I have been hoping to go for a VBAC but seen this BBC story

[MamaMaiasaura]

here and is making me think twice.

Consultant has already said wants me to have extra scans as he feels a VBAC would only be appropriate if baby in good position and not humungous. Consultant also said he doesnt want me in labour for longer than 7 hours (was 48 with ds1).

At the end of day I want what is best for baby. DP would love to have another baby after this little one and am concerned another section will hinder this. So confused.

Midwife (she has now left) was really supportive of VBAC.

can't help, but bumping for you Awen (good luck btw)

I had a vbac and was in labour for 24 hours. But they did continuous monitoring to make sure everything was ok. My hospital (St Thomas's in Westminster) was very encouraging of vbacs.

Ah Awen I didn't manager a VBAC with number 2 after fighting very hard to try. I am still disappointed with the outcome but would be even more so if I hadn't at least tried.

I have gone on to have a third .

DD1 9lb 9oz was breech hence first section DD2 was 10lb 10oz and back to back - wasn't really going to happen.

Do what feels right for you and your baby - it felt right for me until I had been labouring for about 12 hours and wasn't progressing past that bloody 9cm dilated when I then knew it was time to move to another section.

There are many successful VBACs on this board, I have had 2 friends deliver vaginally after first sections for failure to progress. So I will stop gibbering and say do what you feel is right and what you feel strong enough to cope with with.

HTH, Good luck and take care.

You should be fine but avoid being induced and if you're worried insist on constant monitoring. According to my consultant at the time, they can pick up early signs that things aren't as they should be if you're monitored and can take steps to avert disaster.
The chances of a rupture are still quite small.

there are lots of VBACers on here Awen and if you keep this bumped tomorrow I'm sure someone will be along to help you out.

I just had a quick look at the article and it says 9 out of 1000. That's pretty good odds IMO.

Lulu and Klaw linked me with some great websites when I was pg with my DD and wanted a VBAC, but I bottled it at the last minute and went for another section (my problem was mechanical and there was no guarantee it wouldn't re-occur this time). However, at 17 weeks I still haven't fully recovered due to post op infection and I truly regret my decision now. I wish I'd had the courage of my earlier conviction to go for VBAC.

You will be more closely monitored and they won't induce you, or if they do it is a more gentle process.

good luck whatever you decide

OK, Awen... I've only glanced at the article, and numbers/statistics are not my strong point, but it seems to me that the article is quite scaremongering. OK, so women who've had a previous section are more likely to suffer a torn/ruptured uterus than those who haven't. But the risk is very small (IIRC, when I researched this - now 6 years ago - it was something like 0.02%. Sure someone will correct me if I'm wrong.) So, you are more likely to rupture if you've had a section. But even 50% more than a very very small number is still... errr... a very small number. (Gawd... I am not explaining this well. Sorry.)

The main risk factor that I found out about when I was investigating VBACs is having an epidural. The first sign of a tear or rupture is pain which goes on between contractions and is across or near the caesarean scar. Obviously if you have an epidural it numbs the whole area and you will not be aware of 'unusual' pain. I am quite shocked that VBAC-ers are offered an epidural at all, in view of this, but it seems that in some hospitals, at least, they are.

I don't know why you had your first section, and this may have something to do with your consultant saying you shouldn't be in labour for more than 7 hours. But it seems very odd to me. No time limit was mentioned to me when I had my VBAC (though I was lucky and was only 10 hours from waters breaking to birth... still more than 7 though).

I was very anti continuous monitoring when I had my VBAC, because I felt that it would impede my ability to move around and stay as comfortable as possible. My consultant (wonderful man) agreed that continuous monitoring wasn't necessary and even wrote it on my notes, so I could wave them (with his signature) at any midwife who threatened to strap me to a machine.

I had a relatively easy VBAC with dd2 with no complications at all, so it is possible!

Good luck with this. I hope I haven't confused things still more with my possibly spurious statistics.

Oh, yes, and don't let them induce you either. Risk of rupture is doubled with induced births. I had said that I wanted to be allowed to go to 42 weeks, but if I hadn't given birth naturally by then I'd have another elective section, but under no circs would I be induced. Consultant was supportive of this (and dd arrived at 37+5, so all immaterial!)

