VBAC or ELCS?

[MyCatDrinksFlatWhites]

Sorry, I know this one has been done to death but would appreciate people's thoughts on whether to go for VBAC or ELCS - have done loads of reading but would like to hear personal experiences.

I ended up with an EMCS for my first birth following a failed induction in which I did not dilate past 2cm in 50 hours despite pessary, ARM and drip. I now know that my Bishop's score was so low the induction had a low chance of working anyway. Ended up with birth trauma/post-natal PTSD from how the induction was handled and have struggled with MH ever since, though physically recovered v well.

I'm now pregnant with number 2, a few years later, likely to be our last baby. Hospital have been great and said I can have a section if I want one. Only 15 weeks at the moment but have a consultant appointment in a few weeks' time.

I'm really torn as to what to do. I've always said I would go for an ELCS if I got pregnant again to have more control over the situation. But this is likely to be our last baby and part of me feels very sad about not experiencing a vaginal birth and having the baby in such a surgical environment. And I'm terrified of surgery and hospitals.

Equally, I suspect my personal chances of a VBAC are not as high as some stats make out, and that I would find the protocols around monitoring/trial of labour very stressful/triggering. My big fear is that I either end up with a nasty tear, end up with another EMCS and feelings of failure, or end up coming up with a birth plan that the hospital and I are happy with, which is then walked over by the midwife on duty (the care I received last time was dependent on midwife rather than protocols and my wishes were completely irrelevant).

What would you do in this situation? If you've experienced it yourself, what did you choose and did you have any regrets?

I had a semi-planned c-section with DD1: she was breech, section was booked, but then I went into labour early. Although it was technically an emergency, it was very calm and straightforward, felt very controlled, and I had an easy recovery (breastfed without difficulty, out and about (albeit a little bit slower than usual) after a few days, could pick baby up off floor from standing after a week).

I thought hard about what to do second time round and went for another c-section. I have never had any strong feelings about wanting to 'experience' childbirth. It's such a tiny part of parenthood - and so many people have horrible experiences with it. I just wanted the baby here as easily and safely as possible. I decided to sacrifice the possibility of an easy natural birth (which is by no means guaranteed) in favour of a controlled and fairly easy c-section (which is a pretty reliable eventuality if it's a planned one).

My recovery has probably felt a little harder this time round, with a toddler to deal with as well. But it's still been easier than a very difficult natural birth or scary emergency section would most likely have been. It was the right decision for me. I wanted to avoid the possible negative outcomes of attempting a VBAC more than I wanted a shot at the favourable outcome, if that makes sense.

Thanks for sharing, that's helpful. I totally get your point about going for the more predictable outcome. This is my big dilemma about VBAC: it could go very well, but equally it could go very badly and I could be left with injuries as well as a scar (in addition to risks of abruption, risks to baby, etc). I wish I had a crystal ball!

Good to know recovery was ok for you. That has been a concern for me but we have a big enough age gap (4.5 years) that I'm not too concerned as I won't need to be lifting a younger toddler, etc.

I went elective although I ended up going into labour early and had a lovely semi emergency relaxed section. As trite as it sounds, it was very healing compared to the horror show which was dc1's where I thought he was a doll, passed out on the operating table, tried to leave him in NICU and generally lost the plot.

My reasons were: I couldn't cope with labouring on my back on a bed being monitored as the hospital would want (due to age/previous section). I couldn't stop myself thinking something would go wrong again. I was 40 and the stats on tears over 40 made me feel physically sick. I had a very easy recovery from my 1st section even though it followed a long labour (physically not mentally).

I do occasionally wish things had turned out differently but dd's arrival was amazing and I think it was the best option for us.

I’m about to have an ELCS after EMCS first time round. I don’t have any qualms about surgery or surgical environments, and having had a straightforward cs first time I’m not worried at all about this one. I do understand about missing out on labour but as a PP has already said this is such a small part of motherhood (and such a big fuss is made about it) really in the grand scheme its far more important to have a safe delivery and a happy you than force yourself through potential minefield of problems just for a few contractions (that could end in a CS anyway).

ELCS. Better than risking another EMCS.

