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Childbirth

Share experiences and get support around labour, birth and recovery.

Vbac vs cs: can you

265 replies

PollyParanoia · 09/11/2006 11:49

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.

OP posts:
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MKG · 10/11/2006 21:55

I hope you VBAC can help those hurt feeling go away.

lulumama · 10/11/2006 22:12

mummytosadie....putting those feelings to bed....that is just how i felt...my VBAC healed me...all the grief & distress that i felt after the you em c.s, that i and my body had failed....not at all! i can and did give birth,,and it has , quite simply, changed my life..OTT? yes, but true. go for it.....and if you need any support...it is here...

PollyParanoia · 10/11/2006 22:21

Fantastic to feel healed by vbac-ing, but as has been discussed all the positivity and preparation in the world can't guarantee you a vaginal birth. It won't help Sadie's mum to put too much pressure on herself to resolve issues around the first birth by doing it "right" second time. I think the most important thing re. a vbac is to feel prepared whatever way the baby is eventually born and that way attempt to avoid some of that shock and disappointment that comes with a first cs.
Part of my ambivalence re vbacing comes from not wanting to invest too much in it because ultimately it's not something I am in complete control of.
Anyway, still going to try (I think, arggh spot the continual indecision...)
Pol

OP posts:
rainbowgirl · 10/11/2006 22:21

have just read this thread , only took about 2 hours

i'm 20 weeks pg with baby2, had an emergency csection with dd, now nearly 4. she was face up and the labour just didn't progress, i persevered for a long time and moved around and tried everything to get her to come, only dilated to 5cm, had an epidural in the end and syntocin but it didn't help, in the end her heartrate went right up and i was rushed to theatre

i then had bleeding for 6 weeks and retained products and a d&c at 6 weeks, was emotionally scarred by the whole experience and got v bad PND as a result..

i really want to have a VBAC or at least try for one but

a) my hospital policy is continuous monitoring - do i have the right to refuse this if i understand the risks? what ARE the risks of rupture realistically?

b) my dp is not around and may not be around for the birth; everyone keeps advising me to have a c=section because it would be 'easier'. i dont have anyone obvious to be with me through a VBAC. have thought of a doula but not yet made contact with one.

c) am terrified of either option.

any advice??

xx

rainbowgirl · 10/11/2006 22:23

polly.. so have you decided to go for a vbac then? what are you doing about the continual monitoring ? in my mind this is surely a real consideration. because of the relative risk of scar rupture v. slowing down the labour due to being immobile.. ?

rainbowgirl · 10/11/2006 22:24

and i agree with your attitude in your last post.. think what screwed me up the 1st time was this idea of a 'perfect birth' which never happened! think many women are sold the idea that they can somehow control it totally when in reality, of course, you just can't. without the horrendous c-section i had my daughter would probably not have lived and my womb would undoubtedly have split open!!

Mummy2Sadie · 10/11/2006 22:26

that is what i am hoping for lulumama - but i am also preparing myself that i may need an emcs - i plan on NOT having an epidural (for starters i had 2 when in labour with Sadie that failed!) so i feel they are pointless.. i want to feel what is happening and hopefully i will have more control over it. I have felt up and down about this pregnancy from the start - because i am so in love with my daughter and it was unplanned, i felt i was in some way cheating her out of a nice single child few years y'know? But as time has progressed i have started to focus on it as a positive, it is my chance to put right what i felt went wrong, as well as breastfeed which i didnt manage to do last time! And i realise now that Sadie will probably blossom even more with a sibling as she is such a loving giving little girl anyway!! To be honest though, i prob have my heart set on it a little too much - so i ought to be more realistic and read some of the facts in the earlier posts..

lulumama · 10/11/2006 22:26

i know polly....i don't want to be misconstrued... it is hard to put across a point of view on this without personal feelings coming out!

if that appears to be 'pressure', then i apologise...

the feeling prepared however baby comes is a vital point...and a lot of feelings arise around instrumental deliveries or c.s , IMO, becasue you don;t think about it or plan for it...whereas second time, you know it is a possibiilty therefore, it is not so much of a suprise , IFSWIM.....

3andnomore · 10/11/2006 22:28

MKG, totally agree..it takes two and usually somemore...meaning midwifes etc...!
I assume you mean what I , personally, mean by natural"ish" Births...first ds went to 9 cm's when pain got to bad to handle with tense machine and then optend for gas and air (which is not exalty natural, lol) and then once 10cm's was told only thing stopping es coming out was the waters ...well.....stupidly agreed for waters to be broken (never knew about Babys born in cowel and that is a pretty normal thing, lol)....and es went into distress as he must turned around...consultant had his hand up my fango to turn him, which he did and es was not distressed anymore, and hey, never experienced the ring of fire that time, even though es was still posterior, but easlily pushed out (hence my arrogance...I can push whatever out...right...), 2 ds, was meant to be a homebirth, but once diagnosed woth Glucose intolerance (well controlled by diet, etc...) was not given a true option, so opted for Hospital Birth, long labour, but lovely and slow, and no distress...well dh came and as I was still "0nly" 9 cm's I was pushed into having a ARM...even though as soon as dh turned up my contracftions got well strong...wasn't strong enough to stand up, and wow...after rupture pain was unbearable..not working up...just there...and needed entonox there and then..talk about possessed...lol...my head was turning...think I could have had a wonderful natural no panrelief and completely intervention free "NATURAL" BIrth there...but didn't fight for it...and well the time I did it all went wrong...story of my life!

