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!

Honestly I did. Said 'in jest' of course. Mostly from male friends. One very close male friend in particular made it several times. Initially in a text responding to the text I sent him announcing the birth. All it said was "too posh to push then? " I know this shouldn't impact on my decision. I know these comments are ignorant but I'm just trying to think through why I'm hesitating (dithering really)

It was a MAN who said it?????

Well there's your answer.

I had to tell you what happened with me - I had a recent planned section for my second baby having failed to get past 4cm last time, fetal distress, emCS.....etc, breast feeding tricky to establish, wound infection etc....

Planned section was a much much better experience, calm, skin to skin in theatre, and so far a much easier recovery. The risks of a planned section are less than an emergency and you go in far less tired etc....I was home after 24 hours and breast feeding established with no problem.
At surgery they found that my scar was very thin and was breaking down. The consultant essentially said it was lucky that things hadn't progressed any further out of hospital and any further pregnancies would need to be very closely monitored and definitely not for a VBAC. She had advised me in the first place that my gut feeling to have a planned section this time was correct and I'm so glad my husband kept reminding me of this as I had an occasional wobble (including on the day of surgery) about it. In the pregnancy I have come across various professionals who have queried in detail why I wasn't trying for a VBAC. I found this upsetting but now am so glad that we had the section as we have a gorgeous healthy baby and that might not have been the case if I had gone for a VBAC.

In your situation I really would take the consultants advice. I was upset about my first delivery but before long just felt thankful that we were both well. Discussions about mode of delivery in this pregnancy brought it all back but really in the long run, it doesn't matter one tiny bit how the baby is born as long as you have a healthy baby and mum. Anyone who talks about being too posh to push is ignorant and rude and should stay out of it. You're not letting yourself or anyone down by choosing a section, your job is to do what is the safest thing for your baby and yourself and from what you say I would make sure you have very frank conversations with a senior obstetrician. For what it's worth I have a small age gap which probably meant my scar was weaker but in your case it sounds like there are already concerns about your scar. Good luck and congratulations on your pregnancy!

Meh, if the only thing making you consider VBAC is wanting to try to do it yourself, take it from me: natural birth is overrated.

I'm clearly biased, but I had one "gold standard" (in some people's eyes) birth: waterbirth with no drugs. I tore really badly and was traumatised and depressed for a long time.

Had an ELCS nearly six weeks ago and it was wonderful. I spent the entire pregnancy not having to worry about the birth and what might go wrong. The strongest painkiller I had was IV paracetamol once the spinal wore off - after that it was just ibuprofen and paracetamol. I'd stopped taking painkillers entirely within the week. I really am so happy about the way it turned out, compared with the VB and tear which left me a physical and emotional wreck.

I think it's sad that so many women on MN post threads about VB vs. CS because it becomes really apparent that they want a CS but are afraid of not "doing it properly" and what other people think. What other people think doesn't matter.

And besides, in your case worriedmum, that dodgy scar is crucial and would have me ruling out a VBAC. Would it mean you would be heaviky monitored in labour, meaning there would be few opportunities to move around? Worth asking.

Good luck!

You weren't in control with labour pain because that's how it goes sometimes. Thousands of women globally give birth every day without any major problems, 800 die in the same endeavour. You're not a failure because of the EMCS anymore than you would be if you needed bunion surgery because your foot joints wouldn't straighten themselves, or if you needed an inhaler because your lungs don't do their job as they should. If having a body part that doesn't always function as it's meant to makes you a failure, the number of successes in the human race could be counted on one hand.

And the epidural is a chicken and egg situation: quite possibly you required one because the problems that were already occurring were making the process too painful to endure. I mean, it won't be the epidural that caused him to malposition himself and wrap the cord round his neck.

Thanks everyone. This is really helping. I feel really emotional about it now I've started writing it down.

I was in exactly your situation with dc2's birth. I even went to NCT classes with a view to vbac. (I'd has emcs abroad so wanted to find out how it all worked over here). However, once there, I met a consultant anaesthetist with her husband, also a doctor. Going for elcs for personal preference rather than medical need (they were there for the bf/baby care info).

