VBAC or ELCS

[monopod]

20+4 today with DC2 and had been quite certain that I wanted to try for a VBAC this time round but am starting to get quite anxious about it all and thought I would post here for some reassurance!

I had an EMCS due to foetal distress in 2008 and although there are lots of details I don't know about the birth (despite having had a postnatal meeting with one of the midwives to discuss what happened) what I think happened was that I had failure to progress because DS was OP and not putting pressure on my cervix properly, so I never got past about 3cm dilation, and then they found meconium in my waters and his heartbeat dropped so they whisked me off to theatre (and when he was born he had the cord around his neck too).

I had a meeting with the consultant at 16 weeks and he was going to request my notes from the other hospital (I've moved since DS1's birth) and speak with my previous consultant as well to find out the full background. In terms of future appointments I know I'm going to be booked into the VBAC clinic later in the pregnancy and then will meet with the consultant at 37 weeks to discuss my birth plan.

I know I would rather have an uncomplicated vaginal birth than an ELCS but obviously you can't be certain of that and there is a possibility that I would end up with another EMCS, or indeed a traumatic vaginal birth with intervention, tearing etc. etc. And the last thing I want to risk is my baby's safety.

An ELCS is attractive for its predictability and I recovered quite quickly from my EMCS (with pelvic floor intact too) so perhaps that would be a good option.

On the other hand almost everything is different with this pregnancy and a little part of me is thinking hey! that's a good sign for the birth too!

I know there's lots of info I still need to get in terms of the full details of DS1's birth, my consultant's opinion on likely VBAC success, pros and cons of VBAC vs ELCS etc. and am thinking that I could request a copy of my notes and perhaps discuss with my midwife before the VBAC clinic and consultant appointment just to get a headstart on things?

Been reading a lot of recent threads on here about VBACs and ELCSes and there's been a lot of useful information on there but I just feel like I keep swinging one way and then the other. :(

Does anyone have any tips, suggestions for useful reading, advice or just a friendly shoulder to lean on?

I had ELCS for all three of my DSs. The first because he was breach. With the second I tried for a VBAC but DS2 would not arrive. Consultant recommended an ELCS for DS3 because of 2 previous ELCS. I still have a niggling feeling of disappointment that I have never gone through labour and delivery but then part of me feels relieved that I never had to go though labour and delivery. I found each ELCS easier than the one before. The really biggest thing for me though was the safe arrival of DS 1,2 and 3 - no matter how they came out.

Sorry I can not be of more help. I really wanted to experience labour and delivery which is why I decided on a VBAC 2nd time round but you have already been through that so is not so much of a factor for you. GOod luck with what ever you decide (or whatever your baby decides!)

I had a successful VBAC although there were complications which I was very lucky got resolved successfully.

The CS had been more than 10 years previously and was elective, so the VBAC was my first labour.

During the VBAC labour did not progress properly and I spent a very long time (i.e. days) being told I wasn't in proper labour. My understanding (if I remember what I was told afterwards correctly) was that it was to do with the previous CS, in that the uteres and abominal muscles were in second-pregnancy-this-should-be-easy mode (having been previously stretched etc) but my cervix was in first-baby-mode.

Fortunately they were able to give me a little assistance to get me going (external manipulation and manually breaking the waters) and it was all OK. I'm glad I didn't have a CS the second time around, it made the whole thing feel a lot more real and visceral. I remember clearly the sensation of the CS all those years ago and the sensation of the VB, and I'd definitely go for VB if I do it again.

Both options have risks though, and you need to choose what is right for you. It's relatively unlikely that the same issues will trouble you in a second labour, but there could be different issues and no they can't be predicted. ELCS is certainly more quantifiable and predictable, but things can still go wrong. How did you feel after your CS last time? Do you think a second CS would make you feel bad emotionally, or would you be OK with it?

Thanks both for your responses. Agree that baby may decide in the end but in the meantime I'm going to do my best to investigate all available options!

lorisparkle - do you have any lasting ill effects from the multiple CS births? Anything at all - even as shallow as what the scars are like ?

UnbearableRuth - Very encouraging to know that despite the initial problems with labour progressing you went on to have a successful VBAC. I think one of the things I'm worried about is that any of the issues causing my EMCS the first time around were due to me in any way rather than circumstance. I don't quite know from a psychological point of view how I would deal with another CS really, but I suspect that I would feel differently with an elective one where I'd consciously made the decision in advance, rather than failing again to have a natural birth IYSWIM? I think in a way I'm more worried about the physical implications, not being able to lift DS, etc.

Hello.I had an emcs with first baby,spontaneous labour,48 hours and I couldn't dilate beyond 4cm even on the drip. Baby was in a bad position.

Baby no 2,attempted a vbac but didn't get beyond 4cm despite baby being in a good position!The 2nd emcs was much better than the first as I hadn't been in labour for as long and it was very relaxed and like an elcs.

I just couldn't decided whether to go for a Vbac or not. I am glad I tried but if I went for a 3rd baby it would definitely be an Elcs!

I felt like if I didn't give it a go I might regret that decision later on.

