If you had a prev cs with a 10 pounder would you try for a vbac?

[anchovies]

Still don't know what to do!

Didn't go into labour at all last time despite being induced and had ds by cs and he was 10 pounds. The consultant suggested it was his size that stopped him engaging or me going into labour this time. I also have a bicornuate uterus which the consultant said may prevent the baby from getting into a good position or my contractions being effective. But obviously having never gone into labour I don't know how true this is. I am now 7 months pg and suspect this baby is going to be big as well. Basically I don't know whether to try for a vbac or go with the elective cs that the consultant recommended. Any thoughts?

You don't necessarily have to choose, exactly. I would:

• not have an elective cs, as they're generally booked early.
• wait and see what happens at your due date, and see if your waters break, see if you go into labour etc.
• perhaps try natural induction methods, or sweeps?
• probably avoid medical induction, as it's somewhat not recommended with a previous cs.
• if things become too much, choose a cs when you want, or when progress is an issue, or if there's any concern for the baby.

You will probably end up with a cs again. Given your history, it's certainly a possibility. But if you take it easy and don't have the elective cs, your baby will be properly "cooked" when he comes out. You will both have the hormonal benefits of him being ready to come out (milk comes in faster, bigger baby, easier to feed, etc etc).

This is what we did - DS1 was 9lb6oz, born by elective section (footling breech), DS2's head didn't engage, no progress despite weeks of pre-labour (not even effaced!), so we went for a "emergency" section after my waters broke, but he still didn't engage, and I still didn't get real contractions.

It was a lovely relaxed section, and things went much better than with my elective.

So, yeah, I'd give vbac a try, but not push it, you know?

Personally I would go for a cs but I would if I were to have another child anyway as I found vbac too traumatic.

i'm not pg but when we have a number 2 I'll have this issue. dd was 9lb8, emergency cs cos basically too big....

I really don't know. part of me thinks cs, but i deffo agree with NQC ie not to"book" it.

I'd go with NQC's suggestion. Go for the VBAC with the proviso that if things don't appear to happen soon after your due date or be progressing if you 6do^ go into labour, you'll go straight to a c-section. Kind of partway between the 2 really - not exactly an "elective" c-section as you may get the VBAC you're considering (and I assume you would like).

I don't think you have anything to lose by this approach. If you don't "try" a VBAC you still won't know if you would have gone into labour naturally - this may not matter to you at all of course.

DS1 was a 10lb-er, born "naturally" btw.

(DS2, bless him, was 8lb 4oz because he was kind enough to arrive 2 weeks early )

Thanks you very much for this, the try both idea hadn't occurred to me! It seems like I'll get the best of both worlds, especially if I explain to my consultant why I am waiting (she is very forward thinking and wants to do what I want to do more than anything else.) The one thing I wish I had pushed is a growth scan late on to see if this one is looking big but I understand her reasons for not wanting to do this with them being so notoriously unreliable. Plus she rightly said I may never get a relatively small baby out or a big baby might be relatively easy!

The only decision I had already made was to not be induced again, to go straight for a cs if I didn't go into labour on my own. I might ask if it's possible to book an elective for 41 weeks!

The only thing that frightens me is the thought of big babies and nasty tears, can anyone reassure me on that front?!

Anchovy ...
I had a cs with my 10lb DS (went into labour but didn't progress past 4 cm even after 55 hours of contractions, sweeps, having my waters broken and 6 hours of syntocinon) ....
When I was pg with DD I wanted to go for a vbac. Well, to be honest, I didn't mind if I had a cs I just didn't want an elective cs. I wanted to go into labour if I possibly could. Despite much opposition from doctors I had a fantastic midwife who stuck with me and didn't try to persuade me to go for the cs.
Unfortunately they would let me go much past my due date so on my due date I had a sweep. Then 3 days later I had another sweep and the next day I was induced. Nothing happened and 8 hours later I was induced again (the gel). I went into labour and had 12 hours of contractions but didn't get to 3 cm. At that point DH and I decided to throw in the towel and we asked for a cs. The specialist on that day was renowned for going the 'natural' route as much as possible and very rarely agrees to caesars unless it is absolutely necessary but he could see that I had another big baby there and when we told him my history he agreed to do a cs.
DD was born a few hours after that (no scary emergency thank goodness, all pretty easy and chilled) ... a whopping bouncing 10lbs and 10oz which made everyone in the theatre laugh because it was agreed that there was no chance that bloater was going to come out the normal route!

I kept an open mind throughout my pregnancy. I desperately wanted to experience a vaginal delivery ... but I knew it was a possibility that with my frame (small hips) and my previous big baby I may not manage it.

If I have a third child (which is highly unlikely) I will opt for an elective as close to due date as possible considering I will probably end up with a 12lb monster!

Just keep an open mind ... you are likely to have another large baby (I had daydreams of popping out a respectable 7lber .... ) and if your uterus is an unusual shape (does a bicornuate uterus mean it is sort of heart shaped?) ... try and go into labour if you can (good for you, good for the baby) but be prepared for the caesar ...

Hope this helps a bit

Anchovies, my elective was booked for 41+3. We only booked it when I'd gone over 40.

They wanted to do 41+2, but DS1's birthday was 41+1, so I refused. In the end, DS2 came at 40+6.

I strongly recommend the mellow, "see what comes" method. If you've had a previous section, nobody will say "no" if you opt out after a few bad hours.

