Birth Dilemma

[GreenMeerkat]

I am 28 weeks pregnant with baby no. 3. I have an ELCS booked for 39 weeks.

My first two were both EMCS. First was failure to progress and fetal distress and second was due to an intrauterine infection.

I have been adamant from the start of my pregnancy that I don't want to go through any of that again and I would be opting for an ELCS. However, the closer it gets the more anxious I am becoming about it (the prospect of surgery again) and I am going back and forth on whether to go ahead with the ELCS at 39 weeks or try for a VBAC.

I absolutely do not want any induction so I would probably keep an ELCS booked but delay it to 41 weeks so if no sign of labour before then just have the ELCS. The only thing is, I am scared of complications again. I have never had a successful vaginal birth so unsure if I am even capable. I would only want to continue with VBAC if everything was progressing as it should and there are no complications. If they arise, then I'd want an immediate section.

I just don't know what to do, there is a good chance, if I try for a VBAC, I'll end up needing a section anyway and elective is always better than an emergency section. BUT, do I deny myself the chance to try? I'm so confused and just don't know what to do!

It’s a tough one, but you need to be comfortable with your decision either way.

I would say the chances of a successful
VBAC are good as the reasons for the EMCSs are not ones that are necessarily likely to repeat.

I agree you should avoid induction at all costs. I’m not in the UK but my hospital will not induce after a CS as it increases the risk of uterine rupture.

Could you speak to your hospital about how a VBAC would look in your case? Eg will you need to have continuous monitoring?

To my mind the chances of a successful VBAC will be much improved if you can have an active labour without being strapped up.

I also think being relaxed plays a huge role. If you’re worried about ending up with a CS whilst in labour then it’s not going to help. How do you feel about hypnobirthing? You have plenty of time to do some online courses which I think really help.

FWIW I had an EMCS with my first - I was induced as she had IUGR and she got distressed before I’d even had a single contraction. I was desperate to try for a VBAC but like you was worried it wouldn’t work as I’d never even been in labour. As it turned out I had a really easy spontaneous delivery. Unfortunately I had to be on the CTG the whole time as my waters had been leaking but I laboured standing up by the monitor. This coupled with breathing exercises I’d been practising really made a difference.

Good luck whatever you decide!

Just to add that I was induced so was also on a monitor during labour, but midwife knew I wanted an active labour and helped me to stand/kneel/walk when needed.

Good luck whatever you decide.

If I were you, I'd definitely go for the planned section (unless you plan to have loads more children after this one). VB after 2 sections is quite risky. You say "would only want to continue with VBAC if everything was progressing as it should and there are no complications. If they arise, then I'd want an immediate section" but the problem is nobody can tell you in advance about who is likely to have complications or which labour might turn complicated in an instant even if all looks ok now. I don't know how to say this without sounding someway mean, which is not my intention. But labouring twice, and needing a section twice - what makes you think it might be different this time? you have already experienced labor pains, which are no fun. Can you ask yourself what you mean when you say "deny yourself the chance to try"? You've already tried and thankfully there is a safe option that enabled you to have healthy babies when trying VB didn't work out for you and your babies. Some things like foetal distress are very hard to interpret so by saying you have a really low threshold for a section, probably means you'll end up with a section as there are always signs that a baby might be better delivered right now than continue the challenges and uncertainties of labour . So why not plan a section anyway when it will be calm and staff fully rested etc.

Obviously it's entirely your choice but I can see no advantage to attempting VB in your scenario. There is no evidence that relaxing or moving or whatever increases your chance of VB. It is almost entirely out of your control.

Best wishes with your decision.

If I were you I’d have an ELCS and wouldn’t give it a second though. IMO after two EMCS the risks are too high. Vaginal birth is unpredictable. Some women might find it amazing and empowering but I think they’re in the minority, i certainly didn’t. To put it bluntly, if you already have c-section scars, why would you risk damaging your vagina as well? (A tear or episiotomy is a possibility.)

Thanks for your replies.

Both midwife and consultant have said the risk is minimal and only increases a tiny bit between 1 and 2 sections. And sections themselves carry their own risks.

I didn't labour with my second as I had an infection so was admitted for section as baby needed antibiotics. I don't agree that this is a reflection on whether my body is able to labour properly or not.

