vbac or elcs? Can you decide for me pls?

[missp2010]

Ok so brief history, although have posted it on here before so sorry if you've already read it. DD (nearly 5) went to 40+10 went in to be induced. After pretty long labour ended in emcs. She weighed 10lb. DS (nearly 3) was very worried that would be in same situation so went for elcs at 39 weeks. He weighed 8lb 9oz.

Am currently 38+1. Baby is not engaged at all, and haven't had any signs of being near to labour. I have a elcs booked for monday when I'll be 39 weeks. I CANNOT decide if this is what I want at all. I understand the risks of both vba2c and also elcs. I'm really not keen to go over my due date. I found the recovery difficult after having DD and DS. But obviously haven't experienced a vaginal delivery so that may be just the same.

So any way can you decide for me????

missp, I realised recently (trying to decide between vbac and elcs) that the problem was that in no way, shape or form was either of them a better option than the other. I am desperately hoping for a hidden option c tbh. I can't make a decision about something that I generally don't want to do. It's like asking me if I'd rather stick my hand or foot into the fire.

I might flip a coin tbh.

It's not unusual for the baby to not be engaged in subsequent pregnancies until the last minute. No one can decide for you, but what about the possibility of doing trial by scar? You could have an epidural and try for a vaginal, then if you did need to go to theatre, you're already sorted.

I wish I could offer come advice to you but I am in a similar situation and wish someone would decide for me!
NeverKissPigs - I couldn't agree more about the hand or foot in the fire!!
I had an emergency c section with DS1, the hospital and care (and cleanliness) were terrible, the wound got infected and it took nearly 12 weeks to heal. It was a dreadful experience.
With DS2 I was desperate to have a VBAC and did, It was the most painful but amazing experience of my life. I remember being handed him and being so very glad I had given it a go. I was home the same day and driving again that week!
I didn't have weeks of antibiotics and stress over wound healing.
Now pregnant with DD1! And just cant decide what to do. Part of me thinks you've done it, you can do it again and part of me thinks, elective c-section, takes away so many of the unknowns....I don't have to worry about scar rupturing, if the baby is big, if she gets in a awkward position....
My mum thinks c-section, my husband thinks VBAC...I don't know!!!
I would say, with a VBAC, they do keep a very close eye on you and will not let you labour for too long, if it looks like it is not going to happen, they will not mess around, you'll be straight in for a csection.
Good luck with whatever you decide x

Hello,

No idea as you know i'm in a similar predicament.

I think the answer that neither is better than the other is probably the best. If only we could know the outcome before deciding, it would make matters much easier!

Thinking of you anyway.

im 38+2 and have a CS booked for Tuesday so am in similar situation to you. I basically have decided that if it happens before Tuesday naturally i will try and deliver naturally if not then im having the CS.

am actually not worried about CS at all and think this would be the best way for DS2 to be born!!!!!!

Thank you for replying.

neverkisspigs I may just join you with the coin flipping! At this rate I'll be deciding on my way to the hospital on Monday.

Thevisitor I thought the whole not being engaged thing was only if you'd had vaginal births? I don't think I have read this or anything, I'd just assumed. I'd be more than happy to try a vbac (if I'm really honest this is what I'd prefer) however, I'm really reluctant to go past my due date. I'm worried that the baby will be big, and also I've just had enough of being pregnant, not sleeping, piles and running around after two children under 5!

Well if I were you (and you have to decide for yourself, you know that right?!), I would not have the elcs so early.

Having just had a HWBAC with DD & even with the 3rd degree tear (face first presentation, fast labour & big baby) I'm so much better off than i was after my c-s.
I recovered well from the c-s, textbook really, was driving at 4weeks, etc but i still felt like a train wreck for quite a while.
Even with all my stitches this time i felt better by day 3/4 than post c-s.

Also, i think 39 weeks is unnecessarily early. Given that your DD didn't come spontaneously by 40+10 it may be that your babies need longer to be ready for the world.
(Though I assume your DS was ok at 39wks? any breathing probs? more than normal jaundice, any other problems?)

I would say book an elcs (if you have to) for after 40wks at some point. Give your baby time to be ready and maybe your body a chance to VBAC.

Last thing, if you try for a VBAC, I believe you have to be committed to it, and that means checking out their 'rules' beforehand and deciding what you will & won't consent to. Having continuous monitoring, lying flat on your back, an epidural, a cannula 'just in case', etc will seriously affect your chances of a successful VBAC.

