VBAC or C-Section - please help me think it through!

[worriedmum100]

I'm sure this has been done lots of times and I know noone can tell me what to do but I would really value hearing lovely mumsnetters opinions/experiences.

I'm 27 weeks with DC2. Took a long time to get here due to secondary infertility, endo, early and missed mc etc. I have a consultant appointment next week where we need to discuss the birth. I simply don't know what to do.

With DC1 I ended up with an EMCS after 12 hours in very painful labour. Failure to progress. Cord round neck twice tightly. He was in a bad position (b2b, chin up etc). His oxygen level dropped too low. I never got past 4cm despite syntocinon etc.

The EMCS was fine, Ds was fine (but small) and I made a good recovery although I was very weepy and traumatised for a while. During fertility treatment though it emerged that my section scar is "defective " with a loss of more than 50% of my uterine lining. Consultant aware of this and wants to consider further incase it increases chances of rupture.

I asked if I could try VBAC them go for c section at first sign of trouble but consultant said realistically things dont always work like that.

I know that I don't want induction, syntocinon or forceps.

My head says elective c section but my heart says "this is your last baby you need to try and do it yourself".

Most friends who've had vaginal births say that their second baby was much much easier but I'm worried that I didn't get far enough last time for my body to recognise that I've done it before and it will be like the first time all over again. I've also got friends who say a vaginal birth really isn't all that and that if they had their time again they'd have a section.

Any opinions or experiences gratefully received!

When making my decision I felt it most important to consider the opinions of the consultants (ask for a second opinion if you'd like one).

I settled on a planned section, I had an amazing experience with skin to skin in delivery and husband cut the cord. It was tricky a perfect birth experience for us.

If you decide to go for an elcs discuss the options for making it a good birthing experience.

Good luck with your decision.

Truly not tricky!

With a planned section you can write a full birth plan and take your own music.

The leaflet I got about vbac said that 25% of vbacs end up in emcs.

Loved both my planned sections, truly amazing experiences all round.

Thank you!

I was so out of it after the EMCS that I barely recall holding DS for the first time etc. I wasn't able to establish breastfeeding. I still feel a bit sad about that. So a lovely peaceful section without the preceding hours of emergency bell pushing stirrups etc is very attractive.

I just can't rid my head of that little voice telling me to do it myself.

Hoping consultant will take the decision out of my hands!

Well I had VBAC but if I had had anything like your experience the first time, I would be putting my hand up very quickly for a C-section. You aren't a better mother because you pushed it out of you! My birth was very straightforward but I was low risk so could do it in a pool which gave movement and comfort. I have a feeling you will be pretty much pinned to the bed with monitors, so that would really put me off a vaginal birth as you need to be able to move from my experience. Most people I know who had a planned C section have ha very very good experiences, similar to a good VBAC. I would read up on breastfeeding after a c section this time so you have all the best advice and gadgets on hand!
Good luck with consultant!

Go with the safest option for you both! I wanted to actually give birth but after my first awful labour and EMCS I decided that I just wasn't designed for having babies and completely embraced the second planned section which was rather lovely as childbirth goes. You're not admitting defeat by taking the section, you know!

Also, consider how you would feel if you tried the VBAC and it ended in EMCS. Would you be glad you tried or wish you'd just done it that way in the first place?

Good luck with whatever you choose.

Breastfeeding has been so easy to establish this time, unlike last time. I'm convinced the skin to skin helped and I had fed her in recovery at 50 mins old which was good too.

I did quite a bit of reading about feeding after a section and felt prepared.

I had a VBAC (two in fact) after EMCS with DS1 (foetal distress). Despite getting to 9cm before the EMCS had to be done, it was still a 12 hour labour with DS2 - no quicker than the first (DS3 was much much faster). I'm glad I had the VBAC but you know what - it wasn't the holy grail. I think it is overhyped tbh. The main thing is that you both get through it safely.

I did a lot of research into uterine rupture at the time I decided to try for a VBAC with DS2. From memory it can be difficult to spot (although I would say in your case, with a thin scar, you would - and should imo - be hooked up to every monitor going, which may impact your overall 'experience'), and I think they have something like 20 mins to get the baby out if a rupture occurs (although my memory is a little hazy here so there may be some more up to date research about). Being honest, If I had your risk factor (thin scar) I would not in a million years have risked a VBAC - but it's your call ultimately.

worried I could have written your post word for word. I'm actually wondering whether I did and just don't remember .

The only differences are I am 19 weeks and I did manage to breastfeed first time round. But I took 4 weeks to establish.

I am seeing the consultant on Wednesday and live in an area where you really have to push for it if you want a elcs. They strongly encourage vbac. The thing is, I'm so undecided that I don't feel able to argue for a csection so I'll probably end up doing as I'm told .

Good news is, you can't have synto drip if you've had a csection previously because your uterus isn't strong enough.

I also want to put caveats on my vbac like if there's meconium again I just want a csection.

That little voice in your head - who is it? What's her job? Is she there to keep you and your baby safe? Or is she a critical unfriendly voice?
If you can identify her, then you have a chance of working through why this is bothering you.

Fwiw I had two planned CS and they were calm and peaceful, and the burden of risk is on the mother not the baby. Whatever way you deliver, you don't get a badge saying "well done." Good luck OP.

worriedmum, when I had a VBAC some years ago, the consultant did say to me it would be more like a first labout than a second, as I had failed to progress due to brow presentation, so DD1 had not got very far! I did have a VBAC, but I did not have any issues with my section scar. I did also have an epidural and syntocinon with DD2, but it was fine by me.

I'd listen very carefully to what your consultant says - when I first spoke to mine re my second birth, she said that she would be very happy to plan a section for me if I wished but felt there was no reason why I shouldn't have a successful VBAC so was equally happy to let me go that route.

