vba2c or elcs, confused after seeing registrar. Long!!

[missp2010]

I had an appointment with the registrar on Monday to discuss birth options for DC3. It was a nice informal meeting, he was very polite, friendly etc and didn't make me feel bullied at all. However, I am now completely confused about what to do. All along in this pregnancy I have said to any caregivers that I am undecided about how to get this baby out, I am neither overly positive or negative about either method.

DD (4) was an emcs at 41+4. I was induced and got to 7cm and then 'failed' to progress, she was in distress so it was off to theatre. She was 10lb. With DS (2) I opted for an elcs, mainly because I wasn't over DD's birth and was really worried that the same situation would occur. He was born at 39 weeks and was 8lb 9oz.

So far in this pregnancy I have seen the same midwife on most occasions and she has given the impression that there would be no problems of having a vaginal birth this time. She's been positive about it in fact.

I have also seen the senior midwife at the 'birth options' clinic. She was very encouraging of having a vba2c, she has given me the impression it would be better to do this rather than another cs. I went to an antenatal class for women planning a vbac, it was run by the same midwife and she said several times that it is no higher a risk to have a vba1c as a vba2c.

When I saw the registrar, however, he had the complete opposite opinion. He felt a vb would be unrealistic because DD and DS were both on the large side, and because labour didn't progress with DD. He was really very encouraging of an elcs. And kept going over the dangers of a vbac.

I have an appointment on monday which I believe is with a consultant. I am supposed to have made a decision by then. But I really just don't know what to do. I don't like the recovery period of the c-section, but the convenience is appealing wrt childcare for my older DC. I don't really fancy pushing out a massive baby and possibly tearing. But love the idea of being able to come home possibly the same day. But then there is the chance of rupture and also the possibility of a long labour ending in an emergency cs which has it's own risks too........

Any words of wisdom???

I'm 35+2

Its difficult to give you advice because its such a personal thing and there are pros, cons and risks with any choice you make. My experience was that the midwives were very encouraging regarding vbac but the consultants were more encouraging regarding an elcs.

Like you I was very confused. I decided to go for vbac unless I went over dates as there would have been less chance of a successful vbac if that happened. We ended up booking an elcs for 3 days after my due date.

Anyway I did go over, got cold feet about elcs, moved the date to the following week and eventually had my baby by elcs 7 days after due date.

The pros to this were: I knew what to expect re recovery, I could organise care for other child, it was quick and painless.

The cons: I didnt get to give birth vaginally.

I'd talk to the consultant. When I was in hospital having DD (it took a week with a CS after failed induction!) I saw loads of registrars who told me all kinds of things. We eventually went for a CS after one told me that on exmaination my pelvis seemed too small for the baby. I saw a consultant for a debrief and he said that the surgeon (who got an inside out view of my pelvis as it were) said it was fine.

I had vbac after failure to progress/distressed baby with ds1. All medics v supportive but I didn't go terribly over due date.

I believe risk of rupture is terribly small and that's why they monitor you.

I'm not sure why you mention risk of tear? As it happens, I had 3rd degree tear with ds2 but not indicated beforehand that it was a risk and with hindsight I should have been more vocal to MW about how terribly hard it was to push (v long stage 2) and then not pushed like bug*ery after dr told me I was not progressing and needed epidural, forceps and possible c/s. Talk to drs/mw about how accurate their scans are re estimating size of baby? Ds2 was 9lbs 3oz, not terribly big I just pushed him out too fast at the end.

I had planned c/s with ds3 and when I saw registrar he was adamant that I had to have it at 38 weeks which I was very unpleased about. MW told me it was my decision, not registrars, and consultant told me 38 weeks was bol*ocks and it ought to be 39 weeks if no other medical reason to bring it forward.

Lesson - registrars know shit all!

Thanks for your replies. I swing between the two options and so far am completely unable to make a decision.

bosch - no one has said that I'll tear, I just worry that if this baby is big too it's more likely than with a 'normal' sized baby. I have asked for a growth scan but have been told that they're so unreliable there's little point. If I do have an elcs it'll be at 39 weeks, so not too early.

sunshine - I get the feeling that I may end up in a similar position, as dd was late and ds wasn't even engaged at 39 weeks and cervix wasn't even vaguely dilated , I guess it's unlikely this one would be on time either.

I had a terrible birth with my first who is now 10. All the way through i was told my hips and pelvis were not up to giving birth and i would struggle but i was 20 and determined to do it naturally! I ended up being induced at 42 weeks and the having an episiotomy and ventousse delivery! 6 weeks after his birth i was still not healed......this birth has scarred me mentally!
When i had DD i was granted an ELCS because of first birth.....loved it!
Am now due baby number 3 in May and at my 12 week appointment my consultant asked me if i wanted a ELCS this time and i said yes please and she said fine! no arguing at all and infact said she felt with my history it would be the best option. I went for consultant last Tuesday (34+3) and asked about a date for section and a different consultant started going on about risks and how he felt a VBAC was better for me etc etc.......he eventually went off and found my consultant who said that with my history a VBAC was risky as chances of giving birth naturally would be reduced due to first birth and hip/pelvis etc.......Im going for my ELCS on 10th MAy.

