Unscientific survey: What was your successful VBAC like?

[AllBoxedUp]

Hello. I am currently obsessing about VBACs and I am trying to find out more about the details behind the quoted success rates. I've been trying to find out how many of the successful VBACs involve an assisted delivery and how many result in significant tears and how this compares to non-VBACs. If anyone can link to any proper research that would be wonderful but I thought I would see what the anecdotal evidence was!

I had an ELCS because DS was breech so there is no good reason for me not to have a VBAC but I hate the fact that I have to start on the path of intervention (delivery unit and not midwife led unit, CFM, etc.) for a really low (though very serious) risk of uterine rupture. It seems intuitive to me that this is going to lead to more intervention but the only thing I can find is this site which has no references to the increased risk of intervention and this paper which basically says more trials need to be done to assess the risks and benefits. Any words of wisdom, personal experiences and data welcome . Thanks!

Thanks mayhew - I do appreciate that but in some ways it's not like everyone having their first - if it was my first I could go to the MLU and not have to think about CFM. Can't be helped but it's frustrating me!

I had a surprisingly good vbac (after elcs for breech first time round) - no intervention, no stitches. Was horribly painful at the time but recovery has been so much better - I felt completely back to normal after a week. I think what helped me was getting to the hospital pretty late - was already 8cm when we got there (things moved fast, I meant to stay home as long as possible but not quite that long!) Hospitals stress me out but to be honest by the time I got there I couldn't have cared less where I was. They put the belt on for cfm but I'm not sure anyone looked at it, I was pushing by then... Delivered kneeling against the back of the bed, didn't even notice the belt until I turned round to hold ds and got tangled in the cables.
My friend had a vbac too which went quickly and well, she had an episiotomy which was sore afterwards but still said the recovery was loads better than her cs.

I had a VBAC at home almost one year ago. My first birth was a crash section for severe foetal distress with no known cause.

I used One to One Midwives, who are an independent company contracted to offer NHS midwifery services in my area (you can choose to use them or the standard NHS community midwives, it's entirely optional and I chose this).

I planned to go to hospital to deliver, but when my midwife (who came to me at home when I called to say I was in labour) called the hospital to say we were coming in, they said I had to be on the bed and have continuous monitoring and they refused to let me have access to a birth pool without consultant approval. So I didn't go. I had DD2 at home, calmly, peacefully and with no tears, stitches or complications.

I had a conversation with my midwife during the course of my postnatal care where she expressed the opinion that, had I gone to hospital, I would probably have ended up with a forceps delivery. When the pushing stage of my labour began, I was semi-upright and my midwife left me for a while to labour like this. She then approached me to tell me that I had been pushing for 45 minutes and baby wasn't coming, so could she examine me to check for a cervical lip that she may be able to push back. I refused (purely because I don't think I would have coped physically with a VE at that time), so she said I should think about changing position and I needed to be upright. As soon as I stood up, DD2 began a swift descent and was out safely within 10 minutes. None of this would have been possible in the scenario the hospital would have imposed on me.

If you haven't already had discussions with the consultant in charge of your hospital care, I would ask for a meeting and make it clear that you are thinking about this issue. A friend of mine who had a VBAC a few days after mine had several meetings with her consultant during the course of her last trimester and she felt that it made a big difference to how she was treated in labour second time around - she got the impression that they thought she was a bit difficult and a PITA and so treated her with kid gloves. She was very satisfied with the handling of her birth second time around and she had a successful VBAC without an instrumental delivery.

Shit sorry that's a really long essay .

Not that I've had a VBAC, I'm just nosy, but there are plenty of places in the world where CFM is absolutely standard and it doesn't necessarily mean a 'negative' impact. I think with many things surrounding child birth the more you stew over it the more likely it is to stress you out and slow down labour. If you mentally accept CFM (and wireless monitoring really isn't that bad) then it just is part of your expected birth experience and you'll be more relaxed which is means your labour is more likely to go smoothly.

emsyj that was really interesting - thanks for the essay - much appreciated! I already have a list of questions prepared so I think I am going to be a bit of a pain - good to know that might be a positive thing!

