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32 weeks and confused about vbac or elective...when do I have to decide???

(76 Posts)
suMadre Thu 26-Mar-09 23:56:41

Im 32 wks on my 2nd child, ds1 has just turned 2. Was in labor for 4 days but kept in the foetal assessment due to high blood pressure & uterus being 2cm for 3 days...finally made it to 3cm and went to labor ward, had all pain relief and drip to speed up contractions. They tried breaking my waters but the waters were gone (as Id told them but hadnt listened theyd been leaking for weeks)and I was also leaking meconium for a few days. Eventually had emergency cs as my cervix would not move past 3cm.

Up until this week my 2nd baby has been transverse so although I was hoping for a natural birth (and to stay away frm the hosp as long as possible into the labor)I sort of resigned myself to having to have an elective. Thankfully the baby has now moved head down in time for my consultant appointment...but I was surprised that the consultant going through my notes is urging me for a c-section (based on my ds1's size 8'14 ...I am 5'4 and was only 8stone before conceiving him..and on my failure to progress despite the contractions being strong for so long)

Consultant is now sending me for scan at 33+5 to get an idea of the size of this baby. My uterus measures 34cm eventho only 32wks however I barely have a bump this time and definitely dont feel like this is another big baby. So...I suppose the scan will give me a better idea as to size of baby (dont understand why they never did growth scan on ds1 when he was always ahead of dates and uterus always measuring ahead &looked like I was gona pop with twins at 30wks)but will I have to mnake up my mind the following day when I see consultant or will they offer another scan later on!?

Now that babys head is down and I am carrying this baby so much easier than the last one (Possibly the weight Inever shed frm ds1)and so active with ds1...I feel like Id just be giving up to go for an elective... but if I deicide to try for a vbac that could be another horrific nightmare like my 1st birth. Does anyone have any advice or experience of this?If I try for vbac will they induce me early?Will I be monitored? Will I be left at the mercy of the midwives who wouldnt listen to me at all last time despite me being high risk due to health problems(ironically I dont have them anymore but am high risk due to cs)?Will I be left for almost 4 days again? If something goes wrong will I be stuck in the same position waiting for a surgeon to come & might not be as lucky this time!?!Last time I was had blood transfusions and ds1 had infection due to swallowing meconium.

I desperately want a vbac for the following reasons : do not want to be on the post natal ward again (as it was horrific last time and treatment ds and I received was disgraceful and dangerous)nor away from ds1 for long, last time it took 10 days for my milk to kick in (had to switch baby from bottles but managed in the end)...and I wont be able to pick up ds1 for sometime... but these things will be made doubly worse if I go through another long labor with an emergency C...and I might end up in there for over a week again.

Does anyone have an experience of an elective?My sister had one at 37wks due to breech baby and although it wasnt a walk in the park...it seemed a lot less terrifying than emergency C. I presumed I would be urged to try for a natural birth and am a little panicked now that I have to make the decision...dh wants me to opt for elective as both ds1 and I suffered a lot last time...but Im still clinging to the hope that things will be different this time. How do I know if ds1 being so big was the problem...or if its cervical dystocia?

HELP!

becktay Fri 27-Mar-09 06:44:10

hi, I'm in a VERY similar situation to you the only difference is i was induced last time. am now 36 weeks pg w no 2 and had em c sec for failure to progress - induced after high blood pressure. my consultant is pro vbac so feel lucky with her. my plan with her complete support is to wait till 42 weeks and if nothing doing then elective section. if spontaneous labour kicks in i'll have a good old crack at it. If any complications arise like pre eclampsia then elective section. basically i totaly refuse to be induced as it just led to more hassle than it was worth last time.
Have been doing lots of things to try to relax - bloody hard with 3 year old in tow!and basically really talked through last labour with lovely midwives and OB which helped me lay a few ghosts to rest.
I hope all goes well with you and you have a cracking labour and delivery this time. x

becktay Fri 27-Mar-09 06:48:04

oh and the other thing i did was see a paediatric osteopath who gave me a good look over and has reassured me about my pelvis. i didn't want that doubt in labour. they are a charity in london, i think they may have places elsewhere but they were marvelous. here's the link;

www.fpo.org.uk/Secondary/Osteopathy/mothers.html

suMadre Fri 27-Mar-09 10:32:01

Hi becktay I hope everything goes well for you too! I definitely dont want to be induced,after 3 days they tried to "speed up" my contractions which were bloody strong enough...it was the cervix that wasnt opening. Do u mind me asking what cm u got on ur first labor? Thanks for the link...sorry to be really ignorant about osteophathy but can they tell if you have a problem with your cervix? My biggest worry is that its nothing to do with the size of the baby but that my cervix just doesnt open...as I would have thought strong contractions would open it even without the baby pushing down!?!

suMadre Fri 27-Mar-09 10:32:02

Hi becktay I hope everything goes well for you too! I definitely dont want to be induced,after 3 days they tried to "speed up" my contractions which were bloody strong enough...it was the cervix that wasnt opening. Do u mind me asking what cm u got on ur first labor? Thanks for the link...sorry to be really ignorant about osteophathy but can they tell if you have a problem with your cervix? My biggest worry is that its nothing to do with the size of the baby but that my cervix just doesnt open...as I would have thought strong contractions would open it even without the baby pushing down!?!

