Vaginal birth after caesarean (VBAC)

[catherineskelly]

wondered if anyone could offer any advice. I had a horrendous emergency c-section with twins for first birth. Have been told this time I would be given a "trial of labour" to see how the scar handled during labour as really didn't want to go through emergency procedure again. Am really confused whether to go for VBAC or to opt for elective c-section. Any advice?? HELP!!

How far along are you with this pregnancy and how long between your cs and your next birth? Don't panic! I had an emerg cs and then a vbac 20 months later with no scar problems at all.

I had an emergency CS with DD1 - she got stuck, pooed, heart rate dropped etc. Heard all scare stories too about scars and ruptures and but was convinced that a CS with a toddler would be a nightmare. Consultant told me rupture happens in 1 in 100000 cases (or something equally unlikely). The trial labour basically means wearing a monitor throughout labour to check the baby is happy as this is the first sign that all might not be well. DD2 was a normal delivery & quick. Plus you recover quickly ! I could laugh, wee, walk about, sit up, shower, poo etc etc within hours of having DD2. Unlike my CS where I couldn't even drive for 6 weeks...

VBAC was ace ! :)

Just had a vbac 4mths ago after emergency c-sec 2yrs ago. Had a horrific experience and if any more will go the elective c-sec.
What happened to me is apparently quite rare, scar didn't rupture but that was about all that 'didn't happen'.
Go with what feels right to you, whatever you decide stick with it, DON'T let anybody else pressure you, I was pressured to try vbac and have since regretted it and am very angry with myself for giving in now.
Good luck with whatever you decide.

If you look back at other threads under Childbirth, you will see lots of questions on this topic.

I haven't had a VBAC myself so can't give you any direct advice, but I have friends who have had varying experiences of it. Some think it was great, others had terrible experiences and regret not going for elective C-sections. Most midwives will push you to try for a VBAC, whereas doctors are more divided and some recommend going straight to elective C-section.

There are lots of factors to consider. Only you can make the right (very personal) choice for your body and your circumstances and don't feel pressurised by anyone else.

There are loads of website with statistics and advice for vbacs, I will try and find the one I used (sorry no time now, running out the door) and post you a link. I had 2 vbacs - one in hosp with ventouse after a fast labour, and that was still, even with the instrumental delivery, better than my c-section for me, faster recovery etc etc, and then I had ds2 at home which was very straightforward. One thing I did was have a long talk with a supportive obstetrician during my pregnancy and got her to okay my birth plan - her handwriting on it made all the difference when it came to being on the labour ward.

The ASSOCIATION FOR THE IMPROVEMENT OF MATERNITY SERVISES is a godsend to anyone who is having a baby. It covers near everything and is research based and unbiased. It has exellent info on VBAC.

\link{url\aims.org.uk

The best (and only) way to avoid an emergency section is to have a planned one. Planned sections are lovely compared to emergencies. I have two kids. One crash section, and one planned one. They wanted me to do a trial of labour too, and I said "NO F**KING WAY!"(or something slightly more civil).

BTW, the rate of a successful VBAC at Queen Charlotte (which is where I had my lovely planned section) is 70%. That means you have a 30% of a repeat emergency section. Those stats were way to high for me to think about a VBAC. Not to mention I'm sure that I would not find any pleasure in a vaginal delivery. Somme people have a deep desire to experience vaginal delivery. I'm not one of them.

Interesting statistics Uwila, I had not thought to ask my local hospital about the percentage of attempted VBAC's that end up being another c-section (and therefore an emergency one rather than a planned one).

I am experiencing subtle pressure to go for a VBAC this time when I have absolutely no personal desire to add vaginal delivery of a baby to my personal life experiences list.

I will ask them this next time I see them at 36 weeks (am currently 20 weeks). The hospital midwife said we'd discuss the birthplan/options then but I wondered if they were deliberately leaving it late so that a booked c-section would be "difficult due to availability of theatre slots".

I see a different midwife each time and they all read the front page of my notes from last time and then say "why did you opt for a c-section last time ?"

I am considering saying stupid things like "the little green men told me to have one" or that "I fancied the anaesthetist on call that day". If they won't read the notes (which are for their benefit, not mine) of the discussion with the doctor that lead to me having a "maternal request c-section" last time why should I have to keep explaining my decision to each and every midwife I meet.

I had no confidence in my body or even less confidence in their chronically understaffed service, that's the real reason and the first part of that is documented in my notes from last time. My worst fear was a long labour followed by a c-section (with associated long recovery time therefrom) and at 38 there was a greater chance of this than at 28, plus dh and I have larger heads (ds was 39cm at birth) so I could see it being a 50/50 chance which was too high a risk for me given that I needed to be back on form quite soon after the birth.

I'm sure they will eventually, begrudgingly and patronisingly, give me a c-section again this time, "if I demand one" to quote them from last time, but I am going to start insisting that they read the damn notes.

Normsnockers, note that those statistics only count those who opted for / were persuaded to have a VBAC. So you have to also consider the people who went for a planned section. If they were included, than the number would surely be less than 70% success. So, also ask how many previous section have planned sections... bet they conveniently won't have that statistic.

I'm pretty sure they won't even give me the first statistic. LOL

While you're there also ask for the morbidity rates for vaginal births and sections. Having these stats as well will help you make a more informed decision

I had this data thrust at me last time but they insisted on including emergency c-sections in the morbidity rates for c-sections and couldn't see why I felt it was not the right data for comparison purposes. (The emergency c-sections being the end result of a proportion of vaginal delivery attempts)

I'd have to compare morbidity rates from elective c-sections only against morbidity rates from both vaginal births and emergency c-sections wouldn't I to get a true comparision for my decision making process.

