Would you try for a VBAC with a bigger baby?

[MyCatScaresDogs]

Just that, really. DS1 was 50th percentile, via EMCS after failed induction, born at 42 weeks (8lbs 8oz).

DS2 looks to be bigger. Had a presentation scan yesterday and they estimated weight on the 77th percentile, with a large tummy - couldn’t measure the head as too far down. All looks fine.

I’m now really concerned about the idea of VBAC. I’m 5’3” and this would be a first vaginal delivery. I suspect I have a small pelvis (size 3 feet) though midwife said no correlation between shoe size and pelvic size. Age 38. My big fears are baby getting stuck, instrumental delivery, and bad tearing.

Plan A was to wait and see if I went into labour and book a section for maybe 10 days overdue. I’m wondering whether we should plan for an earlier section or just go ELCS.

Thoughts? Is this normal “cold feet”? Or appropriate realism?!

I've not long had my first. I had an ELCS because he was measuring big. He was a very big boy when he was born and I feel like I did the right thing. My experience was very positive, DS was born at 39 weeks exactly.

I had the same situation - first baby just over 9lb, failed induction, ended up with an emergency caesarean in the middle of the night performed by a junior doctor, hemoraged, blood transfusions, continued internal bleeding, opened back up by the consultant ...

Was scared and undecided about what to do when expecting dc2. Best case scenario spontaneous labour and easy vbac if course, but was afraid of a trail of labour resulting in another emergency caesarean.

Dc2 was measuring big on 28, 32 and 36 week scans - predicted weight around 11lb. I moved abroad at 33 weeks and was relieved that the obstetrician here was more prepared to tell me clearly that his advice was to have a planned caesarean (though of course I could have said no).

Planned caesarean went well - nothing like an emergency one, far calmer, no complications, easier in every way, no comparison really. Only thing is he wasn't as big as they thought 8 lb 6 at 38 weeks. Third trimester scans are notoriously unreliable as guides to weight.

I had a terrible first delivery after induction, although it was vaginal. My second was big on scan and I was basically too scared of another induction and was pleased to be offered an elective CS which was absolutely fine. He was 9lb 12 oz. 3rd baby was predicted to be much smaller and I was persuaded to have a VBAC. I declined induction at 40+10 and went into labour spontaneously at 40+12. It was a lovely experience and I was absolutely euphoric afterwards, in a way I just wasn't after the previous births. Really amazing. Baby was 10lb 13oz!

Not sure whether that helps you - for me a good vaginal delivery was fantastic, but there's no guarantees and no crystal ball. I'd say it depends how badly you want a vaginal birth. It was quite important to me in psychologically recovering from my 1st birth, but everyone is different!

I just had your nightmare scenario play out earlier this week, OP, at 41+2. I was really excited for my calm, natural, therapeutic VBAC after an EMCS with DC1 (3.5kgs).

Ended up with failed ventouse, successful forceps but episiotomy and 3rd degree tear, due to shoulder dystocia. Baby was unexpectedly 4.85kgs. 99th percentile!!! Probably the worst experience of my life in some ways, but hasn’t put me off another one day in the distant future. I am actually very glad I didn’t have any inkling of his size as I would have been very scared and probably gone for an ELCS... but I really really didn’t want another section, and the recovery this time has been amazing despite needing an hour of surgery down below afterwards.

I should add, I had an independent midwife who was amazing and advocated for me, encouraged me, and was someone I knew and trusted throughout. Without her and the amazing NHS midwife (who we asked to swap to mid-labour because she was much better than the lady we had at the start of labour who went for her break), I don’t know how it would have gone.

Not sure that’s hugely helpful...!

They couldn't measure DS's head on the last 2 scans I had as the said he was too far down. He wasn't down far enough to engage fully as his head was too big. I had a long labour ending with a c section because he was just to big.
So I would just have the section

Thanks all - interesting to see most of you are encouraging ELCS. The scan was because the midwife thought he might be breech, which he isn’t, but part of me was hoping he would be as it would have made the decision easier.

I feel sad at the idea of not even waiting to see if I go into labour and scared of having another section, but am terrified at the prospect of a difficult delivery, and feel this news about baby’s size does make that more likely.

This is definitely our last baby so no concerns about impact on future deliveries.

Consultant has been pushing VBAC so far.

