Feeling low about chances of a VBAC

[phdlife]

After a textbook-perfect labour, ds was an emergency cs. "Failure to progress in 2nd stage." I don't really regret that - I knew he wasn't coming out, could feel his feet under my ribs. Nobody really knows why not. He was large, but not ridiculously so; he was in the right position but could've had his head tilted; that full bladder nobody told me to empty might've got in the way; we just don't know. I accept this.

I would still like to try for vbac with #2. But 2 very different consultants have both said they'd rate my chance of success at about 30-40%. Partly the fact that last time didn't work out for no apparent reason, partly that second babies tend to be larger. And, I guess, partly because they intervene more quickly in case of uterine rupture. I get all that, too.

But only with my brain, apparently. Even though I know that ultimately, I'm not In Charge, in the way us type-a control-freaky oldest-child virgos like to be in charge, I am still feeling like, if it doesn't work out, I'll be some kind of failure. (Because THAT's a helpful 'tude.)

I've been doing some of Janet Balasakas's exercises, have a birth ball (which I can sit on for about 5 minutes before my back starts screaming), but I'm unavoidably less fit than last time. I don't feel ready or strong or empowered or any of that good stuff. At all. (6 weeks to go or thereabouts.) I feel like ... I dunno, like it's a done deal, like I might just as well go for an elective and save everyone the hassle of another emcs. Like - well, just a bit low, really.

Come and share your stories. Give me a poke and tell me I'm being silly. And pass the muffins.

[VictorianSqualor]

Nice consultants.

The risk of CS in a VBAC is higher than for a non-VBAC, but not by much. If they can't tell why you didn't progress to second stage last time how can they make judgements based on that this time

Size of baby really isn't that important, I'm sure lulu will be along to explain more about this in a moment, but gravity plays a big part in giving birth so a bigger baby can be a Good Thing.

WRT uterine rupture the risk is approx 0.5%, the same risk as for prolapsed cord, which no-one deems necessary to mention to mothers due to give birth so the weight they afford to uterine rupture in VBACs is a bit too much in comparison!

If you want to try for a vaginal birth, then do so. I was all ready for a VBA2C last pregnancy and booked up an ELCS at 41 weeks(after canceling one at 39 weeks and one at 40 weeks) because of placental issues, so you can always change your mind.

Lastly, you can be in charge, you can be in control, but of your decisions and choices, not of the way your body decides to do things. Have you thought about getting a doula?

[Poledra]

Hello phdlife, why on earth are your cons being so negative? I had a fine labour with DD1, in the pool, got to 9cm then it all went horribly wrong and ended up with em c-s under general anaesthetic. She was big (8lb 4), and was probably brow presentation. It would have helped if they had believed me when I said the epidural wasn't working, but hey-ho.

I have had DD2 and DD3 vaginally since. I didn't do anything special, just had a ball (which I'd had with DD1 anyway) and did the resting on all fours thing etc for OFP. None of my babies had lain the 'right' way - they are always on my right side, there must be more room there or something. Both these babies were bigger than DD1 (8lb 11 and 8lb 15) and all 3 had enormous heads. DD2 was forceps delivery, DD3 was not assisted out (though was induced for reasons completely unconnected to my previous section).

There was only one time they intervened based on my previous section, and that was after I'd been pushing for 1.5 hours, the obs felt that was long enough and that I needed some help, hence the forceps.

If you want to know anything else about it, let me know. Have you talked to your mw about this - I found my community mw and the consultant mw in the hospital to be a huge asset to me in getting the births I wanted.

[iwantitnow]

This is a great article

www.rcog.org.uk/resources/Public/pdf/green_top45_birthafter.pdf

However, for me it means that I am now armed about why I want an elective but I have nearly every risk factor that lowers your chance of a VBAC but it doesn't sound like you do - how did they get from 70% to 30%? I have the opposite where the registrars just keep going on about VBAC.

