To VBAC or not to VBAC that is the question ......

[tiredandnowty]

I had emCS with DD at 40 wks due to her being breech and not responding to contractions. On delivery, she wasonly 4lb13oz, was resuscitated and ended up with a collapsed lung, spending 2 wks on scbu with various other complications along the way. DD is absolutely fine now and a bouncing 18month old.

I am now 9/40 and am rather nervous of everything ! Not sure I trust the midwives (previous midwife had been telling me head was engaged for 6 wk prior to delivery, and had guessed DD was going to be 8lb almost). Thinking of either swapping to another midwife group or just askng to be seen at hospital only.

Also nervous about trying a VBAC but nervous too of another CS.

What do you reckon ??

I've been told variously it's a 'trial of labour' and a 'trial of scar'. However I think it's a trial of my stamina more than anything, silly buggers. I've also told them if they think I'm going to adhere to their textbook clock watching regimens I just won't turn up until I'm ten hours in.

Mine was referred to as a 'trial of scar' which immediately puts you off doesn't it? I had this image in my head of every contraction pushing against my scar, and the scar kind of straining and trying not to split lol.
However, the chances are you'll be fine. Rupture of the scar is very rare, and I was told that there are warning signs and you would be given another cs if there was any indication that things werent going well. For me, the worst thing about the VBAC was being in a big hospital. I don't like hospitals (I had dc1 in a very small midwife unit). The danger with a big hospital is that you can end up feeling a bit like it's a conveyor belt and that you're having to fit in with the medical staffs routine, rather than following the natural rythym of your labour.

It always is a trial of scar when having a VBAC even if not specifically noted.

Mine was the one that nearly ruptured. Can't have any more children now as too risky.

NAB.
As a matter of interest, how, precise can the medical team be in knowing how close a scar is to rupturing, what the risks are etc? I was told that one of the early warning signs is that during labour, the pain carries on between contractions. This happened with me - the pain all through labour was very concentrated over the scar area, and after about 9 hours of labour, the pain carried on between contractions. The doctors monitored me closely, but didnt panic or rush into a CS, and actually ds was then born very quickly (too quickly actually but that's another thread).
I think the possible complications of CS, however rare, really highlight the fact that CS's have become far too common, and should be reserved for situations where medically it genuinely is the safer option. It's awful to think of someone being unable to have another pregnancy because the risk from the uterine scar is so great.

Hi tiredandnowty,

Its a pity that you have lost confidence in the m/ws as its very very easy to mistake a breech for a head on palpation, and even on VEs, in our unit it is not uncommon, with the culprits being everyone from the consultants to the midwives! Even done it myself! This is the same in every hospital / and has happened to every midwife. Doesnt make them bad midwives/doctors though.

As for the VBAC, well you will get lots of different opinions here, and you have to decide what is best for you.

If you had a c/s for a breech, your chances of a successful VBAC are very good, as you did not get stuck in labour etc, rather you never really laboured, so you should labour like a first time mum. As for being monitored etc, yes, they will want to do CFM, but your unit may have a wireless monitor, which will give you the mobility that you need to stay active, but even if they dont, you can still walk around on the end of the wires, or if you state that you want intermittent monitoring, you will definately be mobile. With most scar ruptures, you will get a warning of pain in the scar, but not all, but it really is quite rare.

Sorry to hear about DD, but its really unlikely that anything similar will happen this time, so try not to be put off by that.

If you wanted my opinion, I would advise you to have a c/s booked at 40+10 weeks, and if you go into spontaneous labour go for the VBAC, if not, have the c/s, as you cant be easily induced with a prev c/s, without risking your scar.

I don't blame you for being nervous about both VBAC and CS.

Have faith in your ability to give birth, TiredandNowty. What happened to your DD will not necessarily happen to your next baby. There is no reason why you cannot have a VB with your next baby unless you have specific, identified weakness in the scar area i.e. it didn't heal properly or got infected.

But you have to be firm and calm if VBAC is what you really want to try for because the staff at the hospital will be antsy about it. The registrar will be jumpy but will want to monitor you all the time. But don't let them monitor you all the time because you won't be able to move around as much or get in the positions you feel most comfortable and safe in and get gravity working for you.

I had a VBAC with my DD after an ECS with my DS. I can recommend trying for it. I was so determined not to have another C-section. It was an amazing experience. I wanted it at home but compromised as it was my first birth after an ECS. I'll have my next baby at home though.

Good luck and don't take it as a given you can't have a VBAC. Scar rupture is rare.

alfiesbabe - its really hard to predict scar rupture. I have seen several c/sections when the baby can be seen through the wall of the uterus because the scar is so thin, with no signs at all. I have also seen quite a lot of scar ruptures, mostly with good outcomes following crash c/s, as it is often only a small patch of the scar that gives. If the whole scar gives (and I have only seen this twice), after the patient had prostin, the results are very bad.

However I have seen MANY more successful VBACs where nothing has gone wrong, so please try not to be too worried.

Sorry if it all sounds a bit scary - many things in childbirth are scary if you single them out and focus on the pros and cons of each situation, but for most people these scary things will not happen.

(...feels a bit bad in case Ive upset anyone...)

God, don't let them induce you to kick start labour! Not with a CS scar.

Try not to let all this talk of scar rupture scare you too much, the risk is about 1 in 200 people that it happens to.

I'd personally say that if you want a VBAC, be prepared for it, tell the cons you're not willing to book in for a CS until you're overdue and take it from there. Even if you book in for a CS at 39weeks you could labour at 37/38 so an EL CS isn't always going to happen even if booked.

