First birth - em cs, second birth - awful VBAC, what to do third time round?

[bamboo]

I'm currently 10 weeks pregnant and am starting to mull over the birth ahead.

My dd was born 5 years ago. She was back to back. It was a long labour and though I did get fully dilated, after a failed ventouse attempt, I ended up with a caesarean. It was fine, I have no regrets and recovered really well.

When it came to the birth of my ds 18 months ago I never really had any doubts about trying for a VBAC - there seemed no reason not to give it a go. Labour this time was pretty quick. I was adamant I didn't want an epidural because of worries about scar rupture and I'd found it really disconcerting first time round, not knowing when to push or even if I was pushing. It was a struggle because he was also awkwardly positioned, coming out with his arm over his head. I needed an episiotomy and ventouse. The labour was absolutely agonising. Don't get me wrong, I know labour isn't supposed to be easy but I think I have a reasonable pain threshhold - with dd I laboured at home (far too long in retrospect!) until I was 9cm on nothing more than a couple of paracetamol but I coped. This time round I really didn't handle it well, found myself being quite negative, and was very frightened. I got the feeling the maternity ward was pretty short staffed and there seemed tension between the midwifery staff and doctors. To top it all the doctor who stitched me up left a swab inside which I didn't find for 3 weeks which I think had implications for the healing of my stitches. It took me 6 months to feel vaguely normal again.

So, it's the million dollar question. What is my labour going to be like 3rd time round? After 2 badly positioned babies is it likely No3 will be too? If I knew labour was going to be like last time I'd be down at the hospital demanding a c section. But I'd really like to avoid any prolonged recovery time. Though I know from bitter experience that a VBAC doesn't guarantee this. Does the fact that I've had a VBAC mean that risks of scar rupture are much reduced so the decision to go for an epidural may be easier?

Does anyone have a similar experience and what did you do? Or any thoughts anyone else?

I have nothing all that practical to add, but didn't want to leave your post unanswered. I hope that Lulumama or someone will turn up soon (will try to get her and her wisdom over here).

You have a long way to go before LO arrives, and I am sure that the wonderful people here will help.

hi bamboo...... have to get the children ready, but will be back with some info later. also, Doulaklaw and DaisyMOO have excellent VBAC advice...

I think you said it all when you typed "It was fine, I have no regrets and recovered really well." Now, go and reread the paragraph you typed on the VBAC. It is rather clear to me which method you preferred.

10 weeks is not too soon to start exloring your options. I would ask to see a consultant ASAP to discuss methods of delivery. They will probably try to fob you off and say oh we don't discuss this until 36 weeks. I would be nervous wreck if I had to wait until 36 weeks to even start discussing method of delivery.

Also, you might want to look at your hospital options. If you want a section (and only you can decide), then try to go to a hospital who performs a lot of them. If you want a VBAC, try to go to hospital who performs a lot of "successful ones".

Also, something to think about is how you feel about an emergency vs. planned section.

there is a lot you can do to help position the baby well for birth, have a look at spinning babies and optimal foetal positioning also, 'active birth' by Janet Balaskas..i have just read this and it gives really excellent advice for preparing your body for labour....

OP babies can make for a harder and longer labor , that much is true, and it might be you have OP babies..but around 10 % if not more of all babies are in this position! ( my OP baby was a VBAC!)

sounds very much as though with some support, maybe from a doula, that you would have got through the last birth in a more positive way, with some support to get your though the last really painful bit !

as for leaving a swab inside

this website is excellent for VBAC and c.s advice and will be able to advise re odds of rupture in a second VBAC and also whether epidural is still contrainidicated....\link{http://www.caesarean.org.ukcaesarean.org}

also, if you want to look into a doula, doula uk and nurturing birth are good places to look for more info about a doula.

also, IMO, it is really good to get closure on your last birth and to read about VBAC and elective c.s, and help yourself to make the right decision for you...

It sounds to me as though the bad positions were down to sheer bad luck - it's not as though it was the same malpresentation each time, so you may well have the baby in a much better position next time.

Once you've had a successful VBAC your chances of scar rupture in a subsequent labour are substantially reduced. However, having an epidural does increase the chance of needing an assisted delivery, which is worth considering as this seems to have been a large part of your bad experience last time.

From what you've said the thing that was really difficult in your last labour was feeling unsupported and possibly quite scared? When you labour in an unfamiliar environment labour is physically more painful and difficult because of the adrenalin rushing round your body which counteracts the effects of your natural endorphins and the hormone which makes your uterus contract, thus slowing labour down. As a VBAC I'm guessing you were being continuously monitored which can restrict mobility and make it much harder to cope as well as preventing the baby from moving into a better position. Something which might help with this is to hire a doula who can give you undivided support and encouragement throughout your labour - this has been proven to reduce the likelihood of needing medical interventions. You could also think about having intermittent monitoring so that you can move around more.

Another thing to consider would be the possibility of having a home birth. As I said, you are already at lower risk of uterine rupture because of your previous VBAC and at a home birth you should have one to one support from at least one midwife and this in itself reduces the likelihood of needing assistance with delivery and you may well find you have less pain because you're in your own surroundings. If you find that you do want an epidural then you can always transfer to hospital, just as you did in your first labour.

You can also discuss with your consultant the option of having a trial of labour on the understanding that if there's any concern about position or if you need help with delivery that you go straight to c-section.

