To ask what you would do - planned C or VBAC?

[Rebeccaslicker]

baby number 2 due in a few weeks and I need to decide if I want to plan a c section or have a VBAC.

First was technically an emergency c section following a failed induction (suspected large baby due to GD), but in reality there was no emergency; I waited a few hours between the decision and the operation, it was all v calm (apart from my epic projectile vomit, who knew they have a Henry the Hoover for sucking vomit off everything?!) and I had a quick and easy recovery. That was 2.5 years ago.

This time will be the second labour; the baby is so far measuring about 75th centile; and is so far in a good position for labour. The hospital calculate I'm low risk for rupture, blood transfusion etc.

Could I ask people who've had a similar decision what you did and why? I can't decide which is better!!

I had Emcs for failure to progress with my first. I am quite small, and he was stuck. But I was in labour for three days before that dcision was taken, and was absolutely exhausted. I had an infection in my stitches and took longer to recover I think as I was so exhausted from the off.

I was pushed towards vbac with my second and agreed to it. But in the end he was an Emcs too, again for failure to progress. He was 9lb 5 x
Oz and that is by far the biggest baby in my side or DH's side of the family. I am also the first knee in either side of the family not to have delivered vaginally. He was also positioned with his bum side facing my front which nobody had picked up in during my pregnancy. Recovery was slightly better than with my first Emcs, despite me being 4 years older at that stage (I was 36) and that was I think due to not being in laboir so long as they wouldn't let me labour as long due to the risk of rupture. With hindsight, I wish I'd pushed for an elcs.

After he was delivered and I was in the ward, the obstetrician came to see me and said that if I was planning a third, to insist on an Elcs.

My first birth was a planned CS because of a breech, I had had 3 miscarriages and although I wanted aVB I wanted a healthy, live baby more. He was a back to back footling breach, gynaecologist said that he would never have got out vaginally. After that I went for another planned CS because number 2 was also breech. she decided to come 3 weeks early so it was a bit hurried after my waters broke. It was easier to recover from the first than the second because I didn’t have another child wanting my attention, not driving was more frustrating second time round, and I also got a womb infection that laid me low. If she hadn’t have been breach I would have tried a VBAC.

By the way other than the initial quick check with the monitor when I arrived at triage to check I was contacting/ in labour I wasn't on any monitors. I was 6cm dilated when I walked down to the lane suite. Once there I was free to move around and go in whatever position I liked. I used a tens and then nothing... it wasn't painful as such just a lot of pressure like needing a huge poo. 2 pushes and out he came. I don't remember feeling any burning or stinging. The worst part of the whole thing was the local for sewing up the tear.
My baby as 8lbs 9 so not tiny.

The recovery was a walk in the park...i wouldn't want to deal with an active toddler and a c- section recovery.
The way I saw it before I decided was it was worth a shot... if it didn't work then it would be a emcs.... if it did work then a normal delivery. For me going for the elective took away any chance of a normal birth and a guaranteed major op.
But I did my research. I was fully dilated with number 1 (in just over 3 hrs from Labour starting) so I figured I was a quick labourer and therefore less likely to need intervention the second time providing baby was in a favourable position . I was right....2 hours from start to finish. It was intense but brilliant.

Yeah a lot of anti vbac. All mine were excellent and a hell of a lot better than being cut open and all the risks that that entails.

Wow @ProperLavs that's really helpful language to use for those of us who are making the decision.

From what I have read on here and elsewhere a straightforward VBAC would be preferable to an ELCS, but given that in many cases the mother faces the same - or higher - risks as she did in the original CS, a straightforward VBAC is unlikely.

Quite. Comments about "ruined vag" and "being cut open" aren't really helpful either way!!!

I chose vbac. Best decision ever, for me. Birth went well, baby breastfed well, recovery was brilliant.
It was an all round opposite experience from my first and I was much happier during the post partum period because of it.
Good luck, whichever you choose

My 1st dd was an emergency cs after 23 hour labour and baby being back to back.

I did a lot of research into cs for baby number 2, mainly because I was self employed and I had to know when I was going to be fit to return to work. I discovered that if you have to be induced after a cs, you are 90% more likely to end up having an emergency cs!!

I opted for an elective cs and two days before it was due, i had my 2nd dd after very unexpectedly on the kitchen floor after a 2 hour labour.

Both pregnancies were very different. With number 1 I had a very sedate office job, I was 28 and reasonably fit. With number 2 I was a full time childminder, always on my feet right up until I popped, I had constant braxton hicks and I believe I induced myself using nipple stimulation.

Sorry I meant to add, I wanted a VBAC, I had ‘booked’ the birthing pool, but the thought of being induced and then emergency cs was too much to bear that is why I decided on an elective cs.......not that I needed it in the end!

If it’s your last baby then I’d go for an elective section every time.

@MissDuke I think you are rather misinformed. The microbiome stuff is nonsense (I am a medical researcher). Increased respiratory problems are due to earlier births (c sections that happen prior to 37 weeks for medical reasons), so lungs not fully developed. Skin to skin and bf happens straight away in the operating theatre.

Planned c sections are calm, very safe procedures - I've never met anyone who preferred the trauma of labour + vag birth over a planned c. It's what most doctors and medical researchers opt for.

