Vbac vs cs: can you

[PollyParanoia]

Hello I'm 38 weeks pg and still haven't decided what sort of birth to go for. Change my mind on a daily basis and am getting quite irritated at my own indecisiveness.
Ds born 2 and a half years ago by em cs. I was fully dilated, failed ventouse, a bit of foetal distress, blah blah. Found cs recovery to be surprisingly quick (was cycling into town three weeks later, which looking back was a bit idiotic).
Anyway was all gung ho about a vbac and have very pro-consultant, but then his underling doctor was saying to me "what you really don't want is an em cs at full dilation" (and judging by quick dilation first time round is what I'd end up with if it came to a cs).
Anyway, it seems to me a successful vbac is the "best" I can hope for, followed by a planned cs, followed by an emergency. Oh, and a nasty vbac with loads of tearing is I think for me the worst option given that I've already got my cs scar, why have another somewhere else. What I don't know, in terms of safety, recovery, discomfort, is where these births come on a scale. If an elective is way better than an em cs and not much worse than a vbac, then that's an appealing option. If a vbac is way better, then I should go for it etc, etc.
It's such a blooming difficult decision without the aid of a crystal ball.
Arggh, Pol
ps have another consultant's appt on Monday to make final decision. They are being very patient with me. Oh and dh's work means that being on time or early would give us much better paternity leave. Plus he would much rather I have a planned cs as found the whole first birth terrifying.

Consultant is resolutely pro-vbac and believes that there's no reason for me not to have one (though I can push for an elective). If it weren't for him, I think I'd have decided on an el cs months ago for the reasons so brilliantly put by uwila.
Anyway on Monday, he's going to feel my stomach to get an idea of the lie etc and we'll go from there. I will try not to let the fact that he's so good looking he should be in ER get in the way.
Pol

polly...you have to do what is right for you.....we can all tell you our experiences of VBAC & c.s...but you will know what is right for you

i almost changed my mind at 34 weeks.....and was going to have an elective....the FEAR of giving birth was scary..but i addressed the fear....and am sooooooooo glad i did. i don't think Uwila and i will ever agree...but her reasons for c,s are valid......as is toady's list against...

let us know what consultant says re the lie of LO and hopefully what you have decided!! if you want to share that with us !!!

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I too have to make this decision and am facing all the same dilemmas. I have decided to try for a VBAC but not if I need to be induced. In that case I would have a planned section. My first section was because of placenta praevia though so I don't have the bad experiences which must be tainting your decision. It would almost be easier if the doctors forced you one way or the other!!

I just want to clarify that I didn't tell her to flip a coin lightly. It's more of a turn of phrase. She seems really indecisive (sp?)

Polly, you need to make a decision and roll with it. You can't see what is going to happen. Go with your gut instinct.

point taken MKG...

I am unbelievably indecisive! Though also think it's one of those decisions that the more you think about it, the more murky it gets (as opposed to going with whatever your first thought was).
AmyP, I agree with you re. induction. And as you'll know whether the placenta praevia happens again (hope not), then it should make your decision a bit easier.

I just wanted to balance QueenofQuotes's experience against someone else's. My best friend had a VBAC last year and bitterly regrets it, as she had a forceps delivery with a third degree tear and is still having hospital visits and physio now to repair the damage (baby is 9 months old). She feels she was "bullied into it by the medical profession", and wishes she'd gone for an elective.

What I would love to see, and have never managed to find, is some real research on the percentage of women who are glad they went for a VBAC and those who regret it. Obviously lots of women like QoQ had a good experience and are delighted they managed it, but I've also heard the other side of the story from quite a few people.

Polly, the statistics I do know are that of all women who have a first birth by cs, only 25% attempt VBAC for their second. Of those 25%, about one third end up with an emergency cs anyway.

and 2/3rds have a succesful VBAC.....!

I think your state of mind has a lot to do with it. If you are nervous about a VBAC or doing because you think it is the right thing, rather than what you really want to do then you will not be feeling as positive as you could be and this will surely affect you physically. Better to be positive about whatever decision you make and then psychologically you will be in a better place to recover from the section/have a successful vbac.

hi polly, I could have written your post. Vaccillated loads too but in the end, plumped for elective. Now 7 weeks since ds was born, I have no regrets. 95% recovered after 5 days and you wouldn't dream I have had "major surgery" less than 2 months ago.

Yes, you probably have to write off the first week, but with an elective, you can plan the support from your dh and others, which you won't be able with an emergency.

I am no medical expert but the risks of an emergency over an elective must naturally be higher ie no theatre with scrubbed up anesthetist and full surgical team ready when required, risk of mistakes (the bladder, colon could get accidentally cut), you could end up with GA and its higher risks. Plus you are already knackered from labour and so makes the recovery harder.

