VBAC fears

[millimurphy]

Hello. I am neraly 38 weeks pregnant with my second child. My son was born by EMCS due to him being footling breech. My waters went with him at 36 weeks and I was at 4cm dilated with regular contractions when they diagnosed this and rushed me to theatre. It was all very sudden and the choice was taken out of my hands. I recovered very well and was pottering about within a couple of weeks doing most things but heavy lifting and sharp bending.

When I initially saw a consultant at Coventry hospital she said I shouldn't make any decisions on the birth. I thought I would be able to plan an ELCS due to my previous one. Turns out this wasn't the case and have been talked over and pressurised into attempting a VBAC. One of the nurses at the hospital even said I should think of the cost to the NHS when 'considering' my options.

I have seen a couple of consultants who have all said I have no medical need for an ELCS despite having long term problems with depression and anxiety which have been made worse due to this.

I am so scared. I only got to 4cm dilated before and the contractions were awful. I am worried that I am going to die in childbirth - either by scar ruption or blood loss or some other complication. I am scared of the pain, of 3rd/4th degree tears, of not having proper pain relief. I am worried about my son who is not used to being away from me (he is 2 and a half). I keep worrying and crying about this.

Sorry, bit of a rambling narrative - just don't know what to do and feel like I am just a sitting time bomb heading towards impending doom.

Any advice please?

Next appointment say firmly and clearly that you have made a decision and have opted for a ELCS. If anyone tries to dissuade you, then simply refuse to discuss it anymore.
And if anyone mention NHS costs again, thump him/her and blame the hormones. This comment was totally unacceptable.

Hey, you and I are at a very similar stage - I'm 37.5 weeks, have a 2.8yo and had a c section last time for breech (planned though as dd was obviously breech from early on). I feel differently to you though and am desperate to avoid another c section (though I share some of your fears about tears etc...!). I hated the long hospital stay, the feeling of dd's birth being completely taken out of my hands, etc etc, and I know it's a gamble but if I go for a vbac there is a chance I might be home quicker and it might go well (though I know it could also go badly). If you feel very strongly I think you should speak to your midwife and tell her exactly how you feel, and tell the hospital that you want an elcs.

You absolutely should have the birth that YOU want and that is right for you. I desperately didn't want another c-section and I had a great home VBAC, but it was exactly what I wanted and you have every right to have what you want too.

I would take the information, discuss, weigh it all up and make your own informed decision, then tell them what you want. You may need someone to advocate for you if you feel you will be put under pressure or that they won't listen to you. Is your partner supportive? Sit down with him and go through all the advice you've received and do your own research too - be as informed as you can be. If you decide you want a section then you should be offered one. I could sit here and type for half an hour about how positive my VBAC was but that doesn't mean you should agree to it if you're not comfortable with it.

On the other hand, if you do want to consider a VBAC then I will happily tell you about mine! No tears or stitches, much quicker recovery than after section, no hospital, it was great. I was walking into town to meet friends for lunch (with the pram!) on day 3. I was still in hospital and barely able to walk at that stage after DD1!

I agree with a PP that the cost to the NHS is not relevant here.

Totally agree that nhs cost shouldn't come into YOUR decision about YOUR birth and YOUR baby.

I have just been given the green light for my ELCS at Warwick hospital after what I felt was a lit of pressure to go down the VBAC route (dd was c-section for breech -discovered late, but pre-labour).

I read the NICE guidelines on c-sections, and in fact took the print out with me and laid it on the desk when I met the consultant. I told them I had taken on all the evidence provided by the consultant and the VBAC clinic etc, but my decision was to have an ELCS. I decided to go for a cold, rather ruthless approach in discussing it with them, which left them little wriggle room to try and talk me out of it, and while I felt like jelly on the inside while I was saying it all, I think it did pay off and I am relieved to have finally been "allowed" the birth I want.

The midwife who runs the VBAC clinic at Warwick (who was actually one of the less pushy hcp's I have discussed this with) told me I could decide to go for VBAC or ELCS quite late, even at due date, so you do still have time to make your voice heard.

Lots of luck to you!

Lis I will be giving birth at Warwick again (dc1 was EMCS for RFM) and I have to attend the VBAC clinic beginning of march. I was led to believe it would be my choice of ELCS or VBAC even though it'll only be 12 months between births. Eek! Dreading them trying to force a VBAC!

Cannotbelieveit I think they try to steer towards the VBAC in earlier appointments, but the pressure definitely eased off at my later consultant appointment so stay positive.

I actually found Jan Phipps who runs the VBAC clinic, very pragmatic and rational; I didn't feel that she was trying to force me, just present me with facts and she did appreciate my feelings which was refreshing after the consultant appointment which ignored them.

I think if you stick to your guns and demonstrate that you're well aware of all the evidence, then you will be fine. The NICE guidelines make it clear that it should be patient-lead care and if the consultant 'refuses' to offer a c-section you are well within your rights to ask for a different consultant, so the guidelines are on your side and I don't think it hurts to let them know you're aware of that.

To be fair, the consultant at Warwick never did 'refuse' the c-section to me; he just made it clear in my initial appointment that he wanted me to 'aim for VBAC' and wrote those exact words on my notes despite the fact I had said in that same appointment that I was veering more towards the c-section at that stage. I found the way he ignored what I had said to him quite unsettling and that made me more determined to be more assertive with him and other midwives at later appointments.

Good luck!

Thanks so much for replying Lis! Much appreciated

Definitely you can insist on a c-section. NICE guidelines say that they have to refer you to another health professional and if you still want a c-section then they can't refuse you.
I had a vbac after a c-section and I was absolutely determined to experience labour as the c-section was an EmCS after a failed induction. I had an epidural at the very beginning as I had preeclampsia so didn't feel any contractions. I was very unhappy. after the c-section although I physically healed very very well.
The vbac was great, although I did have a 3rd degree tear that got infected. But I was soooo much happier after that birth. And I have had no continence issues whatsoever.
I have just had a second vbac with my third child. It was absolutely awesome. I went in to see the consultant convinced that I wanted a c-section, but it wasn't recommended. Cue tears from me and a referral to the consultant midwife. I decided on vbac because 6 weeks recovery with two other children was too much. I was very frightened but did an active birth course which was great. I spent most of the labour standing up, despite full monitoring. The contractions weren't nearly as bad as the ones I had lying down on my back when I was being examined. I managed without gas and air until transition stage and then I couldn't reach the gas and air so did the pushing without.

But that is only my experience and I spent most of this pregnancy wondering if I was doing the right thing. It worked out well for me, but I still felt it was a gamble.

As PPs have said, cost doesn't come into for you. Your own mental and physical wellbeing are much more important. There isn't actually a vast difference in cost (I think someone on mumsnet said this on another thread about c-section vs. vb).

Good luck whatever you decide

Agreed you can definitely insist on one. I was given one on maternal request alone, although DS was breech it turned out so I would have ended up having one anyway.

The NICE guidelines changed partly because there is no material cost between natural births and cs IF you include all the costs associated with that birth - so including physio and repairs after vaginal births - so that was not only an inappropriate statement to make, but an inaccurate one too.