I've never met anyone who preferred the trauma of labour + vag birth over a planned c

Do you mean a traumatic VB? I had a semi elective CS & a no intervention (except for pessary) VB & would chose that over CS.

This thread is so skewed in its opinions. It's not helpful to anyone making a decision.
In my experience a VBAC was in a completely different league to my c sections.

A successful vbac depends on so many factors though doesn't it. My 5th child, 3rd vbac was 9lb 2. I am very petite, so size isn't really an issue. Positioning certainly is though.

tableshack yes my elective section was calm I suppose, all went well. It was also sterile and surreal and I suffered great problems bonding with the baby because of it. Deciding what date I wanted him to be delivered felt like ordering something from the local Chinese.

I'm sorry you didn't find your section more emotionally rewarding @ProperLavs

Op I think you’d be best talking it all through with your Midwife. I work in Maternity services but am not a Midwife nor medically trained but I’d say that having had an induction you had already entered the so-called spiral of interventions which is well known to lead to more interventions.

If you don’t have GD this time and don’t choose induction (remember you don’t have to be induced after waters break - my first my waters broke long before my contractions started and I had a vaginal birth) then there’s no reason a VBAC should “go wrong”.

But I don’t think stories on here are going to help.

Why not visualise each option happening and see which feels most right to you?

Listen to your gut. It’s your body and only you can decide.

You can only know which would have been better once you’ve had the baby, sadly.

An uncomplicated vbac (by which I mean spontaneous onset of labour, a well positioned baby who descends easily, no forceps / episiotomy / tearing) is better than an elective CS in terms of recovery time. The problem is, you can’t guarantee any of that. Induction, back to back baby, deflexed head that doesn’t go round the corner easily, cervix that doesn’t dilate so well because the head is poorly applied - any and all of these mean the risk of birth complications or an emergency CS is higher.

Significant tearing is more difficult to recover from than a pfannenstiel incision in terms of walking, carrying, infection risk and bowel/bladder function. Emergency CS in labour is more difficult to recover from than elective CS in terms of blood loss, infection, pain, risk of blood clots.

The questions you need to ask yourself / your obstetrician are:

• Why did my first labour end up in CS?
• What is different about this pregnancy which reduces that chance?
• Would I rather recover from a significant tear or CS?
• Would I be OK mentally if I chose vbac but ended up with another CS in labour?
• Is there the option of vbac if I go into labour spontaneously but elective CS at 40/41 weeks if not? (ie Can I refuse induction?)
• How many more children do I want? A second CS means most obstetricians will advise elective CS for future pregnancies and they get twitchy after the third due to the uterine scar rupture risk.

Once you’ve got those answers you will be able to see which way your thought processes are going. Personally I would have an elective CS in your situation but that’s based on how I would answer the questions. YMMV :)

^great post

If only add that they can't force you to be induced. ALL choices are yours to make. You can only be offered options.

DS1 was an EMCS as he was stuck back to back in a long labour and didn't budge in 2 hours of pushing. We were both exhausted.

I felt cheated by the last minute EMCS after so long and so much effort in labour. The less than ideal circumstances and difficulties already caused by SPD meant a slow recovery. I wanted to finish the job off properly and wanted to gamble on the odds of a better recovery, particularly as there were no underlying issues to indicate problems.

DS2 was a VBAC but did get delivered in theatre with forceps resulting in a 3rd degree tear. I was pushing but he didn't descend enough before a panic over monitoring where they wanted him out ASAP. It was a toss up between a difficult forceps or difficult EMCS at that point.

The recovery was painful and I didn't leave the house for a month. It also aggravated the SPD so I ended up crawling up the stairs at one point as walking was so painful.

It did resolve some of the mental baggage though. The majority of the labour was calm and I arranged myself into a comfortable position over a birthing ball.

It's not a position I plan on being in again, but I would have an open choice of ELCS or VBAC. Both births have had their difficulties. In the past I probably would have considered VBAC again, but now the DCs are older and I'm clear of the baby bubble I probably would go for the reliability of a ELCS.

My friend had had a very similar EMCS to my first and a successful, simple VBAC (hers was before mine so influenced me). I agree with the PP who said that a ELCS is a known risk and a VBAC is a gamble of potentially easier outcome or interventions/ EMCS.

My dd birth was the best experience ever..having your body taking over..really strange. But compared to my friends who couldnt bend or drive for 6 weeks due to c section i know what id choose. Once dd was born the pain stopped

Once dd was born the pain stopped I found that the strangest experience! If you hurt or break something or have an operation you have pain afterwards but it’s so weird to be in loads of pain that then just disappears.

Is induction likely to be a possibility here anyway? I know a lot of obstetricians aren't keen on augmentation on a scarred uterus, or sometimes if they do they'll only do it for a very limited period before going to section.

My DC1 was breech and wouldn't turn, so a nice, smooth, easy ELCS for her. DC2 was supposed to be VBAC, but as the time grew closer my BP got really high; that, coupled with the fact that he was getting quite big, made us all agree that I needed another ELCS. I was glad I did when they pulled him out - he was just under 11lbs. Once again I had an easy recovery and in the end VBAC was a gamble I'm glad I didn't take.

@londonrach That's scaremongering. There's no one who can't bend 6 weeks after an elective c section! Most of us are up and about the next day, and back to normal within a week. As for driving, you simply ring your insurance company and are driving much earlier.