Comparing my elective with the emergency, wow, what a difference. The team was chatting with me, baby delivered onto my chest. With the emergency, I signed my consent form lying down on the operating table with the last words being, "we don't have 15 min for a spinal" before I blacked out under GA.

For me, the worst case scenario was as the underling described, fully dilated, baby descended, failed forceps, ventouse, epi cut, em cs, baby pulled up and out. Double whammy.

Compare that with the chances of a successful VBAC. Best chance is if you are allowed to labour according to your rhythms. Check your hospital policy on monitoring and time limits on labour. The midwives at my hospital were very encouraing on VBAC and I was almost seduced into one ie they said I could have water birth with intermittent monitoring if all was well. And that the risks of my worst case scenario were very very low.

But anecdotally, I did not believe the statistics. And in hindsight I made the right decision. The hospital was so busy around the time I delivered they had at one point 4 women delivering in the same room! Another mother who wanted a birth pool (SPD) did not get one because the midwives were too busy to clear it up and check her dilation in time before she had to push anyway. So the hospital can promise the earth when you have your consultation but they may not eventually deliver on those promises.

The consultant also said that I could always refuse a forceps/ventouse epi. But that is not a "real" choice. The doctors only have to say that your baby is in distress, and I think you will agree to anything they suggested at that vulnerable point.

I certainly think the doula is an excellent idea if you want to maximise your chances of a successful VBAC. I would have wanted a home birth as well but for the fact that I could not in all good conscience put my ds at risk if the minuscule risk of uterine rupture materialised.

FWIW my brother who is an NHS doctor agreed with my decision. But then, he might just have been trying to be supportive!

that is very true Amy.....

BUT.....doing it becasue you think you should is different to not doing it because you are scared....IFYSWIM....the point is,the fear can be addressed....

doing it becasue you feel you should is a different mind set...and not the right one for a VBAC....absolutely.....

polly, sorry for that long post.

The bottomline is: do you trust your body? And also, do you trust that the hospital will let you trust your body?

The answer to the first question for me was "maybe" but to the second is "no". But you have to make the right decision for yourself.

My brother (Dr) said that the women who tended to deliver vaginally with the least problems tended to be those that did not think too much. Just an observation he made on his O&G rotation, not necessarily true. That was not me lol!!

those who did not think to much??????????

but i think your post is really relevant,,,

and it is about risk and managing that risk...it is a calucalted risk , having a VBAC. but so is a C.S, emergency or elective...and birth generally........

the risk of rupture is small...but real...but it was for me, a risk worth taking.......and i thought a lot about vaginal birth...and researched it throughout my pregnancy..so i could understand the birth process....had a straightforward vbac.....3 1/4 hour establisehd labour and 2 stitiches.....

sorry lulumama and to all you impressive ladies who have had successful vaginal births - I meant "did not agonise too much over the what-ifs"! ie trusted their bodies

sorry lulumama and to all you impressive ladies who have had successful vaginal births - I meant "did not agonise too much over the what-ifs"! ie trusted their bodies

It is like someone telling you about a movie. It is never the same as going to see it yourself. In my experiences with EVERYTHING, no-one else's opinion of a situation has ever been the same as mine.

In short, the only person who can make the decision is you and everyone else's opinions and experiences are really irrelevant.

ps. not meaning to trivialise birth by comparing to movies..

I get the whole thinking too much thing. I tend to think about things so much that I go crazy. In the end there wasn't that much to think about.

When I was expecting my second a consultant I had never met scared the life out of my giving me all the statistics for what could go wrong. I also had a higher risk of scar rupture than the "average" previous section, but it was still low. The op was booked for 5 days over due. I saw my consultant and also the man who had resutured my scar 15 months after tha birth, and told him I didn't want a section. He said "well don't have one then". I cancelled the appointment and my daughter was born naturally 6 days late.

amy - i agree..up to a point.....but our OPINIONS of VBAC or c.s are helpful ( i hope) and useful as a compare and contrast

after all, i see plenty of films becasue they have good reviews......

and blushoes ...came out better the second time! LOL!

