VBAC Questions..

[anonMum2]

Had an EMCS 2 years ago and now opting for VBAC. Was feeling very positive about it until I googled uterine rupture yesterday and freaked myself out reading a few horror stories. All the ones I read (to be fair not that many as I was crying and cringing after a few) were due to induction using oxytocin.

So I read the notes written by my consultant a few weeks ago when I had the VBAC appointment, and it clearly states that they were to use syntocinon on me if needed. But I'm wondering now, if labour doesn't progress, surely an EMCS is safer than using synto?

Is the true percentage 0.1% or 1% for uterine ruptures in VBAC? Either one, the chances seem pretty high. I was hoping to stay at home as long as possible (until cx every 3-4 minutes) but now too scared to do that as well. Now I'm also thinking, what other risks are there that the consultants haven't told me? Can I still have a sweep and keep labour safe, seeing as consultant thinks that oxytocin IS safe when all websites I've seen states not? Don't really know what/who to trust now.

Guess I'm being a little irrational now that EDD is very near. I know loads here have had VBAC experiences so wouldn't mind hearing some thoughts from experienced VBACers. :)

Hopeful bump? Hoping to discuss some of these with midwife later today.

Hi there

Will have to post and run I'm afraid as DD is just waking up. I found this link very helpful when it came to making an informed decision about the risks involved.

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

Good luck, it's not an easy decision to make I know.

It is something you should discuss with your midwife. I have written a list of questions down for my consultant but I am very early days yet.
My risk is slightly increased though, but 1% to me isn't a high risk but that is just my personal opinion.

You will probably have got all the answers you need before I see my consultant, you may have even had your baby, so I can't really help as I have no idea myself what I will do, or if I'll even be given the option yet.

Hope your midwife can give you some answers.

I had a VBAC, although had 2 VB prior to CS. It is so much better to have a VB - it was so nice to be up and not in pain with my new born

Hi anonmum

I mentioned on a previous thread with u that I had a fantastic VBAC experience 15months after EMCS. Did you get to read any of my older threads on it?

Have a look on the homebirth website, there are many warning signs that you can look out for when in labour and a big one is pain in the scar area inbetween contractions. With my VBAC at home they were with me from 4cm's dilated and were happy with that. Now I'm due to have 2nd VABC they don't want to hear from me until contractions are 3mins apart and very painful - even though the chance of ruture is stil pretty much the same! But I'm happy with that. I'm now 40+9 and I won't accept induction with prostaglandins/syntoconin as to me the increase in risk just jumps too much and the stories I'v heard/read of of rupture have included this type of induction. I will be opting for extra monitoring and if induction is needed I will only accept ARM, then a section if that didn't work. I'm hoping baby will have arrived before any intervention is needed.

During my VBAC I had a sweep at 3/4cm's and then had ARM at 5cm's and everything went very well. Hope some of this hepls a little

NICE guidelines:

uterine rupture is a very rare complication, but is increased in women having a planned vaginal birth
(35 per 10,000 women compared with 12 per 10,000 women having planned repeat CS)

Women who have had a previous CS can be offered induction of labour, but both women and healthcare professionals should be aware that the likelihood of uterine rupture in these circumstances is increased to:
? 80 per 10,000 (0.8%)when labour is induced with nonprostaglandin agents
? 240 per 10,000 (2.4%) when labour is induced using prostaglandins.

So it's actually only a 0.35% chance of rupture if you have a VBAC going into labour naturally.

I must add I absolutely want to avoid a section as my prevoius experince was so traumatic and painful in recovery etc. owever, I personally have a such a bad 'feeling' with using the induction drugs on previous scar I would opt for ELCS if baby needed to come out and the induction drugs were the only option left.

typos !

Hi all, thank you so much for your responses. Overslept and now have to dash to midwife's.

mamasunshine yes I have. I felt positive about the whole thing having read them. Guess I shouldn't really read horror stories on the internet just before birth but I searched because I wanted to know the warning signs. According to some of the stories, when they felt the pain and noticed the signs, the baby had to be out like RIGHT NOW. That's what got me worrying. I agree, I'd rather have ELCS rather than induction drugs.

Will read all in more detail when I'm back from appointment. Completely blaming pregnancy for oversleeping! :)

anonmum2 I've been through all this myself recently (DS 5 weeks old). I was completely terrified of another section and went for a vbac all the way through my pg. Yes, there is a slightly increased risk of uterine rupture, but for me the risk was worth it. My consultant said they wouldn't induce and like you, I made the decision that if things didn't start spontaneously, I'd go for an elcs as lots of women report these are easier to recover from than emcs.

