This has probably been done to death but... which is the safer option elcs or vbac?

[raininginlondon]

Hi ladies, I'm going to try to keep it short here. I have one son born via emcs due to several reasons- failed induction (PE diagnosed at 39wks), failure to progress, meconium in waters, fetus and mother both distressed. Luckily, we were both fine in the end and the recovery from the c-section was not too bad and I was back to normal within 2-3 weeks. Had no real issues bonding or BF.

I'm now 31wks with DC2 and I've got to make a decision about this delivery. I truly don't know what I want apart from wanting the safest outcome for both baby and me. I'm not fussed about not experiencing natural birth so that is not a motivator for me. I would like to avoid another emergency section if possible and am not keen on the idea of forceps (although I know they are necessary in some cases). So far, BP is fine this pregnancy and showing no signs of PE.

Please help! I'm really finding all the information out there so confusing and subjective!!

Tia!

Hiya, I can't help you in terms of offering personal advice as I am not informed enough of the risks of VBAC or repeat CS.

However, I know of an excellent book that identifies the pros/cons of each in and OBJECTIVE manner (sadly this can be lacking from HCPs who might try to sway you one way or the other due to various factors). The book is available from Amazon, it's by Leigh East and called Cesarean Birth: a positive approach to preparation ad recovery

Best of luck to you and I hope that you get the birththat you want x

I would think an ELCS would be safer - you know where you are, the Doctors are planning it etc if you opt for forceps/ventose etc and it doesn't work you might end up having an EMCS .............. I had an EMCS and it didn't bother me at all but I would have preferred to ELCS (which I asked for and it was refused ). A friend requested a VBAC for her second DC and bitterly regretted it.

I opted for a VBAC, and was told it was definitely safer.

BUT the big difference is that I had previously had an uncomplicated natural birth, so I knew it could be done IYSWIM. The EMCS with DC2 was nothing to do with failure to progress. DC3's VBAC birth was the easiest/best of the lot.

Hi similar situation had an emergency section now preg again. Have seen the consultant and the midwife counsellor, they are recommending vbac which confused me as according to their stats c section is safer albeit by something crazy like 1%. I'm undecided but the midwife did admit that they push vbac due to cost as 75% of woman have successful vbacs. None of the stats make sense to me- I've not got a maths brain.

I'll start by saying I am in NO way medically trained and am only recounting my own experience.

I had an EMCS with my DS, after a failed induction when he went into distress and I struggled to bond for the first 3 months; despite everything going well subsequently, healing well, etc - though I did have horrendously cracked nipples for 6-8 weeks.

When I got pregnant again with DD when DS was 12 months old, I was terrified that I would have to have another CS and the same thing would happen all over again, so I chose a VBAC. For me this was fine - I had no problems during the pregnancy and the birth itself was grand, no problems at all for either of us. I found the recovery period after the VBAC much quicker and easier than with DS and given that I had a toddler as well as a newborn and DH was working away during the week, this was important.

After my first pregnancy I also felt 'cheated' that I hadn't managed to give birth properly - I know that sounds very self-absorbed, when I should be grateful that I had a perfect little boy; but I felt I owed it to myself to try the VBAC if I could. Obviously had there been any problems we would have reassessed things...

I hope you come to a decision you feel comfortable with and that everything goes well for you. I also had acupuncture in the weeks prior to DD's birth and I think that helped as well, it certainly helped me feel more positive about the whole thing. Best of luck.

? If you aren't fussed about normal delivery, and don't want emcee or instrumental, then it's quite clear (to me at least) that you're heading towards an elcs! Vbac is great if it goes well, but if it goes wrong, it can go really badly wrong (rupture, pph and even possible hysterectomy). The only situation where I'd say Vbac is safer for you, would be if you're planning to have a lot more kids, as the risk from CS increase the more you have.

Emcs. Stupid iphone

Thanks for your views everyone.
Lunarlyte thanks for the book recommendation. I'll have to look into it as it sounds very interesting.

I just feel that the information I've come across so far is all skewed one way or the other and it's hard to know whether these people have our best interest at heart of just pushing their own agendas.

Ohdoone that's interesting that your midwife actually admitted to cost being a factor in pushing one method over the other.

I think if my c-section would have been for something like a breech lie then I would feel more confident in my body's ability to birth a baby but since I didn't dilate last time I fear it might happen again leaving me with another emcs which I really don't want. I also have a feeling that for vbac to be successful you have to really be committed to the idea. I don't think a 'let's see how it goes' approach is going to end in a successful birth.

Ragwort if you don't mind me asking, why did your friend regret the vbac?

