Vbac/elective section - how do I choose with conflicting advice?

[anchovies]

Ds (now 2) was 10 pounds when delivered by em section at 41 weeks. Had pre-eclampsia and failed induction (didn't even go into labour, his head was still very high). I also have a bicornuate uterus and had growth scans throughout my first pregnancy and steroids etc as they were worried that ds would be small or premature.

Was told after the birth that it was likely I'd need a cs with any future pregnancies.

When I saw the consultant in this pregnancy at 20 weeks I was given the impression she thought a cs was best, with history of big baby, bicornuate uterus, failed induction etc. But at this point I was very undecided so she agreed that we'd make a final decision at 36 weeks. In between then and now, this baby has measured very big for dates but I was not given a growth scan as they (various doctors/the consultant) thought I would be having a section.

Last week at 36 weeks I attended the clinic again but didn't see the same consultant (a specialist registrar this time) he straight away asked whether I was opposed to a vbac to which I said no but explained my concerns about big baby, mismanagement last time etc. He convinced me that trying for a vbac was the safest option (a properly managed labour...) and disagreed with some of the consultants comments about the bicornuate uterus (ineffective contractions etc). The upshot of this was that I am not due back at the clinic until 41 weeks where they will book me a section/break waters. I went expecting to get a date for a cs as I thought this would be what was recommended but am instead now panicing that I made a rash decision.

Basically I don't know whether I've done the right thing as the opinions I've got from every health professional I've seen before have been different. I don't feel safe now whichever option I go for.

Sorry this is so long but I am really worried.

It can only be your decision anchovies

Though I can tell you that my first being an elective section for medical reasons .. and there I had 3 female consultants advising section and the only person who said a natural birth was male (make of that what you will)

I then had no qualms in agreeing to a second elective section .. but then I was told that I only had a 30% chance of a succesful Vbac as I would need an assisted delivery

Another piece of information that helped me make up my mind was that I had a friend who was a genito-urinary nurse who told me that 2 sections offered some protection to pelvic floor but that once I went for 3 sections I would be in same position as someone with 3 vaginal deliveries

again it has to be your decision .. and I suppose it depends how important the mode of delivery is to you .. I would say remember there are no medals on the labour ward .. it does not make you a better mother having a vaginal delivery or c-section

hth in some small way

Did the consultant explain what he means by a "properly managed labour" and what are the signs that things are not going to plan and what are the chances of vbac not working. My stance after my failed induction/e-cs is that unless I am allowed to labour in peace (ie no continuous monitoring, time limits for dilation, no frequent internals, cheerleading etc), then I would go for elective cs. Otherwise my view is that a "managed" (as opposed to active) labour by far increases the risk of a failed ventouse/forceps, leading to an e-cs which is what I want to avoid at all costs.

In your case, because of the risk factors, I doubt the consultant will allow you to labour without monitoring etc. Which is wise, no doubt. But ... the risks of an elective cs are so low these days (even lower now that you have had a successful previous cs), I am not sure what you gain from vbac. That is just my opinion, of course.

Knowing how the consultants just dump you once the birth is over and ignore any maternal distress at a highly medically interventionist labour/delivery makes me all the more determined to take an "all-or-nothing" approach.

anchovies I had an ec with my first after 18hours of labour and failed to progress at 9cm. I was determined that I wanted a vbac for my second and my consultant had no problem with it bu at about 34 wks I developed polhydomnosis and was told that I would have to a c-section as it was too dangerous to go into labour myself but the night before my elective section my waters broke and after checking that the cord had not came down the hospital allowed me to labour (which I tried without an epidural and ended up screaming that they get me one or section me)anyway laboured for 9 hours and consultant told me at 8cm although I was dilating nicely and after reading my notes on my previouse labour the same thing was happening - my baby's head was not coming down into my pelvis and he could not see this happening in 2cm, especially as this is what happened the first time, so it was better for another ec.

I am so glad that I got my wish to try again as looking back I think I thought that I had been some kind of failure but the second time realised that I had done everything I could and that my body was not built for my big babies.

Sorry for the long reply but you do what you feel you need to do as after you have the baby you want to be sattified - I felt so different after my second section!!

anchovies, sympathy to you as these doctors haven't made it easy for you, have they!

It seems unfair that they have put this doubt in your mind then sent you away saying see you at 41 weeks (when it is quite possible you may go into labour naturally by then and feel panicky because you just won't know what the plans are!). You sound like you would like a more definite plan. understandably!.

