VBA2C

[carlypen]

anyone had any experience of this good or bad i would love to hear it. thinking about it for baby number 3 and so far have been surprised by support of gp and midwife

hi re vbac, being a doctor i have biased view but i do feel midwives are generally v pro-vbac and mums don't realize that although the risk of complications are low, the risk itself (ie uterine rupture-hysterectomymaterna/fetal demise...even death) are so horrendous, especially as i've had the misfortune to see it, that i personally think its too high a risk to take. despite reassurances such as closer monitoring etc etc i would not consider vbac having had an emergency section in 2004. my advice would be to think very, very carefully about it.

Aye Tutti - is not just between hospitals it varies thou' as differnt consultants had differnt views too at my hospital too . All I want to say was don't presume you won't be able to do something before hand you never know!

Hiya had an Emergency c/section nearly 7yrs ago after 24hrs labour and 2hrs of pushing, then had a succesful VBAC nearly 3yrs ago. Various reasons for em c/s but decided as my body had been through labour i wanted to labour again and was very determined to have the birth i wanted but also did not want to put my baby in danger so i was prepared for theartre just incase i had same labour as last time and i was monitored very closely in the labour. Glad to say i would give birth by VBAC ten times over compared to my c/s.

and also i wasn't allowed to be started if my dates run over, that included drip, gel and breaking of waters, they would let me go up to 2weeks past my date and then it would be a planned c/s but luckily i went into labour 4days late and after 11hrs labour i persauded the midwife to break my waters, she went and spoke to a consultant came back and bingo 4hrs later i gave birth

I had em c/s for DD1 then VBAC for DD2 - that was definitely the right decision for me, especially as I "only" had em c/s because she was breach and this hadn't been picked up until I was labour. But DS born 7 months ago, and after a lot of agonising (plus a few scares in the final weeks) I went for elective c/s. My consultant told me at the time that if I'd had 2 C/sections, then they'd be absolutely no way that I would have a choice if I had a 4th child - I'd have to have a c/s and possibly a hysterectomy at the same time. I'm not planning a 4th fortnatately!!!!

As with Afrin, am also a doctor with possibly/probably a biased view. The consultant I used to do obstetric clinics with quoted figures for risks of scar rupture with VBAC. I can't recall them exactly, but I think it was a 1 in 400 risk after 1 caesarean, but much higher at 1 in 40 after 2 caesareans, hence the usual recommendation for elective section after 2 c sections. Again, as Afrin said, the consequences of scar rupture are so severe, often resulting in foetal death, not to say maternal hysterectomy or even death, that it is generally advised not to risk VBAC after 2 sections. The figures I've got for mortality after uterine rupture (from all causes, not just in the situation you're discussing) are "there is an approximate 5% maternal mortality and 30% fetal mortality associated with this condition".

Sorry for rather gloomy post, but hope that offers some additional information and statistics.

Jupp - here are some sites:

scanning scars

another one

And also some stuff on epidurals:
Most guidelines say that epidurals are ok for VBAC and says this is based on "good evidence" - based on some American Obstetrics & Gynaecology report in Jul 04 that isn't available on the web. Don't say what the evidence was though.

This site - here - says epidural is ok, you still feel the scar pain (!). Lots of places say there may be no scar pain (raised pulse or fetal distress are often the only sign).

I get the impression that they just don't know, so many differing opinions!

I am due to have a second baby in July - I had the first by c-section, because she was a transverse lie. My midwife seems quite keen on VBAC. When I saw a doctor at the hospital ante-natal clinic yesterday, she raised it as something for me to think about, but I got no sense that she was pushing for it. I have done some searching on PubMed (database of academic journal articles in medicine). I could find very few systematic reviews of VBAC. One that I did find suggested that the evidence base is rather small and its findings were inconclusive. I found nothing to reassure me. Even the hospital leaflet I was given (which was very pro-VBAC) explained that there is a tenfold increase in risk of death for the baby, compared to a repeat c-section. I am therefore pretty sure I want another c-section.

but that 10-times-bigger risk is presumably a 1 in 1200 risk? (going on avp1's stats?), out of the 30% of women who attempt a vbac. If you were talking about any other medical procedure (not that birth is a medical procedure but ykwim), you wouldn't call that a particularly significant risk would you?

Personally, I'd be particularly keen for a vbac next time if only to avoid the situation that LittleMissBusy mentions, that you basically run out of chances to have more babies pretty quickly. It's not like I'm planning a huge brood, but I'd like to keep my options open iykwim.

After one vb which was very traumatic I was advised to have a c section for no.2. After much agonising I agreed to an elective cs. Best decision I ever made! A planned cs was so much better than the vb with no.1. My recovery both physically and emotionally was much faster after the cs. I'm only adding this because I think that there is probably a huge difference between a planned cs and an emergency one. For me VB was a terrible, traumatising experience and something I would never wish to go through again. For some of us are bodies just can't manage VB well, and a cs is the way we get to have babies without either them or us being damaged in the process.

CarolinaMoon: "run out of chances to have more babies"?!! I know people who've had 3 or 4 C-sections. How many are you planning???

I keep hearing you shouldn't have more than 3 sections. I know some people have more though.

It's really that I used (before having kids ) want 4 but if I didn't have any vbacs I'd have to think long and hard about whether it's dangerous to do that iyswim. It is just of other peeps freedom to choose.

Why would I do anything to raise the risk of death for my baby, though?

I've had 2 sections (one emergency and one elective). At my 6 week check up I was told by the Dr that I would have to have a section for any future pregnancies. I didn't even bother to ask why, I wasn't even over the 2nd section to be thinking about ever having another baby.

I had it- well tried.