It's interesting that CFM is routine elsewhere - presumably it's wireless. I think if I can find out as much as possible about what to expect it will help.

I don't think wireless monitoring is that common though, Nom & OP. It's certainly not available in my local hospital. If it had been wireless I would probably have gone in. It was being told that I would have to be on the bed that clinched it for me. When I arrived in labour with DD1, they insisted that I had to lie on the bed to be examined and I remember it being excruciating and being manhandled onto my back when all I wanted was to be on all fours (I actually travelled to hospital on all fours on the back seat of the car ).

Re: being a pain - best thing you can be. You don't need to be rude or aggressive, of course, what I mean is it might be wise to just make it clear that you are not planning to roll over and put your birth in their hands and do as you're told; but that you want information, options and to be heard.

CFM was not even mentioned to me; I was not aware that it was part of 'policy' for VBACs.
I had a CTG on, I think most/all of the time, but as I delivered rather quickly it did not interfere with what I would've wanted to do (which was mainly push ). DS4 is now almost 4, for things may well have changed in terms of hospitals' policies etc.

I just wanted to mention as well that no procedure can be carried out without your consent, which should of course be informed consent, so for instance the reasons for CFM should be explained to you, you then weigh your options and decide to agree to it or not.

Yes, you may have to be quite sure of yourself and... strident in making your wishes known, but you don't just have to go along with what it 'policy'.

emsyi, your delivery sounds amazing btw

I had an emergency c section with first baby and opted for vbac with 2nd as I was desperate to birth a baby. I can honestly say that in hindsight I wish I had another csection. I had another very long labour. I laboured at home for about 16 hours despite being told by midwife to go in and be monitored due to risk of rupture. I asked to go in and they said they were too busy stay at home. Anyway I went in as I needed to know baby was ok. By this time I was exhausted and not coping great with the pain. I ended up having an epidural ventouse and episiotomy. My baby weighed 9lb 2oz and I found the physical recovery from episiotomy much harder than the c section.

Allboxedup I think you really need to ask the question ' what was your VBAC like? rather than 'what was your successful vbac like?'

The problem is that if you select a VBAC, you don't know whether it is going to be successful or not. Nearly all the problems are going to be in the unsuccessful group so I don't want to be negative but I don't know how much of an accurate picture you are getting from these posts. You need the balance, don't you?

What would I do? If I could guarantee a successful VBAC, I would have one. Without a guarantee, I would definitely (without a moment's hesitation) have a repeat caesarean if I had not had a successful vaginal birth previously. This has got accurate information - it is from Royal College of Obs and Gyn

www.rcog.org.uk/womens-health/clinical-guidance/birth-after-previous-caesarean-birth-green-top-45

Good luck whatever you pick

Once again, thanks for the replies and to Helibelly for sharing your more difficult story too.

Ushy you are completely right and I realised this after I posted the thread. I meant "successful" as in people who had a VB rather than an EMCS but obviously by definition this covers all VBACs! Maybe I can ask mumsnet to change the title? I didn't mean successful in a judgey way and how no one felt that.

I don't know how easy it will be for me to get an ELCS as I only had my CS for DS being breech so I want to be as informed as possible before going for a VBAC about what can and will happen.

Saying that, it's been really encouraging to hear that it is possible to have a VBAC without too much intervention or problems (though I do want to know both sides of the story).

Hi OP. I think I know where you are coming from. I was in the exact same quandary for DD2. It's basically the devil you know argument. If you already have a CS scar, and found the recovery process bearable then having a vaginal birth with the associated risk of severe tearing/incontinence etc etc is quite worrying. Worst case scenario you have a CS scar and all the other stuff to content with too.