I've had two babies now one was 7lb 11 vagina delivery and my 2nd was 9lb 8 vagina delivery and honestly I couldn't tell you the difference both hurt as much as giving birth does. Didn't even know the size of Ds2 untill after he was born.
I'm having another big baby this time round he's over the top line been having growth scans as he's a chubby one and having a Vaginal delivery again all being well. They have mentioned that I may be offer an induction earlier but it would be my choice.

I think go with whatever your gut is telling you. X

I'm in a similar position and have previously asked for advice on here about whether to go for VBAC or ELCS. I've opted for ELCS as didnt want to end up with forceps or penthouse or ultimately an Emergency section as was told chance of a successful VBAC was 50-60% which didnt seem great odds to me. The consultant I saw was very helpful and I asked if I went I to spontaneous labour before ELCS and changed my mind could I try a VBAC and she said I could change my mind at any point aslong as it wasnt a few seconds before the csection. She wasnt concerned about babys size when talking about VBAC as she said something along the lines of the baby grows to the size of our pelvis so basically should be able to deliver vaginally (baby on 93rd century and I'm 5ft) although not sure how much I believed her on that part. So I guess what I am trying to say is book the ELCS so you have that as piece of mind but then if you decide a VBAC is for you nearer the time then cancel the ELCS.

Have you spoken to more than one consultant? I spoke to 2, one was convinced I should deliver vaginally. The second actually listened to my concerns and booked me in for an ELCS. I don't intend to have more than one child so it is kind of odd that I've never been in labour. Some consultants seem to have an agenda in my opinion so maybe speak to someone else to get a complete picture.

Oh, I completely agree about agenda - did you know that within two to three days of a vaginal delivery, you’re as recovered as you’re going to get?! (Source: consultant obstetrician. Worryingly.)

So far, opinion in favour of VBAC has been consultant and consultant midwife, with apparent objectivity but subtle bias. Opinion in favour of ELCS is community midwife. I feel they’ve done the stereotypical thing of comparing a straightforward vaginal delivery against an EMCS without properly considering the other options in between...

I had a planned ELCS after the first, I felt the very serious risks (scar rupture, vaginal tearing) with a Vbac were higher. I only wouldn’t have had an ELCS if I was planning more babies. I was normal for the other risks associated with elcs (bleeding). The risks of damage via vbac were more frequent, more serious, in my opinion, and the risk of a failed induction, failed vbac leading to an EMCS - I really didn’t want to take the risks associated with an EMCS.

I had a emcs in September and recovered quickly from it. Like you, it was a failed induction- my waters had gone themselves at 40+3 but there was meconium present. I was on the drip for 18 hours and there was no further dilation for the last four- stuck at 5cm. The doctor arrived and said I could keep going, but due to DD's position I would likely have to be taken to theatre so they could turn her with forceps, or I could have a section. I was so frightened of forceps and potential injury that it was a no brainier for me.

I honestly think it was the intervention at that relatively early stage that made my mental and physical recovery so straightforward. I was exhausted and lost a lot of blood, but I recovered quicker than others I know who had instrumental deliveries and tearing. Even though the trigger point for intervention on VBACs is apparently much lower, due to the state of the NHS (locally in particular) and the pressure on staff and resources I just don't expect to be that lucky twice.

I understand the odds of having a successful VBAC are greater if you did manage to fully dilate the last time- even then it's still only 70% iirc. The only way I would consider a VBAC would be if I had an independent midwife or doula I trusted to advocate for me on the day. In all likelihood however, I'll be going for an elcs with a proper dinner and a good night's sleep beforehand!

I think for me the most important question would be how important a vaginal birth, or the belief that you did everything in your power to have one, is to you. First pregnancy my only concern was healthy mum, healthy baby- I didn’t care how we got there. However, having had my EMCS and feeling like I could have done more to prevent it (for various reasons), attempting VBAC became really important to me and I would have been extremely loathe to consent to an ELCS.

I pushed out a 10lb 11oz baby without any interventions. Normal amount of tearing. No issues at the time or since down there. Luckily we didn’t know he was going to be big, no indication at all, so we didn’t have to make any decisions on how to deliver. I’m a bit taller than you at 5’8, so not sure if that makes a difference. I just want to put it out there that it is perfectly possible to do it without any issues. Good luck!

did you know that within two to three days of a vaginal delivery, you’re as recovered as you’re going to get?!

That doesn’t sound right to me. Certainly wasn’t my experience with a forceps delivery and episiotomy, took a good six weeks to feel normal again.

