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

Thank you Kitty.... What Uwila think is that I am "all pro" naural birth whne I actually support women having c-sections regularely... it just has to be the right decision for that particular person... we're all different. But I agree with you about the feelings !

Bump - look here on page 14 to 17 - this may help you understand more about the effects of caesarean section on a woman's health and a baby's health: nice.org.uk/page.aspx?o=cg013publicinfo

Bump go for the option that scares you less, is all i can think to say

PollyP -- The general pattern of research is that dilating more than 5cm in a first labour gives better chances of a subsequent successful VBAC than dilating less than 5cm. When it comes to having been fully dilated there are some differences in results between US and Dutch research. The main Dutch study [Jongen VH, Halfwerk MG, Brouwer WK
Br J Obstet Gynaecol 1998 Oct;105(10):1079-81] found VBAC rates of 80% overall, for women who reached full dilation in their first labour and 75% for women who reached full dilation last time and had a failed instrumental delivery. This is much higher than in an American study the previous year that suggested VBAC rates of only 13% if a c/s was performed at full dilation in the first labour, but it has been suggested that the different approaches to management of labour in the Netherlands and at the UMC in New York might have something to do with the different outcomes. This is one reason that if I do go for a VBAC I want to have either a doula or an independent midwife.

I know my chances of successful VBAC aren't great if I have another posterior whopper, but the midwives who dealt with me last time said that they thought that if DS had been a bit smaller or anterior then I'd have managed to deliver him vaginally -- so with a smaller baby next time or one who faces the right way, plus supportive management of labour, I should have a better than even chance taking a range of studies and statistics into consideration.

Hi Bumpstheword, I truely don't envy you to have to make a decision!One of the reasons I will not entertain the idea of another Baby is, that I could not go through another Emergency C-section/C-section in general. But then, I suppose I was lucky that I had to postive Birthexperiences with my 2 other children!
Not sure if this will help you at all to put you into ease a bit, but my 2. Baby was the perect Birth, other than that it wasn't at HOme...I had a almost painless Birthexprience...only pain, I mean, real pain in the last hour of labour, and only cause they broke my waters then...and I have heard of so many other people that their 2. Births were much better then the first...of course there will always be some for who it is different...but what I suppose I am trying to say is, that every labour and Birth really is different...so, maybe as someone suggested you oculd try for VBAC with the insurance that if you wish to go for C-section at any point that you can!

Hi Bumpstheword, Please go to this website . Gina and Debbie have years of experience in helping ladies like you.

Thanks Pupuce, but I can speak for myself, and often do. But, you are right, i do think you are pro natural (to put it mildly). And I speak up not because I want to start an argument with you but because I think a poster asking for objective opinions should be given both sides of the coin so she can make an informed decision. So, when I feel your avice is skewed to the natural approach and supply the other (equally credible view).

But, of course, I am no doctor and the things I say are largely founded in my own personal experience. Anyone who really wants good sound medical advice should get it from an ostetrician. Of course, in this case it's a it difficult since he/she hasn't shown up for the appointments.

Thanks lemonaid and Pupuce for responses to my queries re. age and level of dilation in full birth. Pupuce where are you a doula? Can you recommend anyone vbac experienced in London (I'm going to UCH)? Thanks, Polly
ps I've read both Uwila and Pupuce's posts in the past and manage to find myself in agreement with both of you.

Polly - no I am not in London but I know many doulas.... so do CAT me if you'd like some help in finding one.

Uwila: Sorry, but I also think that "technically a vaginal birth is safer for your baby" is debatable at the very least.

Well... just this week in the US!!!!
September 5, 2006, New York Times
www.nytimes.com/2006/09/05/health/05birt.html?
ex=1315108800&en=a9c477603c79ba6a&ei=5088&partner=rssnyt&emc=rss

Voluntary C-Sections Result in More Baby Deaths

By NICHOLAS BAKALAR

A recent study of nearly six million births has found that the risk of
death to newborns delivered by voluntary Caesarean section is much
higher than previously believed.

Researchers have found that the neonatal mortality rate for Caesarean
delivery among low-risk women is 1.77 deaths per 1,000 live births,
while the rate for vaginal delivery is 0.62 deaths per 1,000. Their
findings

were published in this month's issue of Birth: Issues in Perinatal Care.

The percentage of Caesarean births in the United States increased to
29.1 percent in 2004 from 20.7 percent in 1996, according to background
information in the report.

Mortality in Caesarean deliveries has consistently been about 1½ times
that of vaginal delivery, but it had been assumed that the difference
was due to the higher risk profile of mothers who undergo the operation.

This study, according to the authors, is the first to examine the risk
of Caesarean delivery among low-risk mothers who have no known medical
reason for the operation.

