New to board - objective advice required

[bumpstheword]

Hi. I am in a bit of a quandry. I have been given the option of an elective section at 39 weeks and am unsure of whether or not to have it.
I am 37 wks now. My 1st child was 9lb 5oz delivered by emergency section after 24hrs of strong regular contractions i got to 2cm. He remained high - did not engage and was of posterior position and had a huge head!. Iam quite petite 4ft 11.He ended up going in distress and meconium was found when they broke my waters. Lets just say it wasn't a pleasant affair. This babe at the mo is also posterior i have an anterior placenta (i do not believe low), i have no idea of size of this one but am having a scan next week. I feel as though they are pressurising me into trying labour again. They say they will not leave me long (but thats only after i get to 3cm) I am worried it may take me as long as last time. I so much want to enjoy this experience this time. Any one out there had similar experience and go on to have a nice labour with babe in posterior position? Thanks a lot

I had a similar experience insofar as DS was 10lb 5.5oz, posterior, remained high and didn't engage before I went into labour (he got to 0 station after 90 mins pushing), and had emergency c/s, although he was never in distress. I currently plan on VBAC next (hypothetical at this stage) time but (a) I have dithered back and forward (b) crucially, I did get to fully dilated last time, which improves my odds of a successful VBAC. In your position, to be honest, I think I would go for the elective section. And I'm a bit lentil-weavy and would never have imagined pre-DS that that would be the sort of thing I'd say.

Not really answering the question you asked, sorry. Oh, and welcome to mumsnet!

Hi Bump
Welcome to mumsnet
I suspect if the scan comes back to a large size baby... you will have every reason to be tempted for an elective!
However you did labour last time and if you labour spontaneously this time I think the MWs are making a genuine good suggestion.... you may WELL dilate quickly (as you have contracted before). I am sure they will take into account the baby's position at the start of labour... if they see he/she is high and your contractions don't lead to much they won't have a problem getting you a section. I guess it all depends how convince you are that you can do this vaginally and how keen you are of that too.. is it important to you or not ? Only you can answer that. But technically they are probably correct to suggest this. They won't want you to have another 24h labour ANYWAY! So they would go to secton faster. Do not forget that possibly your recovery will be slower if you have a section.. how old is your 1st baby ?

Me me me 6 days ago!

DD1 labour started sun afternoon, not too bad but sore enough to only snatch sleep on sun night. mon had tens on by lunchtime run out of settings by 7pm hospital at 8pm 2 lousy centimetres. told to lie in bath by midwifes demanded diamorphine and then wished I hadn't had it hours and hours of grueling pain while being told to lie down to rest dd1 born at 4am tues morning huge episiotomy and nearly assisted delivery.

DD2 also posterior and anterior placenta. v early labour from monday afternoon but v weak contractions paracetomal did the trick and slept like a log. Saw midwife at 9am and she reckoned today at some point. Kept on my feet and birthball homeopathy kit at hand and took whatever was suggested for posterior and slow labour at 4pm. 5pm forced Dh to put tens on and to phone midwife. (planned homebirth)

midwife appears at 5.20 am 4cm and fully effaced.

carry on walking about watching the simpsons and bouncing on ball. 6.30 firmly suggest to dh that he takes dd out to get her to fall asleep. DD1 put in bed asleep at 6.50 baby born 7.13 after 8 mins of pushing. never even had the gas and air and only on setting 3 on my tens.

fabulous experience am already planning more!

Mrs Apron - great to read and great experience..but you did deliver your 1st vaginally.... Bumps didn't and that will not help her confidence... you knew you could do it... she doesn't...

That is a good point pupuce in fact that was one of the things I told myself during labour.

both mine had 35cm heads if that means anything.

Thanks ladies. My boy is 2 the day this one is due! the worse thing is they said i was not as they class as in "labour" last time as i did not get to 3cm! So they will only count from 3cm as labour. They knew he was big last time as had regular scan (polyhydraminous) They refused me pain relief other than some sort of paracetamolly type drug. Even though i was contracting over 200 (which i believe is adequate for dilation)
A vbac would be easier handling a toddler at home/driving etc, however from what i read. Posterior babe labours tend to be a little more difficult/longer. They keep telling me not to worry about this as generally most turn (my last didnt)
I know there are far less risks to a vbac than a section, but it is also in the back of my mind that they are under pressure to get their section rates down as well! and maybe there is a little of this in their encouragement for a vbac. If you get my drift.

I had a similar experience, and no one will tell me to try for a normal birth again. They do it, because of the figures in thenbooks at the end of the day. A normal delivery costs less than half a C-section. I would say no.