I must admit that I had worked myself up into a right tiz about what to do and this helped me confirm that, actually, elcs would be for the best. I also pressed my consultant, who admitted that he'd advise his wife/sister to have an elcs. My gp (3 cs herself) also gently suggested elcs would be a better experience.

I thought that if I wasn't going to have a lovely active/water birth and would have to labour attached to monitors, with the resulting panic each time they slipped, then I might as well book a calm elcs - and (shallow) dh could finish the project he was on and 'book' and focus on his paternity leave!

Dc 3, they also made a good job of tidying up all the adhesions from previous section/s so that hopefully I shouldn't have gynae issues when I'm older. I also managed to be sterilised at the same time, just by cutting and cauterising. No foreign bodies necessary and meant I didn't have to try to persuade dh to get the snip! That is also something worth considering if this is definitely your last.

I occasionally have a mild pang of regret that I never birthed a baby but the 36 hours of induced labour without pain relief has probably earned me some stripes at least

As my friend (emcs/vbac/emcs/elcs) once told me, of all the things to regret in life, never squeezing a baby out should not be one of them!

I too had a lot of "too posh to push" comments after a similar experience to you and I really felt I should have a vbac and "do it myself".

In the end, after much agonizing and consultations with obstetricians/senior midwives I opted for an ELCS at 39 weeks as the "devil I knew". I had a review of my birth notes around 28 weeks with DD2 and discovered that she was b2b [first I'd heard of it] plus a whole load of medical notes about small pelvis and medical staff having trouble making examinations and establishing what was going on.

DD2 had other ideas and I went into labour at 37 weeks ending in an unplanned vbac. I was heavily monitored and it was not a mobile experience. DH is firmly of the opinion that had DD2 not been so small she too would have also gotten stuck as she was also back to back. As it was she was delivered with forceps and "minor" 2nd degree tears to me. I was told all along that I was doing great and I "could do it". It was certainly faster than DD1 but about 12 hours in the end.

Given your medical advice in your shoes I wouldn't even consider it. I recovered far faster from my EMCS and in hindsight I wished I'd insisted on my ELCS.

Try to forget the too posh to push comments and counter them with the "if it weren't for modern medicine we would both be dead" in your best "why don't you fuck the fuck off to the far side of fuck tone of voice". [we really need an MN acronym for that particular phrase]

These were the questions I prepared with the help of Dr.Google for my consultations with NHS Obstetrics teams. They might be of help.
VBAC
Pain management during VBAC – are my pain mgmt. options more limited due to link between pain in scar area and rupture, or is monitoring a sufficient indicator should I require/wish to have an epidural?

1. Among women who attempt a VBAC after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it?
2. What are the short and long-term benefits and harms to the mother of attempting a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
3. What are the short and long-term benefits and harms to the baby of maternal attempt at a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
4. What are the non-medical factors that influence the patterns and utilization of VBAC after prior cesarean delivery? Birth position for example?
5. Is continuous monitoring mandatory and if it is, or I prefer to have it, are there facilities to be monitored in a birthing pool at this hospital?
6. Should I plan for early hospitalisation – ie if waters break or contractions start naturally to allow for monitoring. What is the general practise in this hospital?

1. Do you induce labour where there is a prior history of EMCS? What induction practices do you use? Can I refuse any?
2. Given concerns about my uterine scarring, will you allow me to go overdue?

ELCS

1. Who will be my surgeon? Can I request the same surgeon as I had before if they are still on the staff?
2. Are trainee surgeons allowed to carry out ELCS's? Presumably not allowed to carry out EMCS's?
3. What are the risks of repeat caesarians ? What would be an optimum number of children to stop at in order to statistically avoid a high risk pregnancy eg: placenta previa, or post op complications eg: hysterectomy
4. My first CS was entirely complication free but what are the key maternal risks I should be aware of with an ELCS and at what rate do the incidences of these types of injuries rise with multiple caesarians. eg bowel injury, ICU admissions, post-operative ventilator use, cystotomy and more.
5. What are the key risks to the infant I should be aware of with an ELCS?
6. Under what circumstances are forceps used during a CS and am I at higher risk of this use as part of an ELCS if the baby has not decended? What are the risks of a forceps delivery to the child via an abdominal route?
7. Will my post op recovery period be shorter/longer with a second CS? Internally due to repeat surgery or shorter due to fewer drugs, lack of labour etc?
8. Will the incision be in the same spot or will I have two scars? Will you use the same method of closure? Any chance of a tummy tuck ?
9. If I go into spontaneous labour, and there is no medical reason not to try for a VBAC, what are the decision criteria for recommending I progress to a CS? My BP or Fetal distress is an obvious one, is there a time period after which Failure to Progress status is declared again and I have a second EMCS. Under these circumstances, do any of your answers above change?

