39 wks, still not sure whether VBAC or ELCS... very confused, please help!

[SmallScrewCap]

After a section in 2003 for transverse lie, I have always wanted to VBAC next time around.

I am due on 25th August and have been preparing myself for VBAC all the way through my pregnancy (trying hard not to set my heart on it, in fact).

Anyway last week I developed signs of pre-eclampsia and have just had a horrible week going in and out of hospital for the night. Seems my liver is struggling. At one point they were going to induce me with pessary for 24 hours - which freaked me out because my consultant has been saying all the way through that induction is too dangerous for VBAC and that I wouldn't be allowed to labour more than 12 hours anyway. So I challenged this and they agreed that my symptoms weren't serious enough to induce, and agreed to just give me a stretch & sweep and sent me home.

Then (after a whole hour at home!) I had a watery bloody show, which freaked me out as it reminded me of a miscarriage years back. Was told to go back into hospital to check waters hadn't gone and prepare for labour to start. At one point I was having 4 contractions in 10 minutes and feeling quite optimistic, it hurt but in a productive way and I was doing a good job of reminding myself that these pains were not miscarriage pains, me and DH had our music on and I was starting to get into the zone nicely. I was told that they had booked a section in case I hadn't got baby out within 24 hours of watery show and I was feeling peaceful with that, thinking I can try and labour but if nothing has happened by tonight the baby will be safely in my arms one way or the other.

Then a new consultant came on duty and said no provisional section would be booked as medical need not strong enough. I flipped out at this point - and my contractions stopped. At this point I had had 4 days of being pissed about, very little food or sleep - I think my body decided enough was enough and closed down again.

I have now been sent home and am being called in every day for foetal monitoring and having my mild pre-eclampsia symptoms checked over. I can't spend any more time on the ante-natal ward, really I can't, I need to sleep and eat and not listen to women in labour all night long.

I have asked for an elective section to be booked for me near due date as I just want an end point in sight to the whole thing now. I can't believe I am asking for a section, I am very sad that my VBAC is slipping away from me but on the other hand I don't want to go through childbirth when I am this knackered and confused, with maximum inductions and interventions.

In summary I am now frightened of going into labour naturally, because it seems that it will be interventions city, but equally don't want to have an ELCS just because my courage failed me in the final week.

Has anyone managed to read all that and can offer anything encouraging to say?

[SmallScrewCap]

Also for future reference I have been under the advice of MANY different duty consultants this week and have heard the following professional opinions about VBAC:

1. No induction whatsoever for VBACers as too risky for uterine rupture
   
2. Induction by pessary for 24 hours fine, but no more
   
3. Induction by pessary for 24 hours and then breaking waters artificially fine, but no more
   
4. Induction by 24 hr pessary, breaking waters, then up to 24 hrs on drip is fine (that was the one I questioned and refused)
   
5. A VBACer can demand a section at any time
   
6. A VBACer can demand a section, but it will be low priority if no urgent medical reason and can take up to a week from the time of request.
   
7. If labour starts naturally, active labour only allowed to progress for 12 - 16 hours before emergency section
   
8. If labour start nsturally, will be allowed to continue for as long as it takes for baby to arrive.
   
   It's so hard to know who to trust. I just want someone to tell me what to do for the best, and I appreciate that it must be my choice, but frankly I have little idea of what my choices are by now.

[Hangingbellyofbabylon]

I totally understand what you mean about the misinformation - I've been told no induction for vbac then hear that my friend was given the pessary for her vbac. No-one seems to want to commit at all. I'm in a similar position in that my labour is likely to fairly intervention full because of my last pregnancy but at this stage (35 weeks) I still want to try for a vbac as I had forceps with dd1 and then the section with dd2 and I found recovery a 100 times easier after the forceps. I think only you know how you're going to feel when the time comes, I can totally understand that you want a date in your mind, especially with all of the added stress of the pre-eclampsia. No real words of advice except to say that whatever you decide fight your corner for it - and make sure your birth partner also fights on your behalf. I've already told dh he needs to grown titanium balls so he can be strong enough for the both of us

[SmallScrewCap]

Thanks Hangingbellyofbabylon.

