VBAC or repeat elective section?

[greywoollyjumper]

My first birth was an ELCS due to breech presentation and I went to the BAC clinic at my hospital yesterday to discuss my options. I'm so torn about what to do. Before I found out DD was breech I was aiming for a water birth with minimal intervention in the birth centre, practised hypnobirthing etc. I naively assumed that if baby was in a good position this time I could try to have that kind of birth this time, but was told that I'd need to be on the delivery suite so they could constantly monitor the baby and whisk me off to theatre more quickly if an emergency section was necessary. There's only one pool on the delivery suite at my hospital so seems unlikely that I'd be able to use it and if I'm being constantly monitored I won't be able to move around. Plus there's a risk that I'd have to have an emergency section anyway!

Part of me thinks I might as well just have a nice calm planned section again in light of the above. On the other hand I definitely don't want a 3rd child so this is most likely my last chance to try for a natural delivery and of course if all goes to plan there's a quicker recovery time...

What would you do/ what did you do? Would you love to hear any birth stories if anyone wants to share.

Thanks in advance 😊

I went for a repeat section - on a "better the devil you know" basis. I had a good recovery from the first one and a straightforward section seemed a better bet than risking complications with an attempt at natural delivery - which could be anything from a breeze to a disaster! I sacrificed the possibility of the easiest possible outcome in order to avoid the worst possible complications, if that makes sense.

It's very personal. I bounce back very quickly from surgery, it turns out, so that was a plus - although recovery with a baby plus toddler was a bit harder. I have parents fairly local though, so I had some help on hand, which also made a difference. I also didn't really care about "experiencing" natural birth. It matters a lot to some people which I've never really understood - but it meant I wasn't giving up anything by having another section, and for some people they would be sacrificing something.

I'd do the same again. It was right for me. But I'd let my parents do the nursery run for six weeks, not three, and avoid the infection I gave myself by stupidly trying to manage a forty minute round trip on foot with a pushchair and baby in a sling! 🤦

Thanks for your reply @MammaPyjama - really interesting to hear your perspective as it validates what I'm feeling about a repeat section being the safer option - whereas a VBAC could be great or horrific.

I've got good parental support too so could definitely set up some sort of rota whereby my DH/mum/in laws help with the toddler whilst I'm still recovering.

Such a tough one! Part of me is hoping this baby will be breech too and take the decision out of my hands 🙈

@greywoolyjumper are you me?? We are in the exact same position. Everything you've said is what's currently swirling around my mind. ELC due to breech, second pregnancy now and want a natural birth ideally but I can't make my mind up. I think I'm swaying towards another Csection for the reasons pp says above, but I'm definitely not having another so wouldn't get a natural birth opportunity again. However I do keep reminding myself who the fudge cares how they came out., As long as it's the safest way for baby. Good luck with your decision!!

I went for a repeat section. My midwives were really dismissive of me when I tried to discuss it with them as I was really unsure what was the best option for me. I was repeatedly and cheerily told that because I didn't have the first section due to a problem with labour (was due to severe pre eclampsia) then of course I would try a VBAC and wasn't that great! I read as much as I could about risks etc. and saw that there was around a 30% chance that I would need another section if I went for a VBAC (stats may be different now, this was 2012). That was too high a risk for me - my first section was awful, very painful and took months to recover from. The thought of undergoing that after being in agonising labour for many hours beforehand did not appeal one bit. I hated the idea of having to go through a section again, but risking an even worse experience was too much of a gamble for me.

My second section was so, so much better than the first and I was amazed at how quickly I recovered in comparison to the first. And the consultant who did it told me afterwards that the scar from my first section was so thin it was on the verge of separating - I would have been in serious trouble if I'd gone for the VBAC. I never fancied the 'natural birth experience' anyway tbh, maybe I'm just a wimp

All that said, it is entirely your choice. I have friends and family who had VBACs and they were very glad they did.

@Constantlurker haha good to hear from another person in the same boat!! It's so hard to know what to do for the best isn't it? A "natural" birth if it went to plan could be great but there are so so many what ifs and I'd be kicking myself if I ended up having a horrific delivery when I could have gone for a nice straightforward section 🤔

There's no reason why you would need to be on delivery suite of the only reason you had a section was for breech presentation. Lots of women have a home birth after Caesarean. Have another conversation with them about being on the midwife led unit of that's what you want.
Ultimately it is your choice where to birth, and how. Barring medical danger they have to support you in your choices.

Following as I'm in the exact same situation too!! ELCS for breech and now 16 weeks with #2...