Bump - the machine does not measure the strength of the contractions unless you have an internal monitor which I don't think you had.
The CTG measures the length and frequency of contractions... so I would not say that 200 was relevant. (sorry).
I would also agree about an OP (back to back) baby... if you did contract last time it is quite likely that your baby if it remains back to back at the begining of labour will turn in labour.

It is impossible to give you perfect advice as technically a vaginal birth is safer for your baby, you will theoretically recover faster but I can almost GUARANTEE you that they won't let you contract for 24 hours this time as they won't want your uterus to contract for that long. So attempting a VBAC is a good option because they won't let you go on like last time (even if you wanted them too... and some women do).

Thanks for that. I did have an internal monitor i think. When they broke my waters they put something on the babies head (Is that an internal monitor?). I think i will see what the scan shows and take it from there. I know these scans can be wildly incaccurate but it was spot on at predicting my first - especially his 38cm head! One thing i think i have decided is that i defo do not want inducing!

How tall is dad ?
Yes it is an internal monitor.... Can you not get a midwife to review your notes with you (from last labour) you are entitled to this ! This will either give you confidence or not!

What do you WANT to do

You say you're feeling 'pressure' to try vaginally .. does that mean you would prefer an elective

If you feel you would then do it

I had 2 electives and I don't regret either one

there are no medals on a labour ward what matters is the baby and you ...

Hi Bumpstheword

I had a long 55 hour labour with my first (also posterior with anterior placenta) .... in the end, despite syntocinon for 6 hours I didn't dilate past 4cm and I had an emergency c/s. He was 10lbs and half an ounce (I am 5'7" with smallish hips).
With DD I wanted a vbac desperately but was also open minded about what may happen as I was equally desperate not to have a similar experience. DD was also posterior and scans from 36 weeks said she would be big again ... but I kept an open mind, knowing that scans can be inaccurate. They were happy for me to have a trial of labour but didn't let me go into spontaneous labour for fear of scar rupture due to size of the baby. So at 40 weeks I had a sweep with no results and at 40 + 3 I was induced with a pessary. That didn't start labour either so 8 hours later they gave me another one which did. I had 12 hours labour before I was examined and found to be only 2cm. At that point DH and I made a unanimous decision to have a c/section. The consultant, who was notoriously anti c/sections, supported us in that decision. His words were, "You can keep going if you are prepared for the long haul again but this baby is not about to arrive in the next 24 hours". As it wasn't an 'emergency' (although I was in labour) I laboured for another 7 hours before a time slot in the Op room came up ... and by then I was only 3cm. Had a lovely calm, exceedingly positive c/section and DD was born at a whopping 10lbs 10oz with a 39cm head circ .
My recovery was the usual 6 week thing (but I did drive after 4 weeks - I have an automatic car and that isn't so bad apparently) but I had support from DH and friends to sort out DS and his kindy runs/swimming lessons etc. It really wasn't too bad ... enforced rest really ... not a bad thing IMO.
Although not bothered by the labour etc I do think, in hindsight, I should have cut the crap and had an elective caesar. Although sometimes sad that I will never experience natural childbirth I don't beat myself up about it because at the end of the day I have two healthy children and I am here to enjoy them ....
If I had a third, which I am not planning at all, I would just have an elective and be done with it.
Obviously natural childbirth is preferable all round (for baby and for recovery of mother blah blah etc etc) but if you are in a situation (like me) where large baby + small(ish) mother + previous c/s = proper health reason for c/section then just go for it.
A positive c/section (as opposed to a scary emergency) can be just as fab as a natural birth experience IME ...
HTH

I would definately go for an elective section. They are worlds better than emergency sections. And, and elective section is in fact the only way to be certain of avoiding an emergency section.

I suppose I would talk to the consultant and if he/she couldn't say I had at least an 80% change of succeeding in a VBAC then I would say forget it, give me a time for an elective.

If you had never had any children, I would say go for natural. But, since you already have all of the side effects of a section, what's one more?

If this baby is big, i think you also have to consider the likelyhood of things like third degree tears, and the consequences.

Sorry, but I also think that "technically a vaginal birth is safer for your baby" is debatable at the very least. I think caesareans are safer for mum and baby (unless mum wants to have a lot of babies).

Talk to your consultant. He/she is the doctor.

hasa nyone given you any tips on how to get the baby to turn? lots of being on hands and knees with bum in the air? not slumping in an armchair? etc etc.getting baby to change position would help either way.

Bumps, my experience was very similar to yours and I am now 16 weeks pregnant with my second. I will have no hesitation in going for an elective c-section. I have already been warned by my community midwife that the consultant, who I'm seeing in a few weeks, may try to pressurise me into trying for a VBAC because the hospital is under pressure to get its c-section rates down.

Everyone is different and I respect the decision of women who do want a VBAC, but reading between the lines of your original post I don't think that's what you really want - is it? You've got to go for what feels right to you. It seems to me that you could totally relax if someone would "give you permission" to book an elective c-section. Tell me if I'm wrong about this.

