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.

I hear ya.

I had an emergency section for DS, and VBAC with DD. Had exactly the same concerns as you - I could have written your original post.

My (pro) consultant, said that they generally have a pretty good idea how a birth might pan out once you get going and are well established in the second stage. For example if you don't dilate approx 1cm an hour they tend to say, ok, lets go for a c/s - though this isn't a hard and fast rule. As long as there are enough people to keep an eye on you, and you trust your medical team, I'd definitely go for the VBAC. Trust is essential however.

They told me that the risks are greater with an emergency C/S than a planned one, as obviously the former has to be done at greater speed. In essence therefore, the actual risks (eg uncontrolled bleeding, damage to other organs, adhesions etc) are the same for both C/S's but the probability is slightly higher for emergency sections. As for recovery, for very obvious reasons, the recovery tends to be quicker with planned sections.

One other thing - risks on subsequent C/S rise exponentially ie they don't just double. But is still considered a safe procedure.

Good luck!

PS Risk of scar rupture is very small, and getting smaller.

Re monitoring, it only becomes intrusive if you let it. You can still walk around, still deliver in a position other than on your back and in a VBAC situation it can actually stop you fretting about rupture. They can even turn the sound off/down so you are not constantly listening to the FHB. They will then just look at the paper out-put every now and again. It's really not the evil tool that the NCT make it out to be... It gave me confidence for my VBAC and I was hardly aware of it.

Hi PP.i am 18 weeks pregnant.My firsy baby a dd was born at 33 weeks naturally[episiotomy..ouch!]and died when she was 15 days old.My second child my ds..i started out pushing etc and ended up having an emergency section..which was harrowing.
This time i am having an elective section.I do not consider this to be the 'easy'option and am aware of the risks but feel it is the right decision for me and my dp and 7 year old ds.
Good luck with your choice..i know it isn't easy!

Just to quickly go back to the issue of uterine rupture.

When I was 36 weeks pregnant with DS3 (after two previous sections) I had quite a bad tummy bug, my doctor came out within the hour and checked my blood pressure and pulse, everything was normal and he was visibly relieved saying "it is just a tummy bug, you will be fine". When questioning him about it his immediate concern had been that my scar was seperating, rupturing. I asked him if the baby was ok as he had not even felt my tummy, he said "your signs are normal the baby is fine" "your blood pressure and pulse are the the first signs of anything going wrong"

Just one doctors opinion but makes sense to me.

toady....trying to find the link to the mary cronk article re signs of rupture...do you have it handy? xx and your list of things more likely to happen than rupture....

Mary Cronk's thoughts on early detection of scar problems during VBAC

HTH

Oh yeah, Lulu...didn't mean to confuse the issue, it just sort of evolved in this thread, iykwim....!

thanks daisy...xx

lulumama

Didn't take offence. What I should have added was a midwife told me about retained placentas when I was expecting my third child and told me not to have the injection to help the placenta on its way.

I was in the same situation and I was very pro vbac and as it got closer and went slightly overdue I decided I wanted a c-section. I was just so scared it would be like last time. I have a 3 year old too.

and it was a piece of cake - I cannot lie. The absolute worst bit was the spray on my back before the epidural and then 15 mins later my dd was in my arms. I recovered very well, breastfed for 8 months, scar almost gone.

very personal choice and I think a good vbac would be great but please don't feel bad/guilty etc or any of that rubbish if you choose c-section. Noone gives you a medal - do whatever you feel like xx

BTW first child born by em section March 2001. Second child VBAC August 2003, no scar pain. Third child born VBAC June 2005 horrendous scar pain and very very close to rupturing plus baby and I dying. Luckily I go in to myself when labouring and didn't take any notice of the emergency button being hit and the room filling full of people. My problem, but also my saving grace, is that I dilate in seconds and can push out very quickly. (12 mins first time, 7 second time). The risk of rupturing may be small but it is no consolation if it is 1 in a 100 for example if you are the one. I am not in any way trying to acare anyone. I am just telling my story.

thanks nab3--- interesting point that syntometrine may increase risk of retained placenta....did you opt for a physiological 3rd stage?

I ended up having the injection. I told them my midwife had said not to and I can't really remember what happened but I did have it. Pushing the placenta out was like giving birth again. It was quite upsetting as I had lost my baby's twin and really felt I should be pushing another one out. I don't know but I think on my second delivery the midwife tried to pull the placenta out, don't think I had the urge to push, and the cord broke with blood everywhere.

`nab3- sounds like you have had a rough time...thank you for sharing that ... xx

I haven't read the whole thread (not enough time!), but I recently had a VBAC after DS1 was born by c/s. I planned a hb, and decided that if things didn't go to plan in any way, I would have a c/s. Ended up with waters breaking, labour not starting, and 4 days later being diagnosed with Group B strep. Was then induced and had a fairly hard 40 hour induction, then an episiotomy for DS2 to be born. During the pg, I would have said definitely no to an induction, but at the time, it seemed fine. End result - very sore afterwards, but I could walk 6 hours later For about 6 weeks the stitches were quite painful, and I wondered what the hell I had done - c/s scar and episiotomy scar, but 16 weeks later it's the best thing I ever did. I was still in a lot of pain from my c/s at this point last time round, this time nothing at all.

Laura, highly unusual for someone to be induced after previous C-section....