I had an EMCS after Failure to Progress with DD1. No foetal distress but it had been two days and she was clearly not coming out without intervention and I was stuck at 6.5cms for over 12 hrs at that point. Fully recovered from CS by 6 weeks and was to all intents and purposes feeling fine by 3-4 weeks. Felt like I had failed somewhat though and it was a standing joke with DH (though not v funny to me) that I'd had every drug going and snoozed through most of my "labour".
Had a case review when I got pregnant with DD2. Only then did I find out that DD1 had been back to back and numerous notes making reference to small pelvis/difficulty making vaginal examinations etc etc.

After a number of meetings with medical staff I opted for an ELCS as the devil I knew. I have a few friends who had had severe tears resulting in surgery for incontinence and effectively were now prescribed a CS for DC2 as and when. I also had gotten over to some extent my feeling of failure and figured that retention of my pelvic floor might help me get over it
DD2 had other ideas though, she came early at 37 weeks, two weeks before my scheduled CS and I laboured and dilated v quickly. There were emergency CS's/high risk deliveries ahead of my in the queue and by the time theatre was free I was being strongly encouraged to have a VBAC on the basis that I was nearly there, and was managing on just the occasional whiff of G&A. I fell for this [didn't query what "nearly there" means] and was in labour for another 3.5 hrs. DH feels that I was "managed" throughout as the staff on duty wished me to go or a VBAC (although outwardly supportive of the ELCS with a few exceptions). He also felt that only because DD2 was smaller we would have been back in the same position as in the end, she was B2B too and we needed forceps in the end to get her out. I had some "minor internal tears" which needed stitching. No episiotomy though even with forceps...... I was euphoric at the time though as I had successfully given birth.

In retrospect I wish I had had my planned ELCS. My recovery period was 12 weeks before I could sit without pain and discomfort (severe internal and external bruising). Walking for any distance more than a half mile or so resulted in days of discomfort. I think the internal healing takes time. Certainly all the medical professionals I met were of the opinion that anything more than 16 weeks wasn't normal. 16 weeks? WTF??

3 months in a pair of yoga trousers isn't good for the soul and I was back at work shortly after so around the point I felt well enough to be out and about, I was back at my desk at almost the same weight I was when I left it. I think if I'd had my CS as planned I have been much more mobile in a shorter period of time and had a more positive experience of mat leave.

Having done both - if a VB is important to you, go for it. If it's not really, then I would stick with a CS. The part that really matters come after they are delivered and there are no prizes if you can deliver drug fee with a gentle sneeze.

I'm a bit the opposite to the previous poster. I had a VBAC with DD2. I wasn't keen on CFM as I wanted to stay mobile as much as possible and in the meeting with the midwife beforehand to discuss my delivery, I was told that most midwives would agree to intermittent monitoring unless there was a problem.

When I actually went into labour, I was encouraged to stay at home as long as possible, which surprised me as I had thought I would be brought in early for monitoring. When I eventually arrived at hospital I was 6cm dilated and progressed to 10cm within 40 minutes. At some point fairly early on the CFM was attached and I don't really remember much about it. I was mobile in the sense that I could move into any position on the bed, including all fours, but I couldn't walk around. However, by that point I felt that I absolutely couldn't walk anyway so it didn't affect me. In all honesty, I don't remember the monitor being an issue for me at all and I actually found it reassuring as I understand that foetal distress is one of the key indicators to a rupture.

TBH, I really really didn't enjoy the birth. I had also been led to believe that there would be a finite pushing stage but in fact they let me push for over two hours. Like you I was fearful of tearing and I did end up with a 3b tear. It was an assisted delivery (ventouse - they said I could do it without but I was so exhausted I just couldn't push any more) but this could have been because she was a large (9lb 2oz) baby rather than because it was a vbac. I had to have stitches in theatre and I was really upset about this at the time as I was worried about future health consequences and, just as with my first birth, it meant I had to spend time away from my newborn while I was stitched up. At the time, I wished I had been able to have an ELCS.

However, with hindsight I'm pleased that the VBAC was successful. The tear healed very well, and I felt that I recovered much more quickly than from the EMCS. FWIW, I chose to tear naturally rather than have an episiotomy. I wasn't sure if this was a good idea when the tear was bad, but I didn't have any pain or issues with healinlg. The biggest reason I'm glad I did it is that although I did have to go into theatre half an hour or so after the birth, one of my most precious memories is of DD2 being placed directly on my tummy as soon as she was born and being the first person to cuddle her. I was really sad that I didn't experience this with my firstborn.

