Help-can't decide whether to attempt a VB or go for ELCS! Birth imminent!

[egyptianprincess]

Hi all
Let me start with the background: 3 years ago I delivered my beautiful DD vaginally at the Royal Free in NW London. She was 9 pounds exactly which was a shocker since I am on the small side- 5.5 ft tall, weighing 8.5 stone. It was the worst experience of my life- screaming my head off at 1cm dilated, no pain relief apart from pethidine (useless!) for 18 hours. Felt completely out of control (like I was dying!) and was begging for a c-section. After 18 hours finally got the epidural and was able to sleep for a while then was woken up to push for an hour. Had a 2nd degree tear repaired by a junior doctor after the midwife said "this is too complicated for me" and ended up with about 35 stiches which were excruciating and took 7 months to heal. Started screaming while I was being repaired as the junior doctor never even bothered to introduce herself and explain what she was doing. In fact she didnt say a single word to me while I was at my most scared and vulnerable. I had nightmares about the birth for about a year.
The whole experience was so horrific we decided to go private for my next pregnancy. Unfortunately, we lost DD2 at 18 weeks last June and I had to deliver her vaginally. Thanks to the wonderful care I received this experience was made as bearable as possible althought I did have severe bleeding for about 8 weeks afterwards and eventually had to have a D&C to remove remnants of the placenta.
Anyway, I am now 37+6 pregnant with DD3 and have been scanned more times than I can count at the Fetal Medicine Centre by the wonderful Professor Nikoleides. I have been told that DD3 is in the 95th percentile for size and heading towards the 9 pound mark. My consultant at the Landsdell Suite at St Thomas' is lovely but is basically leaving the VB vs ELCS question to me. He says because I have already delivered a 9 pounder this labor will be much easier and I will have all the pain relief that I need. He also suggested that an episiotomy (in the event he has to do one) would be much easier to recover from than an ELCS. So the question is, do I attempt another VB of a large baby and risk my pelvic floor (which I already feel is very weak), knowing I am in much better hands this time around or do I go with the ELCS option with the tough recovery. Right now, neither one appeals AT ALL and I am ready to flip a coin. Any opinions/advice very welcome!

Hello egyptianprincess before I post I should say that I am a little biased in that that I had a severe tear with my DD and have opted for a vb against medical advice.

I think you can ignore the baby's weight, I don't think it is a huge risk factor for tearing unless combined with other factors (baby's position, first baby, episitomy, epidural, instrumental delivery and I think induction but I am not certain).

Have you done any pelvic floor exercises post natally and during pregnancy? You should be doing about 100 a day post natally and less in pregnancy but still some (about 10 I think). The main thing to weaken the pelvic floor is pregnancy so provided you are free to move about and birth in a position your body is comfortable in your minimise your chance. The riskiest position for tearing is on your back because you are pushing the baby up through your perinuem.

Have you looked at breathing and relaxation as a coping technique for labour? They are unlikely to give you an epidural as early as 1cm dilated so you'll need something to bridge the gap if you decide to have an epidural or you may find that you manage just fine with breathing and movement.

CS is not without risks, google them, there is no evidence that CS prevents pelvic floor damage. Did you have any issues with incontinence after your DD's birth? I believe that the NHS offer elcs if you are symptomatic but I have spoken with a colorectal surgeon who says that there is no evidence to support the theory that it will prevent existing symptoms worsening. I guess if you are worried about tearing then that in itself can hinder labour so you may choose to go for the CS.

From experience, an episiotomy was much, much harder to recover from than a tear. I have never had a cs so can't compare that but would recommend you google it so that you're aware of the downsides.

Like I said I opted for another vb. My risk of tearing again is in the region of 5%. The risk of a cut to my stomach with a CS is a 100%. I want to give myself the best chance of enjoying DC2's first weeks.

Sorry, that probably isn't much help. I know it's a hard decision, I hope you get lots of info and come to the best decision for you.

C-section.

To put my feelings into context, DS1 was 10lbs 1oz, and I suffered a 3rd degree tear resulting in two hours of repair work in theatre. However, the labour wasn't particular traumatic and I healed quickly and well. I went on to have 2 subsequent children "naturally", one at home. Tore with both but again healed well and quickly. It sounds like you have a bit of a nightmare.

