vbac vs 2nd cs: done before I know.

[bonzo77]

Next week I have an appointment to discuss my antenatal care and perhaps an elcs. I will only be 16 weeks, so I know I don't need to make a decision.

DS was induced at 38+5ish due to loss of foetal movement and reduced liquor. I had maximum dose of gels, ARM and syntocin drip. this took 3 and 1/2 days, I got virtually no sleep. I did get some contractions, but no dilation. I think a number of things caused this...

1. My mother went to 42 weeks with all of us, then had straight forward inductions with gel only. I think that we naturally have longer pregnancies.
2. see above, my cervix was not favourable.
3. see above, baby not engaged.
4. delays due to staffing levels etc meant that doses of drugs were too spaced out and no momentum was achievable.
5. I was very tired and really should have declined the "just-in-case" epidural and got off the bed. The very sweet midwife wanted me to rest. Hard to know what was the right thing to do.

In the end I pushed for a section. I felt I was too tired to go through labour, that if I did I would end up with forceps / ventouse / CS. I was being induced because the baby was not doing well. I didn't want to wait.

Apart from tiredness, frustration and worry, the process was pain free. the section was great, magical even.

Part of me wants another section. It's probably safe for me and the baby, it's easy, it appeals to my desire for control and being able to plan. Physically I came away unscathed last time. It's a known quantity. I've heard lots of awful vb stories in rl. no nasty cs ones (i'm excluding what I've read on interweb, I think it might be a bit skewed).

A (smaller) part of me wants to go for vbac (assuming I am not advised against it for medical reasons), for the shorter recovery, the sense of achievement, for it being the natural conclusion to a natural process. I am terrified of it ending in a horrible assisted delivery, big tears, incontinence, prolapse etc etc. These have all happened to good friends.

If I say to the doctor I'll try a vbac, but want an active labour with intermittent monitoring only, no induction, no assisted delivery. If any of these become required I want to go straight to emcs, is that reasonable?

Its such a hard decision, for me anyway. Some women I know were certain from the beginning that they were a VBAC or a C-section - me, i still haven't decided for sure and I'm due in 6 weeks!

I think your plan looks fine for a VBAC. The only "flaw" I can see, is the assisted delivery part - i.e. if baby has come down far enough to be dragged out with forceps you may not be allowed to have emcs by that stage? Also, the doctors like to push for continuous monitoring. They'll tell you that the monitoring machine ( i forget what it's called) is mobile, so won't restrict your movement... up to you what you say in response to that!!

But don't feel guilty for wanting an elective section more than a VBAC. There's a lot of pressure to achieve a vaginal birth because it's (usually) better for baby but it might not be better for you. A good friend of mine had 1 C-section and a VBAC - she is adamant that she felt no different towards either delivery, or either child.

thanks tinker. I know what you mean about that flaw regarding assisted delivery, I guess its a risk I'd have to take if I went for vbac. I might ask to have a look at their "mobile" continuous monitoring. If it's wifi or similar and looks feasible it's another plus to the vbac option.

I have done a bit of research and it seems CS is just as safe as vb for babies, although there is an increased risk of breathing problems with cs (but how much of that is due to the reasons the birth ended up in a CS...?). It's definitely riskier for women though.

As for guilt... I don't feel guilty about my last CS, not an ounce of remorse over FFing, letting DS sleep in his own room on his tummy, controlled crying or any of the other less "optimal" choices I made. What I really want is what is best for me and the baby. I want a crystal ball that says either "you will have a straightforward natural delivery and will cope" or one that says "your attempt as a vbac will leave you with PTSD, don't do it". I don't ask much do i?

are you tending to one or the other at the moment tinker? if so, why?

Hmmmm, good question! Today I'm tending towards a trial of labour BUT will NOT go overdue by more than a few days. I had a nasty time on oxytocin last time and ultimately it didn't get me anywhere (gas and air didn't really work for me with the pain and I ended up with an epidural. In fact, I "ended up" with just about every intervention on the pathway to EMCS). I'm sceptical that being induced won't end in being tied to the bed, with that "head clip" monitor and an epidural. Not conducive to a vaginal delivery. Psychologically speaking, my scepticism plus a feeling of deja vu IF i was induced would probably stop progress and i'd end up with a c-section anyway... does that make sense? It does in my head!

I have been told that you can have a few sweeps from 38/39 weeks to give you a good chance of labouring naturally.

I am quite scared though - having not birthed before it's like having all the uncertainty of a first time mother, with all the cynicism of a 2nd/3rd/4th-timer AND larger babies. It's not a good mix - and probably why this question comes up so often on here! So, you sum up my feelings exactly with the crystal ball comment! My consultant has repeatedly told me there is no way of predicting what will happen this time...