Anyone ?

They'll never give you those stats. They don't keep stats like that for a reason.

What I would do if I were you is write my own set of notes on the maternity notes, make it very clear I wanted a section. Copy those notes, and mention to the consultant that I had copied the notes. If he/she still tried to persuade me for VBAC, I'd ask him if he really wanted to be responsible for anything that could go wrong as it would be his decision not mine.

And, yes, I too think it is interesting that when a vaginal birth goes wrong and ends up in emergency section it is classed as a section not a vaginal birth.

Here are some statistics...

Your risk of dying during an elective repeat ceasarean section: 18.4 in 100 000

Your risk of dying during any ceasarean section: 40.0 in 100 000

(so risk during emergency cs must be 21.6?)

Your risk of dying during any vaginal delivery: 9.8 in 100 000

from \link{http://www.birthrites.org/uterinerupt.html\Birthrites - scroll down a long long way}

"A large meta-analysis showed maternal mortality of 2.8 per 10 000 for women undergoing trials of labor, and 2.4 per 10 000 for women having an elective cesarean" from \link{http://www.vbac.com/chapter38.html\Effective Guide to Pregnancy}

so thats 28 in 100,000 for vbac and 24 for elective cs. Doesn't say whether those vbacs went to cs and then they died, or not

ratio of 24:18 and 28:21 so ...

repeat elec cs 18.4 in 100,000
emerg cs 21.6
vbac 21
figures might be a bit higher or lower but this is comparative

is that right? can you combine figures from different research like that?

\link{http://www.parliament.uk/post/pn184.pdf\Gov stats from 2000} -

29% of caesareans are repeat caesareans.

Of women who had previously had a CS, 33% had a vaginal birth.

Numbers, numbers.

I had a scheduled c/s and thought it was brilliant. It was calm, relaxed and I felt very safe. I was up and about the next day and was driving after 11 days(the six weeks no driving is rubbish, my insurance company had never heard of it before). Baby was fine and healthy after the op and breastfed beautifully from day one.

Like Uwila said, the only way to avoid an emergency c/s is to have a scheduled one.

I guess it depends how much you want a vaginal birth. If you are not desperate for the experience then go for the elective.

Rochwen - I am a doula and work for many c-section mums after their births... I can tell you many insurance will say weeks and many women (more importantly) do not feel up to driving that quickly either !
Everyone recovers at their own speed, depends how the section went (even electives are not always straight forward).

One of the other factors to consider is why you had a c/s the first time. If you say had a c/s because the baby was breech, then you have a reasonably high chance of a successful VBAC (provided that the subsequent pg isn't breech). But other factors are more likely to be repeated in subsequent pgs.

You might find it interesting to read a document recently on the website of the Royal College of Obstetricians and Gynaecologists. It was a consultation .pdf entitled "Delivery after previous CS birth". As it was a consultation document and the date has passed, you can't find it on the main page anymore, but it might still be available if you search 'VBAC'. If not, I have a copy of it I can email.

It seems that overall 33% of women with a previous C-section have a successful vaginal birth in their subsequent pregnancy. Obviously, a lot of the remaining 67% never opted for VBAC in the first place.

Of those who do go for VBAC, 72 - 76% will have a successful vaginal birth. As Uwila says, that's a lot of women who end up with a repeat emergency section. Great if you're the (approximately) 3 out of 4 women who avoids surgery; a bugger if you end up in surgery after labour again.

According to this document, other things (negatively) affecting your chances of success are age, BMI>30, stature, if your previous Caesarean was for dystocia and if you're carrying a male infant.

I didn't have a problem with the idea of VBAC after my C-section, but having read this (and other information, including something suggesting that women with SPD might be more at risk of malpresentation) I don't know that I'm not marked up to be the 1 in 4 emergency section. Which, personally, is something I'm really keen to avoid. Even though I was perfectly happy with my section - and the recovery was much better than anticipated - I was just too exhausted to concentrate on or enjoy the actual birth. I'm also not prepared to labour under the restrictions the NHS would want to place on a VBAC 'trial' - I think they're antithetical to the smooth running of labour. Yes, you can argue that continuous monitoring is for the benefit of mother and baby, but it's no more successful (and arguably less so) than one to one care by an attentive midwife. If only the NHS would stop making them redundant...

(Of course, I'm not actually pregnant again yet... but no harm planning ahead...)

I had a similar experience to Rochwen with regards to driving / insurance. I had different insuance companies with each section. Both of them knew nothing of driving restrictions post caesarean. The first one had never even heard of such a thing. I've had many conversation on this subject with post caesarean women who drive, and only one has ever said her insurance company had a restriction.

What you should do is when you feel up to driving do a practice emergency stop in a safe area. If you can slam on that break without pain, then you are okay to drive. And, of course, check with your insurance company just in case.

I'm amazed at how so many of you feel that midwives in the UK are pushing you towards VBAC. Here in France I REALLY REALLY want a VBAC and am struggling to get myself heard!! Now if that's not sod's law :(

I thought the driving restriction was rubbish until the physio chick explained that it was a giudeline and had to do with being able to handle an emergency stop, being able to look over your shoulderr while driving if you had to and the risk to your stitches if your car got hit in the early weeks while you're at the wheel (apparently if you weren't driving, you could hold them like you should when coughing or sneezing).

She said to drive once i could do all the above without pain and discomfort. I don't really know if that's all there is to it as i don't drive.