elective booked and imminent last chance to consider VBAC - any ideas?

[ruty]

Elective c section booked and will happen in a couple of weeks. Had an emergency c section last time around, after very long [40] hour labour, blindingly painful contractions and no dilating. Eventually did get fully dilated with oxytocin drip and midwife breaking my waters, etc, but by then after two days and one failed epidural they then gave me an epidural which knocked out my legs completely. Don't know how much of all that was relevant, in the end ds's head so high up and twisted slightly that they couldn't even use ventouse so went into surgery. He was very big, 9lbs 14oz and a big head.
They have suggested an elective this time round because baby looks big and because of complications last time. I really would love to try for a VBAC, my worry is that i had multiple pelvic fractures after a road accident as a teenager, and no one can tell me if this is the reason I couldn't push ds out. Does anyone know anything about pelvic fractures and ability to have a VB afterwards? A niche question probably! would so love not to have to have an operation and stay in hospital this time, but just don't know what my chances are, and want to avoid an emergency c section above everything. Any ideas gratefully received....

[ImightbeLulumama]

i would warrant that a baby in a not very good position, with a big head might have had more of an impact on your labour... do you know if he was back to back? also, if he was not in a great position and your waters were broken, then it would have made it harder for him to turn....

growth scans as you know can be innacurate.....

were you told your pelvis was anything to do with how labour went last time

if you are having any doubts about an elective, it might be worth going for a VBAC, so that you don't have the 'if only / what if ' scenario 6 months down the line

[ruty]

they couldn't really tell me if the fractures had anything to do with it - they sort of said, might, might not. I suppose it is fairly unchartered territory.
He wasn't back to back Lulumama, but his head was slighty stuck and twisted, and he was very high up.

I guess at the moment we are not planning on having any more after this one, but it is nice to be able to keep your options open!

I have to decide whether i am brave enough to go for a VBAC, and whether i am prepared to take the consequences of a possible emergency c section, which i hated last time.

[bringmesunshine]

ruty - I have no experiece of what you have been through but I did want to reassure you that electives are completly different from emergency c-sections.

I have had 2 electives - both calm, peaceful and pleasant experiences...sounds strange but true I have been alarmed by friends who have had emergency sections which have sounded really rather scarey.

You can always request that your DH announces the sex, you have some backgroung music of your choice or lights are dimmed for the actual 'popping out' bit. All might make it a bit more your childs birth...if that makes sense

Good luck with your decision.

[ImightbeLulumama]

if his head position was wrong, and your waters were broken then it would hvae made it harder for him to get in a better position and descend.

www.spinningbabies.com is a good site

i suppose, if this is 'last chance saloon', then maybe you ought to go for it? as riven has said, even some labour is better for the baby..

re being brave enough.... birth is an adventrue, whichever way it happens, with VBAC for you, is it more fear of another long and exhausting labour? if you are seriously considering VBAC , then a doula might really be worth it

[ruty]

Cor that is a fascinating link lulumama - will try to get time to read it all today. Seems to make sense with regards to my last experience. Whether i can really amend almost a lifetime's experience of my pelvis being a bit out of kilter i'm not sure!

The reasons i don't want another emergency c section are:
1]had a very bad experience with a hostile midwife after middle of the night c section [took ds away, fed him without my consent, etc], and totally alone after dh was sent home within minutes of op. Was obviously disoriented and exhausted too.
2]Just the sheer panic of the thing, would rather go in prepared psychologically and have it at a civilised time of day when my dh can stay afterwards.
2]risk factors of emergency c section [eg blood loss] apparently higher than elective, though obviously i know a succesful VB least risky.
I'm a bit worried though about being able to breastfeed when they want to do a c section at 39 weeks, don't know if my milk will come through.

Good to know about your pleasant experiences bringmesunshine, i would like to have music, etc, that sounds great. Those kind of things are reassuring.

[ruty]

i wondered if i could put off an elective until 40 weeks, as you say some labour is better for baby, and the baby would be more 'ready' then i suppose. I'll have to ask next week.

[franke]

Ruty, I can't answer any of your specific questions but I too had an em cs first time round which I was completely unprepared for. The next time I decided to try for a vbac but always said that if it didn't work out I would go for another cs, I just wanted to try. This was a very different mental attitude and I believe I would have been quite benign about the outcome if I'd ended up with another cs. (as it was I had a pretty normal vb).

I think if you're really in 2 minds, as others have said, I would really think about at least trying for a vbac. Your body knows what to do, after all, if you got to full dilation last time.

Also a close friend decided to try for a vbac but after a long labour ended up with another very calm cs. She doesn't regret for one minute that she tried and wasn't at all traumatised by the final outcome.

It sounds as though many of your fears are based around the below-par aftercare you received - I would recommend a full and frank discussion with your caregivers in advance and a written birthplan which includes how you would like things to be afterwards. Good luck

[ImightbeLulumama]

there is no reason at all that you cannot delay until 41 weeks , or even 42, to give yourself the best chance of a VBAC.

a normal full term pregnancy is anywhere between 37 - 42 weeks. we just get fixated on 40 weeks!

also, you can do a very specific birth plan that outlines your wishes re breastfeeding and no formula. your DH should not have been sent home until you were ready to go to the PN ward.

you will be stronger and better informed this time, as wil your DH, to make srue your needs are met this time

and again, a doula can help!

