Will I be expected to have a VBAC as previous elective CS was due to breech baby?

[Pinkjenny]

I struggled a bit to think of a clear title for this thread, but I had an elective cs with dd at 38 weeks, as she was breech, and had been from 27 weeks. ECV was discussed, but not an option due to her position.

No one discussed vaginal birth with me at the time, and to be honest, I think I would have opted to have a CS anyway. I am now pg with dc2, albeit only 5+2 (so getting way ahead of myself here!) and am wondering about VBAC.

Lots of the threads in the archives are about VBAC after EMCS, as opposed to Elective, and people wondering whether the same complications will arise again. Now I'm assuming that dd being breech was just bad luck (please God, no more clicky hipped babies ), so will I be expected to go for a VBAC?

I am totally undecided at the moment, but it seems ridiculous to have surgery unnecessarily.

Does anyone have any experiences?

Great post JoeJoe1977, thanks. It is a really interesting debate, and taking my mind off everyone talking about how I might miscarry all the time, and not wishing to discuss my pg.

Lulu - I think you doula at Ormskirk, is that right? That's my hospital [handy emoticon].

I know I have ages to go, but I am the kind of gal that likes to be prepared. Like a female boy scout, if you like.

Aqua - I'm really glad you said that about your scar. Despite only being in the very early stages of pg, the area around my scar is already quite tender.

that's the one , PJ !!

Oh god, had forgotten about the scar, it used to get twinges all through my pregnancy and when I was in labour all the contractions seemed to start there, and as I hadn't gone into labour with DD1 I didn't know if this was normal or not, but I wish someone had warned me!

It's a very good point JoeJoe, but I had to request a particular consultant at my hospital as the others 'do not encourage VBAC's'
This was from my (lovely) midwife, and she was right. But once I had made it clear that I was goign to be the one making the decision and nothing they said was going to change my mind they soon started supporting me!

I was really keen for a VBAC as had a dreadful time with DS1. As long as it is clear that you are making an informed decision then the support should be there. My consultant didn't encourage VBACs either,(he provisionally booked my CS date at my 20week appointment), but he had a fab registrar and she was much more supportive.

My birth plan, as agreed with hospital, was:-
No induction of labour
To wait until at least 1 week overdue before considering CS (they normally get you in at 39weeks)
If I went into labour, to go to hospital as soon as contractions were established
If I went into labour, to leave it at least 12 hours before contemplating CS

I went into labour at 6 days overdue, in labour for 14 hours and still only 5cm, so I decided to go for CS. But at every point I felt I was making the decisions, and that made a huge difference.

Best of luck.

PJ I think, reading these posts and thinking about my own experience, is that there is a huge difference between how this is approached between trusts.

Armed with all of this you will be in a good place to ask the midwife what the line is with your trust when you have your booking visit. And if the answer isn't what you want you know that other parts of the NHS do offer total informed choice so you have a strong argument with whatever you want to do...

Thanks for the heads up about the scar during labour jackbauer

Been reading this thread with interest as i'm 36weeks pg with dd2, and dd1 was elective csection due to breech.
I have always been keen to go for a vbac as feel quite 'robbed' by the csection last time having never even had a single contracion. Although now its getting close (this baby is head down) the reality is starting to dawn on me and I realise I have no idea how to give birth etc etc!!

Interesting about some authorities not inducing, i'm seeing the consultant next week and will def be asking all these questions

thanks all and good luck PinkJenny!

Just to add, I had an em c-s with DD1 and was induced for DD3 (DD2 was a natural-onset labour inbetween). My trust were fine with induction for me, but would not use the pessaries - I was put straight onto a synto drip (but given a lurvely epidural first ). It was by far the best of my births

Oh, and my scar was never painful during my 2 subsequent ps, but it did itch like buggery as it stretched.

llynnnn - please come back and 'resurrect' this thread once you have seen your consultant, and even better, once dd2 is here!

I have an almost constant tummy ache around my scar, but no bleeding so hoping all is OK.

will do, i have had stretching pain around one side of my scar but only in the last week or so, think its as the baby is pushing downwards. the midwife said mine was fairly normal at this stage as my bump is HUGE! would be worth giving your midwife a quick call about yours though just to put your mind at rest

Pinkjenny - are you me???

I also had a DD by elective CS due to breech, 4.5 years ago. I also had a very easy experience, no pain, walking within a couple of hours. I also had a clicky hipped baby who was in a by the time she was 5 days old!

For my second baby I requested an elective when i saw the consultant at about 20 weeks. He immediately agreed. I have an extreme fear of birth so was very happy to have electives. I was also very lucky in that I had no complications and I recovered very quickly both times.

Re. the scar -sorry if i missed it, when was your previous child born?

ooh ooh ooh can I join too?
DD was a breech baby born feb 07 by elective section and I am 19 weeks with my second. VBAC V elective is something I am thinking about a lot.

I had a great recovery 1st time round really the only problem was not beng in the car as DH doesn't drive.

The first midwife I saw said I would have CFM, no water birth option and not a lot of movement but I will discuss this with The midwife at the GPs who I will see more regularly.