By the way the recovery the 2nd time was a walk in the park in comparison to the 1st.

hi. i had an emcs after long labour, failure to progress etc which was fine and a quick recovery.
i then went on to have elcs with dd. cs was fine although recovery was a little longer.
5 months ago i had dd2 by elcs. this was really tough and long due to scar tissue from previous cs's. they explained they had to take their time as your scar tissue can stick to your bladder. it was becoming painful and took much longer to recover from. ive also been advised not to have more children as subsequent css would be carry more risks.
the risks you talk of with a vb are there even without your history. if they dont advise you against a vb i'd let nature take its course.

Thanks for your posts MrsHoolie and mumnosbest, and sorry for the delay in responding. Good point about the risks of a VB being there anyway... Interesting to think of an EMCS being relaxed too, I hadn't looked at it in any other way than how I'd experienced it the first time, i.e. rather traumatic! You've also made me start thinking about a possible DC3 in the future and what the possible implications of not at least trying for a VBAC this time around could be.

Feeling like I have a clearer head about this now, thank you all. I'll find out what I can and will see what the consultant says later in the pregnancy. And I've just bought a book on VBACs and am looking forward to it arriving :)

I have not had any problems from multiple elcs but after my last cs the scar became infected and took ages to heal. I think this was caused in part by my doing too much and I did feel the last cs was a bit rushed. I still think that a tiny section of scar does not feel right when I touch it. It would not put me off having another elcs though.

An ELCS can certainly be very relaxed but I found it very clinical and impersonal.

No-one can predict what would happen if you went for VBAC but it made me sad to see your comment about your previous problems being "due to you" - you mustn't blame yourself, all sorts of different things can happen and you and the professionals helping you all just do the best you can. I hope if you do go for VBAC you do so having it straight in your head that yes, it is possible that it could end up with another CS if things don't go perfectly, but this is IN NO WAY any sort of failure! Please, be kind to yourself on this.

Thanks lorisparkle, that's useful to know. UnbearableRuth - thanks for that :) I will do my best to remember! I'm feeling more positive about opting about a VBAC again thanks to the posters on this thread and will see how things go over the next few months.

I had a horrible EMCS with dd, after a long labour. I was left with PTSD and birth trauma. After a lot of counselling and work I decided to try a vbac with DS if he came on time and c sec if he didn't.

He was overdue and i went in for ELCS. I am very glad I did because he was 13lb and I never would have birthed him naturally as my dd was 9lb 4 and she got stuck.

An elcs is a very different experience from a EMCS. It was actually weirdly healing in terms of my first experience-a lot of the fear was taken away by going through it again but being more in control and able to walk into the theatre room on my own 2 feet rather than being wheeled in in a haze of drugs, pain, fear and exhaustion. i went in well rested, well fed and expecting it. I kind of almost enjoyed it.

Recovery was rough as I came home from hospital with a DV bug-rather nasty vomiting and pulling on the would scars-but it was still quicker than the first time round.

I managed a VBAC after an emcs due to failed induction/distress. I was really worried as my mum's history is all cs's due to 'disproportion' and I fretted that my pelvis was no good for delivering babies. But, I wanted to try a VBAC so that I didn't railroad myself into a series of cs's if I were to have more than 2 kids. My MW picked up on my apprehension at my 28 wk appointment and booked me in to see the consultant midwife instead of the consultant at 36 weeks. I said that I'd really like to try a VBAC and she helped me put together a birth plan for my notes that made it clear I wanted to avoid induction again, avoid too much intervention, and achieve as much of an independent birth as possible. She went through all the risks with me, mostly related to going over dates rather than VBAC vs cs. I read up lots on the AIMS website, did some antenatal yoga and got myself into a confident place with active births. Knowing that the consultant midwife would fight my corner and that she had signed off my birth plan in my hand-held and hopsital notes helped me immensely.

In the end, after 3 sweeps, I had 3 nights of contractions which melted away during the day and then my waters went. When I got monitored initially in hospital foetal distress was picked up and I was wheeled through for an emcs. I had mixed feelings at that point - had I in some way caused the ditress? How long has it been going on? SHould I have had an elcs and avoided all of this? Yet at the same time I knew how much I hated my emcs and its recovery and how much I was dreading the same again, both physically and mentally. In the end, after a spinal they found I was fully dilated so dd was turned by ventouse and pulled out with forceps.

I have to say the contrast between the 2 births was stark for me. I think my post emcs experience was tainted by PND, but after my VBAC I had energy, confidence and ability to do anything I needed to do. I could turn over in bed, get out of bed and lift dd all with relative ease. Feeling un-pregnant and markedly more able did loads for my wellbeing. And of course, looking after 2, this helped a lot.

Now pg and looking forward to another consultant appointment to go through my notes again and glean any info from dd's birth that may help with this one. But they are all different, as folk keep saying to me!

Forgot to add, dd was in rude health when she arrived and fed immediately. Blue-ish fingers for a bit (I think there was cord around her neck?) but full apgar.