How about asking for an explanation from this dr. about what a properly managed labour means to them? As Blueshoes said I think if they start to impose time limits on you and 'strapped to the bed' style monitoring, I could quite see you ending up with an emergency cs anyway.

I guess your options are going with this approach and taking it as it comes, the uncertainty over how delivery will occur, or have certainty in your mind and elect a cs. You do have the choice I think. I guess the things to consider are that if this is your last child, whether it matters to you about HOW delivery occurs - would you regret not trying a VB?

But don't feel bad about making them clarify things for you - it's not good practice for this Dr to send you away from a consultation feeling more unsure and worried than before!! good luck.

What would you rather have?

i was rather desperate to have a vbac, but agreed to a c-section when i was almost 2 weeks post date, and my waters had been broken for a few days. In the end i went into labour the morning of my planned c-section and had a successful v-bac.

If you want a vbac why dont u use a wait and see approach. If you want a c-section, then just plan it - there are risks either way so dont let the doctor scare u.

It's your decision of course, as to what you want. I had an emergency c-section with ds. We are currently ttc and I would absolutely go with a scheduled section a second time. My feeling is that the risks to me of a second surgery are preferable to the risks of a vbac.

HTH

anchovies -m really depends what YOU want to do. VBAC is a possibility if you go into labour spontaneously. That is a sign in itself you ody is ready to have this baby. Last time you didn't even get that far - you were a failed induction because your body was not ready.

If however, at 41 weeks there is no sign of labour, then the best option would be a repeat C?S IMO. However, if you really wanted to try labour then induction can be attempted. My personal view is that VBACs work best when the onset of labour is natural.

I would ask for an appointment with the Consultanat specifically to discuss your options. I am not tto sure the conultant will be pleased about a registrar changing the plan of care TBH.

btw i wouldn't woory too much about the scans because
at 34 weeks they said baby est to be 6lb at birth
at 40+4 baby is approx 6lb
at 41+3 baby's growth tailing off

he was born at 7 lb 10 oz!

at 34 weeks my mother said, they told her my brother would be small and he was her biggest. I said that was in your days, scans are better now. Well she had the last laugh!

Thanks everyone.

hadn't considered the fact that a managed labour (continuous monitoring, 4 hourly checks etc) would be more likely to result in em cs anyway. Definitely something to think about.

To be honest am swaying towards elective section but have got another appointment at the hospital on friday morning and am going to request to see the consultant specifically, not a registrar or doctor.

Anchovies, I can so remember that feeling of being torn between conflicting bits of advice. I think the advice you are getting here to trust your instinct is good but it is sometimes hard to know what your instinct is when you are frightened.

I had 3 caesareans, one for "failure to progress", one for "deep transverse arrest" following induction (all hospital mismanagement basically) and one for "pre-eclampsia" (they lied!). I then had a home water birth almost 3 years ago with an independent midwife and it was very special. I was 41, overweight, 3 previous caesareans and my baby decided to wait until 42 plus 4 to put in an appearance but I was basically healthy, very sure of what I was doing and with one of the best midwives in the UK. I got a lot of good support from colleagues at the NCT and AIMS and from an email support group on yahoogroups called UKVBACHBAC.

It is hard to decide, especially when you have special circumstances like yours but I know my independent midwife is happy to talk to anyone about their choices - she runs the support line for the Association of Radical Midwives so you can put that into a search engine and find her. I also, third time round, got an independent opinion from Yehudi Gordon who is the consultant at St John and Elizabeth hospital in London - he is an acknowledged "expert" on VBAC and CS birth. It cost me £50 I think (7 yrs ago) and it was great to have someone with no axe to grind give me an objective opinion.

You might find the articles on caesarean.org helpful and there are some good books listed on there too. If you want to talk through your options, get some support the NCT have VBAC/Caesarean support co-ordinators you can phone and they/I never put pressure on anyone to VBAC.

Hope you find the way that is right for you but my top tip is listen to that little voice inside of you.

anchovies, my advice would be to listen to what you think you can do. I had an emergency c-sec with dd after 24hrs of labour and getting to 9cm they said she wasn't going to fit through my pelvis.
With ds I had so much pressure to try for a vbac I said I'd try if I went into spontaneous labour before 39wks and they booked me in for an elective c at 39wks. He came at 36 +6 and my vbac was the worst experience, absolutely horrific every complication there could have been and there is absolutely no complaints about how it was managed I just wasn't meant to have one I'm sure. I now wish I had listened to myself and stamped my feet harder for what I really wanted which wasn't what I ended up getting.
Good luck with whatever decision you end up making.