Is a VABC expected after a C-section?

[UpInArms]

I had a 10 hour labour with dd, I was 10cms dilated and pushed for 2 hrs before being rushed to theatre and having an ecs.

DD got stuck on my pelvic bone and the surgeon told me that I would be fine to give birth naturally next time.

I have desire to have a VABC and risk a repeat of dds horrendous birth so can I just say straight away I want a another CS or will there be a fuss as I will be expected to have a VABC?

I reckon it depends on the consultant you get.

I was offered a CS, having had an emcs in exactly your circumstances. However I concluded the other way - that my DD's awful birth was caused by me being insufficiently mobile (after staying on the bed at the insistance of the midwife) and for me the risks of a repeat CS are worrying, so I am hell bent on avoiding one.

Many consultants (certainly everyone I spoken to after DD's birth) are very sympathetic to women wanting to plan a CS for a second birth, so you may well get what you want without much of a struggle.

Are the risks that bad MrsHappy

I think it depends on your hospital and their attitude. Where I live, one hospital practically has you booked in for a c-section at your first ante-natal appointment, and take a bit of persuasion if you want a VBAC. The other one assumes you'll have a VBAC and makes people work very hard to persuade them if they want a c-section. It's worth asking around to find out what your hospital's approach is, bearing in mind they are all under pressure to reduce c-section rates and therefore are likely to encourage you to have a VBAC if they think it's possible.

I was given the choice of another CS or a VBAC, although I think my consultant assumed I would jump at the offer of another CS (I didn't!)

He seemed quite laid back about the whole thing and said I was not to worry if I wanted to change my mind and go for a CS at a later date.

Well, for me they are because after my emcs I had damage to a fallopian tube that caused 2 ectopic pregnancies. Obviously I can't be sure they are linked, but my doctors felt the cs was the probable cause. Now I only have one tube left and so don't want to risk my remaining fertility.

There are a lot of books, articles etc out there comparing the risks of VBAC and planned CS, but one I have recently read that I felt was quite factual (although you have to be aware that it is written as an answer to people who think once you have a CS you must always have a CS) is the "VBAC Handbook" by Helen Churchill and Wendy Savage. Maybe it is worth a look?

Has anyone ever explained to you why your baby got stuck?

Had section with DS1 after long (50hr) back to back labour and assumed that I would automatically get a section with DS2 and thought that was what I wanted. Midwife, initial registrar and consultant all told me I could have another section if I wanted but consultant also told me it wasn't impossible for me to deliver naturally if I wanted.

Didn't see consultant until 34 weeks so quite late on to be changing my mind but at 36 weeks I decided on a VBAC and very glad I did as I had a great experience after my EmCS. However people say elective often much better than emergency.

Totally personal choice but don't dismiss VBAC straight away - physical healing, bonding, feeding and general happiness after DS2 all significantly better than after DS1.

If you want a section ime you will get one but I know someone who had a vbac after being told her pelvis was too small to give birth vaginally.

I had a emergency c-section then 2vbacs.

I think if you want a CS next time it is extremely unlikely that they will deny you one or force you into a VBAC. I had an emergency section with DD1, it was considered likely that the same complications would arise again so I never had an issue re getting second section, although to be honest the consultant I saw had absolutely no interest in my history at all and when I went in to see him to discuss choices he literally opened his calender and booked me in as soon as I said I wanted a section!!

However, my SIL had very similar situation to you, 10cm and pushing for a couple of hours with baby stuck, before she ended up with an emergency section. She too was told she'd be fine to give birth narturally next time and initially that's what she wanted. But as the months passed she changed her mind and decided she'd rather have another section (she knew what to expect, convenient for child care, felt she'd already messed up one part of her body and had no desire to ruin another part!) and when she said she'd changed her mind they were absolutely fine about booking her for another section. I have never heard of anyone who has had a previous section being denied another one if that's what they wanted.

I was given the choice - most doctors and all the mws I saw were v. encouraging for VBAC but I always felt my consultant thought I should take the option of VBAC (for no medical reason).

As it happened, I ended up with a semi-elective section as my waters broke and I didn't go into labour.

I think if you want a c-sec you'll be able to have one.

I have no explaination as to why dd got stuck. I was just told that these things happen but I should be fine for a VBAC next time.

ah, that does sound similar to what happened to me.

It was only afterwards when I started reading lots about birth that I became absolutely enraged about the cascade of intervention that had taken place. And recently when I told a midwife at my hospital booking appointment about how my DD got stuck her immediate response was "were you stuck on the bed for labour, then?". The cause (lying on the bed) and the effect (the cs) seem pretty obviously linked.