I am in a similar position and have just opted for the the planned c-section in a months time as I feel that the recovery is better than complications with a natural birth or ending up with an EMCS. My consultant was happy with this although would have been happy with attempting a VBAC too albeit with a short trail of labour. My last baby was an emcs due to failure to progress past 8cm (consultant post op said no way baby was coming out naturally). My first was 9.2oz and the second is predicated to be bigger I'm 5ft1. Knowing the c-section is booked has taken all the worry about a VBAC away and I'm so happy to have made the decision, my midwife has been incredibly supportive and said she thinks it's the best decision for me. Good luck!!

I had a EMCS with DC1, went into labour spontaneously, got to 10cm and pushing but he was back to back, awkwardly positioned and big.
Expecting DC2 in January, and I'm planning for a Vbac currently. I've had one extra scan and they are showing at being biggish, but midwives etc don't seem concerned about this. I'm planning on booking a CS for 10/11days overdue ish, as being overdue reduces the odds of a successful vbac. I'm also not keen at all on an instrumental delivery so may well go to CS at the first sign of things not going to plan.
My main reasons for wanting to try for a Vbac though are that I came so close last time, and didn't have an EMCS as a result of failed induction.

@neonglow, exactly - I think my eyebrows got lost at that point. DP thought she was being really objective until I pointed that out! Also, apparently I definitely won’t recover as well this time round from a section as second sections are always harder and more complicated.

To be fair, consultant has said she will sign off on a section, although with the appointment to do so scheduled for 37+5, I have a sneaky feeling this may not be as straightforward as she has made out....

My c-section was scheduled at 38+1 for 39+0 so try not too much to worry about that. Decide what you want and stick to it. Maternal request is reason enough to allow a c-section if that's what you want.

Yeah, it’s the “deciding what I want” bit that’s been my problem!

Have just had a look at the RCOG guidance around VBACs and it’s not very encouraging - apparently birth weight of 4kg or more (8lbs 14oz) and no previous vaginal delivery takes the odds of VBAC to below 50%, increases risk of rupture from standard 0.5% to 3.6%, and also increases risk of shoulder dystocia and 3rd/4th degree tears....

I’m now really torn as I felt I didn’t give birth last time (which isn’t to suggest CS isn’t “giving birth”, it’s simply how I personally felt about my birth experience) and I was hoping to go into labour naturally and have a straightforward delivery. But if the odds are so low, I question whether it is worth putting myself through that and whether we should just get baby out sooner...

Talk to your community midwife about how you feel about it all.
I find it really strange that I have a child but I've never been in labour at all. I'll probably never be in labour as I don't intend to have any more children but it's still early days.
I reckoned my chances of delivering DS myself were slim and I'd probably end up having a section anyway so I did it in the most organised way possible. Everyone is different though and if you'd feel better if you at least tried then there's no shame in that. When I say DS was big I mean big, he was 10lbs 10oz.

I had a relatively normal pregnancy up to the last few months when suddenly DS was measuring big. I had regular scans and was given all the worrying factors like tears, shoulders getting stuck and it really worried me.

However, I went into labour at 39+6 and DS arrived bang on his due date.
He weighed 8lb10 not the giant baby they predicted and I did it without intervention. Yes there are tears but after labour you barely feel the stitches or even realise you've torn.
A midwife told me bigger babies can be easier because they've got gravity behind them 😊

Don't let them scare you into making a decision but go with whatever feels right for you.

A friend of mine only wanted CS after her first CS and that felt right for her. Personally I would always rather go down the VD route because that feels better for me

Op that's exactly why I ended up opting for the planned section last week, those statistics made me anxious about going into labour/attempting a VBAC and I just don't want to worry, although I know many women will probably be ok I just didn't want to risk it. Once I decided and told the consultant at my appointment, the process of actually booking in the section was very quick, I went out and a midwife go the planned c-section diary out, worked out the dates and gave me the closest available one to 39 weeks (39+4), did some bloods, a mrsa swab and gave me my tablets to take pre op and some Information.

"did you know that within two to three days of a vaginal delivery, you’re as recovered as you’re going to get?!"

Er no. It took 9 months to recover from a forceps delivery, tearing and prolapse. I was utterly mangled 2-3 days after giving birth but did eventually recover, although will never be fully back to 'pre birth' state down there.

OP in your shoes I would have a ELCS.