tell me about your VBAC/attempted VBAC

[Mandyville]

I've got an appointment at the VBAC clinic (good innovation) next week and want to get my thoughts/questions in order. First labour was mostly in water and not too bad - but the community midwife has warned me that a water birth probably won't be available for me this time because of the previous c-section. Sooo...

Was your VBAC quite a medical experience? Did you have an epidural? Were you on continuous monitoring? Was it OK?

I hated the monitor first time around and I'm dreading continuous monitoring being recommended this time. I'd love to hear from anyone who had monitoring and found it fine - I don't really want to refuse it if it's recommended...

I don't mind hearing the bad stuff as well as the good - I really just want to be prepared to talk sensibly to a midwife about my pain relief options.

Certainly the midwives I've spoken to, the consultant at the hospital, the vbac midwife have all said that there are less risks to mother and baby with a vbac than a c section or I wouldn't be doing it. (In cases where there is clearly no medical reason not to vbac that is - obviously there are many cases where a c section is preferable for medical reasons) All the data I've researched since being pregnant seems to point that way too. Most statistics are similar to first time mums.

From memory (I have the leaflet the hospital gave me somewhere but not sure where) - a c section carries with it increased risks ... (Some of these include aspiration, blood clots, hemorrhage, urinary tract infections, organ injuries and anesthesia complications, higher rate of death than vbac (obviously still really really low!)). A baby who hasn't undergone labour at all has increased risk of breathing difficulties and a risk of lower agpar score, also c section babies are at increased risk of having difficulties breastfeeding.

There are all the normal risks of having major abdominal surgery with infection risks etc.

Now having had a c section and been fine for all the above (other than recovery - that was just horrid), and they are really routine so the risks aren't high (having said that I know several people who have had post operation complications), its just balanced against the very low risk of scar rupture a vbac is safer - hence why hospitals are keen to recommend it!

The risk of scar rupture is tiny and for most that will be a small tear rather than something catastrophic, the 0.5% figure includes mothers with multiples, much older mothers, and small tears which aren't such a problem. Hospitals will be looking out for signs, whether cfm or a mw observation and check, and it would be likely dealt with very quickly and safely in hospital.

Of course don't rely on me for any medical advice but a good mw or consultant should be able to go through the various risks.

Wantstobeaman - we were told the likelihood of a c section while Vbacing was exactly the same as that of a first time mum. In that case a lot depends on the intervention rate of your local hospital etc.

I too am very much pro people having facts and making their own choices - and am very glad so far people have been through them with me. Whether an elective C or Vbac most most most births produce healthy babies and mothers and that really is the main thing :)

I find it hard when some things are just "hospital protocol" and there are often differences around evidence based practices, but that is life! I was quite naiive when I had my first child and have read up a lot more now.

@usingapseudonym

Hi:)

Sometimes HCPs say things to make you see things their way. Its sad but true. I am not one of those who would blindly go by what they say.
I have done my own research and found out that the risks associated with a normal birth are quite scary- oxygen starvation, cord prolapse, spinal injuries, cerebral palsy ( maybe even bell's palsy, but I am not too sure about it) to the baby. Incontinence, pelvic organ prolapse, the possibility of bladder and anal fistula, sexual dysfunction to the mother. The risk of haemorrhage is high enough with a normal birth as well. These risks become more pronounced in a VBAC.
I am sure that cesarians carry a lot of risks, but the hospitals tend to advertise the risks of cesarians only. The reasons are varied- they are cheaper, require less staff, and hence better avoided. I believe it is unethical to not inform women of the possible risks of a VB. I read the thread about the women with the colostomy and my heart sank.:( No hospital puts that on a pamphlet for women who are giving birth vaginally. But the risks associated with the cesarian ( as rare as a colostomy) are announced from rooftops. This gives an incomplete picture.

I have spoken to some some doctors and I've been told that the chance of a woman requiring intervention if she has already had a cesarian is higher. Intervention could include ventouse, forceps, episiotomy or a crash cesarian- things that I would give my right arm to avoid. So, from where I am a planned cesarian is much better. I also think that it avoids the possibility of shoulder dystocia (sp?) and spinal injuries to the baby.
Different doctors have a different take on it I suppose.

Ultimately i feel that no matter what, the final choice between a VBAC and cesarian must be the woman's. She should be given honest no nonsense facts ( which are unclouded by a doctors preference or the hospital's budget) and her decision must be respected.

The RCOG vbac guidelines put much of the evidence/info about associated risks down in black and white. I am also going for a VBAC. I had an emcs last time which was, as far as surgery can be, straightforward. Due to DS being brow presentation and in distress, which is highly unlikely to happen again, the risks of VBAC, for me, are lower than a repeat CSection. Each woman should be given all the information, and it should all be decided on a case by case basis. I am technically low risk in every single area except the scar, and I have as much chance of cord prolapse or some other nasty incident happening, as I do it rupturing. Such is the joy of childbirth. You cannot ever take this away completely. It is clearly a risky business in many ways. (The statistics for scar rupture also include non-vbacs as far as I am aware so there is that to consider too.)

Michel Odent, a French obstetrician, believes that an in-labour cesarean, which is not actually an emergency per se, ie not a crash section, is safer than going for an assisted vaginal birth, for a number of reasons. His book is an interesting read. As far as I can see it pays to own the situation (haha labour yeah right!) as much as possible and have the information to make informed decisions about the direction it is going in.

Your last paragraph is absolutely right, wantstobeaman. It is so hard to get impartial advice though, as everyone who is involved in the pregnancy and childbirth industry has their own thoughts.

