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.

Can I just throw another element into this discussion....late antenatal Bully/scare tactics...now, I do know they definately happen, over and over an over again if you plan a Homebirth, but am pretty sure it's the same for VBAC...this means, they go pretty much along not arguing or anything until pretty late in pg, and then the comments keep coming to get you where "they" want you...i.e. make you insecure and unsure of your choices, etc...very difficult situation!

This is true for me, after so much planning and research for my VBAC2 I not sure what would have happened if it ended up in another section. I would like to think that I would know that I had done everything I could to have the birth that I wanted.

Hello BlueberryPancake, glad you are back.

hi blueberry. i agree with a lot of what yo have said

being positive and beleiveing you can give birth is a part of it.. a positive mindset is important....aswell as teh rational side of things

i learnt so much about the physiology of labour when i was prepareing for my VBAC...so i understood how & why birth happens, how it can not go to plan and how you can help yourself acheive a vaginal delivery.

connecting with & understanding your body, and the massive changes going on and how the baby is actually born can help.

your body is involved...you need to believe your body can birth IMO. If you go into it thinking you can't,and being afraid and scared....how can you go on to have a positive birth?

i am more than happy to talk about my post natal repsonse to my VBAC...and i am sure that for some, a VBAC was not what they wanted or expected.

Polly - your compromise sounds good....! and certainly positive....

My heart goes out to PollyParanoia - I wish you well whatever you decide. There's a vast difference between someone 'too posh to push' and the choices you are facing at present.

Referring back to an earlier point in this thread - I delivered both mine vaginally without so much as a tear. I don't believe that the fact that I was lucky enough to be able to do so has anything whatsoever to do with my IQ!!!!
(I'd like to think of myself as intelligent and articulate - and I can assure you that I 'think' on a regular basis!)

No - I was fortunate, that's all.

Everyone will give advice based on their own experiences, but pregnancy & birth are such a lottery. Go to your appt on Mon armed with questions based on what you have learned from this thread and then take the advice of your consultant. He knows the precise circumstances of your case and is best equipped to support whichever choice you make. LOL xxx

I was thinking about this last night and ended up wondering if the heart of the matter was very simple. Natural birth carries certain risks, especially for the baby if things aren't going well. C-section risks are almost totally to do with the mother with a few for the baby. So I was wondering if it just came down to the fact that a c-section would almost completely ensure no birth problems for the baby whereas if something went wrong with a VBAC something could happen to the baby and to give that kind of birth a go means that it was through the choice of the mother that something bad happened. Whereas if something bad happens with a c-section at least a mother knows her baby is safe.

Hi, haven't got time to read the whole thread, but I was deliberating the same kind of questions 6 months ago, so I thought I'd tell you my story:

DS was born 3.4 years ago by emergency cs, following a long, traumatic labour, syntocinon drip, meconium in the waters, etc. He was fine, and like you I recovered very quickly.

When I got pg with DD, I was very much up for a VBAC, did lots of research, was very determined to refuse having a canula put in, only wanted intermittent monitoring, blah blah. I thought I was in for yet another long labour, but boy was I wrong!!! Arrived at the hospital fully dilated, no time for discussions, couldn't care less about whether they monitored or not... After about 1.5 hours of pushing DD came shooting out with her hand up next to her face, giving me a 3rd degree tear. Was stitched up in theatre, felt fine and happy for a few days, then the problems started as I got more and more constipated. Was in absolute agony, got readmitted to hospital, lots of enemas and stuff like that, nothing worked! An absolute nightmare compared to recovery from cs, very traumatic as well for DS who couldn't understand what was going on (he's autistic). After 2 weeks I was finally able to go to the toilet, and then got better quite quickly. My bits still don't feel quite right though.

All in all, I'm v proud I had the VBAC, but if I had known what would happen, I'd have had a planned cs. BUT I do realise I was very unlucky with the 3rd degree tear, the risk of that was quite small, but if the baby decides to come flying out like superman, there isn't a lot you can do to prevent tearing!

But that's not quite true Goblinqueen - there are risks to the baby in a c-section, there was research published quite recently that suggested that vaginal birth was actually safer than c-sections for babies themselves. Babies delivered by c-section can be at risk of respiratory distress and at risk of scalpel injuries as well as the long term effects which aren't well understood at present, but may include an increase in allergies.

I also don't think the risk to maternal health is something to be taken lightly, particularly when you have other children to consider who, to be brutal, are probably more likely to suffer if they lose their mother than if they lose a sibling.

I say this as somebody who has done both - two elective c-sections and then a vba2c.

