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!

Finding this thread incredibly useful to read through! Very traumatic first labour and birth with ds ending in an emergency cesarean with awful recovery period, low mood, trauma and extreme disappointment in myself which took years to get over. Now had a diagnosis of gestational diabetes so am facing the prospect of a very medicalised birth and the possible decision between vbac and elcs or emcs. So much to consider it is just so helpful reading others thoughts and experiences!

Hi

Thought I would update after consultant appointment today. The bottom line was that the apparent issues with my thin section scar do not amount to a medical reason for an elective section. Because they don't routinely scan post c-section women there is nothing to say that all c section scars are similar. So the risk of rupture with a vbac is the same as for anyone else which is 1/200.

So as things stand I would have to push for an elective on psychological/emotional grounds which I don't feel able to do.

I did make it clear that I did not want to end up in the same position I was in last time (i.e. an EMCS after a long and stressful labour. Consultant said I'd be carefully monitored etc etc. I also said I wouldn't want to be induced so she suggested a possibility might be to go for an elective section if I go overdue.

Not sure how I feel. Haven't fully digested it yet but I suppose at least I have my medical opinion!

Interesting! Thanks so much for updating. When I spoke briefly to my consultant I said I would refuse an induction and she said then I would likely be put forward for an elective section. I'd hate tohave and induced vbac and the thought of it all ending in an emergency cesarean again just fills me with dread. Sounds like we're in the same boat.

Same boat here too of being pushed down the VBAC route which I don't want. OP I'd do your own reading on your risk (RCOG and NICE websites have decent research evidence) and be prepared to fight your corner if ELCS is what you want. Of course it's entirely up to you which way you go and both options are very safe, good luck

I'm 31 weeks and have the same dilemma. Keep changing my mind.
If this was my last baby I would just choose an elective.. V low risk to baby. Risk is 10 times greater with vbac.
Low risk of inconty issues for mummy.
The main risks if csections come when you have multiple ones unless you are v unlucky.

Had a long chat with DP. If nothing changes (risk factors don't increase or baby stays breech) I'll go with the flow BUT DP under strict instructions to be forceful about a section at the first sign of any distress in the baby. I really do not want 7 or 8 hours of faffing about listening to his heart rate dropping while they poke me and the baby about (I. e. A repeat performance!).

I will try and write a very clear birth plan with this in big bold letters.

I'm clinging to the fact that no two labours are the same and that most people I know had an easier time with their second.....

It is helpful to decide if you want an ELCS or a VBAC. In my experience Any sign of willingness to even consider a vbac in my experience is taken as a green light and there will be "faffing about" while they "wait for theatre to be free" for 7-8 hours. In the meantime nature will take its course [if not, then it's off to theatre anyway] and you will be gently pressured into continuing.

If you want an ELCS, then the broken record technique at every single medical appointment between now and your final weeks. You've already had an EMCS so as far as I know under NICE guidelines it's your call to make.
I would ask for a second opinion. I saw three senior reg. obstetricians in the end as the consultant kept being called away. They all said something different and the last one just said, sure, I'll book you in. I was 35/36 weeks I think by then.

Thank you OP and everyone else who has posted here. PFB was born by EMCS 17 months ago and I'm slowly starting to think about the possibility of doing it all over again.

I had a complicated labour that became very medicalised despite my wishes and best efforts, the pain was manageable, but a pre-labour rupture of membranes led to prostaglandin, then synto, 3 sleepless nights and finally meconium and EMCS for failure to progress (what an awful term) having managed a sum total of 3cm dilation after all that effort.

I was shattered and there were circumstances during the labour that a safe outcome for PFB was far from certain, so getting to theatre felt like a massive relief. The EMCS was actually a good experience, I had a spinal, early skin to skin contact and a really good recovery. But there were issues establishing breast-feeding and a nagging sense that had I held off the induction for a bit longer we might have had a more 'normal' delivery. It's that final thought that nags away at me.
I don't know what I want for DC2 (assuming we get to have a DC2 at all), but I watched friends who had vaginal deliveries develop complications and take a long time to recover, so I know it's not all rosy, my head says an ELCS is the safest/sensible option, but something stupid is nagging at me that I 'should' have a VBAC (as if 72hrs of contractions the first time round weren't enough). Deep down though, my biggest fear is of another EMCS, particularly a general anaesthetic EMCS and I suspect that will be the deciding factor, I need to feel in control and I think an ELCS offers me the best chance of that.
Worried, TreadSoftly is right, the NICE guidelines say that you should have a choice about VBAC and ELCS with full information from your clinical team. Please ask for a second opinion, whichever decision you make it is important that you feel comfortable with it and it doesn't seem like you are yet.