VBAC v ELCS - Is it my choice?

[Pinkjenny]

I am currently 19 weeks pg with dc2, and next week I have my consultant appointment to discuss my options.

History: Dd was an ELCS due to breech presentation, and I found the whole experience entirely positive.

So, for my own reasons (none of which are medical, I might add) I think I would like to have another CS. Now, I have it on good authority from a well-known MN doula , that my hospital is Pro-VBAC, and that my consultant is a "VBAC Expert". This has obviously made me a little nervous about the fortcoming conversation. This is coupled with the fact that although I am generally quite a bolshy (not my most attractive quality ) person, I tend to be struck dumb when confronted with medical professionals.

I have a feeling that I will allow the consultant to talk me into a VBAC, and then come out and start panicing about it.

I have a list of questions written down, but I am just wondering, is it really my choice? I assume the consultant has to authorise my request. Any experiences or advice gratefully received.

TIA

[MamaKaty]

YES IT IS YOUR CHOICE!!

Write that at the top of your list of questions if you think you'll be persuaded otherwise at your appointment.

Keep an open mind though - don't let them make the choice for you but DO listen to their reasons for encouraging you to consider VBAC - you never know, you might feel differently with some more information!

[LovelyTinOfSpam]

I had emcs with DD1 and for DD2 was given a straight choice.

I was also told that I could change my mind at any time if I wanted (well until the point of no return, obviously).

Good luck

[Phoenix]

I had emcs with ds1 and when i told my consultant i was leaning towards wanting an elcs with ds2 he wanted to know why but once i explained he booked me an elcs for 39wks but also asked me to go in at 38wks to see if it was possible to induce me by doing a sweep and ARM (no gel due to emcs last time) it wasn't and i had my elcs. I don't know if it's because it was planned or i knew what was coming but i wasn't in half as much pain afterwards (although i've got a wound infection now 4wks after it) and it was so much better than the emcs.

Good luck

[Pinkjenny]

I suppose I am suffering a bit from a guilty conscience as none of my reasons for wanting an ELCS are medical/trauma related. They're all pretty selfish, to be honest.

[Phoenix]

But it could be traumatic if your previous scar ruptures. I wanted one because ds1 was a big baby, back to back and i ended up with the emcs because of failure to progress in the 2nd stage, I was scared of that happening again and also scared of rupturing scar. Ds2 was almost as big as ds1 and was a week 2.5wks earlier than ds1 had been so he would have been bigger.

[peachygirl]

Pinkjenny I felt a bit like you after a section for breech baby 2 1/2 years ago.

I had my apointment very recently and I am going to go for a VBAC.

The consultant first of all asked me what i wanted and I said (which is true) that I didn't relish the thought of either a VBAC or a C section so was open to suggestions she explained all the risks and what would happen in hosptial and also spoke very positively about the hospitals attitude to Vbac mums.

What has made me happier about it all is..

A, That she said catagorically that they would not induce me. I really didn't want this. and
B,that if I hadn't gone into labour by 41 weeks they would give me a date for an elective.

I am back again in again to check the position of the baby and she said they would book a date for me then.

Above all everyone has said that it is very important to keep an open mind about it all.

HTH

[UngratefulLittleMadam]

Hello, I am in a similar boat, have just gone past 38 weeks with 2nd baby and the advice about whether I am being booked in for VBAC, induction, or being left to labour naturally is changing day by day (as are my feelings about all!)

peachygirl is right - keep an open mind. I am now reaching the point where I don't care what happens, so long as something happens, and I had very fixed ideas about what I wanted until about 2 weeks ago!

Above all, make sure that you question anything you're not happy with. If, when the time comes, you are still set on a section, make sure that the consultant who is on duty hears your POV. Good luck!

[Pinkjenny]

It's just because none of my reasons are actually reasons that will hold any weight whatsoever with a consultant. That is what is making me nervous. The guilt.

[LuluMaman]

now lookie here.. all you have to say is:

Dear Mr Consultant, thank you so much for your advice, but I am making an informed decision to request an elective c.section. I trust you will support in my informed decision or refer me to an obstetrician who can support me.

it is your choice, BUT , based on your history, there is no medical reason , other than your previous section to have a c.section

whatever your reasons are for wanting a c.s, they are your reasons, if you feel guilty, then you need to work through that before you get too far along.

also, think about how you will feel if this is your last baby and you have not experienced any labour or contractions and if you will feel sad about that at all ( some women do )

[GentlyDoesIt]

Aw don't guilt-trip yourself, I know it's so hard to know what to do for the best.

Your circumstances might change as the pregnancy progresses and the decision may become a lot clearer. not much use to you now, but keep swotting up on all subjects and hold on to your patience as best you can.

[fanjolina]

I was not allowed an elective under similar circumstances PinkJenny. Our local trust insists on VBACs, unless there are medical reasons for another section.

[Pinkjenny]

Thanks Lulu, I love the first line of that post

I will open my mind and listen to what he has to say.

