vbac - do i have to?

[bunnyhunny]

Following on from other elective cs threads on here, I really wanted one for ds, but was refused. My labour ended in an emergency cs anyway, due to failure to dilate and fetal distress.

So I would like to try for no 2. But can I opt for a cs straight away this time? they can't MAKE me do a vbac can they?

No I think you can opt for CS your MW should refer you to a consultant who should respect your choice - they'll probably want to discuss both options with you... GL

I had a emergency CS and was advised that although they would prefer i had VBAC, i could have CS if i prefered (if and when the time comes!)

Sorry i seem to be typing in riddles today.. that should have read...

I had a emergency CS and was advised that for my next birth, although they would prefer i had VBAC, i could have CS if i prefered (if and when the time comes!)

My experience so far Hunny is that m/ws I have seen have all presumed I'd go for elective cs rather than vbac straight away. I actually had no medical reason for my emcs as what they thought was a placental node in fron of the baby was, in fact, just a bit of me so I've even less reason to need one second time round.
It's been made very clear to me that cs or vbac is completely my choice and m/ws would support whichever decision I made. Consultant is much keener & more encouraging as vbac is my first choice. Everyone is different and you make the best decision based on your circs. Good luck and I hope you get the support you need with whatever you decide.

you can certainly request a c.s

am interested / nosy to know why you wanted an el. c.s for first baby?

i imagine that part of the failure to dilate was being uncomfortable with the whoel process of labour and birth, the mind is very powerful

have you had any birth debriefing and / or counselling re any problems or fears?

lulu - an interesting point. Early in my pg, I had huge issues with birth, mostly to do with family history and the fact I am so tiny.
I did hypnotherapy, NCT classes etc and felt so positive and empowered about the whole birth thing I requested a home birth on the basis of more control and less intervention. When I went into labour, I felt very positive, and was managing on gas and air (in the hospital, as I was only 1cm but in huge amounts of pain) only before everything went wrong. It ended up with fetal distress and his heartbeat almost stopping with every contraction. Very scary. They thought we were going to lose him

I would like to go straight for an elective next time, just because the birth ended up going so wrong, and I don't want to chance that again. I KNOW every birth is different, but I really don't want to take that chance again.

They can't make you have a VBAC, no. Eleusis is our resident expert on "how to effectively demand a repeat c-section", I think.

It's funny (in a sad sort of way) how many women who want a VBAC feel pressured into an repeat section, and how many women who want a repeat section feel pressured into a VBAC.

hello bh!

I had electve for first dd as she was breech, 2nd time round I requested csection at 12 week appt and they tried to persuade me for vbac I had to give my reasons, they gave me medical stats and some info and said we'd discuss at 24week appt.

At 24week appt again I had to be fairly persisitant but they booked my section for 38+3 (these appts were with registrars) saw my consultant from 30+ due to bleeding and few other minor things and he said that c section no problem in fact we even talked about bringing date forward to 38weeks because of the bleeding but theatre was full and we stuck out till 38+3 (well nearly had emegency section on weekend before xmas as started contracting and dd heartbeat all over the pace)and when they actually did deliver dd2 it appears she had turned into transverse position so am glad i stuck to my decision.

It was great having my c section date from 24 weeks I could plan childcare and prepare dd1 plus because of new year etc (dd2 was born 5th jan) dh could forwarn work etc etc

oh sweetie, that sounds terrifying, and after your leap of faith in going for a home birth and then having a really scary situation.

have you ever talked about it with anyone or gone through your notes? whether you go for VBAC or el c.s, it is really important to have put your first birth 'to bed', as it were

nobody can make you have a VBAC, but you need to make a decision based on what is right for you and your needs. and if you are absolutely dead set against it, then of course, it is your decision.

have you thought about giving it a go at all, or is it too painful?

Claim you can't possibly have anything to do with VACing in your condition and then lie down till they give you a caesarian

Only kidding, sounds like you had a horrid time last time but see how you feel closer to the date, you have lots of chances to change your mind and you may well do so. Apparently some people booked in for repeat cs turn up in labour and decide not to have one after all.

But yes you can demand one and have one booked in, then you can tick that off you list and deal with the job of being a very pregnant person.

Hi eandh - didn't realise both of yours were sections. Hope the girls are doing well

Lulu - I am probably even more scared of a natural birth NOW than I was before! I do feel I am over the birth - I was high as a kite for most of it, so it's only afterwards dh told me they thought we were going to lose ds.

I guess that a c/s is even more important to me now, as I prepared so hard for a natural birth and made such progress mentally (i.e. planning a home birth, when months before even MENTIONING a natural birth would have reduced me to tears), it was a bit of a kick in the teeth for my worst fears to materialise... I still feel I am capable of a natural birth, but would like a c/s not for ME (like last time) but for the potential dc iyswim

why do you feel that it would be for the potential DC? you don;lt have to answer, but if you want to talk and explore your reasoning behind things, then i'm listening/ reading !

