VBAC or ELSC after previous EMCS??

[oliversmummy26]

Hello ladies, I'm sorry, I know this discussion has been talked about over and over, but just wondering if there's anyone there who has had a similar experience to my first birth...

Induced at 40+7 due to baby measuring big for dates on a Saturday morning, with the pessaries. First pessary did nothing, so 2nd 24 hours later, by 8pm Sunday evening had got to 2cm and they agreed to break my waters. But not until Monday morning!
Monday morning at 7am waters broken, drip inserted. Contractions started properly at about 11am. Epidural at about 2pm.
Got to 7cm, 4 hours later still at 7cm and baby in distress, heartrate dipping with each contraction, fetal blood tests showed decreased oxygen. "Urgent" C Section at 4am Tuesday morning.
DS weighed 9lbs 13 and had an enormous head! I forget which percentile, and am going to check before my VBAC clinic appointment at 21 weeks.

I am almost 16 weeks now, and due to see specialist midwife to discuss my birth options at 21 weeks.

I have no idea whether I want a VBAC or ELCS! I am continually swinging between the two, and when I think I've made a decision I read something and change my mind back!

I think I would like growth scans to check this baby isn't getting too big, and would kind of like to try giving birth naturally. However, continual fetal monitoring puts me off, as I know I'll want to be able to move about if I don't have an epidural. Then if I have an epidural (as I suspect I will as I'm a wimp and got one fairly early on last time) I worry that as I'll be stuck in bed then, labour will stall and I'll be right back where I was last time with EMCS...

So should I just get myself booked in for an ELCS at 39+ weeks and have a far calmer birth experience. DS will be 5, so it's not like I have a toddler to run after and DH will be very supportive I'm sure. I recovered quickly from my last CS, was showering within 12 hours and home just about 36 hours after the op.

But then I think maybe I should give myself a little longer and see if they would agree to let me go to 41 weeks before scheduling a section? With the proviso that we keep an eye on baby's size and if measuring big again, I go in for ELCS earlier.

I already know what I don't want: no induction, no forceps, ideally no continual monitoring, but don't know how likely that will be...possibly timing stages of labour so that if I do end up having an EMCS I won't be as exhausted as last time..

Just wondering if any of you ladies had a EMCS under similar circumstances and how your second/subsequent births went?

Have you been offered a VBAC/ELCS choices clinic appointment? If you're veering between the two it could be a good place to go through what you'd like to happen this time and get a sense of how feasible that would be. I'd also recommend undertaking some of your own risk research. Which? publishes figures on types of birth and intervention rates in most hospitals - the VBAC success rate at my local hospital has been a key factor in my decision. If yours has a high success rate you may find that reassuring.

I'm just back from a midwife appointment and have been told that in my trust they won't give a yes/no on ELCS until at least 30 weeks and won't book in until at least 34 weeks, so be prepared for a wait to find out if you decide to request ELCS.

Thanks duggee, yes, I have a VBAC clinic appointment with a specialist midwife at 21 weeks. My hospital has a successful VBAC rate of 43% which doesn't exactly fill me with confidence!

I had thought a decision probably wouldn't be made until later on in pregnancy and had heard that only a consultant can approve a request for ELCS. So am happy to discuss with the midwife at the clinic appointment my options. Also hoping that she'll have my full notes from last birth as it would be good to find out exactly why I couldn't get past 7cm last time.

With the liklihood that this will be a big baby too, I had guessed that it will be later on in my pregnancy that a definite decision would be made. I'm still leaning towards ELCS though, it would be so nice if a straightforward VBAC could be guaranteed, but I realise that's not possible.

It sounds as though having your notes would be very helpful - not knowing why things happened the way they did last time doesn't make the decision making any easier!

I can see why leaving the decision until later makes sense, as it gives plenty of time to research and see how things go this time around. Although I did explain to my midwife yesterday that, as I know what I want, it would be nice to have it confirmed now so I don't have to feel anxious about it!

Hi!

I had an almost identical first birth to you so I'm watching keenly to see what you decide and why!

Ladypug I saw my midwife today, she did say that they fact I got to 7cm is a good sign, and probably means that he was in the wrong position rather than that he was too big..

Still leaning towards an elective section as it's the devil I know and I can far more easily arrange childcare for DS if I know when I'll be going to hospital (which is 45-60 minutes from home!)

I'll be following your thread too! I was induced for an estimated big baby. Had propess which worked and waters broke naturally, was on drip and got to 10cm after 12 hrs but baby was back to back, wasn't far enough down and I couldn't push him out. Had ventouse and forceps but his heart rate dipped so they did emcs there and then. He was 8.11 so not massive.
I'm not actually pregnant yet but hopefully will be soo.

Also following with interest. I'm in a similar position but later in the pregnancy, so have to make a decision about birth plan this week (36 weeks). Was inclining towards VBAC but am worried by a few things:

Baby's head size was massive last time and surgeon said he thought it was a true case of cephalopelvic disproportion. This more important than poundage I think. Current baby also seems from scans to have a v big head though not as heavy as DS. Internet research suggests that VBAC less likely to be successful if it's head size / disproportion that was the problem.

I also didn't go into labour naturally last time. This time they can't induce (my hospital won't for a VBAC), so wonder if it will just be a section anyway at 40 +11, in which case why not do it before?

Just found out I am Group B Strep positive which is I know not in itself a good reason for a c-section, but as on fence anyway... Will you test for that?

