Do these risk factors make ELCS less risky than a VB?

[Mmmmcheese]

My risk factors are:

1. Previous difficult birth resulting in forceps and second degree tear
2. Gestational diabetes so baby measuring big i.e. 10 lbs if go to term
3. Baby back to back and just wont move even after lots of positioning (placenta is anterior left so wondering if baby cant get into right position)
4. Due to previous trauma will be having (consultant approved) early epidural and lots of baby monitoring so may be difficult to stay upright or in a good position during labour.
5. DH is very broad shouldered so worried about shoulder dystocia.

In an ideal world i would rather have a VB but concerned that the combination of factors above will mean either forceps delivery again or emcs and if thats the case would rather go for an elcs. Any advice or comments?

Mmmmcheese, I really think you should discuss this with your doctor/midwife rather than on a forum, simply because you could be missing out other really important factors here. Someone might be able to give you generalised risks but what you are looking for is an individual assessment of your risk without seeing your full medical records properly, so I'd strike a note of caution.

You are clearly still worried about a number of things, which suggests to me, you need a bit of extra information and reassurance from whoever is giving you care. It seems the trauma you had from your previous birth, is leaving you with a few unresolved issues and extra anxiety.

Given you've written down what you are worried about already, arm yourself with that and discuss your options with your consultant. You may actually find they are resistant to the idea of you having an ELCS anyway, which will complicate the matter.

Thanks nice, i have actually discussed with my consultant and she is very anti-c section in general which is why i wanted to get some other views, as if a section is actually less risk then i neednto know this in order to be able to push for a section. I doubt she would ever recommend a section so needntonfind some other way to evaluate thenrisk. My mw just says ask the consultant.

Would it be possible to speak to another consultant, just to get a second opinion?

Hmm, well would it hurt to take the approach of a second opinion on this then? Under the pretext of asking for an ELCS anyway? Its not obliging you or committing you to anything but would give you an opportunity to get a medical opinion. You clearly want to discuss this fully and the consultant you have isn't someone you seem to have a great deal of confidence in for giving you an unbiased opinion.

From what you say and the fact you would rather have a vb, says a lot. That could be the way to consider this; to look at other ways that might help you relax and decrease your chances of intervention. Being mentally prepared is probably going to have as much impact on this as being physically prepared.

It sounds like you want to have greater confidence in what you are being advised, regardless of the route you take with this, more than looking at risks tbh.

I suppose it would be possible but i just dont feel comfortable doing that as this consultant is the top one at my hospital and everyine defers to her, and shes actuall been fantastic in every other way, going above and beyond for me, seeing me every 2 weeks etc, spending lots of time explaining. Its just that she is very anti-section so i know that if i decide i want a sectikn i will need to be very pushy and confident in myself that thenrisks are lower.

I think she wants me to try labour but if things go wrong have a section, whereas if there is a high risk of needing a section anyway i would rather have an elective than labour + emcs. I suppose all i can do then is to go through it all with her again when i next see her.

The main issue is that i would of course rather have an uncomplicated vb than a cs, but rather have an elcs than a complicated vb. And noone can tell me for sure if the vb would be complicated so i need to figure out what the risks are for me of a complicated vb.

I think they would agree to a section if i pushed because of my previous trauma so it kind of feels as if the ball is in my court and i need to have made a decision before i see the consultant.

"whereas if there is a high risk of needing a section anyway i would rather have an elective than labour + emcs. I suppose all i can do then is to go through it all with her again when i next see her."

I think you've got a very reasonable argument there (but I would say that I used the same when I argued ELCS instead of VBAC)

Maybe it's worth asking her about what they've got in place to mitigate the risk of needing EMCS - e.g. are there any ambulatory monitors in the trust which would enable you to be mobile? There might be some things which they have in place which could make an intervention free uncomplicated VB more likely despite your risk factors

What are the trusts own stats of TOL ending in EMCS - it's down to you what percentage you find an acceptable risk

Thing is, your ELCS decision isn't final anyway - if you change your mind, you can still cancel it. Same if you go into labour before the scheduled date - you can then still do a TOL or insist on CS.

I kind think you are summing it all up there yourself. What is it you are most worried about in having a VB? Is it being traumatised again, or is it the physical risks to you/ baby? I get the feeling you've already been looking up potential risks with this with what you posted initially and you want someone to quantify things. I could be wrong so I apologise if I'm assuming things here.

Don't feel intimidated by the consultant's status if you have questions and queries here. You seem unsure of what your current consultant thinks is the best course of action and why. Get her to clarify it and justify it, if you can. If she giving you time, then she realises you need it with her, I doubt she'll be annoyed of offended at more questions.

Am I right in saying a) want to feel in control of the situation given your past history
b) don't want to feel like you are taking unnecessary risks.

Is it possible you could try for a VB and then if its not working out, have a plan for a EMCS in a less stressful more controlled way? Perhaps someone else here might be better able to advise you on that, than me... I did think that there can be ways in which you could have lines draw in the sand to go for an EMCS earlier and in less of an 'emergency way', if that makes sense. The term EMCS (like ELCS) seems to cover a multitude of scenarios some of which seem to carry greater risk than others. (One of the recent changes to NICE guidelines on CS was to reclassify CS into 4 categories rather than simply ELCS and EMCS based on urgency because apparently theres different risk factors involved - I haven't read it very well and I may be wildly out in what I'm saying, but I understood it as EMCS having more variance in risk that I think a lot of studies show and it might be something to think about, given your preference for a VB ideally)

And don't forget, pushing for an ELCS doesn't commit you to it. If it helps you resolve your issues along the way, and gets you answers to the question you need do it anyway.