I had a vbac after an emcs with dd1 - I was completely dilated other than a cervical rim and had felt the urge to push so the mw's let me - which was probably the right thing to do since I had been 9cm when they had last examined me so assumed I was fully dilated. Pushing against that didn't get anywhere so they hooked me up to a drip to try and get rid of the rim, that didn't work and I had my emcs. Fairly slow recovery and struggled to establish feeding but got there in the end.

With dd2 I really wanted to try for a vbac - my chances seemed good considering how far I'd got first time. Went two weeks overdue and was a complete mess when I went in for monitoring on day 14, felt I'd done the wrong thing, should have opted for elcs, etc. To make a long story short, my waters broke spontaneously whilst being monitored and dd2 was born 5 hours later in theatre with forceps, I was fully dilated and pushing - hadn't been pushing that long but dd2 heart rate was going up and they wanted her out.

Even with an infected episiotomy wound that needed antibiotics, I recovered much more quickly after the vbac than my emcs - but dd1 labour was very long as opposed to 5 hours! Feeding established pretty much straight away with dd2, home the next day and at dd1's birthday party 6 days later.

When I was deciding what to do I found it really helpful to go through my notes from dd1 with the consultant (I had remembered things slightly differently to how they actually happened) and also read up on the AIMS guidelines for VBACs. I did antenatal yoga and my teacher was also an independent midwife who was great to talk to and very supportive.

Good luck whatever you decide!

fishandlilacs - poor you :( 13lb! Wow. At the beginning I worried that DS had gotten stuck, that my pelvis wasn't big enough, etc. because I'm quite petite (5' and normally under 7 stone) and everyone kept on telling me afterward how much bigger he'd been than they had expected (only 7lb 13oz actually, but everyone apparently thought he'd be 6lb or something like that). But as far as I know that wasn't a factor at all in the end.

blooblies - What you said about not railroading yourself into a series of CSes (as alluded to by MrsHoolie as well) is really striking a chord with me. I didn't know there was such a thing as a consultant midwife?? Why did your MW refer you to her instead of the consultant - do you know whether it's because of your particular consultant or because what she provided for you isn't something that you would have received with the consultant? When I saw my consultant at 16 weeks he said that they would work with me at 37 weeks to develop my birth plan.

Really glad to hear that your VBAC was successful in the end, that your DD was healthy and that you felt the postnatal recovery period to be smooth. I think I am thinking about all the things that could go wrong when I guess I have no reason really (at least not at the moment) to assume it won't all go right for me.

I'm beginning to think that a lot of my worry is linked to the unhappiness I had with DS' birth about everything going increasingly out of my control. Thinking about looking into hypnobirthing to see how that might help, although that's a subject for another possible thread...

MsTimTam - thanks for sharing your experience with me :) I find it really helpful to hear about others' stories, and I'm feeling more positive about working with the consultant and his team to develop a birth plan that I'll be happy with (and strategies for coping/understanding if things don't go to plan).

The lack of control thing was a big deal for me, and not one that I had realised until quite late on in my pg. I had felt bullied into a lot of things which felt wrong to me at the time, but always trusted the professionals and their judgement.

I had no idea there was such a thing as a consultant midwife either! In my hospital there is a midwife-led unit and then the consultant-led labour ward. I think that the consultant midwife might have been top dog in the MWLU. She certainly suggested that I'd be happier there and that she would be happy to have me there unless there were contraidications, which is against normal hospital 'policy'. And that I should call for her when I arrived at the hopsital (she wasn't on duty when I did, as it turns out). I think I was referred to her because she would give a midwife's perspectives on the management of my VBAC rather than a consultant's, which is more likely to involve medicalisation and sooner intervention? Or perhaps that she may have been more apporachable and less intimidating? I don't know. I never met my consultant so I can't tell. I did meet a registrar at one of my expectant management appointments when overdue and she was very brusque and didn't seem to listen to me much. Being post-dates seemed to be an anomaly that needed sorting out depite my wishes being clearly stated in my notes. She did, however, give me a very good sweep which finally did the trick

blooblies - ah, ok, that makes sense, thank you. My hospital has a shared midwife/consultant-led unit so I'm guessing this wouldn't be a situation that would be applicable for me. Re. the lack of control thing - one of my abiding memories of my first labour was crying to the consultant "I don't want a caesarean" when everything started going wrong and her responding "I know darling" . Of course I signed the form immediately after because DS was in distress!

I had an EMCS with DS1. I was induced at 40+14 but after two days of labour could only ever get to 9cm (he was back to back too) Baby showed distress so we were whisked off to theatre.

I had a VBAC 12 weeks ago with DS2. I was booked in for an ELCS at 40+12 but DS2 had other ideas and after a sweep the day before I went into labour at 11.30pm that night. Baby was born 4 hours later. I did need ventouse as he went into distress (cord around neck) and I sustained a third degree tear but recovery has been fine and I have healed okay. I have thought a lot about whether I would go back in time and plump for the ELCS but now I don't think I would. As I say, I have healed well and it was a positive experience.

Sorry for not seeing your post earlier artifarti. One of the things I'd worried about was tearing but as others have reminded me above, that's a risk I would have faced even without the previous CS, and it's very encouraging to read about your experience :)