the op position and would not budge despite getting to fully dilated. She had a c/s. Second time she did not get spd, baby was in the oa position and she delivered vaginally.....by me!!!! Please speak to your midwife/ consultant about this....all the best.

[withwomanmidwife]

sorry, didnt realise your c/s was planned. Don't worry about next time. Write all your concerns down and arrange to speak to your consultant or a member of the team. Wishing you all the best of luck.

[BetsyBoop]

I had an emergency c/s with DD first time round

I'm pregnant again & just had this discussion with my consultant last week. They were happy for me to have an elective c/s or "trial of scar" as they like to call it. (I think the only reason they would try & push you down the c/s route is if you has CPD or another physical reason, I don't think they'd push you down the VBAC route if you didn't want it)

I opted for VBAC, but it was very much my choice - they want to see me again at 36weeks just to confirm "mode of delivery", just in case anything changes between now & then.

I'd wait & see how your SPD is second time around before you decide, but untimately the choice would be yours.

[Rochwen]

Sorry this is OT. I had SPD when pregnant with my dd and two years on it's still not sorted. Because of that I have decided not to have another child. I could never go through that pain again and had I known about SPD (well, that I would get it and it wouldn't dissappear) before I got pregnant I probably would not have had a child. It cost me my sports career. Harry, have you tried a chiropractor? The physio didn't help for me at all but the chiropractor (who specilises in pregnancy etc) has really helped.

Regarding c/s, I always thought a repeat c/s was the norm and you would have to ask for a VBAC not the other way around. So, what is the guideline. Is it c/s by default or VBAC?

[BetsyBoop]

the NICE guidelines state

"RECOMMENDATIONS
The risks and benefits of vaginal birth after CS compared with repeat CS are uncertain.
Therefore the decision about mode of birth after a previous CS should take into
consideration:
? maternal preferences and priorities
? a general discussion of the overall risks and benefits of CS
? risk of uterine rupture
? risk of perinatal mortality and morbidity."

So once isn't the "default" ahead of the other, it's down to what is best in each individual case.

[Harry2007]

Thank you all so much!

It's so good to think that someone actually cares enough to give advice IYKWIM!

Having a really bad day today with the SPD. Pain is circling around my pelvis and hips at the moment - such fun

You hit the nail on the head there Rochwen - c/s or vbac by default.

I did look at the NICE guidelines but it does seem that every case is regarded individually.

withwomanmidwife - the reason for the planned CS was that the SPD was so severe, my "pain free gap" if you can call it that, was 9cms and I was carrying a 10lb baby. The baby was 8lb 6 when delivered at 38 weeks - early because SPD pain was only being controlled by 4 hourly injections of pethidine and morphine.

I'll let you all know how I get on with the Consultant - I'm really hoping that I'll get to see him soon.

Thanks again everyone

xxx

[Rochwen]

Harry, you have my full sympathy. I hope you get better soon ! Have you tried a chiropractor yet? Try to find somebody who specialises in pregnancy. Good Luck.

Betsy, thanks for the write up of the guidelines. It looks like you can pretty much put your own preference forward.

[jojo41]

I'm an obstetric physio and in several years of treating women with severe SPD I've only known 3 to have had a section because of it. Get your physio to liaise with your midwife to discuss positions for examinations in labour (eg vaginals examinations can be done in left side lying, as can foeatal blood sampling). You can del;iver on your side, or kneeling without needing to open your legs too far. I would say you need to able to open your legs 15 cms to have a good chance. The fact that you had a Cs last time means that your position options may be a bit ltd as your scar will need to be monitored.

[jojo41]

Just scrolling down can't see any mention of the Pelvic Partnership (www.pelvicpartnership.org.uk). It's an excellent website/support group/resource for women with SPD. It was set up by a physio who had dreadful SPD in her 3 pregnancies, and it has a list of recommended practitioners who can help. I find usually that sufferers have a history of ballet/gym/horse-riding/hypermobility/CDH as a child/previous lumbar or pelvic trauma. There is always something that can be done to help from gentle manual therapy to encourage optimalpelvis alignment and symmetry, to home equipment,parking badges,acupuncture, braces (if appropriate). I have just set up Physiotherapy in Pregnancy; I ONLY treat pregnant women.Don't be fobbed off by practitioners who won't treat you,there is plenty that can help.

[eleusis]

I think in your circumstance, you can pretty much have whichever way you want if you are firm in your request to do so.

I had an elective based on having had a previous section.

[Klaw]

I'd suggest getting to a pg experienced osteopath or chiropractor now!

I am pro VBAC but would support your right to choose elCS.

[orangehead]

i had a choice with my 2nd for vbac or section, i was made an appt with consultant about 32 weeks to go through pros and cons. if u have a vbac or 'trial of labour' u r closely monitored which can make an active labour more difficult, and u may still have a section if they not happy. but many people successfully have vbacs

[startouchedtrinity]

Only read OP so HTH.

You can request another section. No-one can force you to have a VBAc but IME they will try to get you to agree to one. If you want a CS then stick to your guns. I have had three sections, one crash, one elective due to breech position and one b/c of the other two and the last two were very positive experiences.