VBAC statistics

[Mandyville]

I know I've seen a link here before but I can't unearth it again... Can anyone help me find the stats for the risks for planned VBAC vs. planned c-section? I seem to remember that the key difference was that planned c-sections hurt a lot less!!!

Also... Does anyone know what percentage of attempted VBACs are successful? I know it will differ from hospital to hospital... I have a leaflet which reckons the success rate is not a million miles off what it is for a first-timer (i.e. 80% success for first time VB; 75% success for first-time VBAC) but I may be making that up.

I HATE decisions!

view not few sorry.

My 16 week appointment was pretty much VBAC centered, I wouldn't say a prepared speech as such but definatly policy led in my opinion.
For the start they just checked my green handheld notes and said oh previous VB and position led EMCS VB it is likely to be then and then went on to discuss that. I was the one who had to point out that my EMCS was only a few months previous to the appointment but again she just seemed very pro VBAC with no real reason for ELCS.
She informed my that the risks get higher the longer the labour lasts and as my previous 2 were quick then it shouldn't be an issue and that they won't allow any stage to go above an hour without intervention which she didn't seem to want to discuss and had fobbed that discussion off till 36 week appointment. I also have a fear of an assisted VB especially as the impression I got was that this will be done irrelevant of necessity at the time I pass their policy timescale rather than allowing natural progression and intervening if there was an obvious problem.

When I got into the discussion about growth as my DD was small and they want to monitor me, I asked what the options are if this one has slow growth, I was informed that if early delivery was necessary then they would induce, which I also questioned as I know this increases the risk of a rupture and I was told they would try one induction process and if that fails, they will just continue to monitor growth throughout the remaining part of the pregnancy :o leaving me wondering if it would really have been necessary to birth early if they can't justify a section for this reason!

Lots of questions, very short and rushed appointments lead to very little answers and home research which isn't always the best but all I have.

I find that horrific! Jesus it seems that you have been presented with a plan rather than discuss it. It makes my blood run cold. I can see I'm gonna have to go in armed with responses if my consultation goes like that. I can't believe that each stage they will micro manage and then discuss induction to say if it doesn't work we'll abandon the idea. Dare I ask which hospital or trust this falls under?

Sorry no idea how that grin got in my post.

I live in Lancashire and fall between 2 hospitals and both have very similar policies. My community midwife is based at the other hospital due to where my doctor surgery falls.

I'm 23 weeks, haven't seen a consultant yet and won't until I am 34-36 weeks.

By which point I imagine that all CS slots will be fully booked!

Anyone know if I can just make a consultant appointment or do I have to follow their schedule?

Haven't a clue sorry, here they see at 16 weeks to discuss options and if no other reasons warrant Consultant checks then the next appointment for decision is 36 weeks.
Speak to your midwife and see I am sure there is a way to be seen sooner, but I think it is general practice to get final decision at 36 weeks, but I may be wrong.

Hmmm I've got my appointment at around 17 weeks it came through with my scan date. I'd chase it with your midwife.

I am down for ELCS at 39 weeks but if labour before (which is likely) then I am to have a trial labour.

Is that what you want Nunnie? See i'm worried that i'll get pressured into that but the studies I linked to indicated that TOL increases a risk of rupture so Im in two minds about it.

He has put trial of labour in notes if labour before ELCS. But this is mainly due to the fact that I labour quickly and if there isn't a problem when I arrives and I am dilating and everything is going well then I will be left to natural. If after 4 hours there is no change in dilation then I will be treated as an EMCS. However considering my 1st was born in 2 hours 5 minutes and I arrived pushing with number 2 I am hoping number 3 will be as quick so will hopefully not need the 4 hour timescale.
I would rather avoid another EMCS. Would be much happier with ELCS so keeping EVERYTHING crossed I make it to that date. But if I don't I think a VBAC is the better option for me if I labour sooner.

yes i think if i had previous birth to go on etc I may be swayed but after 36 hours of writhing about mooing like a cow and not dilating I dont really relish a "trial" of that again ha ha

