Should I have a VBAC???

[clairefromsteps]

I had a pretty horrible birth first time round - I was induced at 39 weeks (I had twins), very painful 36 hour labour culminating in the doctors advising a c section once I'd reached 10cm as my DD was in a funny position. Then I had the CS to recover from, which didn't go too badly but still more painful than not having one!

Am currently 22 weeks and have spoken to my midwife about my birth plans and she has suggested a vaginal birth. The reason being, I got to 10cm last time and the CS was four years ago, so the risk isn't very high of something going wrong.

A vaginal birth would mean a quicker recovery, but the thought of my womb potentially splitting open is terrifying me beyond belief. And I don't want to have to go through the pain of labour again only to have a CS at the end. The thought of a CS doesn't worry me particularly as I know what to expect, but I'd rather not have one.

So I guess this isn't really a 'what should I do' as much as a 'what did you do?'. All stories welcome, no matter how grisly.

If I were you I would go for it. I have had 2 emergency c sections for failure to progress(only got to 4cm maximum.
I am glad I tried for a vbac despite the outcome.
Unless you are desperate for an elective c section then definitely worth going for a Vbac. I knew I'd think 'what if' if I had had an elective.
Each to their own though.

Only you can make the decision.

If it helps you to hear what other people did, I had a very long first labour (42hrs) and got to 10cm but the position of my baby meant it wasn't possible for her to be born vaginally. So I had a EMCS. Second baby was born vaginally - I planned a hospital VBAC, but my baby arrived so quickly I had an unplanned home birth. It was fabulous! My recovery was so much easier this time, and I was able to fully enjoy my new child's first few days (first baby went to SCBU due to complications with the CS.) I did need stitching in theatre due to the speed of the birth and the size of my baby, but it healed quickly (back riding horses 5 weeks after the birth.) I wouldn't hesitate to do it again.

If you are worried about scar rupture, there is plenty of info on the internet which calmly sets out the risks. The risk is there, but it is small and there are ways of monitoring for potential rupture. Mary Cronk has excellent advice here.

I was so concerned about a repeat of my first labour that I employed an independent MW, who was fab. She helped me get mentally ready for and write a birth plan which considered the possibility of a repeat CS. While the intention was always to attempt a VBAC, I had to consider what I would do if I had to have another CS, and my birth plan requested that should a CS be necessary I would prefer to know and have the CS sooner rather than be left to labour for hours pointlessly. As it was I didn't need it.

A vaginal birth doesn't always mean a quicker recovery. I was driving two weeks after my section and felt fine. I am now 14 weeks since my VBAC and still find it painful to sit from my episiotomy.

I was very keen for a VBAC and there is no possibility of me getting pregnant again however if there wwas I would opt for a section.

I know how you feel - I thought long and hard about having a VBAC for my second child too.

In the end, I decided to go for an ELCS. Having done my research, I found there are definite advantages to never having given birth vaginally (less likely to experience incontinence or organ prolapse later in life, for e.g.). I felt that since I'd had one c-sec, I may as well take advantage of its benefits second time round too.

If the experience of a vaginal birth is very important to you though, then that may the best option for you. Even if it did end up in C-sec, the recovery isn't that bad for many people anyway - often I think people overstate this. I was going on long walks 3/4 days after mine and comfortably dealing with my toddler once hubby was back at work a couple of weeks later.

Deep down, you know what you want to do. I'd say just go with that gut instinct.

Without wishing to detract too far from the OP's topic, bluebutterflies I think it depends on the circumstances on the day as to whether it is that bad or not. And that goes for vaginal or CS birth. I for one though would not have been going for a long walk 3 days after my CS - I was in High Dependency unit after suffering the kind of medical negligence that made me want to spend several thousand pounds on a private midwife next time round with the primary aim of getting me out of hospital asap. I do also realise that things can go wrong with a VB too - believe me, as a VBAC myself I know that you sit between the devil and the deep blue sea whichever way you choose.

Backinthebox, I'm so sorry to hear that you experienced negligent care. I agree that things can go wrong. That's the tricky thing with childbirth -it can be very unpredictable, however we choose to do it.

All we can do is make the right decision for us at the time - and for many women the outcome is positive.

Absolutely, bluebutterflies. I made the right decision for me and was ecstatic at the result. I think the OP is asking for other people's experiences to see what is possible for her.

The websites I used to help inform me, that I found most helpful, include;

Homebirth VBACs - useful advice even for a hospital birth.
Caesarean.org.uk - and extremely balanced and informative website, to offer advice for VBACs and ELCSs.
And plenty of good links here.

