VBAC or not?

[Jadefeather7]

Hi

I can’t seem to make up my mind about whether to try for a VBAC or have another ELCS.

I had an ELCS about 9 months ago for my first due to breech presentation. According to my midwife many women who had ELCS for this reason have successful quick VBACs (not sure if she’s just saying that to encourage me to try ).
ELCS recovery wasn't totally straightforward for me in the short term but I’ve been fine in the long term. I had a bad reaction to one of the drugs they use to stabilise blood pressure but luckily the issue resolved quickly and I’m fine now. I did find that my mobility was really bad even though I tried walking around as soon as I could the next day (I had my surgery around 3pm and the numbness didn’t wear off that evening). My husband had to help me off the bed for about 10 days. I just couldn’t manage it on my own for some reason.
I think I’m probably a good candidate for VBAC however what really puts me off is having examinations or any interventions where I might feel something being inserted into me. If I’m going to be totally numb and unable to feel anything then I’m ok with having an instrumental delivery. I cannot imagine having forceps without the epidural (that’s my worst nightmare). I possibly have some sort of vaginismus. Although I’m fine with sex I don’t like medical professionals examining me down below. It’s possibly because I’ve had horrible examinations when I’ve had thrush, bad smear experiences etc. I’m also really worried about having an EMCS as the recovery is supposed to be much more difficult. I’m so torn and I just can’t make up my mind so I would love to hear some opinions.

Can you plan for a VBAC with Epidural at your local maternity hospital? If you're being offered a VBAC then it's likely that statistically that'll be your 'easiest' / 'best' option, but I can appreciate your worries. Do you have the option to speak to a consultant or perhaps have a more in depth chat with your midwife at your next check-up?

I can't give you any advice personally - I've only had one baby and that was via EMCS. But I will have all this to think about if we pluck up the courage to try for a second. I don't believe the recovery from an EMCS is any harder than the recovery from an ELCS though. Your recovery will be a mixture of things ie. Your overall health before, how well your body recovers in general and also the reason for the c-section.

My friend has had two babies via ELCS - hers was due to severe SPD. She did say her recovery from the second one was harder than the recovery from her first, but she didn't regret a thing and her recoveries overall were both straight forward.

As with all things baby related though... we can plan all we like but on the day it will be whatever it ends up being.

Thanks, yes I think i could opt for VBAC with
Epidural.

I should have added I might not be able to avoid being induced and having examinations in early stages pre epidural to check progress.

I couldn't tolerate any vaginal examinations either. I refused a sweep because of it after I went over my due date with DC1.

When I was having DC2, I had it written into my notes by the Consultant that I was under that for any vaginal examinations, I would be given gas and air. It meant that I couldn't be pressured into having a sweep if I did go over, as sweeps are done in surgeries and they don't have gas and air. I also knew that I would be given the gas and air as it was in my notes. So I sort of made that a condition for me going for a VBAC (I had an EMCS with DC1 for failure to progress beyond 7cm after a three day labour).

Would this be a possibility for you?

I had a VBAC after undiagnosed breech EMCS.

I had my VBAC assisted with forceps - as soon as I said "I need some help" they whapped in an epidural, wheeled me to "theatre" then pulled her out.

Had no problems at all, couldn't feel a thing. Recovery was so much quicker.

All birth experiences differ.

I am choosing a ELCS for my second for this reason

Due to non progression of labour with dc1 apparently it puts me in an under 5% chance of success with vbac

Why don’t you go for VBAC and hope that you spontaneously go into labour? But if you get cold feet or there’s talk of induction then just let your midwife know you’ve had a change of heart and that you want to go for an elective CS instead?

There’s positives and negatives to both options but at least the above way lets your body decide to an extent. Good luck!

Does gas and air really help with internal examinations, sweeps etc?

Going for an ELCS if I can’t tolerate sweeps, inductions etc might be a good option if it is available.

Really hard to say. You definitely shouldn’t have induction drugs for a VBAC as it can make a tear in the c section scar more likely. But spontaneous labour should be fine if everything suggests to doctors it will be.

I don’t think it means you have viginismus just because you don’t want medical instruments inside you. Literally no one likes or wants this! If you had this I think you’d have or have had trouble with sexual intercourse at some point!

DS was an EMCS and I was hoping for VBAC with DD. Complications meant she needed to come early and I had to have a semi-elective c section. I was told due to precious c section, I wouldn't be able to be induced.

Previous c section*

Gas and air helped me enormously with examinations. I took a fair bit of it before it even began and then kept going.

I was told that I wouldn't be induced due to the risk of rupture from the previous c section.

