vbac - a few questions

[otchayaniye]

I haven't reached the stage of discussing this with a consultant yet (I'm around 20 weeks) but I have spoken with midwives who have given me literature. What I wonder is since the literature says the risks of vbac are 'insignificant', or 'very small', why they allow you to have another elective? Is
there more to it than meets the eye? Is this partly political (consultants vs midwives fiefdoms?)?

Also, one thing that irked me was the literature said bonding was easier with a natural birth. However, it didn't state what they meant by 'bonding' and they placed it in inverted commas (I don't think inverted commas belong anywhere in medical literature) What do they mean exactly?

Just reading that I was left with the impression that although after an elective for many reasons the second birth was effectively wiping the slate clean, so why offer an elective second time around, given the huge pressures on the NHS? We were
both left feeling there was more to this.

I am about 80 percent certain I want another elective section (no great desire to give birth naturally, no huge fuss either way, just it's not hugely important to my self esteem breastfeeding, however, is) the only reason I'd have a vbac is for even quicker recovery, but husband is a SAHD (more or less) so childcare and help with shopping isn't such a pressing issue. After my first I was up and about in 12 hours and lifting (even though I shouldn't have) stuff without a problem and swimming (eek) in 4 weeks. Driving isn't crucial, husband will
be around. I don't use prams and assume I can wrap carry the baby like I did my first.

I had an elective section with my first (in Singapore) as she was extended breech and I had preeclampsia so had her at 8 months. I recovered incredibly quickly and bfeeding no problem -- in fact, still breastfeeding her at (ahem) 2-1/2 years. No attachment problems here!

I know what you mean about the total contradiction of them saying that a VBAC is safe but them also offering an elective if you want one - it makes no sense really does it. I don't think they're trying to hide anything I just think they want to be seen pleasing everyone.

Bonding - this is a difficult and emotive subject I think. From MY experience, having a section didn't affect long term bonding, but for me not being as mobile post-birth as I wanted to be and not always being able to just pick ds up as and when I wanted to in the early days was horrible.

I also recovered very well from my section. I was out of hospital in 24 hours and walking about 8 hours after the surgery. I didn't suffer any infections or post-surgery complications either. So all in all I had an easy ride of it.

Maybe you need to think about your reasons for VBAC'ing vs section?

For me VBAC'ing was about needing to experience a natural birth. I felt very much cheated out of it aftr my emerg. section.

It was only after having my section that I found out about the possible side affects of a section (and especially multiple sections) and these were also deciding factors for me to have a VBAC.

More likely to require an emerg hysterectomy, suffer with bladder and bowel problems, and fertility issues due to scar tissue adhesion.
Baby is more likely to be born with respiratory distress.

Also the after care at our local hospital is beyond dreadful, and I don't think it's a bad hospital in the scheme of things.

Good luck with your decision, it can be a hard and emotional one to make

Does your literature give actual numbers? Mine says:
about 1 in 200 women attempting a VBAC will rupture
and of those 1 in 200:

• about 1 in 10 will need a hysterectomy
• about 1 birth in 20 uterine ruptures can result in a still birth.

My literature describes the risks as small but serious. I still want a VBAC but was surprised at the amount of ruptures, I know its just perception but to me 1 in 200 sounds a lot more than 0.5%, even if its the same!

I certainly wouldn't worry about bonding but did find b/f difficult physically straight after the birth, and my milk didn't come in (but that could be an entirely different issue).

I was elated after my 1st VBAC and even with a bad 2nd degree tear found it much easier afterwards. I was never offered an elective c section until I had had 2 c sections. After that it was alwasy a c section, especially as I was high risk. I would go for a VBAC everytime unless was high risk or twins etc. My VBAC with twins ended badly and with a combined delivery, yuk!

The uterine rupture risk I was given (end of last year) was 1 in 300 - mw told me that was the latest stats.

OP, I doubt the literature is tailor made (ie, designed for your specific circs). It's probably worded that way as some women will require/opt for another cs for either medical or emergency reasons, irrespective of whether they want a vbac or not.

Form the description of your first cs, it sounds like it was very straightforward and positive with a quick recovery. Unfortunately, not all of us (esp those of us who have an emergency cs) have such a smooth time of it and in those cases, there can be an impact on how we 'bond' with our babies.

google rcog green top guidelines - 45 i think - for up to date statistics.