Thanks for the advice and links, ladies. Luckily I've got a really nice doctor who has said I've not got to decide until much nearer the time. An ELCS would be more 'convenient' - you get a date for giving birth, all nice and calm (with any luck)....but part of me thinks it would be a shame never to have experienced a VB. But then, if my baby comes out happy and healthy does it really matter?

Maybe I'll just toss a coin.

OP you could have been me (bar the twins!) Had DD in July 06 - failed indcution, 36 hr labour ending in emcs. Got to 6cms dilated. The recovery was long and protracted and I was told (during my last pg) that what I had been through was a birth trauma which I may never fully get over.

Had DS in December by VBAC - best experience of my life.

The problem is with an ELCS, there is some certainty to a degree. With a VBAC, you just don't know. Assuming this is a singleton birth, it sounds to me like there's every chance a VBAC would be successful for you. Good luck with whatever you decide.

Forgot to say that I just couldn't make a decision so when I was 39+6 I had a meeting with my consultant and chose a date for an elective in case I went very overdue (was predicted a whopper). And I went into labour 3 days later.
So like your Dr mine was quite relaxed on the decision making!

i was told after my csection that i could have a vb in future.
it was only while i was in labour that they even mentioned the possiblity of a csection again. but only if the labour was stormy.

i would go for it.

btw i didnt want a csection due to not being able to drive for 6 weeks afterwards.

if it's a what did you do ...
I did vbac, stunningly easy 5 hour labour (still painful but absolute textbook) and up and out within 10 hours. It also stood me in good stead for dd later on - I wouldn't have fancied the internal scar tissue of 3 births - but if you're stopping at 3, with twins first and everything, perhaps that's not an issue? I only got to 4 cm with the first before c section so I was amazed it went so quickly

I had vb with dc1, cs with dc2 and vbac with dc3.

Personally I'm really glad I managed the vbac, as the recovery time is likely to be a lot shorter, and you can be literally up and off the bed straight after giving birth.

I know the thought of your uterus splitting open is horrendous (that was the thought that scared me) but honestly, your consultant won't let you labour if that is likely to happen. You'll be carefully monitored. Just try to put the thought out of your mind, and focus on the fact that this is a different pregnancy, and the reasons for your previous cs don't apply.

There are also things you can do to minimise the risk of ending up with another cs - eg keeping mobile during labour. I was very clear with the doctors that although I respected their medical advice that I be monitored more closely than I would have been with just a normal vb, I wasn't prepared to be strapped to a bed - I tried to stay as mobile as possible, eg standing alongside the bed.

The 'not being able to drive for 6 weeks afterwards' info is wrong (possibly out of date, I'm not sure).

You can drive as soon as your doctor says you can, or, frankly, if you are an intelligent sensible person and feel you are quite capable. I was driving 2 or 3 weeks after mine (can't remember exactly now) - I would not have driven before as I didn't feel 100 percent comfortable making a 'braking' motion, which involves abdominal muscles, but as soon as I felt comfortable and strong enough, it was fine.

My insurance company had nothing to say about a CS when I rang them, and said if I felt I was fit and competent to drive, and the same went for ANY operation, then that was fine.

The medical thing to be aware of is that if you are still healing internally, then if you are in a crash, you are more likely to get internal damage and haemorrhage. It's a risk assessment for an individual. Some people will be happy assuming they won't crash, others won't want to risk it.

But not being able to drive for 2 or 3 weeks is a serious disadvantage for many. Plus the fact that it can be very painful and risky to lift for a while - certainly a disadvantage if you have other young children. Whereas with a straightforward vb, you can be driving/lifting etc straight away

I had a CS first time round due to position of baby. It was not a pleasant experience due to long labour before and a difficult recovery including an infection in my wound.

I then had a VBAC, 2.5 hours from first contraction to delivery. Did need an episiotomy and tore but that didn't and hasn't given me any problems whatsoever. Apart from being terrified baby would arrive in the car (which it probably would have if I hadn't needed the epi) it was a wonderful experience despite not having time for pain relief! I felt better a couple of hours after that than I did for several weeks after the CS, was also home within 10 hours of giving birth which was a relief!

Now expecting no.3 and still haunted by the first experience so nervous about going for it again. If I could be sure it would be like the last VBAC then I'd have no doubts at all. I think I will do as with last time. Basically say that as long as it is all going well then I'm happy to go with VBAC, but the minute it looks like it's not going smoothly I want a CS. No other intervention. No drips to speed things up, no induction, no back to back labour.

I don't know whether there is a bit of tendancy to be more likely to post on this thread if you have had a good VBAC experience - those of us with more 'neggy' experiences perhaps might feel we have to keep quiet.