Because of the previous c/s they didn't use the pessaries, just straight onto the drip. I knew the risks, hence my prior reservations about being induced, but on the day, it seemed the right thing to do.

i was induced with my VBAC1 attempt. Dont think it is that unusual tbh.

Hi, new to mumset, will try to be concise!

Polly, sympathise hugely as I was there 6 months ago.

Had dd1 by emcs after a horrendous labour and a section that didnt go terribly well either. Spent all of 2nd pregnancy in a state of high panic about the birth. Was advised that a vbac was possible and the hospital were really supportive of them, although would have let me go for an elective if that is what I wished.. I vacillated constantly and drove dp mad with my indecision. I didnt want a possible emcs that was a repeat of the time before, but didnt really want a cs either with a 2 yr old at home.

In the end had dd2 by emcs after a 9 hour trial (bp high, baby distressed and head v high, despite waters breaking etc). Recovered slightly quicker than last time

After all that, i am really glad that I tried, and although just as painful in all ways as the first birth it was far less traumatic. Even the cs was better, because although it was still an em, it was less of a rush as people were prepared, just in case.

as an aside at the hospital I was at they don't induce vbac's (had a sweep at 41 weeks instead) and I was constantly monitored and unable to even sit up. Guess it's different wherever you go. Also, I had very bad pain from my scar, but when they opened me up it was fine. Also I found the natalhypnotherapy vbac cd very helpful for dealing with the fear

Good luck

No one here can can tell any of you what to do, but whatever you do, don't feel that a planned c-section is copping out. Several "friends" were shocked that I went for a planned c-section, and hinted that the first emergency c-section was due to me being in the wrong frame of mind, not fit enough or - horror of horrors - having pain relief (which I point out I didn't have for the first fifteen hours). It does not in any way make you a better mother to have a VBAC. I may or may not be a good mum, but I can tell you that it has nothing to do with how my kids were born.

Another minor advantage to add to your paternity leave one - I have a similar age gap to Polly and it really helped with planning childcare for DS1 and explaining the whole process to him to say that mummy was going into a hospital today and the doctors were going to take the baby out, rather than him seeing dh in a complete panic when labour starts.

In the end, though, it comes down to how much you loathe the idea of a major operation (some people clearly are really put off by the idea of being "cut open") and how much you loathe the idea of a repeat of last time, which is a significant risk of repeat VBAC. Personally, I'd have done anything to avoid a repeat of the horror of ds1's birth (and I know quite a bit about the risks of vaginal delivery now!) and have no concerns about a non emergency c-section for which all the risks quoted are exceptionally low (most of them are (a) based on outdated statistics because this operation has been going on for centuries and the risks are much lower than when my grandmother had hers in the 1940s and (b) relate to emergency c-sections which are much riskier as no one has the time to plan them), so the decision was easy. However, I still felt guilty about "not trying", which was stupid.

Just wanted to add, that your worst fears eg; late 2nd stage section, pushing baby back etc. is v. unlikely most obstericians will have low threshold for doing a second section on a vbac. They will be anxious to aviod a second traumatic delivery as well. If you were to end up with a second em c-section would be much more likely to for eg give it another hour or whatever if no progress then do section.

Having read most of the thread i think you might as well go for it, you can change your mind at any stage, in a hospital setting I reckon the risks are pretty minimal. That is just my opinion but I have worked in many maternity hospitals and attended many births, many of which were emergency c- sections. Again good luck with your decisions not easy.

I had a emcs with ds. 2nd time around was sure i wanted vbac at the end of pregnancy wasn't so sure got so big. Consultant at 39wks keen for me to continue with trying for vbac. Anyway tried and after trial of labour another c/s dd born but wished looking back i'd just made a clear decision at the time for myself and went for elective.

I just about managed a VBAC with dd, although since it was a very long, hard labour, there were many times during it that I was on the verge of calling for a c-section. Overriding it all, though, was my determination to avoid another c-section if at all possible, not for my new baby or for my own convenience, but because of the effect on my ds. With an age gap of 28 months, I was very aware of potential sibling rivalry - how much harder for him to adjust, then, if he was also told that Mummy couldn't pick him up for a cuddle or for so many of the routine tasks we mums do.

It made a huge difference to be up and on my feet so much earlier afterwards, although I have to say, it took me just as long to feel pain free as after my c-section.

Risks aside, I did it for my son and don't regret going for a VBAC, although it was hardly a walk in the park. I don't think it's an easy decision, but do believe that the decision should be taken more on what works for the family unit, rather than the risks as these are relatively insignificant. Good luck!

These threads always bring out the "I've had the worst birth stories" in us, don't they? And so many people seem to have had an "emergency c-section" when, actually, (it seems to me, unless any midwives can enlighten us) any c-section is deemed an emergency unless it was an elective.

As someone who has experienced a crash c-section and then an ELECTIVE c-section, I'd humbly suggest do go for the VBAC unless there was some very specific and unique difficulty with the first which suggests your next baby might suffer the same. Just based on my personal feelings of not quite being a bona fide mum cos I haven't given birth to either of my children. But whatever you do, don't go for a home birth ... Controversial I know but, there, I've said it. And very best of luck to you. I know plenty of women who've given birth vaginally after a c-section, it just seems those first babies are the hardest to shift!