Pupuce, Dad is not very tall but big built 5ft 11 - 15 stone. Was over 11lb born though. Keep thinking if its a girl it may take after me and have little genes! Not as huge as last time, but not got polyhydramios this time.
Somehow i wish they hadn't given me the choice. I've been brooding over it for weeks. Just don't want to go through the same again. Its a right lottery. I can see pro's and cons on both sides. Either way the little bugger has to come out! The last few times my consultant has not been there and i have seen his registrar and not been particularly impressed. This next visit will be my last before the birth so he'd better be there!

Ghosty - i thought i had a bad time of it! 55 hours is a long time. I was knackered after the 26hrs - too tired to enjoy it.
No i have not had any ideas about turning the babe. Trouble is i don't get to see a midwife and my visits are mostly at the hospital.(High risk pregnancy) so its always very clinical. Not much chance for discussions etc.....

I had an emergency section with DD after starting to contract on Friday and finally having her on Monday evening. She was posterior and brow presentation and got distressed after 3 hours of pushing hence the emergency section.

When I was pregnant again I was also given the choice to decide what I wanted to do. I opted for trying VBAC but on the proviso that I could go to theatre for a section at any point I wanted if I felt I wasn't coping with labour well. DS very annoyingly turned posterior at the last minute and didn't tolerate labour very well with some very alarming heart rate dipping on the monitor, so I had another section after a few hours.

With hindsight I wish I had gone for an elective as I was very spaced out on pethedine when he was born. I felt I should try for VBAC because of recovery but my heart wasn't really in it, which I'm sure affected my second labour. I do think it comes down to what you really WANT to do, rather than what you think you should.

I too change my mind on a daily basis about what to go for, VBAC or planned CS. Currently am booking in for a CS at about 40 +3 or something like that so am leaving it in the lap of the gods as to whether I go into labour before that.
Obviously it's up to you, but reading your message it seems like you know what you want in your heart of hearts.
But I must question something Lemonaid says. With my DS, I got to fully dilated and failed ventouse, and all my reading suggests that this makes a successful VBAC much less likely (along with being over 35, hmmm not looking great for me). Where have you heard that it will make improve your odds? Would be so great if it were true...
Polly

Polly - Your age is NOT an issue any good doctor will tell you!
You need to find out why the ventouse failed. What is true is that you will get to full dialtion quickly ths time.. what you do not know is how well your can push a baby out. If the ventouse failed becasue baby was incredibly badly positioned this may (and probably would not) be an issue this time ... however if the baby never engaged than that is another matter.
The adavantage for those who want a VBAC id to have laboured because your uterus will be more efficient teh 2nd time around. So the vast majority of women have a much easier time reaching the 2nd stage on a subsequent labour.

Kitty raises an excellent point... your heart (and your head) has to be in it... otherwise you will probably struggle...
I support most;y women who want VBAC (I am a doula)... with the exception of one... they ahev all had great VBACs... but they hired me becasue they wanted to succeed! We worked on getting their confidence back and they ahd quick and easy labours. Interestingly most had a 1st section due to a failed induction (and several did not get far in dilation).

At 5'11" and you 4'11" - there is a chance you too are just to different body shape wise and you may well struggle to get it out... though Mears will tell you that she has seen 12lbs babies out of 5' women! And these women don't necessarily have difficult birth or tear... I have not seen anything bigger than a 10lbs baby myself so I can't say the same but I do know of plenty of stories.

uwila. I strongly disagree with you. "But, since you already have all of the side effects of a section, what's one more? "
Well actually in continuing to opt for sections when you don't actually have to you are denying youself the chance to experience natural childbirth, that means alot to alot of women. It can be a truly incredible exprience and I don't think it's right to play it down and put it on par with a section.

Kitty - don't go there... Uwila is always saying this and she does like to pick arguments with me... I just leave it now.

Alright then
Btw I've used a doula 3 times now for all my vbacs ( after 2 sections) and will do the same for this baby. Hats off to you all, you are absolutely wonderful women. I really wish all mothers had access to a doula. It would make SUCH a difference to people's birth experiences.

I yoo have been toying with the idea of trying to get to term. One of the hospital midwives say babies are much better delivered at term, whether section or au naturale. Unless the scan throws up some monster size baby i think i will at least go to term and see what happens. I think i will run it by them as to whether or not the option is mine to throw the towel in if i feel things are progressing well. The other thing i am concerned about is i have coccyxdynia since my last pregnancy - noone is able to tell me if it will improve or worsen with a normal birth. oh god i keep changing my mind!!!!!!!!!!!!!!!!!! A friend of mine had 3 virtually painless labours - y cant i have one!