Second baby post c-section: how did you decide what to do?

[TinkerTills]

I'm pregnant with my second baby, after a previous c-section. Long story short it was a frickin' horrible birth and we spent several weeks in NICU afterwards. I have never had/ been offered an opportunity to discuss what happened, why it happened and whether it's likely to happen again. But here I am looking at seeing the consultant obstetrician in a couple of weeks to plan my next birth.

Am I supposed to know what I want? I'm lost. So far my birth plan reads "WTF? Seriously? You think I'm falling for this again?" I also feel angry that I haven't had the opportunity to talk about the previous birth with anyone. Not even my current midwife... maybe I'm not being fair? I'm nothing special after all - 1 in 4 of the women who walk through her door have had/ will have a c-section.

For those of you who had a previous c-section (emergency or elective) and went on to have further children - how did you decide what you wanted from the second/ subsequent births. What help did the midwives/ doctors give you in making your decision? Did you get a chance to discuss what "went wrong" with the first (assuming it was emcs). I can read the stats on the risk of vbac vs elcs... its not helping me decide.

Did you ever contact anyone to ask for a birth de-brief? Maternity units sometimes offer this as a specific service, but some do not. Thy are restricted by short-staffing and budget issues- and sometimes you do have to seek the opportunities out for yourself. If you contact your labour ward or head of midwifery, the should be able to point you in the right direction.

You should be able to discuss all options with your consultant about the options for this baby, which would include a choice of:

-elective repeat caesarean section
-vaginal birth after caesarean section (VBAC)

they should give you leaflets etc to explain everything but this site:

www.vbac.com/

will give you the research regarding the risks and benefits.

A normal birth after a caesarean section is associated with a very small increased risk of your womb rupturing (having a small tear along the scar in your uterus from your previous caesarean) this is a life-threatening, but rare, complication for mum and baby. The success of VBAC's varies from hospital to hospital, but sits at around 70-80%.

The likelihood of it being successful depends upon whether you laboured in your last pregnancy (if not you will have the same chance of achieveing a normal birth as a woman who has never had a baby before) or whether you are being induced. Induced labours are not 'natural' labours- a hormone drip is forcing you to contract, and hyperstimulation- having too many contractions, is more likely with induction of labour. It therefore follows that womb rupture is more likely too. Most hospitals will induce VBAC if clinically necessary, but they will do it cautiously. A successful VBAC, however, is much more unlikely.

A repeat caesarean section, which will most likely be performed at 39 weeks unless otherwise indicated, also comes with risks- the risks of any major surgery- bleeding, infection, anaesthetic issues, and also specifically, the risk of hysterectomy also increases. It is associated with a longer recovery period postnatally, and is associated with more pain. Elective caesareans can have a negative impact on bonding and breastfeeding- in labour you release the hormone oxytocin- in higher amounts than you ever have, or ever will, again. This hormone is essential for mothering and successful milk production. There is also a risk to the baby's lungs through elective caesarean- they are not exposed to the contractions or the descent through the birth canal, the fluid is not expelled from the baby's lungs and babies who are born via elective caesarean are more likely to be admitted to a neonatal unit for respiratory distress.

However, it will be perfomed under spinal anaesthetic in most cases and you will be given a date for the surgery.

Good luck! I'm sure it feels overwhelming at present but do lots of research, talk to your care-givers and have a good think about what would be the best decision for you and your family. I thoroughly recommend making sense of your last birth experience before this one looms, so you can process what happened and ask questions to try and ensure that this one is a more positive event.

xxx

I urge you to talk to someone about your previous birth experience - until you do this, you cannot be expected to make such a decision about this one. I did this before I could even contemplate another pregnancy. I found it very helpful to understand why things happened as they did. I had an ELCS with DD2, and am considering VBAC with DC3, as it was a very 'healing' experience. Likelihood though is I will have another ELCS as it was wonderful.

Good luck with the pregnancy and birth!

TinkerTills congratulations on your pregnancy :)

I am in a similar situation to you, I'm 32 weeks pregnant with DC2 after having DD 17 months ago by EMCS and she came 3 and half weeks early - it was quite a scary experience!!

You definitely need to tell your birth story to someone if just to get it off your chest. If I were you I'd make a point of bringing it up at your next antenatal appointment and clearly say it is causing you anxiety about planning your next birth. If possible speak to your GP, obstetrician about it and also a midwife, your other half, an anaesthetist about pain relief, and maybe a doula as well as you will get more ideas from speaking to a variety of people to form your own opinion of what you want for this time round.

I know health professionals can come across as being too busy to go into the details but if you push your point and start discussing it they may well be more open to hearing what you have to say, after all it is not good for your health or that of your baby's to keep it bottled up.

Also you can request your labour notes from the hospital which can help to put everything that happened before into perspective.

This was my approach to planning my second birth and although I cannot say yet whether it will actually be a better experience than my first, I can honestly say that I feel good because I'm taking control of the situation much more.

