C-section or Vba2c?

[EilishHM96]

So I previously had 2 emergency c-sections in 2015 (prem baby) and 2017 (under general anaesthetic NICU stay was also needed due to complications).
I'm currently due in November again with another little girl (unexpected and unplanned but very much loved already) and I assumed I would only ever be allowed to have c-sections after my previous experiences but I met with my consultant at 12 weeks who asked "so what's your thoughts on method of birth?" I was a little confused as when I had my second 6 years ago I was told by my doctor at the time that I would have to have sections after he was born via emergency section following a failed VBAC.
My consult went on to explain that there is no reason she would force a section unless there was a medical reason or if it was my personal preference. She went on to explain the only down side to having a Vba2c is that they don't currently have the best statistics on success rate, risk of rupture ect due to lack of information and lack of women opting for it.
I now have until I'm 30 weeks to make a decision on whither to opt for a repeat c-section or to attempt a vaginal delivery and I'm not sure what to do because I never thought of this as an option. Any advice or different perspectives would be appreciated as the next 10 weeks are going to fly in and I don't want to be sitting in an appointment being asked again no closer to a decision.

I guess I'm your situation of be asking myself:

• how did I feel about c section recovery? Youvr had 2, so you know what it's like

• vbac failed.last time - what was the reason?

I've only ever had VB, although contemplating ELCS for my next.
Hmmm I know plenty of people who've had VBAC's. Do you? If so I'd chat with them.
I think it's important to some women to experience natural childbirth at least the once so they push for it after having EMCS, not for everyone though!

If I were you my question would be what poses more of a risk to my baby, VBAC or CS. Your mental health here is v important too.

If Dr thinks OK, which sounds like he does, I would deffo opt for a VB. I loved the spontaneity and excitement of it.

Another thing to consider that might not even be an issue - if you fall pregnant again (it happens!) they definitely won't consider letting you have a VB after 3 CS, so it's now or never.

Congratulations too. I'm currently pregnant with a surprise baby!xx

Since when do women need to be “let” something with their own body?

You can have a vaginal birth after 10 caesarean sections if you want to. It will be advised against but it’s always the woman’s choice and she can’t be forced into surgery she doesn’t want by someone not “letting” her have a VBAC.

I think it depends on whether a vaginal birth is important to you to experience. For me, I had 36hrs of labour before an emergency c section with my first and opted for c section 2nd time, as various medical reasons put the chances of c section even higher. I was told it was a shame I wouldn't get to experience a 'natural' birth but my reply was that with 36hrs of labour I feel like I earned that t shirt and all I cared was my baby was safe. My first c section, I was shattered, I had no sleep and was at breaking point. My planned c section was relaxed and I could make the most of those first hours. Both times it was painful, it's not the easy way out. What's most important is you choose what you want, but be prepared that plans may change.

@Madwife123 I said this because I had an appointment with my consultant just this week to decide on another VB or ELCS as I'm unwell. One of my questions was what would this mean for my next pregnancy/delivery if I chose ELCS this time, and she said there would be no reason why I couldn't have an ELCS or a VBAC next time, it's only after 3 caesareans that uterine rupture risk significantly increases if you try for a VBAC (risk is always it's there anyway) - I don't think most women would take that risk, and I believe it was helpful advice for the OP fresh off the back of my appointment.

Perhaps "LET" was too a strong word, but there's always one on MN prowling around waiting to find something to quibble with. Pathetic really. Quite clearly I'm trying to give helpful and accurate advice.

Sorry you've had drama on your post OP! Hope you come to the right decision, I've posted a similar post on the childbirth birth topic. The replies I got might be helpful to you xx

Language is very important in maternity care. You will discover this when you have a doctor telling you what you’re “allowed” to do with your own body.

As a midwife it’s a huge bug bear of mine. Using language that suggests the medical professionals are in charge takes away women’s control and on a post when a woman is deciding what she wants to do with her body it’s important.

It’s also not particularly accurate. There is no magic number of caesarean sections that uterine rupture increases after. It increases after each and every caesarean section but there a huge number of factors at play that determine the individual level of risk. The type of incisions (classical or lower segment), the time between births, wound infection during recovery etc.