One thing you have missed out in your description of risks is the emotional impact giving birth one way or another can have. There are women who are a nervous wreck at the thought of a vaginal birth, and there are women who would try anything to avoid a CS. I tended toward avoiding a CS, but was comfortable with the idea I could need one during my VBAC attempt. In that respect I feel I was much better prepared mentally than I was when I had my first baby and ended up with an emergency CS after 42 hrs in labour and a failed ventouse attempt. I was keen to avoid a CS, because I got something one just couldn't predict with my first birth - a scalpel-happy surgeon with an eye-patch on. Something I still can't believe to this day! It took me 3 years to find out exactly what she had cut through that she wasn't supposed to, and lets just say I was lucky that I came away with a live baby, only 5 days in SCBU (her) and HDU (me), and was able to go on and have another baby normally.

Obviously, having been effectively butchered during a CS I was very keen to avoid having another one. But for every woman like me, there'll be a woman who's first CS was fine and thinks it is the way forward for her. Everyone has their reasons, and as you say, they need supporting with impartial information, and the decision they come to respected.

Btw, a male colleague of mine once said to me "when women give birth they have one foot on Earth and one foot in Heaven." It's all risky, whichever way round we do it.

As you said, an assisted birth is more risky than a cesarian.

I know for a fact that most women with prior cesarians are at a higher risk for assisted births ( I noticed quite a few on this page itself who had assisted births while attempting a VBAC). That is the main reason i would never consent to attempt a VBAC.

As we have agreed - childbirth is risky. What makes it less traumatic is being able to choose our risks.

Backinthebox has made the most valid point of all- about the emotional impact on the woman. There is no point in forcing something on a labouring or pregnant woman, only to have her traumatised. It is violation of women's rights.

'most women with prior cesarians are at a higher risk for assisted births'

is it possible that this is due to all the monitoring? i have read in many a document that CFM leads to a higher intervention rate, including instrumental births and cesareans... and random consultants recommending induction at 41 weeks for no apparent reason ...

No it isn't due to more interventions. Sometimes it can be, but normally if a woman has had a past cesarian, chances of needing an assisted birth are known to be higher. It would be higher as compared to a woman who hasn't had a prior cesarians, even if less intervention was used.

I knew if I had the epidural I would end up with an assisted birth, but knew I needed the epidural to ease my scar pain. It also prepared me for another EMCS if one was required, as my biggest fear was the spinal failing and me feeling them cut me again (which happened with my previous EMCS), I was told my chances of a successful VBAC was high as I had previously had a VB prior to my EMCS and I progessed quickly to pushing with my son but he was brow hence the need for EMCS.
I personally think I had a successful VBAC I have my daughter and she is healthy which is the main thing. My forcep delivery was not ideal but necessary and to be honest she was pretty low down so they didn't need to go too far in to find the head and she was out in one push and pull with one very small bruise.
I was also planning on a non assisted delivery and if required would have preferred a CS but as it went this wasn't possible and I have to be thankful and grateful that my baby is healthy. I have had three deliveries now and non have been trouble free so I shall not be doing a fourth.

I was down for an ELCS but never made it to the date.

Sorry that doesn't make sense, I was down for a ELCS at 39+4 with a trial labour if presented before and progressing well. I arrived at 37+3 and progressing quickly so trial labour it was.

what is cfm? im very interested in whether to vbac or not after an EMCS xx

I had a VBAC at 40+8 (spontaneous labour, had a section booked for 40+9, talk about timing!). I had had long conversations with my consultant about not wanting to be kept hooked up to monitors all the time, particularly as I was having problems with my hip and couldn't stay sitting down for long. I'd also wanted to try labouring in the water and he said he couldn't see a problem with that although it would be safer not to actually give birth in the pool.

Firstly, my midwife was AMAZING, which helped. She hooked me up to the monitor for a bit while the contractions were still bareable just to make sure there was nothing to worry about in the immediate vicinity. After that, the midwives just held the monitor to the bump every so often, no matter where I was or what position I was in (on the floor curled over a birthing ball mostly). They canulated me (partly my request - I have had problems with needles in the past and wanted them to do it while I was still pretty 'with it'.). I was allowed to labour in the water - but in a bath, not the birthing pool. I never actually found out if this was just because someone else was in the pool. The water really helped for an hour or so, and they popped in once or twice with an underwater doppler to make sure things were still rolling on ok. Once the water stopped doing much good they did a check and I was at 4cm (I think) but waters still hadn't broken (DD too high up) so they wanted to rupture them for me. At this point I gave up hope, as it was at precisely this point that everything went so downhill with DD1 - membranes ruptures at 4cm, five hours to get to 7cm, epidural, then another 9 hours before she was born by EMCS. However, membranes ruptured, they kept me on the bed but I COULD NOT have laid on my back if they paid me, the contractions became so strong straight away. 7cm in an hour, never got an epidural for various reasons (mostly emergencies calling the anaesthetist away) and once I was at 10cm they said there was no point having one as it would slow everything down and would probably cause me to need interventions of one kind or another. DD2 was born less than 4 hours after breaking my waters, with nothing more than gas and air. I was on my back by then, but by then I didn't care.

The monitoring never felt like too much. After doing the waters, they wanted to keep me on the bed on monitoring for half an hour, just to make sure that rupturing hadn't sent DD into distress. They gave up on the CTG round the belly as every contraction was so strong it was knocking the toco out of place and losing the trace, setting alarms off. They put the scalp electrode on and stuck the connecting bit to my leg and after that the monitoring just felt completely unobtrusive. Plus I was high as a kite on G&A and contraction pain by then anyway so didn't really give a toss!

It was SUCH a positive experience and undid all the mental damage that the first birth did. I spent the next week pointing at my little girl and saying to DH 'look what I did!'. 10 weeks down the line, I'm still on a total high from it