In my experience it depends on a) hospital policy, b) whether your midwife is experienced and confident with vbacs c) which consultant you see. I was told after my first 'emergency' caesarian that there should be no reason to expect the same problems again 2nd time around(i had failure to progress as well) and that their preferred option would be a vbac. After all it is a major operation with it's own potential complications. i would have thought it was harder to get them to agree to one than to agree to a vbac iykwim, as you can't force anyone to operate against their will?

I had a similar experience to yours first time round Bunnyhunny, and like you couldn't face going through natural birth again. The junior doctor who I saw at 22 weeks tried to persuade me to go for a VBAC, when I said I really wanted a c-s she said I might have to come back for another meeting with the consultant, but then left the room to discuss it with a more senior doctor and came back saying "We've booked you in on this date". So they needed some persuading, but not much. The overwhelming sense of relief I felt told me that I'd made the right decision.

There were medical reasons in my case, but not clear-cut ones, and different doctors took different views as to whether a section was actually necessary. But I just knew that mentally I couldn't cope with an experience like my first birth.

lulu - thanks for your interest. I think it's really helpful for me to be able to explore this, so thanks for your questions

I guess i am scared of a repeat performance. Like I said, I got over a lot of mental anguish over birth in the first place, and yet the birth was actually far worse than I had imagined. Not in a scary I-can't-cope and I'm-scared-of-intervention way, but in a I-might-lose-the-baby way. (though I don't know how close it was, the drop in heart-rate is something I will always remember).

When I went in, the contractions were coming so think and fast that before I was examined the mws thought I was heading for transition, but I was only 2cm by that time. Then my waters broke and their was blood and mecoium in them, so they strapped me to a monitor (I was mobile and relatively active, and things were still going positively and as planned by this point) and then ds's heartrate kept dropping. When the placenta was taken out, they commented that it was very 'scrawny' - I had high bp during my pregnancy, and I don't know it that had anything to do with it.

I keep thinking that if my waters hadn't broken then, then whatever was happening to ds may have been undetected. Yet being mostly unmonitored was a major part of birth plan so I could get into a good position for birth etc etc. iyswim.

So next time I am pregnant (currently ttc), the birth will be very terrifying not for my sake (I was scared of prolapse (my nan), severe tearing (my mum) - though these concerns will still be there as well), but in case of fetal distress etc. I know I would be more closely monitored, but I also know that a lot of the labour progression is to do with mental state, so I would be severely stressed about it going the way of last time.

Whereas last time I prepared MYSELF for the labour, I guess I never really considered the implications for the baby. So all the way through labour, I would be stressed about the welfare of the baby..

am I making sense?

By bunnyhunny on Thu 01-Nov-07 21:19:12
lulu - thanks for your interest. I think it's really helpful for me to be able to explore this, so thanks for your questions

I guess i am scared of a repeat performance. Like I said, I got over a lot of mental anguish over birth in the first place, and yet the birth was actually far worse than I had imagined. Not in a scary I-can't-cope and I'm-scared-of-intervention way, but in a I-might-lose-the-baby way. (though I don't know how close it was, the drop in heart-rate is something I will always remember).

heartrate - a drop in heart rate can be a sign of foetal distress, but it becomes more compelling when the heart rate does not recover well after a contraction has finished, a dip in heart rate does not neccesarily mean your baby is not going to make it. labour is stressful for the baby, and monitoring the HR intermittently or constantly is one useful way of seeing how well baby is tolerating it. do you know if it did recover between contractions? this is where it is useful to go through your notes..

When I went in, the contractions were coming so think and fast that before I was examined the mws thought I was heading for transition, but I was only 2cm by that time.

2cm do you know what position the baby was in ? a posterior baby can make dilation slower, even with lots of strong contractions

Then my waters broke and their was blood and mecoium in them, so they strapped me to a monitor (I was mobile and relatively active, and things were still going positively and as planned by this point)

meconium not sure re blood in the waters, but blood can be a sign of dilation, but frank bleeding can indicate an issue. there are degrees of meconium, and sometimes it is old, sometimes new, if old, it is less of an issue.. my waters were meconium stained, but DD was absolutely fine.

and then ds's heartrate kept dropping. When the placenta was taken out, they commented that it was very 'scrawny' - I had high bp during my pregnancy, and I don't know it that had anything to do with it.

placenta IIRC, a high bp can affect blood flow through the placenta , which can affect the baby;s growth, don;t know if this would cause an issue with the placenta itself.. what weight was your baby? a MW could answer that for you re the placenta .