Dr etc were happy to give it a go, in fact the consultant suggested it! It didn't work out for me- but it was an early switch to section and that was the best section I had. Recovery was much easier than after my 2nd (although took longer than after my 1st).

Michel Odents book on sections is worth reading- he favours sections in labour over elective sections - and I think he is right. DS2 was an elective section and really wasn't cooked- had no end of problems with him for the 1st few days. DS3's was fine- was much more ready to be born (more awake etc- made feeding far easier). I;d recommend it - it made giving it a go seem sensible and early switch to section sensible as well.

Thank you for all the messages that have gone here to help me make my decision. I think I am edging towards elective CS now - but will make it as late as poss! I have also heard babies having problems in the first few days as they weren't 'ready' to come out. A VB would be great in an ideal world, but survival for me and the baby and as stress free for all (including my DH who worries about all these things) are my priorites.

teacle I'd really recommend the /link{http://www.amazon.co.uk/exec/obidos/ASIN/1853437182/qid=1140769468/sr=1-5/ref=sr_1_3_5/026-6955216-1630068\odent book}. It's very interesting and made my mind up for me

One thing to bear in mind is that elective sections aren't always easier than emergency. I had 2 emergency secitons (for non-progression so not scary baby in distress ones), and both were so much nicer than my elective. If you do go for elective sections check your hospital policy. The hospital I had ds2 at gave electives at 38 weeks, which was too early for him, I thought it was standard, but when I had ds3 at a different hospital their policy on electives was between 39 and 40 weeks (whcih in hindsight would have suited ds2 better)

try again .

JimJams, what was it about your elective cs that you didn't like?

I have to say it would freak me out to go into theatre for a cs stone cold sober as it were - with my em cs I was well into labour and v tired so it was all nice and hazy .

Oldiemum, we do risky things with our kids all the time - do you never take yours out in the car, for instance?

Mainly that carolinamoon- very clinical and too long to think about it. horrible anaesthetist (both emergencies they were lovely), they also opened me and said 'quick quick call a consultant where is he, get him here quickly' and wouldn't tell me why (scar tissue.

The other issue is that ds2 was born too early, had breathing difficulties, had to be in an incubator, didn't feed very well, was very sleepy for weeks (!) and then got an infection.

DS3 was born holding his head up (section after going into natural labour).

Carolinamoon - I do understand the concept of risk and feel intellectually equipped to make sense of the difference between a risk of 1 in 10 000 and 1 in 1000 (the two figures in the leaflet I mentioned). However, as an academic social scientist, I also understand the concept of cost-benefit analysis. So, for example, car journey to take DD to Tumbletots = very small risk and significant benefit; VBAC = extremely small risk, but what benefit? And benefit for whom? For her?

I had an emergency CS 12 weeks ago now and have been thinking about no 2 already! I am in two minds as to whether to go for a VBAC the second time around but am worried about it ending up with another emergency CS. I think I would rather have an elective in case of another emergency (despite being induced labour didn't progress) but would like the experience of a VB. I found the CS itself to be absolutely fine and had no complications but the whole "emergency" part of it I found quite scary.

Oldiemum, the benefits to the baby lie in its being "cooked" if you've gone into labour naturally (even if you end up with a em cs), and as you're prob aware, it's thought the actual journey down the birth canal and the baby's hormonal response to VB are beneficial to the baby and help avoid breathing probs that may occur after cs as well as encouraging a good start to bfing and bonding.

Personally, I think that's enough benefit to be worth the risk (although I wouldn't risk being induced or having an epidural, or a homebirth - we aren't particularly close to the nearest hosp) - but we each have to make our own assessment, don't we .

This is something that I have been thinking about. Ds1 was stillborn so I was induced at 32 weeks. Had ds2 just 9 months later, consultant decided on section at 36 weeks (with hindsight but at the time a welcome relief) Ds2 was fine and quite huge for gestation. However, I had massive pph and 4 units of blood, spent 3/4 hrs in theatre and 24hrs in HDU.

Different consultant for dd (now 6mo)- due to several of old consultant's dubious decisions. New one planned elective for 38+6, which I was a bit sulky about at the time (By then was horrid, shouty woman) but again know it was right decision. Another pph- not as serious, and only(!) 2 units blood.

At post-natal check up asked consultant if I should knock the having babies thing on the head- said no, another would be fine, now they know about my predisposition to bleed everywhere they can combat it earlier. Will ask next time if can have VBAC, but think already know the answer, and any risk to baby, however small, would be too great for me.

So I suppose it depends on the state of your womb and scar. Sadly, scanning the scar, as someone mentioned earlier, would not be normal procedure- it is unfortunate that you only get more monitoring once something has happened to you or a baby. If I could go back I would have ds2 and dd naturally, but I made my decision based on what I needed at the time.

JoseyJo- so sorry to hear about your son

Hi, I had a VBA2C in 2002, in hospital, and for me it was the best decision I ever made. She was a big girl, over 5kg, but no stitches and no complications - it was perfect. I was very lucky to have a super supportive midwife and a consultant who was persuaded to look again at the medical evidence which actually points to no increased risk if you've had 2 cs. A good website to get started is
www.plus-size-pregnancy.org/CSANDVBAC/csvbacindex.html#VBAC%20After%20Multiple%20Cesareans%20FAQs
(sorry for long link). My story is up there amongst many others.

There are risks with everything, but the risk of uterine rupture in a VBAC are less than 0.5%, so more than 99 times out of a 100 all is fine. For those who do try VBAC, the success rates are great. These risks really need weighing against the risks of cs, which cannot be ignored but maybe not as well publicised.

I would really recommend the Yahoo! discussion group ukvbachbac which has members who have recently had caesareans, VBA2C, VBA3C and yup VBA4C!!