It is a personal choice. I dont want to run the risk of needing an emergency CS which is high if i go for the VBAC and DH wants to be at the birth so for me it is an easy decision.

Just a quick CS vs tear thought from me. I had a third degree tear with my VBAC, although it was down to a combination of factors - very quick birth, hand by face, undiagnosed varicosity. My baby was 9lb, but that WASN'T one of the factors that lead to me tearing.

As it happened, I never even noticed the tear happening, it was repaired quickly, healed easily, and I was back horse riding about a month after giving birth. With my EMCS I was in HDU for 5 days and it took me ages to recover. It was definitely easier to recover from a VB than a CS, even with tear. So don't let that colour your decision at all.

I also happen to think the registrar is not in possession of all the facts if he is laying on thick about the risks of a VBAC vs a ELCS. There are lots of good threads on MN giving more info on this.

I had an emcs with DS1 and tried for a vbac with ds2, I failed to progress and had another c section. Midwife came for her last visit today and we were discussing it all and she said if I were to have another child, it would be an elcs with no option for a vbac.

I said but I'm sure I've heard of people trying for a vbac after 2 emcs and she said in her experience, there are more negative stories than positive ones and she didn't think it was worth the risk

Obviously it is up to you but I think considering you have big babies, you may end up giving birth and finding it worse than a c section from a tearing/getting stuck perspective and you could still end up in hospital recovering from that...

Good luck with whatever you do decide though - its hard as I really do understand the desire to give birth vaginally!

I have been faced with similar disagreements as MW says VB and consultant said cs. He actually said he'd support me whichever and when I asked questions about risk during VB to twin 2, he was honest and said their was more of a risk so I said: "So if I'm putting my twins first, then CS is the best option in this instance." He nodded and smiled and I said that's fine. At 15 weeks I was given 2 possible dates tbc nearer the time. MW tried to convince me to try vb but I'm not going to put dt at risk. So confusing though.

Basically, everyone has different opinions so you need to go with what you feel comfortable with. It's your body and your baby. (that doesn't mean it's easy though! Good luck x

OP, are you me?! This is my dilemma too. DD1 (4) was EMCS, DS1 (2) was ELCS as mentally I hadn't recovered from trauma of first birth and I'm now weighing options as what to do for number three. I'm only 17 weeks so have lots of time to think about it. Both babies were nine pounders, which is big for someone my size although I know this shouldn't have any real bearing on my ability to vb. My midwife is supportive of vba2c which initially was my instinct - i don't have any real desire to have a vb but i do want to recover quickly so I can drive and look after my older children. But having spoken to some friends who have had vbacs I am starting to lean towards elcs as some have had harder times recovering from vbac than they did the first cs (it was perhaps a mistake to discuss it with them!). I have an initial meeting with the consultant at the end of this month so will see what he says re risks etc. It's terribly difficult when you get conflicting advice. Good luck with your decision OP and hope you have a fantastic birth whatever you decide.

Hi OP i had a very similar history to you. DS 1 emergency section after I failed to progress following induction (pre-eclampsia) at 38 weeks. I then had an elective section with DD which was very calm and a much more pleasant e xperience. When DS2 was due i was told the policy here (N.ireland) is an automatic section following two sections and I was very happy to go with that. As it happened though ds2 never made it to his section date and I had a very very quick labour at 38 weeks which led me to theatre for another emergency section. Of course nothing is ever so simple and DS was born on operating table before I even had time for epidural. Had forceps and a 2nd degree tear which very competent registrar stitched. Quite sore for about 2 weeks but still mobile and now 5 weeks on I feel pretty perfect. Go with your instinct and then see what nature has planned for you!

Size and degree of tearing are not related

It's interesting to hear other people's stories, thanks for replying.

I saw another registrar today (I'm beginning to wonder if consultants really exist as no one seems to want to let me see one!) she was rude, pretty dismissive and made me feel very small. I even cried!

I went in still undecided, not really having a preference either way. I was hoping to ask her opinion and make a decision during the meeting, but unfortunately she was so rude I really didn't feel able to talk to her properly. I think in hindsight she took me saying 'I'm not sure' to mean that I don't want a cs. After belittling me for a while she has booked me in for a cs on my due date, if I go into labour before that I'll give a vb a go. I've come away still feeling unsure about the decision though, and feel really unsettled by how rude she was, I've never seen a doctor like this woman!