VBAC or elective C/S.. opinions and advice needed!

[koonelly]

hi, just wondered what peoples experience were at having VBAC.
I had c/s 5 years ago had previouly had 3 normal deliveries (all teenagers now). On speaking to consultant he said that with a VBAC, labour wasn't induced or artificailly speeded up and that u were monitored cos of risk of scar rupturing. On my 3 normal deliveries my progress was always slow, all were back to back with me, each pregnancy labour was longer and all ended with waters finally being broken (after much pleading)then baby was born. With last baby after about 12 hours of no progression found baby in distress and had emergency c/s. Does anyone think it's worth trying VBAC (as consultant advises as say each pregnacy and labour can be different)or go straight for elective C/S?
I'm worried that although they say u'll be monitored,are u? my previous experience tells me that if its a busy night u can be left ages and don't want to risk anything going wrong as i'm 40 now and finding it all harder going than when i was 25! Surely the odds of having a quick labour are pretty low? Not sure i want to go though hours of labour that doesn't really do much but wear u out only to face the stress of emergancy c/s again anyway! On the other had recovery is so much quicker with normal delivery that c/s and all professionals tell u risk of infection complication higher with c/s. Just don't know what to do!

Hi. I had emergency c/s nearly 4 years ago and elective c/s 5 months ago.
I only 'elected' for the c/s this time because I was advised not to go overdue due to risk of scar rupturing and induction was ruled out as there were 4 induction attempts with my 1st baby & it just didn't work.

So, not sure it's much help but I understand why you are thinking about VBAC cos that's what I wanted. In the end though (I went a week overdue) my elective section went extremely well, I was out of hospital after 2 nights and it was a pretty good experience.

I think you just have to do some basic research then make your mind up and not give yourself a hard time thinking about the other option. You can tie yourself in knots wondering if you've made the right choice.

Fingers crossed for you whatever you decide.

thanks, what i really want to do is try for VBAC, but have option to opt out and go for c/s if i'm worried that all taking too long! but i really don't have the faith that the system would alllow me to do that, just depends on who's on duty at the time!In past experinces (maybe i'm not assertive enough) no one seems to pay much attention to what i've said and worries in labour, things may have changed (i hope) as ds's are now 16/15/13 ans 5!

When I saw my consultant in 2nd pregnancy he told me that I had to have a text book labour (1cm dilation ph) or they would section me anyway. In other words I would have thought that the medical staff would want you to have a section if it was taking too long. Maybe they all have different opinions though.
What has your consultant said?

koonelly, it's a tough decision isn't it!

I fought to have a vbac, in the birthing centre (mimimum intervention, not constantly monitored, etc etc) at my local hospital. I felt this was my best chance of having a successful vbac . If there were any problems, I was told I could be immediately transferred up to the labour ward where the staff there would take over, plus there were always 2 anaesthetists available 24/7.

After a day in the birthing centre, I ran into difficulties, midwife became v concerned and rang the labour ward saying that I needed to be transferred immediately. They could not take me - very very busy, theatres full, with patients waiting etc. 4 hours later, after numerous phone calls, the very fraught midwife just wheeled me up there and said she couldn't be expected to take responsibility for me (she was right - I needed to be on the labour ward hours before). I was so relieved when they managed to locate ds2's heartbeat, but concerned by the doctor's concern about it. They wanted to do a c section straight away, but there was only 1 anaesthetist on and I was in a emergency c section queue.

Anyway, we got into theatre in the end, and ds2 was fine.

I was extremely ill afterwards - contracted an infection and didn't leave hospital for 2 weeks.

The system in the hospital didn't work that night and that was what I had based my decision to go for a vbac on. Looking back, maybe I was naive - but I had asked questions like "What if one of the anaesthetists is sick?" and was told cover is always found.

I am sure other people will come on and tell you about their successful vbac, but I think it's important to tell you my experience, because we all know that what you anticipate will happen in a hospital, isn't always the case.

Puff - that sounds like an absolute nightmare.
Glad your ds was fine in the end. Phew!

I had an emergency c-section under a general due to high blood pressure and baby in distress. A horrible experience and the recovery afterwards was really difficult so I really wanted to try for vbac with my 2nd. I was told that with my second I would have more ante-natal appointments with my consultant which I didn't. And I didn't have any extra monitoring when in labour although to be fair it was quite a fast labour and dd was born (a successful vbac) within 2 hours of arriving at the hospital. For me and my labour it worked very well and I was delighted to have the vbac. I don't think I would have been as keen if I'd had to be induced again (as I was with what ended up as the c-section). My intention was to take it one step at a time and never outrule the possibility of a c-section.