There's plenty of time to think about all your options and if you decide that an elective c-section is the way to go then go for it. Most people find them a very positive experience (I've had two before my VBAC) and they were fine.

Sorry, that's ended up rather long! I'm sure Lulu will post some links to more information but I've just noticed the time and that dd isn't even dressed for preschool - aaarrrgh!

Can I hijack as a first timer with a question?
You say "with dd I laboured at home (far too long in retrospect!) until I was 9cm" - why was this far too long? Just because you were so close to giving birth by the time you went in? And it was a bit of a rush?
Sorry I can't give any advice, but it sounds like you had an awful time with your 2nd birth, with useless maternity staff - I suppose your choice depends on how worried you are this will happen again.

Daisy, my lovely, would you mind having a look here and posting your wonderful advice?

Thanks for all your replies.

Eleusis, it's a good point about seeing a consultant earlier rather than later. I see my midwife again at the end of April so will broach that with her then.

Lulumama, I knew you'd be along sooner or later . I know what an advocate you are of VBAC. I'll read the links this evening when the kids are in bed. If I'm honest what I would like is a successful VBAC but it's the fear that my labour would be as horrendous as last time. I don't think I have a lot of confidence in the NHS system or, perhaps even in my ability to birth successfully. I guess a doula could help with that.

Daisymoo, What you say makes a lot of sense and I did feel scared frankly. Although I wasn't constantly monitored there was a lot of "Try this position, or this position" from the midwife when maybe I should have been listening to my own body IYKWIM.

My booking appointment with the midwife was a bit rushed so we decided we'd thrash through labour options at a later date but she did say they really supported home births though had to admit I wasn't an obvious candidate. I think I'd like to explore this a bit more. dh might take some convincing but I know he'd support any ultimate decision.

Katy44, I feel I laboured at home too long as I was in agony, and felt scared and alone I suppose. Which perhaps contradicts me saying the whole experience was fine but I don't mean to! We made a couple of calls to the hospital during the night but they maintained if I was able to stand through my contractions instead of leaning over a chair then I was not in labour enough and would be sent home. My contractions were erractic by this stage because I was tired so, it being my first time, I had no idea how advanced my labour was. I should have been more forceful with them but I don't think I was in my right mind at the time. Does that make sense?

Yes, it does, thank you.
I've been told that you should stay at home for as long as you can, so don't want to end up in the same situation, and as you say, you have nothing to compare it to!
Wishing you the best (and your DH) with what you decide to do.

The trouble with staying home for as long as you can bear it is that, if you want an epidural, you could be told it's too late when you get there (but they don't tell you that until they are telling you it's too late).

Hi, I started discussing my options for labour straight from the first booking appointment with the midwife. I had an emergency c sec first time around, because of a string of problems both with me and witht hte baby. Having a section was a relief, to be honnest, as things were getting pretty hairy in the delivery room with the baby's heartbeat pretty unstable and my blood pressure was very low and I had a high fever probably caused by bladder infection, anyway, cutting a long story short when I got pregnant second time around I asked straight away how the hospital would feel if I was to want a planned C section. They said it would be OK, so I have been very relaxed about it for the entire pregnancy. I am now 35 weeks and placenta is low lying, baby transverse so it looks like I will have to have a section anyway, but it made me feel a lot more relaxed as I knew from the start that they wouldn't say no if I'd request a planned section.

After having done lots of research and talked with people on this board, I would really like to try for a VBAC, it is my top option and midwife is supportive, but knowing that the option of a section is there has made my pregnancy a lot more enjoyable and less stressful. So I would say go ahead and speak to consultant?/midwife asap.

Take care!

Hi Bamboo,

You've already had some great replies.

IMHO, the best chance of a trauma free birth is to research like crazy and ensure that your birth partner knows what is important to you, why it is and how best to enable you to get these things.

If you just pitch up at the hospital with faith in the system and a half hearted birth plan then you will have to hope that you get lucky.

So, I have a resource file (word.doc) that I have on another forum so can't really redirect you. If you email me at klaw @ macmail dot com I will gladly forward it to you and you can start researching your options yourself. It's not just about VBAC, there's CS stuff there too and great links about birth in general.

Think long and hard about a Doula and/or a homebirth. It doesn't have to be a Private Doula, if yuo have someone you can trust who can educate herself about childbirth and how to support you. But if you have the money spare then it's a great idea, as we do have to go through a recognised preparation process to be on Doula UK or Scottish Doula Network. I'm doing that right now!

I beleive that you can have a lovely birth experience if you make informed choices. And you've got the next 30 or so weeks to do this.

Enjoy your pg!

Having had vaginal birth with dc1, cs with dc2 and a VBAC with dc3, i'd def recommend trying for a VBAC. I think the reason you VBAC was so distressing was because your body hadn't experienced actually pushing a baby out before. You obviously have a good pain threshold to labour to 9 cm at home, but tbh, the second stage of labour is totally different, and in my experience the most painful and hard part. I agree with the post about your body coping less well with pain if you are in unfamiliar or stressful surroundings, and that's why a doula or certainly a very empathetic (sp?) birth partner would be good. You sound like a woman who is 'in touch' with her body, and therefore a positive VBAC will be very empowering for you. I would try to avoid an epidural if possible, because you said you didn't like the feeling of being numb and out of control first time round. Also, the danger is it could prolong the labour, leading to more interventions and even possibly another cs. Think positive - u were unlucky with the position your baby got into before, but that doesn't mean it'll happen again. My experience was that a VBAC can be immensely empowering.