@zurala I asked about being in the birth centre but they said they didn't have the equipment for constant monitoring there, which they said I'd need as I'd be at risk of uterine rupture (which sounds delightful)

I had this decision last month. I went for the VBAC. I was on the consultant led delivery ward rather than midwife unit but i could of pushed to be midwife led if I wanted. I had a pretty bad postpartum hemmorage after my csection so felt ok on consultant unit.

So glad I chose VBAC, continuous monitoring but was still able to move around, had no pain relief (by the time I asked I was about 3 pushes away!), discharged within 3.5hours and got back home in time for dinner and into my own bed. Recovery so much quicker than my csection, felt fine within a couple of days and now 3 weeks down the line am pretty much back to normal- so much better with a toddler to run around after!

Thanks for sharing your experience @Roomba. That's great to hear you had a good recovery from your second section and that it was a positive experience for you. The risk of an emergency section is definitely playing on my mind. Need to look up the stats.

I’m a long time past this but I had two csections. They tried to make me go for vbac but the downside risk was too big. They’ll tell you all the risks of csection and there are plenty and in good cases, where it goes well, a vbac is better. But the downside risk with a vbac outweighs all of that for me.

Not quite the same but I had an EMCS after 5 days failed induction and this time I've chosen a planned section.
Although it's my last baby I don't feel in any way like I've missed out by not having a natural delivery, I tried the first time but it didn't work.
I see it as this time I have some control over the situation and I would hate to try a VBAC to then end up having a EMCS again. I like that I know what's going to happen.
This pregnancy has kicked my arse and I've still got 8 weeks to go so from my point of view I'll just be glad when he arrives safely. X

Opposite decision taken here. Opted for VBAC after planned c section with first. No regrets... wasn't allowed to use pool, so used a combination of self-hypnosis and a TENS machine. Stayed at home for many hours until I could no longer manage the pain. Somewhat disheartened when I got to hospital and found I was only 1 cm! Four hours to get to 4 cm, then a rather excruciating 20 mins to get to delivery room, where they discovered I was now 10 cm and ready to push. Overall it was a straightforward birth, just used gas and air, and it was lovely to be able to walk around straight after the delivery. That said, I went on to have a 3rd pregnancy, and as that was twins I opted for a c section that time!

Great to hear some positive VBAC stories too @Mrsducky88 @JumpingFrogs - so pleased it worked out well for you. If I knew for a fact that it would be a positive experience for me I'd definitely be up for a VBAC...it's just the risk that worries me...so totally understand why you made the decisions you did @Binterested @strawberry2017

I'm in a similar situation and have gone for VBAC on delivery suite. I'm hoping for wireless monitoring, so I can move about and to be able to use the one pool they have. I'll just have to keep my fingers crossed that it is available on the day.

You can ask if they have any wireless monitors and if so, how many. You should also have been given leaflets and stats on the relative risks. Ask for them if you don't have them.

I have an up to date (2019) NHS leaflet that says:

• 25% of VBAC women will end up with a C-section, only slightly higher than the 20% of mothers who end up with a C-section during a normal labour.

• the risk of the baby having breathing problems requiring admission to special care are a 1% chance for labour, 4% chance for C-section.

• there is an icreased risk of the child developing allergic diseases such as asthma and of obesity and diabetes after a C-section. Thought to be due to the transfer of healthy bacteria to a baby during a vaginal birth, but it's not well researched yet.

• the risk of baby dying or being brain damaged if you go into labour is 0.2%. This is the same as if you were labouring for the first time, but higher than if you have a planned C-Section (0.1%).

• higher risk of complications for mother after a C-section include damage to bladder or bowel, developing blood clots (0.2% risk for labour, 1% for C-section), excess bleeding, a longer stay in hospital and a longer recovery period. You will likely require antibiotics and 10 days of self-administered injections for blood clots.

I think the official NICE/NHS position is that the differences in risk are so small that it really doesn't matter which you pick.

In my area, you can ask to be referred to a midwife for counseling on your decision. I got referred to a 'modes of birth' clinic which helped me decide.

Just to address a point made up thread. They can't insist you do anything, so yes, you could deliver at home or on a midwife led unit. They will advise against it though. On delivery suite they can constantly monitor your babies heartbeat to check for any problems with your scar rupturing, which happens in 0.5% of VBACs. On a midwife unit or at home they would manually listen in every 5-10 mins and so would not be able to pick up any problems as quickly. Plus it would take longer to get you into theatre if anything went wrong. Technically, NICE no longer recommend continuous monitoring, as there isn't clear evidence that it picks up problems earlier. NICE just says someone should do more research on the issue. NHS trusts seem to strongly advise it anyway though.

