vbac or elcs

[natharley11]

so long story short I changed hospitals new consultant has suggested a vbac and not gone straight to elcs which previous hosp did

her suggestion was
a vbac if spontaneous labour and elcs booked 39/40 weeks

or vbac but with careful monitoring strict birth plan

think we leaning towards option a as wary going as overdue as with dc1 10 days over and 9lb 6 which ended up as emcs

anyone any advice im torn as to what to do don't want end up with two emcs xx

I went 10 days overdue with DC1 and ended up with an EMCS after a failed forceps delivery.

I had an ELCS with DC2 - it was all too raw and I was scared of labour and especially of another traumatic section. On reading the RCOG and NICE guidelines, ELCS seemed a very valid choice (slightly safer for baby, slightly riskier for me) and my consultant was happy to agree.

I'm now expecting DC3 (imminently!) and for whatever reason am keener to try a VBAC than I was with DC2. So I've booked an ELCS for bang on 40 weeks, and have agreed that if I go into labour before then we'll cautiously go with it. In practical terms this means continuous fetal monitoring, baby's head coming down, and proceeding to a section if at any point labour does not seem to be making good (not just 'adequate') progress. It really helped me to talk through my first labour with my consultant. I always thought that it went badly wrong at the end (and am - and was with DC2 - very keen to avoid another full on emergency section). But the consultant explained that, applying the tests he would for my VBAC, he'd have proceeded to section at 4/5cm, the point where labour first seemed slow and a drip / ARM was suggested. This would, although technically an EMCS, be far less traumatic than a section at fully dilated.

I think what I'm saying is that both a repeat section and a VBAC are valid choices, but reading up a bit more, and talking through your personal history in more detail, might help to clarify your thoughts? With both DC2 and DC3 I've actually managed to get to the position where I'm fairly clear about what I'd ideally like to happen, albeit that I've made very different decisions.

thank you that really helps.
I think i will be discussing more with midwife on Friday
think in principle I would like a vbac as long as monitoring. With the section booked for 40 weeks

Its difficult isn't it. I had the choice of Vbac or elcs this time and have gone with Vbac. I had a traumatic labour of 43 hours, failed to progress, had blood clotting complications, synto drip with no epidural as it was too dangerous for a spinal bleed as my platelets were too low, then almost ended up with a GA in theatre but in the nick of time anaesthetist agreed a spinal but it all became an emergency as DDs heart rate had dipped to 70 and they had to get her out. I was thoroughly exhausted by that point and very emotional and had lost the plot with all the goings on.

Consultant said this time I've got a 75% chance of having a successful Vbac. I just don't want to be in that 25% that ends up with another emcs but staying on the positive side, I would love a Vbac this time.

The plan is consultant will see me at 40+5 and if I haven't gone into labour by then she'll book me for ELCS at 41 wks. If I do go spontaneously she'll give me 12 hours of established labour and if I haven't delivered then it would be emcs. I clarified what she meant by that at my 36 wk apt last week and she said it will be more of a reassess at 12 hours. If im 9cm she wont be whipping me off to theatre for an emcs but if I haven't progressed well enough at that point then it would be a section.

Im going to at least try a Vbac and see what happens. Just need to keep my fingers crossed that its successful. I do keep swinging between maybe I should just be done with it and have an elcs but no I think I will just stay positive and try Vbac.

this is soo helpful im hoping for vbac esp with a 3 year old at home recovery be better
but im a bit concerned as to what monitoring would be
last time gt 10cm thwn ended up with emcs as bby distressed due to getting stuck

I had an EMCS (undiagnosed breech), followed by a VBAC. There was no medical need for me NOT to have a vaginal birth, if you see what I mean, and I wanted a quicker recovery time, among other things. However, I was booked in for an ELCS if I went a week overdue, because I didn't want to be induced. That was because of the (small) increased risk of scar rupture, and I was worried that more intervention would lead to a higher risk of ending in EMCS anyway. I was told that they can't induce for VBAC - they would never use a pessary, only breaking waters and a low level drip.

Have you read the VBAC Handbook (you can get it on Amazon)? It's quite informative, and had lots of VBAC stories.

