Starting IVF after a C Section birth

[raphbec]

I am pregnant with my first baby and because of complications i have been advised that an Elective CS may be a possibilty. We would like to try for more children and one of my main concerns is can having a c section effect the success of IVF should we try for a 2nd/3rd baby? Can the scar on the uterus prevent an embryo from attaching, and are you more likely to suffer a miscarriage if you have had a C section? If i was lucky enough to be pregnant with twins the 2nd time around would my uterus be too delicate to support 2 babies after the surgey? And does anyone know how long you need to wait after a C Section before trying again for a baby? (I am not getting any younger and we would love 2 or 3 children)

If anyone has been in this situation or knows anything on this subject i would love to hear from you. Really do not want to make it harder than it already is to get pregnant with IVF on our 2nd go, but also want to deliver our baby in the safest way possible and if we need to have a CS then ultimately we will do whatever is in the best interest for our baby.

Any advice would be very helpful

I had to have a section the first time around after IVF. Not what I had in mind. Wasn't advised anything on time frame to try again but waited a year to recover well and also to enjoy DC1.

When speaking to my IVF consultant they said section wouldn't have an impact on embryo implanting.
I got pregnant again on first try and DC2 is now sleeping in basket next to me. Again I had a section- this time by choice.
What I discussed with my consultant however was:
Not to put 2 embryos back to avoid twin pregnancy and the pressure on scar. Also with any pregnancy after a section you have the risk of embryo implanting in scar or scar tissue and a rupture during birth.
Hope this was helpful.

Thank you thats really good to know. Congratulations on your babies! We are thinking around 1 year to try again so that sounds perfect. We have a few frozen embryos so hopefully it will be a lot less invasive the next time around! Thats worrying about the chance of the baby implanting on the scar..wasnt aware of that. I am due to chat to my doctor next week so hopefully he can give me some advice on it all too.
How did you find the C Sections? Was your first an emergency? If so was the Elec CS a different experience to the emergency?

We had a frozen embryo transfer the second time, too. Very straight forward.
Both of my c sections were elective. First because of placenta previa and the second by choice. Both straight forward and quick recovery. Same consultant and midwife both times. Calm and relaxed atmosphere.
First time round I wanted a natural birth though- but it wasn't possible. Was devastated to find out I had to have a section. So I can understand your worries.
Hope your consultation will go well!

Oh thats great to know, thank you! I've kind of been given a choice of a VB or elective c section...which in a way is harder because its kind of up to me! Because its my first i dont know how my body will be..i may find my body is fine with a VB and i have no complications...but it could equally go the other way and end up complicated with an emergency CS which is want i really dread & want to avoid... i guess i just have to weigh up the pros and cons of both and make a decision. I hate the idea that with a CS not being mobile & able to go home and be with my husband and baby straight after..and also the pain & recovery scares me a little. But im also petrified of something going wrong in VB! Very confused, hopefully the consultant can help me to come to a decision!
Thanks for your support x

This time I had the choice of VBAC or section. I knew I did not want an emergency section. After talking a lot with my consultant, I decided for the section.

Oh and pain meds are great. No need to be too worried about that.
Also you could speak to consultant and midwives to make sure you get the things you want after the baby is born. E.g. Skin to skin straight away if baby is well, breastfeeding support and you can cuddle baby loads on the postnatal ward. Yes, not the greatest place but still cuddles!
I had first section on Wednesday am, out Friday pm. Second time section Tuesday am, out Wednesday pm.
People take sections differently though but even a natural birth can have complications. My friend whose baby was born a week before mine had to have forceps. Her recovery was slower than mine. Another friend gave birth the same day as me and went home 5 hrs later...
There just is no guarantee...
Lots to think about but I am sure you will be absolutely fine!!!

Hello, congratulations on your pregnancy! I have 2 DDs: DD1 born via assisted delivery (ventouse) and DD2 by ELCS (following 2 years of TTC and 6 Clomid cycles, FWIW). The ELCS was, for me, the best birth experience. However, I understand your individual concerns and think that the following book might be able to help you in your thoughts/decision. It's Cesarean Birth: a positive approach to preparation and recovery by Leigh East.