Anyway, as everyone has said, this decision is entirely up to you and it is all about what works best for you. When I first had DD I was pretty traumatised, felt I would never put myself through 36 hours like that again and thought I would elect for a section, but over time I became more and more convinced that my body must be capable of birthing a baby. So a VBAC has become pretty important to me. If you don't feel that way and want a section I am sure you'll be able to get one, but if you're not sure there are lots of things you can read that might help you decide which way you want to go.

MrsHappy I seem to be in the same place you were as I also cannot imagine putting myself through that again.

Up till now I have never questioned my cs, but like you I was forced to stay on the bed dispite reapeateadly telling them I wanted to get up and move around. The midwife put me on a syntocinon drip as my contractions had slowed down which pretty much tied me to the bed. I have never questioned this though, maybe if I had been able to move around a different outcome would have been possible.

I'm convinced that if I had given birth naturally at the end of it all I would have no problems going back into for a normal birth.

I think that you are right and I do need to do some research and speak to DH about the risks before making a descion.

I have to be completly honest though and say a VABC scares the life out of me. Which is silly because the thought of giving birth the first time didnt scare me.

Do some reading and see how you feel.

The more I read the more I understand how so many factors come into play with a birth. I had (naively) assumed that the midwife knew what she was doing. And she did - for achieving a medicalised birth, but not for letting my body do its thing. I was very uncomfortable with being stuck on the bed (I also asked to move a lot of times) and was badgered into letting her break my membranes. In the end I sort of disassociated myself from my body, had the epidural and pretended I wasn't there. Even so, one thing I do remember is that my contractions went off whenever I got scared or intimidated. At one point the (frankly bonkers) midwife told me she would be doing an episiotomy - I had not even started pushing so she cannot possibly have known - and my contractions slowed to coming every 20 minutes. Anyway, all of that seemed like a very unsatisfactory state of affairs and while I am loathe to repeat 36 hours of labour and then to end up with a CS, I reckon that if I can labour on my terms and only have a CS for foetal distress or because I genuinely am one of the tiny minority of women who can't deliver vaginally, then I will be happy.

It is a tough decision though, and it has taken me the last nearly 3 years to reach this point and to embrace the idea of a VBAC. It is a scary prospect but I just find it very hard to believe that my body is not capable of doing what it has been designed to do.

Are you pregnant now? And if so when are you due?

I may be pregnant >

We are trying. Which is why I have started to think about the birth, something I've tried not to do since dd was born 16 months ago.

Another problem I'm worried about, something which I dont even think I could mention to DH or close friends, is what if I manage to have a succesfull vaginal birth and then bond better with DC2? I have had no problems with blonding with dd but what if it feels different because I've given birth naturally. I know thats irrational but it feels like I would be giving one child a better start than the other.

re bonding - i have had a "bad" vaginal delivery and a "good" em CS. I felt much less traumatised after the cs and better able to feed the baby.also the LO was much shocked and fed better.i dont think that for us the birth experinces have made any difference to long term attachment

MrsHappy, your story sounds alarmingly like mine!

Everyone here has assumed I'd be having another c/s, but like you I've been reading (search this topic for all the vbac threads) and concluded it's worth a try. I'm a wee bit scared of it going wrong - what if I do move around this time and the baby gets further down (ds was parked under my ribs ) but then gets stuck??

But I've concluded that the overall benefits are worth that risk - provided I find a halfway sensible MW when I get in there. (Worst thing about the public system IMO, you don't know what you'll get on the day.)

UpInArms only you can know what you want, after you've done a fair bit of reading. It can also help to talk through your 1st time experience with another MW or doula.

I worry about that too Upinarms, but I figure that if I am not drugged up and recovering from surgery I will be in a better state to look after my DD too, and so everyone will be better off.

It was when I started ttc this time that I had to think about these issues too. Prior to that I had just been (deliberately) too busy to focus on it all. I don't think I realised how terrifying my DD's birth was until I started ttc again. Then it was only when I lost a pregnancy that I realised that there are worse things than a bad delivery and I stopped being quite so scared. I also found that working out what I might do next time would help. So I knew that a section was an option (pretty comforting to know that), but also looked at whether I might be able to have a VBAC and, if so, how I might give it the best chance of success. In my case I have hired a private midwife to help me labour and to come with me to the hospital. I suspect that having someone I trust with me will make the world of difference. And I am reading everything positive on childbirth that I can get my hands on.

It might help you to know that women like us who have previously dilated to 10cm are thought to be really good candidates for VBAC, since obviously our bodies do know how to labour.