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 wrote a piece for one of the baby mags which looked at stats, a while ago: here's an extract...
Some obstetricians do recommend going straight to Caesarean, because there is a risk (less than one per cent) that your scar will rupture if you labour and deliver vaginally – particularly if you’re induced. However, most will take into account the reasons for your first Caesarean. If there’s no reason to suspect that the same thing will happen – and especially if you went through labour before – the advice may be rather different. However, the risks mean that women who do labour are closely monitored and tend to be moved to a Caesarean relatively quickly if things aren’t progressing. Overall, the national figures show that over 60 per cent of first time Caesareans in the UK have a second one. However, another study which looked a bit more closely at women who did try labour – about half the total number – found that over 60 per cent of these did manage a normal birth.

In your case, this will be a first labour (they usually are longer and harder - but that doesn't guarantee a long hard labour either!).

Hope this helps, very slightly. Whatever you opt for, please please PLEASE remember that none of us fail giving birth. We just choose different routes.

The one thing they'll probably be reluctant to support you with is a home VABC, btw.

I had a successful vbac 7 months ago after an emerg.cs (failure to progress) first time round. I think my recovery from cs was impaired because I was so unprepared for it - hadn't even considered it as a possible outcome so it was disappointing and a big shock. This time, although I was determined to try for a vbac I was also prepared and accepting that the outcome may be another cs; I was just happy to give it a go. My recovery from vbac was very fast (despite a tear) but I suspect recovery from a cs if it had ended up that way would also have been much easier simply because I was better prepared for that as an outcome.

I suppose I'm just trying to say that if, as you say, you feel inclined to try for a vbac, go ahead, but being mentally prepared for a range of possible outcomes should hopefully make a very positive birth experience whether the vbac attempt is 'successful' or not.

ditto all you've just said there about being unprepared emotionally for c-section, hunny. That was certainly the case for me.

I also meant to say I agreed with everything you said Cupcakes (sounds like we've had very similar experiences both times and similar feelings afterwards).

Keeping your options open is a good way of taking the pressure off yourself. If you have a supportive midwife deciding at the last minute shouldn't be a problem.

hi, I've had two vbacs and am writing a book about how to prepare for childbirth, which includes a chapter on caesareans. I was also v.shocked and unprepared for my 1st caesarean and upset afterwards about it, largely I think coz so unexpected. I think that unless you have any medical condition that rules it out, then VBAC is a fantastic idea, on many levels (it is,for instance, actually safer for the mother than a caesarean, which is major surgery, however you look at it). According to the American College of Obstetricians and Gynecologists, if you give VBAC a go, you have up to an 80 per cent chance of having a vaginal birth (this is about the same as any first-time mother in most hospitals). A whopping 67 per cent of us don’t try VBAC probably because we aren’t getting the support we need to give VBAC a go. Instead of encouragement, we get bombarded with ‘risks’ (fair enough, but often scary sounding). One in 200 VBAC mothers experience uterine rupture of some kind but not all ruptures, by any means, are life-threatening. There are good vbac support orgs out there. Try

Vaginal Birth After Caesarean website: www.vbac.org.uk
or International Cesarean Awareness Network: www.ican-online.org

Well, it's surgery, all right, but it's not exactly a heart-lung transplant! You are awake for a start and it takes about 10 minutes!

What I mean is, I would call someone cutting my fanny with a giant pair of scissors so they could insert a giant bit of metal and then sewing me up again 'surgery' but you hardly ever hear that, do you?

Um... I had stitches below as well as the c-section as I laboured unsuccessfully and had a failed ventouse. The recovery from that was very slight compared to the recovery from the surgery on my stomach.
And I wasn't awake because it was a general. Epidurals don't work for everyone.

Just think cupcake, if you had had the caesarean in the firtplace, you would have skipped the stitches down below all together. I can't believe you had both. What a bad deal.

I had an emercency c the first time around. Before I was laying there in the delivery room it had never even occurred to me that might have a caesarean. Just never even thought that anything would go wrong. But, when I heard the phrase "borderline foetal distress" I didn't pause for a second. We went for caesarean. And, I found that the recovery was a bit painful, but it wasn't really that bad. And it didn't hurt to sit or pee. And I'm quite glad I've never had any stitches down there... ick! I have my booking appointment for pregnancy no. 2 on WEdnesday and I plan to make my preference for a planned caesarean know loud and clear. What I don't want is another emergency caesarean.