Still, some part of me can't believe my body is really so stupid that it keeps growing babies with heads that I literally can't get out... My DS was badly positioned and never engaged but this baby is lower down and anterior so wondering...

Very similar 1st birth - induced due to my waters going two days before, 22 hours of induction for only 3cm dilation, emcs. Baby was 10lbs and in a crap position. I'm only 8 weeks and already thinking about it constantly.

I'm erring towards elcs. I found continual monitoring very hard to handle (no epidural, silly me). Big babies and bigger second babies run in the family. And my son will be 22 months when I have this one, I could really do with not having to recover from both labour and surgery.

It is my understanding the NHS can't actually refuse a csection, at least if you've already had one. They might try to push you one way or the other, but since 2011 the woman's wish is the final factor. Can you tell I've been researching this a lot?!

Edgar no, they can't refuse you (thank goodness!) I've even saved the relevant guidelines to my phone, along with a whole load of other stats, ready to see the consultant again. She and I don't currently see eye to eye on this

If you are already erring that way, mention it to your midwife at booking in so she can arrange an early consultant appointment to get the ball rolling.

Thanks Duggee, I certainly will. The more I dwell on it, the more I think I will go with an ELCS. I don't mind it not being booked in until later, I just want it agreed in principle as soon as possible so I can relax about it.

I too am in a similar situation. DS wasn't a big baby though, he just got stuck. In fact had a ring around his head where he got stuck in my pelvis.

I had my first ob appointment last week and he has already brought that I need to have a think about what I want to do this time around.

Like op I know more what I don't want than what I do. I'm only 8+4 so have a lot of time left but it's still on my mind.

Edgar the agreement in principle is the bit I'm working towards - I think I'll finally breathe once I have it! Good luck with your appointments

Still erring towards ELCS here, as would so much rather get booked in, turn up and have baby whipped out! Also the devil I know sounds far more appealing than the devil I don't! 3 weeks until my VBAC clinic appointment, so will let you all know what happens...it's with a specialist midwife though, rather than consultant, so I expect I will have to have another with a consultant later as MW can't make the section decision I don't think?

As far as I know it's the consultant who has to sign it off. At least after the clinic you'll be able to show you've had all the information to make your decision

Was exactly the same. Ds is 5. Birth was horrendous. Baby in distress and had a emcs. Lots of associated birth trauma. Had an elcs 5 weeks ago. It was amazingly different from first experience. I loved the whole thing and it has given me a much more positive start to the newborn phase, which I'm actually enjoying this time! For me, elcs was definitely the right decision. Good luck whatever you choose X

This is interesting. I had my birth options clinic this morning with a consultant midwife. Before I went in I was strongly leaning towards an ELCS but now I'm not sure. He said the things I was worried about (being induced, given the oxytocin drip or being in labour for ages with little progress) wouldn't happen even if I chose a VBAC and they would go straight to c section if needed. But I don't know how I'd cope emotionally with another EMCS. He recommended I tried a VBAC but stressed it was completely my decision. I'll have another appointment at 34 weeks when I'll have to decide so lots of time to think about it. I definitely didn't feel fobbed off or put under pressure. He didn't say anything about having to get anyone else's approval.

OP your birth story sounds identical to my first, apart from the big baby (she was 3.12kg).

I have had two vbacs since. The first I was a bit worried about rupture but still I requested intermittent monitoring only. This was agreed with the consultant MW but unfortunately I had meconium do agreed to submit to wireless monitoring after a couple of hours. Baby born via forceps.

2nd vbac was only 2 hours of active labour and wireless monitoring for the second stage only. Baby born with no assistance or pain relief (not my intention!), 3.78kg. It was amazing to be up and about immediately after.

So I had my VBAC clinic appointment this morning, the specialist midwife I saw was lovely. She want through all the pros and cons, but basically said they would support me whatever I decided.

She's going to request my notes from my previous birth as it was a different hospital and will give me a call when she has them. It will be interesting to find out exactly why I had to have the section and why labour stalled the first time.

I suspect DS was in a funny position and couldn't get himself out, but deep down I also expect this wasn't helped by the fact that due to being induced I was on a bed for all of my labour and therefore gravity couldn't help him get down.

I have a consultant appointment booked for 34 weeks, so don't have to decide until then, but I am about 80% sure I'm going to go with an elective section. I really don't like the idea of being continuously monitored and stuck on a bed (I'll also end up with an epidural, as I was such a wimp last time and got one about 2 hours after the drip kicking in and contractions starting properly) and having the same thing happen again.

I really like the idea of turning up at hospital on the morning of the surgery, freshly showered, with clean hair and all calm and relaxed going in for the op. Then baby being with us so quickly. My biggest bug bear is being in hospital overnight afterwards and away from DS, but I can cope with that for 1 or 2 nights if I have to.

So I think that's my mind just about made up for an ELCS

ELCS - better the devil you know IMO.

Good to hear you had such a positive appointment! It sounds as though you'll find it helpful to go through your notes regardless of your birth choice.

Hopefully you'll feel more relaxed through the rest of your pregnancy now you've made your decision

Just to update, since writing the above I've been confirmed as having gestational diabetes.

As this means I would have to be either induced at around 38/39 weeks to prevent baby getting too big (growth scan yesterday put him on 95th percentile for tummy at least!). My consultant is as worried as I am about history repeating itself were I to be induced again, so is more than happy for me to have ELCS at 39 weeks.

I was 90% convinced on ELCS anyway, but this has kind of taken the decision out of my hands...also baby is still breech and I have a funny feeling he's going to stay that way!