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Childbirth

Share experiences and get support around labour, birth and recovery.

Elective casarean? VBAC?

82 replies

tex111 · 02/08/2005 14:54

I had an emergency C-section with my first baby three years ago and I'm seriously considering an elective C-section this time. My first section was a very positive experience and I was showering and walking around the following day. I know each birth is different and there's no guarantee that another section would be the same but I know what to expect with a section and the thought of surgery doesn't frighten me. It certainly didn't hurt DS either so what are the reasons to consider a VBAC? I should also add that this will probably be my last baby.

My concerns with a VBAC are:

  • possibly rupturing my scar. I understand that this can be fatal for me, baby or both and the thought really frightens me. I've been told that it happens about 1 out of 400 VBACs but I can't find any stats on mortality rates or the damage it can do to mother and baby. Does anyone have any information?
  • my piles. I never got to the pushing stage with DS and I've still had really dreadful piles since his birth. I'm afraid that if I actually attempt labour again I could do myself some serious damage. Going to talk to my midwife about this but haven't yet.
  • that I'll try for a VBAC and end up with a second emergency C-section. I've heard that this puts the most stress on mother and baby and I would much rather just schedule a section than go through the pain only to end up with one anyway.

Things I like about an elective section:

  • being able to set the date and arrange childcare.
  • knowing what to expect.
  • the extra time in the hospital. I actually liked my stay with DS and I think it would be especially nice this time to have some alone time with the baby before going home.

I've never felt that I missed out by having a section the first time around. Is there any reason I should change my mind to VBAC?

OP posts:
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QueenOfQuotes · 02/08/2005 14:57

The chances of a successful VBAC are around 70-80% (I had one - not entirely 'succesful' - labour from hell after being induced - but it was a VBAC all the same).

The risk of rupturing is around 1-2%

bundle · 02/08/2005 15:00

I had an emergency c/s first time, then a trial of labour 2nd time but made sure consultant & me put time limit (didn't want to be tired and have another c/s..say a day later) on the labour - in my case 6 hours. in the end my BP dropped, wouldn't come back up and I had a crash c/s just as they were about to administer the induction drugs. so had a GA..which was the only downside (ie wish I'd had an epidural very early ie when broke my waters..so i could have been awake)

tex111 · 02/08/2005 15:00

QofQ, that's interesting. I was told I couldn't be induced since I'd had a section. I had an image of a long, ongoing pregnancy until I finally begged them for the C-section!

OP posts:
Aragon · 02/08/2005 15:05

tex111

I had an emergency section too with my first child. I'd love another baby and if I ever concieve again would have no qualms about booking a second section. I've been a midwife and I know that VBACs have many positives going for them. However, if you're really concerned about a VBAC then book another section and look forward to your baby.

tex111 · 02/08/2005 15:09

Thanks Aragon. That's a very positive way of looking at it. I think I've been beating myself up a bit about wanting an elective section since I joined an antenatal yoga class. I love the yoga bit but they've been trying to talk me out of a C-section and have even suggested a home birth, which I wouldn't even consider. My first birth was unpredictable. I just wouldn't feel safe at home. I've gone from being 99% sure I wanted a section to feeling a bit confused and upset about it all.

OP posts:
Aragon · 02/08/2005 15:11

No - go with your thoughts and feelings. Don't let anyone pressure you into doing something you don't want to.
I HAVE delivered babies at home (only 2) to Mums who were having VBACS - all well and good but you have to be absolutely certain that it's what you want and you have to feel safe about it. They shouldn't be putting the pressure on - just tell them you've asked for a VBAC and then "oh I needed another section" afterwards. They'll never know.

expatinscotland · 02/08/2005 15:13

Tex
You need to do what YOU feel is best for your state of mind and baby's health. Don't let people pressure or bully you into trying something you're not 100% comfortable with! I had a forceps delivery and only now am feeling more confident about this next delivery (in December). But if I didn't I wouldn't hesistate to research all my options and make a decision w/my doctor or midwife NOT based on what others consider best for me.

bundle · 02/08/2005 15:15

tex, I thought I would go straight for a section, but my consultant explained the options and we decided things together. in the end it was a bit scary but I'd built up real trust with her and her team.