Mummy2Sadie · 10/11/2006 22:30

oh - and the consultants have been really positive about a VBAC - they have intermittent monitoring rather than constant. I feel that if i can move around and remain upright that my birth will go to plan!!! I also have been crawling on all fours loads playing with Sadie to encourage baby to stay back to front - as it was back2back that meant Sadie wouldnt come out!
There is alot that can be done to help assist a VBAC i believe !!

lulumama · 10/11/2006 22:30

rainbow girl...you can refuse continous monitoring and have intermittent monitoring so you can be mobile

toady has posted some good info re statistical likelihood of rupture , as has tuttifrutti lower down on this thread

to find a doula

train & place doulas throughout the uk with no fee

and

doula uk website

HTH!!!

3andnomore · 10/11/2006 22:31

Pol...yeah, keep your options open, and not just echincally but emotionally...I think that is the best way, but also know as much as you can....also though, must say...maybe if we had a person not quite as emotional involved (like a Doula) maybe we would have fared better...not sure!

rainbowgirl · 10/11/2006 22:33

thank you LM!!

i wish there was a 3rd option!

as polly said originally, i'm terrified of trying VBAC and ending up with a horrific labour followed by another emergency c-section, that is the line people give you to encourage you to not even try tho isn't it?

what a minefield

lulumama · 10/11/2006 22:34

mummytosadie..

can;t remember the name of the sites but google the following:

optimal foetal positioning , developed by Jean sutton

and

mary cronk (independent midwife)

and

associtaion of radical midwives

and read anything by Ina May Gaskin...eg 'spiritual midwifery' and 'ina may;s guide to childbirth'

those sites, amongst many others i can't remember off hte top of my head are excellent sources of information about active vaginal birth & VBAC....

rainbowgirl · 10/11/2006 22:34

what does any1 think about the emotional aspect of VBAC without your partner there, i mean, is there any merit in thinking, a c-section would at least be over quicker? of course the recovery isn't tho..

3andnomore · 10/11/2006 22:35

lulumama...that is the danger....ok if you had an instrumental Birth or C-sectin you have that in mind,,,,and with the first, generally you do sort of keep an open mind, I know I did....but after 2 normal Births...it came as ashock to the system that I failed to push that one out....

lulumama · 10/11/2006 22:35

rainbow..those sites might be of interest to you too!!

rainbowgirl · 10/11/2006 22:36

arrrghhh i can't find the posts about the risk of scar rupture... too late and the thread is far too long!! ... can anyone locate them and helpfully give me the time they were posted??

3andnomore · 10/11/2006 22:37

Hm...I wonder if anyone would be interest in setting a Birthpartner scheme up where the loved ones are just not available, but for which you don't have to pay for...not saying that Doulas aren't doing a fa b job, so do independent m/w's...but that just isn't always an option...now, I personally am dying to be at an actual Birth, rather then my own....

lulumama · 10/11/2006 22:41

rainbow-- post by daisyboo & tuttifrutti at 11.43 or thereabouts....!

rainbowgirl · 10/11/2006 22:41

3andnomore that is a really, really good idea, i wish there was something like that. i just don't have a suitable person for various reasons. my mum just wouldnt be appropriate for a start! we would both hate it. it's hard to have that as an added factor, the whole thing is hard enough..

.. have just been thinking tho, i don't fancy recovering from another c-section on my own, as it took so long.... so trying for a VBAC might be the way forward, if it did work out for me, at least i'd feel more empowered afterwards

doing it with just midwives there would not be end of the world would it?

Daisymoo · 10/11/2006 22:41

I wonder if Nikky meant that I was using scare tactics because I mentioned the risk was higher for the mum with a cesarean compared with vbac? I certainly didn't intend to scare anyone, but I do think it is absolutely essential that no matter what decision a woman makes it is an informed one. Neither option eliminates the risk for mum or baby entirely - vbac is probably slightly safer for mum and possibly slightly more risky for the baby. Elective c-section may be safer in terms of mortality rate for babies but there is a higher chance of problems for the mother. I really don't think discussing this is a scare tactic, but I apologise if it came over that way.

I would not and do not judge anyone whatever decision they make for themselves and their family. FWIW I had an extremely traumatic first birth after an induction which led me to request an elective cesarean for the next two babies. With my fourth I had healed psychologically from the first birth and was desperate to try vaginal birth again, but I do not assume for a second that everyone would feel this way.

I always seem to end up posting the following link but in case anyone is interested there is a vbac yahoo group which many women have found helpful when making a decision.

PS Re rupture rates - yes, NICE states 0.5%, however there are other studies which show a lower rate, around 0.35%. Some research suggests that the risk may be higher or lower than these figures depending on whether induction or augmentation agents have been used.

lulumama · 10/11/2006 22:43

i know what you mean 3and

but also, bear in mind a doula also meets with you antenatally several times...knows your plans, thoughts & feelings about the birth..should be familiar with the protocols of where you are birthing...and has some knowledge about labour & delivery and is on call from 38 - 42 weeks for you and is there for the entire labour , however long!

rainbowgirl · 10/11/2006 22:45

ok thanks LM.. so the risk really is v low.. this is a bit graphic sorry if people don't want to go there, but what happens if the scar ruptures, and has it ever happened to anyone? if you're not being monitored at the time, would you and/or baby die?

lulumama · 10/11/2006 22:51

ok...the monitoring will not stop you rupturing....and the midwife should not rely on the monirtoring to tell if you are rupturing

there is a difference between dehisence- where the scar starts to come apart and true rupture , where the uterus actually opens.

the signs are:

increased pulse rate in the mother

foetal distress in baby

burning pain around the scar

vomiting

pain that doesn't go away between contractions

total cessation of contractions

it is rare, but catastrophic

it can be fatal to mum & baby.

that is the absolute worst case scenario.

if caught at the stageof deshisence..then an emergency c.s can be done quickly enough to preserve mum & baby

an epidural can mask the pain of a threatened rupture.....

and overstimulation of the uterus through induction can increase the risk