Trying to decide between c- section or VBAC

[Nichola2310]

With my first pregnancy I had an old back problem that flared up at 6 weeks, and continued for the entire pregnancy. I was in agonising pain and only left the house to attend hospital appointments from 16 weeks until I had my baby at 39+2. Due to this, and the fact I'm not ever allowed to have an epidural I had an elective section. It took 9-12mths after having the baby for the back problem to improve.

I'm now 28 weeks pregnant with baby number 2 and much to my delight I've had no back problems so far.

I'm torn between having another section or having a VBAC.

Some of the factors influencing my decision are:

1st vaginal deliveries regularly seem to result in bad tears
My first baby's head was on the 99th percentile at all scans, and at all his health visitor check ups (my DH has a big head!)
I have had vaginimus so I really struggle with any vaginal exams. In my last pregnancy the consultant tried a sweep and I nearly leapt of the bed, I couldn't tolerate it at all.
I won't be allowed an epidural.
However recovery from a section won't be easy when I have a 3 year old.
With covid restrictions I know I'll be in hospital on my own after a section.
This is almost definitely my last baby so my last chance to experience delivering a baby, but also I don't need to consider the impact of multiple sections.

I'd appreciate any advice.

It's about 3.5% (1 in 30) for a third or fourth degree tear. First and second degree are minor and will tend to fully heal with no lasting issues, it's the 3rd/4th which are nastier.

Not sure whether head size impacts upon this.

You are allowed to refuse vaginal exams. Lots of women find sweeps painful - I've never consented to one as I've heard they aren't effective anyway and don't like the sound of it!

It sounds like you know what recovery is like. Would it be possible perhaps for DH to take some extra time off e.g. holiday in addition to paternity leave? Or someone like your mum/MIL/sister to move in to help? Or hire a postnatal doula?

You would have the benefit of knowing exactly when the ELCS would happen which makes arranging childcare easier. With COVID they are tending to discharge earlier than they normally would which is helpful, and staff are more helpful knowing that you don't have anyone with you to help you. But of course it would still involve a stay in hospital for at least one night, probably two.

How do you plan to labour/give birth if you fo so vaginally? I have given birth vaginally twice and opted to use a birthing pool and be upright to give birth birh times. I had no tears each time and I honestly think birthing position and the water helped. My midwife told me lying on your back increases chance of tearing.
Also, epidural increases the chance of required assistance (forceps, etc.) which increases the risk of tearing. Since you can't have an epidural, that risk is gone.

Just putting that out there if you do opt for vaginal birth. It might help.

@BertieBotts thanks for the info. My husband will be off for a couple of weeks so I will have his support.

@HumunaHey I'd definitely like to think that if i labour I'll stay upright and mobile as long as possible, and would also be keen to labour in water. At the same time though I know things don't always go to plan.

Yes that's the major benefit of a planned C section. You never know when baby will arrive with a VB or how things will pan out. I'll also say, I'm sure a recovery from a C section is much worse, but it's not always the case that you get a rapid recovery with a VB. I felt loads better immediately after my first VB. Not quite the case the second time around😣.

You might want to ask about whether your hospital allows VBAC in water and what options are in terms of monitoring etc if you want to have a natural birth.

I would also consider opiate pain relief for the earlier stages and gas and air only for the end. I somehow had these mixed up in my head thinking that gas and air was less potent so you would go for it first of all. But actually the problem with the opiates is they don't want to give them too close to delivery as they can pass through to the baby. Gas and air is powerful but only if you save it for when you really need it.

@BertieBotts thanks for the tip and I will definitely ask those questions.