32 weeks and confused about vbac or elective...when do I have to decide???

[suMadre]

Im 32 wks on my 2nd child, ds1 has just turned 2. Was in labor for 4 days but kept in the foetal assessment due to high blood pressure & uterus being 2cm for 3 days...finally made it to 3cm and went to labor ward, had all pain relief and drip to speed up contractions. They tried breaking my waters but the waters were gone (as Id told them but hadnt listened theyd been leaking for weeks)and I was also leaking meconium for a few days. Eventually had emergency cs as my cervix would not move past 3cm.

Up until this week my 2nd baby has been transverse so although I was hoping for a natural birth (and to stay away frm the hosp as long as possible into the labor)I sort of resigned myself to having to have an elective. Thankfully the baby has now moved head down in time for my consultant appointment...but I was surprised that the consultant going through my notes is urging me for a c-section (based on my ds1's size 8'14 ...I am 5'4 and was only 8stone before conceiving him..and on my failure to progress despite the contractions being strong for so long)

Consultant is now sending me for scan at 33+5 to get an idea of the size of this baby. My uterus measures 34cm eventho only 32wks however I barely have a bump this time and definitely dont feel like this is another big baby. So...I suppose the scan will give me a better idea as to size of baby (dont understand why they never did growth scan on ds1 when he was always ahead of dates and uterus always measuring ahead &looked like I was gona pop with twins at 30wks)but will I have to mnake up my mind the following day when I see consultant or will they offer another scan later on!?

Now that babys head is down and I am carrying this baby so much easier than the last one (Possibly the weight Inever shed frm ds1)and so active with ds1...I feel like Id just be giving up to go for an elective... but if I deicide to try for a vbac that could be another horrific nightmare like my 1st birth. Does anyone have any advice or experience of this?If I try for vbac will they induce me early?Will I be monitored? Will I be left at the mercy of the midwives who wouldnt listen to me at all last time despite me being high risk due to health problems(ironically I dont have them anymore but am high risk due to cs)?Will I be left for almost 4 days again? If something goes wrong will I be stuck in the same position waiting for a surgeon to come & might not be as lucky this time!?!Last time I was had blood transfusions and ds1 had infection due to swallowing meconium.

I desperately want a vbac for the following reasons : do not want to be on the post natal ward again (as it was horrific last time and treatment ds and I received was disgraceful and dangerous)nor away from ds1 for long, last time it took 10 days for my milk to kick in (had to switch baby from bottles but managed in the end)...and I wont be able to pick up ds1 for sometime... but these things will be made doubly worse if I go through another long labor with an emergency C...and I might end up in there for over a week again.

Does anyone have an experience of an elective?My sister had one at 37wks due to breech baby and although it wasnt a walk in the park...it seemed a lot less terrifying than emergency C. I presumed I would be urged to try for a natural birth and am a little panicked now that I have to make the decision...dh wants me to opt for elective as both ds1 and I suffered a lot last time...but Im still clinging to the hope that things will be different this time. How do I know if ds1 being so big was the problem...or if its cervical dystocia?

HELP!

meant to say WITHOUT birthing partners...my mum and dh were only allowed in at visiting hours

Hi sumadre,

I don't want to influence you too much with my experience - but I am seriously considering a vaginal birth after two caesareans. My second was not easier than the first - the scar would not heal, i couldn't pick my first DD up, and i felt awful. I have always regretted not trying a VBAC after the first caesarean. This time I'm really considering all my options.

Having said that i did not have as many complications as you before i had my emergency c section and i don't have the big baby problem!! mine was a simple failure to progress.

Thanks SuMadre for posting this question...i am only 6 weeks pregnant and already dreading having to make this decision.

My story is like many here - I was induced but did not progress at all and ended up with a traumatic section and horrendous hospital stay....

i am off to the docs tomorrow to tell them i am pregnant and ask for some counselling to help me get over the trauma of last time...don't want to be a nervous wreck for the whole 9 months!

I'd love to know how you get on SuMadre - so please post again when DC arives!

Also - has anyone read any inspiring books on VBACs?

Hi lucyfer no Im glad u wrote - I want people to influence me lol ... the more experiences ppl share the better as I need to get a fuller picture and consider all the possibilities. My ds1 just turned 2 a couple of weeks ago and I still pick him up now,not being able to pick him up after cs is one of the biggest worries for me as I will still be able to do everything for the baby but not him. It must have been really hard for you but dont regret,its not really much of a choice is it? I hope u finally get ur natural birth!