Hi egyptianprincess the VBAC/ELCS decision is a tricky one and, as you know, no-one apart from you can tell you what to do.

That being said from reading your post it sounds like your first birth was traumatic for you and that should certainly be acknowledged. What shines out to me in that post is the fact you didn't feel respected, listened to acknowledged or indeed cared for during your first birth. It is AMAZING the difference in how women feel after exactly the same birth when they have felt supported, cared for, involved and treated like an adult.

Perhaps it is worth sitting down with your partner and working out what it was about your first birth that you found upsetting. Against each one of those things work out how you could ensure that doesn't happen in this next birth if you went for a VBAC. Once you've done that you may find you feel clearer about the decision.

Another helpful idea is to write down the story of your first birth in detail. It's a way of acknowledging it and beginning to move past it.

I'm always banging on about doulas on here, and I'm biased because I am one but it's worth considering a doula even if the birth is pretty imminent. I work with couples who've had a tricky one first time round. A lot of the benefit is actually before the birth - in really helping you make decisions, explore your feelings, make a plan you are happy with. Then you also have someone on the day to make sure you are comfortable and supported throughout your birth and also help you and your partner to advocate for yourselves. PM me if you want me to help you find someone locally.

I think squiggly said what I wanted to, perhaps some of your feelings about the birth are to do with how you were treated rather than the outcome. I had PTSD after DD's birth but that was because I was treated like just another vagina and the fact that I was in agony wasn't respected and not the tear. I couldn't understand how I could be in so much pain and have no one bat an eyelid. If I had been in hospital for anything other than labour I would have been better treated, I am certain of it.

I had an emergency section with dc1 and then vbac for my next children. I would opt for a vaginal birth.

I have to choose. Am only 17 weeks but have until 38 weeks to decide. The real problem is that I don't want either tbh. I just want the baby here. No surgery, no vaginal delivery.

I know everything, every statistic, every pro, every con. But I cannot make a decision. Neither scenario outweighs the other.

Is there an option c? Magic? Sneezing it out? I might just flip a coin tbh.

hi,
i also had traumatic first labout resulting in emcs although my recovery was painful to start was pretty much problem free so this time i will be choosing an elsc. I battled with the decision, more than the physical pros and cons more than anyhting it was the fear of the memories of last time flooding in and freaking me out if i was to attempt labour again. for me, knowing what will happen and being able to prepare will hopefully make the birth calm and fear-free.
good look with your decision....its a tough one isnt it??!

I had a natural birth with a failed 3rd stage with my 1st, and then an EMCS for brow presentation with my 2nd. I was 99% sure I wanted a ELCS. But have now decided I would prefer a VBAC. My main reasons being my ELCS wouldn't be carried out until 39 weeks, and my first was born at 39+1 and my 2nd at 36+4, so it is unlikely I will make it that far. I didn't want to psych myself up for an ELCS and then go into labour before.
Have decided in my case it is much better to plan for a VBAC and hope for the best.

However my natural birth was only for a SGA baby, so have no experience of a larger baby sorry.

Doesn't help you I know, but it really is a decision only youself can make.

Could Natal Hypnotherapy or something similar help with the fears about feeling out of control with a VB? I was in a very different situation but started using it in preparation for DD's birth after I was diagnosed with OC and my plans for a home water birth went out of the window and I started panicking. I ended up with a failed induction including 2.5 days of continuous ctx and an EMCS a week after I was induced where there were issues getting the spinal in. Managed to mainly stay very calm thanks to the hypnotherapy and I'll definitely be using it next time when I'll be hoping for a VBAC but may not have the option as I probably won't be able to get to full term.

I'm very sorry to hear about your experiences, and the very sad loss of your daughter. I can't imagine how hard it is to face all this again.

I've never laboured, or been in your position, but what I can say is that the one thing a PLANNED c section tends not to be, is traumatic. It's highly medicalised, calm and controlled. It doesn't hurt, and doesn't hurt afterwards if you keep on top of your pain meds.

