More VBAC angst.....

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Hello. Just looking to vent and get views really. I had a ELCS due to DS being breech 3 years ago and am now 16 weeks pregnant. My instinct is to have an ELCS but I saw the midwife last week and she made it pretty clear that she thought I should have a VBAC. I started to think I should give it a go but I just get annoyed when I look into it.

I hate the fact the midwife says I should have no more problems than any other first time person attempting a VB but I'm not allowed to give birth in the midwife led unit. The hospital leaflet says I only have a slightly higher risk of EMCS than if labouring for first time but I should have IV access and continuous monitoring. It says that if I choose to have a water birth I would only be able to be monitored intermittently and even though there is no evidence that this is less effective continuous monitoring might be better so I should have that.

It just seems like mixed messages to me. They seem to downplay the chances of anything going wrong but prepare for the absolute worst. Why don't they do this for everyone if I'm not that different.

I also live in an area where there is a lovely shiny new midwife led unit which I can't use. There is heaps of information on the website about it with pictures and video tours but only a few paragraphs about the delivery unit.

I also dislike the fact that there is a big section on the disadvantages (risks really) of having an ELCS but no corresponding section on the disadvantages of a VB (I'm very obsessed with the risk of having a major tear).

Anyway, maybe I am being unreasonable but at the moment I just feel like it's not very balanced. I guess if this was my first pregnancy I wouldn't have the choice (and I was really upset when I was told I needed a CS) but if it's such a good idea for me to have a VBAC and it's not that different why all the precautions? Of course I don't want anything bad to happen to the baby but either there is a significant risk to attempting a VBAC. The impression I now have is that the chance of things going wrong aren't that much higher but if they do go wrong it will be much worse but that is reading between the lines really. Congratulations and thanks if you've reached the end! Just needed to get it all out!

ok.

what you need to know is that if there was a rapture in the C-section scar (remember that it could be anywhere within the 7 layers of skin/muscle they cut through and stitch up) and there's bleeding they have to perform an EMSC immediately with you being undet GA.

the more time has elapsed from your previous C-section the less likely this might happen - after 3 years the risk is almost nothing.

you are right, if things went wrong they could go horribly wrong - but that is a risk of every birth anyway, whether it's a normal birth, ELSC, EMSC (obviously that's already scary) or VBAC, so in my mind that doesn't make me vote against VBAC IYSWIM.
there are risks with surgery, epidurals, contracting infections, bad reactions to drugs and so on...
the whole things is a bloody gamble, where sometimes we don't even have a choice, but all we can do is hope and pray for a healthy baby!

My old MW said that in her 25 years carrier there were only two incidents when the babies died due to scar rapturing while VBAC, but I don't know what percentage that is of total VBACs, what else happened.
it's sad, but both happened about 15-20 years ago - I do believe technology & knowledge have improved since because with C-sections' numbers going up each year I'm sure VBACs are now more common as well.

DS4 was ELSC due to being footling breech. he was almost 3 years and 5 months old when DS5 was born.
DD was born 2 years after DS5.

DS5 and DD were both born VBAC - there was absolutely no reason to have another C-section with either.
they looked after me really well and with DD I was in the high-risk unit (her being 6th) and MWs were watching me like a hawk.

I recovered well from both births, in fact with DD I didn't even tear, not even a graze. (she was 8lb 3).
it was fantastic and in hindsight the best choice.

I'm pg with #7 and I'm hoping for the same, I want to avoid having another c-section if at all possible.

obviously it is a very difficult decision to make for most people, and both times I went through "cold feet" periods when I was sooo tempted to just book a section!

does any of this help?

I attempted vbac with dd, who has recently been 2. Hospital policy and also my preference - I wanted a quickish recovery with a 3 yo to look after too! As it happened, I had a uterine rupture and everything went a bit pear shaped. I was very pleased I was in the consultant led unit as I was wheeled off for my crash section under GA when dd's heart stopped.

I think the thing is, the likelihood of something going wrong in vbac is not much higher than in a first labour, but if it does, the consequences can be much worse.

Hello. Thanks it does help to hear of other people's experience. I just feel they make it seem like the best option with little risk but then give you little choice on how it happens. DS was 8 lbs 3 oz at 39 weeks as well so that worries me a bit. I have another thread on here but I would rather have a straightforward CS than a GA EMCS or 3rd degree tear and almost can't imagine an ok VB.

I think I want to stamp my foot and say it's not fair that I am in this position in the first place but that probably won't help.

Lovely to hear your VBACs went well and good luck with number 7.

Cross posted BikeRunSki. That sounds terrifying and glad you are both ok. It sounds like there is a reason for the precaution and I guess they don't want to emphasise it so they don't put people off.

you can stamp your foot, but as a wise Chinese person once said "why cry? you got to do it anyway!"

the thing is as I had 4, then 5 kids already a quick recovery was so very important to me.
plus I had previous experience of vaginal births (DS1 was forceps delivery and I had an episiotomy - ouch!) so I knew what to expect during and after with both types.
if it had been my second I honestly don't know if I had gone for a VBAC!

