VBAC after two c-sections - anyone? I need some advice, please.

[pinkyminky]

Having been told, I now discover erroneously that I would be unlikely to have a safe vaginal delivery, my new consultant thinks I have a good chance of having one and I think trust him. I have plenty of time to decide, but I would love if anyone has experience of this could give me some info/advice.

There is a nice birth story here

Thanks so much. All the online things I've found so far have just said the usual 2 sections inevitably means a third, and a friend and I discussing it today were of the opinion that it prolly isn't that much more risky than after one- and this link seems to agree.

There's a really good book on Amazon called Vaginal Birth After Caesarian which covers this area (I'm having a VBAC myself so I just read it). Basically the risks of repeated CS are still higher than the risks of VBAC unless you have a compelling medical reason to deliver the baby surgically.

You also massively increase the risk that you will die or need a hysterectomy with a third cs. If you have to, you have to, if you don't, it might be worth investigating a bit further the reasons you needed them last time to see whether the problems will recur?

This is part of my problem. My original reasons for the other two sections have been cast into considerable doubt. I won't know the full picture until I get more info from the hospital where I had my first emcs, if they have any.

Good luck with your VBAC, by the way!

Thanks. What do they say are the reasons for them, if they are:

-failure to progress
-too small pelvis

• meconium in waters not followed by 10/10 (top apgar scores)

usually you will not find it recurs.

Large bleeds can recur, and although placental abruption/previa can be recurrent it still remains about 1% chance.

Your risks of uterine rupture are still very low - a maximum of about 2.5% if you have a classical scar (vertical) chances are you are in the much lower risk than if you have a horizontal cut (also if the scar was tidied during your last CS again the risk is reduced because they have improved the stitching techniques to add extra layers so like a darned sock, it doesn't tend to tear in that area (though the areas around it may suffer). The other thing to note is that uterine rupture is rarely entire (although obv it is deadly if it happens and you can't have immediate surgery) and quite often uterine ruptures are 'silent' (ie there is a leak of fluid from the scar with no side effects - it can happen at any time too, not just in labour so the arguments for monitoring sound fairly flakey in some ways.

There is no evidence btw that continuous fetal monitoring improves outcomes in VBACs and you have every right to turn in down in favour of 15 minute doppler checks (makes sure you have a midwife with you continually too rather than relying on a machine which relies on a belt which falls off every five minutes and scares the crap out of you!).

Ask either to see your hospital's birth afterthoughts service to go through your records, or when you see the consultant, call up beforehand and ask the secretaries to dig out your records (otherwise you'll have to go back once they have found them).

Oh also I should say if you have had inductions which have failed (this happened to me) it simply means the induction failed, not that you can't give birth vaginally. Blame the drugs not the mum!

I find it a bit embarrassing I don't know why, I have an unusually shaped womb which caused my DS to get sort of wedged stuck and very tangled up. But I ave since come to the conclusion that this could have been avoided if
a)the first mw I saw had not broken my waters for no reason and without asking if it was what I wanted,and

b) being made to sit on a bed the whole time so I could be monitored with that stupid belt thing you speak of, and told off for moving!

essentially, I should have been more mobile to help with positioning, and it all wasn't helped by the fact that they frightened me so much about DS heart rate that my labour eventually effectively stopped.

I was given a planned section with very little discussion the second time, and I was so ill with HG at the end of that pg that I was not in a state to argue. I did find the second planned section very calm and I liked the different hospital, so it wasn't all bad.

I like the sound of the doppler monitoring. Last time, the machine was pretty much all that was checked- I felt I was kind of ignored much of the time.
Having read the info you linked, so far the consultant I have seen seems to be saying the right things, but I want to go back at 36 weeks with as much info and preparation as I can.

I don't see quite how having an unusually shaped womb can stop normal delivery - wombs are quite malleable (they have to be) but yes rupturing the membranes is a bloody stupid idea in that case.

Very few women can give birth in the lithonomy position and it doesn't make any sense to try. You might want to get Ina May's guide to childbirth to get some ideas on different positions and experiences. Definitely turn down CFM it's a bloody waste of time and as you say you end up feeling like your job is to watch the machine go bing rather than to get into the right position and let the baby come out.

