Should I try for a vacation or just take my scheduled c section?

[Pitmountainpony]

So I am scheduled in for 4 th aprilfor a c section.
First baby was a ecsec after long labour. Baby was over ten pounds and ob said my pelvic opening was smaller than average and there was no way I would ever have got the baby out.

So now I have a c section scheduled but I do have the choice of trying for a vbac if I change my mind. Now clearly I will not be trying if this one looks to be as big and they will scan 2days before to assess the weight.
At the moment baby is average weight and head is average size.

Ian not anti c section at all and feel lucky I am able to choose one if that is what I feel is best. But part of me thinks if I could do it without surgery I will be better equipped to look after my 2 year old.
I will have 7 weeks of help afterwards so will not have to be on my own.

I am not attached to having a particular experience of birth......but if I thought I could do it without surgery of course I would.
Anyone had a good vbac.....as I know they can be very risky for babies?

Did you mean VBAC and get an auto-correct?

I'd take the holiday

On a serious note, everyone has an opinion and you'll not get a consensus. Knowing what I know now if I had my time again I wouldn't have gone for an elective section for DC2 - but at the time, with the information I had to hand it was the right decision to make.

i've heard of quite a lot of people who have been told their pelvis is "too small" and that they can't birth naturally.
it's generally a load of tosh

one person I know was booked in for a c-section as she could "never" give birth naturally as she was "too small"

she went into labour early and by the time she got to hospital it was too late for the c-section and she had her biggish boy naturally.

i would read up on it though... from what I recall the pelvis all opens up during labour and there is no way of knowing how big a baby you can get through it, I would maybe look on the homebirth website. I know you aren't considering a homebirth, but there are a LOT of vbac stories on there, some of whom will have been told they were too small to birth their babies.

ultimately though, it's your choice and you should do the thing that you feel most comfortable doing...

I would take the holiday too any day over giving birth.......

No personal experience but I would wait for the scan and see what position baby is in. If baby looks smaller and is in a good position I would be tempted to wait and go with the vbac. Any hesitation re weight etc - or you just feel uncomfortable with the vbac then take the section as the best way to get your baby in your arms Good luck.

Ha- now that is a title for a thread...yes auto correct created that one- I meant vbac.
Thanks TIY and lurker I will check out that website. I am sure sometimes docs call it incorrectly on the c section front and this happens the other way when they delay doing a c section and the baby pays the price for the delay.I do think it highly likely that some women's pelvis's really are too small to deliver big babies which may explain why so many women died in child birth in the past- I did ask the doc who delivered me last time what would have happened in the past when c sections were not a possibility. He told me the sad tale of how his grandma had delivered two large babies stillborn- they had to wait for the babies to pass away before they could deliver them several days later as they were simply too big to come out- very sad.It was one of the things that inspired him to become an ob.gyn.He let me labour a long time before he advised me he would recommend a c section but if I wanted to keep pushing longer he would support that so he was supportive of vaginal birth.

I guess I am a long game person so I do not mind being laid up for longer than possibly with a vaginal birth if it means baby is safely delivered and the advantage of the c section is that I will not be exhausted as I was last time after such a long labour.
At the same time I do believe you should avoid surgery if you can- it is trying to guess whether I can indeed avoid surgery.
My mum delivered naturally but had to be put under and had forceps and remembers how painful her undercarriage was- she stayed in hospital for 2 weeks after and my bro was well over 9 pounds so biggies run in the family.My grandma had a prolapsed womb her entire life from delivering my 11 pound father.Just trying to put together the various factors to make a decision-no pressure from my ob/gyn at all-I have the freedom to choose.

just on your pelvis being too small, i'm a small person, 5ft3", size 3 feet (2.5 really but they don't exist), very narrow shoulders etc. and i had my DS vaginally. did need forceps at the end after 2 day induction and his head was twisted but i only had one stitch.

i think people with pelvises that are too small is possible but extremely rare. they didn't have forceps back in the day either so my DS prob wouldn't have made it 100 years ago.

I know babybladder- I see women smaller than me who manage the vaginal route- although I guess your baby was not over 10 pounds right? Why would the OB say that to me though?He really had no agenda in terms of wanting me to have a c section.
I would rather have c section than forceps to be honest- because both involve wounds that need to heal at the end of the day but forceps is more risky for baby I think.

I saw my ob yesterday and I think if I go early I will try for vaginal but if we get to the 4th I will just go for the surgery.
My husband said-just go for the c section...I saw how hard you pushed last time and made no progress so save yourself all that energy for something that may happen again anyway however hard you try.
I am unbothered about experiencing vaginal birth if you know what I mean-I know some really expect to give birth a certain way. I could not give a fig but I would rather be able to hold my older ds after birth than not but maybe this is the price I will have to pay if I take a calculated bet and just go down the c section route.

