Differences between VB and VBAC

[PSL1990]

Hi,

Can anyone tell me the practical differences between a VB and a VBAC? I know for instance that you can't usually have a VBAC in a birthing centre.

The main differences for me, bearing in mind this wasn't recently are; having the monitor on my bump the whole time, which limited which positions i could get into.No food allowed - could only have ice cubes for food and drink the entire labour in case I needed a c section.

All that said I was fine and had two successful vbacs.

Scar rupture.

That’s what would of happened to me if I had had a vbac instead of a c section

Like Livedandlearned, I had to have the monitoring equipment which was irritating as it restricts your movement, I would have felt far more comfortable on all fours but had to be on my back. I was also put in a room closer to the operating theatre just in case. Thankfully I had two complication free VBACs.

I tried (and failed, sadly) for a VBAC. I wasn't constantly monitored for the time I was there. They hooked me up on arrival and before being dispatched to the birthing unit, and in between had a midwife occassionally listen in with one of those bugle-type things. I was in the assessment ward for a number of hours and was allowed to spend all of it in the bath. I was due to have constant but wireless monitoring in the birthing unit and had been ok-ed to use the pool. This has since changed at our hospital (thanks to me 🤦🏻‍♀️) and all VBACs must birth in the consultant-led ward, but the pools and wireless monitoring is still available. Other hospitals in neighbouring towns still allow VBACs in the MLBU, so it seems it varies.
I was allowed to eat up until the point things looked like they were going south, although I can't say I really felt like it by that point.

The only other difference I found was being warned I would be going straight to CS if I went near/over 42 wks (I didn't) rather than trying to induce.

@BakerBear how do you know for sure it would have ruptured? This is something I am worried about as hoping to have babies about 20 months apart...

@skankingpiglet what was it that went wrong with your VBAC? I had an EMCS last year due to heart rate dropping and ventouse not working. I really want to have a VBAC but I'm so scared of making the wrong decision in case it leaves me with long term side effects!

It’s so hard to feel you’re making the right decision, after experiencing it going wrong the last time you made a call. What do your doctors say? In my case I was really keen to avoid further abdominal surgery. Although I went on to suffer a prolapse after my (smooth, uneventful) VBAC I’m not sure if this was partly due to previous surgeries and 2 pregnancies as much as the vaginal delivery. Importantly for me, the birth itself was a really positive experience after a traumatic crash CS the first time around.

Practical differences: I was fitted with a cannula in my hand at the start; eventually they switched to a form of internal monitoring via a small clip to my baby’s head. Sounds awful but was brilliant as I could move freely but have the reassurance of continuous monitoring. I also had a midwife in attendance at all times, and I’m not sure if that’s the case with a low-risk VB.

I suffered a uterine rupture. In answer to your question to another poster about how you'd know: unless you've had an epidural, trust me, you'd know. Interestingly for all the insistence on monitoring you to check for this, I knew what was happening for about 3 hours before the monitors recognised it. Sadly the doctors and midwives trusted the computer over what I was experiencing, otherwise it wouldn't have been such an emergency. There was no doubt in my mind what I could feel.

I should add I don't regret my decision to try for a VBAC. I was low risk in every way except for my previous CS, which itself had been an ELCS due to breech rather than from any issues during labour or pregnancy. I was low risk in my first pregnancy up until they discovered she was breech. VBAC was an obvious choice for me on the balance of risk. I was just unlucky with the rupture, which was exacerbated as it was picked up very late. I was keen to avoid the tough CS recovery I had with DD1, although weirdly in the end the recovery was easier after DD2 (this may be thanks to the morphine drip I got the 2nd time around!).

The surgeon told me that if I had carried on in labour my scar would of ruptured and the outcome for ds would of been very different.

My 2 children are 4.5 years apart

Oh this scares me,

I’ve had 4 vaginal births however all four was continuously monitored laid on a bed with a cannula in anyhow. Then I had an EMCS.