Here it was discussed at 16 weeks with Consultant pros and cons of both etc, leaflets given. Then it was left for me to think about and finalise at 36 weeks. Due to needing a scan at 34 weeks I got to discuss it a little sooner, but because the scan was clear (my placenta had moved) there was no "medical need" for a section, but I was still told it was my decision.
However if you appear to be uncertain which I was but 80/20 in favour of section, then it was a little difficult to argue my corner and they picked up on that. They didn't pressurise me at all but we decided the best course is to opt for ELCS but if I do labour early and at the same speed as with previous two then I am likely to arrive at hospital in a situation where it is potentially too late or pointless to carry out a section unless there is a problem.
It was explained that the rupture risk is larger in a fresher scar but is still not huge and also the higher rate of a rupture is related more to prolonged labour or failure to progress where the scar is subjected to pressure for a longer period. Which if this one follows the pattern of my previous two I am unlikely to labour for long unless there is a problem, and I will be monitored closely so hopefully any problems will be spotted earlier on and dealt with quickly.
One of my major worries which has made my decision more complicated is that with my EMCS the spinal block failed to numb my torso and I felt the incision and was swiftly knocked out, this was very frightening and also meant I missed my little boy being born. I am petrified that if I require another EMCS then this will happen again. The anaethatist has set out a plan for ELCS which she says can in theory be done in an EMCS but it is dependant on level of urgency. So if I arrived in progressed labour and still wanted an ELCS, then it would be carried out as an EMCS and dependant on level of dilation etc this may have to be carried out urgently which is something I really don't want.

It hasn't been an easy decision for me if I am honest and I am still not certain this is the right one for me but now I am getting closer I really want some sort of plan in place and a what if plan, and this seems like the only one there is to suit my concerns if that makes sense. They can't carry out an ELCS before 39 weeks due to lungs etc which is understandable so I can't avoid the what if I labour before scenario. Might have to wear tights for the next few weeks ;)

Hope everything goes ok with your appointment, you appear to be clearer in your mind about what you want which can only go in your favour, I hadn't got my head round being pregnant again at my 16 week appointment and hadn't really had time to research so went in not really knowing the risks or even having faced up to what went wrong with the birth of my little boy and how I really felt about it all.

I have just totally waffled, I think I must have read a previous reply of yours and just answered it without checking if it was the most recent oh well I have written it now, not that it is relevant now

It is relevant, thankyou. It's quite frightening sat at home alone with your concerns being at the mercy of a consultant. It's reassuring to hear your experience. My independent midwife text last night saying did I want to talk about the options. She's back working in the nhs but in a city miles away. If I could go there, I'd try a vbac as I know she'd stay with me even if it was in a doula capacity.

My conflicts come because I was pro natural birth, read ina may gaskin and was booked for a homebirth. Then when dd was born she was back to back, I didn't dilate, transferred to hospital as I was begging for an epidural, that didn't work and then they whacked the hormones in. Back to back contractions with epidural and gas and air. After Christ knows how many hours, shift changes and shitty midwives, I said if I was only 6cms I'd throw myself out the window. And meant it.

I was 6cm. They laughed. I was never more scared in my life! Dd was back to back coming face first sucking her fingers so she wouldn't have come out, but I cannot face that level of fear, vulnerability and despair in a clinical strange environment again. A c section hurts but the fear was gone. But I can't use that in my rationale can I?

If it is a true feeling you have then you can use anything as a rationale. From my understanding if there is a possibilty of a long labour which there is if you haven't birthed vaginally before or got to fully dilated then the uterine rupture risk becomes more relevant. I was told that this would not be allowed to happen as I would be monitored throughout etc, but I have to say that didn't relieve any of my anxieties as I was monitored pretty much from arriving with DS and it still took 3 and half hours of intense pushing before a Consultant was finally called in to assess, which is when it became clear that my son was not coming out that way and I needed an EMCS. So saying something and doing it could be two different things altogether if the delivery department is overstretched or I end up with a junior doctor who was unable to diagnose a brow presentation as she thought she had felt and ear, when in fact it was apprently his eye according to the Consultant, which meant she didn't actually call for a 2nd opinion until I was shattered and DS was in distress, and even then she scanned and said he was presenting well when he clearly wasn't and was preparing me for a forcep delivery.
So if I labour before my ELCS I will be petrified and all the monitoring in the world is not going to remove that fear.

I entirely understand what and why you have a fear and if you go in there with the same understanding of risk etc that you have shown on here, then I can't see why you wouldn't be taken seriously.