Vbac after a very large baby, long, difficult labour and EMCS?

[hiphip]

I am 31 weeks and starting to think about what i will do with regards the birth. i am booked in for a scan at 35 weeks to check on the growth of this baby, but so far the hospital seem happy for me to make the decision on vbac or elcs.

With DD she was 11lb3, got stuck after a very long labour. Can't remember the position, but midwife said it was rare to give birth naturally in the position she was in, plus she was big all over, in particular size of head.

To cut a long story short, i ended up with an EMCS. I would love to hear any stories of people who had a difficult 1st labour and ELCS and what you chose to do 2nd time around. It looks likely that this baby will also be big (runs in the family) and struggling with my hopes of a vbac against the possible risk of what may happen again.

Please help!

Hello. I had a long labour followed by an emcs the first time although DD was only 9lb 5oz so a nipper compared to yours!She was in a bad position and I didn't dilate.
I couldn't decide whether to try for a vbac with my 2nd but decided to go for it in the end. I ended up with snot her section as again I didn't dilate despite him being in a good position. He was 10lb 6oz and I had 8 growth scans altogether as my bump was massive.
Tbh if my first had been 11lb I would probably want an ELCS but lots of women give birth to big babies with no problems.
FWIW my 2nd section was really calm and very much like an elective. It was fantastic.
I think you'll get loads of responses of both sides.
It's a tricky situation to be in.

havent had a section but have had big babies, one 10lb 13oz so not quite as big but he did have a huge head and shoulder, off the top of chart his head circumference was!

i had him in a pool, very quick labour and was kneeling when i gave birth.

if you want to try for a vbac then i dont see why not to, but i would try and have an active mobile labour and try to deliver in an upright postion and maybe use the pool?

what does your midwife think?

oh and your next baby might not be as big, after my big baby i had alittle 8lb one! tho the drs thought she was big and scans said over 9lb, do remember scans are not accurate in size prediction and are usually a good ten percent out.

Thank you both so much for replying

It's good to hear your stories. MrsHoolie nice to hear that your 2nd section was calm, but not that your 2nd Dc was so much bigger!

4madboys Have already been told no to water birth, which was something that really appealed to me if I went for VBac. I was very active and mobile last time which helped during the long labour. i have been told I will be having continuous monitoring but i can still be somewhat active, i know I can say no to continuous monitoring, but also know i am not confident enough in the decision to go without it in case anything happened, though i have thought long and hard about it.

The accuracy of scans does worry me, as last time I was predicted 10lbs and was well over and I likewise, I know I would be gutted to be predicted another 11lber and it only be 9lb! However the head measurement would be the key indicator for me.

Sorry for waffling on... any other advice from the evening crowd would be much appreciated...

bump

Hi hiphip,
I'm in a similar situation to you and just posted something really similar in the wrong place!!
My DS1 was 10lb 3oz so not as big as yours, but it was still a long labour and a lot of pushing to no avail - wrong position, big head etc. I ended up with an emcs and it was all very traumatic at the time. I wanted to have an elcs this time (I'm 34 weeks) but have been told today by consultant that have to go for vbac, as growth scans are looking within the average band. Just feel a little bit like the choice has been taken away. It's good that the hospital are letting you have some input into the decision, as mine didn't.

The thing swaying me towards elcs in the first place was the fact that a vbac is very restricting - no water, harder to be active, lots of monitoring and if there is any risk to baby or scar it's emcs straight away anyway.

Sorry I didn't have advice or previous experience! Hope it all goes well at your 35 wk apt. Good luck with your decision.

By the way,the hospital where I had DS are very pro vbac and even let you have a water birth but I know this is unusual. If you are near another hospital it might be finding out if their vbac policies are any more relaxed.
I just knew that my DS would be a 10lber even though a scan 3 days before he arrived said 9lb. Having said that he did have a small head and was skinny.....but 2ft long!

Hi Allypally sorry that you are in a similir position, it's really not an easy decision, especially hard for you as you feel the choice has been taken away. AFAIK, they can't make you go for a Vbac if you are against it. I read an interesting thread on here a few days ago where somebody had posted the NICE guidelines for vbac/elcs and stats for the complications for both. The risk of rupture is (relatively) small but it should be your choice to take that risk or not, not theirs! I may be told the same as you when i have the growth scan if baby ends up within the normal range too. I also understand the reasons you were swayed more towards the cs as i worry that i will once again labour and end up with an emcs and will feel like it went 'wrong' again rather than choosing it iyswim. however, on the whole I am more swayed towards vbac at the moment

mrshoolie Thanks for that, I hadn't thought about asking about other hospitals vbac policy, might be something to think about, also will check at the hospital when i go at 35 weeks as it was the community midwife who told me they don't 'allow' water births.

thanks once again to you both for replying. It really is helping me to think more clearly about some of the issues.