So a woman that had 1 caesarean section 12 months ago, with a classical incision and had wound breakdown postnatally is at higher risk of uterine rupture than a woman that had 3 caesarean sections 3 years ago and lower segment incision with good healing.

@Madwife123

Really? Are you suggesting that the risk of uterine rupture doesn't increase even more so after multiple caesareans (especially so if trying for VBAC)?

And that my consultant was totally inaccurate in telling me that?

Interesting. The RCOG seem to put a lot of emphasis on VBAC after 2 caesareans, where as my consultant was hovering around 3. I suppose they all have their own experience as surgeons.

I must admit with the oral cavity being my area of expertise, I've learnt a lot that I didn't know since having my first last year. Interesting to hear midwife suggest that after having 10 caesareans you'd even be offered a VBAC.

https://www.rcog.org.uk/media/kpkjwd5h/gtg_45.pdf

Sorry, see specifically 6.3.

I have another appointment in 10 days. I'll quiz her then!

Did you miss where I said the risk increases after each and every caesarean?

Did you also miss where I said a woman can CHOOSE to have a VBAC after 10 caesarean’s and she will be advised against it but it’s ultimately her choice?

Or are you deliberately misquoting me?

So all of this was because I use the word "let"? You've got to be kidding me?

Language in maternity care is very important, I agree, so when you comment saying the below perhaps you should put a little bit more emphasis on why it's advised against. Some women might think if a midwife wrote that it's merely advised against yet you can absolutely have a VBAC after 10 caesareans, that the risks are tiny. I'm not a Dr of Obstetrics, but I imagine that after 10 the risk would be great!

"You can have a vaginal birth after 10 caesarean sections if you want to. It will be advised against but it’s always the woman’s choice and she can’t be forced into surgery she doesn’t want by someone not “letting” her have a VBAC."

@pampam24 stop being so reasonable, it's making too much sense
You can't win with posters who just love to argue.

For me, what made by choice for a ELCS after EMCS, was because they wanted to induce me due to GD. My EMCS was due to failure to progress after my waters breaking and several hours on the drip. Therefore, I knew I didn't want to be induced to potentially go through that again.

If the risks would have allowed me a spontaneous birth - I would have considered a VBAC.

Hi all.
Thanks for your responses. I don't think I'm any closer to a decision as it's not a decision I thought I had (I was 20 when I had my last so I took the doctor at the times word of not being able to have a VB as law, I don't know if in the last 6 years evidence has changed or if doctors are just more supportive when they see you as less of a young mother).

Just as a little bit of added info, my previous vbac failed after 4.5 hours of labour and progression to 6cm due to infection leading to sepsis and baby's heart not coping with contractions, due to the severity of the infection an epidural wasn't an option due to the high risk of meningitis. Which lead to the NICU stay as LB wasn't breathing and needed brain scans and chest CT as well as IV antibiotics for 2.5 days after he was born.
I am classed as high risk due to my previous premature baby, nothing major just means more scans, checkups, blood tests and doctors keeping an eye but my second baby went full term so they aren't overly concerned about another prem birth. Obviously babies health and wellbeing is the priority and always will be.
Our hospital don't support induction during a VBAC the most they will offer is popping waters during labour to help progression, not that this is a huge problem as I didn't require induction previously but if it's medically needed to be induced they won't induce and will recommend a CS same goes for limited pain management options.
My recovery from sections was okay, but at that time I was 6 years younger, my children were younger and didn't have school runs so it was more relaxed.

I'm leaning towards a VBAC still open to more advice and suggestions though, but I can definitely see the pros and cons of both decisions.

@Madwife123 Language is very important in maternity care. You will discover this when you have a doctor telling you what you’re “allowed” to do with your own body. …or when your midwife is telling you when you’re “allowed” an epidural!

Exactly!

If you're not due until November you have more than 10 weeks to decide. Have a think about it by all means, but you can have an ELCS booked and then decide at 38 weeks that you actually want to try for a VBA2C, or vice versa. You don't have to decide before your next appointment and then no longer have any control over what happens.

