Thinking for the future - vbac or ercs

[Dancinggroot]

hi all
Not currently pregnant yet, however we are starting to think about dc2 and a friend has recently delivered so I've been thinking about options / birth plan. I would quite like to have an idea what I want from the start so I can stick to my guns if need be. Obviously this all is dependent on being able to get pregnant again and having another child of course.

Dc1 I had ElCS. Was told at 20w that I had placenta praevia and they would monitor me and depending on placenta may need Cs. I had monthly scans, and was told at every one that I still had placenta praevia. At my 34w scan they informed me that my placenta hadn't moved so I would need elcs, and arranged for me to see the consultant at 36w to get it booked. By this time after multiple scans I had already thought this was likely to be the case, and had prepared myself for a Cs with no thoughts at all of a vb really. At the 36w appointment I had an internal ultrasound, and they told me that my placenta was nowhere near my cervix and probably moved around 10w prior. They said they were cancelling my cs and would see me when I went into labour.
This caused massive panic and anxiety. I have a family history of haemorrhage post delivery and in my mind I linked this to my placenta. I was so scared, and was adamant I wanted the cs anyway.
After discussion with the consultant they agreed for me to have a maternal request cs and that was it.

Cs was very calm and went really well. Scar externally was almost healed by the time they took the dressing off on day3. By day 6 I was walking around like I'd never had surgery. I've had no lasting effects, no pain, no overhang, nothing. Unless I specifically point out my scar its invisible. My only issue was struggling to BF however dc was tongue tied so that was also a factor.

Based on all this it would make sense for me to want a ercs. However I think I want a vbac.
The fear I had previously seems rather silly now, and I sort of feel a bit like it was a cop out. I know its silly, but I can't really explain it any other way.
I think I would refuse induction as I believe that is linked to poorer outcomes? But what have other people done?

Would I be able to request sweeps from say 38/39w to try and encourage labour?
What are peoples experiences of vbac via induction?
Or is ercs a better (safer / calmer) option?

The only benefit I can think of to ercs would be the planned date and it being daytime so we could take dc1 to nursery/school/relative then go to the hospital for delivery. Rather than having to have a plan for different eventualities including middle of night childcare.

Sorry this is so long!
What are peoples thoughts?

I am in similar position to what you're preparing for though I had an EMCS with my first (majorly overdue, induced but with no chance for it to get going naturally between induction steps and ended up with EMCS after 7 hours of labouring due to fetal distress) and am now pregnant with my second.

I'm not completely sold on what I want yet (got a few more months to go) but my current plan is have ELCS booked for few days ish after my due date. If I go into labour naturally before then I'll try for VBAC but will have low threshold for having C Section if is failure to progress. I'm going to refuse induction of labour. Won't mind rupture of membranes to try and progress things if I've gone into labour naturally and might be ok with membrane sweeps from around the 39week+ mark but am definitely not being induced to initiate labour and definitely not going on the drip.

Main reasons are I like you had a very good first c section experience & don't think it affected my ability to breastfeed or anything. Only thing was my uterus took for ever to shrink down! Wouldn't mind having another CS but are benefits to VBAC in that I have a toddler and may be easier dealing with in terms of recovery and if I wanted more babies in the future won't mean automatically another C Section later/increased risks.
I personally would not go for induction with VBAC as would argue the risks of uterine rupture then outweighs the risks of an elective C Section overall and chances are higher that it will be a less straightforward/failed VBAC and you end up with EMCS anyway. But appreciate may be biased from my experiences with my first. Don't think my plan is that unusual though certainly my midwife said that's quite a typical plan & should be no issues with it.

Should also add the main thing which is making me unsure with this plan and wonder if I should just push for elcs is fear that if I go into labour but things fail to progress I may not be able to request CS/might be fobbed off to keep trying for longer and end up with either higher risk emcs after prolonged labour or vbac but with lots of intervention/complications. Does feel like more of a gamble depending on what midwife/obstetric team you end up with on the day...