Annie I know how u feel I honestly dont know how I didnt have post traumatic stress,people really underestimate the affect such a horrific experience can have on you..and its hard to talk about it to people because they cant possibly understand or u feel they think ur exaggerating or playing the victim. I think counselling is a really good idea and hope it goes well for you,ul probably be so busy with 1st dc you wont have that much time to stress. When was your cs? Ive done what I do best - not thought about it until I have to - just blocked it out really - I was almost relieved to have the decision taken out of my hands with a transverse baby...but then he turned the same day I seen the consultant and I was given the choice...which is forcing me to think about it. Its sad that knowing Im not in safe hands if I opt for a vbac is swaying me towards an elective...eventhough I promised myself straight after ds1 that Id go for a vbac next time... I guess I didnt realistically think of the complications even 1 cs brings.

If only home birth after ceserean was safe!?!

hi again! had an appointment with ob today and the upshot is that i will see her again at 40 weeks to book in c section for 42 (depending on bp which is being checked weekly). should i go into labour she was saying i will be monitored but there is a degree of mobility - and that if i am having 1 contraction every 10 mins that is when i should go in.
the other thing of interest was that if i do have a section she was saying we could do skin to skin and lower the screen and breast feed in theatre - situation permitting of course.
maybe that's something your hospital could do too?
who knows what will happen though!
going to start necking the raspberry leaf this week for sure.

My DS is just coming up to 2 now and like you, after his birth i swore I wanted a VBAC next time...in fact I think I said i would rather be locked in a room on my own than go back to a hospital where they interfere with you so much you end up with a c-section and then they neglect you for three days on the ward!

However - now the reality is facing me I am scared I'll go down the VBAC route and end up with a csection anyway....or I'll be so scared that my scar is going to rupture that I won't dare to push....I know this is stupid of me but it is at the back of my mind.

Hopefully some sort of counselling will help as I think I need to be able to talk about the last birth without crying before I can have a positive attitude to this one!

Hi Becktay! Things sounding really positive for you!Not long left now...either way ul have ur lovly dc soon,pls God. Do u knw if its a boy r girl yet? Last time they let me feed in recovery room (well actually they let dh who was scared to even hold the baby lol give him to me) but nothing happened. Hopefuly this time my milk will come in quicker Im well used to feeding and pumping after ds1. Are u sure about the raspberry leaf tho? Last time I was taking them and afterwards it occured to me could they just make the uterine contractions stronger as opposed to helping with labor!?!Im only asking as my contractions were SOOO strong which made the slow labor harder.

Annie
"i would rather be locked in a room on my own than go back to a hospital where they interfere with you so much you end up with a c-section and then they neglect you for three days on the ward! "
My sentiments exactly! I believe I said I rather have my baby in a bush! LOL

The only hope we can cling to is does lightening really strike twice? Can we really be that unlucky again? I was freaked last night as had braxton hicks for the 1st time in this pregnancy and I started panicking thinking am I mad how could I possibly go through labor with the fear of something going wrong? Despite wanting to do it naturally and away from the hospital...my first instinct is to go and check everythings ok...and thats probably what I'll do. Was reading leaflet (the link is on here) and the statistics for scar rupture are REALLY low especially if you have the bikini line scar they do nowadays,so thats really reassuring.

Hi there

went to the gp today who has requested my notes from last time and is getting someone to talk through them with me.

She also told me her own experience and how after an emergency section she elected for her next two children.

i was quite shocked at how honest she was about why...she said she worked as an obstetrician and had witness scar ruptures....

having said that - I reckon for every obstetrician who would say that - you would find another who would recommend VBAC!

Best wishes - what ever you decide SuMadre - let me know how you get on! x

I feel compelled to give a positive VBAC story after reading about all your worries:

I can honestly say that DS3's VBAC delivery at 41+5 was the best birth experience I had, I would go for VBAC again (given half the chance..)

My consultant literally asked me: "How would you like to deliver this baby?" once I had a scan at 20 weeks to rule out placenta preavia which I had with DS2 (emergencyCS, NOT crashCS at 31 weeks).
I did not read any books however found the website I linked to above v helpful (Radical Midwives). It also helped me to look at the risks quoted (sorry, cannot remember the numbers and cannot be bothered to look them up again )from a statistical point of view: if the risk of scar rupture is 1:3000 then the chance of it NOT happening is 2999:3000 which is just HUGE. If a horse had a 1 in 3000 chance of winning, nobody in their right mind would bet on it.
Also, obviously all the reasons already quoted for vag delivery appealed to me. I had not been v successful with BFing the first 2 and was hell bent on doing it with this baby (still going at 1 year ).