I too have been told I am 'Trial of labour' but no-one has really mentioned my scar, I'm being pushed towards a CS more because of times than scar rupture, and I've had two CS's. I have however made a point on ym birthplan that I do not wish to be treated as a potential scar rupture, and like whomovedmychocolate I will not be restricted to certain lengths of time for each phase.

good luck victoriansqualor hope it works out, i like the point on your birth plan
in the past i've found mw's much more supportive of vbacs than doctors.
sometimes if you tell them when you've gone in to hospital that you don't want to see a doctor if all's going well they try to keep them out as much as poss, and on my last the doctor didn't come in at all
I'm not encouraging doctorphobia (well spose i am a bit) but they seem to get worried sooner than midwives.. and the young ones even more so! failing that a trip to the loo when
the consultant's on his round can do the trick...

LOL, I think it's just that consultants are trained in surgery, midwives are trained in natural birth, so both will be more supportive and moew knowledgeable of their own field.

When I explained to DP I was not happy with the CS plan he got all worried and asked why the cons would say a CS if VBAC was possible, like I said, to the cons, if the are going to end up with an EM CS it's easier for them to have you all booked up and ready to go rather than have to take you down suddenly to get baby out.

I have to say, my obs was far more supportive of my VBAC plans than my mw.

her VBAC advice:

her: are you going for another c.s?

me: no, i want to try for vaginal delivery

her: good for you

end of discussion

everything i learnt about VBAC, i learnt myself.

my consultant was far more supportive and understanding, partic. of my emotional need to go for a VBAC.

Actually lulu, I think after I explained my emotional need to my cons she understood much better, she still isn't exactly happy with my choice, but has said, it's my choice and she'll continue to look after me in whatever way she can, I was quite surprised at her reaction after the cons with DS's attitude towards VBACs.

Do cons have to do any training wrt emotional issues regarding surgery??

that's fab lulu
just goes to show one can't generalise..

i don;t know the answer to that. i would hope so. but for a lot of HCPs mode of delivery and its impact is secondary to everything else.... certainly, my experience reflects that.

i think that the value of listening and hearing what women are saying in their AN appointments cannot be underestimated.

exactly, i think you have to take your mw and obs as you find them, and if they are not addressing your needs ,then take it from their, generalisations may not always be true !

alfiesbabe

Been out all day so a bit behind with answering you. I was being monitored the whole time I was pushing and before that too. The baby wasn't doing great and usually if Baby is fine, Mum is fine. I had an awful lot of pain, this was my second VBAC and I hadn't had any scar pain with the first VBAC and the baby had been fine too, but tbh I blocked a lot of it out. I know they gave me a pill as they were planning an emergency section and the room filled with Doctors, but I had my back to them so wasn't really aware. I saw the emergency button go too. Luckily I am good at pushing at got him out in 7 minutes but he needed help but is gorgeous and all fine now. IT wasn't until quite a few months later when I asked DH about having another baby that he told me he nearly lost both of us and another baby wasn't an option. TBH I think 3 is enough for us but I would have loved another one in a few years.

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I'd avoid CS wherever possible. Every surgery has risks and the baby doesn't get to benefit from all those birth hormones.

Try for a VBAC. Good luck. Let us know how you get on.

I think that when I looked at this decision I found some research which looked at the reasons behind the need for a previous c/s, and the degree to which those were repeated. I think that the rate for a successful VBAC is around 70-75% overall, but depending on the previous history the rate varies and can drop to below 50% (but also be as high at 85-90%).

In the end I decided that going for an elective c/section, where I could make firm arrangements for support after the birth, was best for me. The birth of ds2 was calm and relaxed, and the recovery period was fairly easy as well. But then I didn't want to be supermarket-shopping with a 1 week old baby, and everyone has different level of support in place.

Some women do have a very strong emotional desire to give birth vaginally, and if that is the case then I think that you need to consider that carefully. I do have friends who view their c/sections as failures, and it did seem to contirbute towards some mild pnd.

Incidentally doulas can give support for C/s and recovery too.

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I had em c sec first time around, after having gone through labour up to 10 cm and I did loads of research on VBAC for second.

I basically found myself on high risk care, which was fine by me, so I could ask for lots of extra things and I made absolutly sure that I'd have a scan in the last few weeks of pregnancy. Also, I chose to book a planned C sec 6 days after my due date (problems with first birth were mostly related to being 13 days overdue, and a string of other things...).

In the end, I went into natural labour on the day that my c sec was booked, and went through labour AGAIN and pushed for two hours, but ended up with another C sec. HOWEVER I do not regret my decision to try for a v bac at all. I would say it's really worth it, go for it, prepare yourself, take a doula if you can afford it.

I've been watching this thread with interest as I will be TTC'ing from May and want to go for VBAC homebirth with the next LO.

I wanted to ask you all about doing a VBAC homebirth - apologies for the hijack tiredandnowty

With DD1 I had a CS (very relaxed) because of failure to progress after 48 hours of labour and not getting past 4 cm's. I put this down to the constant monitoring they did on me and DD for the 48 hours of labour because my waters had broken on the Sunday night and I wouldn't go in till the Tues night as I was convinced I could do it naturally.

Basically I want to stay well away from the hospital so I can do it in peace at home and would love to know your thoughts on this?

I had a VBAC at 32 weeks. I also saw a hypnotherapist to get rid of all the emotional stuff lingering from the first birth and to prepare myself for a natural delivery.

Baby wasn't distressed at all during labour and he is now a healthy 3 year old.

My other child was 17 months old and could pick him up and swing him around the day I had my second. This gave me so much joy after being debilitated by a c section the first time and I wouldn't change it for the world.

Just throwing in my penny's worth!