Titanium balls would be very helpful!

I'm interested that you seem less worried about the prospect of an intervention-full labour than me - maybe in my case it's fear of the unknown.

The trouble for me is that it's very hard to be told by a consultant for 6 months that induction increases the risk of uterine rupture, and then be expected to just sit back and happily accept a pessary/water break/drip because the consultant on call that particular night is of a different opinion.

I am up for induction and intervention if there is a very good reason and several professionals are in agreement about it, but I can't relax when the goalposts keep changing like this.

Add to this my poor 6 year old DD who has been sent off to babysitters twice this week and told that next time she sees me it'll be with the baby (because that's what the last consultant told me).

[SmallScrewCap]

And another thing - did anyone change their minds between VBAC and ELCS (and maybe back again!) close to the end, and if so how did the hospital take it?

[Hangingbellyofbabylon]

I can imagine you are worrying about your other dd too, it's really tough for you all. I think that I am in a bit of unique position because my c-section experience was not great, delayed and not handled well resulting in my dd being disabled. So I guess in my mind, c-sections don't save babies whereas the first delivery with forceps did the job. I have considered rupture but again I think after nearly losing dd I feel a bit invincable! They've given me till 41 weeks to try a vbac so I'm hoping for the best. I think they are used to women changing their minds and I think you have the right to do so at any point. I keep telling myself that whatever happens I'll be holding my baby girls in my arms soon.

[SmallScrewCap]

Thanks again. Sorry to hear that your section was not handled well and resulted in your DD's disability. It's good to be aware of the possibility, though.

That's why I'm torn - do I take the offered elective section and have things done in a steady, planned way (not risk-free I know, but LESS risky than a crash section), or continue putting off a section for the sake of getting my VBAC and potentially cause harm to myself and therefore LO?

It's such a tough call. At the moment LO is very healthy by all accounts, it's just me that's falling apart - so I'm happy to struggle on for another week if I'm being carefully monitored.

[SmallScrewCap]

actually reading that back it's not a tough call at all - reads like any sane person would take the offered section! However I know from experience that section brings its own risks, not just during and after, but for a long time to come. I had abdo pain for 4 years and PND for 2. My reasons for wanting a VBAC have less to do with being an earth mother, or experiencing childbirth - it's more about what would be simplest and quicker to recover from, really.

[SmallScrewCap]

bumpity

[discojen]

SSC I think I would go for the ELCS, VB (in my experience) isn't always the easiest to recover from.

[SmallScrewCap]

Thanks everyone, this has really helped.

Have weighed it all up and decided with hospital's agreement to give it another couple of weeks to try and VBAC.

[Caro1302]

Good luck with your VBAC. I think you've made the right decision. I had an emergency section with #1 and a VBAC with #2 13 days ago. Even with a 3rd degree tear my recovery was much, much quicker than after my section. My stitches were sore for about a week afterwards but the painkillers that the hospital gave me made sure I wasn't in any real discomfort. I can't tell you how much easier it was to recover.

Because I went 8 days overdue and had high BP I was offered a choice of section or having my waters broken (with a 2 hour time limit for progression before further intervention of Syntocinon drip). I opted for the breaking of my waters, and just over 4 hours later I was holding my baby daughter. Go for it, and good luck!

[SmallScrewCap]

Wow Caro, that is great to hear! Well done and congratulations on the arrival of your daughter! I've been really spooked by the thought of induction for VBAC, so I will add your story to my mental strengthening list

[Hangingbellyofbabylon]

Smallscrewcap - I think you've made a great decision and well done on getting your lo to be in a good position. I really need to think about that as dd1 was back to back and dd2 tranverse lie. I look forward to hearing your good news very soon.

[oneopinionatedmother]

get some sleep to prepare you for whatever happens next

good luck.