Good luck again.

There some good practical advice from Ellbell Awen.

Would second don't let the MW force you into monitoring - keep moving around as much as possible. They can listen in intermittantly if needs be.

Also not sure where the 7 hours has come from - I was advised there was no real limit but would be based on how labour was progressing, how you were feeling and any physical signs of concern.

Worth mentioning too that as you have already laboured your chances of success are higher I think.

Yes, I think that's right, gomez (about 2nd labour). I had had an elective first time round, so my VBAC was my first labour. First stage was a piece of cake (well... -ish!) but second stage was longer than expected (2 hours).

Awen, I did have a uterine rupture on ds2 on my VBAC. Thank goodness, it was caught on time and there were no serious consequences and I did go on to have ds3
Now, I believe there were a number of reasons why I had a uterine rupture. Firstly my first CS for ds1 was not carried out by someone competent, the wound was uneven and became infected, perhaps led to thinning of the scar?
Secondly, I was continuously monitored. This seriously impeded my ability to move around so got no real help from gravity.
Thirdly I was given synotocin when I failed to progress. This should never be given to a woman attempting VBAC, it increases the intensity of the contractions and increases the risk of rupture.
So there you go, How Not To Manage a VBAC by Chipmonkey.
Oh, and I didn't have an epidural so was able to tell the midwife that I was getting a really sharp pain with each contraction and that the pain was located in my scar. This alerted them that there was something wrong, and I was whisked to theatre very quickly. Very glad now that I didn't have the epi.
Honestly the vast majority of VBAC's work out fine Awen. I think proper management is essential. If managed properly the risk of rupture is very small and staff should know the signs if all is not well.

The thing with this article is that it doesn't actually give us much new information for women planning a VBAC and IMHO isn't particularly helpful in making a decision whether to go for VBAC or elective section.

It has been known for a long, long time that uterine rupture is a rare complication of VBAC and can be fatal for the baby. The overall risk of this is very small though. This research found an overall rupture rate of 0.8% in women attempting VBAC. This immediately raises some questions as this is quite a bit higher than most other research has found - the 'accepted' rupture rate is 0.5% so you do need to wonder what was going on with this group of women that the rupture rate was comparatively high.

The main flaw IMO is that this research does not give us any information on the risks of VBAC compared with women having an elective section, it is comparing women attempting VBAC who've had a rupture with women attempting VBAC who haven't had a rupture. CS carries its own risks, so it would have been helpful to have had neonatal mortality figures for this option to compare with VBAC.

It's also clear from this research that induction increases the risk of rupture significantly. You also need to bear in mind that the other risk factors - such as being overweight, having a big baby, being postdates (and note, this is talking about 42 weeks, not before), being older - are all factors which often lead to induction in themselves. The research does not appear to have taken this into account so we don't know how much of the risk is due to these factors in themselves or because they were induced because of these factors (iywswim)

AFAIK augmentation of labour(ie syntocinon) which causes stronger, longer contractions, had also not been taken into account when working out risk of rupture.

The take-home message though from this research is that the risks to individual babies is very very small. Of the 0.8% of women who had a uterine rupture 95% had healthy babies - so the overall risk of losing your baby because of uterine rupture if you go for VBAC is tiny - 0.016% if my maths is right

I'm hoping for a VBAC at some point in the next month

Don't let the figures scare you too much, a very small number of women suffer a rupture & in an even smaller number is it actually serious.

To balance the agrgument, about 1 in 100 of ALL labouring women (VBAC or not) have a placental abruption which can be equally serious for mum & baby, but you never hear anyone trying to scare all women out of labouring naturally because of that risk....

Yes it'a a risk, but there are loads of risks associated with giving birth, at the end of the day you have to do what feels right for you & not let the scaremongers get to you.

(However I do agree with the article when it says if they reduced the c/s rate in the first place then less women would be put at risk in the first place...)

Please come & join us in the "support for imminent VBACers" thread - there are some great links available near the bottom of the thread so you can read various viewpoints of the potential risks & issues of VBAC.