I really really hope you get the birth experience that you want. Very very best if luck. X

Just follow your instinct. I had poor care with dd1 and tore with 37 stitches. Took a long time to heal. dh and I went to speak to a consultant before even ttc as I didn't know if I could do that again. Consultant agreed to cs but it wasn't set in stone. Am now having twins and have been advised to have a cs so the decision is made for me.

What ever you decide, stick with it and be positive. Most of all, enjoy being pg.

Best wishes
x

I had 2 Caesareans and my 3rd was supposed to be an elective but he came early and by the time they got me on the operating table with an epidural, he was on his way out. I found the combination of episiotomy stitches and piles far more uncomfortable and longer to recover from than either of my caesareans! I still couldn't drive for 3wks because I couldn't sit down very comfortably. I'll admit I did quite enjoy the excitement and drama of spontaneous labour and I handled it a lot better than my first attempt (that ended in general anaesthetic CS) but TBH I'd rather have kept my pelvic floor intact!

Also, my 2nd CS was elective and completely cured the post traumatic stress disorder I'd suffered with since the 1st labour attempt. It was so different, I felt in complete control.

HTH and good luck.

Hi egyptianprincess
I am in a similar situation to you at the min.

My first birth was a very slow progression, 36hr labour, crash team, theatre team arguing with Drs as they wanted me in for a section. My son was eventually dragged out via ventouse.

My second birth was at 32 weeks as my daughter was stillborn last July.

I am now 29 weeks pregnant with my third and have been scanned constantly and given the choice of an early induction or early section.

I change my mind every week as i honestly dont want either, im just keeping my fingers crossed she decides to come early and takes the choice out of my hands (highly unlikely seeing as my son was 15 days late.

I had a similarly traumatic first birth, with very poor care (also at the RF).

My advice would be to go with your absolute GUT instinct about what you think you can manage.

I was completely all for a VBAC - did masses of research and prep, hyno birthing and exercise, booked a doula etc - until the last few weeks before birth, when it suddenly dawned on me that I just could not deal with another long, drawn out, uncertain birth experience...and so I opted for a section.

For me, an elective section was wonderful. Pain-free, serene, quick - so different from the horror of my first birth. I was awake, refreshed and calm when my baby arrived in the world, and I did not come down from that high for months.

Physically, I recovered very well - first few days are always a shocker, but once I was home and rested I was remarkably spritely, and within a week or two I was out and about.

Best wishes for whatever you decide x

Can I just recommend the NCT's 'Refresher' course for anyone trying to decide? I did it for my 3rd and I really feel it made a difference as to how I coped with my unexpected VBAC. It's different to normal antenatal classes becasue you can now put yourself in the picture and the science bit actually sinks in for future reference. Also nice to debrief with other mums feeling the same apprehensions and be taken through how to avoid the same pitfalls if you do end up VBACing again.

So sorry to hear about the loss of your daughter BreakDancingBadger. :(
Thanks all for all your advice. Seems like the elective c-section is getting lots of votes here. I had my last scan today at the Fetal Medicine Centre where they confirmed that I am heading for another 9 pounder! I was advised by the Professor to adopt a sort of compromise birth plan whereby I will wait to go into labor spontaneously (up to 40) weeks and try for a VB. However, if it soon becomes evident that things are going to be difficult and I am not progressing well I will not labor for hours and hours and will have a c-section sooner rather than later. I think I'm happy with this plan as it I feel that if a VB is meant to be it will be and if not, I will be psychologically prepared for a c-section. I am becoming a little more confident about the whole thing knowing that I won't be at the horrible RF again and that I will be delivered by a wonderful consultant whom I really trust. I have to admit that while I'm still scared of VB and know that it's a force to be reckoned with I'm equally scared of having my abdominal muscles cut. There is no easy way I guess! Hope this helps the rest of you trying to decide.

Glad you're feeling more confident about it.
Do ask about what you can eat in labour as an empty stomach is safer for a CSec. Mine was delayed as I had had a massive roast dinner thinking it was just niggles and would not have him til the next day! By the time they agreed to my semi-emergency CS and got organised (shiftchange, bitchy registrar etc), baby#3 was well on his way. But we weren't high risk so they weren't desperate to do the CS and once the epidural was in I didn't really care what happened. Pushing with epidural in is utterly surreal!