VBAC v ELCS - should I follow heart or head?

[PSL1990]

I'm trying to decide whether to go for a VBAC or ELCS. My head is pointing towards one direction and heart another - which would you follow?

Follow your head

I had the exact same feeling when pregnant with DC3. First two were EMCS and before I was pregnant I was adamant I was having an ELCS but I think instinct or hormones or something kicked in and out of nowhere I wanted a VBAC and could not decide for months. In the end I went with my head and went for the ELCS and it was the best decision! Thinking back now I have no idea what I was thinking wanting a VBAC!! But pregnancy can do weird and wonderful things to our minds.

If I were you, having been there, I would go for the ELCS. But I do understand how you feel.

I’d also go for ELCS. A recent study found higher problems with VBAC, though all risks are small
www.nhs.uk/news/pregnancy-and-child/planned-caesareans-safer-women-past-history-caesarean-sections/

I would follow head, particularly with an existing child. I'd want to do the safest thing for their sake as well as my own and that of the unborn baby.

I'm trying to decide the same. It's so difficult!

I know I want to book an elective section but I don't know what I want if I go into labour before hand.

Are you usually head driven or heart driven? Have you had a consultation yet?

Follow your head I'd say. I tried VBAC & wished I'd gone with ELCS. I could have prepared for not having a vaginal delivery where as I still had the disappointment afterwards to contend with.

Get some professional advice and perspective and follow your head. You needed a c-section previously for a reason, find out what that reason was and what the chances are of it happening again.

Personally, I chose an elective for my second after an emergency c-section with my first. After having both babies, I would now always choose the section and never even consider a vbac.

I have the same dilemma. I had a vaginal birth with my first and a c section with my second because he was breech. The recovery from the vaginal birth was so much easier, but the birth experience very extremely painful: had a forceps delivery, episiotomy and the worst was the hemorrhoids after!! No one warns you about them! The c section itself was so much better but I struggled with the recovery. My scar was painful, I couldn't drive and lift my other kid etc. I also hated the look of my scar and my tummy. After 4 years now it looks normal again. So now im pregnant with my third. It's very early days but already thinking about it. I'm thinking maybe a vbac with an epidural, if that's even possible.

I had an EMCS for a failed induction first time round. Had DC2 last week, having spent most of the pregnancy ambivalent about VBAC and ELCS. Before I was pregnant, I would have said ELCS without hesitation but like @BellatrixLestat, I don’t know if it was hormones or what, but the idea of booking a section for 39 weeks just made me feel sad.

Basically, I either wanted a spontaneous water birth or a highly controlled ELCS. I definitely did not want an induced or instrumental delivery.

So we went for a compromise and booked a section for 41 weeks, with a view to seeing how things went if I went into labour spontaneously. I didn’t, so I had the section.

Overall, I feel that was not only the right decision but the right timing for me - the chances of a straightforward VBAC were apparently lower after 41 weeks, ditto lower with a larger baby (and DC2 was a sniff off 4kg at 41 weeks). But I felt I’d given nature a chance to take its course. And seeing the size of DC2 and his shoulders, I don’t think a VBAC would have been without incident.

I would definitely recommend you explore your options with your consultant and, potentially, a specialist midwife who is used to caring for VBAC patients.

Definitely talk it through with a consultant. I had vbac and was so very glad.

You can't ask people to give you advice as everyone will be different.

This is a decision you should make with your care team, they can asses your personal risks and benefits and help you decide.

I had a VBAC and for me was what I wanted and was so happy about it. Everyone's experience is different and everyone will feel differently about how they want to experience birth.

For me to have another vaginal delivery was something I wanted after an emergency c-section with my second. Plus the doctor considered I had really good chances as my first was a vaginal delivery.

I went for VBAC and didn’t even consider ELCS, as I felt oddly disappointed after my previous EMCS (despite genuinely believing the first time around that all I wanted was everyone safe and well at the end of it all). Second pregnancy was spent very very sure I wanted to attempt VBAC. I ended up with forceps and a third degree tear; baby was unexpectedly over 4.8kgs. I’m still delighted with my experience, even though it was objectively a pretty bad birth, and was concerned about another section triggering PND.

You need to do what’s right for you. Think ahead 3-5 years, what decision will be the one you don’t regret- regardless of possible complications?

I don’t think there is a right answer. You need to weigh up those head & heart things & decide what’s most important to you.

FWIW, I had an elective recently for #2 after an emcs with #1. My consultant tried her best to persuade me and didn’t think there was any reason for me not to try for a vbac. But I was clear in my choice. It was a great experience. And I’m so glad I went for it, because when they pulled him out they said he was back to back with his head in a funny position in my pelvis, exactly like #1. I probably would’ve ended up with a section anyway. His head was also 99.6th centile, so I’m very glad I didn’t try to push it out!

There are lots of factors to consider. Amongst other things the risks vs benefits depend on why you had a section previously, whether you have ever given birth vaginally, how long since the previous section, and your risk factors in this pregnancy. Read as much as you can - the relevant NICE guidelines and Royal College of Obstetricians and Gynaecologists "green top" guidelines are good for starters and there was an excellent piece of work done by UKOSS (The UK Obstetric Surveillance System) a few years ago. Beware of looking at older papers or those where the data is entirely or mostly from other countries as obstetric and midwifery practice varies a lot and may not be relevant to care here.
Then talk to your MW and your consultant about your specific situation. Other people's experiences are always interesting to hear, but their decisions are not necessarily right for you. For what its worth I have had 2 VBACs and was very happy about them. In my specific circumstances I believe I made the right choices, but those same decisions might be absolutely foolhardy for others.
Talk to your caregivers, and if you don't feel comfortable with their advise, get another opinion and weigh up what you are being told against the published, evidence based guidance.
Best of luck whatever you decide, both can be very good experiences.