VBAC or another C-section?

[evuscha]

I’m going to start by saying I’m currently in the US and so a system is a bit different here, more medical and I have a dedicated gynecologist for my pregnancy and birth, not a midwife.

My last pregnancy, 4 years ago, ended in an emergency C-section because DD was face up and wouldn’t come out during the pushing part. Otherwise no other issues in that pregnancy or this one. My scar isn’t vertical/T, pregnancy is low risk, on paper I should be an ideal VBAC candidate.

I would love to hear your experience, is UK generally pro VBAC or is it often a scheduled C-section there too? Was your VBAC successful? My Dr, while claiming he’s objective, is pushing me towards the elective C-section, citing “increased uterine rupture risk” in general as a reason. (not due to any issues I specifically have) I’m getting a bit of a feeling it’s just more convenient for him, shorter, easier to plan, less risk of a lawsuit (big thing in the US), and more profitable for the hospital.(also a big thing in the US; with NHS I would assume it’s the exact opposite with emphasis on cost savings) I appreciate I might be paranoid so would love to hear what is the recommendation in other places.

I don’t think the lawsuit angle is a thing here, as far as I know. It costs the NHS to carry out a c sec so they usually try me persuade you to have a vaginal birth. I wouldn’t say a c sec is more ‘convenient’ at all. Both deliveries come with different risks. I had to go through two consultants before being accepted for an elective c section. (Breech and I was 40).

I would guess as you required an emergency c sec last time (and I think most people would opt for another c sec) that your consultant may just feel it’s the safest option?

Have you asked for a vaginal? I would think unless there are major risks that you can opt for your preferred method…. It’s been awhile so I may be completely wrong!

Thank you for your comment! I think there are major differences between the UK and US healthcare and therefore the reasons for VBAC vs elective C section are possibly not very objective in either. By the “convenience” I meant convenience for the doctor - he shows up at a set time to perform what, an hour of (for him) a routine surgery, vs. hours and hours of labour with an unpredictable outcome.

He did tell me ultimately it’s up to me to choose and my chances are 50:50 (I never had a successful vaginal birth but I never had issues apart from baby’s position either) however I will be required to sign paperwork assuming all the risks of VBAC, and he’s fully expecting me to choose a C section.

Which I absolutely would if there were some actual objective reasons, baby breech, baby too big, any other issues from my side putting me at risk - by all means whatever is safest. But at this point there isn’t any objective reason and yet I’m being steered towards a C section.

Personally I would worry the consultant didn’t feel competent enough to do a vaginal?

I don’t know. I had some risks, everyone I saw from nurses to sonographer told me to get the c sec!

If you want a vbac OP have one, do you have faith in that doctor though?

Hope someone pops along soon - DD is 7 so things have changed.

Uterine rupture - and hands up I just googled, holds a risk to both the baby and to you. The risks seem small for both of you.

I would want a second opinion- that’s my advice. (I was quite happy to fly through an amazing c sec- on a specific date, nice and controlled.) I would lose faith if I felt I was being pushed.

Hi there, I'm in the UK. I had a planned c-section which ended up being an emergency one as my daughter came early and was presenting feet first. After this I was very much encouraged to go for VBAC . It went fine for me. It was a number of years ago. I was aged 33 with my first C - sec and 37 with my son VBAC. I had an epidural for VBAC delivery and once that was in there wasn't any pain whatsoever. Although I know this is often not the case. Perhaps you should seek a second medical opinion to help you decide. I must admit I would have been happy with another C - section the second time as my first one went so well.

I had an emergency section with DD1. When I was expecting DD2, I tried for a VBAC. The situation was complicated because DD2 had poor growth so I needed to be induced. However, after discussion with the consultant, I was happy to still try for a VBAC, though I knew it was likely (about 50-50, the consultant reckoned) I'd end up with another section, which I did in the end.