Sorry for the barrage of information, but I made a lot of notes while I was trying to decide. All those stats are from up to date leaflets I was given by NHS midwives, not random googling, I promise!

Oh wow @setsoma - this is incredibly helpful, thanks so much Top of my list of questions next time I speak to the midwife will be whether they can offer wireless monitoring. Need to have a think through all the stats too and come up with a list of pros and cons. Luckily I've got a good long while to decide!

In exactly the same boat and running out of time rapidly to decide! My hospital are great in that they talked through the benefits and drawbacks of both options.......which didnt help me at all! Wireless monitoring is available and i can use the pool if i do go for a VBAC but what worries me is, to be brutal, being ruined after a natural birth! I was home the next day with a c sec and so many friends had more issues with a natural birth, but they were also up and driving about in no time.

I really dont know how to make the decision

I'm currently feeding 4 week old DD who was born by ELCS. Her older brother was born by EMCS after he got into distress during my induced labour.

For me, my decision against VBAC was mostly to avoid getting into an EMCS situation again. Mine was a category 1, serious emergency, general anaesthetic experience that I didn't want to repeat. I felt like I would have had the worry of the same thing happening again hanging over me, and my consultant agreed that this would not be conducive to labour progressing as it should. I was also told I'd have to be monitored closely, and there would be a limit on how long I could be in labour for, I believe due to the risk of scar rupture. So added pressure, and probably not able to be mobile etc.

I also recovered very well the first time, and this was a big factor in my decision. DH was able to take 4 weeks off work this time so I didn't have to worry about being able to look after toddler DS.

My ELCS was such a positive experience, and I'm happy I made the right decision for me. Part of me is a little sad that I won't experience a natural delivery, but on the other hand I'm pleased to have avoided the pain!

I'm vbac at birth Centre mdiwife led unit.

They don't have the equipment to constantly monitor but will listen in every 15 mins. That's a risk I'm willing to take seeing as though rupture is 0.5% chance and there are other ways to spot a rupture too.

I had planned cs with dd1 due to severe pre-eclampsia. Was bulllied into vbac by consultant. Telling me risk of cs etc. I went in for a routine check at 40’weeks with dd2 as was older mum 38! Where nasty consultant put in gloves to check me. Then as I’m getting on the bench she said she would induce me!!! I’m afraid I was alone, was scared and then suddenly said a loud no. She asked was i refusing the intervention. I said I was and bravely insisted on a planned cs. It was booked for after the week end. She was unkind but I stick to my guns. Loved my 2nd cs with a quicker recovery xx

@Bubblesbubblesmybubbles what did you go with in the end? I had an EMCS last time after 30+ hours of waters breaking and early labour followed by merconium for them to discover he was breech. Was meant to be a home water birth so polar opposite but dealt with it well. Had a lovely recovery from the selection, easier that some people I know who had natural births. I'm terrified of going for a VBAC and ending up with a massive tear or episotomy and being worse off than with a section. I think.id regret that more than not trying for a VBAC. At the same time though I will have an almost two year old to run round after and I'm worried my recovery this time won't be as easy as my last.

I had a VB, then an ELCS (breech). For my third the consultant said she'd like me to try for a VBAC. I hadn't made up my mind, but was edging towards another ELCS when it was discovered I had a grade 4 placenta previa with placenta accreta and the baby was breech again, so the decision was out of my hands.

After a successful but complicated CS with a lot of blood loss, and a 50/50 chance of a hysterectomy, the surgeon sternly told my husband 'No more!' (She may have been waving a scalpel at his nether regions at this point)

I was in this position when I had my second, my first baby was breech. I went for the VBAC and although it was successful, I regretted my decision and it was a traumatic birth. Now I'm due my third and was asking for a ELCS but I just found out this baby is breech as well so I need a c section anyway.

I was in your position several years ago, although my first emcs was after a long labour. I chose to go for an elective cs for my second birth, and like other people on this thread have said, it was so much easier and a much better experience than my first cs.

I think there is a big difference - actually I know there is - between elective and emergency cs, both in terms of medical outcomes and how positive you feel mentally about it. I was shocked how quickly I could walk, sit up, feel pretty normal again, compared with the first time. The experience itself was pain-free, and no worse than a visit to the dentists. When I think of the agony I was in with contractions during my first birth, I feel annoyed that I had to go through that.

I recovered really quickly after the elcs, and had fewer problems than some of my friends who had vaginal births.