Thanks GwennieF for your account. Yes that sounds like you had a hard time afterwards. Unlike you though I didn't feel 'cheated' as such. I know I couldn't have done anything differently. It was totally out of my control. I was a little sad that I didn't have a natural delivery but was happy to have a healthy live baby in the end. Btw, please excuse my ignorance but how did acupuncture help you with the vbac? Was it mentally or actually physically?

KnockedupMell I'm not planning on any more kids so that's not a consideration either. I guess it does sound like I'm leaning more towards elcs. But I do know it's an operation and carries it's own set of risks.

I wish I had a crystal ball! I would opt for a vbac if I 'knew' it was going to turn out right!

Hi. It's such a difficult decision isn't it? I had a true crash section with ga for dd. It was a horrible experience. I had no trouble bonding but breastfeeding didn't work for me. Also fely cheated out of the 1st hours or so of her life. Sounds crazy I know. When i had dc I opted for a VBAC. I got to about 8/9 cms but it was recommended I have a section due to failure to progress. In a way I am glad I gave it a go even though I ended up with a section anyway. The only disappointing thing is that I wasn't in a position to get the section I wanted. However, breastfeeding was fab.
This time i wil probably be having a planned section.

Hi like you I had a emcs due to failed induction and failure to progress, I didn't even get to 1 cm dilated despite 2 x prostaglandin pessaries and 12 hours syntocinon drip. 2nd time around I wanted to see if it would happen naturally as I felt a bit of a cop out for not having given birth vaginally (stupid I know but there you go). However I was adamant that I did not want to be induced as it hadn't worked previously. My hospital let me go term plus 7 and then gave me an elcs which was a great experience. I breast fed my first and am breast feeding my second with no bother, I've had no issues bonding and healing after both sections has been fine, the gap between my 2 is exactly 2 years and toddler care post cs was not a problem. I was keen to vbac but my desire to push for this was coloured by the experience of a friend who lost her 2nd child due to uterine rupture (along the 1st cs scar) at 36 weeks :( this was obviously a heartbreaking experience for her and although she has since gone on to have a 3rd child, her experience was in my mind a lot during my pregnancy. She had had no idea that uterine rupture was a (small) risk when the idea of VBAC was first suggested to her.

Sorry for lack of paragraphs am on my phone.

It is very difficult to decide.
I know a couple of ladies who have had really successful vbacs with virtually no tearing etc. They seemed elated after these births. I'm aware that probably isn't the case after elcs (it certainly isn't after emcs). All I remember is feeling relieved that we were both alive and well (albeit exhausted and battered from a long labour).

I would like to feel that elation and sense of achievement but I wouldn't want to risk our safety in order to get that.

My gosh Salvadory how awful for your friend. So sorry :( Sounds like your second birth was a positive experience.

I've also read somewhere that apart from previous cs other procedures such as erpcs can also increase the chances of uterine rupture. I've had to have 2 due to missed miscarriages so that may increase the risk for me a bit more.
Has anyone else come across that information? I can't seem to find where I read that.

I definitely don't want to be induced and thought that it's not an option anyway for someone with a previous cs? Looks like it depends on hospital policy though as many of you have been offered inductions even after cs.

i had a successful vbac with DS2 and im getting myself ready for another vaginal delivery in a few days (hopefully!!) times!

my emcs with DC1 was because i lost my waters early, no contractions at all so got induced after 3 days and then failure to progress at 8cm with both baby and me distressed.

with DS2 i really wanted to avoid induction and pain relief as i felt that led to my emcs. so i hired a doula and that was the best thing ever!
at 40 weeks i started to have small contractions which became slowly stronger for... 6 very loooong days! then after finally going to the ospital, baby was born in 4 hours with no pain relief at all and no damage at all but a small episiotomy.
it felt really great.

Having been through an emcs once, id say, why dont you try for a vbac, and if it does indeed end up in another cesearian, at least you know what to expect, you know it is ok to have one, very fast, very effective.
because you are high risk, they wont let you take a lt of risks anyway during your vbac so you wont be madly rushed to an emcs (i suppose)
i was terrified of forceps and ventouse but having a doula with us, we felt that the midwife and consultant took our vbac wish more seriously and suggested loads of ways to get the baby out before doing the episiotomy (he was 4.2kg... and i tried to push him out for 2 hours!!! before they did the episiotomy)

again with DC3 (due in a few days) we hid anothe doula. i had to go to hospital last weekend. at one point my doula was away for an hour and i ended up in a delivery room with consultant takking about inducing labour, but when she and my hubby came back, we sorted everything out and i "escaped" !!!

if they have a room, they might as well use it... i was 37 weeks so in their own words "baby was cooked" so there was no harm in inducing me there and then... even though it wasnt necessary. having a doula with us, we feel we are taken more seriously when we do say we want minimum interventions.. but maybe that is just us or our hospiatl!

good luck with whatever option you choose!

