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.

blueberry, what you described is a "natural cs" ie the uterine contractions push baby out of the incision rather than surgeon tugging away. I think you need to be in labour for that so not a true scheduled cs as such.

Try telling that to your bogstandard NHS doctor ... I did not raise it lol.

Yes, it is true about the fluid not being squeezed out of lungs by passage through the birth canal. I haven't heard of a cs in which this was a problem and the hospital can always suction out? baby might be chesty for a few days but it sorts itself out. I would be more concerned about lasting injury to baby through ventouse/forceps than fluid in lungs tbh.

This is obviously a sensitive subject so I hope I don't offend anyone.

I had my first DD via em c-section under a GA. I was in full blown labour and pushing like crazy but DD needed out quickly and they couldn't get a epidural in. It felt pretty traumatic because it was also very quick. There was no time to gather thoughts between contractions or even process it all.

When I got pregnant with DS I talked to the hospital and the midwifes and the support service they offered post delivery. I decided that I wanted to go for a VBAC this time although I was terrified it could end up in the same way and be quicker. As my due date got closer I got more and more stressed and part of me wished I had more courage to go against those opposing elective c-sections. I went into premature labour at 31 weeks but they managed to stop the contractions. At 37 weeks I went to hospital with a bad stomach bug and they found foetal distress (not because of bug). After a second opinion I had an emergency c-section.

It was a completely different experience to my first one and I was actually relieved after it. I enjoyed the whole experience and I recovered so much quicker. So much so I only remained in hospital for 2 nights but when I got home DH then got the stomach bug. I had to clean everything down with detol/milton. I was just trying to stop my newborn getting the bug. This was on top of looking after a 17 month old. What I am trying to say is that c-sections can be so different when you aren't in labour. There are positive stories.

To all those out there, lets not judge one another for our choices. We all have our reasons and although we may have been in the same shoes they always pinch differently. What ever your decision 2nd time around you will have to deal with the unknown and I reckon that is the hardest thing.

Good luck with your decisions. Do what's right for you.

hello, me again, loving all these messages. It's such a tricky issue and one that so many of us have to go through (although judging by the reported statistics few of us go for the vbac option).
So sorry to hear Homsa's experiences with third degree tear. That's where the crystal ball need comes in. And am envious of Blueshoes' certainty in going for a cs and Lulumama's in a vbac. Although I'd be furious if I were denied the choice, it is a hard choice to make and part of me wishes that the Nice guidelines just said, eg, a vbac unless there are compelling medical reasons otherwise. If a vbac were a more normal course of events then this decision would be easier. And I suppose I have to tell myself that my chances of an em cs this time round are statistically not that different from the first time round (not that I ever even contemplated the possibility then). Although a second cs is a trickier operation due to existing scar.
Anyway, let's see what Dr Handsome has to say on Monday,
Pol
ps and very much agree with poster about "birth experience". I was far too obsessed with that first time round and every single day I've spent with my boy since then has been as important as the day of his birth in different ways.
And agree with Blueberry about how irksome it can be to feel that a perfect birth is yours for the taking if only you have a postitive attitude and some candles. I've never had a day off sick and got pg v easily and never had a day's suffering in 9 months. Then I had birth from hell, breastfeeding difficulties and, last year, a miscarriage. Unfortunately our bodies are fallable.

Polly whatever you decide at least you will be well informed, I think that is the key to feeling you have control.

By the way with all the talk about forceps and ventouse please massage your perenium and do those pelvic floor exercises.

Pelvic floor, pelvic floor... squeeze, release, squeeze, release, all together now girls!

squeezing & releasing as i type.....

perineal massage....

Don't necessarily assume you will dilate quickly with this birth. Every birth is different. I've had 3 - the first was the most natural. Gave birth vaginally with no assistance but took quite a long time (all normal though for a 1st birth). 2nd time had one dose of prostin and as I was so overdue (42 weeks), progressed fast, dilated quickly and gave birth again vaginally. I assumed the 3rd birth would be easy but labour failed to progress and didn't dilate properly, passed a blood clot and so on and ended up with a CS.

Sorry not read all messages - good luck whatever happens!

I had a planned c-section after my first emergency one. They said I had a 60% chance of success with an attempted VBAC, which they seemed to think were good odds. However, given the first birth involved the loss of three pints of blood, them thinking (twice) the baby had died and going into shock straight after birth and having to be given a general anaesthetic in order to survive, I thought a 40% chance of repeat was not worth the risk.

I'd ask what they think your chances are of a successful VBAC - it does vary from person to person, including the reasons for the c-section and the state it left you in, but I would say a couple of things about a planned c-section. It is much much nicer than an emergency c-section - you recover even faster, the scar is usually in the same place and heals quicker (basically they can plan the major operation, not rush it to keep you and the baby healthy) and the process is calm and enjoyable.

the birth of my first (emergency c-section) was easily the worst day of my life - everyone in panic, ds and I having life hanging in balance, a really amazing amount of pain (he was back to back for 36 hours), not really noticing baby except to check that he was fine before they knocked me out - I had no idea why people kept talking about the wonder of giving birth. The birth of my second (planned c-section) was the best day of my life - calm, relaxed and they passed me this perfect baby who hadn't been exhausted by failing to push himself out for a couple of days.

Evening all, especially polly. I too had to face the vbac or elective section option twice.