You can get nasty tears with little babies too though

I did tear badly (3rd degree) with DS1 but with hindsight, that was not due to his size. He was back-to-back, I was exhausted, they did a ventouse and at that precise moment, I worked out how to push... he shot out in one go and virtually had to be caught by the consultant. It was the combination of the ventouse, episiotomy and rapid delivery rather than size that meant I tore.

Hi Anchovies, my sister, who is a mnetter (I'm sure she wouldn't mind my posting this), had her 2nd at home, he was 10lb and she had no stitches and no tears. She also had her first, 7lb something, at home. So a big baby doesn't necessarily = tears although this was 2 x vb so who knows? Good luck whatever you decide.

Ds was 10lb, and I went from 7cm to giving birth in ten minutes flat. I did have a little tear, but nothing that needed stitching.

Dd2 was 9lb 10, and again no significant tears.

If you do get that far, I recommend upright leaning forward kind of positions for avoiding tears. For both ds and dd2 I was standing on the floor with my upper body leaning forwards over the bed. Not a very elegant position (Dh was slightly traumatised I fear!) but an efficient one.

Good luck!

I would go for an elective C-section, but book it as near to your due date as they will let you.

If you don't book it, the risk is that you will go into labour on a day when the hospital is really busy, so if you need an emergency C-section (which must be quite likely) there may be problems finding enough staff to do it. A C-section takes 6 people off the ward, so in busy periods or at weekends/bank holidays when staffing levels are lower, you might have to wait longer than you'd want to. An elective also means you can plan childcare around a known date.

I had a very similar experience to yours last time - emergency cs after 23 hour labour with not much happening despite being induced, and big baby (9lbs 8oz). In my case it was fibroids stopping my contractions being effective, and stopping baby's head engaging or starting labour. I will book an elective cs next time and wouldn't even consider a vbac as I don't want a repeat of the panic-filled atmosphere I had last time.

You sound a bit like me - didn't go into labour with either baby, neither engaged at all. I was hoping for a VBAC with dd earlier this year, and we agreed with the consultant that they would let me go over up to the date that they would normally induce (term +12 in that hospital), and the elective section was booked for that day - if I had gone into labour beforehand all well and good. But I didn't - and that's fine because I gave it the best shot.

I was like you, adamant that I didn't want to be induced. You might find that they wouldn't induce you anyway if you've had a previous section. I think it varies from trust to trust but my consultant was very clear that he would have been unwilling to induce me with dd.

As you sound like you have a sympathetic consultant, I would specify with her that you are not happy to be induced.

go for the elective

I had a nine and a quarter pounder first time, spontaneous labour but didn't dilate beyond 8cm so Em C. I so wish I had gone for elective second time as ds2 was 9lb and I didn't get beyond 9.5 cm due to anterior lip, and it ended in another Em C .

Since you ask, my advice is don't put stress on your body, well your vagina and pelvis really, and go for an elective.

One thing I have learned the bloody, literally, hard way is that there are no medals awarded for a difficult birth. Good luck.

i have a ds who's 7 months and i'm 5 months pg with my 2nd. i had ds vaginally but he got stuck and was born by ventouse (he was 9lb 7oz) i had an episiotomy and tore as well and i still feel tender there if i have been standing for too long. this time i have opted for an elective c-section as i dont want to go through all the trauma i had with ds (he wasn't breathing properly when he was born and was cold)but i'm doing that as i feel that is the right option for me. you just have to go with your gut instinct.

i'ld go with what your consultant recommended, paticularly given that there are a combination of factors involved (i.e. not just size, also shape of your uterus).

I had a vbac and ds turned out to be 10lb 6. I tore which I found traumatic for weeks/months, I have a prolapse and I displaced my coccyx which is still sore six months on.. If I was to have another baby I would definately opt for an elective section (if possible) but tbh it was enough to put me off for ever.. Good luck, some women have very positive vbac experiences. XXX

anchovies I had ds who was 11lb 4oz naturally (not VBAC) and although I tore it didn't need stitches so healed with no problems.

DD was 8 lbs and had nasty tear which needed stitches and then operation when she was 7 months do not sure size has much to do with it!

Blimey such different experiences! Thanks everyone for your thoughts on this. It is such a difficult decision, on one hand I feel like with trying for a vbac I would be setting myself up for another disappointment where as an elective would mean I'd never know what may have been.

DD1 was 9lbs 6oz arriving at 42 weeks and 2 days by Em C (failed induction) but I gave it a whirl second time. I sympathise. It's a tough one. I was much fitter and a bit more active in my second pregnancy but was still scared and tempted to plead for an elective on occasion. I was lucky, dd2 was in a good position (dd had remained doggedly spine to spine) and in trend-bucking style was the 7lb 6ozer that (like Ghost) I had daydreamed about which was a really nice surprise!

Just thought I'd add my two penn'th.
DS1 3weeks early 7lbs 3oz, natural birth some tearing.
DS2 1 day early natural birth 11lbs 7oz (no indication he would be so big, infact he was breech until 37weeks and turned by himself!) tore like billy oh but very quick.
DD monitored and likely to be large so induced 2wks early,worst slow labour of the lot, monitored whole time, had everything including scalp monitor and registrar's arm up me to try to turn her as she was face up, but with a change of position and a lot of pushing and shoving she came out at 11lbs 9oz vv slight tear.
Moral of the story keep your options open, but you never can tell. Good luck. keep us all posted