Right, pregnant with number two after EMCS with number 1 - advice please!!

[flootshoot]

I'm 4 weeks pregnant withbaby 2. DS is 16 months and was born by emcs. To cut a long story short(ish), there was meconium in my waters (broke when I was 3 cm), I was monitored, had an epidural because of intense backpain and strong urge to push at only 4-5cms (I demanded it!!), I failed to dilate further than 9 cm, DS got distressed and the dr attempted to take a blood sample from him. This failed and he was delivered by c-section. At my de-brief the midwife said in her opinion DS was obviously back to back (hence backache, delayed dilation, distress and urge to push early on), but no-one had picked up on it in my notes until about two hours before he was born.

I have no idea what to expect this time and would like some sound advice. I know I will be referred to a consultant, but how early do I need to book in? Is it the same as first pregnancy (in our area we book in at 10 weeks) or am I supposed to book in earlier? When am I likely to see the consultant for the first time?

And crucially.... would you recommend a VBAC or elective cs? I am very small (under 5 foot) and several people commented after DS was born that they weren't surprised I'd had trouble delivering (including my midwife!!).

Thanks in adavnce for any words of wisdom...

Congratulations on your pregnancy.

I had an EMCS with DS1 after a long horrible labour and suffered with PTSD and PND afterwards. When pregnant with DS2 I knew I didn't want to go through the same thing and asked from the off that I had an ELCS. I was classed as high risk as I had had a EMSC, so saw the consultant after my 12 and 20 week scan. No decision was made about me having the ELCS until I saw him again at 36/37 weeks where I was booked in for the section for 39 weeks. I also had an ELCS with DS3 but wasn;t given the option for a VBAC.

Hi
I had emcs with ds1 due to long labour (44hr) and not dilating - cord around neck & head.
I booked in with midwife as normal, called her around 6 weeks & she came over a couple of weeks later. I was then booked in to see consultant at 23 weeks.
He had my notes from DS pregnancy/labour & discussed briefly what had 'gone wrong' and what my options were for next delivery. I told consultant what I would like to happen for next delivery & we discussed it. He's booked me in again for 4 weeks.
I think timescales differ depending on where you live.
As far as your size goes I personally don't think it makes a difference.
Hope this helps a bit.

Congratualtions!

I am 24 wks pg atm with dc2.

DD was emcs after failure to progress, I dialted to 10cm then pushed for nearly 2 hrs before having emcs.

I booked in as normal at 8 wks with midwife, dating scan at 12 weeks then another at 20 weeks as is normal.

10 days after 20wk scan I had appointment with consultant, who read through my labour notes. DShe quickly decided I had a 50/50 chance of acheiving a VBAC so therefore that would be the best option. Not much of a discussion to be honest. I think wanting an ELCS would be a fight tbh.

I'm booked in to see her again at 36 weeks when she will decide if I need an elcs, if not its full steam ahead for a VBAC.

If you want a ELCS be prepared to face some opposition and to have to push for what you want. Personally I haven't got the energy for the fight, so it looks like I'll have a VBAC unless I go over my due date in whihc case I will have to have an elcs

I had an EMCS under general with DD after failed induction because she was wrapped up in the cord (several times - including twice round the neck).

When I was pregnant with DS (born 2 years and 2 months after DD) I knew I wanted a planned section. I had to put my case forward, but they agreed to it fairly quickly. The one thing I really didn't like was that they would not schedule the section until 36 weeks. And, in my opinion, that is very very late to leave it. This is standard practice at a lot hospitals. So, if you want an ELCS be prepared to start asking for a date (persistently) around this time -- or before this time if you are like me.

I am now pregnant with third child and have already expressed preference for ELCS. I expect I will get it, but I may have to jump up and down a bit to get them to schedule it a bit earlier.

It really depends on the hospital. Some some women have trouble getting the onsultant to agree to VBAC, and others have trouble getting a ELCS. I would suggest that, if you know which you want, you choose a hospital who likely to be of your chosen persuation. And, of course, time is of the essence in making ahopital choice. Some of them fill up very quickly.

Try looking at birthchoice.org.uk (or something similar)

You don't need to book in any earlier - you should get an automatic consultant referral if you have had a previous CS. My sirst consultant app was 16 weeks, came through automatically after booking in with hospital.

Personally, I would go for ELCS. But it's a very subjective decision. Have a look at the web site www.csections.org - it's got some really useful info presented in a neutral way. I found it was very hard to get advice on whether to have a C-section as people, including doctors and midwives (sometimes particuarly midwives) can have very strong anti-CS views (too posh to push etc etc). So it's difficult to sort out actual risks and benefits from people's agenda.

I have to say I have had no problem getting an ELCS - it must depend on the hospital. If you do decide on ELCS, then be prepared to fught. NICE guidelines say you ought to be able to have one, so be prepared to wave it at them!

I wouldn't offer advice on whether to go for a VBAC or another section, but I would say that you should start doing some research into it all over the next couple of months, so that you are in possession of all of the facts and can argue your case for which ever you decide you want.

Bear in mind, it is relatively simple to change your mind and go for an elective right up until the wire. You might have to fight a bit to get a VBAC, at least with the right conditions to make it more likely to be successful (e.g. active labour, limited monitoring etc).