Anywhooooo, I had first pain at 5am, in hospital 7.30, was 8cm dilated and delivered him @ 11.30. The position of his head was not ideal and took a little while to turn. I am WELL aware that I was v lucky to have a short and entirely bearable labour. There was no time for an epidural and it was fine. I did have huge sense of achievement afterwards, which interestingly I did not have after induced birth of DS1.

Equally I was not traumatised by my CS and count myself lucky on that count, too.

I realise that one positive experience does not mean squat in regards what it going to happen to any of you, just as one negative example cannot predict your experience. Just felt I needed to address the balance... (BTW, am also GP with very little some obstetric experience).

At the end of day, get all the information you can, and then decide on what you are most comfortable/least uncomfortable with.

V best of wishes to all you posters on this thread!!!

mummyfor3 thats great u had such a succesful vbac and bearable labor. From the succesful vbac stories Ive heard it seems the chances are better if youve (1) already had a vaginal birth previous to cs or (2)if u had a cs due to reasons other than failure to progress...as in people who have had cs whilst not in labor due to some other risk. I dont know why my consultant is worried about the size of the baby (surely that would affect me ripping or having trouble at the pushing stage) to me the worrying fact is that my cervix never opened past 3cm after such a long labor and strong contractions. I have a list of questions ready for the consultant but I know I wont get a chance to ask them as its a different consultant each time and they are very matter of fact in the examining room and then pop off again leaving u with midwife to give u back the notes... Im hoping the reason my cervix wouldnt open was bcos ds's head was posterior (which hasnt been confirmed to me) and bcos the cord was stuck around his head 3 times (something I discovered from my discharge letter)Mummy for 3 as a gp can u shed any light on this if it would have caused the prob?My bro in law is also a gp but hes made very little comment other than go with what the consultant says lol. I know its hard to answer a random question like that I just dont buy the size of ds being the problem...

Just going through my notes...consultant has written down I had "obstructed labor" Im sure this is just another term for failure to progress but I wish I hadnt googled it - all that comes up is maternal and baby deaths! As I already suspected obstructed labor is due to malpresentation of the baby's head or misproportion of the babys head to the mothers pelvis....Im thinking it was ds head being posterior but if it was the other reason then the consultant is right about me going for elective...for the first time Ive realised the "risk" in a vbac for me isnt having another nightmare birth ending in an emergency cs - but perhaps the baby not making it this time.

Has anyone heard a successful vbac story of someone after having failure to progress on 1st cs?(and not having given birth naturally prior to that)?thanks

on the other hand...

Critics of doctor-ordered Caesareans worry that Caesareans are in some cases performed because they are profitable for the hospital, because a quick caesarean is more convenient for an obstetrician than a lengthy vaginal birth, or because it is easier to perform surgery at a scheduled time than to respond to nature's schedule and deliver a baby at an hour that is not predetermined. [33] Another contributing factor for doctor-ordered procedures may be fear of medical malpractice lawsuits. Italian gynaecologyst Enrico Zupi, whose clinic in Rome Mater Dai was under media attention for carrying a record of caesarian sections (90% over total birth), explained: ?We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest her to [get a c-section]?

can you book another appointment with another consultant to get a second opinion?

I'm 24 wks and have already decided to go for VBAC. But, need to have another scan first to check baby's position.

If it's back to back I'm going to ask for elective. I was failure to progress. not sure what obstructed means. It's never easy when you haven't got a clue what could happen.

Have just bought a CD: Natal HYpnotherapy for VBAC. Hope it's going to help me relax!

Have heard of successful VBAC after failure to progress on here. but, have also read about women who had another c-sec.

Whatever happens, we just want our babies to be safe really and the best for us too!

thanks wowoo was ur cs your first birth? I think youve got the right idea - thats what I was thinking vbac unless baby in wrong position. A scan should show if babys head is posterior or not!?!On ds1 he was engaged from 32/33 weeks but then the mw's said different things that he was/wasnt engaged and he was/wasnt posterior...basically they didnt know but I feel he was posterior,Im hoping the consultant on tues can tell me for sure!(its actually a different consultant so Im hopeful he will be nicer/listen to me more)

yes, my first. Good you'll be talking to another consultant.

