Had my vbac appointment today. Still undecided!

[Sparrowlegs248]

Ds was born by elcs due to being breech. He will be 18months old when I am due Dc2.

31wks pregnant.

Was told today :

They prefer not to induce (good, I don't want to be)
I will have to have continuous monitoring. They have one mobile monitor, but with the usual ones you can walk around the bed.
They generally don't give an epidural.
No water birth allowed.
They would be concerned at going overdue as baby is big.
Chance of rupture is 1%.
They would advise sweep at 41 and membranes broken at 42. I'm not keen on the latter......

I am absolutely at a loss as to what to do. Of course an important factor is having a very active toddler.

Help anyone? Advice?

What is your attitude to risk? A 1% risk of rupture would be way too high for me, but you might be different.

How does that and the other risks of vb compare to the risks of ELCS for you?

Will you have help with DS during the initial days? ELCS guarantees a few days of incapacity, as you know, but VB may be better, barring major tears etc. How was your recovery last time?

I thought I was being wimpy about the rupture but agree, 1/100 is high.

I have mum and Mil who will both help, and husband who will have to step up a bit.

My recovery was great. Obviously I got to sit down a lot last time!

I don't think it's wimpy at all, especially given there is an alternative that eliminates the risk. Is it mainly the ELCS recovery that's bothering you?

they generally don't give an epidural

Why not?! They would have to if you had elcs?

I had ds1 by elcs due to being transverse. I was all set to have ds2 by vbac, but had another elcs booked at 42 weeks if I hadn't gone into labour by then. At 38 weeks I then asked the question, "if I'm in labour and need a crash cesarean, is it possible that both operating theatres are busy and there is no surgical team available?" The consultant said, "we can't guarantee that wouldn't happen". I made my appointment for a second elcs at 38+6 weeks there and then. No regrets, but then I don't feel I've missed anything by never having been in labour. I have two healthy children and how they got here is secondary.

They prefer not to give epidural for vbac due to the potential to slow labour and not identify scar rupture. It increases chance of rupture I think.

I'm not worried about the recovery as such, more how I will manage ds while recovering

Good point nobetter, I hadn't thought of that! I have no hang ups about being less of a woman/mother/whatever due to not having laboured. Labour scares me more than c section! But if I had a good natural birth it would be much easier after.

I had emcs with first and vbac with second where I was induced 2 weeks early due to size - size of first caused the emcs.
I had my waters broken at 8am and an epidural from mid day and ended up with vontose delivery just after midnight. No rupture but a cut to help prevent tearing with assisted birth. I would take the recovery from that over my emcs everytime.

Don't forget the chance of you needing an emcs anyway is up to about 50% depending on the stats for your hospital. For me, a planned option with minimal risk would be the best option unless you're very keen to experience a natural birth.

The recovery is what was driving my initial decision towards VBAC. However, I have to say in many ways my recovery after my second section was easier than after my first. I think purely because I was more realistic about what it would involve.

With my first section, I believed all the people who say, "oh yes, I had a section. I was skipping down the corridor two hours later and after a week climbed Mount Kilimanjaro with the baby strapped to me in a sling, all whilst breast-feeding". With the second section, I knew the recovery wasn't going to be easy and we planned for the fact that I was most likely to need to take it easy for the first month or so. We set up the house to minimise having to go up and down the stairs, DH took a couple of weeks off as holiday to help out, we kept ds1 in nursery for the entire time I was on maternity leave (half days) so that he didn't get bored and I got some time to take things easy with ds2. Unfortunately, my dm booked to go on holiday for a month starting the week that ds2 was due, so we didn't have help from extended family, but being realistic about what recovery involves certainly helps.

It's a difficult decision to make and imo neither vbac, nor repeat elcs are ideal, nor without risk (remember elcs carries the risk of surgery too) - not that I mean to sound alarmist!!!!

Good luck, whatever you decide

Is the 1% rupture risk specific for your circumstances, or in general? Because I had more than one VBAC and was told/read that the risk of rupture was much smaller than 1%.

There are pros and cons to both decisions, but surely there's no reason to be induced if you don't want to be? If you go to 41/42 weeks with no sign of labour starting on its own, why not book in for a section then?

So what they're saying is you won't be able to be in water, you won't have access to the most effective form of pain relief available and you'll have to have continuous monitoring?! That doesn't sound like a tempting trio, if I'm honest.

Gah typed a reply, which disappeared.

I was told success rate of 70% however, looked up my hospital and turns out their success rate is 54%!

I have no hang ups AT ALL about needing to push a baby out of my fanjo. I don't feel less of a mother/woman etc.

Vbac scares me more than elcs. Because it's so unpredictable I think.

The 1%rupture risk was a general stat, I have read from 0.5 - 2% either way its pretty high. Imo.

I recovered really well from my c sec with ds. But, I was able to sit and rest quite a bit. I remember taking him.out in his pram at a week.old, and feeling pretty pleased, but having to tell my mum to slow down as I couldn't walk as fast as her. Ds is very active. I would have help from dm and Mil but Ds is still a baby himself, I'm not sure how it would work.

Hyacinth - indeed. I'm not convinced.

I just think, if they were trying to design something to put off as many women as possible, they couldn't do better! Pretty much everyone from across the entire spectrum would object to at least one of those.

Your hospital sounds a bit odd. They don't want you to go overdue as you have a history of large babies yet you talk about sweep at 41 and AROM at 42 weeks? Seems contradictory- surely 42 weeks is the absolute maximum they would like for anyone, let alone a large baby in a previously scarred uterus.

I personally would share your assessment of rupture risk as too high. And then just do whatever needs to be done for recovery. VBAC might mean an easy- ish delivery but most first vaginal births have issues like tearing and stitches, and can also include horrific injuries. A section guarantees an incision and everything that goes with it but makes catastrophic injuries much less likely.

I had DS by EMCS. I'm 34 weeks at the moment and am planning another section.

As pp's have said a vaginal delivery can result in horrendous injuries /long recovery time also.

Sycamore - they were the options given, so I knew what I was in for if I chose that route. Indeed I won't be going overdue whatever happens! I'm leaning towards c section.

How old is ds old?

This is my one worry. Mine is so active, and still so young.

I've had two; one EMCS and one ELCS.

Recovery from my ELCS was a breeze compared to the first one. Plus I didn't have a log failed labour to recover from as well. Many of my friends who had vaginal births had much longer lasting ill effects. If you've got family help around then that's fab.

That rupture rate and the other stipulations would make it an easy no for me.

Hope you find peace with whatever you decide :)

First was emcs due to RFM, second was vbac only 13 months later.

Was induced, decent size baby (nearly 9lb - tho I was 41 weeks), epidural didn't work so I felt it all. Healing was better than emcs (and tbh the emcs healing was fine as I hadn't actually laboured).

I was told general success rate was 8/10 same as a FTM if you hadn't actually laboured the first time.

Good luck whatever you decide x

My elcs was one of the most stress free positive experiences ever, never for a moment have a regretted it. Recovery was a breeze compared to the emergency. Good luck with what you decide.

No epidural? Fuck off! I have the same decision to make but I'm not as far on as you, I have my vbac discussion booked for about a month's time. My local hospital's success rate is not much over 50% as well. I was leaning towards vbac but if there's no epidural on offer I'll go for C-section.

Seems to vary massively Fat - someone I know had the same appointment samehospital and came away thinking very differently to me. But, her first birth was very different, 2 wks over, induction, 4 days labour, emcs bad recovery.