[lizzytee]

I've posted on a similar thread - am 31+5 with dc2 (dd1 delivered by emcs as a footling breech). I have not had particularly positive responses from docs - I would really recommend you discuss your preferences with a midwife. Their viewpoint will be very different - one pointed out to me the blindingly obvious point that docs won't participate in a wholly successful VBAC so tend to hold an inherently more pessimistic view.

Do ask as many questions as you can about hospital protocols - once you know what they are, then you can make more informed choices and discuss them.

[vacaloca]

I think it's quite normal to feel like that when you've got 6-4 weeks to go. I was planning a VBA2C and at that stage I really didn't have much hope at all. DD1 and DD2 had been EMCS for failure to progress during the first stage. I never got beyond 6cm. Neither of them engaged, both were 9lbs and possibly not in a good position. So when I was told I was expecting a boy who was likely to be larger and still no engagement and I was very unfit because of SPD so not much chance of OFP exercises and he still wasn't in a good position I honestly didn't think I'd manage it. But I did . Get a doula - I really believe she made all the difference.

[phdlife]

thanks for this all.

my UK consultant was a bit useless about his reasons for the low estimate - don't think he was used to being asked WHY .

My Australian consultant is fab though - seems to like me asking questions! She simply said that the 70% success rate tends to be women who had planned CS or early EMCS last time - either elective or because of baby's position. Women like me, who had a perfect labour, beautiful dilation, ideal presentation, etc., and then the baby still didn't come out, well, they tend to be at the lower end of the success rate. She clearly doesn't mean to be discouraging (she snorted at UK doc's mumbling about my vast age) but wants me to have as much info as possible about what is likely.

Think my major issue is just getting my head round what VS said - "you can be in charge, you can be in control, but of your decisions and choices, not of the way your body decides to do things." I know it, but I'm too control-freaky to be happy with that

btw no way I could afford a doula, but have been thinking about taking my dsis, who is a v experienced MW ("well then, let's prove them wrong!") in as a second birth partner. Still considering though how well I'd cope with being bossed around my little sister

[TheApprentice]

hi. I'm surprised your consultant is being so negative. Mine actively encouraged me to go for VBAC.

In my first pregnancy with DS1 I didnt dilate despite my waters having broken 48 hours previously and being on the drip etc etc. I had to go for emergency section under general anaesthetic as epidural, spinal block did not work. As you can imagine I was not particularly hopeful about a subsequent pregnancy being a VBAC especially at my age - 41. However, I'm pleased to report that despite me doing very little in the way of exercises etc I was able to deliver naturally the next time (this was 6 months ago) - DS2 was in a perfect position, and although I was on the drip again as labour was not progressing fast enough, the delivery went very smoothly.

Sometimes some things are just meant to be, I think. Its hard not to be in control and of course there are things you can do to encourage natural birth, but ultimately its not really down to you, or for that matter your consultant. I wish you all the best.

[Lulumama]

if it was a 'fluke' your baby did not come out first time, then surely as much chance of this one actually coming out ? IFYSWIM

a full bladder can impede descent

as can being on your back

being immobile, working against gravity

also, your baby might have had his head at a strange angle and that can make all the difference.

you might never know why, but i warrant if you don;t try for a VBAC, you will feel worse emotionally in the long run, if you feel low about a planned c.s now.

what does your sister think?

[Olissa]

This is about me and not about you but thought it might give you some hope

First labour was induced at term + 15, baby not engaged and OP. Got to 9cm and stuck there, emCS.

Second labour was spontaneous at term + 18... baby not engaged and OP (cue panic and I admit it, tears!) This time I got to 8cm and stuck there for a good three hours... but I think that was DD turning around, and she was a VB in the end I pushed for an hour and forty minutes and had to have a little help (forceps lift out) but still felt much better about it than I had about the CS.

Oh, and my second baby was exactly 1lb SMALLER. No guarantees...

I think having your sister for support sounds like a fab idea. And I agree that feeling a bit 'wobbly' at this stage is common. Best of luck!