In all likelihood, you won't have the 'big' meeting with the consultant to make a proper decision until well into the third trimester anyway (in my experience - I met with the consultant several times and it was only at about 34 weeks that he really let me thrash out the whole issue!).

Good luck whatever you decide!

Interesting that some people seem to have to fight for VBAC whereas some have to fight for ELCS. Talk about consistency in the NHS!

Agree with Reasonabledoubt that the best thing you can do is loads of research and think through you're own position.

I think these days most hospitals are pro-VBAC in theory, they just aren't 'pro' all the conditions you need to have a successful VBAC. It can be a real fight to get things like no or limited CFM, an active labour, waterbirth etc.

Hi fs, I had emcs with dd. Short version - 9 days over, meconium in waters, failed induction, never got past 2cm emcs 24 hrs later.
When pg with ds I was open with mw about being pretty sure I wanted a vbac but would like options open.

I had a consultant appt at 37 wks, all ok but I wasn't ready to make a decision so they booked another at 39 weeks.
Was examined and given approx 30% chance of 'natural birth' with a caveat that forceps/ventouse intervention (including episiotomy) would be "very likely".
They could leave me until I was up to 12 days overdue and then if it didn't work do a cs(that worked out Christmas Eve - lol, sure they would not have left it quite that long!)
Anyway, estimated weight was over 9lb and with the odds of VBAC they gave me I chose elcs. It was very different to emcs, more waiting about but much calmer.
Good luck with whatever you decide

Last time round was pretty similar to yours, except DS was also brow presenting so he wouldn't have come out any other way, although this was only discovered I think once I was in theatre. I did get to 10 cm via the drip, but was not 10 cm by the time I was in theatre, so they did a c-section. This was in a different hospital to the one I will be giving birth in, in October. My experience is different to many listed above. The trust is very VBAC focussed. I didn't get an automatic referral to a consultant, but after talking to my midwife, was referred to a consultant mw at the hospital, whom I met last week at 26 weeks. There has been no talk about an elective at all, even when talking about going overdue, instead they have talked about breaking waters, etc, controlled induction via drip. Infact I am still a little unclear about this and will ask some more questions.

I have been told that there is NO reason at all why I should not give birth naturally, and that there is the same chance of intervention (forceps, etc), though the risk of c-section is a little higher of course. She said that some months they have a VBAC success rate as high as 82%, so I am quite hopeful. I know of 2 friends who have had VBACs in the hospital this year, the only 2 who tried them. Of course I know people who have had c-sections too, but bizarrely they were ones who had a vaginal birth first time round!

I had my letter today saying I can use the birthing pool and will not need a cannula put in.

I am scared, but would like to try and avoid an operation if not necessary. Good luck!

Had emcs with ds urge to push - not dialated.

Saw consultant at 34 weeks with dd- asked vbac and waterbirth, consultant raised eyebrows and referred to midwife to make possible.

I had a successful waterbirth was monitered throughout with one of the remote monitors. So only had a strap round my belly and a love on the canula which was removed straight after the birth.

It was a truely awesome experience and unlike the first time it was really quick (went to hospitl at 1.30pm and had dd in arms at 5pm . If consultant says go I can honestly say that the worry that you will need a section is their at the back of your mind but you soon have other things to think about.

(

Flootshoot - my DS1 was back to back and I'm 5ft 1" with skinny hips (50 hour labour and EMCS). My mum was quite negative after my EMCS with him (only got to 4cm) saying it was cos I had a small pelvis etc. and that no woman in my family could give birth naturally (OK I was section birth but she forgets her mother had her naturally).

Got refered to consultant for DS2 and DS3 at around 20 weeks. For DS2 assumed section was my only option but quite pro VBAC round my way. If I'd fought I think could have had a section but chose VBAC on both occassions and they both worked out well. So much so that went home 4 hours after lovely waterbirth of DS3 (4hr labour) - what a difference to my EMCS when I couldn't walk for about 5 days. Like Honeydragon says it's truly awesome and I'm so proud of myself for doing it.

I'm VBAC all the way cos of my positive experiences but I was well read up on it. It's a hard choice and a very personal one. If you do go for it just make sure you work on getting your baby in a good position.

Thank you for all your advice. I've managed to speak to someone in RL who's had elcs after an emcs and she said 'you have to listen to all their advice, and then tell them what you want' which was pretty accurate I thought!

I would love to try for a VBAC but I'm worried about the pressure to 'perform' to a certain standard, ie. progress quickly etc. I did get to 9 cm with DS and was almost ready to push when his heart rate dropped. So I guess my second labour would be a true 'second' labour IYSWIM.

I've made a list of pros and cons - feel free to cut and paste and add your cown comments!

VBAC
pros:
Safer for me and baby
would feel like an achievement
hopefully no delayed milk like with DS
shorter recovery

cons:

if it goes wrong it will be another emcs
pressure to 'perform' and have textbook labour
if it's traumatic like my first labour it may affect my bonding again (it did with DS)

ELCS
pros:
calm atmosphere, less traumatic
easier to plan care for DS when the time comes
safer than an emcs which is a possibility
less tired afterwards to care for baby

cons:
long recovery with toddler to look after
possible delayed milk (I ended up FF DS because my milk took ages to come in)