VBAC or ELCS?

[mendipgirl]

Okay, I am 26 weeks pregnant. With DD she was breach, but only discovered in early labour so had an EMCS, all went fine.

Not sure what to do this time. My DH really wants me to try a natural birth, my instinct is to go with a ELCS, as I know what to expect, already have a C scar and am basically scared of something going wrong in labour: tearing, stitches, long labour with a EMCS at the end etc. etc. It seems logical to just have the ELCS and avoid all the uncertainty.

My midwife is lovely and says I can have what I want, but there is no physical reason I can't have a natural birth so they would recommend that, better recovery time (if all goes well) which would be good as I already have a 2 year old to look after!

Am so confused and stressed, just don't know what to do! Any advice welcome, good and bad experiences of both would be appreciated?

I'm about to have a vbac (fingers crossed) in a couple of weeks. I had an elcs for breech first time around. And this pregnancy, i started out thinking a c section was the safest option. But after some research, i'm really looking forward to the chance to have a natural labour.

As i understand it, the risks of c section become higher after each one, so if you're planning on having more children, it may be safer for you to have a vbac.
Also, i wouldn't miss out on the chance to bond with my baby in the first hour after labour with all that oxytocin. I still feel a little disappointed that I didn't have that with ds.
There are risks to both vbac and c sections. The one that seems to be trotted out the most for vbac is uterine rupture, which works out to be 1 in 200 (including ur which doesn't affect the wellbeing of mother or child) The odds are more like 1 in 1000 for uterine rupture that negatively affect mother or child.

If your uncertainty is so great that it affects your mindset, then maybe elcs is the best option for you. But i'd give changing your outlook a serious go, before attempting major abdominal surgery; elcs also have many serious risks attached which are sometimes easily dismissed as par for the course.
Good luck and i hope you get the birth you want!

I've had both. (and an emcs)

Found the elective v stressful, had to wait for hours (11 hours) from arrival at hospital to going to theatre, had adhesions from first C/S so surgery was longer. Some slight complications too so had a drain in for a day or two after, horrible. Wouldn't want to do it again unless absolutely had to. It was definitely my "worst" birth.

My VBA2C was really really fab though, had a doula, stayed at home till the very last moment, baby born an hour after arrival at hospital. Half a dozen stitches. Home that evening.

I would say though, if you really want a VBAC you need to be up for it/totally bloody minded, and make yourself believe that it is possible.

Good luck with your decision!

ds was an el cs as he was breech so with dd I was confused about it all too, I decided I'd like to try for a VBAC but after chatting with my cons I got myself booked in to the cs list as a back up. After doing all the research I decided that I was happy to go for the vbac but I didn't want to be induced. As I'd never laboured before and other factors I just felt an induced VBAC wasn't going to work.

I went 10 days over and after some scans and head scratching I went for a second el cs as my placenta was showing signs of degrading. In terms of the birth it was fine, no problems with dd, no problems bonding or feeding afterwards. I did however take longer to recover from it than my first with more discomfort. I had pain the scar for about 6 weeks or so. I'm sure it's because I wasn't able to rest so much as I was first time (having a toddler at home is not great for cs recovery!)

With hindsight I think I would have tried harder for a vbac, but I'm still sure that I wouldnt' have wanted an induction. That hasn't changed at all. However possibly I would have waited longer. Circumstances at the time though meant that it felt right to go for the second cs.

I was induced with DD due to pre eclampsia then had to have a emcs.Pregnant again and I'm booked in for an elcs on monday at 39+1,though if I go into spontaneous labour before then I said I will have a trial of labour.It's a hard decision knowing what to do,my emcs was a more positive experience than the induction which was awful.Consultant said they wouldn't induce me this time and I would only be allowed to labour 4-6 hours max,that's if I go into labour before monday.But I am panicking with every little twinge,I know I'm not mentally prepared for a vbac.Basically I opted for the elcs because it's what I know and I followed my gut instinct.Must admit I don't have a burning desire to experience natural child birth.

Like Bimbleberry I had the emcs due to pre-eclampsia and failed induction. I think I'm going for elcs next time as my body just completely failed to "do" labour - my cervix was tighter during induction than it was on my 11th birthday! I also have absolutely no desire to experience a vaginal birth.

I think that's it with me, I don't have a desperate desire for a vaginal birth and in my head see all the things that might go wrong which probably means it is less likely to go well as I am not mentally in the right frame of mind for it!