Have a read up on the benefits/risks of ELCS vs. VBAC in your circumstances.

I did this when choosing, and for me there was a less than 50% chance of the VBAC succeeding plus an 18% chance of long-term rectal incontinence if it did. With a CS the mortality risk was doubled for me but four times lower for DC. Based on that I went for ELCS.

It's different for everyone, though, so definitely worth checking out your individual risk factors.

My consultant for dc1 wasn't overly happy with me having the elective section after they decided my placenta had moved, but overall she was really good and did agree once she realised how anxious I was.
Knowing other people who have had babies at my local hospital it seems like they're quite happy to follow what you want regarding interventions which does give me hope. They don't seem to be vbac at all costs either which I've heard about other hospitals.

My current thoughts are to try vbac on the conditions that I'm not induced, and can change to a section if labour isn't progressing.

I think based on reading I've done that I would be happy to have my waters broken to help, but not the pessary or drip. It seems like those don't have the best outcome? Especially in terms of vbac.

Do you know how much monitoring is required in a vbac too? I wouldn't want to have to lie still, I think i would want to be able to move around.

It's hard because I've never actually gone in to labour so don't know how I/ my body would cope with it and the pain if you get what I mean.
I think if I'd had an emergency section it would perhaps be an easier decision as I would have experienced labour. Perhaps not though if you're having a similar dilemma!

@DuggeeHugs

Have a read up on the benefits/risks of ELCS vs. VBAC in your circumstances.

I did this when choosing, and for me there was a less than 50% chance of the VBAC succeeding plus an 18% chance of long-term rectal incontinence if it did. With a CS the mortality risk was doubled for me but four times lower for DC. Based on that I went for ELCS.

It's different for everyone, though, so definitely worth checking out your individual risk factors.

how did you find the info on your specific circumstances? Was it on an nhs website?

If you don't mind me asking, was your first section elective or emergency? And did that have an impact on your choice?

I looked on the RCOG website. I had to do a bit of reading around but I was glad I did.

DC1 was an EMCS after a failed induction. It did influence me towards an ELCS anyway - I didn't want to go through anything like those 104 hours again - and the EMCS itself had actually been brilliant. Dealing with a newborn at the same time as the physical and mental exhaustion from that failed induction was horrific.

The consultant was in opposition, though. She thought I ought to 'at least feel like you've tried' despite the risks. I stuck to my guns and it was eventually approved.

For me, it was absolutely the right choice. The surgeon told us DC2 had the cord wrapped around her neck three times and would almost certainly not have survived a VBAC. I realise that's a complete coincidence, but it really validated my decision.

I don't know how 'normal' my experiences are, though. But I've read so many other stories that I think my circumstances aren't that uncommon. For example, 10% of inductions fail, which I wasn't told before they tried it with DC1.

On the other hand, risks and personal experiences of birth are definitely not one size fits all, so it's always worth listening to the stories of others, but getting your own risks and going with what you feel is right for you.

That's good that your hospital sounds supportive/open.

To be honest despite having EMCS I don't feel like I ever understood what 'normal labour' felt like as was completely augmented contractions that only got me to about 3cm in like 7 hours (that was the problem I think really my body wasn't ready and wasn't getting the hint/time to take over itself). So still no idea what natural labour pains will really be like. I think that's where induction tends to fail vs succeed is when you're body really isn't ready or receptive as ultimately it has to get going itself if it's going to succeed that's where I think things like sweeps/membrane rupture that encourage you're body to go into labour vs try and just do it artificially are more likely to be successful. But am not a midwife and this is based on my opinion/understanding rather than any research.

I think that because you need continuous monitoring you will be more restricted than other vaginal births but once again I think it depends upon the midwife you have and how much you're encouraged to move or remain still. Have heard stories where women are told they have to lie on the bed because they're being monitored and it will disturb the trace/wires whereas others have managed to be more up and about and have actually been encouraged to move despite the monitoring. So is possible but experiences are again variable.