I also had a nasty emcs for dc1 and am now 35.2 weeks pg with dc2. Have been planning a VBAC all along but now am starting to waver, particularly as m/w today said baby is breech. However I had a good conversation with the m/w about it when she reminded me of the risks of cs (e.g. post-partum haemorhage, infection, damage to bladder, breathing problems in the baby), which I had been completely ignoring when I thought about how straightforward it would be to have an elcs rather than a vbac. Also just reading this thread has reminded me how beaten up I felt after my emcs, and so I think I'm still going to go for a vbac, but in the best conditions I can manage to give myself and the baby the best chance for things to go well this time.

Can't really decide for myself. I had a VB with my 1st with a failed 3rd stage. Had an EMCS with my 2nd due to brow presentation.

Was going to have an ELCS, but spoke to the Consultant who said 39 weeks is the earliest which is fair enough, but also pointed out with my history 1st 39+1 2nd 36+3 that I may not make it to 39 weeks, and also as my labours are quick with my 1st 2 hours and 5 minutes, with my 2nd arrived at hospital pushing but he was obviously stuck.

So now have VBAC in mind just because it is the most likely ending for me if all goes well.

To be honest I am still not happy it is the right choice but hopefully will turn out to be the best choice.

Hope you can make a choice that suits you and you get the best birth possible.

nightsdrawingin Please have a
look at this before you decide - it is the Royal College's guidance. www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45 This is the gold standard bang up to date reference guide.

There's a lot of misinformation out there. Epidurals are associated with INCREASED not decreased VBAC success as is commonly stated and haemorrhage is more common with VBAC not repeat c/s.(see guidance above).

As a rough guide, if you have had a previous vaginal birth and plan more children it is probably safe to go with VBAC. If you haven't had a previous vaginal birth and this is likely to be your last baby, you are better off, in safety terms, with repeat c/s. Obviously, though, personal choice comes into it. That's a very rough guide but you need to talk to an obstetrician.

There is lower risk of respiratory problems in babies with VBAC but this is almost always resolved and the baby is not harmed. However

"Women considering the options for birth after a previous caesarean should be informed that planned
VBAC carries an 8/10,000 risk of the infant developing hypoxic ischaemic encephalopathy." (HIE - central neverous system damage from oxygen starvation- can be mild to disabling).

Good luck whatever you decide

Below are direct quotes from the guidance

Women considering planned VBAC should be informed that this decision carries a 2?3/10,000 additional risk of birth-related perinatal death when compared with ERCS. The absolute risk of such birth-related
perinatal loss is comparable to the risk for women having their first birth.

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 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."

Sorry -pasted above in two bits and missed the number for body mass index which should read 30

Had emcs with 1st. Went for vbac 2nd time. Ended up having a section anyway. If i did it again I would go for a csection. Although looking at prev post I was onto a loser anyway!

I'm so grateful for all your replies. I know it sounds terrible, but I'm glad I'm not the only one finding it difficult to make this decision.

Last night I was all set to cancel cs booked for monday and at least give it another week, just incase I do go into spontaneous labour. However, I've woken up this morning feeling that that would be such a selfish thing to do. I have been told by several doctors that cs is the safest option (perhaps not the case after one cs, but I have had two). Does it really matter how this little girl gets out? Surely the most important thing to consider is that she and I are healthy....

But still, it would be nice to at least give a vb a go. I'm not going to have any more children so this is my last chance....

I'm off to find a penny to flip.

The main concern in terms of outcome is a healthy baby and and healthy mother.

But that doesn't mean that the rest of it isn't important too. I know from first time round that the method and facts of labour and delivery can have a long lasting psychological effect.

Trouble is, I made no decision last time. DD got stuck in deep transverse arrest and I had to have an emcs eventually. That was chance. This time round I have to make a decision and if it pans out that it wasn't the best thing for me or if anything is less than optimum, then I'll always know that I made the decision in the first place iyswim. It's silly because realistically I know that it's not something I can control, but I'm still utterly incapable of making a decision. I don't plan on having anymore and that small voice in my head says 'what if I regret not trying a vbac' while the other voice says 'feck it, schedule a cs, you know what you're getting'.

I might just flip that coin.

leedsgirl from the statistics I've been told about my chances of vba2c are slim. Didn't labour spontaneously, failure to progress, 2 cs, big babies. The list goes on. I would really love to try and feel quite envious of those who have successful vbacs. But I also want to do whatever is safest, unfortunately I'm getting conflicting advice from midwives, registrars and consultants on this.

I'll see what they say at my pre-op appointment on Friday. I went for a HUGE walk yesterday and may even attempt sex tonight, see if that gets things moving .

I would recommend trying to get hold of a copy of "Silent Knife" hard to find but I got a copy second-hand through Amazon which I've passed onto the Yahoo VBAC group.
Very interesting reading despite being a little old and US-focused.

The Yahoo group is also very useful for advice on how to deal with your hosp/MWs, etc.