Rachey99 Fri 27-Mar-09 14:50:22

I am in a really similar situation and now at 41 + 2 and still none the wiser! Have been 'encouraged' to have elective section as you cannot have the same amount of induction pessaries when there's a risk of scar rupture from previous section, but I am clinging to the hope I will dilate this time. I previously didn't get past 3cm after 36 hours in labour (induced at 42 weeks). Have tried 2 sweeps this week but no joy as my cervix closed and I still don't know what will happen next week, either I will be allowed a short trial of labour via ARM or will have to decide on a section, but like you have 2 year old and want to avoid if at all poss. It is not easy to just resign yourself to having a section, you want to give yourself another go at doing things how nature intended!

newgirl Fri 27-Mar-09 15:07:24

it sounds like you are in a great position to go for your vbac - have you thought about talking to someone from the nct - a one hour appt - to talk it all through? they were very helpful for me

i had an elective c section and it far far easier than the emergency - i recovered faster and did not feel traumatised. I also had another child and it was ok this time as we all knew what to expect and my partner took 3 weeks paternity leave.

whichever you decide the best of luck and i hope you are ok and have lots of fun with your new baby smile not long now!

MrsBoo Fri 27-Mar-09 15:21:03

I know it is different for everyone - but I had an elective CS for my second DC. It was way more straight forward than the first EC.
I had a fantastic recovery both times mind you - and prety much able to do evreything after about one week.

iwantitnow Fri 27-Mar-09 17:47:45

I had an elective 10 days ago. I recovered very slowly after emcs last time, this time I am nearly back to normal already although not lifting my toddler yet or driving yet. I only spent 2 nights in hospital so DD was not too distressed. My milk came in on day 3 so no delay there, probably because I got to have skin to skin straight away. For a number of reasons I didn't think my chances of VBAC were high and I definitely didn't want 24 hours of labour and emcs again. My elective was a really positive experience. They insisted I spent the first night on the ward (not a good experience) to "look after me", the next night I paid for a private room where I got some sleep.

I also hired a post natal doula to help me round the house 2/3 days a week for the first month but to be honest that is a bit of a luxury as I feel so well.

suMadre Fri 27-Mar-09 19:21:20

Thanks for all the advice/experiences. I am coming round to the idea of an elective as I think it may be best for me, baby and my ds1 too. I recovered amazingly well frm first cs eventho I lost a lot of blood and had 4day labor marathon before hand...I know it would be a lot better with an elective... I guess there are pros and cons and as someone said before its all luck...none of us can see into the future and know what will happen. Unless the scan shows ds2 isnt very big I think I will be going for the elective..it would be a dream come true to give birth naturally and without complications but it depends on what chance I have of that actually happening. I dont have family around so definitely will need some help...this sounds like a silly question but if you hire a private midwife or doula will they be allowed stay with you for the first night in the post natal ward?The worst part of the entire experience last time was not being able to reach over and pick up ds as he vomitted and swallowed meconium...ringing the bell and no-one coming or doing anything!DH for the next2nights tried hiding behind the curtain after hours but was always discovered and kicked out.Was being in a private room not worse as they dont come to check others so dont come at all???

becktay Fri 27-Mar-09 20:15:12

Hi SuMadre,
I got to 6cm last time - after about three days!! Have decided to leave myself in the hands of the labour gods now.
Osteopathy is more for muscle/bones etc, just gave me a bit of confidence that my pelvis is flexible. DS1 was really high up and not pushing on cervix for me hence 'failure to progress'.My OB was worried about my pelvis being narrow and I found that a bit of a mental block which the osteopath has removed.
I'm in the what will be will be frame of mind now - can you tell!
x

suMadre Fri 27-Mar-09 21:12:53

lol I think all the uncertainty is whats getting to me...last time some of the mws said they thot ds's head was resting on my back the wrong way hence the back labor and cervix not opening...the cord been wrapped round3times also might be a reason he cudnt push down (Thank God) I think you're very brave waiting til 42 wks I dont know I could do that. If you change your mind at 40 wks will they give u an elective then? Consultant was very brief...am going to have to have a proper talk and take dh with me next time (although its a different consultant)

newgirl Sat 28-Mar-09 12:34:13

sumadre - i dont know the answer about having a doula in the ward but i do know that with my elective i felt completely different from first time and I could reach over and pick up baby straight away as long as I was in the right position.