My own experience was that I regretted having vbac.

I am quite small and at all my hospital appts the doctors, although very reluctant to advise either way, seemed to me to be veering more towards c/s.

My gp and sil (who is a dr) also didn't want to say anything but I got the feeling they thought vbac was unadvisable.

Anyway I did opt for vbac nevertheless and had to have ventouse in the end and lots of stitches,and this was without epi as there was no-one around to administer it. Ds was born with a ridge on his head which some junior dr told us might be a condition called craniosynostosis - premature fusion of the plates - so it was all extremely traumatic, although ds turned out to be fine.

I would say, either way it's a gamble. It is a very difficult decision but if I get preggers again I will ask for elective c/s.

magscat - it was a nightmare - very very frightening at the time. Basically I paid for my decision to choose the birthing centre over the labour ward because I ended up at the back of the queue. I went against hospital policy in my stubborn determination to have a vbac my way. I could have paid a very high price, thankfully I didn't .

Bloody hell...so much fun to be had with this giving birth malarky. I'm 38 weeks, had a hideous C section with Dd ( now 2) after trying for a home birth and getting no-where, I had an epidural which was fine for the contractions but didn't work for the op itself. I was SO stuffed by the process that I really want to try for a vbac this time. However keep getting told this one is a BIG baby, and the chances of a succesful vbac are low..but this is just the one Dr who seems desperate for me to have another C section. So far I've been given 3 due dates..2nd july, 29th june and now maybe 25th June ?!?!
I hope to try for a vbac, but will have another C section if I have to. Dd was the wrong way round ( posterior?) this one is at least facing the right way....and if I have to have the op, I'll make damn sure I'll get a spinal block this time. The appeal for a planned C section would be NO LABOUR...and being able to organise care for Dd well in advance...not so appealing, the long recovery, not being able to lift with a 2 year old will be a nightmare.
But hells tits honey, you deserve a blue Peter badge of honor for having 5 kids!!!Good luck.

to add my twopence worth
go for planned C.
If not least for being able to arrange care for your youngest kids.

you've popped out three kids, and we all know there are no medals to be had for that, so make it easy on yourself and go planned

Well I would say with 3 previous successful vaginal births I would go for the VBAC actually!
No time to post more at the moment but I have plenty of successful VBAC storie to tell

Koonelly I had an emer c/s 6yrs ago today! And 4yrs later I had a VBAC. Like you I was slow to progress with my labour and after 24hrs needed an Emerg c/s as baby was distressed, back to back and weighed over 9lb etc. When I had my 2nd baby 2yrs ago I was advised to have a planned c/s but as I had already laboured a full 24hrs and had pushed for 2hrs, I thought I may as well let my body have a trial of labour and my consultant agreed. I was very determined at the time to have a VBAC. I was monitored as soon as I went into labour and they preped me for theatre with the canula etc It was another slow start of labour but eventually I pleaded with them to break my waters to which they did break my waters to speed it up and although the baby was slightly stressed it was not nearly as stressed as my first born, after 16hrs of labour baby was born safely with a lovely VBAC. And at the end of the day as long as the baby doesn't suffer it doesn't matter which way the baby is born!

Message withdrawn

I had a VBAC six weeks ago and would definitely recommend it simply because of recovery time. c-section first time round was at 36 weeks because of pre eclampsia so no labour. was keen to at least give it a go with no 2 and had induction because I was 15 days overdue with no signs of labour at all.
my experience was they didn't over-monitor me and only induced when I begged them to - they were happy to wait and see once wk 42 placental scan showed all was well.
I'm 39 by the way.

I've had 2 c/s, and tbh would have been better off opting for an elective 2nd time around. i agreed a 6 hr trial of labour with obst but blood pressure dropped rapidly (and didn't recover, so they thought i'd ruptured) and i had a crash c/s (hadn't had epidural as contractions were fairly mild and 10 mins apart following ARM) which wasn't v nice. but that's all said with hindsight...