MrsBoo · 02/08/2005 15:43

Tex
I had an emergency C-section like you with my first DS in 1999. Don't remember too much about it all, except huge relief that at last something was finally happening!. Very fast recovery too, and couldn't believe what all the fuss was about.
In 2003, with my DD I was given the choice by my consultant if I wanted to elect. Second time around was miles better, really relaxed and a really positive experience. Again very speedy recovery for me, and I'm not particularly healthy or anything. I knew the date for the birth for about 10 days (had to work round the consultant's holdiays!), booked the haridresser for the day before. On the actual day, dropped DS off at nursery at 7.45am, in hospital by 8.15am, and after usual checking in etc, was first baby at just after 9am.
I know other people will slate me for saying this all, but surely it is more important that everyone has a good and positive experience whatever method of childbirth they opt for.
Good luck whatever you choose

uwila · 02/08/2005 16:13

DD was born by emergency section 2 1/2 years ago. DS was born by lovely planned calm section 9 weeks ago. You couldn't pay me to have a VBAC. And I certainly wouldn't ever choose to have a home birth. I find security and safety knowing I'm in a hospital if anything should go wrong.

My only advice on the section is to take Arnica. Get the strong stuff and eat it like candy. Wonderful stuff... or was it just a coinicidence?

I think that both methods of delivery have their drawbacks. And since I already had those associated with caesarean (ugly scar, etc.) I saw no reason to take on those associated with a vaginal delivery (torn you know what, incontinence, etc.). So I went with the Caesarean and it was definitely the right choice for me.

franke · 02/08/2005 16:41

Tex - it sounds to me like you really want the section and I think you should go for it. It's all about personal comfort zones after all. I had an emerg. cs first time around but a successful vbac last year. I would never be prescriptive about what is best, although I know what was best for me. Personally I think it is out of order for your yoga buddies to try and talk you out of what you really want - shame on them for being so unsupportive.

lydz · 02/08/2005 16:53

Lots of stats etc to help you make an informed decision at this vbac site

louli · 02/08/2005 17:08

I had an emergency c-sect with DS and went for trial of labour with DD which ended up as another c-sect. I don't regret for a minute the second long labour followed by c-sect because I really wanted to try for a natural delivery. Second time around I didn't feel so disappointed but then I went into it with a far more realistic view. I think whatever you choose it has to be what you really want to do not what anyone else suggests and that will make it a better experience. As for induction my consultant made it quite clear that under no circumstances should you be induced after a previous c-sect. Good luck with whatever you choose to do.

toothyboy · 02/08/2005 17:23

Tex - I'm trying to make the same decision. Had emercency section in April 2003 and am due no2 in March 2006. For me, I'm very squeamish and can't bear the thought of another section - if I had to go through the next 7 months knowing I was going to be cut open again I'd go crazy! Having said that, if it happens at the last moment then I can cope with it cos I don't have time to dwell on it.

I also had quite a quick recovery last time, but I wonder whether it might be more difficult this time, with having a small child to look after as well - especially not being able to drive for 6 weeks (dp is currently on a driving ban which won't help matters).

I'm hoping for a VBAC this time.

tex111 · 02/08/2005 17:44

Thank you all so much for your feedback and especially the links with more information. I've been doing some reading and I do think an elective section is going to be the best choice for me.

OP posts:
Nome · 02/08/2005 18:17

I'm due in 10 days and am hoping for a spontaneous start to VBAC. I was given the option of a section if I wanted, but have to keep up with a toddler afterwards. Ds was born by elective section, so I have never laboured. I'm feeling a bit apprehensive, but if I can have a straightforward VBAC, the recovery will be loads quicker. If I have complications I have already said I want an elective rather than lots of tinkering around the edges, ie, no augmentation, no ARM. Spontaneous labour seems to offer the highest chances of successful VBAC.
I'll keep you posted on how it all goes.

Ellbell · 02/08/2005 20:51

Tex

You must do what feels right for you, as everyone else has said. However, you are right to find out all you can and try to make the most informed decision that you can.

My situation is that I had an elective section with dd1 for placenta praevia and a VBAC with dd2 (22 months later). I was very keen for a VBAC because I'd been hospitalised for 10 weeks with dd1 and felt that not only the birth, but also the pregnancy had been taken completely out of my hands, and I wanted to take some control back with dd2. It was pure bad luck with dd1 - the treatment I had in hospital was great and the section was great too ... all very positive, except that it wasn't what I'd planned (and I didn't even get to do 'pregnancy stuff' like decorating the baby's bedroom, buying a carseat, choosing a buggy, etc.)

