Can I ask a question about vbac vs elcs?

[Glitterkitten24]

Hello,
I am 27 weeks with my second DC- I had an emcs with my last dc, 4 years ago due to failure to progress labour at 40+5. I also had pre eclampsia (but uneventful) if that's relevant.
As far as I know I didn't dilate at all last time, never even got any rhythm of contractions started before being sectioned.

So i have been offered elcs this time round and met with my consultant who explained all the facts and that it was my choice- she made it clear though that they will not try and induce labour, but would emcs straight away if labour didn't progress if I wanted to try vbac.

I also understand that the fact I didn't labour at all last time means the odds of vbac being successful is lessened.

I am struggling to find stats about how likely a successful vbac would be given what happened last time.
My consultant and midwives have been really good at giving me the facts- but can offer no opinion on what I should decide, it's my choice.

Can anyone offer any thoughts on what the likelihood of a successful vbac would be given my history?
Any experience or thoughts would be gratefully received!

Thanks!

Hello. I'm in a similar boat, had ECS three months ago and already thinking about what the plan of action should be for next baby. My labour was different in that I was completely dilated but the baby's head was just too big and wouldn't fit through my pelvis, DH is a big man..

I have done a lot of reading on ECS vs VBAC and am still unsure myself, I read that 4 out of 10 women who try a VBAC end up with ECS anyway. Don't quote me on that though.

The preclampsia may of had something to do with your ECS - if your blood pressure is fluctuating during labour so if you don't have it this time round you may be left to labour longer which may give you a better chance of a VBAC!

Let me know how you get on, sorry couldn't be of more help.
x

Hi,I've had two Emcs for 'failure to progress'. In labour for bloody ages both times and stalled at 4cm even with the drip. Baby 1 was in a transverse position so as baby 2 was on in a good position so I thought I'd give it a go. On my due date I had a wobble and booked in for an elcs at 41 weeks. I went into labour before so the Dr's left me to see what happened,I didn't dilate so had the c section.
Do you have a gut feeling either way?My trouble was that I couldn't decide!
I would go with your gut feeling. FWIW my 2nd was very much like an elcs,great atmosphere,calm and the most amazing moment of my life (apart from baby 1 although I was pretty out of it). It made me realise how special an elcs can be.
I can't help you with stats as it was a while since I was looking at all of that.
Best of luck!

Hi,
I'm not sure I understand why exactly you had the emcs last time? Failure to progress means you've been in labour for a very long time but can't get past a certain stage, despite contractions and drip etc. But you say you've not been in labour and contractions weren't ever regular; so that would rule failure to progress out?
Fwiw, I had an emcs with my first due to failure to progress, this was after 36 hours of gruelling labour and seeing several shifts change at the hospital! Eventually my cervix started to thicken up again due to very strong contractions but baby in posterior position, so I never got past 5cm and they suggested the c/s.
I tried for a vbac with my second - this time labour was still very slow, but faster than with my first. I got to 7cm after only 24 hours, not on the drip, and waters broke on their own (they had to be broken with my first). Sadly then I had a cord prolapse and had to be rushed off for a crash section, but had it not been for that, I think I might have succeeded.
With my third, however, I just couldn't face going through days of labour again and having had 2 caesareans and big babies put me at higher risk for complications. I also had to arrange childcare for my 2 and 4 yos, so having a fixed date was beneficial. The decision for an elective caesarean was quite easy that time.

I can't really give you any advice about your chances, it's hard to tell anyway, but the story of your first labour was a bit unclear. I think it depends on how confident you feel as well - the more relaxed and determined you are, the better your chances of having a successful vbac.

I think the most important 'factor' is what you feel inside (someone said your 'gut' feeling)....

the 'vbac stats' I think say roughly what you said, but after all that stats are stats, how do you know you will be the one who ends up with another c/s or the one with a vaginal birth?

it's about what 'you' feel you want to aim for.

you can discuss the potential to go for VBAC but with certain 'agreements' ie:

I will try labour but if this does not progress on its own I am not willing to give the hormone drip a try
I would like an early epidural (or I would like to try going without an epidural for as long as possible, or not have it at all, depending on your choice)
etc etc

let's remember that c/s is not without its risks, whatever we do has risks, so the main factor is what you think you want and is best for 'your' situation

Thanks all for your responses- it's really useful to hear other experiences and thoughts.

