Remind me why I chose VBAC? Too late to change?

[4pudding]

Having spent 5 days of the last week bedridden with piles, one day up & about to be woken up with more last night, and had a day of agony today, I am wondering why the bloody hell I chose VBAC! At least recovery after a CS you can get some decent painkillers.

Worried about how much longer the baby is going to take to get here and I'll be in pain, and about what labour will do to the piles too.

So sick of being so sore, so fed up of being in bed, so tired from not being able to sleep.

At least if I'd had the CS it would prob have been done last week!

Feeling very sorry for myself, as you can prob tell :(

Oh bless you. I really can sympathise with how fed up you're feeling! I'm booked for a elcs on the 9th but am still dithering really. I'm not sure what I want to do. (DD and DS were both born by cs). I'd recommend giving your midwife a call, they've been really good to me and no-one has said anything about the way I keep changing my mind between vbac or cs. If you ask for a cs they'll probably let you have one. How many weeks are you?

WRT the piles there have been a couple of threads on here recently, I've recommended proctosedyl (sp) or scheriproct (sp). They're both really good. Have you got anything to put on them? After I had DS I was in agony, I went to the out of hours surgery (which is in the A&E dept here) and turns out I had a thrombosed haemorrhoid and an anal fissure. I'm glad I went to the OOH though as I was seen within an hour and was able to get it sorted there and then. Is there any way you could d this?

You would still have had the piles after your section so that's not a case. Hopefully you'll have a successful VBAC and I can't tell you how amazing the high is. Depending on whether you get an epidural or not you should also be able to stand up half an hour later and drag yourself into the shower. Ds1 I spent 5 days in bed post section in agony and could barely help my baby. Ds2 arrived by vbac and the pain ended immediately after he popped out. 1 night in hospital (probs not necessary). Ds3 left hosp. 4 hours later and went home to put ds1 and 2 to bed. Was doing the washing up 5 hours after delivery!!!

missp2010 thank you, yes I've got proctosedyl, one of these is thrombosed and turning a lovely shade of dark purple/black hence the agony. They won't do anything until I'm not pregnant any more. I know the pain will subside in 3/4 days but I'm just so fed up already. Can't go back to GP now any due to all these bloody bank hols. Worried I'll get another after this one the longer this pg lasts. Currently 39+3.

lollystix I know I'll still have them but at least I can look at getting them sorted and they won't get worse! They cleared up really quickly after my CS with DD1. Thank you for your positive view on VBAC- I do want that skin-on-skin straight after the birth moment, think I need to focus on that.

vbac, amazing. piles sodding nasty, vbac worth them

Thank you Princess x

Pleasure! Genuinely go for a vbac if you can, I had no clue and was worried after my cs but up and walking around so quickly and instant pain relief the second ds was born!

Hi,

Like many others I'd encourage you to go for VBAC if you are able. I was up and having a shower within an hour or so and just generally felt more able. It's not unusual to have doubts about going for it as an EDD comes and the passes. I started freaking out about 38 weeks and all but booked the section. I'm so pleased my family and midwife helped me focus on the benefits of VBAC.
Best of luck for whatever happens/you choose.

Thank you ParisGarters. I do need to focus on that! I think once this pain has died down a bit and I can get some sleep I'll feel more positive too- just feel like I've reached my pain threshold right nOw and could do with a break!

Hopefully labour will hold off another couple of days, and I have a MW appt on Tues am so might ask for a sweep (do they need to book you in or can they just do it there?)

Thanks again ladies, really helps being able to talk (moan) about it xx

Go for the sweep, at least you will know if you are semi dilated or not and sometimes its just that little push that is required!

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 and that is the big if. Unsuccessful VBACs can have MUCH slower recovery than electives - especially if a long labour leads to an emergency C/S late in labour. They are also riskier for the baby. The chances of success seem to range from about 40% to about 90% but if you have not had a vaginal birth before your chances are not at the top end. Epidural is associated with increased success rate.