My plan for VB would be to go into labour naturally (no induction) and to be monitored closely and if I'm not progressing as I should then I'd go for a section. If labour doesn't happen then I'll just go along for my ELCS as planned.

I am a little more certain now about my decision after writing my OP. A section is major abdominal surgery and having been through it twice, if I can avoid it then I certainly will. I am fully aware that I may well end up with a section anyway so this part doesn't bother me. My expectations are well managed.

I'm pregnant with my third and have had one EMCS and one ELCS. I will be having another ELCS. Midwife told me that in 30 years of practice she has only seen one woman choose to try VBAC after 2 x CS.

I wouldn't risk it, personally.

Well if this has helped you make your decision that’s good. Best of luck.

How odd that professional opinions differ so much.

Both my midwife and consultant were nothing but supportive when I mentioned it and were very positive saying plenty of women in their care have done it.

I suppose it depends on the area and which trust you are under.

I'd be surprised if they would be willing to induce after 2 sections in any case.

@MingeUterusMingeMingeYoni They will, but only on syntocin drip as it is less risky than the gel/pessary when it comes to uterine rupture. But I had a terrible time on that drip the first time so I have no intention of doing it again.

Like I said, the only way I think I would try and VBAC is if labour starts naturally and progresses well.

Really? I don't believe they will in my trust when it's a VBA2C. Moot point yes if you're not interested anyway. I tend to agree, in your shoes the only way I'd be interested in labouring is with a ripe cervix.

I think the trust I am under are just very open to things I guess. When I was pregnant with my last two I was under a different trust and was told after my second section that any more would have to be sections. Now I am amazed I am actually being given a choice, and they are quite positive about it and have had good success rates.

Yes, I only want to try it if my body is ready to labour. If not I'll have been having a planned section anyway so I figure I may as well push the ELCS back and give my body a chance to do its thing. If it doesn't happen, such is life.

I'm in a similar situation but with only one EMCS behind me. I've struggled with the decision but in the end, the % chance of needing another EMCS if i go for VBAC (35% at my hospital) was too high for me personally and that helped me make my decision. I didn't want to be out of control of the situation. Have you asked your consultant what the VBAC success rate is at your hospital? (also to a certain extent echo a PP's point about leaving your bits in tact if you've already got a scar!)

I'd be surprised if they'll book your for a ELCS at 41 weeks, by the way. It would have been my ideal too, but consultant said that due date was the latest they would book it, as otherwise the risk of going into labour and coming and requesting a section is too high - I can understand that logistically this would be a problem. So I had to choose between VBAC and section at 40w (though they can't guarantee that day either and it could be any time after 39w). That said, if you choose a VBAC and get to 41 weeks, you will probably have a section as they won't induce you (or at my hospital anyway, it is extremely hard to get them to do this): the risk of rupture is much higher with an induction apparently and they would rather section. So that's your route to leaving the option open. You can always change your mind (though i do know someone who went into natural labour with an ELCS booked and got a very sniffy response when they still requested the section! that might not be true with 2 behind you though!)

Good luck OP!

interesting how every trust/hospital/consultant seems to differ!

TBF if you want to attempt a vaginal birth, you don't actually need anyone's approval. You'll always have a choice about that unless you don't have capacity, which is massively rare and needs a court order. It's not like with a section, induction etc where you do need the active co-operation of the clinicians performing the procedure. You just turn up in labour and they're obligated to attend you as you attempt to birth vaginally, whether you were advised against that course of action or not.

I do appreciate many women wouldn't be willing to try for a VB if it were going against medical advice, but just thought worth pointing out that VB attempt is your decision not anybody else's.

40 weeks wouldn't be so bad. It would give me a fair chance I suppose and if it doesn't happen it doesn't happen. It might just be that my ELCS is pushed back a week and I end up having it anyway, but if I do go into labour naturally beforehand, I think I'd definitely like to give it a go. Again, if it doesn't work out, so be it.. another section it is.

It may all be a moot point anyway as at my 28 week appointment my fundal height was 2.5cm ahead so he may end up being too big for VB anyway! Will see how he measures at my 34 week appointment!