10. My previous birth notes refer to a narrow pelvis repeatedly, but my daughter was also in a back to back position. Do you recommend an ELCS or a VBAC? Is it my choice? 11. If you are recommending an ELCS or I am choosing to have one (assuming I have the choice), when will it take place ? Week and date?

Don't put yourself through another emergency section if that might happen after failed labour.

Straight for the planned section. That's what I did! Good luck

labour attached to monitors, with the resulting panic each time they slipped - flipping soul destroying. In the end DD had one attached to her skull with a clip. Her head was a mess when she was delivered in the end.

It does sound like your need for a VBAC is coming more from outside pressures than a real desire. I think you should really reflect on whether that's true.

Take the time to write a list of all the reasons you would want a VB. Next to each reason write down whether its/your baby about you or whether its for outside pressures.

If its about comments like too posh to push then you really need to think about why you are letting ignorant people dictate huge decision in your life for fear of what they might think. I've never had a comment like that tbh and I thought I would. If anyone did attempt it, they would be liable to get a verbal pasting for their ignorance.

There is some useful info on the ROyal college of gynaecology and obstetrics and NICE sites about VBaC, eg stats, factors making success less likely and so on.

I felt pressured by health professionals in two different areas of London into trying for a VBAC with DC2. I was never sure and had a number of factors making success much less likely, but wasn't informed of this and hadn't read up. Had I known then what I do now about my "odds" I would have insisted on a section.

In the end had another unplanned C-section due to failure to progress and the scar not coping well (burning agony! And thin, transparent, knackered uterus!) after induction with syntocin, and complications due to adhesions (which would have happened even with a planned section), all pretty unpleasant but DC2 and I were fine!

Oh and please ignore what anyone else says about it, especially random blokes!

TreadSoftlyOnMyDreams that is incredibly helpful, thank you so much.

Thank you all. The list of questions is so helpful.

I think it may well partly be external pressures opinions manifesting internally mixed with a strong sense of failure from last time . I want to be totally dispassionate and pragmatic about it and having all your opinions is really helping with that.

Sorry if this is a drip feed ( was trying to keep OP within reasonable proportions! ) but I was also diagnosed with Ashermans just before I fell pregnant. Most likely caused by repeated ERPCS. I was due to have surgery to remove adhesions when I got the BFP so I'm really interested in what you say about the complications you had duck.

I also totally relate to the awfulness of being monitored and hearing the heartbeat slowing down and not recovering. It happened a lot during DSs birth. He also ended up with a clip on his head and blood samples being taken from his head while he was still in me. Horrid.

The consultant is supposed to be reviewing the notes from my last birth before I see him and also wants to review any reports I have re section scar and Ashermans (both from private clinics). Do hopefully we can go over the whole picture from a medical risk point of view.

Do they have anything like the Birth Afterthoughts service in your area? It helped me so much. I went in feeling like a complete failure and left understanding that it was the opposite. I felt like I was walking on air when I left, it made such a huge difference.

Hi OP so glad you have asked this. I'm 24 weeks & feel the biggest failure in the world for having DS1 by EMCS. I felt like labour is a job my body should be capable of doing. No one in my family ever had a CS & I was the link in the chain. 2 years later my sister comes along & wow everyone's praising her on her 6 hr start to finishers & air labour. Lots of "wow she was amazing" I felt because I couldn't do it no one could say I did well if that makes any sense at all. Did well for what? I didn't do anything. They cut me open & took the baby out. Im finally happy but not over it at all. Im truly gutted. I think it depends on the kind of people your around etc too. Had lots of friends giving birth easy at the same kind of time.

