VBAC or planned Caesarean after previous emergency C?

[Uwila]

Okay Spilla, here's the thread for you.

Spilla comment from previous thread:

Hi
Can anyone help?? I am 5 months pregnant with my second baby. I had an C-Section with my first due the placenta preavia. I now have the choice of what kind of birth I would I like for my second - I had a blood transfusion after the first and did not feel well for at least 3 months even though the pain if the cut seemed to dies down after two weeks.

I honestly don't know what to do - whilst I like the idea of knowing when my baby will come and not risking being an emergency case due to rupture of scar etc I feel quite inclined to try and deliver vaginally.

I can't stop thinking about it all - Anyone got any experiences of this sort of thing I would love to talk to you????

I think if you don't have placenta previa this time the chances are you could have a perfectly normal vaginal delivery if thats what you would like - good luck x E

Hi Spilla,
My DD, who is now 20 months old, was born by emergency caesarean. I am now almost 4 months pregnant (you can find me on May and June threads). So, my situation is rather similar to yours except that I did not have placenta previa. DD was born by emercency caesarean when she went into foetal distress about 30 hours after I was induced. What happened was she was all tied up (literally) in the umbilical cord (twice around the neck), so when the contractions were forced, the cord tightened around her neck, reducing the blood supply and her heart rate dropped... EEK! So as soon as they mentioned caesarean, I signed the form and off we went. I was given a block, but it didn;t take effect fast enough and they wanted to get her out fast, so the upgraded it to a general, and I woke up in recovery with DH and DD next to me.

I didn;t have the blood loss that you had, so that wasn't a problem for me. And I was out shopping at the mall when DD was 3 days old (straight from the hospital). So I tend to think that caesareans get a bad wrap (hence I started the other thread about the positives of caesareans). I think that a planned caesarean is the safest and best way to have a baby, especially if you have already had a caesarean. Big emphasis on the word PLANNED there.

If you choose to try for a VBAC, I would ask the hospital what the success rate is for attempted VBAC. I think the stistic is 40% of them end up in an emergency caesarean. I might have this wrong though. Can someone else confirm the rate of attempted VBAC that end up in emergency caesarean anyway?

Although, I should add that there are definitely women out there who have had successful VBAC and are glad they did. I just wouldn't like to risk another emergency section.

Also, the ill effects of a caesarean (the numbness and itching of the scar, the slight tightness when I sneez, etc.) I already have and aren't likely to be made worse by a second. So, the trade off for me is basically a painful abdomen for a week or two in exchange for not experiencing delivery and down below won't hurt.

Thanks for the advice everyone - I have to see my Consultant at 35 weeks to discuss what I have decided, I have to admit I would rather have a PLANNED section than risk an emergency, do they automatically have to let you if you've had one previously?? - anyone else with any experience I would be glad to hear it

Spilla, I have my booking appointment next week, and I am spending this week preparing myself to beg, plead, persuade, threaten lives, whatever it takes to convince them to give me another one. I think the usual approach is to recommend VBAC, but that if your REALLY want a caesarean they will give in if you stand your ground. Depend on the hospital though. Some are more resistant than others.

Mind if I ask what hospital?

just to add my two pence worth

go for elective C. I should, with hindsight, have gone for an elective instead of trying for a VABC after emergency C with ds1. I had a horrid experience and lost a lot of blood because they had to slice through the scar tissue from CS number1 in a hurry to get ds2 out. If I had gone for an elective they would have had more time and ... well you know.

Plus and this is a big plus - I would have been able to prepare for the recovery time afterwards.

Hope you get what you want.

Uwila

Queens, Burton on Trent

when I saw Consultant the other week I felt fairly happy about trying VBAC -but now fear has set in. I was rushed in by ambulance last time as I bleed heavily - and ended up an emergency, a week earlier than planned, the more I think about it the more I think I might just demand another section PLANNED! 1st was quite big too - 9lb ½oz!!!

Hi ya,

I am 8 months gone, and had emergency c/s with ds1. I DEF. want an elective c/s this time round!! I am terrified of giving vbac especially all the horror stories ive heard.
My hosp. (west middx)has assumed that I am having vbac..and have not even asked. Will they let me have an elective c/s? What if I go into labour before c/s date- what happens then?

Try looking at www.birthchoiceuk.com/Frame.htm for the unit stistics. I just had a quick look and queens is there. IT doesn;t give a lot of detail, but id a hospital is above the national average, then they are probably a bit more willing to consider patient request for elective.

Or you can get some more detailed statistics on www.drfoster.co.uk.

Shirella, I think you have to speak up loud and clear to get an elective. And, at 8 months, I think you better do it ASAP. If you call the midwives in a state of panic they should be able to get you an appointment with the consultant. Have you seen the consultant.

You must be relatively close to me. I live in Sunbury. In fact, tried to get into West Mid, but was turned away due to them being full and me being out of their catchment.

I had no problems at all at Kings requesting a second section. The midwife said, 'would you prefer a natural birth or another section?' and I said, "to be honest, I'd prefer another section' and she said, "fine, I'll book you in with the consultant'....and that was that! Seeing him next Friday morning.

Hi
I had emergency section with my first. She got stuck, ended up in distress and it was all pretty horrid. She was a whopping 9lb 11oz. With 2nd I started my antenatal care in York where they were fairly determined to get me to have another section. However moved to Brighton at 32 weeks and they were fairly determined to let me try VBAC. I did, and it was 4 hours and fine, he was a bit smaller at 8lb 9oz. I know it can go wrong, but it is rare for scar to rupture and they did monitor me carefully. Mine went well and I am glad I tried it. I think the most important thing is that you are comfortable with whatever you go for. Good luck

Suzywong - if you have an elective after a previous emergency do they not cut through old scar then? Do you get another one?