My decison making process was this. Do I have a burning desire for vaginal birth? (for me no). Does the risk of doing anything that might result in even a very small risk for the baby worry me? (Yup - particularly brain damage - on a personal level if anything like that happened I felt I could have prevented it, I'm not sure how I could handle it. One of our family was brain damaged so particularly poignant for me) Finally, how likely is it that the VB will be succesful as opposed to ending up with an even more risky emcs? (For me, turned out m/w had given over optimistic assessment) I opted in the end for elcs which was fine.

So all the people posting and saying VBAC is wonderful are in the group who either had a successful VBAC or who really had a deep drive to try vaginal birth and did not have serious complications as a result of VBAC failure. There is also a smaller silent group who might not want to be tell their side of things to someone in your position.

It depends on your attitude to risk and how important vaginal birth is to you. I am risk averse and have no wish for the 'high' of a successsful vaginal birth - doesn't ring any bells for me at all. So for me a no-brainer. Not everyone is the same.

If you think the info you have had isn't balanced,you can change your mind. I did and was initially told too late. I didn't take that as an answer.

'VBAC - when it is good is very very good and when it is bad it is awful' (lovely comment from my neighbour whoi is a HCP)

Good luck whatever you decide smile

Aargh...what did I do..I meant

Good luck whatever you decide

Don't know whether it helps, but if you are going down the risk assessment route remember that there are risks and benefits attached to all the various options. C-section is not without its own set of risks. The safety of you and your baby will be paramount to all those involved in your care.
I hope you manage to get some comfort for the rest of your pregnancy and that your baby arrives in a way you can all be content with x

Don't know whether it helps, but if you are going down the risk assessment route remember that there are risks and benefits attached to all the various options. C-section is not without its own set of risks. The safety of you and your baby will be paramount to all those involved in your care.
I hope you manage to get some comfort for the rest of your pregnancy and that your baby arrives in a way you can all be content with x

Ushy - I did lots of research before vbac no. 1 and the success rate I read was 70% with epidurals leading to reduced, not increased, success rate. I have 2 friends who had failed vbacs and ended up with another section but they were not allowed to labour on and on. I was assured I would have to progress 1cm per hour and 30 mins for stage 2. If it wasn't going along those lines then we would have gone to section. Cfm is also advised to detect possibilty of rupture (1 in 2000 in my hospital and that's not complete rupture) and you then have 17 minutes apparently to get to theatre if it does happen. I got assurances from consultant mw about no. Of theatres and obstetricians in my hospital to again appease myself that there would be help if I needed it. It's a very difficult descision - the hardest I have ever taken.

I don't understand why you need to wait until no longer pg to have the thrombosed one sorted. When I had mine, I just had a local anaesthetic injection and he cut it out. It was still a little sore the next day but no where near as much as it had been.

It's interesting to see the replies you're getting, I still can't decide what to do. I now have my husband and mum pushing me to make a decision, any decision, so they can sort time off work etc. I know they want to help, but really they're just putting more pressure on me!

Forgot to mention, you said about the skin to skin after a vb. You can still have this with a cs. DS was placed straight onto my chest, he wasn't held by anyone else first or cleaned up or anything.

Interesting - as Ushy points out, the RCOG guidelines do indeed say that one (among many) factors which are associated with a decreased likelihood of VBAC success is no epidural. I didn't know that.

And it says at the end of the para that the info (all of it, not just the bit about epidurals) should be shared where relevant with the women, 'to enable the woman to make the best informed choice.'

I've pasted the relevant paragraph below: -

"A number of factors are associated with successful VBAC. Previous vaginal birth, particularly previous VBAC, is the single best predictor for successful VBAC and is associated with an approximately 87?90% planned VBAC success rate. Risk factors for unsuccessful VBAC are:
induced labour, no previous vaginal birth, body mass index greater than 30, previous caesarean section for dystocia. When all these factors are present, successful VBAC is achieved in only 40% of cases. There are numerous other factors associated with a decreased likelihood of planned
VBAC success: VBAC at or after 41 weeks of gestation, birth weight greater than 4000 g; no epidural anaesthesia, previous preterm caesarean birth, cervical dilatation at admission less than 4 cm, less than 2 years from previous caesarean birth, advanced maternal age, non-white ethnicity, short stature and a male infant. Where relevant to the woman?s circumstances, this information should be shared during the antenatal counselling process to enable the woman to make the best informed choice."