If it is literally just relative risk you are interested in (not judging, just saying!), then this might be of use -

www.bbc.co.uk/news/health-17353803

Basically repeat ELCS is SAFER for the baby than a VBAC. Check out the view on RCOG, too - even they admit it, and they tend to be very pro-VBAC.

As others have said, risk is a complex picture. If you wanted lots of kids, then some risks are increased with repeated CS which aren't great (placenta accreta for example, and scar adhesions).

if you want to take a wider public health view, than VBACS are cheaper, given the way the NHS currently accounts for birth, even though something like between 1 in 3 or 1 in 4 (depends on hospital) end up as EMCS. This is one reason why the NHS push them. Especially as women may end up having more than 1 or 2 DCs. I'm not suggesting you should take this into account, btw - just that when you tell women that VBAC carries a proportionally greater risk (though still VERY small) of the baby being born injured or stillborn than a repeat CS does, then the next question they ask is why the NHS are pushing VBACS.

Remember that the part of the NHS that pays for birth and midwifery does not pay for aftercare of mothers damaged in birth, physically or mentally, nor does it pay for the care of infants damaged during birth.

Another thing to bear in mind with a view to CS or VBAC is your health - if you are very overweight, have blood pressure/blood clotting issues or any allergies to painkillers or antibiotics, this will increase the risk to you of an ELCS.

I wish you all the best. It is not an easy decision, I understand.

It depends what you mean by safer really. With ELCS you are guaranteed to have a major trauma to your abdomen, which will take months to heal completely, but it is predictable and you can prepare for most of the likely problems (although unexpected things do go wrong in ELCS too).
With VBAC there is a risk you will end up having an EMCS, or tear or episiotomy etc, but there is also a good chance (depending on a number of factors) that you will have a straightforward delivery and a quick recovery.
It's a matter of balancing the odds for yourself (reasons for previous CS, your fitness, your willingness to prepare for an active birth and all the other bits that give you a better chance) your practical motivations and your gut instinct.

Induction offered was cervical catheterisation (stimulation of cervix via balloon catheter) instead of prostaglandin pessaries as contraction can't be controlled predictably enough with them, then syntocinon drip as before.

Future I think it's a bit extreme to say it takes months to recover from a CS - some women might take a long time, just like some women take months to recover from a vaginal birth. I had an EMCS and was fully recovered within four days - I don't even have a scar ; I was in my 40s and was not 'fit' or even a healthy weight when I had my CS - just lucky I suppose .

Raining I can't remember the exact details about why my friend wished she had a second CS instead of a VBAC - I think it was to do with the pain and the lenght of labour, plus tearing etc. .

OP, I'm just over 3 weeks post ELCS and am healing much faster that I did after VB with DD1 - I feel almost back to normal :) Don't want to sway you towards another section, but it's just not a cut and dried as VB = faster recovery CS = slower recovery. So many variables ... That's why it's so damned difficult to make the decision

Thanks everyone for your views. And thanks for the link as well fruitybread. I think I need to give it more thought maybe. I've got a couple of weeks before I discuss this with the consultant so I want to be well informed. During my first appointment with the registrar she couldn't offer any useful info (gave me a couple of leaflets though). All she said was that I should give it a go and I could always have an emcs if it all went wrong. That just sounds too much like my last birth to me. I don't want to feel that out of control this time.

Good luck to all who are also going through the same decision process!

If you decide on a repeat CS, dont let various HCPs talk you out of it. Inform them that you are aware of the risks and want to take the risks of repeat CS over the risks of VBAC.

Whichever mode of delivery you choose, I sincerely hope you get the birth you want. Good luck! x

fruitybread

Remember that the part of the NHS that pays for birth and midwifery does not pay for aftercare of mothers damaged in birth, physically or mentally, nor does it pay for the care of infants damaged during birth.

Very interesting, thanks for that info.

I can only share my experience.
I was in two minds a few weeks ago as well.
My first was a vaginal natural delivery ...
A fractured coccyx bone and rotated pelvis as a result of the 28 hour labour went undiagnosed.
Only with pregnancy nr 2 I realised that the last pregnancy had caused all these issues...it resulted in bad spd this time...
So i have opted for an elective c section as the so called natural birth left me with bad knees and bad lower back ...I do not want to aggrevate this at all.

So have it all planned for week 39 and happy with it

And also repeat cs is different for everyone...my friend had a traumatic first birth where baby had to be pushed in and taken out via c section as it was stuck...
that was 3 kids a go ...she has had two elective c sections since and is in for a fourth c section this summer...