VBAC v ECS

[Pinkjenny]

What questions do I need to ask the consultant?

I have:

CFM?
What if I go over?
Likelihood of scar rupture

anyone?

remember that your best chance of a VBAC starts with a spontaneous labour without induction or augmentation

CFM will be offered , you can make an informed decision to decline it

if you go over you will be offered induction via gel ( 2 doses max is our trust's policy)

likelihood of scar rupture is relatively low, have a search on here , there have been loads of stats. on it posted.

i also asked my consultant how many ruptures he had seen. ( none !)

have you been referred to teh VBAC clinic?

I would have a clear idea of what you want and then ask questions. Consultants can bamboozle you with 'policy' and 'procedure' and what you 'have' to do...

Everything that LuLu said.

Not yet Lulu, seeing Mr Jones on 20th August, just trying to get my head around the options really. The thing I am most scared of is needing an emergency cs. The elective cs was so calm and civilised, and I don't remember feeling scared at all.

I am also worried because of the time of year. EDD is 31st December, and I have to admit, a big plus for an elective CS is the fact that I can plan (as far as possible) around Christmas, and make sure I am there for dd. I realise this sounds a bit 'too posh to push' though.

MrsMattie - I wish I had a clear idea. I just don't know.

PinkJenny, I'll be very interested to know what your consultant says. I'm due on 27th Dec and the Christmas thing worries me too.

Our trusts policy is to allow no more than 8 hours active labour for vbacs... which seems odd to me as effectively it's my first labour so in 8 hours I'll achieve nothing, just lots of pain and then an em cs.

They also have a policy of cfm, but apprently if you're pushy enough you can get them to take it off. I'm not very pushy at all esp with regards to labour as it's my first.

I'm also thinking, I know hospitals claim they're fully staffed year round but surely at Christmas time there'll be a some people off? So I keep picturing myself strapped to a monitor, alone, for 8 hours and then being sent for my em cs.

I'm sooo tempted to do the el cs a week before Christmas and have it all done with. However, I do feel that's "the easy option" and that I should at least try for a vbac. I'm so torn!!!

HeadFairy - that's exactly how I feel, although mine would be the week between Christmas and New Year. I was a bit worried about admitting that on MN though, for fear of being lynched!!

don;t have a c.s on the basis that it will be easier, have it because it is the right thing for you and your family. think about recovery with a toddler around xmsa time too

there is no medical reason this time , apart from previous c.s why a VB is not a possibility

think also about how you will feel in 6 months time if you will regret not giving it a go, especially if no more babies after this one.

also bear in mind, a lot of emergency c.s are ones that need doing within the hour, rather than all emergency c.s are ones that need to be done within minutes IFYSWIM

That's what worries me Lulu... but then the flip side of a labour then emcs worries me more - isn't recovery from em cs longer? My recovery from el cs was pretty straight forward, no pain, no infections, was driving after 2 weeks. It's not the need for the easy option that drives me more than the fear of the worst option.

I appreciate em cs can be the outcome for many labours, vbacs or not, but isn't it more likely for vbac? I know three friends who've gone for vbac recently only to have em cs.

I think that's the problem, Lulu, I am trying to compare it to last time, but this time will be a completely different kettle of fish.

I did find it easy last time, with a 6lb baby to pick up, with a 2.7yo, perhaps not so much!

the recovery can vary so much, can't it?

obviosuly if you are knackered from labour and had more drugs etc you will find it a bit harder going for the first few days pre op

but there can be complications with a planned c.s

there is no set answer

from my personal experience, I knew I had to go for a VBAC, or i would have spent eternity wonderign if i could have done it. I had a totally normal, straighforward labour .

the kind of support you have for your VBAC is vital

also, how your hospital 'manages' VBAC

being given a time limit for example does not help .. i would counter that by saying you will not consetn to a c.s 'just because' a certain amount of time has passed, if laboru is progressing, albeit a little slower.

the 1 cm an hour rule is an average and can;t possibly apply to everyone

some women take 15 hours to get to 4 cm then will deliver 1 hour later

so saying if you don't deliver within x hours we will give you a section is just silly !

Lulu - I don't feel passionately either way at the moment. The person I am most worried about in all of this is actually dd. Lots of questions about which method will be easier on her are just running through my mind.

I do realise I probably won't feel like this when dc2 arrived

Do 'our' hospital have a good track record with VBAC? Would I be supported by the midwives? Dh is a bit useless, bless him.

whatever happens, DD is going to be adjusting to a new baby in the house

and you being in hospital for 24 hours +

hospital pro VBAC, hence the intro of the clinic

should be supportive.

I feel just as you did Lulu, I want to know if I can do it, but I know the policy the hospital have for vbacs is not the ideal way to labour. Not the way I want to labour. I've already been told I can't go to a mw led unit, I have to be in hospital. I didn't ask about hvbac but judging by their reaction to my request about the mw led unit I think they'll try to discourage me.

Never having had a baby this way I just don't have the confidence to go against what they're recommending for me.

Now I'm starting to get worried about swine flu too (call me irrational I know!) not so much for my health, but for staffing levels. I know the NHS is gearing up for peak levels to hit this winter, surely that'll hit staffing levels.

That last point of course could affect however I have my baby, an el cs could be postponed if staffing levels are low as it's not high priority etc...

pinkjenny, my dh is useless too... that's the least of my worries of course, but as someone who's played sport all his life and thinks nothing of "running off a broken leg he's ridiculously unsympathetic about pain. I can just picture him telling me "if you don't think about it, it won't hurt" swiftly followed by me punching him

thing is, all these policies can be challenged

you can ask for a HBCAC. you can make an informed decision to do so

more chance of success if you are not labouring under someone else's terms and conditions

you can be advised of the time limit, cannula, CFM etc etc etc, but you can reject any or all of that advice

I know they can Lulu, but I feel very much that I don't have the confidence to.

I could have pushed for a vb when ds was diagnosed as a breech, but as it was my first baby, I just didn't feel I was in a postion to question the judgement of the mw (who afterall had delivered hundreds of babies) when she said a cs was the best option.

hi - sorry this is long....
i was wondering if anyone could shed a bit more light on the risk of going for a 2nd c section (and maybe in future having a 3rd). i am finding that i am being given a huge amount of info on VBAC and what the good things about it are and how the risks are really low etc and then on the other hand being given a couple of terrifying facts about the c section option but nothing more in depth than that. i really want to make an informed decision but feel am being pushed down the VBAC route (which am terrified of doing but am open to to trying if that seems the right option) and not being given a very balanced picture of the risks/benefits ...ie i was basically told if you have an elective section (my first was emergency and pretty traumatic and could have ende very badly for the baby) you cant have any more children and also that there are big risks of placenta accreta and adhesions and they increase with each op.
i understand there are risks with c sections but are they really really so dangerous and likely to result in a lifetime of pain? i didnt go into labour first time round so with VBAC it would be completely unkown territory.
I am worried about not having enough support and that the reassurances i am being given now about continous care/being allowed to move about even with cfm/epidural as and if i need it/and being given choices at the time etc may well go out of the window when we are actually in hospital and the poor midwives are short staffed and stretched to the limit etc...to be honest i am so terrified at the prospect of that situation arising and me feeling panicked and out of control and helpless (i'm a panicker...)and ending up even more traumatised than last time (or worse...something happening to the baby) that i am leaning towards the elective option....but i am really worried about the risks and feel i havent really been talked through them properly....can anyone help..? sorry for rambling...