This time, I’ve gone for a VBAC and again am prepared for the constant monitoring and cannula, already been told this is what will happen. Scar rupture does concern me, I’m starting to wonder if I should speak to my consultant again and go for ELCS

The rate of 'rupture' is 0.5%, which means 1 in 200. Not all of those will be the most dramatic full blown uterine rupture, dehiscence (which means the scar opening slightly) is much more common.

So obviously although it's not something you want to happen, it's very rare.

The main differences between guidelines for VB and VBAC are:

• delivery suite rather than midwife led
• continuous fetal monitoring
• time limits on active stage of labour and pushing stage
• positioning of canula 'just in case'
• no induction drugs as they increase risk, though they might want to do sweeps and breaking of waters

It's worth bearing in mind that this is what they recommend but you can make other choices if you want to - they can't force you to be monitored etc. You need to look up the evidence on the level of risk and decide for yourself.

Birth is less likely to go well if you're flat on your back strapped up to loads of stuff, gravity and movement help. Some hospitals have mobile monitoring equipment so you can move around, or intermittent monitoring is an alternative.

Preparing for VBAC myself and a bit disillusioned at how they want you to try it but the restrictions they want to put on it make success less likely!

I was always a bit confused about how they monitor for uterine rupture: is it indirectly, through the fetal heart rate? Or do they rely on the mother to report pain? It’s awful to hear PP’s experience of feeling it go wrong and not being believed - this chimes with my experience first time round (ended in crash CS for other reasons).

fretnot I experienced everything I was warned about: sudden pain and a popping sensation along my scar line that didn't go away between contractions and got worse with each one. They told me they felt I just wasn't coping well with labour and if it was a rupture I'd be in more pain (I'd only been given paracetamol despite asking for more until about an hour before the rupture, when they were kind enough to let me have gas and air ). It was fetal heart rate they were monitoring and didn't take action until it suddenly dropped through the floor, at which point with all credit to them there was no messing around. I was immediately wheeled into the operating theatre and knocked out. She was out within 3 or 4 minutes of the alarms sounding I was told at my debrief IIRC. They said they had a maximum of 7 minutes to do it (not sure how that figure is calculated!).

I agree with HoustonBess that the risk of rupture is small so shouldn't put you off considering a VBAC, but it's also worth remembering that if it does go wrong they literally have minutes to get the baby out so choose your birthing site accordingly (ie within striking distance of an operating theatre, which our MLBU is). My rupture by far wasn't the worst example of one, but it was still life threatening for both of us. I ruptured neatly (according to the surgeon!) along the scar line, but her head had still managed to push out into my abdomen and I lost a lot of blood. I've seen women post on here about trying for a homebirth VBAC. It makes me go cold thinking about it.

I am looking into VBAC. Read the AIMS booklet birth after a cesearean. The risk of scar rupture is way lower than many birth risks for a first time mother eg cord around the baby’s neck and yet first time mums are encouraged to VB. Scar rupture come in different degree and very few are the most serious.

Hospital policies are often based on believed best practices rather research based. Look at the research yourself and remember you have the right to refuse anycare. If you say you don’t want continuous monitoring they can’t refuse to give you intermittent monitoring.

I had a VBAC two weeks ago. I was overdue but 3cm so they were able to break my waters. But 7 hrs and lots of breathing and bouncing on the ball later there was no progress. I hated the continuous monitoring as felt it restricted me from progressing labour.

I thought I’d then be straight to CS but actually they said we should try the syntocinin drip. I’d not realised it was an option. I went for it (and all the epidural I could lay my hands on) and my lovely 9,8lb boy was born ten hours later after an hour of pushing.

Pushing him out was one of the most amazing and empowering experiences of my life and don’t regret it a bit, even though the birth was not the hippie experience I’d hoped for! My first CS was ELCS due to breech baby.

@skankingpiglet, I think my hospital is a good option for that, so that is a good point. My EMCS last time was because of complete placental abruption during labour at 31 weeks, as soon as that fetal monitor showed she was in big distress I was signing forms loads of people was around me and I was whisked straight to theatre this was 23.47 and she was out at 23.52. The theatre was just down the corridor from my room. So I do have every faith in them should anything happen this time. VBAC is what I want to go for im just hoping it all goes ok.

This thread has been a real help to me