VBAC vs ELCS - am I the only one?!

[Laquila]

I had an EMCS two years ago after (long story short) going into the early stage of labour naturally but struggling to get much further despite two more days of on/off contractions, artifical rupture of membranes and syntocinon. My EMCS felt a bit panicky at the time but actually was fine, recovery was very straightforward and my scar healed well. I had a lot of probably with bf but managed to crack it and fed for 19 months.

I'm due again in a few months and met a registrar today to talk about VBAC vs ELCS. Is already done some research into it, and the results were backed up by today's appointment - I'm very much feeling as though having an ERCS is viewed as the easy, selfish option. I guess there's (understandably) been so much work on encouraging women to have VBACs in recent years that this isn't really surprising.

If I could guarantee an intervention-free birth, ideally in the pool, then maybe I'd feel differently, but at the moment I'm more nervous of ending up with forceps/ventouse, episiotomy/tearing, bladder/bowel problems as a result of an instrumental delivery than I am of a repeat section. There doesn't seem to be any evidence to say that it's more likely that a VBAC is more likely to result in an instrumental birth than a non-VBAC, but I guess sometimes statistics don't come into it, and your instincts overwhelm you. I can find countless support groups and articles online encouraging VBACs, but no-one telling me (convincingly) that if I've researched and considered everything, and still go for a repeat section, that's OK. Is that because it's genuinely not OK? Am I actually being selfish/blinkered here and worrying unnecessarily about VBAC or did anyone else feel the same?

Can I reply to you in the morning? I'm going through the exact same thing but I'm near enough falling asleep. I defo want to talk to you about this though xx

Absolutely, MrsP! :)

I had a great VBAC after an EMCS. It was my best birth out of the three. I am now expecting again and likely to be induced due to my age and the fact that I always go over my due date by at least a week.

I am having the same problem. Knowing that I am likely to be induced means that I am more likely to need intervention based on my previous experiences. I am thinking that for me the ELCS might be a better option.

After my EMCS I was quite upset for a while because I felt everything spiraled out of my control. With DC3 I went for a smaller hospital where I was left alone much more for my labour to progress. Thankfully, my labour started at home so I was also able to delay going in for as long as possible.

Your second labour could be completely different to the first so personally I would consider going for the VBAC.

Hi Laquila I'm going through similar thoughts - although not regarding a vbac vs elcs but natural Vs elcs,

This is my 4th pregnancy, I've lost 3 babies prior to this one (all since May 14) and my 2nd mc was utterly brutal and even just thinking about that one makes me feel physically sick.

So pregnancy number 4 is doing well and I'm nearly 24 weeks but for the exact same reasons as you, I am fucking terrified. I have no confidence in my body and can barely speak about it all without getting tearful.

I've been told by my incredibly kind consultant that I've got a "good - probably 60% chance of a natural birth " - sorry those stats aren't good enough,

My BIL is told me there is only about a 10% chance of needing forceps (he's a surgeon)

Well after the bloodbath that was mc 2 I was denied any help as I'd not had 3 mcs in a row and was told "the chance of having 3 mcs in a row is only about 1%"

Well that ended well didn't it!!!!

Anyway I've totally lost confidence in my body, I don't believe any of the natural stuff empowering me etc, my pregnancy is a means to an end. I just want my baby delivered quickly and safely. My view is that it's all gone horrendously wrong before, why is this one different?

Anyway people are saying to me but a cs is really the answer etc etc. And actually my view is that it's no ones business and a good birth is a birth that has a healthy mother and baby at the end of it.

But it has crossed my mind, am I doing the right thing just going for ecls?

I just have no confidence in myself is what it comes down to.

My feeling is, do what is right for you

I'm not pregnant now but had an EMCS, in different circumstances to you last year and have thought a lot about the future. I laboured well with minimal pain and got to 10cm walking around before events resulted in a crash section. I found post section pain worse than any labour pain (but I did have an unusually easy labour to be fair), and had lots of complications requiring a long post natal stay. In the future if I have another I will be having an ELCS, even though in theory I would have a good chance at a VBAC. I would prefer to go with a controlled circumstance than risk another EMCS.

I had a traumatic emcs the first time. My hospital this time were all about VBAC and not in a balanced way, getting an ELCS has been a massive fight - signed off a few days ago at 37 weeks. I wasn't impressed at the level of pressure throughout my pregnancy.
Long story short due to a higher risk of rupture for me (small age gap and previous premature c section - sewn up small) and hàving never had a labour I had about a 60% chance of success and I know it wouldn't cope well mentally with another emergency. So I went for the ELCS.
I hope I've made the right decision!

I had emcs two years ago (tomorrow!!) at 38w after failed induction and baby had bradycardia.