I was advised to have continous fetal monitoring, which I was worried about because I didn't want to be 'strapped to a bed', even though I was happy to be monitored. Some hospitals have telemetry monitors (wireless, waterproof) so you can move about and use a pool. In the end, I got the last room going at my hospital so they didn't have any left, and I laboured with wires attached while leaning over the back of the bed... BUT it was totally fine, and I wouldn't change it at all. And rhe difference in recovery was AMAZING - honestly, the fact that I could get up and shower afterwards was amazing, if you see what I mean. And of course, it's easier when you get home to your older child.

Good luck with whatever you decide.

Remember that a "75% chance of a successful VBAC" just means a 75% chance of the baby coming out of your vagina rather than via ELCS. Of that 75% who avoid an ELCS by having a vaginal delivery there will be proportion who have forceps/ventouse/serious tearing or other injury etc or who generally have a traumatic experience, and who don't regard their VBAC as being "successful" but instead wish they had had a section instead, but are nonetheless classed as VBAC successes for the purposes of the stats outlined above.

I think that the 75% chance thing also applies to first time mums, at least that's what I was told by my consultant, so you're not necessarily more likely to end in an EMCS just because you've had one before, although the reasons why you had one may have some effect.

Pig of a choice isn't it? I ended up going for ELCS instead of VBAC as my first went to EMCS (and PPH...and baby in SCBU...so did NOT want a repeat) as his head was too big to even descend into my weeny pelvis. I had lots of growth scans with DS2 and I kept mental note of DS1's head circumference at birth. Four weeks before D-day, DS2's head was the same size as DS1's at birth so I figured it was a non-starter, plus he was obligingly transverse which made the decision even easier. Right choice in the end, because DS2 (9lb 6.5oz) was even bigger than DS1 (9lb 2oz) so would have ended up as another EMCS.

If your first baby got stuck I'd be wary of VBAC for the same reason in your case. I tried very hard to not let the convenience of a known ELCS date interfere with my decision. Yes, it's easier when you already have a small child, but I don't think it's appropriate to use that as a factor when deciding on VBAC vs ELCS.

Oh, and if you do go for ELCS, the recovery is MUCH quicker than after EMCS. I was a wreck for weeks after the EMCS, but driving and lifting my two year old again three weeks after my ELCS. Totally different beasts.

I had an EMCS for DS1 and chose the VBAC route with an ELCS booked for 40 weeks. My labour started and after 7 hours with no progress and contractions every 2/3 minutes, I went on the section list and by 1pm (another 4 hours later) when I got to the top of the list, I was still only 2/3 cm so had the section. Definitely the best decision I made as baby turned out to be back-to-back.

My main reason for choosing VBAC was the scar tissue risk from repeat sections and as it turned out a consultant had to do the second section due to the positioning of the scar tissue from my first.

thanks for all your advice after lengthy discussion with midwife . decided to go for vbac if spontaneous labour and if goes over book an elcs to avoid big babies that difficult to deliver

I would have just grabbed elc by both hands, then its all planned and contained as it were and very little is left to chance for things to go wrong. its safe and calm....

Taking McMuffins point I booked an ELCS at 39 weeks after much agonising - devil I knew and birth notes from dc1 (spontaneous labour at 39+1, failure to progress, EMCS) indicated small pelvis. I was give 50:50 chance of another EMCS.

In the end my waters broke at 37+1 and I had a much faster labour. Was almost fully dilated by time theatre was free (DH reckons I was being managed towards VBAC though), encouraged to keep going and I did. Continuous monitoring, baby kept blipping so was monitored with a clip on her head and 'successful' vbac with forceps. She was only 6lbs7oz so I reckon she would have also been stuck had she been a 1lb heavier like dc1.
It was 12 weeks before I could walk normally, I was v swollen and bruised internally. Initially euphoric at having 'done it the hard way' I soon wished I'd had the planned ELCS. Yes it hurts after but just in a different place and you spend a lot of time sitting with a newborn.

There's no right answer but it's wise to read up on both options. I'd assumed the Elcs was a given and done no prep for natural birth