VBAC vs ELCS

[Chanel05]

Background: had my daughter at 40+2 in September 2020. Had an emergency section at 10cm after 2 hours of pushing and had a major PPH and blood transfusion. My dd was transverse.

I'm due my second baby between 23rd - 27th December. According to my dates (and I was spot on with my dd), most likely 27th.

I'm completely torn between an elcs and vbac. I think I'm a good candidate for a vbac due to going into spontaneous labour and fully dilating but there's a lot to factor in. I'm terrified of another section, especially an emergency. I'll have a toddler to contend with this time. Second babies are often early and I could have a baby born on Christmas Day if I leave it to fate! My dh is terrified of me having another (frightening) emcs and would rather I opted for an elective. I'm on the VBAC UK Facebook group but I don't find it gives balanced experiences of either (obviously - promoting VBAC).

So for those of you that have had to make your minds up about VBAC vs ELCS, what did you go for and why?

I think with VBACs the ultimate deciding factor is whether you want to experience a vaginal birth. If you do, try for a VBAC. You can always move to an unplanned section sooner rather than later if you find things don't go to plan.

If you don't care too much about having a vaginal birth then I'd go ELEC

Can I join for advice?

OP, our situations are almost identical. My DD was born Sep 2020 by EMCS. Baby #2 due January 2023 and I'm weighing up the idea of a VBAC versus an ELCS.

My main advice would be that you don’t have to make a decision just yet, and you can wait to see what happens and how your pregnancy progresses.

I had an EMCS with my DD in July 2020 and I am currently booked in for an ELCS next week!

I was induced with DD at 40 weeks due to her measuring big and like you got all the way to 10cm when she showed signs of distress. They said I was a good candidate for a VBAC, but I said that I wouldn’t agree to being induced again. This baby has been measuring really big again and so the consultant advised that ELCS would be the safest delivery given the risk of shoulder dystocia and not wanting to be induced again.

My first was ELCS due to breech baby and I had the choice of VBAC or ELCS for my second.

I found it VERY hard to get good guidance and pretty much had a ton of stats flung at me which made me want the baby never to come out! Ultimately, after quite a lot of digging it transpired that because I was by then over 40 (years old, not weeks ) the recommendation was not to go beyond 40 weeks if spontaneous labour hadn't started and they would suggest induction. HOWEVER due to the previous c section, they wouldn't use the most common/preferred induction method (sorry I can't recall the details) in case it was too effective and caused scar rupture AND that the threshold for deciding induction wasn't progressing and switching to EMCS is much lower than non-VBAC inductions.

All of which sounded like too many what ifs and my first ELCS had been so straight forward I opted for another, which fortunately also was.

This may be totally irrelevant if you are young and able to go more than 40 weeks plus I think the induction options may vary by Trust, but hopefully it's helpful for you to look into.

All the best to you both!

Hi OP, just came across your thread and see that you must have given birth now! I am due in May, extremely similar circumstances but my first was June 2020 instead. I am currently going through all the forums and doing a pro/con list. I'm also a good candidate for VBAC due to body labouring well, but EMCS happened because my daughter turned around in labour and got stuck in my pelvis.

Did you decide on electing or did you go for a VBAC? Happy with your choice? :)

Congratulations as well, I hope you had a good birth either way!

Hi @LittleLlamaMay I now have a baby boy who is almost 6 weeks old.

Dating scan put me for due date as 22nd December (though as per my original post, I knew for certain that this was wrong!).

I ended up booking an elcs for 22nd as I thought this would be early enough. Went back and forth for ages on my decision.

Ended up going into spontaneous labour on 16th December when I was 39+1 (38+3 by my own dates) and it progressed extremely quickly. Contractions were 2 mins apart from the get go. Arrived at hospital 3 hours after the first twinge and I was 9cm. My back waters had gone but not front so they said I could either go for a vbac or still a c section. They warned that if my front is waters went, baby was coming with them and I could actually feel him moving down into the birth canal with contractions and then going back up again. That part wasn't particularly painful, just felt very strong in my body. There was a long emergency in theatre but my waters held on and I continued to contract for the next 3 hours back to back whilst I waited. I had gas and air but it did nothing at this point. Finally got my theatre slot and spinal didn't work the first time so it had to be done again. An hour after arriving into the theatre, my son was born. Very minor blood loss and I was up 6 hours after surgery having a wash. My recovery has been much better this time, even though it was still an emergency section.

I have to say though, I regret not going for a vbac. I just wanted the control of deciding and I think I bottled it!! I was absolutely certain at that point that baby would have been out in a few pushes and the consultant basically confirmed this too.

Basically, I'm probably mad still having opted for the section but that was right for me in that moment. I'm not having a third child but if I did, I'd be having a vbac.

Hi
this is very interesting for me, why did you decide a emcs instead of vbac? I had a failed vbac due to fetal distress (waiting on birth debrief to find out if there was a reason) and we want a third and I think I would try a vbac again. First emcs was also due to fetal distress but I had the section at 10cm so my body laboured very well and I know it can again. I have a strong urge for a vbac and I don’t know why.

@Chanel05 thank you so much for taking the time to respond, especially with a 6 week old. Congratulations again! Your comment has really given me a lot to think about. I do feel in my gut I want a VBAC but C-Section just has so many practical sides, and it does remove that fear of scar rupture that seems to keep taking over. I mostly want a spontaneous labour though so I think I would probably make the same decision as you, that would be my ideal. The fact that you would go for a VBAC next time does give me some real confidence though so thank you so much. I'm going to speak to the consultant team, but it's all real food for thought.

I was in this position not long ago. My first child was born by EMCS after a failed induction at 39+5 for reduced movements. I didn't dilate past 6cm and he started getting into distress. I thought that because of my previous experience my body just didn't labour well and I would be likely to end up with another EMCS so maybe I should just have an ELCS, but I also knew that I wanted to experience vaginal birth and would regret it if I didn't try.

Everything was completely different second time round. I went into spontaneous labour at 40+1 following a sweep at 40 weeks, and after about 12 hours of early labour to get to 3cm, had a very quick labour. (2 hours of active labour, 5 minutes of pushing, small tear.)

I'm glad I went for the VBAC, but I also think that a second C-section would have been less traumatic than the first.

@gfuche I'm the same
I'll go for a vba2c with our next and final x