HI Polly, if you are 38 weeks now, how would you feel if you went into labour today? Would you be phoning the hospital saying you wanted a cs or just happy to sit it out at home? This is a difficult one I know, I booked an elective cs with my DD for T+14 as she was breech and I deffinatly did not want to be induced, I went into spontaneous labour at T+10 and whilst all the way through my prgnancy I wanted a vaginal breech birth I panicked and found myself saying "I don't know what to do, I was supposed to be having a cs in 4 days!" not "oh good I have gone into spontaneous labour just as I had wanted!". I think having an option can sometimes be a bad thing, it makes you doubt your choices, your damned if yu do and your damned if you don't. Sure a cs when the baby's head is in the pelvis can be more difficult, but you should talk this through with your consultant. As a midwife I have been into many cs where a babies head had to be pushed back up into the abdomen vaginally, I really don't think an obs should be "swinging" on a baby's legs to get them out. Pushing the head back is done very gently and I have not seen any evidence of trauma to babies or mums through that procedure. I think what you want to avaid is any intervention with a VBAC labour, just like a breech, either it will happen or it won't, no induction of labour, no syntocinon drp, no artificial rupture of membranes and I would say no ventouse or forceps (but that is a very personal choice). The one good thing is that no one has jumped in to offer you an elective cs prior to 39 weeks as this increases the risk of respiratory distress syndrome for your baby, likewise, going into labour, even if you choose to have an elective cs, will reduce this risk further. Good luck and best wishes for the next few weeks.

Polly, maybe you could go through your notes with a m/w or the Hospital, anyone who may could clarify what exactly happened the last time...that should then make it easier to make an informed decision...saying that, your proper consultant is, if I remember right, in favour of VBAC , which makes me assume that whatever it was the last time, it's not somehting that he/she finds will necessary reoccur, iyswim!
Uwila...but her consultant is in favour it was the Underdoc/g...that wasn't...and who knows what sort of and how much experience that one actually has?
Blueshoes...not all Emergency C-sections are "TRUE" emergencies, though...mine is classed as an Emergency section, but they had time to give me a Spinal, time to try the ventouse and then proceded with teh C-section...my son was never in distress neither, and I was physically in no distress (well..o.k. was in labourt but you know what I mean....)...and I assume with a trial of labour it would be pretty much the same thing, because they would intervene usually well before there is a risk for anythig to go wrong (well, that is my understanding anyway)
Oh, and incidently I can say I sort of agree with that Brother of yours...es...just sort of let it all happen and was very opnenminded...had I had a C-section then, I don't think it would have mattered to me all that much, with ms, was slightly better informed, but went all in all wiht the flow, brilliant Birth again, better then the first one even 3. child, all the info in the world, adament to get my Homebirth and ended up wiht a rubbish experience...hm

OK, I'm back and calm now - god my hormones are raging!! Anyway, just to add that we have to consider all the risks associated with a natural birth, not just the risks of a rupture.

Also, just want to point out - maybe I'm just too detached about this, or just a bit sceptical - but having the right attitude - being positive and all that - doesn't guarantee a safe and positive birth. Actually, it increases the chanced of being very dissapointed or depressed if things don't go to plan, because of the feeling of failure. It hurts a lot more if you fall from high up, iykwim.

Was I positive about my first birth? Yes, so much so that I never actually thought I might end up with an em section. I even skipped the pages in the books about c sections cause I thought it wouldn't happen to me, I was so confident about the birth but still, shit happens. And it's not because of a lack of confidence, or negative feelings, or lack of preparation, or because you're scared... hands up who on this board has given birth without being scared? Or nervous? All this 'do you trust your body' thing I really can't connect with... For me what works is rational thought, pros and cons, risks on both sides. Not 'be positive about your body'.

BBP, know what you are saying...with ys , after 2 natural more or less straight forward Birth, I only put in the bits about transferring into Hospital and even C-section to be on the safe side...never in my dreams would I have ever thought it happen to me...I was so well informed and did trust my body, etc...no good if the m/w's don't though, I suppose.....and I definately say that my trauma came from completely being unexpected and well, so not what I wanted!
If, which I don't plan, lol, I have any more Kids, I will go for Homebirth but I will prepare myself mentally for everything....and will try to feel like I just gonna go for this, but keep all my options open...

Hurrah, Blueberry's back. As am I - talking of film reviews just went to see Little Children as a wee "I'm never going to get to go to the cinema again" prenatal treat.
Gosh so many interesting and thought-provoking comments. Like the one from Blueshoes' brother about those who angst too much - sure there's an element of truth in that.
But perhaps most persuasive was snugglebum's. If I went into labour today, there's no way I'd be asking for a cs, I'd be going for a vbac no doubt. So what's the difference in two or three weeks time? Hmmm not sure, I think I am fearful of being overdue and the associated risks of that. Think, pending consultant's comments on Mon, that I'm going to ask for a cs for some time in the week after my due date and leave the rest in the hands of fate. Bit of a half-assed compromise, but all options are kind of compromises in a way.
Whatever I go for I'll report back because I think as has been said on this thread, there needs to be more about the postnatal responses that women have on their decision to go for a vbac or not.
I am hormonal too, blueberry. It doesn't with trying to rationalise a very emotional issue.