I'm not pg but would love more kids (4? - that could well change after one more though). I heard you can only have 3 sections anyway so will have to try for at least one vbac

I think that they cut through the same scar on the skin, but make a new incision in the uterus. When you get pregnant the next time and the uterus stretches out, the scar tissue does not stretch. So, once you have 3 sections, the rest of the uterus has to stretch even thinner to make up for the part that doesn't stretch at all. And past 3, the uterus can get dangerously thin. That's why they say no more than 3. But, I have spoken to more than one person who has had 4 or more, so I guess it depends on each individual what your limit it.

I, personally, only plan to have 2 children. So I'm not too worried about it. If I wanted to have six kids I would probably plan to at least try the VBAC.

Flumberrysauce

they do cut through your old scar, in fact you cannot tell I have had two sections, the scars are as one, but without the emergency element they would have had more time to deal with the internal scarring and I wouldn't have been so badly butchered and lost so much blood, they hacked at me to get the baby out (even though he wasn't in distress, just that labout had gone on for a long time)

I was able to choose up until quite late at my hospital - I think that possibly they consider the reasons why the previous birth was Caesarean and how likely that would be to happen again. In my case, dd1 was emergency Caesarean due to undiagnosed breech presentation. I moved to this area when 8 months pg with dd2 and was referred to a consultant. He agreed that as there had been no physical reason other than the position of the baby, I would be fine to try for a VBAC if I wanted. Otherwise I could have had a planned Caesar at (can't remember) 38 or 39 weeks, I think. If the baby had been breech at 37 weeks they would also have done a planned Caesarean. As it turned out, dd2 was nicely head down and I had a completely straightforward VBAC with a couple of puffs of gas and air. As different to dd1's birth as you could possibly get...

They can even tidy up the scar the second time round. I had a rather messy scar with a keloid reaction the first time round. The second time they cut away the keloid thickening and my scar is now much neater.

I had an elective c/s after em c/s - it was more a hospital decision than mine as consultant felt baby 2 would not come out through the natural channel given the probs I had trying to deliver baby 1. It is a completely different ball game though. Everyone has given valid reasons for both but it really depends on how you truly feel about surgery/the fear of being out of control should a em c/s situation arise again.

I wanted a vbac after my emergency caesar with no2. I ended up having an elective caesar 10 days after dd2's due date. The consultant was prepared to let me go two weeks over but would insist on a caesar then if nothing had happened. They were concerned about the stres son my scar as no2 was a large babe compared to no1.

I took arnica this time round from the time I got back to my room for the week I was in hospital - not sure if that made a difference but I seemed to heal quicker this time.

I was a little disappointed that I did not get my vbac but that very quickly went away once the decision was made to have the caesar. The day was great - calmly went in and was prepped for surgery and then had the babe.

THey cut just below my old scar and took it out and so I just have one scar now too.

I had a successful VBAC after an emergency c-section, long labour, pushing but baby not coming out, ventouse and forceps followed by emergency c-section.

The second birth was just as long and just as difficult but I had a successful outcome.

THe big difference second time round was how stressed I was, which definitely meant that it impeded my dilation.

However, delivering DS2 naturally, for me was a life affirming experience and I think was the moment that I finally got over the traumatic birth of DS1. A lot of people do have successful VBAC's, for me it was important but if it isn't so important to you then certainly an elective c-section is just a as valid way of delivering a healthy baby into the world.

I mean after all without modern medicine - either me or DS1 might not be in the world today.

with respect Kaz33, you had a successful outcome the first time too, just because a birth is labelled and emergency C section, doesn't mean it isn't successful.
Healthy baby and healthy mum = successful birth no matter which kind of delivery

sorryto be such a pedant and I don't mean to objectify your birth experiences, but I think (and this is subjective, it is my opinion) that a lot of women feel they have failed if they have an em C and press for a VBAC which may not be the best thing for them.

I remember when I had my first emC for failure to progress, the doctor said to me as she gave me the consent form to sign " it's not an emergency and you haven't failed, it's just the best way for you to meet your baby" and that made a hell of a difference to the whole experience.

I was not suggesting it was not a valid form of giving birth - I was just giving another side of the coin, that personally for me it was important and worth the risk.

Uwila

Been to see midwife this morning and was an emotional reck even though it's months away. She said she would push for whatever I decided!! Very supportive to let me choose - now I really have some thinking / researching to do.
Thanks for the web links I will have a look at these later. Keep in touch, will be interested to know how you progress.

I had a vbac - like others have said it was chosen out of emotion as I was unhappy with the emergency c-section I'd had previously.
And, for me, it was absolutely the right decision. But that, unfortunately, is something you can never predict in advance. The benefit of hindsight is a wonderful thing. For example, I would never have allowed myself to be induced, a factor which I believe led to the complications. But that's another story!
The vbac was perfect because it was an easy, quick, straightforward delivery (even though the baby had been measuring up large). I came home the same day and recovered much more quickly.
I knew I wanted to attempt vbac but right up to the delivery we kept the option of an elective open as a possibility.
Personally, I would go for a vbac again (should I ever need to!) with no hesitation. But I can only be so confident because I had a very positive experience. And it is impossible to predict what your experience would be!
If you are still undecided I would try and keep your options open and decide the closer you get.