I think we can probably disregard these scalpal injuries if we just check beforehand that the surgeon isn't going to use a lawnmower for the procedure.

And I think that junior doctor had a point about how it would be worse if the baby was so far down that they would have to pull the baby back. And "yike" to the story about the surgeon in her last procedure have=ing to brace herself against the table to pull hard enough to get the baby out. Seems a valid point to me.

Hi Polly

Haven't read whole thread so don't know if Toady is on here but she really is the best for VBAC advice. She was great when I asked the same question and pointed me in the right direction for advice and help. Tried for a VBAC (DS is 7wks) but my scar started to open so had EMCS. Actually a good thing in the end because DS had a True Knot in his cord and would have been stillborn had he of been born naturally!!

Whatever you decide just remember you are going to have alovely baby at the end of it so does it really matter how he/she comes out??

FB x

Hi, I've joined the discussion a bit late and haven't had time to read all the postings, but am in a similar position to PollyParanoia. I'm 30 weeks pregnant, having had an EmCs almost exactly a year ago (foetal distress at about 4cm dilated - cord round neck, as it turned out). The recovery was reasonably quick, but my main worry about having another CS this time around has been the recovery time - I'd be interested to hear how other mums have found it with a small toddler. I was lucky last time as my partner was at home during the whole recovery period, but may not have that luxury this time around, and of course, a newborn isn't quite as heavy to lug around as a 14-month old...
My consultant has encouraged me to go for a VBAC and I'd like to do so if at all possible, but in the end of course it's what is best for you and the baby, PollyParanoia. Of course an EmCs isn't the ideal, but my impression is that if you went for a VBAC, they probably wouldn't let you get too far before intervening, in which case it mightn't be quite so distressing for you as your last experience?
If it's of any interest, my yoga teacher, who's also a midwife, told me that the risk of rupturing the scar with a VBAC is actually pretty low - about 3%.
Anyway, best of luck with the decision

Much lower than 3% MidnightExpress - 0.35%

The NICE website says it's 0.5% if you've had one cs before, and a bit more if you've had more than one.

Hi - mother of 2 DSs. First born by em-C section nearly 4 years ago and had a planned C-section for the second. My planned section was a fantastic experience and put to bed (so to speak) many of the demons after the first. As for coping afterwards with a 2 year old and newborn......I managed 3 weeks with husband and mothers help and then was left to my own devices (was out and about at toddlers groups etc by week 3). A friend of mine opted for VBAC and her recovery went on for 6 weeks....she did say that in retrospect she should have opted for elective c-section. However....everybodys story is different and its all a bit of a lottery I think. Good luck with whatever you decide!

There might be respiratory problems, for babies born by c section, because their little lungs haven't been squeezed in the birth canal and they have lots of liquid on their lungs. Apparently, it might cause longer term breathing problems as well. And then there are the hormones - if the mum doesn't labour, some of the hormones don't kick in straight away and breastfeeding might be more difficult, PND is higher in cases of C sections, so loads to consider...

I spoke to a midwife friend yesterday and she told me that hospitals now have to follow new guidelines to encourage VBACs, but not all hospitals do. So the rate of women choosing a VBAC might increase, which I think is good news. Also, many hospitals have a policy not to book VBACs before the 36th week of pregnancy (unless there is a very serious cause for concern such as diabetes).

She also told me to STOP WORRYING about it - she's so right, I'm only 17 week pregnant - and to enjoy the pregnancy! There are two reasons why I might opt for a planned C section at a later date - the size of the baby, and if I go overdue which I really can't control. First baby was a big boy and one of the many reasons why I had an em section is because it was a very 'tight fit' as the consultant said - my pelvis wasn't large enough. The other reasons why I had a section is because of foetal distress and the baby's position, which is unlikely to happen again.

Just made boohbooh in previous email, I wrote: "not to book VBACs before the 36th week of pregnancy", what I actually meant is that they don't book a planned c section before 36th week of pregnancy.

BlueberryPancake - that fits in with what my consultant has said - I've provisionally said I want a VBAC, but I have to go for a review at 35 weeks.

And yes, I'm sure you're right that it's best to get on with enjoying the pregnancy in the meantime. I remember with my first I kept on worrying about the birth plan, then finally wrote it the night before my contractions started, and ended up chucking it in the bin anyway as they wheeled me into theatre for the EmCS. So much for the birth pool with gas and air!

Blueberry, I agree with all the risks of cs you listed.

But a planned cs at 39+ weeks in polly's situation is much less likely to have such problems bearing in mind the statistics include em cs (where baby in distress, mother already tired, possible traumatic failed ventouse/forcep, hence impact on breast feeding and PND) and planned cs before 37 weeks due to problems with baby or pregnancy (hence respiratory issues).