If I were you I would arrange your birth prior to 32 weeks as much as you can - the last month or so you are so knackered the fight is gone out of you. But you sound very much like you have your head screwed on and know what you want and don't want. Now is the time to do the research and just go in and repeatedly state it until they understand you know the risks and that you are going to do this anyway.

BTW your physiology is totally random and nothing to be embarrassed about. We all have vaguely unusual things going on that you only get to know about when you are pregnant - I think it's nature's way of preparing you for the lack of dignity of a baby shooting out of your fanjo while you curse creatively!

You are so kind, thank you!
I think that because my womb is very heart shaped, DS was just unlucky and and got wedged when I contracted, my consultant says it was purely to to with how my body and that particular baby interacted with each other and the chances of it happening again are highly unlikely. My failure to progress beyond a few centimetres was I am certain to do with my treatment on the labour ward, as I was doing really well on all fours at home!
I feel quite well with this pregnancy so think I will be able to plan effectively.
On a plus side, I was very happy with how my second elcs went, even if I didn't need it, so I am not worried if my TOL doesn't result in a VBAC, which by all accounts is a good thing.

Hmm well up your chances by staying at home as long as possible and avoiding anything which limits your mobility. Remember 70% of people who go for a VBAC succeed, even more when they don't go to hospital until 6cm dilated (up to 90%). A heart shaped uterus sounds sort of romantic actually In theory at least!

You are lucky to have the choice. My local hospital told me they refuse to allow VBAC after 2 x cs, so if I have another I would have to have a 3rd cs.

Good luck.

sideways - they can't refuse to allow you a VBAC for the simple fact that you cannot be forced to have a cesarean against your will! They can tell you they advise against it, but they can't STOP you having a VBA2C!!

There's increasing evidence that the risk of uterine rupture (which is the major concern with VBACs) is about the same if you've had 2+ CS compared with a single CS and more and more women are choosing to have a VBA2C.

change hospital sideways

no-one can make you have a c.s

you take on board the risks and benefits and make your own decision. an informed one, rather than being pushed into something

www.aims.org.uk is great for support when you are being told you are 'not allowed' to give birth the way you want to

Heart shape sounds romantic but doesn't look very pretty! Though I doubt normal shaped ones do either.
I only went in to hosptial for them to check- I was 3-4cm, and about to go home when 1 mw had her bright idea, to 'bring things on a bit' I would have been quite happy with a bathq and a sleep.

Riven- well done you! Did you have independent mw etc. or was it a normal communtiy mw?

Sidways I would definitely change hospitals. I don't want to ever step foot in the one I had DS in again. They were very 'you have to do this, that or the other. I have also learned through a number of unrelated hospital situation recently that you have to be quite assertive sometimes to make your wishes heard.

Did you do anything particular to help you hold your nerve,or are you just naturally that confident/ emotionally strong?

pinky, I've done lots of research about it already, i can e-mail you some stuff if you like. We can hold each other's hand through this whole thing too. There is an imminent VBACers thread as well which has lots of useful links. I'm in for my scan on Monday and have written VBAC all over my notes so I should get the chance to speak to someone about it (my less than enthusiastic mw wrote "would like a trial of labour" in such tiny illegible writing that I doubt anyone at the hospital would have noticed it. I'm sure she thinks if it isn't mentioned loudly then no-one will talk to me and I'll have forgetten all about it in another 25 weeks!)

anyway, e-mail me at daisybump at yahoo dot co dot uk if you need any information

I got the book WMMC mentioned the other day and have read it from cover to cover already. I also got an american book with VBAC stories in. A bit different to our healthcare system , but there are some useful statistics in that as well. I'm thinking of getting the Ina May book too. My husband thinks I'm a possessed demon about it, but is supporting me all the way, including agreeing to us hiring a doula.

Avoiding induction and CFM seems to be the key to a successful VBAC as far as I can see.

I'm sure I read something about a heart shaped (bi-cornate?) uterus in Lesley Regan's book (or might be miriam stoppard). Can't remember the ins and outs of it though.