I had twins at 29 weeks by emergency section, then when i had dd 20mths later i was adamant that i would have a vbac at home (to avoid monitoring and general bullying by staff to follow protocals) DD was posterior and i laboured from 6am finally transfering in to hospital at 6pm after pushing for an hour and a half and developing a thick cervical lip. It was awful transfering in, but by the time i got in and the doc showed me the ventouse cup i pushed and she came out, leaving me with a very nasty 3rd degree tear. Next time i was prg i still wanted to try for a vbac but was encouraged to opt for section due to the tear and labour of dd. I again remained determined and went for a home birth, ds #4 arrived in 8 hours and i had a 2nd degree tear, ds#5 arrived in 40 mins, 2nd degree tear again. Baby #6 is due in may and i will be having a home birth again.

I was very determined and read as much as i could so i was fully prpeared. It made a big difference as i was consultant monitored and had to argue alot! I dont regret my decisions to try for the vbac's, one of my main driving forces was i knew i wanted a big family and repeat sections are so not good.

Im sure you will make the right decision for you polly, sometimes mothernature makes them for you! The most important thing is to totally believe in your decision whichever way you go as this can help you so much afterwards. Good luck and keep us posted xxx

Just to add risk of respiratory problems is approx 1: 100 for elective c-section at 38 weeks. Falls to 1:1,000 at 39 weeks.Therefore guide lines now suggest elective sections to be performed at 39 weeks. Breathing difficulties are less common in babies delivered after mother has laboured reguardless of mode of delivery. Obstertric colleagues have suggested that elective section at 39 weeks carries lowest risk to fetus, but vaginal delivery is safer for the mother. Do n't know if this will help at all obviously the risks are pretty low either way. Good luck not an easy decision to make.

My elective section was one of the worst decisions I could have made. I found it very difficult to bond with my son. I felt like I hadn't given birth.
I had no sense of achievement. You can never know what kind of birth you will have. But in my experience and opinion a successful vbac beats a section anytime.

goblin...but that isn't quite true, there are some real risk to the baby with c-section, and they are more likely to occur, iykwim...C-section is fab an option for mum and Baby if it's necressary, but that is the only time

Uwila...don't thiink that with a VBAC the hoiking would be in the equasion though.....

Blueshoes...a planned cs reviewed at 36 weeks doesn't mean it is done at 36 weeks, just a prelimary date is set, and usually they are not done before 38 weeks of pg...to make sure baby is ready enough!

hm, ys had bad bruise right on the forhead...on top...which shows that at least they didn't lie about the military position...but it luckily healed well....but felt really terrible about that....ms was born with a rather bruised nose, poor thing...as I pushed him out...going from 9cm's after 28 hours, waters were ruptured and dh finally came..he was in ni at the time...and suddenly strong contracts and wambamboolie...he was out an hour later....felt bad about that bruise too!

lulu...knowledge helps you in the build up...but I think it's mainly luck (not all) and true trust in your body that gets you there positively....saying that, had all that and it still went tits up for me with my last!

ceasarean is not just another way to deliver a baby....elective or not, it is major abdominal surgery , with all the inherent risks.

having had an emergency c.s and a VBAC... i can see both sides of the coin...until i had had my VBAC i would have said , have an epdirual, it;s great...you can;t feel anything...!

having had my VBAC with pethidine and G&A..i would not recommend epidural !! i now understand you need to feel what is happening! IMO.

don;t want this to be an epidural debate..but it is an analogy.

until you have had your VBAC..you don;t know what you are going to experience...IFYSWIM....

But i accept vaginal birth has risks too....just IMO..the risks are outweighed by the benefits many times over......benefits to mother and baby.

caesarean used to simply be a life saving procedure,...now it accounts for almost 1 in 4 births.....IMO..i don't believe that child bearing women have changed so much in a couple of generations that vaginal birth is becoming less & less possible....

again....my opinion.....but it is something i feel strongly about .

but i am not trying to force my views on anyone or judge...hence i keep saying IMO!!

3and...true trust...yes...i think i had that in the end~!

having had my VBAC with pethidine and G&A..i >would not recommend epidural !! i now >understand you need to feel what is happening! >IMO.

When I attempted my VBAC1 I had an epidural, too me it is fairly obvious that I would have had more chance to give birth if I hadn't and didn't have someone screaming at me when to push, having my legs pushed back and put in stirrups etc etc, I mean FFS I am amazed anyone gives birth like this. God I was so stupid!!

lulu...funny enough, there was 3 nov 02 mums on another site, that decided to go for natural,after interventional Birth, and e-c-section after long labour and they all said, that even though the pain is of course bad/not nice tey all felt the sense of control and feeling the Baby come out made up for it big time and empowered them....oh...if anyone could promise me my perfect homebirth next time I might be tempted, lol...but not really reason enough, lol!

"..i don't believe that child bearing women have changed so much in a couple of generations that vaginal birth is becoming less & less possible"

Sadly, Lulu I think that is what is happening. When I recently had my first ob appointment with a new practice (what you call the booking appointment) They took my history and assumed that I had an epidural (as it's really the main painreliever here). I had to correct them as they automatically checked the box, and explained that I didn't. The nurse gave a surprised look.
The attitude of many practitioners and patients is, "why suffer if you don't have to".

We live in a society (or at least I do) where we spend less time out side, work behind desks, and don't push our bodies as much as we can or should. So it's not that it's less possible, but it's becoming less palatable. IMHO

with ys I was given a spinal block, because incase the ventouse failed, etc...but I think that was the main reason it failed....I so wish they had just left me to my own devices with a supply of entonox and then , if nthing changed just let me have a C-section but with more warning!

no, it is truely because doctors obviously don't see normal births...m/w's do....so, they panic a bit easier and see the worst case scenario instantly, and m/ws are not only bound to stupid timesaving protokols, rather then individual care, but they also are overworked and work for a pittance for what they do!

"doctors obviously don't see normal births"

In the US midwives are fairly uncommon although they are gaining popularity. So most normal births here are still under ob care.