I think that the stats you've been given on scar rupture seem a bit pessimistic. I was told that more like 0.02% of scars rupture. However, I gave all the factsheets and stuff that I had to my NCT antenatal teacher (who wasn't all that clued up on VBAC), so I don't have them in front of me now. Different hospitals have different rules about whether they will induce a VBAC. However, if you are induced there is a much much higher risk to the scar. (Again, I'm sorry that I don't have the stats on this.) For this reason, I decided that I would not be induced, and that if I got to 42 weeks without going into labour naturally, I'd opt for another elective section. (I suspect that they'd have pushed for this from 40 weeks - I don't know if I'd have made it to 42, but I had my baby at 37 weeks, so it was irrelevant!)

The thing that made a big difference to me (THE big difference, I think) was that I asked my consultant to write on my notes that he did not consider that I needed to be continuously monitored in labour. Most hospitals continuously monitor VBAC births as a matter of course, but I'd spent a lot of time strapped to a monitor with my first problematic pregnancy, and I knew how restrictive it was, even when not in labour/in pain, and I was pretty certain that I'd never cope in labour if I was strapped to a monitor and unable to move throughout. I was monitored for about 15 mins when I first went into hospital, but after that the midwives simply listened to the baby's heartbeat with a handheld monitor every 20 minutes. I don't believe I was taking unnecessary risks, and had there been any concerns I'd have agreed to continuous monitoring, but as long as everything was fine (at one point I remember the midwife saying 'this baby is the most relaxed person in this room'... and she still is a pretty laid back child to this day!) then I didn't see any need for continuous monitoring.

I also decided that I would not have an epidural. Because the epidural numbs the body completely, it masks any unusual pain - e.g. pain in betweeen contractions - which might suggest scar rupture. I therefore preferred to be able to feel what was going on. I used TENS, water (baths - would have used pool for 1st stage, but someone was already in it) and a little bit of G&A.

With a VBAC, they usually like to put a cannula in when you go into hospital just in case there is an emergency situation and, say, you need a section very quickly under GA. It means that they can get the anaesthetic into you quickly. They also like to take some bloody to cross-match and save, just in case there's a problem and you need a transfusion or something later. I agreed to both of these things (I'd had the bloods done twice a week for the whole of my first hospital stay anyway... by the end they were sending students in to practise on me!) As it happened, though, neither of them were done. A doctor came to do the cannula and I looked at the needle and promply threw up everywhere... at which point she went away and I never saw her again!

I did have the fear that you have, of going into labour, labouring for hours and then ending up with a stressful emergency section anyway, but I decided to go for it, and I am glad I did. My VBAC was great... but it was great because it was what I wanted. I felt I missed out on lots of things first time round, but not only because of the section (actually, the section was the least of it... it was not being at home to prepare for my baby, and not being able to take her home with me afterwards which broke my heart). I also had childcare problems - my dd1 was only 22 months old and we didn't have any family nearby, which meant that a 2nd section would have been more problematic than a natural delivery (I went home the same day that dd2 was born). But none of these things apply to you, and I really don't think that you should feel pressurised into going for a VBAC, just because it is right for other people.

Hope this helps. Sorry it's so long. Good luck

pupuce · 02/08/2005 21:12

Why was your first birth an emergency section?

I have seen first hand a near scar rupture and it was picked up routinely in labour and was at no point a threat to mum and baby. The mum was very happy she had tried a VBAC and the 2nd emergency was done in a very relaxed manner (in what she saw, I know they were more concerned but all was absolutely fine).
I met recently a woman whose first baby's birth led to a proper uterine rupture and it all went fine (she wasn't a previous section either!)

eidsvold · 03/08/2005 04:34

tex - I had an emergency c-section ( due to poor dopplers and fluid loss) with dd1 - wanted a VBAC for no 2 ( simply as I had a child with sn who was 2 and not walking attending all sorts of therapy etc - did not feel I could take the 6 weeks recovery period etc.)

Got to 10 days over and dd2 showed no sign of wanting to appear and so went ahead and booked an elective c- section.... what a fab thing that was.... knew when it was, could organise child care, could sort out the 6 weeks post care and organisation and have no regrets...

Funnily did not want a c-section at all with dd1 - but so be it - it was that or let her die....

you do what it best for you at the time. I did have a registrar wanting to book my elective at 26 weeks and I said I wanted to try a VBAC - consultant was very supportive and then when I changed my mind at 10 days over ( huge as a house, hot as hell and wanting it over with!!) he took that lead also.

Speedy recovery with no2.... and am glad I went ahead and had the elective and I personally do not feel I have missed out on anything not having had a vaginal birth......

