Consultant appt. on Tuesday, CS or VBAC?

[francohoops]

Hi
My wife is due on 4th Jan with our 2nd child. Our first we had a ELCS due to him being a very large baby (10lb) and his head wasn't engaging.
After the CS my wife's stiches re-opened and recovery took 6-7 weeks. It was a very stressful time with the nurse having to visit daily to re-dress. Thankfully there were no infections, and it healed naturally.

We have to decide whether to try for VBAC or have another planned CS. We have a growth scan and a appointment with the consultant on Tuesday. We've been trying to come up with questions to ask.

Is there anything specific we should ask? My wife would ideally like a VBAC but doesn't want to be induced.

To add to things, the midwife thought 2 weeks ago that the baby my be breach.

At our initial appt in Sept, the consultant said that if we elected for a CS at Watford General, we'd have to have one after 39 weeks, which would be between Xmas and New Year, I was concerned that the hospital wouldn't be fully staffed during this period. So many things to think about....Help!

Thanks in advance for your help.
F

Hi franco.
In a similar position to you guys.
You could read the rcog green top guidelines. They give a summary of evidence of risks of both and some of studies on factors that affect likelihood ofvbac success...previous vb,age,weight,baby's weight ( although scans aren't reliable) position of baby etc etc.

If breech with prev cs would be def elcs for me.

It's such a difficult and personal decision isn't it.

Bear in mind the consultant might get you to see special vbac midwife before decision. Worth having rough birth plan written with thoughts of the what ifs (if waters break but don't go into labour, do you want to limit time in labour before switching to cs ...i.e. Guidance is 1cm perhour dilation once it is established but if never dilated before might allow longer as more likely to labour like a lady who hasn't had a baby..consultant will advise.. date in diary for 41 weeks if go over and don't want induction.

Good luck to you both for your decision. Tricky i know!

Perfectly logical to want a VBAC but no induction - read up on the normal length of pregnancies!

Scan will show how the baby is lying but are notoriously inaccurate in estimating baby weight - just been to see a mum who was induced because of a "very big baby" and her baby was 7lb 1oz so not exactly huge!

If your wife decides that a repeat section is her preferred choice, and that is scheduled for around 39 weeks please don't worry about the unit not being adequately staffed - women have babies 27/7 365 days a year so all units have to be staffed all the time. You could always set a date for just into the new year if you wanted which would put her at around 40 weeks and a bit - if she starts labour before then you just head in and the section is done that day instead - no big panic but she may experience some contractions before the op (which might be something she would like - to have something of the experience of labour before the baby is born by section)

HTH

I wish you both good luck with it all. This time last year i was pretty much where you are ds2 was due on 30/1 but arrived on 26/12. I had concerns about staffing too but there was no need to have worried. Ds1 was an emcs in 2009. I decided to try for vbac and see how it went (my understanding is that the risks of complications are there but not huge). I'm glad i did. After a stop start labour over two or three days baby put his foot down and after two hours of proper contractions he arrived safely. Its a horrible feeling trying to make what feels like a huge decision. Ultimately i decided to play it by ear but that's me. Is trying for vbac important to you/your wife? or would she rather have the devil she knows? I tthink going overdue is the big problem so as much of a contingency as possible to avoid that. Good luck

I had a VBAC 6 years ago after an emergency section under GA. I was desperate to have a vaginal birth - that really was the biggest factor in my decision. Please note, I am not saying that a VBAC is for everyone - just for me!

Anyway, you seem to know what happened last time pretty clearly - ask the cons how likely it is to happen again. For me, DD1 was brow-presenting and facing the 'wrong' way, so the cons said I was as likely as anyone else to have a vaginal birth, it was just one of those things.

Ask what happens if your wife goes into labour but then things do not progress - would they consider a synto drip, and is this something your wife definitely does not want? If she doesn't want it, get it on her notes!

What sort of labour do they recommend for a VBAC? My hospital had wireless (telemetric) monitors so although they wanted CFM, it was still possible to move around. Would they allow her to labour in the pool, if that was what she wanted (wireless monitors can be used in water)?

Finally, have an open mind. I was adamant that I did not want an epidural with DD2, as my epidural failed with DD1 and this was the reason I ended up with a GA. On the day, when I was really struggling and asking for a section, a lovely obstetrician persuaded me to have the epi 'as I'll need you to have one before I can do your section, and we can just see where you go from there.' This time, the epi worked and DD2 was born vaginally with just a little help from forceps. And I felt on top of the world! I did thank the obs the following day when she came to see me, and she said she was just dping her job, and getting the best result for me and my baby.

Best of luck to you both!

PS I see you say your first baby was big - all my babies were over 8 lbs and also (perhaps more importantly) had head circumferences on the 95th centile or above! The two babies born vaginally were the bigger two, and had the biggest heads.