I keep thinking that if my waters hadn't broken then, then whatever was happening to ds may have been undetected. Yet being mostly unmonitored was a major part of birth plan so I could get into a good position for birth etc etc. iyswim.

monitoring but you see, if your labour is progressing normally, you don;t need constnat monitoring, also, if meconium was old, then it does not indicate anything bad happening at that moment.. so would be useful to know this too, for your own peace of mind . a normal birth should not require contsant monitoring, so the mother has the freedom to move and be comfortable. nothing wrong with that at all.

So next time I am pregnant (currently ttc), the birth will be very terrifying not for my sake (I was scared of prolapse (my nan), severe tearing (my mum) -

prolapse/tear no reason at all that this should happen to yuo, they are not hereditary issues, AFAIK, and your birth is not destined to go the same way as your mums or grandmas.

though these concerns will still be there as well), but in case of fetal distress etc. I know I would be more closely monitored, but I also know that a lot of the labour progression is to do with mental state, so I would be severely stressed about it going the way of last time.

stress have you thought about hypnobirthing and / or having a doula with you to support you before . during and after the birth, it can reduce the need for intervention quite significantly, and you will have someone with you, on your side, to keep you calm, safe and supported.

Whereas last time I prepared MYSELF for the labour, I guess I never really considered the implications for the baby. So all the way through labour, I would be stressed about the welfare of the baby..

welfare of the baby yes, labour can be stressful for the baby, but with monitoring, and little or no intervention, with things progressing naturally at the pace your body needs to go at, then baby should be just fine. mother nature has designed things quite well ! also the stimulation of going down the birth canal, squeezes fluid out of the baby's lungs, so baby is ready for their first breath.

what do you think?

ultimately, if you are terrified, then you cannot go inot this birth in the best frame of mind, whether it be VB or el c.s so definitely worth exploring everything to do with first birth first.

am I making sense?

bunnyhunny, as everyone has already said, they can't make you have a VABC anymore than they can stop you (am on the otherside of it here - trying to get my VBA2C!)
If you get a consultant/doctor that says you can't have a el-cs then you can ask to change medical staff so you have someone who will support you.
Good luck with whatever decision you make.

lulu - thanks for going through that very long post for me I did do hypnotherapy etc to help with the first birth, NCT classes and a lot of self-educating so I could be positive about it, and it worked. But now it's almost like once bitten, twice sky iyswim.

On the basis of what I have said, am I likely to get refused an elective?

like tuttifrutti said - it would be an overwhelming sense of relief to know I wouldnt have to go through it all again.

And I'm not even pregnant yet - that's how worried about it I am!!

lulu - thanks for going through that very long post for me I did do hypnotherapy etc to help with the first birth, NCT classes and a lot of self-educating so I could be positive about it, and it worked. But now it's almost like once bitten, twice shy iyswim.

On the basis of what I have said, am I likely to get refused an elective?

like tuttifrutti said - it would be an overwhelming sense of relief to know I wouldnt have to go through it all again.

And I'm not even pregnant yet - that's how worried about it I am!!

oops posted twice, when trying to correct
'once bitten twice sky' Now THAT would be interesting!

Hi BH

No you dont have to have a VBAC if you dont want to. The drs will probably try to get you to have a VBAC, but mostly they will not push it too much, and if you do happen to meet a jobsworth, just ask at antenatal for an appt with a consultant who is happier to do the el C/S.

Drs have to try to keep the c/s rate down as it is 40-50% in some London labour wards, so you cant blame them for trying.

Reading through your concerns re last labour, as Lulu said, it would be interesting to see your CTG, to see if the decels were late (peaking after the contraction), or early, (peak of dip with peak of contraction). Early dips are often associated with some cord compression, and although they can look terrifying to the parents, they seldom cause a problem to baby. Late decels are more sinister though.

If you had decels, mec, slow progress and were only 2cm dilated, it sounds like a c/s was definately the best option, but these are not necessarily going to happen in another pregnancy, and they are not due to any mechanical reasons, for example you did not get stuck in labour with no descent or dilatation.

A good compromise is to get a c/s booked at say 41 weeks, and if you have not gone into labour by then, have the c/s. If you do go into labour before then, give it a go with the proviso that you can bale out and have a c/s if things start going pear shaped again, ie mec, decels or slow progress. This way you have nothing to lose (as your c/s slot is booked)but a potential vaginal birth to gain.

Sorry this post is a bit rambling but good luck whatever you decide.

i know women who have had an elective c.s on the basis of similar birth experiences, so you are more than likely to get one, IME. if your consult. is not supportive, then you can get a second opinion

i think mintpurple;s idea re el c.s booked for 41 weeks is a good compromise, and i still believe that going thruogh your notes, to see if things were as terrifying and close to the edge as you recall, would be really valuable. it might be that things were not as dire, and that might help you feel better about it? ifyswim

thanks everyone!
like I said, still only ttc, but knowing these things really helps me feel more positive.

right, now to tick off the other things from my 'worried about in pregnancy' list

oh sweetie, i spent the 6 years i have between DCs worrying about going for a VBAC

neurotic, moi ?