About uterine rupture, it obviously does exist as a risk. However, from what was said to me, in normal circumstances, it's not a particularly high risk. It did affect how they managed the induction, but I was still allowed to go on the hormone (synthetic oxytocin I think?) drip - I just couldn't go up to as high a level as someone who'd not had a section. And I had just under 21 months between births, not four years. (I was told not to get pregnant for a year and wanted a smallish gap, so we started trying as soon as DD1 turned 1 - rather to our surprise I was pregnant pretty much straight away.)

Welllll...

I had a natural birth 4 years ago & my daughter was very poorly.. I personally believe this is because I was in labour for 72 hours. So a month ago I had an elective section with my 2nd.

All I thought, had gone ok, but I had the most uncomfortable feeling in my stomach, like the biggest ball of gas you can think of. I was so distracted by it.

A few days later I was back in hospital as DS was poorly & in NNU. The pain came back & was awful. I had a CT scan, then was told they needed to reopen me up, then & there as an emergency as my internal stitches had partially come undone & my bowel had herniated through these stitches. So off I went to theatre.

Not trying to scare you, but tbh if I had another child (I will not!) I would go for a natural birth & I never thought I'd say that. I was extremely unlucky (surgeon said he had never seen anything like it before) but just sticking in my opinion for what it's worth x but as a PP said they both come with risks x

I had an emergency c section and then a VBAC. I loved my VBAC. I didn't rip or tear and her coming out was actually magical. I would recommend trying it to anyone who wants one.

Statistically speaking (in the UK at least) there isn't much of an increased risk with a VBAC after a section.

I should also say that my first section was complicated as my placenta was attached to my womb wall so I lost an awful lot of blood when I was on the table. It was generally pretty awful. But I'm so pleased I went for the VBaC. The early labour was just as long but once I had the epidural on board it was plain sailing.

I appreciate everyone’s responses so far, I of course agree that with any complication with me or baby the C section would be absolutely fine and I would happily go with that if necessary. I didn’t love my recovery after C-section but so be it. I just don’t want to be pushed towards it for non-medical, unnecessary reasons - and that’s exactly the feeling I’m having from it now especially since it really does sound like the VBAC is perfectly acceptable in the UK under normal circumstances. I also want to add that US maternity care generally seems more pro-intervention than the UK one, midwife is seen as more of a “hippie” choice over here and home births are not common at all, so I am not surprised by the preference for repeat C-section; in fact some hospitals here flat out refuse to do VBAC (not mine though).

I had an emergency c section 2 years ago, currently 30 weeks pregnant and trying to decide whether to go with Vbac or planned section. I’m consultant led, but still have regular midwife appointments. They’re both very much, completely up to you and we will support you no matter which one you decide. I’ve said I’m not being induced due to failed induction last time. I have a friend due similar time to me, who’s been told they’re pushing for Vbacs due to cost, but I haven’t heard that from my midwife.
What I’m finding, which really does not make the decision any easier, is that everyone’s experiences are so different, you can do all the research and talk to many women, but your experience is likely to be so unique, it makes the decision so hard. I’ve kind of said, if babies not out by 40 weeks I’ll go for an elective, but we’ll see.

Thank you for sharing, that’s great that they’re giving you a choice and yes, it is very much up to each person. Even if my Dr was extremely supportive of VBAC, he might not be there on the day so it won’t make much of a difference.
I would ideally like to figure out a scenario where it’s safe to have a VBAC vs when I should opt for a C section on the day (e.g. baby breech, baby too big, being induced, slow progression or really any issue) and decide on the day ideally! It’s kind of impossible to know now (and for my Dr it’s definitely a thing of convenience to schedule me for a planned C section)

I heard that gas and air isn’t freely available in the US. So worth considering your pain relief options if there’s not time for an epidural (or you don’t want one).

OP I had an elective CS for my first breech baby, then three years later I was talked into a VBAC by my consultant. This ended in uterine rupture with me in intensive care for 3 days and my son on a neonatal ward in a different hospital for two weeks as he was born asphyxiated. If you go for a VBAC have a plan as to when you will go for a section of the birth does not progress.

