WWYD - VBAC2 or ELCS

[BramblyHedge]

I am only 10 weeks pregnant but have my booking in next week and just having a think about birth options (mainly because I am having vivid recall of my experiences so far),

I am pregnant - unplanned - with dc3. I have chronic high blood pressure which adds an extra risk factor.

1st ds: My waters broke at 37+4 but I did not go into labour so was induced 36 hours later. After 12 hours I had not gone beyond 3cm, was exhausted. Ended up with an EMCS and found recover took a long time and had worst bruising mw ever seen. DS1 was wedged and apparently would never have come out normally.

2nd ds: VBAC but only just. I was given an epidural at 2cm as monitor showed I was having very intense contractions. Had this all night and the next morning had made it to 10cm. DS2 went into distress, I couldn't push and he was dragged out with forceps (9lbs) - was told I was minutes away from an EMCS. They didn't realise I'd lost lots of blood and I needed a transfusion the next day but recovery was fairly standard after that (usual undercarriage issues). TMI alert: Only think I would say is that the wall between my back passage and vagina had lost all muscle and I struggle to poo as it gets pushed into my vagina and trapped - I have to 'help myself' there a bit.

So basically my question is - what would you do for dc3? VBAC or ELCS. I am so unsure about what I want - not sure if I am overreacting about my VBAC experience but worried that if I opt for VBAC I will be so stressed about it going wrong again that it will go wrong. I also worry a bit about my loss of strength down there (I have been doing some physio but not sure if enough). I know the consultants will push for VBAC as they did last time but a part of my thinks an ELCS would be a better option.

I know people have worse labour experiences than this and it is not that I am traumatised - more that I have little faith in my ability to give birth naturally.

thanks.

It's a tricky one and not one that anyone can decide for you.Personally I'd go for a planned CS but then I have had two EMCS.I attempted a Vbac in may but I didn't progress again.I don't regret it as now I know my body CAN'T deliver naturally.

If you feel nervous about the Vbac then book an ELCS.Although my 2nd section was 'emergency' I was only in early labour and it was a great experience and made me think that an elective must be fab,all calm etc.I recovered really quickly and had hardly any pain compared to the first one.

If you go for a Vbac the chances are it will be quicker and easier than your last birth.

I only made a decision when I was 39 weeks pregnant although they wanted a decision by 36 weeks so you have loads of time.
Sorry not much help just thought I'd ramble my thoughts.

Thanks for the reply - I think I just need to try not to think about it for a while and maybe my frame of mind will change by the time I get there!

I have had an EMCS and a vbac and an ELCS (just a week ago). In your situation I would have an ELCS in a second (especially regarding your poo situation). You wouldn't potentially want to do any more damage down there. I ummed and ahhed and worried throughout my 3rd pregnancy about how I was going to give birth. I had various problems with epidurals with my EMCS and VBAC, and at 36 weeks went to my consultant in floods of tears and she agreed with the EMCS. I did have to fight for it.

It was the best decision I ever made. I know there are risks etcetc and I feel the need I have to explain myself to everyone, but I am feeling absolutely great a week later. The baby has had no problems breastfeeding, After 4 days I didn't need any painkillers any more. The baby ended up being 2 pounds more than my previous vbac and I have no regrets.

It was a very relaxed, wonderful birth. So much better and less painful than my EMCS.

I wish you good luck, and make sure you fight for what you want. It's too important.

xxx

In your situation I too would go for ELCS. But you've lots of time to change your mind. Even when I was in labour with my VBAC they said I could change my mind at any time. My VBAC went wrong and ended up a cat 1 emcs, baby could have died, I could have died - thankfully I was in a great hospital. I had cold feet about VBAC in the run up but pressed on. I think if you have done both EMCS and VBAC and suffered some damage an ELCS would have less overall risks ie not just key medical ones but your own future wellbeing. remember too that an ELCS carries less risk than an EMCS. But, it is your decision ... AND even if you make a plan now you should be able to change your mind. Good luck!

This thread might help you

Thanks for the replies - it hadn't occurred to me that I really could leave it to the last minute. Glad to see that ELCS generally has a better recovery than EMCS. Shall have a read of the support thread tonight when the kids are in bed.

i am 28 weeks and still fairly anxious about my forthcoming vbac. firstly get your booking in appt sorted as after mine i found out that my hospital now has a vbac clinic. the consultant i found to be rather pushy, but when i met the mw in charge it put everything right in my head. i felt in great hands and she answered all questions in full. if your hospital doesnt offer this maybe ask for it anyway. ask to see several people that will be dealing with you on the day. my community mw is rubbish and never answers any questions. i think that in your shoes i would go for elcs. you said that some people have worse experiences. what if next time its worse for you not better. i really hope not i dont want to sway your decission ultimately its your choice but with a little family waiting for me and my own health/well being to think about i know what i would do. right now just think of the sort of questions to ask and take your time to conclude. be strong and good luck x

In your shoes I would definitely go for an elcs.

I had a bad forceps birth with ongoing bladder concerns and a long, slow recovery seeing consultants and physio. That was 21 months ago.

8 weeks ago I had an elcs and am healing very well.

In your situation I would put a lot of store by your longterm health prospects, if you have bowel issues now they are likely to worsen with another pregnancy and potentially significantly worsen with another vaginal birth. I wouldn't risk it. Post menopause the changing hormone levels mean all incontinence tends to worsen anyway so please look longterm here, not just the few months post birth.

The Royal COllege guidelines are www.rcog.org.uk/files/rcog-corp/uploaded-files/GT29ManagementThirdFourthDegreeTears2007.pdf here for you - check out part 12. It suggests that if you are already symptomatic an elcs would often be best.

Also, it would be worth reading some of the thread in General Health on childbirth injuries - www.mumsnet.com/Talk/general_health/777985-Continued-support-for-SPHINCTER-INJURIES-FISTULAE-and-other-CHILDBIRTH-INJURIES as it's sobering reading given the longterm nature of many complications.

Don't want to scaremonger but I would hate someone to go into a vb already symptomatic without really weighing the risks.

Sounds like it might be a Rectocele that I have - lovely!

I have had 3 VBACs after an ELCS because of breech.For me I preferred the VBAC recovery time and thought labour wasn't anywhere near as bad as the pain the day after ELCS.However my VBACs were normal deliveries with little or no tearing. In your position I would choose ELCS tbh.

elcs.

i had vbac2 and dd2 suffered birth hypoxia and has cerebral palsy as a result.

i may be a bit biased, though...

(elcs the first time for macrosomia and vbac1 nearly ended in emcs - ds1 was back to back and failure to progress, they spent a week trying to repair my undercarriage...) vbac2 labour/ delivery fine apart from the obvious. lack of monitoring meant that no-one noticed fhr was down to 28bpm. i was fine, she spent 5 weeks in scbu with seizures and will be disabled for life.

i am frankly rubbish at childbirth. i now have a letter from a consultant telling any future docs that i should have elcs.

my original elcs was no picnic, but in comparison to my vbacs i know which i'd prefer!