Please have a read of the RCOG guide www.rcog.org.uk/files/rcog-corp/GTG4511022011.pdf

Make sure you speak to an obstetrician as well as a midwife.

VBAC leads to a quicker recovery only if successful. Unsuccessful VBACs can have MUCH slower recovery than electives - especially if a long labour leads to an emergency C/S late in labour. (Won't say any more)

Good luck whatever you decide

The way it was explained to me was the following-

you've got to fully dilated in your first labour so your body is capable of it

we will be monitoring you more closely of course but that doesn't have to mean you won't be allowed to be active, get off the bed, use the swiss ball, your tens machine, gas & air

if things are progressing nicely (roughly a centimetre every hour) we will let you get on with it

It was really highlighted that I WAS capable of it, that it was understandable that I was nervous and they really appreciated that I didn't want to repeat the experience of my first labour-

to have to go for days having contractions first at home then in hospital, then being induced, then not dealing with the exhaustion which meant I couldn't deal with the pain which inevitably led to the cascade of intervention- epidural,catheter, diamorphine, synto drip (yeuch) then whipped into surgery for an emcs. Blah.

Nearly 3 and a half years after my first baby was born, I succeeded in my quest for a vbac and IT WAS MINDBLOWING ! Such a different experience from the first, I felt so much so much more in control, confident and trusting in my body, I was completely lucid and felt the rush of endorphins immediately the moment I saw my DS.

A lot to do with luck, I think, he was in a much better position (DD was posterior and had got distressed during that 72 hours latent labour, am sure she was as exhausted and pissed off as I was!)

Also a lot to do with the staff really taking heed of my birth plan- I made a much bigger deal of staying upright and active, they used the telemetric monitor so I could walk about, lean over the bed,they brought me heat pads for my back, they could do all this as was a smaller, less busy hospital.

I really recommend 'BloomingBirth'www.bloomingbirth.net the nicest book I have ever read about birth (and that is some claim)- factual but written in a lovely warm tone. The website is great too.

I hope this helps you !

Take a look at this article, it might help regarding your rupture fears midwifethinking.com/2011/02/23/vbac-making-a-mountain-out-of-a-molehill/

I also had an emergency c-section with twins after one got stuck. I went on to have 2 VBACS (one induced at 12 days overdue, th last one was spontaneous 17 days overdue) and I'm about to do another in June. I'd really recommend it (but then I had a REALLY bad time after the section). With the VBACS, I left hospital 8 hours after the births and recovered really quickly with no after effects. Depends on your experience of the c-section?

I don't know if this is helpful or not but I used hypnobirthing to keep me really calm on the VBACS as the c-section had left me really frazzled. It didn't take the pain away but it certainly helped keep me on an even keel. I didn't use any other pain relief though so maybe it all pulled together to have some sort of effect?

Hi. Had em cs in dec 2008. Fantastic recovery. Was advised to try for vbac next time, cdn't afford a private midwife so hired a wonderful trainee doula. Attempted vbac 3 weeks ago which turned into another em cs. Am having a horrendous recovery this time. But I won't have changed it for the world. Had I not attempted it, i'd never have known. I had a wonderful 7 hours labouring with the doula at home, then An epi at the hospital, then the cs. The one thing which is v difficult is not being able to lift my dd1, so I can't put her to bed, wake her up or give her a bath on my own. Luckily my dh has taken a month off work and I will be getting other family down to help.

It has to be your choice. This was just my experience. Good luck.

The risk of rupture is tiny and they should notice it before it actually happens and get you straight into theater. My baby was delivered under GA and on her way to NNU within 20min of them discovering her foot was being born. They can move fast when they need to.

I had an elective crash section second time and this time I plan on a VBAC.

I've had bad experiences of a section and everything I know as a doula and from educating myself tells me I can do it. My body works, I've always got to fully dilated without incidence or even pain relief, I've always gone into labour on my own and I've always gone pretty quick. Last time I was flat on my back unable to pick my baby up, I had to buzz them each time. I couldn't stand up straight for a long time, I was in a lot of pain for a long time and really struggled with everything. Compared to how well I've handled labour I'd rather do that!

There are many ways to reduce the risk of rupture and you might find getting a doula or attending a VBAC antenatal course helps.

But don't listen too much to other people's experiences. They're totally separate situations to yours with unique sets of circumstances and don't relate to your birth and quite often even to statistics. If it was based on my experience alone I'd say VBAC every time but based on someone else's you'll get a section every time. All that will do is confuse your situation.

Do what makes you feel most comfortable.

I had a VBAC and was really pleased I could experience what birth this way was like. Recovery was quick too.

Everyone is different though and its you and your baby that count.