It's a complex picture! Frustrating that this tends to get lost in a simple message of 'VBAC good, repeat CS bad.'

I've no idea 4pudding whether any of these are relevant for you (or whether they've been discussed) - but I appreciate it's a very hard decision to make, and I wish you the very, very best with your birth, whatever you go for.

I think sometimes we can get hung up on the extent of the decision to be made. I know some women desperate for a vbac who have had another section, and women booked for asection that have had vbacs. For me the decision was this: do I want pre planned invasive surgery or do I want to give it a go. Everyone was clear that I'd be moved to section more quickly if needed. FWIW I had spontaneous onset for both labours and got to 9 cm 1st time around. My second stage was way outside those guidelines though.
Try not to get too pressured about the situation

On the epidural issue, there's also the thought to consider that potentially, pain felt in between contactions can be the first indicator of scar rupture. This won't be felt if you have an epidural (although the risk of rupture still tiny). Plus although having an epidural may lead to a 'successful' VBAC, given that it's known epidurals lead to increased use of forceps and ventouse it may be that many of the women ended up with that intervention, and they may or may not consider that to have been the best option. I'm not saying all women would prefer a CS to a forceps birth, but (hoping for VBAC in next 3 weeks) if I ended up with a bad forceps birth, substantial damage etc I imagine I will regret having opted for VBAC at all! For that reason I am hoping if possible that I can manage VBAC without an epidural, although I wouldn't rule it out as who knows what will happen.

Zimbah that is a good point about rupture but there are a range of symptoms of rupture and it would sometimes be hard for a midwife to recognise rupture based on pain alone because some women have such fast contractions there is hardly any gap between them so they would be in pain continuously anyway. This is the list RCOG give:

abnormal CTG
severe abdominal pain, especially if persisting between contractions
chest pain or shoulder tip pain, sudden onset of shortness of breath
acute onset scar tenderness
abnormal vaginal bleeding or haematuria
cessation of previously efficient uterine activity
maternal tachycardia, hypotension or shock
loss of station of the presenting part.

As said before, the evidence as to whether epidurals CAUSE more instrumental deliveries or are simply associated with them is conflicting. (Just to explain - I know all this stuff from the day job - I am involved in medical litigation).

The important thing about epidurals is that if you don't want one, don't have one. However, if you do decide you want one, and particularly in the case of VBAC where there does seem a a fairly strong association with VBAC success (again we don't know it is causal), don't be put off by frightening 'risks'. The one in a hundred headache is a real risk - you should consider that. Also some of epidurals don't work and need to be re-positioned - you need to think about that. However, you are twenty five times less likely to suffer serious long term damage from an epidural than you are to die in childbirth! Like winning the lottery in reverse!

Zimbah Just had a look at the RCOG guidance and it does look at the point you raised about whether epidurals lead to more instrumentals in VBAC women and that study showed no difference.
Here it is:

A smaller observational study showed comparable rates of unsuccessful VBAC and operative delivery in those women receiving epidural analgesia compared with those not receiving epidural,even when correcting for oxytocin usage.84

Thanks everyone. I've got MW appt tomorrow so will discuss it with her then I think. Lots to think about!

Ushy - but surely epidurals will be associated with higher rates of forceps/ventouse for VBACs, in the same way that epidurals are associated with higher rates for non-VBAC births? Not saying that it's necessarily causal, but I don't see how it would make any difference whether it's a VBAC or not.

4pudding sorry for hijacking your thread! Hope your midwife appt goes well, I've got a 39 week appointment on Wednesday and feeling a bit anxious about that. Let us know how you get on.

missp2010 - did you get yours done at the GP? I am still in absolute agony and don't think I can take much more :-(

I went for a Vbac but my bump was enormous and I got nervous at the end,so at my 40 week appointment I asked to book in for an ELCS!They booked me in for a few days later but I went into labour at 40+3.
Decided to go for it but ended up with a C section again.I'm glad I tried but I was also glad it was a section as DS was 10lb 6oz

I think you should go for it and you are just having some wobbles.
Good luck and keep us updated.