Good luck :)

I had a similar experience to you OP, including the weeks in NICU.
We wrote to PALS at our hospital with a list of our questions about DS's birth. We received a long letter in response, from my consultant and head of midwives which answered most of them. This did help, although they also said we could have a meeting if we wanted to dicuss it further.
I am now 33 weeks with DC 2 and have an ELCS booked for 39 weeks and also if I go into labour early.
I think for me I dont want to risk labouring for hours, my baby being distressed, ending in a stressful EMCS again and then NICU. mentally I couldnt do it again.
Luckily I have the same consultant who totally understands and backs me all the way.
Looking forward to a lot calmer experience this time and holding my baby before they are a week old!
Good luck OP x

Thanks for all your helpful and supportive messages. I did ask for a follow-up/ de-brief a few months after the first birth. I was told (by the health visitor) that I would get the opportunity IF i ever decided to have another baby but that they weren't offered as routine postnatally. I think I should have been more forceful - especially as I now see from the 2011 NICE guidance on c-sections that all women should be offered the opportunity to discuss post-section. I was more worried about DC's health than my own and so I let it go (aka buried my head in the sand hoping it would magically go away!!).

I have my 28 week appointment in a few days, I'll definitely bring it up with my midwife and force home that I really have no idea, am anxious to the point of randomly bursting into tears etc

Thanks again.

I had a traumatic birth with my twins, ending in the second one being a crash c-section, no pain relief to come round to and didn't see my babies for 9 hours. I didn't really understand how it had all affected me until I went for my first VBAC appointment with a consultant 7 years later. She was brilliant. It really helped to pour out my concerns, fears and confusion and to have my experience acknowleged by another professional.
I flip-flopped between desperately wanting a planned c-section to avoid any emergencies and a VBAC where I had a chance of a quicker recovery and to be able to hold my baby.
I am now 35 weeks and still slightly nervous but planning on a VBAC with a realistic approach that not all births are going to go as planned and a safe delivery is always the best outcome!
Ask your midwife to make you an appointment with the hospital's VBAC consultant. You may have more that one choice of hospital in your area, do some research and see if one is more pro VBAC than the other. My midwife recommended a hospital that is slightly further away but the consultant-led care for what I want to do is more encouraging.
Whichever way you choose will be right for you x There really isn't much in it as far as safety for the baby goes. Trust your instincts and don't worry if you change your mind!!
All the best!

I'd also highly recommend seeing a midwife about your first labour. I did, having had an emcs with ds1 and it confirmed my view that I wanted to try for a vbac with ds2. So whereas with ds1 I was in hospital for a few days (I can't remember exactly, this was 10 1/2 years ago!), with ds2, I had him about 9am and was discharged by 3pm the same day!

Some of the reasons why natural birth didn't work with ds1 (first labour after extremely normal pg, so mw didn't spend much time with me on a very busy labour ward) were resolved by being a 'high risk' when vbac and having a mw with me ALL THE TIME. That made an enormous difference.

Best wishes, hope you get what you want.

I'm on my first pregnancy, so I'm not speaking from direct experience. My Dsis was expecting to have an uneventful first birth, and ended up with an induction because she went overdue and an EMCS. I think it is taking her a while to come to terms with everything that happened even though both she and baby were healthy.

She isn't sure whether with future pregnancies she would go for a VBAC or an ELCS. I think she'd like to go with the former, if she thought it would be successful, but she doesn't want the trauma of going through both labour and the CS again. She has since read up on CSs and was surprised that there are a lot of choices that mums can make (assuming it isn't a life-threatening emergency) just like preferences for VB. Things like having the lights dimmed when the baby is delivered, allowing you and your partner to discover the sex yourselves, skin to skin contact with one parent or the other etc. I can't remember which book she recommended, but there are several on CSs and maybe other mothers here are familiar with them.

I suppose what I'm saying is that in order to give yourself the best chance of a good experience if you opt for a CS/need one this time around its worth really looking into what options are available at your hospital so that you can at least feel in charge of somethings and don't see the whole thing as a traumatic event. An ELCS is generally calmer than an EMCS. It still comes with the usual risks of surgery, but it isn't a mad rush.

You are right that you can't be expected to know what you want to do with this birth until you have had a chance to talk through what happened last time. There are lots of different reasons why your first baby may have needed a CS some of which may have been definately baby specific and won't affect this pregnancy giving you the same chance of a successful VBAC as anyone else, and some that might be more specific to your body, that might suggest you are better opting for a CS again.

Yes, lots of women have EMCS, but they don't all have the experience you and your baby had of ending up in intensive care for weeks. Don't feel bad about needing to find out What happened and Why, these other women (who you assume are coping better than you) didn't have your experience, they aren't you and they may well have needed to talk about it afterwards too - that's why 'birth reflections' are should be offered to women, especially where their birth wasn't straightforward.

Some women experience PTSD after a stressful birth. I'm not saying that this is what has happened to you, but maybe it helps to know that it can happen and that you can get support?