you wont be exhausted (sounds like you had a very long tiring time) - it will be a planned time so probably in the am so you will feel refreshed. WHen you want to pick up baby, make sure your bed is raised to a good height, tuck a pillow infront of your tummy, then reach round to pick baby up. The advice I was given was dont pick up anything EXCEPT baby - so as long as you support your very tender abs with a cushion (more psycological than anything) you will prob be ok

Mummyfor3 Sat 28-Mar-09 12:43:23

Here is what worked for me:

Supportive consultant; IMO v important
Not induced, spont labour started 41+5, so hang in there
Bouncing on birth ball whilst watching telly grin
Raspberry leaf caps
Lots and lots of physical exercise (teaching DS2 to ride his bike without stabilisers got me going)
Acupuncture once I went past my dates

I drew the line at having sex wink.

As you have not (yet!) delivered vaginally you have what is known as an "untested pelvis". There are no certainties and nobody will be able to predict with absolute acurateness how you will get on. Obviously if your baby is in a better position this time, there is reason to be optimistic.
Defo speak to your consultant and make sure all your questions are answered.

FWIW, I can honestly say my VBAC was my best delivery experience (after induced vag delivery and emgCS) and I would not hesitate to try again...

Best of luck to you!!

suMadre Sat 28-Mar-09 14:14:25

Thanks I guess it can go either way...last time I was so prepared had been using birth ball(but they wouldnt let me take it in the foetal assessment and by the time I got to labor ward I was just happy2be druggd up on bed)and taking raspberry leaf caps...rubbing wheatgerm oil on perenium etc..I thought I knew it all and would be able to do it no matter what,ds had been engaged for over 2mths and I thought everything would be ok...but then my bp was high and they kept me in and it all went downhill from there... this time im not so naive and knw its actually all out of our hands and upto God... but Im really encouraged by the successful vbac stories and am hoping the consultant tuesday week will give me lots of advice and support.

Newgirl thanks for the advice on elective...I think by the time I had ds I was so drugged and out of it and although I held my straight away and tried to feed...I didnt know what was going on...next thing I knew all the family were gone home and the baby was miles away in the cot...the nappies wipes etc in bags under the bed...even the control for the bed and table where far from reach...I know I forced myself to stretch to reach ds but it was so bad... this time like u said I would have gone in a couple of hours earlier,prepared...and will have my feeding cushion with me & not let dh leave until everything is within reach. Also it would mean seeing my ds1 after the op and hopefully being able to come home the next day or following one...providing I dont have blood transfusions etc again. Last time I didnt eat or drink anything in 5 days due to the long labor I also couldnt go toilet for that period...dont know if thats normal or not.On day 2 after cs I was fine bcos I had to be,walking around getting water etc...I feel a lot more confident about an elective it really does have a lot of pros...

however going to wait for the scan results and then make the final decision...If they estimate baby is over 9lbs it will definitely sway me towards elective.

Thanks everyone and Ill keep u posted.

Academicmum Sun 29-Mar-09 21:47:36

suMadre - I was also really worried about whether to go for VBAC or elective section with ds2. I was down for a VBAC up until 39 weeks and then I started to get doubts so I went back to my consultant armed with a long list of questions e.g. if I try VBAC and need a crash section has there been an incident in this hospital where there has been no surgical team available? He answered that yes there had been cases of that and I decided on the spot for a repeat section. He completed the paperwork there and then and I was booked in for 2 days before my due date. So, although they like to make out that you have to decide early, actually you don't and you can leave it to the last minute.

It is a really difficult decision to make I think and as you know recovery after a section is harder than after a straight-forward (no complications) VBAC, but recovery from an elective is easier than from an emergency and I think a second section is easier just because you know what to expect. For my second section the surgical team played music that we chose and both the 'lead' surgeon and the 'lead' anaethetist were women, both of whom had been on the table themselves and that really helped. I was out of hospital in 3 days and although walking etc was painful it was just easier this time all round.

suMadre Sun 29-Mar-09 22:27:48

Acedemicmum thanks for that I had no idea I could change my mind. The choice is still sinking in as I didnt expect it! I see the consultant (but a different one frm last time) on the 7th of this month when Im 34 weeks...Im going to go armed with a list of questions. I cant help thinking 34 weeks is very early to do a scan and am hoping I will have more scans/consultant visits!? Eventhough u chose vbac originally were u booked in to see the consultant at 39weeks anyway or did u contact someone to be referred? Its very reassuring to know I can change my mind and also another thing to take into account...elective is looking more and more like the sensible option for me...