In hindsight I think DD had been breech for a considerable period of time before it was picked up (at least four weeks) and I think she got stuck in one position (which the MW said was quite possible)
I have an appointment with the consultant at 31 weeks. At the moment I am happy to go for a VBAC but really have no real desire either way I certainly do not feel I was robbed of a birth experience.

Sorry if this is a bit rambly but I have found this book to be very good VBAC Handbook the first section in particular made me feel like I could do it and could argue against things like CFM.

I've very suprised that anyone would insduce a VBAC with PROSTIN! That is considered v. risky and I have been taught it is a no no, synto however is used for vbacs

peachy it is so nice to hear other people say that they in no way feel they have been "robbed of a birth experience" or cheated or anything like that.

TBH I have no pressing desire to try and force a baby out through my most sensitive areas, but sort of feel I ought to see what happens for forms sake. All very odd. I think when you have had one easy section it is so tempting to have another one.

It is such a hard decision.

But you know the best thing? we will all agonise about it now, but a few weeks after the babies are here we will look back and wonder what all the fuss was about

I'm 31 weeks on Sat, so llynnnn then me? Then you then PJ. Have I missed anyone?

Rebecca - dd was born in May 2007. I don't think I'm you! I am emotionally scarred by the clicky hips. Dd has her check up on 8th June, which always makes me want to run for the hills.

BigBella - I am so with you on every point in that last post.

I had CS for breech with DC1 - great experience, really easy and I didn't feel at all robbed of any birthing experience. I then had my next 2DC by vaginal delivery - surprised by the pain first time round and had to have epidural, number 3 just popped out. Having already had one child I was glad of the slightly quicker recovery with vaginal delievry after DCs 2 and 3 - no lying in bed after or scar to think about, so I think it was easier to cope with toddlers DCs bouncing on top of me, wanting to be picked up etc. Also I think I felt more comfortable with pregnancy no. 3 knowing it wouldn't be another operation at the end of it. However I think in the end it doesn't matter as long as you feel comfortable with your experience. FWIW giving birth vaginally wasn't something that I felt I had to do, just wanted the end product of a baby.

It's so reassuring to know that I'm not alone in feeling like this! I had DTs by CS 6 yrs ago and am 7wks PG with DC3. The prospect of unexpected pregnancy, impending sleepless nights, even "major abdominal surgery" do not phase me in the slightest. However, the prospect of being bullied into ejecting this thing out of my fanjo scares the living crap out of me! I have so many friends who have had truly horrendous experiences giving birth (yet no reports of nightmare CSs, I note) I really feel an ECS would be the better path for me. Am I being terribly irrational here?

No I don't think you are being irrational at all, mrsrawlinson. I feel much the same, but have the following concerns about a repeat CS:

Having surgery for no real reason
Recovering with a 2yo toddler jumping all over me this time
Compulsory stay in hospital which means an extended period away from dd
The poor postnatal care that I experienced last time
Immobility after section which contributed to my failure to commit to bf dd

I would state though, that is is my list of concerns, and is no way intended to judge the choices of others, in that I don't know what decision I will eventually make!

me23, that is intersting, as i was informed by the trust that synto is absolute no-no for VBAC induction, whereas a maximum of 2 prostin is fine..

peachygirl did i email you some c.s info when you had your DD,or am i thinking of someone else??

Lulumama, when I was discussing my induction with the Foetal Medicine specialist I was seeing before DD3 was born, he said that the use of prostin was usually a decision made by the particular obs who looked after you on the day. A small number of them (his words) would use prostin but most would not. I didn't get prostin, but went straight to synto and, as I said, had an excellent birth experience.

Oh, obviously all that is only in relation to my particulat hospital trust

that is really interesting, i am going to ask about it at the next maternity forum, as i was under the impression syno was far more powerful than prostin, and far more risk of hyperstimulating the uterus. thanks x

I was told as well that Prostin was ok for VBAC, but not Synto.
My consultant v much left the choice of how I would prefer to deliver up to me, to the point where I would have preferred a bit more guidance. In my mind I liked the idea of VB, but equally did not want to do anything stupid to endanger baby's or my life. Lots of reading, mainly on-line, really helped.
My consultant knew me pretty well, had looked after 4 MMC, genetic investigations, anmio/CVS x3, major placenta praevia when pregnant with DS2 and he delivered DS2 eventually by emergCS. We had a good relationship and I think he had a fair ideo what made me "tick".
My VBAC as I posted before was a phantastic experience, much more satisfying than DS1's previous VB after induction.

I am a HCP myself (GP) and from the other side of the fence , it really helps when people have thought about their preferences, have sought out information, and ask questions. It is great when somebody knows what they want and is assertive about it, but equally bear in mind, that no dr/MW/other HCP can read your mind or necessarily know what you have previously been through. It works both ways: terrible birthexperiences that left the woman v traumatised can on paper look ok, and complicated deliveries can leave a woman satisfied with the overall outcome - I count myself lucky that I can look back fondly at all 3 of my deliveries although they were all so different, and yes, VBAC defo my favourite .

Hope all you ladies will be heard when you attend your various appointments.

I would agree that synto is more powerful but I seem to recall that prostaglandins will soften scar tissue as well as the cervix and this is the increased risk factor. Right now, I can't look for refs to back this up (DDs 2 and 3 sitting on top of me ) but am dragging it out of the depths of my brain (I'm a pharmacologist).