Hi - I'm new to this site and was really after some advice. A long story short I had a thorric Vaginal Birth - the whole thing lasted hours - only had gas and air, ended up having an episiotomy and lots of blood loss after.. and my daughter was 9lb 9oz. I am 28 weeks preg now and know my baby is "big" again and have been suffering many probs, one of which is SPD - overstretching of the ligaments - so at the moment i can hardly walk and expect to be on crutches soon. basically the decision I need to make is do I go for another natural or go for elective C-section. I am just concerned about recovery time especially as my daughter will have just turned to. Anyone help and advise what they may go for??? please help...

good to read all your stories!!! had em.cs a year ago (long labour, big baby, head was in wrong position, got distressed, i got exhausted after 2hrs pushing) - and i am due with #2 in october! i keep changing my mind about what i am going to have this time!
but so far i'll try vbac! firstly because of recovery time (was in hospital a week; home 2 days and had to go back in for another week due to an infection); secondly you can't drive for 6 weeks afterwards (don't wanna be stuck in the house) thirdly i've got a toddler on my hands! so i need all the strenght i can get! -
BUT since my plancenta is still quite low atm i wait till my next scan wk32 and decide then! well, if it's still low i'll need a cs anyways - and the decision is out of my hand!
and also vbac can never be as difficult as the last birth i had. - will see consultant wk36 and talk choices through like: can i change my mind? don't let me go through this for too long, act sooner!!!

I really feel for you ladies that are struggling to make what is quite a big decsion. I'm not a pro in any way as I have only had 1 c/s and 1 vb. But you can discuss all your options with your midwifes etc to find the best birthing option for you. I would def agree though with having a trial of labour if your body has already been through a labour to the stage of pushing but ended up a c/s. As you could agree on a set trial of hours and if your body isn't responding to the labour you can request the c/s. Does this make sense!

Don't know whether this helps or complicates. It's from the American Journal of Obstetrics and Gynaecology:

"Elective Repeat C-Section May Negatively Affect Neonatal Outcomes

NEW YORK (Reuters Health) Jun 09 - Compared with intending to deliver
vaginally, undergoing a scheduled repeat cesarean delivery apparently
raises the risk that the newborn will be admitted to an advanced care
nursery, according to a brief report. The researchers say women
should be alerted to the possible negative effects.

The study, in the May issue of the American Journal of Obstetrics and
Gynecology, is the first to directly compare the neonatal outcomes of
elective c-section with those of a trial of labor in uncomplicated
pregnancies, note Dr. Nicholas Fogelson and colleagues, from the
Medical University of South Carolina in Charleston.

In a retrospective cohort analysis, the investigators assessed the
neonatal outcomes of 3134 mothers intending to deliver vaginally and
117 mothers who underwent elective repeat cesarean section.

In the overall analysis, the risk ratio for admission to an advanced
care nursery was 3.58 for infants in the elective c-section group
compared to those from the intended vaginal group (p < 0.001).
Transient tachypnea was also more common in the elective cesarean
group (p = 0.0009).

When the analysis was confined to mothers who underwent unscheduled c-
section after a trial of labor, the advanced care nursery finding was
no longer statistically significant. Also, infants born to such
mothers were more likely to have lower APGAR scores than those in the
elective c-section group.

"The decision to undergo elective cesarean delivery appears to have a
negative impact on immediate neonatal outcomes," the authors state.
They advise that for women considering a scheduled cesarean
delivery, "physicians should counsel patients about potential
neonatal issues in addition to concern for maternal well-being."

Am J Obstet Gynecol 2005;192:1433-1436."

Thanks for your messages - I think I will discuss with midwife and consultants next week and go for the induction and then if it gets too bad I will then have the ceasar...

Just a further thought...

From what I've read (and this only what I've read - I don't have any personal experience in this), induction can be problematic with VBAC because of the risk of labour being too fast, thus putting stress on the scar.

I thought that too RZ, but my consultant (v experienced, the one the midwives ask for when they are pg) said they would give me a low dose for induction

Thats really good that they will give an induction where you live. In my local hospital they won't induce you if you have had a previous c/s. You are left to go into labour yourself or after 42weeks you are booked in for a c/section if you haven't delivered spontanously Sp?

I was told that I won't be able to have an induction, having had a previous C section, because of the stress to the scar...I was going to post a question about it, but it sounds like one of those things that it just depends on your local hospital policy/ attending Drs current belief.

yes, I think it's true that some hospital will induce for vbac and others won't. Personally I'm with the ones who won't. Even if my doc said it was okay, I would decline anything that increased the possibility of scar rupture.