[PortAndLemon]

I had a very similar birth experience to you first time (40 hour labour, eventually got to fully dilated, pushing didn't seem to shift DS, his head was coming down at an angle so they couldn't do ventouse, and he was a big baby (10lb 5.3oz).

Three weeks ago tomorrow () I gave birth to DD by VBAC -- you can read the full story here. I had dithered a lot before getting pregnant and in early pregnancy about whether to go for repeat section or VBAC, but for me I am so glad I went for VBAC. While I recovered well from my c-section first time the recovery this time was easier on a whole different scale.

That doesn't mean it's what you should do I didn't have the past fractures to contend with just my viewpoint.

[ruty]

what a lovely birth story Port and Lemon - i would love to have a birth like that! Food for thought. Sounds like you did have a very similar experience first time round, my problem is not knowing why i had that experience and whether my funny old pelvis will 'work'!
Lulumama i did have a written birth plan in my notes last time but nobody seemed to bother reading them. i will certainly be more assertive about what i want this time and so will dh.
Franke, if i have the courage to do it that way i will. I think not having a choice about when and who does the op kind of scares me.

[ImightbeLulumama]

your DH or you has to thrust it into the hands of the MW, and make sure the relevant bits are underlined and in red!

[ruty]

nobody is taking the baby away from me this time! And dh has orders to stay with the baby if i have to be separated for whatever reason. I dread seeing that horrible midwife again [all the others were nice]. Aaargh. what to do.

[franke]

Ruty - you will be more assertive this time whether you opt for "trial of labour" or el cs. I was very, ahem, assertive second time round . There's some good advice here and I can see how the pelvis issue makes the decision more complicated for you - especially as you can't get any conclusive answers. Good luck in whatever you decide

[ruty]

thanks franke
I guess i was hoping someone might come along who'd had previous pelvic fractures and who had managed a VB, maybe MN is big but not that big!

[orangehead]

I had a vbac after a emergency section, in my experience the hosp explained that they was no reason why I couldnt try for a vbac but it was fine if I wanted an elective section, they gave me all the fact and figures on both and left the decision to me. From what I have heard this is usual to leave the decision up to you unless they is medical reason why a section is better. Its seems a bit strange that they have suggested a section, Is it possible to talk to them again to find out why they thimk a section better

[pinkyminky]

Riven - my fertility certainly hasn't declined after two sections! It only took us a month for number three bfp! (anecdotal I know, but still)!

[ruty]

thet had left the decision up to me until the last appt, and i had been umming and ahhing, and i was surprised when my kindly old prof consultant came out with the recommendation. In a way it was a relief to have the decison out of my hands and so i went ahead and booked the date. Perhaps he has a feeling that because baby is big again [i know scans can be inaccurate but he is pretty sure] and because of last time and the wonky pelvis he decided to suggest it. I was surprised though, last time they left it to me and i tried for a VB.
Mind you I've had flu for the last week and the bump hasn't grown as big as it was at this stage last time. Maybe she will be smaller!

[ImightbeLulumama]

ruty, have you had an MRI scan or anything like that to assess your pelvis between pregnancies?

[ruty]

my last MRI was before my first pregnancy Lulumama, and they said it didn't show any obvious problems except for a torn disc but that didn't mean that there wouldn't be any problems! That's why i tried for a VB first time. They don't seem to know much about the situation really. No one suggested an MRI in between pregnancies though, i guess because there was no one looking into it.

[pinkyminky]

Can you speak to a specialist in pelvic fractures, so you can find out a bit more about how well you have healed etc.?

[pinkyminky]

I know people who have had problems as a result of a tilted pelvis, but not sure if that is different to your situation.

[pinkyminky]

Sorry, missed you last post there, Ruty.

[mistermoo]

Sorry, don't know anything about pelvic fractures, or your very specific situation. But it does seem to me that anyone, pelvic fractures or not, would have a hard time getting a baby out who was stuck in that position, esp after waters were broken.

Don't know how your fractures healed etc., but I believe its the ligaments between the pelvic bones that have to do all the stretching to let baby out...? This link to Gloria Lemay's 'pelvises I have known and loved' is quite reassuring...
www.midwiferytoday.com/articles/pelvis.asp?a=1&r=1&e=1&q=pelvis

It's entirely your decision, but some labour is v good for baby, and for your milk production too. Maybe you could get a doula, and create a very specific birthplan for labouring for a short time, with a calm transfer to CS if looks like nothing doing. Then you could have as many of the benefits of a 'planned' CS with as many of the physiological benefits of labour too.
You never know, this one might just pop out before you know it...

[VictorianSqualor]

ruty, as you know I understand what a hard choice VBAC/ELCS can be, I don't have any advice except be comfortable with what you decide and remember even as you walk down to that theatre you can change your mind, just as you can once you're in labour, you don't have to make that decision til the very last minute, just get an idea of what you think you want to do and remember it is flexible.

Good Luck