I'm pleased you're not the "guilty" type - too much pressure already!

If I say to the doctor I'll try a vbac, but want an active labour with intermittent monitoring only, no induction, no assisted delivery. If any of these become required I want to go straight to emcs, is that reasonable?

As a mum and a midwife I think the above would be perfectly reasonable. Have a plan but don't be too rigid, and yiu could always ask for membrane sweeps at the end of pregnancy.

I tried a vbac. The deal was I would go into hospital as late as possible, get in the pool, have intermittent monitoring and managed third stage. We also agreed a low threshold for transfer for cs.
In the end I needed a crash section, but as long as I understood that the docs would step in at the slightest risk, the hospital were happy for me to try. And it was a good experience, even though I realise it sounds a bit traumatic!!

Thanks. I feel guilty about all sorts of things, but not over my decisions with DS. DH (and the rest of my family) are pretty supportive of my choices. When they're not I ignore them!

Tbh I'm terrified of sweeps. Apparently they're only useful if your cervix is ripe, and mine all fucking hurt as mine wasn't. I didn't realise at the time, but with each VE and each pessary placement I was given a sweep. Which is why they were so painful. Looking back that was something of a violation and I will mention it. See, that's another thing. No vbac = no VE!

I had a planned cs first time (breach) and vbac second time. Definitely a faster recovery second time, and thankfully my vbac was relatively straightforward (although long). I was really keen to try to vb but, as you are thinking, had a really clearly written birth plan that I'd discussed with my consultant. We even wrote on it that she had agreed to it and any questions, please could the midwives phone her. I know as a result people did things during the birth because I'd said I wanted them - eg moved me back out of the delivery room to the ward to progress naturally rather than escalating to assisted birth because of the time I'd been in the delivery ward.

I really didn't want continuous monitoring but found when I got there that in my (nhs) hospital the monitors weren't in any way portable - apparently in some private hospitals they have all kinds of brilliant wifi kit, even monitors you can wear in a birth pool. I might have chosen a different hospital if I'd realised that, and probably also chosen one where I'd know the midwife so could agree things with her too.

Another thing to consider could be hypnobirthing techniques? I found that brilliant for sweep, VE and the actual birth.

Mostly I think take your time talking to people about the options and finding what feels best for you and then push for it!

I've 9 weeks to go and still haven't made my mind up. I have no contraindications against vbac as this is a totally different pregnancy from my first, thankfully, so I'm also leaning towards a trial of labour providing my blood pressure keeps behaving itself.

The only thing that is slightly worrying me is that having a premature baby by cs without going into spontaneous labour, as I did, increases the risk of rupture/dehiscence in subsequent pregnancies. Something I'll be speaking about with the doc.

My consultant has already explained they don't like to let a vbac woman labour too long so I want to discuss that further with her. I am going to refuse induction. I don't mind monitoring but I refuse to be unable to move from a bed. Tbh if they tell me I have to have continuous monitoring on a bed, I will opt for the cs. I already know a water birth is out. If I should go overdue I know it is my hospital's policy to offer a cs at one week and that sounds ok with me.

Such a difficult decision to make as I also have no bad feelings towards my cs and recovered well from it even if it was painful at the time. The only reason I'm swayed towards a vbac is because I now have a five year old to look after and it seems easier (hoping I'm not going to have to eat my words). However birth does, quite frankly, scare me and a total unknown for me compared to a cs.

Don't be surprised if it's not a choice at all - they might insist on vbac unless you lay it on thick about psychological worries etc.
How about going to 40 weeks and c section after that so at least you're nearer the due date?

Don't be surprised if it's not a choice at all - they might insist on vbac unless you lay it on thick about psychological worries etc.
How about going to 40 weeks and c section after that so at least you're nearer the due date?

merci yes, I realise this is a real possibility. And some of it will depend on the staff on the day too. 2 friends had ELCS after emcs at the same hospital as I'm at. It's also the same one I had DS at so they should have my history.

Hypnobirthing interests me. I think if I go for vbac I will invest some energy and time into this and other strategies.

merci yes also to going to 40 weeks or further. I definitely think DS needed an extra couple of weeks (but it wasn't safe to leave him in there).

Oh yes, of course, am sure your ds needed to be taken out then, poor love :( just thinking they often schedule at 39 weeks so maybe another week with your mums history would be no bad thing

Good luck at appointment!

of course, it could all get taken out of my hands, a swift spontaneous labour. Or a breach baby or placenta praevia.

Thanks for all your thoughts ladies. I suspect I will be revisiting this several times over the next 34 weeks!