Congenital malformations were the leading cause of neonatal death
regardless of the type of delivery. But the risk in first Caesarean
deliveries persisted even when deaths from congenital malformation were
excluded from the calculation.

Intrauterine hypoxia lack of oxygen can be both a reason for
performing a Caesarean section and a cause of death, but even
eliminating those deaths left a neonatal mortality rate for Caesarean
deliveries in the cases studied at more than twice that for vaginal births.

"Neonatal deaths are rare for low-risk women -- on the order of about
one death per 1,000 live births -- but even after we adjusted for
socioeconomic and medical risk factors, the difference persisted," said
Marian F. MacDorman, a statistician with the Centers for Disease Control
and Prevention

and the lead author of the study.

"This is nothing to get people really alarmed, but it is of concern
given that we're seeing a rapid increase in Caesarean births to women
with no risks," Dr. MacDorman said.

Part of the reason for the increased mortality may be that labor,
unpleasant as it sometimes is for the mother, is beneficial to the baby
in releasing hormones

that promote healthy lung function. The physical compression of the baby
during labor is also useful in removing fluid from the lungs and helping
the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like
possible cuts to the baby during the operation or delayed establishment
of breast-feeding, may also contribute to the increased death rate.

The study included 5,762,037 live births and 11,897 infant deaths in the
United States from 1998 through 2001, a sample large enough to draw
statistically significant conclusions even though neonatal death is a
rare event.

There were 311,927 Caesarean deliveries among low-risk women in the
analysis.

The authors acknowledge that the study has certain limitations,
including concerns about the accuracy of medical information reported on
birth certificates.

That data is highly reliable for information like method of delivery and
birth weight, but may underreport individual medical risk factors.

It is possible, though unlikely, that the Caesarean birth group was
inherently at higher risk, the authors said.

Dr. Michael H. Malloy, a co-author of the article and a professor of
pediatrics

at the University of Texas Medical Branch at Galveston, said that
doctors might want to consider these findings in advising their patients.

"Despite attempts to control for a number of factors that might have
accounted for a greater risk in mortality associated with C-sections, we
continued to observe enough risk to prompt concern," he said.

"When obstetricians review this information, perhaps it will promote
greater discussion within the obstetrical community about the pros and
cons of offering C-sections for convenience and promote more research
into understanding why this increased risk persists."

There aren't really enough facts here, Pupuce, to analyze the article. For example, if a vaginal birth went wrong and ended up in emergency section for a woman who was originally diagnosed as low risk, is that a caesarian statistic or a vaginal birth statistic? My view is that it belongs in vaginal births, but that isn't usually how it's reported.

Also, what do they mean by "voluntary" sections? Is that like an "elective" over here? Or does it mean an elective with no medical basis at all?

And how have they defined "low risk" mothers?

The claim that vaginal births are safer for mother and/or baby is most certainly not without opposition in the medical community. I'm sure I could find an article to support the other side of the coin, but I don't really have the time.

Okay, so I made the time (but I really should be working!). Here's but one example.

Second Section Safer than VBAC

Or this one.

No Extra Risk in Caesarean

Okay, must work now.

What about ceasarean section being LESS safe than vaginal births for mother?

And anyay what ever the stat there are risks in everything.,... if a section is needed then it's needed... no one is arguing against that ! You seem to think that I am against c-sections....

"Elective Caesareans should not be done until the baby's lungs have developed sufficiently or on women planning to have more than two or three children, the panel concluded. " - EXACTLY! (unless medically needed -and this includes psychological reasons)

"The report was praised by advocates of giving women more of a choice in how they deliver their babies, and denounced by opponents who say Caesareans are dangerous and overused."
THEY ARE CERTAINLY - IN THIS COUNTRY- USED WHEN WOMEN ARE POORLY MANAGED THROUGH INDUCTION!

You've got to wonder why birth centres have section rates (transfer for sections) of less than 10%! ANd the US is not at nearly 30, the UK 25!

If women were better cared for when they had their 1st baby we would have far less sections in the 1st place and these women would not be left traumatised (either from traumatic vaginal deliveries or emergency sections) and requesting elective the 2nd time around (and who can blame them !!!)
You can see Mumsnet is full of those examples... there is about 3 threads a week from women wondering if they should have a VBAC or not ! You got to question if the care they got in their 1st labour has not made them loose faith in their body's ability and the midiwves' time, skill, patience, support to help them have a beautiful, straightforward experience.

And the US is now at nearly 30, the UK 25 c-section rates!

Just to throw the cat amongst the pigeons pupuce (and I am pro nat birth, just couldn't do it myself ... I don't think even the best doula in the world would have made my babies come out without killing me) ... Haven't maternal deaths (ie dying in childbirth) rates been reduced since c-sections became more common?

I don't have any statistics ... it is a genuine question ...