I will also think about whether I will feel any sadness having never experienced natural childbirth. I will be very glad when this appointment is over. I am relatively sure that this is the same consultant as I had last time, and I do remember that he was very nice indeed, so hopefully the experience won't be too intimidating.

[Pinkjenny]

Fanjolina - you see, I'm actually quite relieved you've said that, as that is exactly what I am expecting him to say!

[fanjolina]

I wasn't expecting it so it was a HUGE shock to me - partic as the hospital I'd had my first DD at (different part of country) had said that due to complications I suffered during the CS it would be too risky for me to give birth naturally. But fastforward two years at a different trust and that is what I was made to do.

[Pinkjenny]

And how did your VBAC go?

[fanjolina]

I failed to progress and ended up with an emcs under GA!

BUT...I was actually really pleased that I went for the VBAC. I read up loads beforehand and felt very empowered. And in no was did I see my emcs as failure, nor do I have any regrets or negative thoughts about the whole experience.

Mostly I just feel strong for having gone through 20 hours of back labour with no pain relief. And my DH was in awe of me!!

[LuluMaman]

what day is your appointment, PJ?

how much of your reasoning for el c.s is based on fear?

it is always easier and more comfortable to go with what you know

staying in your comfort zone is great, of course.

if you want to talk more, you know where i am.

i do know some women do come to regret the el c.s choice, as they wonder 'what if?' and you can;t go back and do it again

obviously lots of women are totally comfortable with it and have a wonderful and positive experience, but it is a big decision and it is good you are putting a lot of time and thought into it

[Pinkjenny]

My appointment is next Thursday. I'm not sure any of it is based on fear, I am ashamed to admit that a lot of it is based on convenience.

I suppose I can also be a bit of a control freak, and I found my cs very calm and controlled, and I liked that.

[lazylion]

The risk of scar rupture is a real one, and if you look into it further it is very scary. You do have proper medical reasons to request a c-section.
My hospital offers c-sections routinely if you have had a previous one. I picked my consultant because she is pro c-section and very good at them. I have no faith in a midwife noticing if things are going wrong. It should be your choice.

[LuluMaman]

there has been numerous links and studies posted re scar rupture

afaik, the risk of scar rupture is equivalent to that of cord prolapse which is a risk for every woman.

also, a c.s is not without risks.

there are risks each way , to the mother and the baby

also, an unscarred uterus can rupture, rarely, but it can happen

i think , on the whole, a MW would notice scar rupture., and there are usually warning signs before hand

i do think though that it is important to look at the pros and cons of both modes of delivery

[lazylion]

Agree Lulu, a good midwife should notice scar rupture but in my experience you don't always get a good one.
I think some of your decision rests on how you feel about experiencing natural birth (or not). I couldn't care less about how it happens as long as the baby gets here in one piece so it is easier from that point of view.

[LuluMaman]

i am in the fortunate position of knowing that the doctors and midwives where PJ is going to deliver are on the whole, absolutely excellent.

i do agree that if you don't care much how the baby gets here, as long as it gets here, then go for the section, but if there is going to be some niggling doubts and what ifs, then a VBAC might be better.

so many things to weigh up!

[peachygirl]

the consultant spoke about scar rupture at my appointment and how that by monitoring and awareness of signs they would be able to pick it up quickly.

She also said if I were not progressing well enough they would consider taking me into theatre. Most importantly she said ALL staff would be aware that there was a VBAC mum on the ward.

I read The VBAC Handbook (sorry laptop isn't letting me do cut and paste for link)and took this into the appointment too.

It didn't help that the morning of the appointment I had a chat with one of DDs nursery nurses and her scar did rupture!! Just what I needed to hear!

[paz1]

hi. i am also in a similar position.

i had emcs last time because of fetal distress due to cord around neck 4 times. they also discovered when she came out that she had been breech (noone picked that up beforehand). it was a pretty traumatic experience - she wasnt in a good way when she came out. i hadnt been in labour and had gone in to be checked cos of decreased movement....i was rushed to theatre etc we were really lucky there wasnt a much worse outcome...it was a very close thing.

i feel i have pushed down the vbac route at every single appointment i have had so far. i dont feel anyone has really listened to how i feel - which is that i am terrified of having a vbac. i have made sure i have done loads of research on both options and have asked loads of questions at appointments. i find i get massively detailed responses on vbac and how the risks of anything bad happening are sooooo low. then on cs i have got answers such as: well they might sew your fallopian tube into the scar!!! and you will be infertile... you cant have any more kids after this......you could end up with adhesions and pain forever etc (this from three different people)...i dont feel this is a very balanced picture. if i knew a vbac would be straightforward i would go for it but there are so many unkowns with it and after last time i am so frightened of feeling totally out of control again. i dont have a real need to experience labour. i would be totally devastated if i forced myself to try and ended up with an emcs - especially under GA. i havent managed to get through an appointment without crying and also now they are worried about my blood pressure...which is actually fine (had it checked at the docs twice this week). its just whenever it gets checked at these appointments i am practically on the ceiling with panic and stress. am not sure really what to do. am i being a wuss? should i go with my instincts and push hard for a cs?