I realise this is just anecdotal, and i'm not here to try and persuade you one way or the other re how you birth, that's entirely up to you
but I have this friend, who had a fairly hideous first birth. really long labour, pushed for a very, very long time, eventually baby born by emergency section.
consultant informs her that her pelvis is not wide enough to birth babies naturally.

fast forward 3 yrs and she is pregnant again.
same consultant suggests scans to measure her pelvis (despite the fact that the pelvis moves and "opens" to allow baby through)- wtf?
friend then hires an independent midwife and requests copies of all her notes from the first labour/birth,

from this they deduce that baby was in fact a brow presentation and unlikely to have been born vaginally regardless of how big or small her pelvis is.

not all consultants/obstetricians are as well informed as they should be. the whole "your pelvis is too small" is just a stock answer for some of them. It doesn't necessarily have any medical backing and people of all different sizes with babies of all different sizes can have trouble pushing them out due to many, many different factors.

anyway, my friend eventually went against hte advice of the consultant which was to have a c-section, and birthed her second baby at home

Now, she was incredibly lucky to find and to be able to afford an independent midwife, but even if she hadn't been able to that baby would still have got out

As I say, it's anecdotal. But it does show that consultants don't always know everything, and sometimes are giving misinformed or outdated advice.
Unfortunately the only way you;ll know if your pelvis is big enough, or rather opens enough, is to try it...

but as I said before... the "right" birth is the one you feel comfortable with. If having a vbac is going to leave you panicking and worried then maybe that isn't the right decision.
I think there are risks with both options and it's a case of weighing up the pros and cons and deciding which you are most happy with.

there is a bit here about CPD (which is when the pelvis really is too small), it's in relation to homebirth, but applies for a vbac too

if you scroll up and down you'll find other interesting things too, including advice on vbacs

I have nothing to add but read this as was interested in how you might get a vacation instead of a section :-)

Thanks tiy....yes I guess they must have stock answers. Will check out bit about CPd

I did read a sad tale of a baby dying due to a c section wound rupturing with a vbac which freaked me out.
I kind of hope I go early a d then I will just give it a go as surely a smaller baby will be easier to push out. My son,s head was99 th percentile and frankly I am glad I got a c section as ther would have been sewing up anyway.....but knowing this one is smaller does change it a bit.
I had a very positive c section experience last time but clearly surgery is to be avoided if you can get them out safely the usual route.

So it is settled. I shall take the vacation.

In all seriousness, there is a recent study just published finding repeat CS was 3 * safer in terms of serious outcomes (haemorrhage and stillbirth for mum and baby) than VBAC. Although remember the risks of these serious outcomes are very low whatever route you choose. For me though, I would pick repeat CS based on this.

I copy the press release, source and results below (its an open access journal which means you can go and read it for yourself).

For women who have already had a cesarean section, choosing to have one for the next pregnancy may benefit both mom and baby more than attempting natural vaginal birth, researchers said.

Planned elective repeat cesarean (ERC) was associated with a significantly lower risk of fetal death and maternal hemorrhage than vaginal birth after cesarean (VBAC) (P=0.011 for both), Caroline Crowther, MD, of the University of Adelaide in South Australia, and colleagues reported in PLoS Medicine.

They cautioned, however, that the absolute risk of poor outcomes for either method remains small.

There haven't been any randomized controlled trials comparing outcomes after VBAC and ERC, mainly because of the challenges in conducting such a trial -- women are unlikely to want to be randomized to either procedure; they'd rather have the choice, researchers explained.

So Crowther and colleagues conducted a prospective cohort study of women who were able to choose their procedure, along with a small, nested, randomized trial to compare the benefits and risks of a second planned cesarean versus a planned vaginal birth.

A total of 2,345 women with one prior cesarean were recruited from 14 Australian maternity hospitals; 1,225 chose VBAC and 12 were randomized to it, while 1,098 chose repeat cesarean and 10 were randomized to it.

The researchers found that the risk of fetal death or liveborn infant death prior to discharge or serious infant outcome was significantly lower in the planned elective repeat cesarean group than in the VBAC group (0.9% versus 2.4%, RR 0.39, 95% CI 0.19 to 0.80, P=0.011) -- with a number needed to treat of 66.

When the individual components of the composite endpoint were examined, the researchers saw a significant reduction in risk of serious morbidity for infants in the cesarean group (RR 0.41, 95% CI 0.20 to 0.83, P=0.014). There were no significant differences for the other individual components, they found.

They also saw that the risk of maternal death or serious morbidity was lower in the elective cesarean group, but the difference wasn't statistically significant.

And when the individual maternal components were examined, risk of major hemorrhage was lower for women who'd opted for a second cesarean (0.8% versus 2.3%, RR 0.37, 95% CI 0.17 to 0.80, P=0.011).

They noted that the maternal findings were in "sharp contrast" to other reports and require further study.

