Advice needed on birth choices after baby loss

[birthworries]

Last August we lost DS shortly after he had to be delivered via emergency section at 28 weeks. He had a specific condition that caused his early delivery. This was a hugely traumatic experience and we miss DS terribly. However we were lucky enough to get pregnant again and DC2 is now due early Feb. My consultant has said I can have a c-section or VBAC. I don?t know what to do for the best and am finding it rather stressful. Relevant facts:

• It will only be about 16 months between the deliveries
• As DS was very premature the womb was not fully stretched when they did the section which I understand is more risky
• I?m concerned about the risk of scar rupture which exists anyway with a VBAC but particularly given the above two points
• The hospital don?t want to induce me and I really don?t want to go overdue
• Physically I recovered well from the previous section and have no real ongoing problems as a result
• If DC2 comes home we would ideally like to have 1 or possibly two more children in the future but DC2 is the priority
• I don?t have a huge amount of confidence in our hospital but it is the only practical option. In particular I?m concerned if I have a VBAC that I won?t be monitored closely enough, something will go wrong and they don?t notice quickly enough. We would however be wiling to pay for an independent midwife to come to the hospital although I?m aware there is quite a limit on what they can do. We?d also be willing to spend money on other care if it would help. I wouldn?t consider a home birth.
• The post natal ward at the hospital has a particularly bad reputation ? the idea of 48 hours there post section isn?t desperately appealing
• In an ideal world I?d have a VBAC but I?m worried about it
• I view DC2?s wellbeing as far more important than my own and want minimum risk for the baby.

The options I can see are to schedule section for 39 weeks (normal time for electives at my hospital) or 40 weeks and try for a VBAC if I go into labour before then. Or schedule for 39 weeks and if I go into labour before then have a section immediately. Any advice on what you?d do or other steps I could take that might help?

I'm so sorry for your loss, and can fully see why this is such a worrying time for you. I am normally a great enthusiast for VBAC but it is vital that you have confidence in the birth plan you choose. It sounds as though you are leaning towards CS (which, frankly, I would too in your position). There are implications for future deliveries but the statistical risk of a 3rd or 4th section is still very low.

The main drawback seems to be the postnatal care. Is a private room an option?

Is private an option? I lost a child at 41 weeks and had sections privately with subsequent children. 13 months between 1st and 2nd deliveries but didn't cause an issue. Found out I had specific condition which meant I had to go the section route, but I would have done anyway for peace of mind

VBACs have continual fetal monitoring as standard (you have to request 15m monitoring instead) and if you have CFM then you need to have a midwife with you at all times, so I wouldn't worry about not being monitored closely.

Also find out what the VBAC success rate is at your hospital. At mine (the Princess Anne, Southampton) 67% of all vbac attempts end with vaginal delivery.

It's a tough one. I'd probably schedule a section for around 40w and try for a vbac if I go into labour before then but then women in my family tend to give birth later rather than earlier.

Do you have any choice of hospitals, in our area there are two and we are given the choice. Otherwise I know private units exist but imagine they would be very expensive and possibly only London based.

Can't comment on your CS v VBAC decision as I think it is a very personal one, but in your situation I would speak to the consultant and then go with my gut feeling.

Another thing: are you getting specialist midwifery care? I know in some Trusts there are midwives with specialist training to support women in situations like yours. Having someone like that around, particularly postnatally, might be a real help.

Thanks for your posts.

There is one other local hospital but frankly it makes mine look like a centre of excellence in comparison.

Private is an option financially and geographically. I think what worries me is that if there are major problems with the baby, can they cope with it?

I'm not under any specialist midwife care, maybe that is something I can consider. I could contact the head midwife who I have met before when I wanted to tell them how crap their service had been last year and she said I could contact her so maybe I should do that. She should certainly know what the policies should be on monitoring.

I didn't know specialists in this sort of situation exist, I'll ask thanks.

I'm not sure what my hospital's VBAC rate is. When I'd spoken to the consultant previously he said 80% chance it would work but no idea if that was based on their actual stats or my chances or a finger in the air. I'd like some more figures on that.

I think confidence is going to remain an issue - regardless of what they SHOULD be doing in a particular situation, I'm worried that they won't do it or won't do it well enough. We had one point last year prior to delivery where the midwives were awful and although they should have been doing certain things urgently they repeatedly failed to do so despite our best efforts. And I think it is partly this that scares me.

That's precisely why we went private. I didn't have any confidence in my midwives. I went privately to one of the high risk consultants who was absolutely wonderful. They listened to my fears and had me up at the hospital daily for monitoring near the end, to allay my fears and obv keep checking baby was fine. I felt safe with them and knew that they were more than capable, given that I was high risk. If you are in London, PM me and I will give you his details. The only reason my children are here was because of him.

Sorry...that sounded a bit melodramatic ! Just saying, you can find brilliant care ( in lots of places, NHS included, but in order for you to feel comfortable for the remainder of your pregnancy, you need to feel able to trust in your medical support)

Mince, have PMed you.

In your situation I would seriously consider the private route but use a hospital in London which is NHS but has a private ward (like St Mary's, Kensington & Chelsea and some others). That way you have all the care you could need, with a named consultant and properly staffed post natal care (that was a big issue for me) and also have full NHS provision for NICU/SCBU and intensive care for you if needed. Also you don't have the worry that you are racking up bills if you or your baby need that higher level of help as would be the case at a fully private hospital like the Portland. I can't comment on the choice of ELCS or VBAC.

I am so so sorry for you loss. I lost a baby [DD1] at a similar stage of pregnancy in 2009 (though had a DD healthy and full term last December). I understand all your emotions about protecting your second DC and it sounds to me like you are leaning towards CS? I had a planned CS with DD2 - though she was lying transverse at term so in the end my hand was called - but I had all the same thoughts as you and really wanted a planned calm delivery, and I was so afraid that would not happen any other way. I think the elective CS may be a good route for women who are very anxious due to previous loss; it certainly was for me. [On the other hand, I am not planning on having more so the risks of repeat CS's don't worry me at all].

The post-natal ward was awful but I was only there 48 hours (and DH was there all visiting hours so most of the day time). You will most likely be so overwhelmed with emotion when DC2 arrives that time will just pass in a bit of a haze! [just accept DC2 might cry for a while overnight before anyone comes to help you ... actually it won't harm him/her even though you really won't like that]

Good luck in making this decision

OP, am I correct in thinking that the situation that caused you to lose your first baby was not related to the way he was born? If so, you should be able to think of yourself as having a normal birth this time. I can highly recommend using a private midwife for a planned hospital birth. I had an unpleasant, but ultimately successful, experience first time in hospital, a complicated emCS followed by days in HDU for me and SCBU for DD. Second time I hired a private midwife with the aim of taking her into hospital with me. She was fabulous and gave me the confidence to approach a second labour with optimism and a sense of calm. As it was, my second baby was born in unusual circumstances too, a very rapid and unexpected birth at home, with suspected PPH and 3rd degree tears necessitating an immediate transfer to hospital. My midwife still helped me to enjoy the experience, rather than suffering it as I did the first time. I cannot recommend her highly enough (if you want to know if you are in her area, PM me.)

Thanks for the later posts. I think I need to have a private midwife with me or go fully private so will investigate both options. Backinthe box, will PM you.