Currently 22w with number 2 and I'm having elcs this time, which the consultant has already agreed to.

I have to deliver at 38w due to diabetes and I worried about the risks of early induction rupturing scar etc.

I was prepared for a bit of a battle, but consultant was very reasonable and agreed, all things considered, that was the best option for me.

Must admit, I felt very relieved!

My VBAC after EMCS was also my best birth.

This is my fourth pregnancy and it's a breech so ELCS for me but I think I'd have pushed for that anyway as this is a surrogacy for my friends and I've had some problems, stress incontinence, vaginal prolapse from last birth (or poss the EMCS birth as she was nearly out and her big fat head got stuck!!). Also, we can plan things now.

Though if it started tonight and scan showed proper presentation Id go for it naturally. I just want it done with now.

Roll on Wednesday!!

I was lucky enough to have two straight forward VB without intervention but I absolutely would say to you to do what you are most at ease with.
If you feel more comfortable and confident with an ELCS then go for it. There is no shame in choosing the option that makes you feel happiest. Happy mum = happy baby and there's no medals or prizes for having a VB or a VBAC. It's great that women are having the option to have VBACS but equally that shouldn't mean pressure if that's not what you want.

Xx

Good luck with your decision!

Elcs is not an 'easy' option and I hate the way it's often viewed as such. I had emcs followed by elcs, I found both very frightening. There can be a long recovery after either.

Thanks very much for the replies, everyone - I really appreciate it. I'm still confused, but it's good to know I'm not alone! Brummiegirl, I'm so sorry to hear your story and wish you the very best this time round.

People keep telling me I have ages to make my mind up, but that's just making me feel more anxious - I can't spend the next four months deliberating about this or I'll go bananas! I think we're going to speak to the Supervisor of Midwives but am not confident that will help, to be honest.

Sugarandsalt, I think your point about "controlled circumstances" is key - I'd never thought of myself as a control freak in the slightest, in fact I'm usually very relaxed and patient, but this is one area of my life where I don't feel prepared to sacrifice control for what would statistically be a marginally safer birth, but not necessarily a less traumatic one.

I also had an EMCS two years ago which I found pretty traumatic. Am due to have my second baby next month. I'm having an ELCS and the hospital has been great about it, though from reading other people's experiences on here I think that might be unusual.

There are medical reasons for them supporting my decision (risk of ruptured scar tissue and various things) but they also seem to have acknowledged that I am so petrified of things going wrong again that emotionally an ELCS is the best option. The midwives said they want me to have a "good" birth experience this time, ie one where I'm not a nervous wreck about the prospect of everything going tits up again. The only emotion I can remember from the birth of DD is fear. Of course I've had fantasies about a lovely VBAC and if I could guarantee having one then I wouldn't opt for the major surgery of a c-section.

It's your decision and if you want an ELCS then stick to your guns. I think if you've had a traumatic birth once then you know in your gut what's best for you the next time. And anyone who thinks recovering from a c-section is the "easy" option needs a smack in the chops x

Ds1 was an ELCS as he was breech. When I found out I was pg with DS2 I had no hesitation in requesting a second ELCS.

Both experiences were calm and enjoyable, and I had no objections from the hospital, I just had to take away fact sheets on both options.

Sorry for such the late reply!

I had my ds through ECS. I went into labour naturally, although I was in labour for 2-3 days before it went fully established. My ds was back to back and tried to turn himself round but got stuck halfway through. It was rather traumatic as it was all rush rush rush. I was severely anaemic and collapsed in theatre. Then again on the recovery ward. I had 3 blood transfusions and tbh should have had a huge heart attack with the stress my body was put under. My scar became infected and split open. I was in and out the doctors day in and day out having it redressed, numerous antibiotics etc. it took 3-4 months to clear up completely.

I'm currently 33w with dd and I had a consultation with a senior midwife, who suggested I try a vbac birth this time. My body laboured well and handled it brilliantly but it was the infection and scarring that caused all my problems. They said that with an ECS I would be at risk of having my bladder punctured as they're not sure how thick my scar is due to the infection I had. They're worried about my recovery and if I have a repeat infection I could be really ill again.

I'm confused about what it is I'm going to do because me and my family have big babies. I'm already measuring bigger and having to be monitored again.

My advice is go with what you feel you want to do and that will be best for you. I still haven't made my mind up yet and I only have 7 weeks roughly left. X

I had a wonderful vbac after an elective c section first time (he was breech). I was so determined having psyched myself up first time around and went on some hypno birthing course

Had pethadine and I went from 4-10cm in 45 mins

Would still recommend it if you have any desire for a VB. Otherwise, just go with elcs as I believe that much of childbirth is psychologica .

abbeyroadcrossing, can you tell me more about the advice you got to elcs rather than vbac after previous premature section? I had my ds at 27 weeks by emcs, and it's something I panic about, the strain of a full term pregnancy on a 6 month scar.

