What do you think my chances are of a successful vbac?

[Neverme]

Only 9 weeks now, but considering whether I would ask for an ELCS or go for the vbac.

DS was born 2.5 years ago via EMCS. No one specific reason why things went that way, but lots of little things - 13 days overdue, labour had been going on for 3 days off and on, I was shattered and hadn't slept during that time, had done lots of puking so no energy, he was back to back and in a funny position which the doctor said would need forceps birth in theatre which might end up in c-section or we could just go with the c-section there and then. Decided to cut to the chase and went for the c-section. I did get to 9.5 cm dialated on a syntocin drip, but they said the way his head was, it was stopping complete dialation or something like that.

So now I am considering what to to do this time round. First appt with the m/w next week where no doubt we'll discuss this. I am not phased by another c-section as i've been throught it before, it's more the recovery issues wtih a toddler on my hands as well as a newborn. Plus (and I know this sounds silly), I feel disappointed in myself and feel like I have something to prove as a woman!

But from what I read here and talking to people, I get the impression those who are successful with Vbacs are people who had ELCS for things like breech babies i.e. it's not an issue with going into labour and birthing the baby iyswim?

Has anyone had a similar difficult first labour and then had a good vbac? If I do go for the vbac btw, I won't be allowing any forceps within a mile of me!

Your history, post maturity, long latent phase and prolonged labour, augmentation, awkward positioning is not unusual in first timers. I have seen it many times in women who have gone on to have a straightforward and much quicker birth second time round. The fact that you managed to get to nearly full dilatation means that the hormone receptors in your womb have now been programmed to know what to do. This is why subsequent labours are nearly always much shorter.
For a successful vbac, I would suggest
:prepare for along latent phase (it might not happen) so that you keep yourself in good condition, fed, watered and rested ready for action
: request no continuous ctg unless there are specific causes for concern (its not at all good at predicting scar rupture?..) so that you can be mobile and upright to promote descent and rotation of the baby's head.

Thank you. I can't remember if I said in my lengthy essay but I did have the syntocin drip to go from I think about 5 to 9.5cm. Also( being stupid) what's the latent phase?

Thanks Emma. Do you think you can be a bit mobile on continuous monitoring. I.e say bouncing on a birth ball gently? Or I wonder if they could give me periods off it to get mobile - or does that ruin the point of it that you have a big read out of activity over long periods

Your previous labour sounds a lot like mine. V slow, baby back to back and serotonin. I got to 9cm but couldn't get passed that. Eventually went for a c-section. No distress and all very straightforward.

The second time round, like you, I didn't know whether to try a vbac or opt for the elective. Consultant, as per the wise words above, was optimistic that having got to 9cm there was a good chance I could go the vbac route. I wasn't completely convinced - c-section was something I knew and understood. But, like you, recovery with a toddler was a key issue so, he and I agreed that I would try for a vbac with the agreement that if I needed any interventions (inc serotonin) then I'd go straight to a c-section.

And I'm so glad I went for it. I went into hospital at 9am after a couple of hours of contractions at home. DS was born three hours later entirely naturally - g&a only. We were home for tea time with DD. It really did feel like my body just got on with it this time.

Obviously this is purely anecdotal and the c-section route is a perfectly sensible choice as well - I dithered right up to the last. See what your consultant and mw say. You won't need to make a decision until 36 weeks or so.

The latent phase is that time when you feel things are starting but dilatation is minimal and it stops and starts for what can be several days. Changes are happening but they are subtle. It does prepare your body for delivering a baby but can be painful and cause a lot of anxiety. You can feel that something is wrong because if it is dragging on. However, a long latent phase is not a prediction of difficult labour and delivery. it is very important to look after yourself and stay positive.

This is a leaflet produced by one trust's midwives explaining the latent phase and what you can do to get through it in good shape. ttp://www.stockporthealth.nwest.nhs.uk/documents/19961_mat101.pdf

No idea which talk guidelines were broken, but it does look bizarrely as though recommending cfm is against mn talk guidelines!

My cs was for alleged macrosomia, had vbac1 where Ds was back to back, drip etc like your first labour. Did eventually manage vbac but consultant was arranging theatre for emcs so it was a last gasp chance. I was in a pretty shocking state and they kept me in for a week to repair the mangled fanjo. Vbac2 was an unmitigated disaster without cfm as the monitor was broken, and intermittent aural monitoring by a student, and dd2 suffered brain damage due to hypoxia. Vbac1 was 24 hours in established labour, vbac2 12 hours.

I like CFM because it does provide some semblance of a clue towards well being. And evidence in the event of a problem and subsequent enquiry.

I would go for a vbac, but Afaik, nice guidelines still suggest CFM.

Hi, I'm hoping for a VBAC (very soon!). My story last time was slightly different - waters went, got to a cervical lip only by myself after about 10 hours contractions (from closed cervix, 8cm when got to hospital) but back to back labour, fully dilated with drip (epidural at this stage as needed CFM and room badly set up so I wouldn't have been able to stay mobile). Failed forceps in theatre although he had turned right at the end - which worried my consultant.

I just hope as my last labour progressed fairly quickly we'll know fairly quickly either way, and otherwise the default is CS anyway and my worry is also the recovery with a toddler.

Will be having CFM though, they have said I should still be able to stand and bounce on ball. Any sign of things not progressing, will request EMCS.

Have ELCS booked at 40+10 though - definitely don't want induction.

I'll let you know how it goes!

I went for an elcs following an emcs. I looked at the stats from the RCOG and cross-referenced those with stats from my local hospital. Given my age & circumstances incl. the problems which occurred the first time, the chances of a successful VBAC (without interventions) was low, under 30%.

During the op a problem was found which I hadn't even begun to consider - baby was so wedged in that they needed ventouse to get him out of the c-section hole! So it would've been an emcs anyway.

So it was a good judgement call for me to go for elcs.

Thanks all. Madwoman sorry to hear your two vbacs didn't go well.

Just to update, had my vbac! Wasn't easy, very medicalised but no major trauma and no cs scar! Fully dilated really quickly but really bad head position and I was needing to push which was distressing dd and just wedging her further. Had epidural so contractions could turn her without me pushing. Consultant examined me again, felt she was moving down and ears were free, so there was probably space in my pelvis! Ctg showed dd was quite happy, so no big hurry - was consented for section and taken to theatre, but trying to avoid. Used a kiwi to flex head, then low forceps with episiotomy to get her out as heart rate started dropping. It really felt like deja vu, but different ending, and actually pretty calm once epidural was in. Not the birth o wanted, but great end result and so glad I didn't insist on cs rather than epidural/ forceps ( I did say I didn't want 'traumatic' forceps - was reassured that head was low and much easier vaginally!).

Good luck whatever you decide.

I did have an EMCS with DC1, because breech was discovered when I was fully dilated.. recovery was about a week.

DC2s labour was exactly like yours: back to back, exhaustion, forceps. It took me about a month to recover from..

This time around I want to avoid forceps but have been informed that there are scenarios when forceps is the only thing that'll do (even in an ELCS!). So I assume that you can ask for no forceps, but the decision will be with the med staff.. And surely they know what they are doing.

So, for me it is another cesarian this time around. In my experience the VBAC only works when you properly prepare for the birth.. hypnobirthing etc.. however if you end up on a syncotin (sic) drip like you did with DC1, then all the hypnobirthing in the world won't help the pain.

Good luck with your decision.

I had an almost identical labour as yours the first time round OP, and also the same feelings of still having "something to prove". I don't know what I'll do when the time comes to have DC2.

Mayhew your posts are very reassuring, you have a very soothing tone!