Hi! I am also 31 weeks and ds was 12lb 4oz and emcs after two hours of pushing. He was back to back and his head was tilted back and looking sideways.

I had been measuring large that pregnancy and they estimated ds would be about 10lbs which I figured I could manage and kind of expected really. However, that doesn't fill me with confidence about growth scans!

I will be having a growth scan later this month, tho this one was already heading for the top of normal at 21 and 23 weeks when I had anomaly scans.

Personally I want a c-section, but I already know it's something I will need to argue for if this one doesn't measure large (but I don't know what they class as large actually!). Mostly because I don't trust their measurements and I was so exhausted after induced labour then having a major operation. I firmly believe I could deliver a 9 or 10lb-er, but there's no way to know and I am far too scared of complications of next ds getting stuck if he's massive like ds1.

Hi continuum wow, sounds like you went through it last time and can see why you don't have much faith in the scan measurements. I would love to know how you get on at your growth scan, if you remember would you pop back and let me know?

It's hard because on the one hand having a scan that shows a smaller baby would be great, but then you never really know if it is accurate, and after our experiences last time it's not as simple as big babies can be easy to birth, in fact both of us have found that is not the case for us. though interesting we both had the additional complication of the baby being in the wrong position!

I'll let you know what the scan says!

It's crazy but I've spent 7 years flip-flopping over if we have another what birth would I have!

Growth scan update.

So this baby is measuring on the 90th centile, big but not massive. She went back and looked at ds's chart and he was actually only supposed to be 9lb 4oz, so that was a whole 3lbs out! So it couldn't be said for certain the size of this one would be fine!

It was noted that I would prefer a c-section from what I'd said early on and there was a letter in my notes from the anaesthetist saying that c-section was fine so that was it.

If I wasn't so set on a c-section it would be difficult though, because obviously this one could be as large as ds, but equally, it could turn out to be a size I would have been happy to try to birth.

I have another growth scan at 36 weeks, though that's more because I'm at risk for gestational diabetes and they want to make sure there's no sudden spurt of growth signifying I have developed it since the GTT.

It's been a while since I did this (DD1 is now 7, DD2 is 5!) but I did have a VBAC after a long, difficult labour and em c-s. DD1 was a tiddler mind you, only 8lb 4, but her head circumference was on the 97th percentile, if that allows me to join this party.

Anyway, she was a brow presentation, so just was not coming out. DD2 had an even bigger head, and was a forceps delivery almost exactly 2 years later, which healed a lot of wounds for me - I was very upset with the direction DD1's birth had taken.

Would suggest you ask to talk to the Head of midwives at your hospital about what (s)he thinks. When I was having DD3, I did get agreement to labouring in a pool, but not to giving birth there (had a PPh after DD2, so they wanted me on dry land). Ask if your hospital has telemetric monitors - these use wireless technology and can be used in water, so give you more movement and the opportunity for the pool. Someone else said recently that tese are no used on the NHS - that would be rubbish, as my hospital had them 3 years ago! It will depend on your hospital - mine was a large teaching hospital and referral centre, mind you, so was pretty up to date.

I was not bothered by the CFM in either of my two VBACs, but I actually laboured best sitting upright, and also had epidurals both times so might have struggled to walk round much

hi hiphip only read ur post, we had the same with our 1st only she was 9lb 5oz and lying back to back, thought 2nd would be the same but scan showed he wouldnt be huge so had vbac, he was 7lb 13.5oz (not true that boys or 2nd babies always bigger) so this time around planning another vbac. a relative recently had a 2nd cs as they thought he would also be huge, turns out he was nowhere near huge at all tho!
good luck

continuum Thanks for the update. It's good that you are more sorted now. Hope your next scan goes well. it's just so hard, like you say, your scan in your last pregnancy was way out so you never know, but easier if you are sure that you want a CS. Will keep a check on this thread, would be great if you could come back and let me know how you get on

Poledra Yes, large head allows you to join the party Thanks for the tips, my next step is to see exactly what is available and question what my community midwife said about no water birth, will ask at the hospital. Interesting that your DD1 was brow and DD2 required forceps due to large head circumference, but great that you managed the vbac.

jimmijam Good to read that your 2nd Dc was smaller, usually hear the opposite! Also shows that scans areen't accurate, but you just don't know if it will be bigger like continuum or smaller like your relative found!

It has been interesting reading more stories and has given me a lot to think about, thanks to you all

I had a natural birth with my 1st, and and EMCS with my 2nd as he was brow presentation and stuck.
I am currently 36 weeks with number 3 and am down for an ELCS at 39 weeks, however if I labour early and progressing well on arrival I am going to try for a VBAC.
If my previous 2 are anything to go by I am looking more at labouring before the 39 weeks so a VBAC is a strong possibility for me.

