What questions should I be asking the obstetrician in deciding to have a Vbac or CS?

[SenoritaViva]

My last birth I ended up having an emergency CS. The obstetrician advised me that there was a 20% chance of me being able to have a vaginal birth in future and therefore she recommended an elective CS next time.

I am now pregnant again and the MW is persuading me that a Vbac would be better; I have an appointment with the obstetrician to discuss my options but can't think of all the questions I need to ask. Problem is I gave birth abroad last time so no one has my medical notes, it's all rather based on hearsay rather than my specific case.

Any advice would be appreciated so I can go fully prepared.

[tiggersreturn]

your best hope would be to track down your medical notes and/or a letter from your former ob so you can take a view on just why the last birth ended in an emcs.

Short of that, you need to go through your experiences and from memory work out what were the steps that resulted in you needing an emcs. Also you need to find out or get them to scan you to find out whether you had a vertical or horizontal scar. If vertical (older type) then your chances are dramatically reduced and risks are majorly increased.

When you have this information you'll all be better prepared to make decisions and you'll also have more of an idea of chances of success and whether it's worth doing.

If they try and persuade/force you into a decision without having the facts ask them:

1. What type of scar do I have? (This can only be found out internally ie xray/ultrasound as an external scar may not mirror the internal one)
   
2. Why did the last birth end up in EMCS?
   
3. What are the statistical rates in this hospital for vbac from this type of EMCS? (There are varying ones everywhere.)
   
4. What % of these successful vbacs are instrumental?
   
5. What are your policies on cfm, epidural etc for vbac?
   

HTH

[SenoritaViva]

Thank you that's really helpful and the kind of stuff I was looking for! Unfortunately, tried to recover notes to no avail.

I know a little about my last labour but what the obstetrician who delivered my last child said just totally conflicts with what the MW says. You never know, the obstetrician might say something different but I want to be armed with questions like the ones you suggested rather than waft in there and have them make the decision for me. I do feel like I'm being asked to run a marathon having been told that the likelihood is that I'll fail to finish...

[tiggersreturn]

Have a look at this link too and download the guidance www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-information-you that might explain the obs' comment and also help you get clearer in your head what you think your real chances are. Saying which it is always a gamble if you go for a vbac and you could be in the small % who succeed for some types or the small % who fail for others. Remember that you do need to find your hospital's success rates for the particular reason you needed emcs last time as well which the consultant can give you.