It's a difficult decision to make as there are uncertainties with any birth. All the stories above show you that just like any birth, every VBAC experience is different.

I should point out that obviously there was some pain with the tear, but it was very well managed with painkillers which I took for a couple of weeks and I didn't suffer any further pain once I stopped taking them.

I had CFM and didn't really find that it impeded me either. If it slipped though all the alarms went off which is pretty annoying. Similar to Grace I dilated very quickly but went to the hospital once my contractions started as I was planning on an ELCS.
Grace has made a good point about your baby being placed straight on you. It was a lovely feeling with DD2 and the cuddles meant that I was pretty much oblivious to the afterbirth stage
I have a very precious memory of DD1 being cradled in DH's arms after my EMCS though. I don't think that either one is more special to me and I had skin to skin contact and a first feed with DD1 in recovery.

I hope you don't mind me adding an unsuccessful VBAC story here. First DC born by EMCS due to foetal distress/failure to progress. Second DC I chose VBAC and even considered HBAC for a while. I am so glad I did not go for HBAC. I had a complete rupture during labour in the delivery suite. DD was delivered within 12 minutes under GA (she's fine and nearly 4 now). Risk of rupture is low, but it does happen and if it had happened at home it is highly likely she would have died - possibly me too. I was very very lucky. The risk is low but what you are risking is immense.

I read lately that recent studies have shown that repeat CS is lower risk for the baby than VBAC - I don't know if this is absolutely true. If it is, that is what I would choose. Ironically a very kind doctor told me when I was being checked over at the hospital in pre-labour that I could change my mind at any time and elect for a CS. How I wish I had!

I appreciate that many VBACs are successful, however, I have two friends who have had successful VBACs. Just wanted to say that sometimes ... they are not. And it's not easy to spot that a rupture is happening, I don't think. I think I worked it out by instinct and shouted out 'it hurts on the scar' which was sort of hard to identify during established labour and final stage contractions!

I wish you luck whatever you decide - and hope you don't mind this story being added.

Thanks again everyone - as you say grace maybe it's a bit silly to look for patterns as every VBAC will be very different. Sorry you had a rough time oscar - that is the kind of scenario I am worried about. I'm not that bothered about having a VB but I imagine if it goes well it would be special. When DS was delivered they had to give him some oxygen (thankfully I was a bit oblivious to the fact they were having problems until it was over), dried him off and put a nappy on him and then we had skin to skin while they stiched me up so I did get to hold him quite quickly. The first feed was in recovery so it would be nice to do that all immediately.
Thanks very much for your post too Wednesbury - all experiences welcome! Uterine rupture sounds terrifying and I am glad you were both ok. It's a good reminder for me as I've been feeling like the risk is so small that it's not worth thinking about but it does happen in some cases. It's interesting it was you who realised - I read a blog somewhere by an independent midwife and I think she was saying that the mother normally realises first and the preparing the mother about what she should be watching for was the best way to detect it. I think I also read that maternal heart rate increasing is a better indicator than CFM as the baby gets distressed relatively later on. So pleased you were in the right place for it to be dealt with.

Emcs for dc1 and vbac for dc2. Going for 2nd vbac at home in the next month or so. I was similarly torn re approach to bac but decided for me the absolute worst approach would be to attempt a medical used vbac. I declined cfm and got permission to use the birthing pool in the mountains in the hospital. This involved getting permission from consultant and senior midwife. laboured to fully dilated in the water using just the water and g and a. Pushed for a while and no progress so transferred to delivery suite. Baby found to be back to back and rotated by consultant. I then delivered, still just on getting and a, and with episiotomy and one contraction with venture. Had a few stitches but nothing to write home about and no discomfort sitting etc. I'm hoping to be signed off for a home birth next week. We live close to hospital and would like to avoid any postnatal hospital care.