HTH, and very best wishes to you xx

Thank you for your messages. I keep swinging from VB to ELCS!! I was thinking if i did try to do a VB maybe i could come to an arrangement wth the consultant... whereby if the baby is in a difficult position / on the big side (i hope they can tell that before its too late) / or he is more than 40 weeks then i go for an ELCS...i wonder if they would agree to that...will ask at my next appointment. i feel like because its my 1st maybe i should try to do it VB way, as i may be one of the lucky ones with no complications, and put myself through the risks of a CS unnecessarily - of course i will never know either way (if only we could!!)
Thank you MolatovBomb - will order the book on amazon now - and read it before i make any decisions. Did you have an epidural with your first?

Hi raphbec, no, I did not have an epidural with DD1 - bloody wish I had, in hindsight! It was a long labour where I only used G&A. I was 2 hours pushing but she needed help to be born. It would had been good to conserve my energy by taking away the pain for a few hours, but I ended up exhausting myself without the adequate pain relief.

As DD1 was delivered by ventouse, this meant an episiotomy for me. Although I am completely healed now (DD1 born February 2009), it took several months for everything to feel back to normal with my undercarriage!

It may be that you are advised to have an ELCS for medical reasons. Mine was a 'Maternal Request' ELCS on paper, although the reasons for my request were a lot more complicated than that. I damaged my coccyx with DD1's birth and a chiropractor advised that I was at a significantly higher risk of damaging - and worsening - that part oft body with another vaginal delivery. I was advised AGAINST a CS by my consultant, but I was suspicious of the hospitals' reasons for doing so i.e. Their monthly figure for CS births should be 15%. Their March 2012 figure alone was 34% (my DD2 was born April this year). So, if they could get me to birth vaginally, that's one less CS for them.

I went into my CS informed of the risks and benefits and believe it was the most sensible option. I am aware that a woman really ought to have no more than 4 sections (the risks of CS increase with each one). However, i have heard of women having 4 (sometimes more) sections. Please bear in mind also that the risks of ELCS are less than with EMCS and that research figures tend to be bundled together.

I preferred the controlled nature of ELCS as opposed to my VB. I felt a bit scared, but not at all panicked. It was beautiful. There was a light-hearted atmosphere in the theatre and I was so well-taken care of. If you do have an ELCS, look at it positively: as a birth rather than an operation.

That book by East is great - all facts and zero guff.

Best of luck to you for now and the future x

Oh that is such great info! Thank you for sharing this with me. I too feel very suspicious of midwifes and doctors who try to put me off of ELEC CS! Its all about ££ and figures to them which is sad - you feel that they dont have your best interests in mind.

raph would it be worth disclosing the reason a CS is being advised? Just thinking, if you're having to make the decision it may be helpful to hear from others who have been in similar situation and if they feel they made the right decision.

Not any experience personally of a section, I had DS vaginally and had an excellent experience and speedy recovery :)

I was told quite clearly to wait at least a year after my EMCS before trying again, which makes sense in terms of wound healing, both uterine and abdo muscles.

If I was given the option of VB versus CS, I think I'd try for VB because the risk to the baby is greater with CS. My son spent his first night in the SCBU and, had I not fought through the post-surgical haze and demanded to see him and give him his first feed, I wouldn't have seen him until the following morning. He hadn't absorbed the amniotic fluid in his lungs properly, which is a reflex stimulated by a vaginal birth that can't really be replicated when the do a CS, so it's a known risk. He wasn't in any distress at all during the preceding (failed) induction so it was a complication that arose purely as a result of the CS. I'm sure it's a rare complication, but I know I was under the misapprehension before hand that a CS was an 'easier' option somehow with risks equal to a VB.

Also, having the abdominal wound is quite uncomfortable if you want to breastfeed, not to mention the tubes coming out of everywhere which get well in the way of the whole process. You're also not allowed to lift anything heavier than the baby for 6-12 weeks, you can't really go for any walks with baby and/or family for 6 weeks, and walking and pushing the pram is also out during this time. I'd say you can't lift baby in the car seat either, but since you're banned from driving for six weeks post-birth as well, that comment is academic! Sitting up and rolling over in bed is also really uncomfortable for weeks after, and just imagine how many times you're going to be doing that during the night.

