Midwife pushing me to VBAC - can this be true?

[GogoTheSmall]

28wk appointment yesterday and the midwife started selling VBAC to me after I told her I was undecided.

Truth be told I have been edging towards an elcs, for a number of reasons including that I have a bicornuate uterus which can make pushing babies out more difficult (which is why I ended up with em/cs with DD1 after failure to progress - not sure I want to exhaust myself all over again just to end up in theatre).

Anyway, she told me there are higher risks with repeat c/s due to higher risks of scare adhesions, and long term bladder and bowel problems. I thought it was vaginal birth that gave you bladder and bowel problems!

Anyone heard of this with repeat c/s?

scar adhesions i mean....

I don't know about possible complications, but I find it worrying that a MW would try to influence you one way or the other. Surely they are meant to listen what you want.

I've read there are so many risks and benefits for either ELCS or VBAC... I don't think there's a right or wrong answer, although common thoughts seem to be that VBAC is just as safe, if not safer, than ELCS. I think it depends on a lot of different factors. Nontheless, I currently intend to ELCS next time, though I'm sure pregnancy emotions might make me change my mind.

Don't let yourself feel too pushed in either direction.

What she says is true. You are also at a higher risk of requiring an emergency hysterectomy, future fertility problems and your baby having breathing difficulties at birth. Yes, the chance of these happening are relatively small, but they are still risks.

What did the MW say about your bicornuate uterus?

It is your choice, maybe research both VBAC and repeat c-section? You may have any questions you have answered so you can then make your choice.

I had an emergency cs with DS1 and wanted an elcs with DS2 - I felt some pressure from the senior midwife at my last consultant appointment to try for a VBAC - she said things like 'well, a CS is a lot more riskier than a natural delivery' and 'you will take a lot longer getting over it the second time around' - I felt quite upset but stuck to my guns and got my elcs.
I think it is quite common for them to try and persuade women to have a VBAC, and though it is right for some (and in the end, I 'agreed' to go two weeks over and see if I went into labour naturally - I didn't so they scheduled my CS) My fear was failed induction, which happened in my first birth. Stick to your guns and be firm with what you want - for what it's worth, my recovery after CS2 was no better or worse than the first one. Good luck!

ILikeToMoveIt- are those risks from having a second elective cs, or is that data taken from emcs and elcs combined?

My midwife and consultant did the same.. I was convinced its because it's cheaper for the NHS.. They tried to make me go on various vbac courses and I refused an stuck to my guns.. They have since agreed

Have a look at this www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-information-you. It outlines some of the reasons a VBAC may not be successful. A failed VBAC is likely to have the worst outcomes.

There is also an online calculator which can help you work out your chances of successful VBAC, but I'm afraid I don't know the link.

For me my baby was large (98 centile), I'd never had a vaginal birth, I'm overweight and an older mother so I had a low chance (around 35%) achieving a "natural" birth. The hospital I was at were very forceps happy, and there was a 30% chance of forceps even if the birth was vaginal. There was going to be no good way to give birth, but a planned c section had the best probable outcomes for me and my baby. (More babies die during natural births than c sections but the figures are very small for either). I fought for this option.

It is true you can have incontinence etc after a cs, but it is less likely than after a vaginal birth.

I had all the problems (for me, not my baby) you can have with a c section the second time round, and I'm still struggling physically nearly a year on. But I still think it was the right choice for me and my baby.

I think I may have had tokophobia (fear of childbirth) though, which was exacerbated to a horrible degree by the hospital's bullying tactics, trying to get me to have a VBAC. There is a culture in some hospitals that thinks vaginal birth is the only way - and until recently hospitals have been financially penalised for allowing csections. Remember what is right for the hospital is not necessarily right for you.

Newtothisstuff

I agree, alot of the time you think the person you are discussing your deepest fears with, actually cares about you. You are a sauage on the production line, they have budgets to meet, beds to free up. And as we know most of our hospitals are under huge strain with increased population numbers and no resources to back that up.

Its much easier to take a gamble on you - and you might come thru not needing a c seciton or more medical attention....much cheaper and less use of resources.
If you have ELC you will definalty take up that slot, that bed, those drugs, those nurses and that extra cost compared to Vbac.

Somone posted about Epiduals on here - (a midwife I am sure), said its down to beds, this is why they say - " oh no your not dilated enough yet" what they actually mean is - " I cant give you one yet as it will slow down the labour and we have people due in who are more dialted and need beds" .

I started a thread asking peoples experiences for ELC or natural birth and the ELC response was so positive, I will definatly be fighting for that. AND that will be maternal choice not due to physical problems because I found labour physcologically terryfying, the not knowing what is going to happen to you or the baby....

with ELC of course there are risks but you kinda have a smaller amount and you know what they are. NICE has produced its new ELC guidelines because its so much safer than it was to have an ELC.

Well, it depends what sort of bladder and bowel problems you mean, tbh - it is true that repeat CS increases the risk of scar adhesion - but then you don't risk a 4th degree tear with a CS, do you?

I think factors like higher risk of future infertility with CS (true) is something to be balanced out against how many future DC's you might hope to have. And yes, there is an increased risk of your baby having breathing difficulties at birth - but overall, putting it bluntly, a baby is more likely to die during a VBAC than a repeat CS. Even the most pro-VBAC propoganda usually admits that.