Poorly managed births are such a problem aren't they. In my opinion inductions are used far oo frequently for no good reason. It's like "you've gone one day over youn edd, ley's force th baby out even though there's no eveidence that there's a problem. if you baby doesn't want to come out then we can always cut you open and haul it out that way" I just wish they would chill out a bit and not frighten women into going into labour by a certain point.

If you are very overdue I think it is sensible to have more frequent cheackd done but MOST babies come when they are good and ready. Of course everyone can quote stories which show that the baby neeeed help but that doesn't disprove the rule that MOST babies initiate labour when they are ready to come out ( as far I as understand by reading research etc.) Forcing a labour can reqally be asking for trouble.

Hi there,

I had quite a traumatic birth, Pippa was born bradycardia and i had to have an emergency section under a general anaesthetic. She was big at 9lb 7oz. They rushed me out of the room , iwas hurtled down the crridor at 90 miles an hour with doctors and midwives running beside the bed to the oprating room and given a peice pf paper to sign before they put me under.
Pippa was in the right position and ilaboured to 7 cm without much problem then everything went pear shaped.
I am scared about next time, not sure what to do, we would like 3 more kids and I don't think you can have 4 sections. I plan on having 3 more over a period of the next 8 yrs.
Anyone any idaes.

Uwila,
you say: "There aren't really enough facts here, Pupuce, to analyze the article. For example, if a vaginal birth went wrong and ended up in emergency section for a woman who was originally diagnosed as low risk, is that a caesarian statistic or a vaginal birth statistic? My view is that it belongs in vaginal births, but that isn't usually how it's reported. "

An emergency C-section would not be classed as a low risk C-section though, would it....so, would it make a difference to the sttistic in Pupuce link?

I mena post, not link, doh!

I am also a great believer that if labour would be managed differently in teh first place less interventions would be needed and the risk of first C-sections would fall and so would the number of traumatic Births, and therefore elective C-sections would be less of an issue!
What I do find sometimes confusing though is, that even a C-section that has medical indications will be classed as elective because it's preplanned...find that is not quite right...or at least it should be differentiated by saying medically elective and just elective...!
Not that it makes any difference to this thread!

I think it is ridiculous the amount of intervention that happens in childbirth, it is not surprising that so many end up in emcs.

It is obvious in my opinion. If a labouring mum was left to her own devices she would retreat to a safe place, be in the positions she wants to be, would not want people around her etc etc.

Instead at a hospital birth, you are in a strange placee, you have fingers stuck up your woo woo , a monitor strapped round your belly, a lot of the time lying on your back, people telling you when to push, your body full of drugs (I know it helps the pain), epidural - which means you cant even feel when your body wants to push. Bloody hell its not suprising woman wont dilate, their body is telling them it is not a safe place to birth their baby.

3andnomore,
I was wondering if a woman shows up, is classed as low risk at that point, then during labour it goes pair shaped and she ends up in a crash section. She was low risk to start with. But, she ended in an emergency. Is that a section statistic or a vaginal birth gone wrong?

Oh, and I agree, I would like a name to differentiate a section that is planned for forseeeable medical complications (previous section, placenta previa, whatever) and one that is simply because the mother prefers is for say a matter of scheduling her childcare.

Also, Pupuce, I think you hit the nail on the head when you talk about the quality of medical care on offer. A large reason for my planned section was a distrust in the NHS to make the right decisions when/if needed. So I saw the planned section as the safe option. I also agree with you that the NHS is too quick to head for inductions without seeking the problem first. See, we agree on some things.

Uwila...I think for statistics sake a low risk VB that ends then as Emergency C-section would probably end up in the C-section statistic, just not low risk!
But I would say that the statistics in Pupuces post were about the complete Birth, i.e. low risk from start to end...oh...I don't know...am getting confused now, lol...doesn't take much!

3andnomore, my point is whatever they used it isn't revealed in the article. So, I can't really evaluate their conclusions.

And, I really wonder what the stats would look like if all births that begin (not end) as vaginal deliveries were in the vaginal stats.

Hello Bumpsttheword, I had an emergency section with dd1, she was 9lb 10 and I was in labour for ages.

I did actually dilate to 8cm I think, but my contractions stopped, dd1 was in major distress and I was rushed in.

With dd2, I wanted to try for a VBAC, my consultant wasn't pro or against, said it was up to me but they were very supportive.

Dd2 was born very quickly, very quickly dilated in about 3 hours. I had to have an epistomy and vontouse as they didn't want me to labour for too long - she was 9lb 5!!!!

I am tall however, not sure if that makes any difference. What did make a huge difference was having a midwife BY MY SIDE the whole time, didn't have that with dd1.

That gave me a huge amount of confidence.

Good luck in your decision, tbh you can get advice all day long but what you want is what matters.

xx

also, recovery was far quicker than section and everything still works .

remember you will have your other child to look after as well which will be hard after a section.

x