Hope your birth goes well Bimbleberry

I think that unless you feel totally committed to the idea of a VBAC and have an overwhelming desire to have a natural birth, then you'll probably be happiest having an ELCS. I had an emergency section after a long labour with DC1. When it came to DC2 I really didn't feel any particular pull towards a VBAC and it just seemed so much simpler to opt for a CS. I've since had a 3rd section with DC3. My experience was that the planned sections were happy relaxed experiences (unlike emergency one). Babies were put straight into my arms a couple of mins after their birth (after a v quick check) and I was helped to hold them skin to skin on my chest while I was stitched up. I found recovery from both planned sections much quicker than my emergency section and I think that's probably because my body wasn't exhausted from having been through labour too. I have exactly 2 yeas between each child and didn't experience any physical difficulties dealing with the others - i just took things very gently and slowly. Being able to plan childcare for the others during the birth and while I was in hospital was a great help too as I knew the date a couple of months in advance.

I also felt rather selfishly that having already messed up one part of my body (with the CS scar) I was loath to risk wrecking another bit!!

so pleased to read this thread as am in a very similar position after failed induction and EMCS last time I am prepared to consider VBAC but won't be induced. Am also concerned that because its a VBAC there are certain things that are not allowed (at my hosp.anyway)like water birth, continuous monitoring means you can't move around much which makes it less likely that labour will be successful or as easy as it might be (hated this aspect of being induced - everytime I tried to move off the bed they lost the trace and made me recline again). As I also have GD they won't let me go overdue so highly likely I will be a CS again anyway but am a bit worried about looking after DS1 who will be 20 months then. Ultimately am pissed off that this has been caused by the due date induction last time because of GD when DS was not scanning large and was perfectly average at brth. Had they let me go overdue I might have had a successful vaginal birth and not be in this position now. Have to say am also with those who have no burning desire to experience vaginal birth. I won't feel like I've somehow missed out or anythng - purely about the best outcome all round.

What puts me off VBAC is the fact that the baby is more likely be to brain damaged or die. I KNOW the risk is remote but I'm just one of life's worriers!!!

I didn't know that Ushy - that's cemented my decision though!

Check out this website for pros and cons of each but remember, the downsides to a section are all lumped together - emergency and elective so not totally representative if you going for an elective which would be safer. And as for the breathing problems, this is reduced dramatically by delivering at 39 weeks and does not mean baby will be whisked off to SCBU but may just need a few whiffs of oxygen so different extremes.

And as my DH said - it's not how you give birth that matters but that baby and your are safe at the end.

This is from someone who had vaginal for first but baby born with a disability following a long labour and intervention but thankfully resolved itself. Booked in for section next after long deliberation!

Oh nearly forgot! Website is www.csections.org/versus.php

Ushy can you tell me where you got that information from? I too am a VBAC (currently 28 weeks)and haven't seen any information about risk of brain damage.

"Ushy can you tell me where you got that information from? I too am a VBAC (currently 28 weeks)and haven't seen any information about risk of brain damage"

Hi RBJ72
It is from the RCOG Green Top - they are very accurate because they get used as 'best evidence' in litigtion. The risks are remote but if you are a total wuss like me it doesn't make any difference!!

The risks of VBAC are 2-3 times greater for death of the baby per 10,000 and of brain damage 7.8 per 10,000 versus zero (hypoxic ischaemic encephalopathy). This does not always mean every child who gets it has cerebral palsy or learning difficulties - it depends on severity. So again really low but I just think of that big finger pointing at me !!!

There are a couple of risks with C/S like respiratory problems in the baby but these hardly ever have long term consequences so I think that is the lesser of the very remote risks.

The other thing is that I'm not planning any more children after this and there are risks if you have more than two c/s but that doesn't apply to me.

May be I should start a thread for neurotic-scaredy-cats

Here is the link:

www.rcog.org.uk/files/rcog-corp/uploaded-files/GT45BirthAfterPreviousCeasarean.pdf

Hi, just adding my experience. I have had a natural birth (21 hours, gas and air, stitches) and an elective c-section due to placenta problems (very calm birth, nightmare recovery). Out of both options I much preferred the natural birth as I was up and about within 2 weeks whereas with the c-section I was in agony for 8 weeks afterwards. Good luck with your decision. I will be going for a VBAC if possible next time around, but will certainly ask consultant about risks. x

Had EMCS first and VBAC with second.

VBAC was 100 times better, far smoother quicker and recovery time swift.

Don't be scared and have faith in medics and yourself.

What decided it for me was ds2 was in perfect position for natural birth, whereas ds1 was back to back and long, long labour.

Also consultant reminded me that 75% or more can have sucessful vbac. Had faith in him and midwives.

You've got ages to decide. Good luck. P.s. My bits down below are fine too!