Thanks nunnie how did you reach your decision to book in for a Elcs? Was there any factors that swayed your decision. i think it was your thread that i saw about the risk factors for both vbac and Elcs?

Hi I had a brilliant vbac with ds2 last november after ds1 wad a emcs (an induction, full dilation then no descent leading to emcs). Ds1 was 9lb 13, but the problem was that he was brow presentation rather than just being big. Things that helped me prepare for the vbac were:

1. getting a debrief of my first labour from a consultant and midwife "birth options" team. Answered lots of questions about what had happened first time and that the emcs wasnt my "fault" in some way . They also said "there is no anatomical reason why you couldn't naturally deliver a baby just as big or even bigger but those words helped me to believe.
2. Upon a mumsnetter's recommendation reading Ina May Gaskin book on childbirth. Amazing inspiring woman.
3. Listening to Vbac natal hypnotherapy disks. When I got to the delivery room I was able to ignore irritating midwives and registrars wanting to intervene and let my body get on with it. The labour started a couple of days early was quick and I didn't need any pain relief. Such a positive experience compared to the first time.

Good luck with whatever route you choose.

Hi hiphip, there were risk factors that swayed my decision to be honest, but it was the Consultants idea as I was in two minds and he felt this was the best plan for me.

My main concern with a VBAC apart from the obvious uterine rupture worry that I think all CS mothers get. Was that my spinal block only numbed my legs and I felt them cut me I was quickly knowcked out and DS was lovely so took my mind of it afterwards, but falling pregnant again brought it all flooding back and how terrified and scary the whole thing was. So I saw an anethatist and talked it through and apparently it isn't anything avoidable on my part, it was possibly just down to the rush once in theatre. However it doesn't stop my being worried that it will happen again this time round if I have a VBAC and something goes wrong and I require another EMCS. I have been told if I have an ELCS then they will do combined spinal and epidural for double effect and pre time for an ELCS isn't as rushed so there will be plenty of time to check that it has taken correctly. However with the best will in the world they have put me down for a CSE if EMCS is required but she did say that there may not be time. So if I arrive in labour and progressing well I won't be pushing for a CS due to the time factor etc.

I think if I am honest the reason the ELCS was put on the plan was because of my uncertainty and the unlikliness of me actually getting to 39 weeks. The anethatist seemed to know what my main fears were without me actually having to go into major detail which made the appointment easier as she explained it to my Consultant.

Hi hip hip.

Ds1 - 9lb3oz, emergency section for failure to progress, mostly due to his chin not being tucked in.
Ds2 - 9lb11oz - vbac at home in water
Ds3 - 11lb2oz - vbac at home in water

Ds2 was a very fast birth.

Ds3 not so fast as he went slightly posterior and descended into the pelvis at an angle. My MW got me on my side to move him from the posterior position, then I had my bum in the air and My head on the floor to bring him back off the cervix. I then squatted to open up my pelvis and he descended again but this time properly! He was then born quite quickly after in the pool.

I had only grazes and no tears with both ds2&3. I put this down to being in the water ( you can get into great positions very easily, it helps soften the perinieum)

I had an Ind midwife for ds 2&3 so I didn't have any battles with hcp's about how I was going to birth. I knew that being at home and in the water were going to give me the best chance of having a vbac.

I read Ina May Gaskins books and I listened to a hypnobirth cd which was for vbac. It was about letting go of the emotionL baggage surrounding the section and I found it very useful, even though I wasn't going to be hypnobirthing during the birth.

Good luck, whatever decision you make.

hi, sorry not to have come back to the thread

Thanks for sharing your experiences and nunnie for talking about your decision. I think i am going to look in to hypnobirthing CD or book and really push for a water Vbac when i see the consultant or midwife, it has been realy good to find out what others have done, so thank you all again.

Hi Just thought I'd emphasise the point that growth scans should be taken with a pinch of salt. I had a scan at 36 weeks where I was told that my dd was measuring 9lb then so I should expect around 9.5lb at term. Well she was born at 42 weeks and weighed 8lb 3oz

Are you still around OP? As it happened I actually had a VBAC!

At my last growth scan he still wasn't measuring huge and when she checked to make sure I still wanted a c-section I couldn't reply! I ended up deciding to be undecided!

I was booked to go in at 8am at 41+5 to have waters broken and if that didn't work then it would be c-section. I actually had him at 6am that day after going into labour at midnight. It was a quick and incredibly painful labour, bollocks to being induced being more painful!! And I ended up with forceps. Also ended up being readmitted one week later cos of problems with episiotomy stitches. But still it was sooooo much better than a c-section!!! And ds was 9lbs 14ozs, so more than 2lbs smaller than ds1!!

Congratulations Continuum