The risk of uterine scar rupture was low for both groups 0.1% for second cesarean versus 0.2% for VBAC though the researchers noted that this was lower than in previous studies.

Crowther and colleagues cautioned that although the differences between second cesarean and VBAC are statistically significant, the overall absolute risk of adverse health outcomes for either of the two methods remains small.

Nevertheless, these small differences "are likely to be of considerable importance to the women," they concluded.

In an accompanying editorial, Catherine Spong, MD, of the National Institute of Child Health and Human Development, commended the study for being based on the intended delivery route. Most of the current literature is based on the actual delivery method, she said, not the intended one, which makes it challenging to counsel patients.

For instance, she noted that in the study, "nearly 98% of women who planned elective repeat cesarean succeeded, yet only 57% of those who planned a vaginal birth after cesarean did."

Since it's challenging to do a randomized controlled trial in this setting, she called for a future retrospective case control study to further assess the benefits of each method.

However, Spong concluded that the responsibility for properly counseling mothers-to-be falls on the clinician. "All this discussion would be moot, and neither the patient nor the clinician would have to fret about whether to attempt a trial of labor or choose a repeat cesarean if the first cesarean had been prevented."

The study was supported by the National Health and Medical Research Council of Australia and the Women's and Children's Hospital Foundation of South Australia.

Neither the researchers nor the editorialist reported any conflicts of interest.

Primary source: PLoS Medicine
Source reference:
Crowther CA, et al "Planner vaginal birth or elective repeat cesarean: patient preference restricted cohort with nested randomized trial" PLoS Med 2012; DOI: 10.1371/journal.pmed.1001192.

Additional source: PLoS Medicine
Source reference:
Spong CY, et al "To VBAC or not to VBAC" PLoS Med 2012; DOI: 10.1371/journal.pmed.1001191.

Thanks jules....v interesting study. I must admit I am leaning towards the repeat c section. Reassuringly as they know the risks they have a supply of your blood type on hand unlike in an emcs........it is funny I was so relaxed last time aftervlabouring so long to have the c section and a healthy baby, but now I have time to think on it am more nervous knowing I will go onto that operating table....read a sad article about a poor woman who died 11 days after c section from a blood clot....I know it is rare but it happens for some poor mothers and I guess some poor woman becomes that 1 in 100 000 or whatever the figure is.

I am interested in what your OB said about delivering large babies pre-c section. How does the baby being sadly dead make them easier to birth - do they shrink then? Not being facetious, I just can't understand how that makes sense.

Pitmountainpony Have a read of Jules research above - the risk of death is greater with VBAC for both the woman - although incredibly unlikely so I wouldn't worry about it.

There is a useful book 'Caesarean Birth: a positive approach to preparation and recovery' www.csections.org/ which talks a lot about the relative pros and cons of caesarean versus VBAC. Essentially there are risks with both routes and so it is important that you fully understand what these are so that you can make an informed decision about which set of risks feel more acceptable to you.

People talk a lot about scar rupture risk in relation to VBAC but what is important to remember in this is that the risk of this in either mode of birth is actually incredibly small (less than a percent in both cases).

All the best with your birth.

I could not give a fig but I would rather be able to hold my older ds after birth than not but maybe this is the price I will have to pay if I take a calculated bet and just go down the c section route.

There is no reason why you can't hold your baby after a CS. I held both of mine (ELCS) on the operating table from the minute they came out. Second time I had a 15 month old too and still was able to give him cuddles. Don't automatically assume your recovery will be worse with an ELCS - most of my friends took longer getting over their VBs than I did with my ELCSs

Truth sweet. Yes sadly that is exactly what he said happened in the past.....after a few days. So for eg his grandmother survived but the two babies being too big to birth did not make it.
Thanks hybrid....I know I will hold my baby as I will be feeding him or her but it is my 2 year old I will not be able to do much with that bothers me.
If I go early will try for vaginal but otherwise think I will take the c section 2 days before due date. Baby likely to be just under 9 pounds if I were to go to due date and last time I was a week late with my over ten pounder.

Thanks ms moo will try and get book in library. Less than 1 per cent still does not seem that low to be honest.....who wants to be 1 in 100 or 200 when it goes wrong?

I had two VBACs and they were fine. The first was heavily monitored and the birth finally happened in the Operating room (after I'd cleared the hospital of staff, as it was one more push then we'll do a CS). The second happened in a normal delivery room but was nearly a home birth/ambulance birth/lift birth.

I certainly recovered faster, had no complications and would recommend it. It was much easier not having restrictions on weights I could lift etc.
However if it is medically necessary I'd certainly recommend a CS.

Thanks mummy time.
Knowing it was impossible to get a ten pounder out it is just a case of calculating the odds of getting a smaller but still big baby out......estimated just under 9 pounds......if baby was smaller I would feel better taking the chance on a v b a c .......just do not want to do that long labour again to have surgery anyway......anyway I am lucky to have the choice I know.