Most hospitals recommend CFM for vbacers - apparantly this is the best way for them to pick up the early signs of a uterine rupture - if it occurs, I believe they have to deliver the baby within 20 mins iirc.

Remember, the hospital will have their guidelines for managing vbac women, but you are the patient and they have to respect your wishes. So they can't give you sintocon without your consent. If you don't want it (I wouldn't have had it) that's your choice.

I really do know how tough a decision this is - good luck.

maxpower I had decided all the way through it's definitely VBAC but for some reason started to doubt my decision and was thinking perhaps it isn't too bad if I'm overdue and HAD to have a CS.

I have to shake it off really as I too had a bad time with EMCS and really want to avoid it if possible. Thank you for yet another reassuring experience.

anonmum2 if you want to read my vbac birth story I'd be happy to send you the link x

i tried for vbac with ds2. after 48 hours went to hospital where they offered me synto, i refused as was worried about increased risk of rupture, had section instead. was very surprised to be offered synto as it seems to be the number 1 thing not to do in vbac. because i had been at home throughout the labour, i felt very calm & relaxed and able to make a rational and considered decision... so although i was obviously a bit sad the vbac didn't come off, i've also never 'regretted' the section which felt like the right thing to do at that time.... very different from my first section.

maxpower yes, that'd be great. If not I can always search?

ladySanders I think that's it, I'd have to be be able to make a rational decision at that point and say no thanks to synto. I felt completely out of control when they pressured me into having epidural last time even though I specifically put in my birth plan that I don't want epidural. Midwives basically told me every 20 minutes from the moment I had the synto drip on that I would benefit from epidural. After 8 hours of repeated asking and persuasion, in my drowsy/tired state(hadn't slept 3 days prior), I gave in to pressure. Going to have to give DH clear instructions it's CS rather than synto if need be.

www.mumsnet.com/Talk/childbirth/982766-Anyone-up-for-a-VBAC-support-thread

it's at the very end

During my pregnancy I had to see a specialist mw who I have to say was utterly fab. After talking through what had happened in my first birth experience, she reassured me there was no reason I couldn't try for a vbac and we talked through all the options open to me about the management of my labour and what could happen if things didn't progress as planned. I felt hugely reassured and much more prepared in the event that the vbac didn't work out. Have you had an opportunity to discuss your first birth with anyone?

with my vbac the consultant said to me they would never induce or use the drip. if things did not progress then they would do an emsc or if i did not go into labour then they would take me in for a cs. anyway after a great sweep from my consultant i went into labour but my vbac failed as dd was in distress and my contractions were so intense that they thought i my scar would rupture. in the end my labour was v short and the c section was not half as traumatic and in fact was quite nice and i recovered much quicker too.
where is your hospital?

Hello all

I am soooo glad I found this thread! . Have spent the last week trawling for info & boring DH silly about my worries over VBAC! I'm sure he has NO idea what I'm on about!

Baby no 4 is due in a few months and I have some major concerns (damn you Google!! lol).

DD1 & DD2 were both VB but I had to be induced at 42 weeks & have never gone into labour naturally despite trying every trick in the book!

DD3 was breech & ended up ELCS which was (ime) HIDEOUS. Terrible pain, and I had a Pulmonary embolism 3 days postnatal thanks to an undiagnosed DVT. I am high risk for that as well as the previous CS less than 2 years ago. I would give anything not to repeat the experience!

My main worry is induction of labour and the subsequent risks with VBAC. Given that my body seems unwilling to get cracking without several hefty doses of prostin gel AND breaking my waters (!) I feel that IOL is highly likely.

Does anyone know of current guidelines regarding IOL and VBAC? Or is it dependant on the area you live in?

Any advice or reassurance would be fantastic...thanks!! XXX

evening clouiseg iirc, it's the syntocinon drip you need to avoid if you're hoping for a vbac. You've got a great chance of doing it if you've had a vb before (90%). Can't post links - on my phone. Will try to pop back later. Pm me if I forget :)

ty motherofsnortpigs!

Any info is much appreciated tbh...especially from someone who's had both CS & VBAC.

I had read that the prostaglandin was the biggy to avoid (something to do with softening the uterine scar as well as the cervix??!) especially if the last CS was in the preceding 2 years so it would be interesting to see if the synto drip is also an issue. God its all so confusing I haven't a clue!!

At this rate I'll be praying for the stork to drop baby off so I can avoid all the hassle hehe.

I actually had no idea, despite being a 4th time mum, that there were so many potential pitfalls / decisions to be made after CS.