I'm honestly not trying to scaremonger - just filling you in on the things that I had no idea about before having my CS (albeit emergency rather than elective).

I had a section nwith twins, then had a frozen embryo transfer only three of for months later.mtwins were born in March, embryo transfer in either June or July. I think it must have been July, so four months. I then had FETs every other month until November.

No one even mentioned my previous section, or waiting for a year. The consultant even agreed to transfer three embryos based of their poor quality, and us not wanting to waste any as they were frozen in straws of three.

Mandinga, your recovery sounds awful. I'm sure there are a lot of factors, and the differences between emcs and elcs are huge, I think - but my recovery after elcs was nothing like that. I was out and walking roubd the block on day 4 after my cs - pushing the buggy was no problem, in fact my mw advised me to. I didn't do anything adventurous and was cautious, of course. Stitches out 5 days after the op, and I really felt fine. I lo

Sorry, on damn phone! Meant to say, I was sensible but can remember doing 40 minute strolls with the buggy happily 2 weeks after ds was born. Would have been longer but 40 mins was the longest he would go between feeds...

And I was driving again somewhere around 3 weeks. Doctor was happy for me to, insurers didn't know why I was ringing them to check. As the pointed out, there's no law - people have ops all the time for various things and have to judge when it is safe to drive, why would a cs be different? You have to be able to do an emergency stop - the same eould be true if you had a splenectomy or heart surgery.

I had an emergency CS and pushed my pram to my appointments/drop ins etc - midwives etc were happy for me to do so but said not to push it up steep hills.... I'ld point out that from the main road to my door was a steep hill and they'ld laugh and say "just avoid avoidable ones", same for stairs, if there is a lift, use it, if there isn't its okay

they explained the big problem with CSs compaired to many other injuries is you don't get "pain indicators" necessarily to tell you when you're doing too much, so you do need to be gentle and ease into things but I think NO buggy whatsoever is probably a bit of a misinterpretation!

I guess it's just different advice in different areas - I've still got the sheet from the physio, handed out post EMCS and ELCS, saying no standing or walking for longer than 5 mins for six weeks post CS then not longer for 30 mins for another 6 weeks thereafter. I also begged my GP to authorise me to return to driving before the 6 weeks was up which she categorically refused to do, saying I was underestimating how serious a CS is in terms of abdominal surgery, and I am a health professional myself, working with patients post major abdo surgery, so would underestimate less than most! Because of the GP's refusal, my insurers wouldn't have a bar of me returning to drive either.

Walking with a buggy 4 days after? Wow...I ignored the advice given to me and tried walking with a buggy 4 weeks after and thought I was going to collapse after 5 minutes! I'm an exercise fiend (did my last ballet and weight-training classes at 36 weeks pg) so it's not like I'm just really unfit. My EMCS was also not that physically traumatic in the scheme of things so I would have thought it was on a par with an ELCS.

Oh well. Maybe I'm just a wuss!

There is some evidence of a lower pregnancy rate after CS - if you google you should be able to find it. If I remember correctly I think that it was mainly linked to choice though - that people were less likely to want to have another baby after a CS - I think that it was in the BMJ.

If you have a CS you would usually be advised to wait around a year before getting pregnant again. That advise (and advise on whether it is safe to have another pregnancy) might vary depending on what your uterus looks like when they do the CS, and that isn't predictable before you have the section.

Elective CS isn't the safest option generally for mother and baby - it can be if there are medical reasons, but it seems from your posts like you think this is a safer option being witheld from you on financial grounds. An elective CS is a pretty safe thing, but statistically a VB is better, especially if you want to have more than 1 baby (because then every subsequent pregnancy is in a uterus with a scar on it).

