2nd timer unsure about vb vs cs...

[lurcherlover]

I have ds who is 16 months and have recently found out I am pregnant with dc2. It's early days, but I want to start thinking about my birth options so I've got some ideas when I go for my mw appointment (and also I have been told that following my first birth I will be under consultant care rather than MLC, so I want to be ready for that too).

So here's my background. With ds I had an easy pregnancy, no health problems at all (I'm naturally quite healthy anyway). I went into labour spontaneously at 40+3 and things progressed smoothly - waters broke, I dilated no problems, I had an active labour at home and then at the hospital using a ball, on all fours etc. It all went a bit pear-shaped after the head was out when it emerged ds was presenting with shoulder dystocia. They put me into mcroberts and applied suprapubic pressure and he shot straight out, but I tore quite badly in the process. I also had a pph and my blood pressure dropped through the floor, so that when I stood up to have a shower afterwards I collapsed. I felt terrible for a couple of weeks afterwards - really, really, weak (could barely climb the stairs) and very sore. It emerged a couple of months later when dh and I tried to have sex for the first time after the birth that I hadn't healed well and it was very painful - it turned out I had been stitched up too tightly and had a lot of scar tissue on my perineum, so when ds was 8 months old I had to go back in hospital for a Fenton's procedure (re-cut and stitch under general anaesthetic). I found this extremely painful and would never want to go through it again. Thankfully it worked (and we have been able to conceive dc2!). So now I'm weighing up my birth options. I have been told that a cs will be an option for me this time, but I think it will be my decision really and they won't push me either way. In a nutshell, here are my concerns:

1. I'm worried I might have another baby presenting with shoulder dystocia - I had none of the risk factors for it (not overweight, had an active labour etc) - and yet it happened. What if it's the shape of my pelvis causing it? I do have relatively narrow hips. Ds was 8lb 14oz at 40+4, so on the big side but not massive.
2. I really, really don't want my perineum messing up again now I've had it repaired.
3. I really did feel very ill after the birth (I think as a result of the pph) and don't want to feel like that with a baby and a toddler to look after.
4. I would love a natural birth if I could guarantee it going smoothly.
5. I want to breastfeed this baby - I found bf easy with ds luckily and fed him until very recently, and I want to do so again. I don't want to risk anything affecting that.

Any thoughts? Would you opt for vb or planned cs? Sorry it's long.

I had a cs first time around and had a vbac second time. I really wanted to avoid a c section as I wanted to be able to cuddle my child. You're not supposed to lift anything heavier than your baby after a c section so that includes lifting toddler into bed/bath etc and I thought she'd have enough disruption with another baby without not having me able to cuddle her (stomach kills) and care for her.

I had a huge pph after the vbac (ended up in intensive care) and like you was weak and very run down afterwards BUT I could actually move once home and could go up stairs, walk etc which I couldnt after my c section. This alone would make me want another vb rather than c section. I was also told at my debrief that another vbac was safer for someone with a history of pph than a c section so in my case it would be advisable.This does hugely vary though and everyone is different after both c section/ vb.

You should be able to establish bf whichever route you go down. If you go for a planned c section you can talk to bf counsellors, ask on here, etc before you go in for tips for establishing after.

I don't know about risks of shoulder dyslocatia. Have you had a debrief from your first birth? You should be able to make a special appointment to talk about the first birth and specifically your risks this time around. Obviously you're going to get a veriety of opinions based on people's personal experiences, it will be worth seeing a hcp to talk through all your options properly. I had a lovely Supervisor of midwives go through my risks with me when I was questioning things as well as the consultant.

Hi there, congratulations on your pregnancy! I'm currently 34 weeks pregnant with Baby no.2 and have been agonising since week 20 about whether to birth this baby naturally or go for an ELCS. I don't want to hijack your thread and go into the looooong details of my particular case and history, but if you are interested, you can read about it here for more context: www.mumsnet.com/Talk/childbirth/1401146-Coccydynia-and-second-delivery-what-to-do

Essentially though, I developed coccydynia during the 2nd stage of DD1's delivery (serious pain in the tailbone). Three years later I would say I'm 90% better, but another vaginal birth might reinjure the same spot. Then again, it might not and I've been busy assessing the risks/benefits of each mode of delivery for my individual case, which hasn't been easy! I'm slightly different to you in that, if I go for ELCS then it would be 'maternal request' so the perspective from my obstetric team is different (but I'm going on now about things that don't directly affect you.)

I think that the decision is actually made more difficult when you are who one who has the responsibility of making it! I completely sympathise with you; your desire to preserve your pelvic floor and avoid a repeat of the awful after-effects of PPH. Yet, there is no clinical suggestion that any of this will automatically recur.

It's just that you'd kick yourself if it did (that's how I feel about my case, anyway).

I think that I am perhaps ahead of you in terms of my thoughts regarding mode of delivery for my baby and I wouldn't want to influence you through my lines of enquiry/thinking. What I feel is right for me and my new Babba might not be right for you and yours. There is a book that I'm finding very useful at the moment called Caesarean Birth: A positive approach to preparation and recovery by Leigh East. I'm not recommending it because I think that you should necessarily go for an ELCS, but rather because ELCS is on the cards for you and you, too, need to weigh up the risks/benefits of each mode of delivery and decide what's best for you. The book contains information that is equally relevant to VB, and Appendix C 'the benefits and risks of caesarean and vaginal birth' would, I think, be useful to you.

There are in addition of course, the new NICE guidelines which might be useful. Here's a link that I've found useful: publications.nice.org.uk/caesarean-section-cg132/appendix-c-planned-cs-compared-with-planned-vaginal-birth

I too, would love a natural birth if I could be guaranteed that things will go smoothly. But, I have a previous injury that means I'm at a higher risk of doing the same damage again. This also means that there is a small chance that everything will be fine in terms of my tailbone ... which really only acts to muddy the waters and make the decision so much more difficult

The harsh truth is that there are no guarantees with childbirth - which feels so much more true when you've already encountered problems. It's a risk/benefit analysis. I think that the key is researching your birth options and then being able to consolidate your findings by relating them to your particular case. Having confidence in your decision then is very important. My mind still isn't 100% made up (and I really need to hurry up!)

Good luck, and I hope that it all works out for you x I'll happy talk more if you'd like