VBAC or ELCS???

[Liloosmum]

I know there have been several threads about attempting a VBAC or chosing to have an ELCS, but I'm still undecided.

We had an appointment last week with the consultant mid-wife who was very positive about VBAC (as expected). She said I would have a 75% chance of success and the chances of tearing or needed an instrumental delivery were the same as if it were my first labour (I only got to 2 cms last time and she said that didn't really count as being in labour before).

It all sounded fairly positive and so I thought I'd give it a go as long as I went into labour spontaneously, baby was head down and everything looked favourable.

I've since done some more research and 20% of births at the hospital are instrumental births, and the chance of me having a 3rd or 4th degree tear is approximately 10%. I can't find any statistics for episiotomies.

So I would have a 25% chance of needing an EMCS, if I do get a VBAC there's a 30% chance of bad tearing or instrumental birth.

So given those statistics, wouldn't an ELCS be better?!

What were the reasons for the emcs last time and are they likely to reoccur?

How did you recover from your c-section last time?

Do you feel a deep drive to birth vaginally or are you more concerned about longterm damage and your longterm health/baby's health?

I had emergency forceps with DD and have lasting bladder problems and a lot of internal damage. This time I am going for an elective even though a vaginal 'should' be fine and I got to 10cm no bother. DD's position was unusual and shouldn't be repeated etc - but for me there are too many risks to gamble what's left of my vaginal/bladder/pelvic floor health on.

I am not looking forward to the pain and slow recovery of an elcs but it cannot be worse than my forceps damage. I was unlucky and don't feel massively optimistic this time either - hence my choice.

Any gut feeling on your part?

If you are half hearted I fear a VBAC may not be for you as it does take confidence and could involve a lot of guts and determination.

The first vbac was the hardest for me and I had to fight for it, with myself as well as the professionals. It was bloody mindedness, and a lot of research, and a passionate desire not to have a section, that got me through.

Am fully in favour of a vbac, and the biggest reason for me is being able to be normal with the older child very, very quickly, picking up for cuddles and reassurance and all the rest.

That's what drove me on: I think you need to be very confident that's what you want.

Liloosmum, I agree with you that given those stats an elective cs would probably be a better bet. That's what I decided when I was in your position 3 years ago, and it was absolutely the right decision for me.

What particularly swayed me was that, of all the women who had the choice of VBAC, only 25% attempted it. In other words, three quarters decided that it wasn't the right decision for them. Obviously some of them may have had medical reasons, and just because 75% were in favour doesn't make them right, but still.

And out of the 25% who did attempt it, only about 66% achieved it - so the "failure rate" is higher than for first-timers in general.

I'm not saying an elective is the right decision for everyone. If for example your first cs was for a reason relating to the baby, like breech, and not a reason relating to the mother, then you are more likely to give birth naturally relatively easily. Also, some women have a burning desure to experience natural birth, in which case I can understand that it would be worth trying extra hard.

There are no right or wrong answers to
this, though. Go with your gut feeling.

Last time my waters went but I didn't get any contractions so I was induced. I then developed a temperature and my DD's heartbeat wasn't fluctuating as they would like so they were worried she was in distress and decided on an EMCS. The consultant midwife thought the induction might have failed due to her position, but there wasn't anything in my notes from last time to confirm that.

I don't think I'd have to fight any professionals to try for a VBAC, they seem very pro-VBAC. I do worry about tears and damage though especially as I didn't have any damage in that area last time.

My recovery last time was okay, probably helped by not having a long labour. I don't have any burning desire to deliver vaginally and we're not going to have any more children so don't have to consider subsequent pregnancies/births.

I change my mind depending on who I talk to, but I think if I end up with an EMCS again or a bad tear that I will regret not chosing an ELCS. Whereas if I have an ELCS I don't think I'd regret not having tried a VBAC as much. I guess that answers my question, but I think what's stopping me is knowing that it's major surgery and I might have complications this time or a worse recovery.

But presumably when the consultant advised you of your positive 'chances' this was after considering your own individual case/notes/examinations and whatever? That's very different from the general hospital statistics. Now I am (see another thread) someone who had 2 ELCSs. But I am also very pro-choice and it seems to me that if you want a VBAC and the consultant is optimistic then it's worth going for. Agree with tutti - for me another ELCS was right but this is your choice.

PS - having had two electives I am not in a position to judge on recovery from an EMCS, but most people do seem to regard recovery from an elective as faster.

All she would say with regards to tears, instrumental delivery etc was that I had the same odds as someone giving birth for the first time. I only got to 2cms dilated last time and she said that didn't really count as going into labour.

A 10% risk for 3rd/4th degree tears sounds very high, the general risk is around 1 or 2%. Did she say if this was the hospital's rate? If so, I would be wondering why (i.e. are they a bit too forceps/ventouse/episiotomy happy?!). Although of course it's so difficult to unravel the real reasons behind these hospital statistics...

Just wanted to give a positive account of VBAC. I had an emergency c-section with DS1 - high BP and pre-eclampsia and he wasn't doing well in labour. I recovered well. Imagine my surprise when everyone was talking about what are you going to have the next time ? etc etc when I realised I wasn't given a choice! My consultant said as long as you are healthy and the baby is healthy, then there is no reason to have a c-section, and that was that. I felt annoyed and depressed that the decision wasn't really mine. When I went into labour I wasn't prepared, but it went very well. I went into hospital at 12 and the baby was born at 4:30pm. No instruments, just a couple of internal stitches. The pushing bit surprised me on being absolutely fine and I felt no pain at all (think I was in shock from getting through labour on gas and air as my epidural didn't work !). I felt so free being able to go and pick up my baby whenever I wanted to and I had a shower just an hour after. The next day I was in a ward with lots of c-section mother's groaning with their stockings on and I felt lucky to be able to be walking around, normally. I didn't want to admit it, but my consultant was right.
The problem is you don't know how birth is going to go - each one is different.

I also only got to 2cms by the way. When I got into hospital I was only 2cms too - so depressed, but it advanced very quickly. It was very painful, but as I said, I didn't prepare at all. The labour was hard - but the pushing was just uncomfortable rather than painful. Don't know if this is TMI, but sex is actually better for me now too.

Good luck in whatever you choose. I am preg with number 3 and terrified. Hoping for another vbac, but who knows ?