I only have two children but the second was a VBAC. I felt really strongly that I wanted to experience vaginal birth, that my C-section had not been a good experience for me (other than my baby being born safe and well, of course) and I wanted things to be different second time round. I also had a small age gap between my children (21 months) and wanted to be able to pick up and cuddle my largely non verbal toddler who wouldn't have understood why I couldn't do those things when I got home from hospital.

In your case, your children are older and much more independent, they're out of the nappy stage and you don't need to physically pick them up. They will understand that they need to be gentle and help you out as much as possible if you're recovering from a C-section.

So really what it comes down to for you is how you feel about it. Do you want to have a go at delivering vaginally or not? If you have an ELCS will you regret not at least trying for a VBA2C? Or if you try and it doesn't work out and you end up having an EMCS, will that make you feel worse than if you had just gone for the ELCS? How do you think you would feel if you had a successful VBAC? It's all hypothetical but if you give it plenty of thought, I wouldn't be surprised if you end up with quite a clear idea about what you want as you get further along in your pregnancy.

It's true that there is a lack of data about the success rate for VBA2Cs due to the low numbers of women who have one. But that's not to say it is high risk; if they knew it to be high risk they would advise against it. I would imagine that they will monitor you pretty closely during labour if you do give it a try and it would be worth asking your consultant what the likely conditions would be if you do try for a vaginal delivery. For example, in my case my doctor said she wanted me to have an epidural in place in case they had to do an EMCS, and that if my labour stalled, they wouldn't wait too long before making the call for a C-section. She was willing to induce me if I went beyond 41 weeks, which not all doctors will do for a VBAC. In the end I had a more or less spontaneous (after a sweep) labour and was able to use the bathtub with intermittent monitoring during early labour. Then I got a fairly lightly dosed epidural when things really started to ramp up, had a nap on the bed for an hour, and my daughter was born an hour after that. It was a really positive experience.

I had an emergency c-section with my first and was surprised they wanted me to have VBAC with my second 2.5 years later. I went for the VBAC though, as they said they'd intervene much quicker because of previous section. As it turned out it went smoothly and I went on to have my third via VBAC.

@EilishHM96 what did you choose ? :)

I am in a similar situation. Am 30 weeks pregnant. Had 2 previous 'emergency' c-sections. Last one 11 years ago. But would like to try for a VBA2C this time if possible. This pregnancy is slightly more complicated as I have type 1 diabetes (diagnosed 2 years after my last child was born). So the advice is to deliver around 38 weeks, which would also mean I'd need an induction. I'm having lots of extra scans and am going to make my decision nearer the time. Both my daughters were big (10lb 8 and 9lb 15) so if this one is likely to be large I'll probably go for an ELCS. I'm reading a book on VBACs by Hazel Keedle. I think the thing is, you need to feel that you are in control and making the right decision for you and your baby. Historically, professionals always advised after 2 c-sections that you should not be allowed to try a vaginal birth, but that is not always the case now and not always the safest method. Also depends on whether you want more children after this one. With a VBAC the risk of rupture increases but it is still relatively low, increases again with an induction. But if you want future pregnancies the risk of placenta previa and accreta also increases if you have another C-section. Just don't feel you have to go along with what the hospital are telling you, do your research and make your decision 🙂

So interesting how each hospitals policies differ I am pregnant after 2 emc and they said absolutely no form of induction could be use would have to be spontaneous labour

A bit late but I've just had a successful VBA2C and would recommend as long as labour progresses naturally and with no issues! My hospital wasn't for it but they were open to me trying and can't force your decision, only advise, and since my waters broke, I had 24 hours to let the labour progress before I was having another CSection anyway. I was closely monitored and made them aware of any scar pain or if things didn't feel right while you're in active labour, thankfully all was okay and it turned out to be fast and straightforward! I also had the births close together (15 months between my sections and 19 months between section and VBA2C) but a VBAC isn't suggested if it's been less than a year since your last caesarean!

Hope this helps anyone considering it x