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.

I wasn't advised to wait at least a year after CS before getting pregnant, and actually my consultant said you're as healed after three months as you're ever going to be.

OP I was wondering if trying something like hypnotherapy might be helpful with regard to helping you relax about the instruments? Sorry if you've tried all these things already but there is still time if you haven't and it might help you have a more positive experience however baby enters the world?

Next time you have an appointment make sure you spell it out to the MW, that you are concerned about the small age gap and associated risks.

Get her to focus on your specific situation and not how great VBAC are in general.

I also was never told to wait a year after my c-section to get pregnant.

With a small age gap, I would go for the ELCS. I also had ELCS for breech baby, and then I had a VBAC 18 months later and it was a tough delivery. I was encouraged to go for the VBAC by my midwives, yet when I went into labour and got to the hospital the doctor working on the Labour ward was clearly very nervous about it. He only gave me 12 hours to deliver before I was being wheeled in for an EMCS, and I ended up having to have pitocin to speed things along to avoid that. Although technically it was a successful VBAC on the books, it was a hard delivery. If I had known then what I know now, I would not have agreed to it.

Of course some people have very positive experiences, theres really no telling until it's all over and done with.

It's completely up to you but our local hospital recently was involved in some research around VBAC where they concluded women who had elective casareans were the most likely to have successful subsequent vaginal births. Those women are those with breech presentation, twins or placenta previa most often so you fit into that category.

Standard advice is to wait a year but if you haven't it doesnt mean you are pushed into a caesarean. There are slightly higher risks of abruption though.

I agree with OutNumbered some sort of therapy would be helpful. You shouldn't be enduring this level of anxiety about the thought of examinations or forceps.

You can then hopefully make your decision based on what is safest for you and the new baby, rather than basing it on your phobia if that makes sense.

I think if I didn’t have the experience that I did where I was convinced I was dying I would probably go for the c section again even through the recovery wasn’t easy. I think it’s that experience that really worries me especially because the HCPs I saw seemed to clueless about it. I’ve done my own research now and I will show them the studies about it so at least they have some idea but there isn’t really much in the way of a solution because my understanding is that you need to have vasopressors in order to keep blood pressure under control during the procedure

I had a vbac, after a EMCS 18 months before. I had some tearing but was genuinely amazed at getting up for a shower after the vbac and how spritely I felt.
My EMCS wrecked me, I felt awful for ages. The vbac on the other hand was a breeze. I had my membranes ruptured, and was put on the drip. From my experience I would try vbac.

With regards to gas and air for examinations, they were pretty much impossible for me without gas and air. I went so tight they couldn't even get to my cervix. With gas and air it was pain free and completed easily. I'm also pregnant after emcs I think I want to opt for vbac with elcs at 41 weeks.

Looking at your last post, I think you have bad health anxiety and a phobia of medical procedures. You're now catastrophising the reaction you had to blood pressure medication during the cs when you previously said the issue was resolved quickly and you were fine. I thought the issue was being examined vaginally.

I would advise talking all this through and asking for counselling. CBT would help you with coping mechanisms. Screaming if you have to have a vaginal swab or blood taken, thinking you're dying for example will not be compatible with a vaginal birth.

A first start would to be completely honest with your hcp about your anxieties and phobias.

@SmileyClare You have no idea what the reaction I had was and how it made me feel so please stop speculating. There are studies that describe what I experienced as the same sensation a person feels when having an aneurysm. It’s not me ‘catastrophising’. It was a very real reaction as my body did cope with the drugs I was given.

Sorry Jade I get that and I have come across a similar phenomenon where sudden blood pressure changes can cause awful feelings of dread and foreboding.

I was basing my comment on your OP where you minimised the reaction. I assumed the thread was more focused on your fear of internal examinations.

Apologies anyway. My post obviously wasn't helpful.

Bear in mind that assisted delivery isn't negotiable- it would be deemed essential or life saving.
Not necessarily. There are occasions where a c section could be done instead of an instrumental delivery and they cannot do an instrumental without your consent. In OPs situation, her birth partner could ask whether there are alternatives to instrumental delivery.

Similarly, OP you dont have to consent to a membrane sweep, they are completely optional. You also dont have to consent to internal examinations.

@Sproutmucher mentioned above that she had forceps without epidural. Not sure if she was given the option for a c section instead or if there are cases where they can’t do a c section for some reason.