My consultant seemed neither pro CS or VBAC, but did talk about the risks of another CS and risks of rupture in VBAC. Both options a bit scary thanks!

Long labour and was finally in so much pain and knackered that CS was welcome.

think they can change position at end though. So, i'm thinking even though scan may say optimal position at 34 wks baby may turn like he did last time, the cheeky monkey!

Will be on all fours again in a month or two...

Good luck! I hope everything goes well for u and baby..like u said the birth itself isnt important...its the outcome. I think maybe I should stop reading so much as it wont affect the outcome,its pretty much out of our hands. My original plan was not to "study" this time and just try a for vbac...like u said all options are scary x

hi just thought id update everybody had my scan today and baby is fine for dates (33&5)She said hes good size(mentioned around 4lb something but didnt write it in my notes)and theres lots of fluid which is good. Asked how big ds1 was and when I said 8'14 she said she doesnt think that was the problem as its not THAT big anyway Am seeing consultant tommorrow so hopefully hell be supportive about me trying for vbac. Babys head is down...feels engaged but we'll see tomoro after check up!

Great - suMadre - hope the consultant is supportive tomorrow - keep us informed!

thanks...well today was a total waste of time...an hour and a half waiting to see consultant only to be fobbed off my registrar..the consultant I was supposed to see wasnt on....didnt check babys position or anything...and didnt read my notes...just asked me what happened last time and what I wanted this time...chatted to me and said "babys okay for size so yeah why not try a vbac,but we wont let u go to long in labor,realistically speaking u might need another section" then told me he was happy with that but hes not my consultant and neither is the consultant I was to see...so come back in 2 weeks to see what my consultant says..bloody typical!So none the wiser...will have to wait until 36 weeks to see what consultant decides...

seen midwife today and she said baby is "Oblique" so still not really head down...

suMadre - trying for a vbac means you have a chance of ending up with another emergency cs. After one horrific experience of emergency cs I went for elective cs for my second for this reason. Elective CS is so different to emergency and you can do a bit of research and ask for the best people to do the operation (it's worth a try, it worked for me). I also don't trust midwives to actally notice if there is a scar rupture so for me I didn't feel like I had a choice.
I'm pregnant with number 3 and going for an elective in September, I am actually looking forward to the whole thing. Except for the one night on the ward like someone else said, that's like trying to sleep in a war zone.
Good luck with whatever you decide.

thanks lazylion im so glad things worked out for u and congratulations on ur 3rd one,hope its a good experience. U have a very good point...the last thing I want is another horrific emergency cs...Im still really unsure but will wait til consultant the week after next and see how I feel then...how babys doing etc

just to revive the thread - am 37weeks in a few days and baby is still oblique...very worrying as if my waters r membranes break then will require emergency "classical" ceserean as cervix is not blocked by anything so risk of cord arm or shoulder prolapse and not possible to deliver baby unless he turns. Seeing consultant wed week at 38wks...think I will have to opt for elective if things still so uncertain...my last 2 visits to consultant I ended up seeing 2 different doctors and did not get a proper consultation...so think safest bet is probably to go for elective as Im not being monitored at all...

Hi SuMadre,
It's a real rollercoaster isn't it! I have appointment with consultant tomorrow and we will book in elective. Blood pressure has had the odd wobble so I'll listen to her advice but am still hoping to spontaneously labour before section. Have to say acupuncture has massively helped my state of mind and highly recommend it. Is meant to be good for position of baby too I think... Why aren't your hospital monitoring you? Is there a consultant that you've seen that you've liked and trusted? If so can you get a bit bolshy and demand ask to see them? Whatever happens I think as long as you are confident in your decision that is the best thing. Good luck x

Hi everyone, just wanted to say good luck to you all in whatever you decide to do. I went for a vbac at home in November and had a great birth (although wouldn't have been the word I used in the middle of it ) My first emergency cs for for failure to progress after a long induced labour for post-maturity. Apparently 30-50% of people who are induced for being late end up with a cs!! So I personally don't think that failure to progress is that theew is something up with you, more like baby not ready, feeling anxious, bad position (which can be altered sometimes with good care) or something like that. Anyway, if anyone is local to us in Coventry we are running a 'birth choices after caesarean' support group to help mums going through these hard decisions- if anyone's interested send me an email [email protected]
I really hope you have positive experiences this time, whatever mode of delivery you choose Rachel xxx