I had my first by crash section and aimed for a vbac with my second. Hypnobirthing, pool etc. Laboured all night, never got further than 3cm and at that point they said they could break my waters and keep trying and I refused and opted for a C-section. It was calm, and so different to the first one.

I wish it had worked out, but I'm glad I tried and I'm also glad that my birth plan was really clear - vbac with no intervention or C-section, nothing in between. It was the cascade of intervention ending (very suddenly) in theatre that made the first one so awful.

I honestly don't understand the obsession some women seem to have with vaginal birth. It seems to me many women put their 'experience' before the health and wellbeing of their precious new born.
I'm not saying that scarring, infection, trauma etc. is small potatoes, but I always felt as an adult I am better equipped to deal with the stresses.

Really sorry if this is coming across as offensive. I don't mean it to be, it's just an observation I've made. Also I'm not against vaginal birth when it is an informed choice.

In the spirit of honesty My DS was born by elective section. No medical rational, it was a text book pregnancy, normal sized baby, but after weighing up risks and benefits, I found the risks of CS more acceptable. I would have done anything to avoid an instrumented delivery even if I was low risk.

I had elcs after emcs for the same reasons as you. I had to meet the supervisor of midwives to discuss but it wasn't really a discussion, more her trying to persuade me to have a vbac. I still wasn't convinced and had a consultants appointment where I said that I had considered all the evidence and wanted an elcs and he got the diary and booked a date. I was so relieved when he did that, I knew I had made the right choice for me.

This time, I said from day 1 that I wanted a elcs and no-one has contested it. Well apart from the maternity receptionist who insisted I had to go to another v bac discussion. I declined this appointment with the full support of my midwife as it would be a waste of everyone's time.

Good luck in making your decision.

Signorita my hospital actually advised me to VBAC and still are advising that but based on my own reading I've decided on ELCS. DS wasn't very premature but I only have a year age gap, so less healing time. Both together increases the risk of rupture. It's still a small risk though but I'd ask, especially as yours was a lot earlier than mine.
They did reassure me that they'd constantly monitor etc so any sign of rupture I'd be straight in the theatre, but for me, mainly mentally, the planned section seemed the right decision.

There's a guideline on the RCOG website for VBAC vs repeat caesarian. It was updated last week so I expect this will be what the consultants are using. The PDF is quite long but gives an idea of success rates for VBAC. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/

brummie I agree when you are always in the 1% or 5% then the stats stop being so reassuring! I also suffered repeat mcs, then shoulder dysotica at the birth of my daughter (less than 1% chance of that happening).
I am having an ELCS for that reason, no one can guarantee it won't happen again although statically the most likely option is a straight forward natural birth, I am always on the wrong side of it!

there is an interesting 'stat' in a c section book I have, when you pull out ELCS stats from emergencies the outcomes for both mother and baby are actually better than vaginal birth.

I didn't want it try for a VBAC and chose an ELCS. No regrets at all. I wanted to know what would happen and trying for a VBAC with the possibility of an instrumental delivery or EMCS was too uncertain for me. The ELCS was a very positive experience. The surgeon after the second caesarean told me my uterine scar was thin and it was probably a good job I'd had a caesarean so I felt like that vindicated my decision too. If anyone thinks I chose the 'easy' option they've been too polite to say so ...

If I get the 'easy option' crap of other mums I usually ask them why they didn't request one then, as any woman can. It usually turns out that they don't really think it's easy after all.
For what it's worth I don't think either is easy. But having this baby magiced out of me isn't an option unfortunately

I am in a similar position to you of choosing VBAC vs ERCS after an EMCS last time. Baby and I were ok in the end but it was a close run thing.
After much research we are going for ercs. On balance, the risks are far too high for me given the individual history/risk factors involved to try for a VBAC.
I did not find discussing the pros and cons with the consultant I was assigned helpful or even possible. They gave me incorrect information and weren't interested in the risks that applied to me at all.
I second the RCOG guidelines as an unbiased, informed source of the risks of each choice and how this might vary in your situation. Also this book was really useful: www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110

Had decided for a planned c section after first emcs, very similar reasons to yours for the first EMCS. But the body decided to go into labour the morning I was due for a planned c sec! Ended up trying for a vbac. After a few hours developed an infection, high temp and bradycardia again so had another emus. You know what, I have absolutely no regrets, no issues about having c sections. It wasn't my first choice, I actually wanted home births, but somehow despite all the reading, preparation, yoga, hypnobirth bullocks, I had two c sections and now have two gorgeous boys. No regret whatsoever. And whoever told you it was the easier option is full of poo.