It would be unusual to offer a c section if forceps are advised. The forceps need to fit around baby's head so the baby has descended the birth canal and is crowning. You can imagine how difficult and dangerous and damn near impossible it would be to pull the baby back into the womb for a section.

They cannot do an instrumental without your consent. Instrumentals are used when the baby is stuck in the birth canal and pushing is not working sufficiently. I doubt many mothers would refuse consent to assist the birth with forceps or ventouse. The only other option is to change position and try more pushing under monitoring but that wouldn't always work.

@smileyclare

That's not true. If you refused a forceps as many do these days (when I was in a mainstream GP practice a good number of women would have this on their birth plan), the only option would be a caesarean. I do agree that the women are often I'll informed about the differences in risk between a late stage caesarean and one earlier in labour or not in labour at all. But if you refuse but accept a casarean and they are recommending immediate delivery, the caesarean is the only way to go.

Oh and many places now have a device called a fetal pillow. You push it into the vaginal canal and fill it up with water which pushes the babies head more gently back into the uterine cavity.

Fair enough. I wasn't aware of the foetal pillow. That sounds ground breaking for babies that are completely stuck in the birth canal .
I can't quite understand mothers not giving consent for forceps when they are putting themselves and baby at huge risk by opting for a late stage cs? Hopefully they are made aware of the risks of choosing this option prior to the birth. For a start you're delaying a potentially distressed baby while you're prepped for surgery.

I had a forceps delivery with my first. It simply pulled him the last tiny inch of the birth canal. Over in seconds. I'm very surprised a good number of women refuse this option.

www.safeob.com/fetalpillow.html

I don't know how many actually refuse in the moment once it's explained to them. My feeling is that once you can feel that the baby is so low that you'd be more confident in the safety of the forceps. I'm sure some do point blank refuse though.

If you didn’t have the epidural did you have any local anaesthetic and was it effective?

I had a planned section for breech presentation and had no end of trouble post operatively. My VBAC ended with a forceps delivery of a 9lb 12oz baby and a reasonably high amount of blood loss (borderline transfusion) - BUT - I was up and about without any difficulty whatsoever as soon as the epidural wore off. I asked for one at about 10am (as I'd chucked my guts up on Entonox and I found out that Pethedine wasn't particularly effective) and it took about 45 mins for somebody to actually do it, but it was fine from then on.

All I had in terms of pain afterwards were some rather tender stitches and some slight bruising from catheterisation, which I hadn't noticed them doing.

Just as well, really, as two days later I was lugging the buggy up and down five flights of stairs, doing the shopping and school run with no help. I knew that, just to cope with all that, if there was any way I could safely avoid a second section, I'd do it - but it was clear throughout labour that if I changed my mind at all, they were perfectly happy to perform one.

I'm not keen about being touched for examinations, but I managed a sweep the afternoon before - I was already at 4cm, though, so that probably had some bearing on it - when it came to examinations in labour, I was somewhat more focused upon the contractions than somebody checking - I didn't feel them putting a monitor clip on her scalp at all, and that was before the epidural (the belt wasn't picking up very well due to her position and my belly fat )

So I'd go for it, personally - but that is just my opinion.

Hi Jade I had an epidural with my first. It was a long labour and it had pretty much worn off by the time I was pushing. I was told this was best as the epidural would slow that stage (?)
. I didn't have a local anaesthetic for forceps but in all honesty I was so tired, fully dilated and struggling to get a big baby out I could have kissed the obstetrician who helped him out with forceps. It didn't hurt to have forceps.

Bear in mind that using forceps generally means they want baby out as soon as possible. It's likely there wouldn't be time to do an epidural or wait for a local anaesthetic.

I wish you all the best with whatever decision you make. As GEEpEe says, in the moment plans will change and you may feel differently. You may try for a VBAC and end up with a CS.
It sounds as though you found your first birth fairly traumatic and have had bad experiences, not only with your miscarriage but with internal exams so don't feel pressured into a vaginal delivery if you feel too fragile. Good luck

If you didn’t have the epidural did you have any local anaesthetic and was it effective?

Yes I had a pudendal block, which must have helped as the episiotomy only felt like a scratch. I had high forceps so it wasn’t effective when they were put in/pulled out but if you have low forceps maybe it would be more so? Also I’m sure it was much less unpleasant than Not having any pain relief at all!

I would not overthink it. Had EMCS with dd1 very slow first labour waters broke nothing happened blah blah dd2 arrived at 35 weeks normal birth VBAC no intervention at all 6 hours start to finish. Births so different may as well have happened to a different person!