I guess the issue with VBAC is that there might not be a theatre or surgeon available at exactly the time you need it (if you do!) so a planned section might make more sense. I know quite a few people who have had planned sections, and they were very happy with the experience.

Best of luck whatever you decide!

Oh, and esablishing breastfeeding - I did manage it with DD1 but it took me 10 weeks of mixed feeding before we got there. DD2 came out knowing what to do and was feeding almost straight away (and has been eating ever since...). I genuinely believe it was not anything I did, because she just rooted and latched on without any help at all.

I attempted a Vbac after an EMCS I got to 9cm after 72 hours in Labour and needed another EMCS. I am embarrassed to say that I only went for the vbac because I felt like a failure after dc1 I had so many nasty comments that I had the easy option and that I was too posh to push this influenced my decision sadly. Currently pregnant with dc3 and I have decided on a planned section. My friend however had two successful vbac's . Do what you feel is right . Good luck

My dsis felt like you with her second.
With her 1st she's laboured quite well, she was fully dilated and was almost ready to get pushing but it ended in an EMCS due to baby's heart rate going crazy because of, then unknown congenital heart probs.
Anyway, she knew the second would be the last and wanted to try a VB. She laboured around 5 hours and delivered her dd vaginally without any problems.
She said the biggest factor that made her glad that she went ahead was the recovery but to be fair after her EMCS she had a bit of a nightmare - infection, re admittance etc.

Good luck with your decision.

Worried, same situation as you.

Lemon why would you ask for a CS if there was meconium?

Oddity how did you get classed as low risk for a VBAC?

I had an ELCS first time round due to a breech baby. Second time I really wanted a VBAC, but baby was also breech. I considered a breech VBAC, but for me the concern was making sure I and the baby were as safe as possible and I recovered as quickly as possible (for our sakes, but also because of DS1 and DH). DD1 is also likely to be my last, so I understand what you mean about doing it yourself, but for me the motivation was primarily selfish (not saying this is true for you!) and ultimately I thought that a second ELCS offered the highest chance of a smooth birth and recovery = better for all the family!

First time I had an emergency section having failed to get past 4cm.
When it came to my second I wanted to try again but knew I was at risk of another failure to progress. That's exactly what happened so I had another emcs.
My third was an elective section, having revognised my body doesn't like going past 4cm.

I don't regret trying again the second time but the elective experience was a lot better than the emergency one. For starters, it was at 39 weeks, so 3 fewer weeks of pregnancy!

PennilynLott I think because there was meconium last time and I didn't have the csection until 22 hours later. During that entire time I was listening to DS's heartbeat struggle and even stop for a few seconds. It was like torture. I felt like he was being put at risk because of the hospital's reluctance to perform the csection. The meconium in my waters was the first sign that he was in distress. If that happens again, I just want the baby out.

Oh and DS2 latched on in recovery and my milk was in within 3 days.

I had a very similar experience with dc1 and faced the same dilemma with dc2. After lots of thought, and doing birth afterthoughts - a service offered in this area that takes you through exactly what happened and why in a previous labour, I decided that I wanted a vbac. I got myself really geared up for it and felt really positive and then darling dc2 decided he didn't want to come out! I never went into labour and at +15 days I had a c-section. My PCT will not medically induce for a vbac and they were not able to break my waters. I felt strangely deflated, I thought I was prepared for every eventuality but it wasn't an outcome I'd ever considered!

Dc3 is due in 3 weeks and I'm having a planned c-section.

Thanks so much every one. I'm reading all the posts but at work so will reply in full later!

I'm in a similar position to you OP after an emcs last time.
A few things that might help you decide:

• my hospital offers a VBAC session where they go through what will happen, risks and benefits etc.
• There's a recent research paper on the RCOG website on VBAC. As others have said 75% are successful but there are factors that make this more or less likely for you personally.
• The hospital also told me it doesn't have to be an either/or decision. They said I could say "a VBAC if things happen before 40 weeks, but no induction - ELCS at this point" so that could be an option.

Good luck, it's not an easy decision

You don't 'need' to do it yourself. There are plenty of us who have given birth both ways and found the vaginal delivery to be no great experience or achievement. There are also plenty of women who have never given birth vaginally and lead happy, fulfilled lives giving not the tiniest of shits. If it was something you really wanted to do, great, go for the VBAC, but it doesn't sound like you're actually at all keen?

I do think I would want to discuss in much greater detail with your consultant about the loss of your uterine lining. Really you need as much information as humanly possible before making that call. Is there any possibility that you could be given a ball park figure for your rupture risk level? It also sounds like they might not be keen on induction or syntocin even if you were ok with it. Those things are riskier even with a 'normal' scarred uterus.

Thanks everyone.

I do think my consultants assessment of the scar issue will factor hugely in the decision. He's already explained the success rates for VBAC and I do have several of the factors that make its success less likely.

I don't feel a "need" for a vaginal birth as such and I can't really put my finger on why I'm even hesitating. I did get a lot of "too posh to.push " comments after DS. I also (rightly or wrongly ) felt a sense of failure at not coping better with the pain. I had an epidural after which it all seemed to go downhill so in mind (again rightly or wrongly) I associate my inability to cope with the experience I ended up having. I should have been more resilient, tougher etc. Thousands of women do this every day why can't I? I cope with a highly stressful work environment why wasn't I more in control with labour pain? I'm a high achiever generally I SHOULD be able to do this myself and so it goes on and on...

I do wonder if I'll end up booking a section but going with the flow if I go into labour before that date.

Did you REALLY get a "lot" of too posh to push? I only ever heard that once and the woman who said it was a dimwit. Anyone with half an ounce of common sense doesn't actually think that do they?