Sansa- my emcs last time was as labour just wasn't starting. So I had 3x pessaries, my waters broken, drip x2 and still couldn't establish labour. When it was approaching 24 hours with waters broken, they decided to emcs due to risk of infection setting in.

I kind of feel like I might regret not trying a vbac, but if the chance of it being successful is low, I'd much rather a planned section than a crash one!

I was booked for an ELCS but agreed to a VBAC if I went into spontaneous labour. Had previously had emcs for failure to progress.

Second time round I went into labour at 38+4 weeks and had a success VBAC although it was a long labour due to back to back positioning.

I found recovery from VBAC much easier especially as I had a toddler to look after and would probably go for another VBAC if I had more children.

As I was monitored quite heavily in my first labour I knew what to expect second time round so wasn't hoping for a juju water birth etc. But I think that worked to my advantage as I was keen to manage my pain with drugs and an epidural rather than expecting to manage naturally.

I think the consultant said 70% will have a successful VBAC.

Glitter I was in a similar situation to you :- 1st pregnancy at 42 weeks I had 3 x pessaries, waters broken, drip and didn't get past 1cm!

I found it so difficult to get any opinion out of the midwives and consultants I saw for DS2 pregnancy, it drove me nuts.

Don't quote me on this, but from the research I did I found the following

Vbac is marginally safer than an elcs
Elcs marginally safer than emcs
If you've had one 'failure to progress' your statistically more likely to have another and therefore end up with emcs.

Basically, there wasn't much in it... I told them I would aim for vbac, but editor not be induced again. If I went over 42 weeks I would have an Elcs. The plan was to get to 41 weeks and have a consultant appt. If I got that far, we would put in a date at 42 weeks for the section.

As it happened, I was so uncomfortable and fed up at the 41 wks appointment I just said "gimme a c sec asap!!!!" and got put down for 3 days later.

"Editor" = "would"

I've had 3 vbacs after my emcs and wouldn't choose differently in my position. The emcs was due to baby being in a tummy down position and a prolapsed umbilical cord. Very rare etc.

If I'd had the choice, I would prefer an elected c-section over an emergency one! If you book an ecs appt, and change your mind, no harm done right?

After long deliberations [similar circs to you but my waters went and then failure to dilate after every drug going] I decided on an ELCS.

Waters broke spontaneously again and ended up with an unplanned VBAC as things progressed relatively quickly [in comparison with my first delivery at any rate]. All fine but I was totally unprepared and the recovery from a forceps delivery was much longer than my previous calm EMCS. I was gung ho initially but it was 12 weeks before I could sit down normally so by then I was heartily wishing I'd had my ELCS.

If you are ambivalent, then one option is to book in an ELCS and if you labour spontaneously ahead of that, take it as it comes. The risk is that you don't have a slot in theatre but with an ELCS you are just as likely to get bumped. Fine if you are not in labour already though.

Why were you induced at only 40 weeks? It sounds like you just weren't ready.

It is common practice to induce your labour if pre-eclampsia occurs late in your pregnancy. A caesarean section can be done if necessary. The risk to your baby is small if he or she is born just a few weeks early.
patient.info/health/pre-eclampsia-leaflet

Ah okay, I didn't think it was always an indication for induction.

vbacs statistics paper - I hope this helps.

I had an emcs for ds1 after a failed forceps delivery so fully dilated and had 'laboured'. He was 9lbs 1 and just got stuck.

My recovery was not good so when they estimated DS2 would be 8.5lbs I decided to go for a vbac second time round. I was very anti having another section and just wanted to avoid having to the same very slow recovery again (still holding stomach in pain when I sneezed or coughed after a year).

In the end ds2 was 16 days overdue and I showed no sign of going into labour and they refused to induce so I had a planned section on the Monday (at 42+2) The experience was very very different to the first time and not as bad as I had expected. That said having had forceps and pushed for along time I fee I've done as much of labour as anyone else has without actually popping out a baby, I would still rather have that than a section.

You should go with your gut feeling. Baby may well no go along with your plans, just be prepared for that. I burst into tears when they said I needed a section, I was not happy but at least I had a weekend to get used to it. It tuned out he was 10lbs 2oz and would never have come out so nature chose for me and did the right thing.

Good luck 😊