Tough decision but having had an elective and a vbac, I found the vbac to be a fantastic experience and I was amazed by how physically well i felt afterwards. But nobody can guarantee you anything. Hope it works out for you :)

Thanks everyone. It is a tough decision.

I need to speak to my ob/gyn in Singapore I think as he performed my first (and I was elated after a c-section - maybe I'm weird!) and may have specific recommendations.

And then speak to the consultant.

I'm at Kings in London and they didn't say anything about having had 2 sections, anyone I spoke to seemed to accept that I could simply choose.

I have no particular urge to give birth naturally for any reason than faster recovery.

Argh! It IS a hard one

Thanks for your experiences.

I've just posted on the other thread about this.

They shouldn't be saying the risks are small - have a read of this www.rcog.org.uk/news/bjog-release-risk-uterine-rupture-after-previous-caesarean-section

The average risk is one in 200 of rupture but that includes women with repeat c/s who have a very low risk. The risk for the VBAC women is closer to 1 in a 100 and considering this is a life threatening catastrophic risk that's far too high for many people UNLESS they have a burning desire to experience vaginal birth.

If you haven't otchayaniye don't be persuaded. The bonding stuff - as you have found yourself - is complete rubbish and based on a study that showed that women who had c/s were initially less responsive to their babies. Hang on though... they had just had an operation...what do you expect? Was there any difference later? No none at all (but sh..the nhs don't want that leaking out)

It is all propaganda to get the caesarean rates down and save the NHS money.

It is a very hard decision I agree, I am in a similar situation and just when I think I have decided something at the back of my mind niggles.

I have had a VB with my first and an EMCS with my 2nd, neither made me feel elated and both had complications.

Good luck with whatever you decide.

I have decided something at the back of my mind niggles.

Totally!

I agree about the bonding, didn't make a difference I don't think. I didn't even see DT2 for several days as we were too ill and on different wards but we are very very close and were as soon as we were together (had a section with him). Also, adoptive mothers are very close to their kids in my experience (in my family/friends) so it isn't always about birth itself.

I was told that it was not always set in stone after 2 sections to have another one but because of my risks (2 post 20 week losses, blood thinners, immune disorders and a cervical stitch in situ) it was strongly recommended. I actually would have preferred a VBAC but I knew I had to go with their advice and didn't want another emergency section (quite high risk with a stitch in as sometimes after it's removed the cervix doesn't open due to scar tissue). It was the right thing though as it was so straightforward.

My dd was an ELCS as she was breech, and I elected to have a CS again with ds. Unfortunately, he came of his own accord at 37 weeks, with no option of a CS, as I arrived at hospital fully dilated.

With regard to bonding, I think I bonded more quickly with dd, because I was so prepared for her arrival. Ds' one and a half hour labour was a total shock to the system, and I have no recollection of holding him for the first time. He is now 15mo, and a cheeky little scamp. The bonding was established after a day or so. I was actually in hospital longer after my VBAC than after my ELCS, as I developed an infection, as did ds.

My point is, do your research, go with what you feel comfortable with, and then be prepared for anything!

Really thank you, this is most helpful and it's good of you to share your experiences.

As I said, I haven't spoken yet to a consultant but midwives have asked what I wanted and I said ECS and no one said that the choice wasn't available.

In response to Ushy's post, the study that you are referencing found there was an 8 times higher risk of uterine ruptere in VBAC including where labour had been induced. It's well known in RCOG guidance that induction increases the risk of uterine rupture, particularly using the pessaries. Therefore most hospitals will not induce for a VBAC as it hugely increases the risk.

If you go into labour without induction, the risk of rupture is low - 1 in 200. Of those 1 in 200, the majority will not have any negative effects, as 'rupture' includes minor opening of the scar that doesn't cause any problems to either mum or baby.

Yes there is a small risk to VBAC, however there are risks to giving birth at all. The absolute safest way for babies to be born would be for all women to only have one child, and for that baby to be born by C-section. That puts almost all the risks onto the mother (aside from breathing difficulties). However to suggest that would be absolute madness!!

I'm not saying anyone should choose VBAC over ELCS (or vice versa) unless they want to, both have risks and benefits, and currently being in that situation myself at 33 weeks pg I feel like it's between a rock and a hard place.