I thought all of those things you are thinking. I went for the VBAC having worried myself silly about what the best option was throughout my pregnancy and wrote out a very clear birth plan refusing the cannula, refusing continuous monitoring and timed stages. I embraced hypnobirthing and hired a doula, gave it 100%. When it came down to it, the midwives poked and prodded and interfered so much between contractions in terror that my scar was rupturing, that any hope of any natural, calm hypnobirthing experience went straight out of the window. The pool ended up not being so calm and I hated every second of it.

Ultimately, although my birth was textbook and I didn't have any stitches, I know now that deep down I knew right from the start that I should have had the c-section. I even far preferred recovering from the section.

Go with your instincts, stop second guessing yourself.

I was the same as you - section for breech the first time. With DS2, they said the same - no Midwife Unit but they also said they would support home birth if I wanted! Crazy!

I went for the VBAC in hospital and it was great! 6hrs, totally straight forward. Had a 2nd degree tear because I shoved his fat head out too fast but that was a minor discomfort really. Sent home the same day.

3yrs on from that, DD was born at home a fortnight ago with no damage to me whatsoever.

Do have a read about VBACs elsewhere than the hospital lit. There are lots of websites that will give you an alternative view than the worst case scenario. Ultimately, do what you are comfortable with! Good luck!

Do what you want, I had a VBAC with DD and I wish I had just pushed for an ELCS. I still feel traumatised by her birth - although at the time I tried to be positive - it was actually awful. I had an epidural and EMCS with DS and I actually found the experience quite positive. But I went into labour early with DD, I suspected this would happen and so when I begged for a c-section they said no I was too far along. It was only 4 hours but they are burnt into my memory for ever. DH also found it tricky.

I forgot to mention that I stamped my foot and pushed for minimal monitoring, active birth, went to pg yoga/hypnobirthing, read up on vbac a lot, and got it! To this day I am eternally grateful that I ruptured and haemorrhaged and dd's heart stopped during a period that I was being monitored.

Thanks again for the replies. I think if a VBAC goes well it can obviously be an amazing experience but if it goes wrong it can be pretty horrendous (as with any birth I suppose). Having an ELCS does seem like the best option - if you were doing a risk assessment I guess it has a higher risk of a severe outcome (maternal death) but that probability is quite low. The VBAC has a reasonably high risk of EMCS where you're exposed to the same things but in a more stressful situation.

I imagine I will change my mind a lot before May but it's definitely good to be informed and prepared.

In order for continuous monitoring to pick up any problems, someone has to be constantly monitoring the equipment! This may sound like an obvious statement, but the hospital I was booked to go to for my VBAC announced that I would have to wear a foetal monitor at all times, and I said fine - if there is a MW there to observe and act on the info the monitor is giving. The hospital spluttered a bit at this, and said that they would not have the staff to let me have a MW in the room with me the whole time, she may have to look after other women too. I stated that if I was 'high risk' enough to need a monitor on all the time, I was high risk enough to need one-to-one care, and if they were providing that, they could monitor me and my baby effectively enough without strapping me down to a bed. I used the same argument against wearing a cannula throughout labour.

Mary Cronk has a few things to say about effective anti-rupture monitoring. All useful stuff!

I felt much like you, tried for VBAC and ended up with a section, not great experience but nothing dangerous occurred thank goodness. My SIL recently had a good VBAC.

If you want clear info on both options there are NICE guidelines on birth after C-section on the website, it's aimed at clinicians but readable!

Think the midwives are required to share a lot of it with you in writing, mine did anyway, they might put this off until much closer to due date, but you could always ask for it.

In some circumstances, for example, successful VBAC is less likely.

Marking my place - had an EMCS because baby was undiagnosed breech 3 years ago, currently 9 weeks pregnant with baby 2, and anxious about what to do - VBAC or ELCS. Was given the impression at my booking appointment that I have a choice - maybe that was because I got upset going back over the EMCS - but i am booked to see a consultant at 20 weeks to discuss options. I don't know what to do.

OP, the hospital where I will give birth also has a much hyped new birthing unit but I know I won't see it. Which is actually fine by me because I want the theatre/doctors nearby if anything goes tits up.

My advice would be to be clear to your midwife/consultant that you are planning an ELCS from the outset. You can change your mind later/research all the pros and cons in your own time without any pressure. If you are firm from the outset they will shut up about it.

I had a VBAC after a fairly short spontaneous labour (but was booked in for an ELCS after much angst, meetings with consultants etc etc) and my experience is that the recovery period was longer (no episiotomy, but forceps delivery and "minor internal tears") than my EMCS for failure to progress. I had major internal bruising and couldn't sit properly for almost 3 months which was a major PITA (literally) when you spend all that time sitting around bfing.