I had gas and air for getting my waters broken and my internal, I was quite far into labour so they needed to give something to keep me still to do it (I was induced so in my case at that point I was 8cm and in quite a bit of pain) it certainly took the edge off Both the examination and waters being broken but there was nothing like when I got my epidural! Bliss!!!😂😂😂 I did notice the gas and air helped with contractions at this stage too but I def was wanting my epidural at this point!

Hmm the need for induction would be a factor in favour of ELCS for me. I'd want to know I had a good chance of a straightforward VB. Afaik clinicians are usually very careful with induction after section because of the increased risk of rupture, and you're usually only given a limited period of time.

Are you actually pregnant OP?

My birth plan was to have VBAC if I went into labour naturally and ELCS if I needed to be induced. (They would book an ELCS instead of induction.) Fully supported in that by my midwife and consultant. Definitely an option and you can change your mind at any point.

I wanted a vbac and tried with dd2 but she was too big, wanted one with dd3 and they said no as she was too big. She ended up being 7lb 12oz! I kept looking at her thinking “I could’ve pushed her out!”. Really wish id has been able to try as there were some issues during the section trying to get her out (adhesions made it a slow process and they thought that they had cut into my bladder).

My first birth was a ELCS due to baby being breech and I opted for a VBAC with my 2nd. I am so glad I did as I had a nice straightforward labour/birth and my recovery was much quicker than my CS. I then went on to have another 5 vbacs.
As others have said you can change your mind at any point.

That option will be available. If you say you would like a VBAC but review at 40 weeks (or whenever your Trust start stretch and sweeps), with a view to booking a LCSC at say 41 weeks. If you explain your wish to avoid an induced VBAC it will make sense!

You can change your mind at any point for either option

Amazing! I didn’t know that induction isn’t advised with VBAC. (Is it the same for a membrane sweep?). It’s good to know that if I didn’t go into spontaneous labour I could opt for ELCS instead.

Hopefully Gas and Air will help through any internal examinations that need to be done before the epidural kicks in or perhaps I can just refuse internals? It’s not simply a case of not liking it, the last few times HCPs have attempted anything (including putting a small swab thing in me) I was screaming so much they had no choice but to stop. I think it could either be because when I had the examinations I had bad thrush so was extra sensitive there or it could just be psychological because like I said I’m fine with intercourse and I’ve also recently had a transvaginal ultrasound (which I inserted myself). I feel embarrassed telling my midwife this as I had a very rude midwife previously who laughed at the idea of me giving birth because I asked if I could recline the chair in order to have a blood test

I had an induction/augmented vbac six years ago. The was via drip so it was more controllable. It did involve a number of regular (two hourly I think) internal examinations for progression and I knew if it didn’t hit certain progression stages I would default to a csection. I’m not sure this method would be used without the internal examinations although some of the timing element may have been specific to my pregnancy history rather than this technique though.

My vbac was a success even though I’d spend 40 weeks being convinced it was never going to work. Fingers crossed for you whichever way baby decides to come out.

I think planning for a VBAC but if I go over asking for an ELCS sounds promising.

Those that had gas and air for examinations were you previously ok with examinations but just didn’t like them very much or were they pretty much impossible for you in normal circumstances like they are for me?

Honestly, I would consider the ELCS anyway if I were you.

I had forceps without epidural and it was excruciating. In an emergency, this isn’t uncommon (I’m not saying it happens to most people but it’s not a remote possibility you can discount either). If you ask for an epidural early in labour you could aim to avoid this risk but unfortunately, you aren’t guaranteed an epidural. It depends on availability of a bed on the ward and the availability of the anaesthetist.

I had a EMSC for first DD due to her being back to back and failure to progress beyond 7cm after 40 hours in labour. I wanted a VBAC for DD2 and had to fight for it as the consultant wanted me to have ELCS which I'd of been ok with if he gave me an actual reason why I couldnt have VBAC. Eventually got him to agree BUT if I didnt go into spontaneous labour I had a ELCS booked for 13 days past my due date. DD2 came 11 days late perfect VBAC no complications, much better experience and easier recovery. However it is you decision that only you can make dont let anyone try force you one way or another.

Should of added an induction was completely off the cards the consultant said as it has too much potential for complications if you have had a previous csection.

Don’t want to frighten you but with my VBAC I did indeed up with a forceps delivery without an epidural.
In my case it was the classic failure of medical staff to listen to what I knew was happening so they refused an epidural as said I couldn’t possibly be progressing that fast and then “oops you’re too dilated for an epidural”. Not pleasant. However I had recovered very quickly from my EMCS so for me the VBAC was far more unpleasant whereas it sounds like you had a harder time with your section. Good luck whatever you choose.