Meant to add that never to feel I missed something. There was no emotional trauma for me. In fact, in the end, I was quite happy about having missed the experience of delivery. I guess everyone is different, but I have no inner need to experience unbearable excrutiating pain. Can't really understand that need, to be honest.

aloha what are you talking about

If I'd known I'd have ended up needing a c-section I would have gone for an elective one straight away. But I didn't know.
An elective c-section is obviously preferable to an emergency c-section. But given the choice I would say that a successful vaginal delivery is preferable to any c-section.
The problem lies in the fact that you never know how your labour is going to be till you are there.
And yes, the pain of birth is bad but I would still go through that again if it meant I achieved a natural delivery.

Misdee - I'm talking about episiotomy and ventouse/forceps...aargh!
I CANNOT really get my head around anyone volunteering for pain...like Uwila, I seriously just don't understand it. Why? And personally, I'd much rather have c-section stitches than stitches in my most sensitive nether regions. The idea of being literally split open by the baby's head makes me shiver.

and you don't have a general for an elective as there is all the time in the world to get the anaesthesia right.

No - epidurals do not work for everyone.

Sorry - I don't want to have an argument over what is a very sensitive (!) issue.

I don't want to argue either - honest! But you can have a spinal block if not an epidural. I think an emergency section is a very different thing to an elective. Much harder on the body, esp if you've been through labour and are tired etc to start with. It does sound as if you had the worst of all possible worlds. I've never heard of anyone having a general for an elective unless they wanted to.

Have to say I know very little about elective c-sections, only emergency and vbacs!
I understood a spinal block to be the same as an epidural? Please correct me if I'm wrong! When I had my c-section they attempted an epidural twice and although it was apparently fitted correctly I got no relief from it. If I was going to have an elective they would have tried an epidural again but it may have needed to be a general again (I don't know why).

That is obviously one of my reasons for going for the vbac over a 2nd c-section but not my only one. I just think that surgery itself can be an unnecessary risk if there is no danger to the mother and child.
And as far as the pain of natural childbirth goes I am not a martyr and would have killed to have that epidural work!

aloha u r right about emergency section being harder on the body.. after labouring 48 hours uterus failed to contract back which meant i bled quite a bit.. I think for the next one i would consider elective if the advice was that for health of baby & me but I totally understand uwilla's inclination to try vaginally.

A spinal is different, it is different anaesthesia, a more complete block and wears off more quickly. I had to literally chase an anaesthetist down a corridor - at 36 weeks pg with complete placenta praevia!! - to get her to come back and explain it all to me. It was the fact that it wears off so quickly that really appealed and I didn't feel ANYTHING during the procedure. It is effective in just about 100% of cases - much more so than an epidural. I would recommend it if you want to go that way/have to go that way.
I'd never try to persuade anyone to have a section if they didn't want to - quite the contrary. But I really do think an elective that you have long planned, when you haven't been in labour and are well rested and calm is totally different to a horrible emergency after a long,stressful and painful labour or when you are told something upsetting like your baby is in distress. I wouldn't want that either.

Dear Aloha [smile}
You posted this : "I CANNOT really get my head around anyone volunteering for pain.."
I am not going to try to change your mind .... but until you have been through a vaginal birth I don't think you can imagine the exhileration (sp?)... the rush of hormones that you get, the sense of achievment of the labour's results. Whilst I have not had a caesarean myself I too cannot compare but as you know I am a doula to many VBACs (quite a few had a 1st elective).... and they find the feelings of the vaginal birth amazing. These are not just my birth clients they are my postnatal clients too wo didn't have a doula for their birth...

i had em c/s with ds 2001, and next due in mar 05. consultant has already told me that we'll discuss birth options when i see him in feb. but even so, here where i live, hes already said that after having one c/s they will not induce you if you go over time, and even if labour happens naturally they'll only give you 6 hrs of labour to 'see how you go' and probably end up doing c/s anyway. personally from my exp b4 and based on what they've said i would opt for c/s this time round - i feel i know what to expect from c/s and prepare for it better and especially for recovery.

Charlie - why did you have the section ? How far in labour were you ? You might have delivered the baby well befdore the 6 hours !!!! Quite common second time around.

But it HURTS!! And "hurting is horrible", as ds tells me .... sorry, I do know people apparently enjoy giving birth naturally, and I have to believe them... but I just cannot comprehend how this is possible. It always looks and sounds just terrible. Even watched a woman on Discovery Health have a natural birth centre waterbirth (I know, they never normally do, do they?) and it was by usual standards quick and straightforward, and I kept thinking 'oh, you poor thing. How dreadful it seems'. I can see the practical advantages of a very quick birth without intervention - ie you are home sooner, but it HURTS, and I can't get over that (let alone all the other stuff, like the hours it takes, the unpredictability, the indignity etc etc etc). I really don't understand.

But Uwila, if you fancy it, PLEASE don't let me put you off!! Sorry if I am. Honestly, some people say they actually enjoy the experience. Baffling to me, but they all seem perfectly sane