Yes Blueshoes, I understand what you're saying. I thought that some of the resp problems (immediatly after birth) could be due to the fact that the liquid on the lungs doesn't get squeezed out as in a natural birth... Has anyone seen on TV/heard about a hopspital that offers 'natural c sections' (bit of a contradiction there???) ? I think I saw that on a daytime TV show. Basically, the surgeon cuts the belly open as per normal c section but instead of pulling the baby out, the surgeon leaves the uterus to do the work and push the baby out. During this process, the liquid on the lungs of the baby is squeezed out and there is less risk of respiratory distress immediatly after birth... I wish I'd remembebr which TV show it was!! Does it ring a bell with anyone?

the respiratory factors are the same for emergency & elective i believe...as the baby has not had the fluid squeezed out by the journey down the birth canal and also doesn't get quite the same stimulus to breathe.......and the scalpel injury is a factor not mentioned by many docs,, but it is a real - tiny- but real risk....as is the risks in any surgery....

I am in a similar situation as could have gone for VBAC if I chose to do so. For me, going through 30 hours of labor and ending up with an emergency section with ds was so traumatic that I did not want to chance it again. Plus, although I know the risk of uterine rupture is small, again did not want to chance it.

Having a planned section has been very calming for me. I know what to expect, in general of course, and it has taken a lot of the focus off of the "birth experience" and put it back on the baby. I was wayyy to far the other way with ds. I think actually it has helped me to bond much more with this baby in utero as I'm just not really thinking a whole lot about the birth process, just him.

Scalpel injury is a risk, of course... in my experience, with a failed ventouse extraction, my son was born with a huge black bruise on his head and they tried so hard to pull him out (and twist him) that the skin was ripped in places. He's one year old now and there's no hair growing in patches where the ventouse ripped the skin. I know, it's so hard to compare the risks associated with both and god I wish I had a cristal ball to see if a VBAC would go well, but i guess you can't compare them really.

jabber, I would add that knowing I had the choice of cs and likely to take it made my 2nd pregnancy much more carefree. I barely dwelled on the birth whereas for my first, I read up obsessively on birth stories but in the end, my detailed birth plan was not worth the paper it was written on.

absolutely bluebwrry..i am sorry you and you LO had such a horrible time... i did post earlier down that there are risks inherent in birth - vaginal and caesarean...we have to weigh up those risks...taking into account other womens birth stories if we want to..and teh advice of our doctors and midwives..and do what we feel will give baby & mother the best outcome.....

maybe i was lucky....i KNEW i wanted to go for a VBAC.. i had a really great experience...maybe through luck, maybe i was prepared due to the amount of research i did....i'll never know!

and that's the issue...none of us can guarantee if you make choice A the outcome is guaranteed to be x,y & z.......

whatever Polly chooses...it is her choice , right for her and will not be the exact same experience any one else has had...

we can offer our opinions, stories & statistics, but Polly will make the choice that is right for her...and that is the best choice.

Risk of scalpel injury - so basically 17 in 896 caesereans

Obstet Gynecol 1997 Sep;90(3):344-346
Fetal laceration injury at cesarean delivery.
Smith JF, Hernandez C, Wax JR
Department of Obstetrics and Gynecology, St. Joseph Hospital, Denver, Colorado, USA.

OBJECTIVE: To investigate the incidence of fetal laceration injury in cesarean delivery.

METHODS: A retrospective review was conducted using a computer-based data coding system. All neonatal records were reviewed for infants delivered by cesarean during a 2-year period. Maternal records were reviewed in those cases of documented fetal laceration injury. The Fisher exact test was used when indicated.

RESULTS: There were 904 cesarean deliveries performed during the study period; of these, 896 neonatal records (98.4%) were available for review. Seventeen laceration injuries were recorded (1.9%). The incidence of laceration appeared higher when the indication for cesarean was nonvertex (6.0% versus 1.4%, P = .02). One of 17 (5.9%) maternal records indicated the presence of the laceration of the fetus.

CONCLUSION: Fetal laceration injury at cesarean delivery is not rare, especially when it is performed for nonvertex presentation. The minority of obstetric records show documentation of such lacerations, suggesting that this complication often may not be recognized by obstetricians.

we can offer our opinions, stories & >statistics, but Polly will make the choice that >is right for her...and that is the best choice.

(round of applause from Toady)

I just am appalled (sp?) at the lack of information that woman are given by consultants, midwifes, etc how can anybody make a fully informed decision on what is best for them.