Academicmum Sun 29-Mar-09 22:44:54

No, I wasn't booked to see a consultant at that point. My original plan was to wait until 41 weeks and if labour hadn't started by then they would book me for a section close to 42 weeks (I didn't want to be induced because of increased risk of scar rupture), but at 39 weeks I started to get really worried so I made an appointment to see the consultant (I was under consultant-led care anyway because of both a previous section and an unusual blood type which may have caused complications) and he fitted me in the next day with the section booked a few days after that. I was told that if I went into labour before the date of the section I should just call the hospital and they would arrange for the section to be done then in a sort of semi-elective type of way.

suMadre Mon 30-Mar-09 17:34:03

Rachey any news on baby?

Academicmum u said u didnt want to be induced because of scar rupture...I havent looked into it mainly bcos I didnt want to think about things this time(last time I knew everything and could do nothing lol)is scar rupture common?and is it common even without being induced? My contractions started on their own last time and were really strong for a long time (but I didnt know they were contractions at 1st,Ithink I had what they call back labor...never felt any pain in my stomach just my back and vagina felt like it would explode the whole time)It is worrying that the scar can rupture or that there might not be a team available if in an emergency/crash situation. Im so pleased for u things went well with your elective. Did u have any complications and have they said how many sections u can have (I definitely want at least 3 kids)

Academicmum Mon 30-Mar-09 17:46:49

If I remember correctly the risk of scar rupture is only very small (something like less than one in 3000) without induction, but rises significantly with induction. I can't remember the figure, but I do know some hospitals won't induce for a VBAC. I found a very good website when I was looking into it with lots of good info. I'll see if I can find it and send you the link.

I know that repeat caesarean can be less preferable if you are wanting another child (I knew without a doubt that I didn't want more after ds2). Who has just woken up from his nap. I'll be back later...

suMadre Mon 30-Mar-09 17:52:26

lol thanks

Mummyfor3 Mon 30-Mar-09 18:27:19

Sorry for butting in; I have just returned to this thread.

Here is the link to the website that helped me make up my mind to try for VBAC. There is all sorts of links from that site as well.

BTW, I was slightly put off by the "Radical Midwives" tag, however it has been explained to me that the association was started up in the 60s in an attempt by midwives to ensure that not every delivery had to have an episiotomy!

And, yes, you can change your mind a the v last minute, nobody can make you have a CS or VBAC if you do not want to, no matter what you may have indicated beforehand.

Good luck, I hope you get the delivery you want.

suMadre Mon 30-Mar-09 19:38:20

thanks mummyfor3 I'll be sure to check it out.

Academicmum Mon 30-Mar-09 21:52:19

Hi again. Here's that link I promised www.birthrites.org/BR_booklet.pdf. Its quite a long booklet, but I think it gives a reasonably balanced view of the pros and cons of each choice. Good luck.

suMadre Mon 30-Mar-09 22:34:59

Thanks for the link...just one line alone has made up my mind for me - re risks involved in ceserean: • Increased blood loss – which may lead to a need for a blood transfusion, or
an emergency hysterectomy

I couldnt control what happened last time and ended up with blood transfusion...this time I have no control either but I definitely want at last 3 kids and if I have an elective section this time then I will never be able to deliver naturally. Also this part struck me
• Each caesarean increases the risks for future pregnancies – the risk of the
placenta implanting low in the uterus (placenta praevia) or into the uterine
scar (placenta accreta) and the risk of uterine scar separation

My emergency cs was two years ago exactly and I have a had miscarriage since then, I cant help feeling my uterus wasnt healed properly...and possibly still isnt...which is scary especially taking the risk of vbac...I know theres less chance of anything going wrong with an elective cs...but I still feel if things go wrong with vbac I will cope as I did last time (and at least I will know I need an elective on the 3rd no matter what) It is a big risk and things could go terribly wrong and Im probably making life a million times harder for myself...but if I go for elective I will always wonder what if??? Sorry for rambling but theres a strong feeling inside me which says vbac despite what dh and docs think...nor what common sense might even indicate.

Can anyone please tell me did they have a vbac without being monitored the whole time and made to lie on a hospital bed? My plan last time was everything natural but once my bp was up and they kept me in the foetal assessment away from dh and mum...on a busy ward with no room to even walk round the bed...and kept me strapped to machines...nothing progressed. If I go into natural labor and ignore the contractions at home until they get really strong and close together am I risking my babys health? I really feel If I try to get through some of the labor on my own at home and then go in when Ive progressed a bit...I might be ok...but the fear of that horrible hospital & the horrible midwives(Im sorry but they were)wont help.

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