Hi Op :)

You mention that last time you got to the pushing stage with your first? I take it to mean that you fully dialated? From what i’ve been told, that increases your chance of a successful vbac.

If for example, like me, your reason for emergency c section was that you failed to progress/dialate, this lowers the chance of a successful vbac. This is why i’m opting for an elective section this time. Also because I had horrific care and I don’t trust the staff to help me through a vbac and I don’t want to risk the need for another emergency section.

I believe the risk of uterine rupture increases if you are induced, so if you go overdue, you may end up with another section anyway.

Blimey. Really sorry you had to go through that 💐

Yikes, that is horrible, I’m glad you’re ok. And yes that’s what I would ideally like to do - attempting a VBAC if all is good but defining a set of criteria where I would go to a C section (failure to progress etc). I will be birthing in a hospital so the emergency C section would be readily available.

Yes, I was fully dilated and pushing for 2 hours but as DD was face up, she would partially come out then slide back in as she wouldn’t pass with her nose through my pelvis. It’s too bad I can’t know if it’s also to do with the shape of my pelvis or if in a normal position it would be fine. Either way, the hospitals here in the US don’t like to take risks so I didn’t continue pushing and just went for an emergency C section. That also means I’m in the “never had a successful vaginal delivery” category so really my chances are 50:50 I suppose.

Ideally I would like to be able to decide closer to date and of course if any risk increases (baby too big, induction, baby breech…) then C section it is. But my provider wants me to just pick a date now which annoys me a little bit 🙄

That is true. Last time I did get an epidural and I would aim to get there early and get one again (we’re 10 minutes away from the hospital). Definitely not feeling brave to go unmedicated!

I went for a vbac with a 15 m gap and had another EMC and on the brink of rupture BUT you have a 4 year gap in your shoes I would 100% attempt a vbac

I bumped another thread which includes my v positive story. Best of luck!

I saw it, and so happy for you - thank you for sharing!

Could you get a second opinion of another doctor in the same hospital? Also, other things for you to consider, is costs, what does your insurer want you to do, if you try for a VBAC and you end up in a EMC would that cost them more money etc. (I have very limited knowledge of the US health system, but from what I already know and what you've said on here, I'm so glad we have our system) We are so lucky in the UK we don't have to think about these things and the NHS is not commercially minded.
How many weeks are now? What ever outcome you decide, please don't worry about the fact you've never had a vaginal delivery, recovery from C-sections are a lot harder, so a c section is definitely not an easy way out.

@evuscha My first was back to back / face up and I narrowly managed to avoid a c section, he arrived naturally after several hours of pushing! Annoyingly my second was in the same position and after four hours of pushing I was taken to theatre where they decided it was too risky to do forceps so I had a c section. Obviously this may not be the case for you and I really hope it’s not! But I think I’d just have a plan in place as to what point during labour you would have a c section if things weren’t going to plan. Good luck!

I think if I were to have a third, as much as I’d be really tempted to go for a vbac, I’d have an ELCS as it’s just more certain. But that’s me as an individual.

@Springbaby2023 yeah I would definitely be flexible. I’m still going back and forth tbh. A part of me is thinking - since I have heard of many “face up” babies coming out anyway, and my fairly small one wouldn’t after 2+ hours of trying - if maybe my pelvis is a bit narrow and I might end up with interventions (or at the very least bad tears) anyway. In that case ELCS might just be easier…and I did hear good things about the planned ones (vs. emergency).

Hi OP. I had a private obstetrician in the UK so a different care pathway to most here.

My first ended in an EMCS. I ended up being induced via drip after my waters broke and labour failed to start. I got to pushing stage, followed by attempted ventouse and forceps before the c section. Not fun. Baby was big, I’m quite narrow and they were not quite in the right position.

With my second, my doctor (same one) said they would absolutely not induce me having had a previous c section and based on my first experience gave me a 30% chance of a successful VBAC. I opted for a planned c section but on the understanding that if labour started naturally I would have the option to attempt the VBAC. The section was booked in for 39+2 and that was what I ended up with.

Recovery from both was absolutely fine.