Also told my much yearned for water birth is not an option at this hospital due to the need for monitoring so hoping I can at least walk around a bit! Oh well as long as little one arrives safely! And wishing the same for everyone! X

Hi clouiseg

I had an elcs with DC1 as she was breech and my registrar has kindly said I'd like to try for a VBAC with DC2 due in 3 weeks time.

He has written in my notes that labour is NOT to be induced, and my midwife has concurred with this on the grounds that they only 'play' at induction when you've ahd a section. On that basis I'm booked in for an elcs at 41 weeks if I've not laboured by then.

I'm seeing my consultant later this week as I have questions about how the hospital I'm booked into deals with various scenarios - length of labour before they'll section etc as up until now I've not had any real answers.

I've been told by my midwife & physio (for PGP) that only the consultant can make any firm decisions about your deilvery so try & get a list of questions together & get an appointment with yours before the worry drives you mad! I know I'm hoping to pin mine down to a few requests that I have!

HavingAnOffDAy thank you!

I think thats fantastic advice and booking for a section at 41 weeks takes away the worry about being induced so I may follow in your footsteps!!

Will sit with (a very weary!) DH and compile a list of questions for my poor consultant. Not due to see her for another 7 weeks at my growth scan (as far as I know!) so plenty of time to think. Lots of questions...teamed with pregnancy neurosis but then thats why they're paid six figure salaries - they have the pleasure of listening to us lol!

All the very best of luck, and please let us know how you get on. Will cross my fingers! x

This is the article I wanted to post yesterday. I love it so much I might have it displayed somewhere in my house :)

Seriously, print it out and highlight the bits you want to discuss with your consultant. I think it really makes you realize that you have every right to take charge and you can't be arrested by making a choice that goes against hospital policy. For example, if you chose to decline continual fetal monitoring, you could theoretically then get in the pool - your choice. If your first 2 took a long time to cook, it might be worth pushing back your elcs date to the end of your 42nd week (sounds better than 43 weeks). My first (the one that was the emcs) was delivered at 43+1 and didn't look overdone. Having said that, my biggest fear is still going massively over dates. I used acupressure once I got to 40 weeks with DC's 2 and 3. Have a read of this to see if you think it's something you'd be willing to try (if you haven't already!)

Anyway, three cheers for us soon to be 4th time mothers. We're a very special breed :)

motherofsnortpigs thankyou.

What a fantastic informative article! This should be offered to VBAC mothers prior to making an "informed" decision! The emphasis being on informed!

I would give anything for a homebirth but have ruled that out based upon, among other things, the fact I'm on Clexane and have a history of PE & bleed like a nutter! I will, however, push for my waterbirth and at the very least, a mobile labour! DD2 was 6 hours first CX to birth despite being induced- I'm certain its because I literally traipsed the hospital howling through CXs until I was 9 cm dilated!! lol.

I know they say that CFM is essential but surely its reasonable to ask for intermittent monitoring to promote freedom to move? I do find it a little shocking that they encourage so much intervention but fully respect that some mums are happy to accept this. I do have the niggle in my mind..."what if..." but trust that our bodies are made to withstand serious stress!

I wonder how many mothers have shunned the clinical labour in favour of a more natural approach with a VBAC? And what the outcomes were? I am truly intrigued!

Am raising a glass (of Schloer!) to 4th time mothers too...a special breed we are, and certainly made of tough stuff!

motherofsnortpigs that's a great article. I wish I'd printed it out to take into the delivery room with me as I was hounded by three registrars/consultants to have an assisted delivery after I'd been pushing for 2 hours. I had primed DH to fend them off and we did for a while.

"Is the baby ok?"
Yes it's fine
"Right, well I'm fine too so please leave me alone to get on with it"!!

But after 24 hours of exhausting labour, arguing with them took the wind right out of my sails and I ended up with forceps.

clouiseg I went for a more natural approach and managed to spend a long time in the pool. DD has just started yelling so I have to dash but if you want it I have a copy of the AIMS publication on VBAC which was very useful. I can post it to you if you are able to PM me your address (just lurk here normally, no idea how PMing works!!)

chocolatejunkie I think you did amazingly well to labour for so long while everyone around you is telling you it can't be done. How helpful I hope you get the booklet clouiseg it's really useful. If you're interested, I'll tell you about my low tech vbac's... I am a complete hospital phobe :)

Hi clouiseg

I saw my consultant today & am booked in for ELCS next Weds!!!

He was VERY flexible & said the choice was totally mine.

I felt cowardly asking for a section but do know it's the right decision for me. I feel so much more relaxed about things now...I had sooooo many questions/concerns about the labour that now I don't have to worry about.

The only problem I have now is persuading DH's parents that they don't need to visit for the two consecutive weekends after the op. Although I may be what I need to get me on my feet & out of the house