RedZuleika · 03/08/2005 07:36

I have no comment on VBAC / Caesarian as I've never had either and am going for a home birth. However, I just thought I would chip in my twopennorth as it rang bells with regard to something I read yesterday, when researching issues on my own situation.

"Women who have had a previous caesarean section can be offered induction of labour, but both women and health care professionals should be aware that the likelihood of uterine rupture in these circumstances is increased to:
80 per 10,000 when labour is induced with non-prostaglandin agents.
240 per 10,000 when labour is induced using prostaglandins."

This is based on a BMJ article [Guise J-M, McDonagh MS; Systematic review of the incidence and consequences of uterine rupture in women with previous caesarean section BMJ; 2004;329:19 (3 July).]

As regards your yoga group, ooo - it gets my goat when people try to pressure you into a particular course of action. Planning a home birth brings them all crawling out of the woodwork. My husband got an email from some relation the other day saying how I'd be better off in hospital, the trauma of the death of a child, blah blah blah. The fact that he knows pitifully little about my medical history didn't stop him commenting on things of a personal nature. He didn't have enough respect for either of us to think that we might have researched the issue and come to an informed decision.

piglit · 03/08/2005 09:37

Tex111 - I am in a similar situation to you and have in fact been booked in for my section in November already (on the advice of my consultant). I have thought long and hard about a VBAC but there is no reason to suppose that this labour would be any different (I have v small pelvis, dh has large head which ds inherited) and I can't bear the thought of the induction and hideous labour only to have either very bad tearing or another emergency section. I do find that people are swift to judge so I tell people my due date and when they they say "Another section then?" I say "Who knows". Of course, when db arrives a week early I'll tell people I had another section but I don't plan to leave myself open to criticism from interfering nosey parkers by telling them up front about this section.

I guess what I'm saying is do what is right for you and lie to people if necessary. It's none of their business. Good luck.

kid · 03/08/2005 09:46

Tex111 - what were the reasons for you needing a section first time round?

I had an emergency section with DD as she was brow presentation, they didn't find this out until I'd been in labour for 22 hours!
I found out I was pregnant 2nd time round when DD was 2.5, I opted for a section and was allowed due to the reasons for the 1st section.

scully · 03/08/2005 10:09

I'm facing this decision, with baby no 2 due in Dec - dd was born April 02 as a caesarian, because she was breach. Not getting any pressure from anyone so far, and am definitely considering a vbac, more from the expected easier recovery, although I had no probs after the first caesarian. Just concerned about looking after a 3.5yr old and not being able to drive, after 2nd surgery, with no family support. DH would prefer a caesarian, as last time was so smooth and 'easy' but he is leaving it up to me as he'll be back off to work a week after the birth, leaving me to it......
Thx for your long message Ellbell, I found it helpful and have started a list of questions for my first consultant appt later this month.

aloha · 03/08/2005 10:12

You must do what you feel is right for you emotionally and physically - it's nobody else's business - unless they plan to have the baby for you
I had an elective section for placenta praevia first time - had an excellent experience I was keen to repeat for dd. Unfortunately, due to a combination of factors, I went into labour just on 39 weeks and had a really horrible time before I got my second section.
There are arguments for having your section in labour (hormones are right, baby is definitely 'cooked' etc) but sadly in today's NHS you can't guarantee to be looked after or cared for at all so for me it was a negative experience. I also never felt I missed out on a vaginal birth first time around (escaped more like!) so didn't have that consideration. For me, it was definitely the right choice - I just got caught out a bit by that evil bitch Mother Nature!

oliveoil · 03/08/2005 10:12

I had an emergency section with dd1 after a long labour - contractions stopped, her heart rate was alarmingly low so was rushed in for surgery. My epidural wouldn't top up either so I had to have a GA so missed the birth. I was 9 cms as well so could have had a normal delivery but they didn't want to risk it.

With dd2, the hospital were brilliant and didn't exactly push me to have a VBAC but were very pro and supportive. They would have gone for an elective if I had decided but as my first birth was nearly textbook (apart from the ending), they said a VBAC would be possible.

It was a fast and furious delivery - within 3 hours of arriving I was pushing, my contractions stopped however and they would only let me labour for so long. In the end I had an epistomy and voutouse delivery. Painful at the time (gas and air!) but the recovery was far far quicker than a section. I could pick up my toddler for one, and am so pleased that I went for a VBAC.

Talk things through with your midwife and doctor, but personally I can recommend trying a VBAC.

And you can also say you have had one of each and be a font of all knowledge on giving birth .

xx

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