VBAC - Talk to me about options if i go overdue... Fairly urgent

[stickybean]

I am 39+5 with my second child. My first baby (only 18 months ago) was a c section for failure to progress.
I did however go into spontaneous labour on my due date.

I am hoping to have a VBAC this time.
When i saw the midwife yesterday i asked her what happens if i go overdue this time, induction etc. She said i wasn't allowed an induction of any sort and was shocked and a bit panicked that i hadn't been booked in for a c - section 'just in case'. She promptly phoned the hospital and had me booked in for one at 40+8.

Now, i have no reason to think i will go overdue... But 8 days late isn't really that late.

Is a planned C section preferable to an induction for a VBAC woman? Is the risk of scar rupture hugely increased if i were to have an induction? From everything i read about induction it seems like a horrible experience anyway.

I feel like such an idiot for not thinking about this sooner and all the info i can find seems to be for American websites which isn't really relevant to our health system.

I am keen to try for a vbac all things being equal, but not so much so that i am willing to take huge unnecessary risks. The problem is finding someone (in the system) who will tell you the risks and likelyhood of them happening honestly rather than trotting out the hospital protocal!

I don't know what to think / do. Any opinions, advice, suggestions and experiences welcomed please

My consultant gave me the choice of either ELCS or induction if baby had not arrived by 42 weeks. Was a bit surprised, as like you I had heard many places won't induce after a section. I eventually decided if I got to 42 weeks I would be knackered and baby would be big (I had huge bump) so would prefer a section if it came to that, although ideally I wanted to avoid one so I could get back to normal quicker for my toddler.

Unfortunately when they tried to book it though, they found the latest slot they had for ELCS was at 40+9. I wasn't v happy with that as felt it would reduce my chances of successful VBAC if I went overdue again (as there would still be a good chance of labour starting naturally between 9 and 14 days overdue), so then I changed my mind and opted for induction instead, as that could happen at 40+14 so more chance of things happening naturally before then, though I was a bit nervous about reaching that point!

Luckily DD was more prompt than her brother and decided to turn up quite naturally at 40+5 so it never came to that!

Can you ask if it's possible to rebook your secion for a later date? Or if you really don't want it, ask about other options?

According to NICE

"NICE guidance states that women with a previous caesarean section can be offered induction of labour but they should be aware that the risk of uterine rupture is increased (to 80 per 10,000 using non-prostaglandin agents and to 240 per 10,000 with prostaglandins)."

I think the risk is 35 in 10,000 if you go into spontaneous labour for a VBAC, so the risk basically doubles with non-prostaglandin agents and you are six times more likely to rupture if using prostaglandins.

Whether or not a planned csec is preferable to a induction depends on your own feelings regarding both processes. They both carry risks.

As for inductions some hospitals do them, some don't. I am overdue and I have been offered one round of propress and they will also consider low dose of Syntocinon. Not that i'm up for either of those.

You can phone the ward to reschedule your csec if you want to go till 42

I would look at having the c section move to 42 weeks and in the meantime ask for sweeps and expectant managemetn, if you've spontaneously laborued before, no reason you won't again, given time

induction can be offered, different consultatns have differnt attitudes, as libra has siad, the risk of rupture is increased , but some trust will induce with synto drip s othat it can be shut off if signs all is not well.

but your best chance of a VBAC is a sponteanous start to labour

and staying upright, active and mobile when in lbaour

Thank you so much for your very helpful responses, so much to think about.
My gut feeling is that i will go into labour before then but am now stressed out and worried this will affect the baby coming out... mad i know but i blame the hormones!

hospital policy seems to vary hugely on this matter. I was told by one consultant that I would be allowed to go 6 days over then offered 2 small doses of gel, followed by ARM if cervix favourable and then CS if still no action however when I went to see consultant at 40w appointment on Thursday they were very negative about the success of VBAC following induction and I was offered ELCS at 40+5. However community MW was very surprised at this. My local hospital won't use syntocin at all for VBAC. There seems to be so much conflicting advice - I know my head is in a spin about it.
I am keen to try for VBAC and had sweep today and have another scheduled for Monday. Like Lulumama says I feel my best chance of VBAC is with a spontaneous start to labour.
I would like to avoid surgery as I also have a toddler however this baby is big and I can barely walk now so really don't want to go much further overdue. I thinnk I am going to go for the ELCS rather than induction if nothing happens before that.
GL with whatever you decide stickybean

Have accpunture and sweeps on alternative days after your due date?

I had an EMCS following an induction (9 days late) with DS1.

Went for a VBAC with DS2, and was told that I would not be induced if I went overdue.

I was examined at 2 days overdue, had a sweep, and had him, vaginally the the next day (they had booked a CS for I think 7 days overdue)

I had booked acupuncture, and was taking homeopathic remedies. Also, - hot curry and sex (not at the same time)

I sympathise with you. My EMCS was after 13 hours of labour, 2 hours pushing, and I wanted desperately for that to happen again - so much so that I toyed with having a planned CS right from the beginning. However, I had a lot of encouragement from the Consultant Ostetrician (he quoted a 70% success rate for VBAC), so I was feeling fairly confident when it came to it.

stickybean - just wanted to add, that, though I was glad I'd been able to have a vaginal delivery, and felt so much more in control during the labour, my recovery was probably worse than it had been from the EMCS. I healed very well from the operation, whereas I was plagued with piles and a 2nd degree tear after the VBAC.

For me, the difficulties with the EMCS were mainly to do with having been unprepared for it, mentally.

I am saying this so that you don't feel that an ELCS would be such a terrible thing.

I wish you and the baby all the very best.