That being said, the risks of a CS aren't hugely worse than having a VB, but if it isn't being recommended by your obstetric team then IMO you shouldn't assume that they don't have your and the babies safety as a priority.

mandinga, that's bizarre (that advice should be so different in different areas of the country) - I am in the Uk btw, in Wales. I got very little formal advice about CS recovery, although I read a very good book about Caesarians and recovery, which uselessly I can't remember the name of now.... maybe it was the East book, there can't be too many!

anyway, that was very helpful, and suggested levels of mobilisation and gentle exercises to help with recovery, as well as tips for doing things like getting out of bed in a comfortable way. These were much more extensive than 'don't stand up for longer than 5 mins for SIX WEEKS after a CS!

Maybe the advice was old? I was very careful that I looked after myself, and I think it would be dangerous to underestimate recovery times and overdo things - but I genuinely felt a lot worse and took longer to recover after having my appendix out.

I guess the difference, and this relates to planned v emcs, is that I had my appendix out after several days of escalating pain, including some SERIOUS pain in the last 24 hours, before we knew what was going on - so after very little sleep for 3 days, virtually no food, vomiting and pain, it was no surprise recovery was a bit grim. Even though the op itself wasn't such a big deal.

I'm also in Wales! I admit I ignored the no standing/walking for longer than 5 mins pretty quickly (kind of impossible to adhere to with a newborn) but I don't think the advice was old. I got it both verbally and in writing from the physio, who is also a work colleague and friend as I work in the same hospital I gave birth in, so she would have modified the advice if she thought it was in any way outdated. I was also given abdominal exercises so it's not like I was on enforced bed rest for 12 weeks, although given my usual level of activity it felt like it!

Circumstances leading up to EMCS were a lot less traumatic than your appendicectomy - my waters had been broken for almost 48 hours with no onset of labour, even with 12 hours of syntocin, so it was time to go in and get him out. I'd had no real pain, or contractions, no cervical dilation and he wasn't stuck anywhere awkward (other than in my tum). Like I say, not entirely different circs to an ELCS.

Sorry, hijacking the thread a bit, but I guess a message to take from this is to see what the post-op precautions are in your area and bear in mind that you might be immobilised by both them, and how you feel after a CS, at a time when you really can't afford to be!

Can I please respectfully correct Mandinga79: "the risk to the baby is greater with CS"

Statistically, there are different risks to consider to mother and baby between CS and VB. Generally, electives are a safer way for the baby to be born. 'Wet lung' is more common amongst CS babies as the surfactant is not squeezed out of their respiratory tract. Scalpel cuts to baby are a risk; a low risk and even lower with ELCS. That said, rates of babies born with hypoxia and shoulder dystocia are higher amongst VB babies.

Ps. I was in much better shape after my ELCS compared to my VB. I didn't have it easy with the assisted vaginal delivery, whereas the CS went exactly as it should. The abdominal wound was easier to care for and healed more quickly than the perineal wound.

I had an elective section for my first (IVF baby) as she was breech. I was given no option as this was protocol at the time. I was upset at the time as i had hoped for a vaginal delivery following all the medical intervention at conception, however it was not to be and the birth was lovely. My only regret is I wasn't able to breastfeed her and I always blamed the csection for that. She was very mucousy at birth and wouldn't latch on and despite staying in the ward for almost a week to try and establish her feeding I had to admit defeat and formula feed, which was fine and she thrived, it just wasn't what I'd hoped for.

A year later I had a surprise BFP. This time I opted for a VB due to the reasons given above, and I didn't see how I could cope with the recovery time toddler and newborn. I was carefully monitored and because they thought I wasn't progressing fast enough given an epidural in preperation for a CS. As it happened it wasn't necessary and I had her naturally. She was able to breastfeed and I recovered much faster than last time.

Both good experiences, but were I to have a third I would opt for the VBAC again.

Good luck whatever you decide!

I also went to an hour long postnatal exercise class that was taught by one of the local midwives, and takes post CS women from 8 weeks (VB women can start earlier)

I would have thought that the risks of not being on your feet for more than 5 mins for weeks on end were a greater evil unless they also supplied anti clot stockings etc

(and the class was up a hill and lots of us walked/bussed with buggies and the very good MW who taught it didn't see it as a problem - she was very VERY VERY anti jogging in the first months post birth though! walking - fine, jogging - not for much longer than you'ld think! )