I had a vbac. It was good. Felt normal again straight after rather than long horrible feeling after emcs following long labour first time.

Whatever happens, it wouldn't be like your first labour. They don't use induction drugs, they put time limits on things like first stage and second stage.

My plan was to go into labour naturally or else go for elcs at 41/42 weeks. Hate the idea of induction. They induce by breaking waters or using a balloon catheter thing if you had c section previously.

Also bear in mind guidelines are not the law, you can choose to stray from them. I said I wouldn't have constant monitoring (went for initial 20 mins to check baby was ok then intermittent, tho i didn't mind straps in the event so kept them on).

You could also agree that eg if your labour was slow you'd opt for CS at that point. It would be subject to availability but still possible.

Look around the delivery suite and see whether it's as bad as you think. Some trusts are open to you using the midwife led unit or can be persuaded if you threaten a home birth instead!

Also look into a doula if you're worried about your birth plan being overlooked. They can help advocate what you want more assertively.

They don't use induction drugs

That must vary from Trust to Trust as one of my friend's got the drip whilst trying for vbac number 1.

Have you considered a jentle c section? I was being bullied into a vbac and really had to fight against it as I knew it wasn't for me for many reasons. Had an ELCS with number 2, pretty standard but better than number 1. Knew I was having a ELCS with number 3 so did my homework. I was lucky enough to have my delivery managed by the midwife (Jenny Smith) who introduced gentle c secs into the uk in conjunction with a sympathetic consultant and it was a truly calm, empowering and beautiful experience that knocked the other two out of the water. I would highly recommend it as an alternative to vbac and traditional c sections imo.

www.positivebirthmovement.org/natural-caesarean-a-decade-on/

Very difficult as this is very personal.
I had an emergency c section at 9cm due to abnormal CTG and sepsis. Baby went to NNU and had meningitis. I was unwell, needed blood transfusions. We recovered and all was well although I did have PND.

Second time I was desperate for a vaginal birth. I wanted a healing experience and for me that was pushing my Baby out and him given straight to me.
I was induced due to huge baby (again) and acute polyhydramnios. I had a normal birth but with a 3B tear and 2.5L PPH. I was however happy I went for a VBAC and it was healing for me.
Like I said though, it’s very personal and that’s not how everyone would see my experience.
When we have no3 I will be planning a VBAC again.

houstonbess
Just saw your comment. As above, it varies trust to trust re induction. I was induced with propess pessary following a previous CS, had waters broken and had synto drip.
There is no standard for this

Sorry, have only just seen more replies to this! Thank you to everyone who has shared their experiences.

@HoustonBess, I know it wouldn't be like last time, not least because I wouldn't consent to induction under any circumstances. If this baby needs to come out quickly/early, it will be by EMCS.

My concerns, tearing aside, are about the extent to which a firm (rather than rigid) birth plan is realistic (given that, you know, it involves birth and babies often have other ideas), but also about the care I receive being dependent on the midwife rather than agreed protocol/what's in a birth plan (in the absence of any clinical indications requiring a change of approach).

While I would obviously be more assertive this time, last time most aspects of my care (access to pain relief, etc) were dependent on the midwife rather than my wishes. In short, I have little faith that my birth plan would be honoured at the point I presented myself in hospital for a VBAC, whereas I have more faith (possibly misplaced) that this is less likely to happen with an ELCS (partly due to fewer variables). I am also concerned about finding the delivery suite environment triggering. Definitely need to see about tours.

@iamclaireandfleabag, thanks for your suggestion - I will take a look at "gentle sections".

Has anyone been in this position and sought perinatal mental health support?

I would say that in my experience at least, getting the consultant to express your wishes in your notes works wonders (possibly for either mode of birth).

I was offered peri-natal support with dc2 but I was already under a psychiatrist for ptsd and also having therapy so seeing a clinical psychologist so declined. I know someone who has had it though and they were really positive about the experience. They saw a peri-natal midwife who was with them in theatre and helped advocate for them so based on what you've said, I think I'd look at a referral if I were you.

@Dinosauratemydaffodils, thank you - I have a separate thread in Pregnancy about perinatal mental health support so you're bang on the money there!