Yes, the absolute risk of neonatal mortality is very low with both VBAC and repeat CS - but the risk is definitely higher with VBAC. I do find it grim that some relatively rare risks of CS are pushed heavily in the VBAC v repeat CS info - but the issue of infant mortality is rarely mentioned.

Tethers - from memory it is from any type of section, But the risks are higher the more sections you have and if they are emergency. I remember researching it when pregnant with ds2 and finding that the majority of the statistics don't always separate EMCS or ELCS and/or first and subsequent births, so it is difficult to get specific answers from the statistics.

An online calculator to give you your chances of a successful VBAC?

I had a similar conversation with my midwife, also have a bicornuate uterus and dd1 was a emcs, breach and had the cord wrapped round her neck. Ended up seeing a consultant who took one look at my notes and said, why are we having this conversation, you're having a c-section. Suited me fine.
Talk to your consultant and ignore the midwife, it's your decision.

I didn't have to fight at all- they asked what I wanted (elcs) and that was the end of it.

Having one in five weeks.

Thanks ILike- I can't seem to find any data which differentiates between elcs and emcs outcomes/risks.

I had an elcs for breech DD1, so would be interested in finding out the risks of two elcs as opposed to an emcs followed by another emcs IYSWIM

Here is the VBAC risk calculator - my likelihood of achieving VBAC is 56.5% apparently although it looks pretty rough as an indicator

Am going to keep an open mind until I speak to the consultant and hopefully he won't have as much of an agenda...hopefully

The midwife did also say that if anything went wrong or wasn't progressing as planned they would just whip me straight in for em/cs rather than persevering with augmentation etc. She made it sound as if I may as well give it a go as I'd have nothing to lose. But elcs and em/cs have got very different risk factors haven't they? not least the likelihood of the anaesthetic failing!

I got that talk from my midwife too. Until I told her my cousin lost her baby and had a hysterectomy after her VBAC rupture. All these risks are rare and I was really annoyed that the midwife chose to discuss one lot of risks and not even mention the other side of things.

What does this mean? (might be a bit daft)

Indication for prior cesarean of arrest
of dilation or descent?

Nevermind, googled.

Predicted chance of vaginal birth after cesarean: 72.3%

Mine was 72%, and was fine in reality.

Gogosmall "But elcs and em/cs have got very different risk factors haven't they? not least the likelihood of the anaesthetic failing!"

Too right they are different - stick to what you think is right - it's you having the baby not the midwife.

Good lucl

Have you been through your notes for the previous section? It is usual for the surgeon to write their recommendation for future births, which will be based on what they have seen at the time. That may help regarding the uterus situation.

You may also want to check vbacfacts.com for info.

I'm not convinced by the calculator btw, some very important factors are missed out (for instance how far you dilated before your emcs makes a big difference in outcome)

thinneratforty

can you tell me how you found out about your uterus please and I guess thats why baby was breech?

Its just I had an early scan, the scanner casually mentioned I have heart shaped uterus, so I didnt think anything of it - I also casually mentioned to midwife - she said nothing.

So I was quite suprised when googled and found out it can mean a number of things!!!!

It doesn't necessarily mean baby is breech. DD2 was the right way up, ie head down. I think a lot depends on how separate the two bits are (IYSWIM). Mine is two horns so quite separate but a heart shaped one may be still one big area (sorry, not sure I'm explaining this very well). It also depends how much it stretches.
I found out years before due to cysts on my ovaries and various scans. I remember having literally 20 junior docs at my first scan for dd2 as they were so excited to see a bicornuate uterus up close (I did ask them to leave for the vaginal one - told them to look at the pictures - didn't want to go through that with 20 onlookers!).
Have you seen a consultant? I would recommend talking to one if pos. It may make no difference to you at all, I have one friend who has lovely, easy deliveries/labours and it seems to make no difference and then another had emcs twice and first son had some leg problems due to lack of space. But everyone is different and I would really recommend seeing a consultant if pos.
Hope that helps, feel free to pm me.

I totally agree that your widwife should not be pushing you in one direction or the other. It should really be about informed choice. Fortunately at 28 weeks you still have loads of time to research your options.

Scar adhesions are certainly a possibility as are some of the other risks people have mentioned. However VBAC is not without its own risks too, one of the most significant being that 30% of VBACs end in emergency caesarean.

There is significant difference between a planned and an emergency caesarean both in terms of experience and risks. Being aware of these and the likelihood of each of these possible outcomes may be a useful way to inform your decisionmaking?

There is a really useful book 'Caesarean Birth: A positive approach to preparation and recovery' by Leigh East www.csections.org which has conducted an extensive analysis of the research relating to pros and cons of caesarean birth and vaginal birth. It has a entire chapter on pros and cons of both VBAC and repeat CS. It then details how to plan for and recover from a caesarean so increasing your chances of your surgical birth being as positive an experience as a vaginal birth if that is the route you go down.

Good luck with your decisions.

Interesting thread and links. I am pregnant with dc3 and I have had one crash section and a failed vbac. I have been told I must have a section this time. Yet risk seems to be higher after 3 sections. Confused now.