I think like others have said make your choice & keep positive. If you do go for a VBAC & it turns into another EMCS then don't be disheartened. Easier said than done I know, but don't be harsh on yourself. X x x

Glad to be of help. I like to feel that I've covered all the bases before I go into a meeting like that so I don't come out and think - gah, I forgot to ask X.

Many of the questions were answered in general discussion so I didn't actually sit there and ask them all one after the other, but I think that medical professionals are more likely to take you seriously if you have read up on the options and appear to be making a rational decision based on fact. I had no resistance at all when I finally took the decision to go for an ELCS.

If only DD2 had been quite so accommodating. My one piece of advice is that you should be prepared for a VBAC in any case. I had no frickin' clue what I was supposed to be doing as it was a Saturday so only one theatre open, and there were several emergencies ahead of me. By the time the theatre was free I was fully dilated and euphoric at the thought of "doing it myself" on G&A after having every drug going the first time. Was another 4 hours before I delivered and 12 weeks before I could walk without discomfort due to severe internal bruising.

My very nice female GP said to come back at 16 weeks if I was still in trouble in the manner of - it's perfectly normal not to be out jogging 4 weeks after a vaginal birth.

I think I might have a slightly different outlook on this to most other people on this thread, but this is such a personal decision so you should definitely take some time to think clearly about what you want, possibly with the help of a birth afterthoughts service or similar.

I had an emcs with no labour due to severe pre-eclampsia at 34 weeks. Recovery was long and difficult (even though there was no labour, so procedure was more like an elcs). I was absolutely determined to try my hardest to have a VBAC with dc2 for personal reasons, mainly related to recovery but also because I really wanted to experience labour (oddly!). My consultant insisted I was booked in for a cs at 40 weeks but thankfully I went into labour spontaneously at 39+6.

For me, it was an excellent decision. The birth went well, it was bizarrely less painful than I was expecting and I felt (mostly) in control throughout. I had a wireless monitoring belt which meant I could move about as much as I wanted. I had a second degree tear but recovered much faster than from my cs. It also put a lot of demons to rest for me.

I do appreciate though that I was probably unlucky with my experience of cs (long recovery, prem baby) and very lucky with my VBAC experience. Unfortunately you can't tell how it's going to go until it actually happens!

I had an emcs with a great recovery, really easy. I'd like a vbac for the next one, but that's because potentially we'd like a few more children. If I knew I was only having one more, without question I would have an elcs. In your shoes, with the scar issue, that would be an added indication for elcs. There is no easy way out when it comes to childbirth - you just have to make the best decisions you can based on the information you have at the time in order to keep mother and baby as safe as possible.

For balance I should say that I do know several women who have had successful VBACs!

The Asherman's is also relevant and of course another C-section could make it worse since it's uterine surgery - think you've said you're not planning more DC but I am in a similar boat (having had the 2 sections and probable ashermans from the first one) and do worry about unplanned pregnancy!

I've had an EMCS and a VBAC. I was really keen for an ELCS second time round. ELCS was all booked but baby came a bit early and was sick of being pregnant so just went with it.

Your consultant has advised ELCS because your scar is thin and presumably more at risk of rupture. If I were in your shoes I would definitely take the consultant's advice and have an ELCS. At the end of the day it's about the safe delivery of your baby.

There are threads ad infinitum on here about the positive experiences people have had with ELCS. There are very few people who seem to have had bad experiences.

I'm sorry that you've had negative comments from people about your section. Unfortunately there are some knobs about who are incapable of original thought and will just twat out the old "too push to push" bollocks. Personally I found the recovery from an EMCS much more difficult than a VBAC but that was because of the underlying reasons for the section. I was unwell, labour was not progressing and the baby was distressed.

My VBAC was fine, so if you do go down that route, all the best but I would suggest you strongly consider what your consultant is advising and why.

Hello everyone

Lots of food for thought thanks. Consultant has advised me either way yet. He's just said he wants to review the notes from last birth and other reports re section scar then we can discuss it. But I got the impression that an ELCS wouldn't be a problem if that is what I wanted. I'll report back after my appointment!

*hasn't