IMO, this has been blown out of proportion, i won;t bother repeating what has already been said, but it seems to be scaremongering..

just ditto what daisywhoo and ellbell have said

I had VBAC but this was supported by both mw and consultant. I think that if your consultant is leaning towards cs then you should go with his advice. I know that goes against the grain and may interfere with your choices etc, but from my experience consultants only point you in direction of cs if absolutely essential. i'm sure that's not true everywhere but it was in my case.

I do hope Lulu is on this thread. She can do it unemotionally. THings like the consultants comments make me burn!

am here mars, but am cross

consultants do not always, though they should , give you the correct advice for each individual.

you are allowed to question them, you are allowed to research it yourself.

ask yours how many uterine ruputres he has seen, i asked mine, the silence that followed was priceless

i am not, nor have i ever dismissed it as a risk, but in light of the benefits, it is one worth taking, IMO. well, it was for me.

also, i take issue with repeat c.s when first c.s was for 'failure to progress', very often as a result of a failed induciton, in my mind that is not an adequte reason, as there are so many reasons why labour might fail to progress.. and no reason they should be repeated in a subsequnet labour.

also, why should a c.s be needed because baby is a little larger.... women can and do give birth to big babies, having the confidence in your own body, rather than being scared , is the first step.

obstetricians see the very worst case scenarios and are experts in the complex and abnormal, midwives are the experts in the normal.. IMO and IME obs. tend to err on the side of caution as they see more of the bad stuff.

at the end of the day it is a personal decision, but i hear from a lot of women who feel bullied and pushed into making a decision that pleases their doctor rather than themselves.

Marslady -
not all consultants are bad - mine was totally pro VBAC and very anti cs unless absolutely essential. So, had he suggested another cs I know that he would have been doing it for all the right reasons.

I had a (heavily monitored - and induced ) labour with DS2 - lots of intervention too. I was encouraged by the consultant to go for another CS. I was also told I couldn't labour for more than X amount of time (thought I'm sure I did go way over their "time limit".

DS3 I had monitoring using a doppler only and no intervention at all. Again they suggested a CS and I told them where to stick it! Time wasn't an issue with him as he was in rather a hurry to arrive.

I had a VBAC 4 years ago, and there is nothing in that article that wasn't known then.
If you want to reduce your risks of scar rupture do not get induced, do not go over-term (ie. have a section if you are over term), do not have a syntocin drip, and if labour is not progressing well (speed-wise) be prepared to have a section instead...Plan for a VBAC but be prepared that is some instances it is safer to have a repeat section - make the decisions as you go along..I was very clear in my birth plan that although I wanted a VBAC under the above conditions I was prepared for a section.
You will almost certainly be put on continuous monitoring from the moment you get to the labour ward so make sure that the hospital you have chosen has mobile monitoring (I could still sit on birthing ball and move around whilst being monitored) and stay at home for as long as possible!

Not sure what I would do in your situation, my first del was normal, 2nd a section so I guess if I had another I would have to consider the risks with both options.

Just wanted to say a friend of mine had her 4th section a few weeks ago and was up and walking around the next day and has had no more problems than with any of her other sections. Whatever you decide to do I hope it goes well x

I have also been debating whether to have a VBAC. My mw and consultant seem to take it for granted that I will have one (first cs was failure to progress) and NOBODY has mentioned any increased risks of anything to me, nothing about no induction, no epidural, nothing.

Should I kick up a stink next time I see them?

Whe I read that BBC article, I thought hmmm yes, having a section can lead to scar rupture. Duh! Tell me something I don't know.

You say you are concerned that 2 sections will hinder having a third baby. This is not true. Whoever told you this was scarmongering. Talk to mumsnetter Lisalisa who has had 5 sections. I have had two and would happily have another if I wanted another baby -- which I don't.

If you want a VBAC for other reasons, then by all means go for it. But, don't do it because having a section will hinder a third pregnancy.

It will be like a second labour up to the point where you had the section last time. If you got to 5 cm last time then it will be a first labour after you pass 5 cm this time. And if your last section was elective and happened before labour, then I'm afraid the whole labour will be like a first.

Good luck with your decision.