Elective casarean? VBAC?

[tex111]

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?

i had a horrible vaginal birth 3 years ago - needed operation when ds a year old to sort out the mess. have been offered elective c section this time as am obviously petrified of another "normal" delivery. have been weighing up options & after reading these positive experiences of c sections am definitely opting for that! thanks for helping me with my decision everyone & good luck to everyone with similar decisions to make.

I was going to have an elective section with ds after traumatic neonatal death of 1st child but consultant changed his mind & said no let's try with natural birth. As it happened the pg was so stressful I went into labour 4 weeks early and ended up with an emergency section anyway. Despite fears of pain afterwards etc I had no pain at all (fantastic painkillers) just stiffness, quick recovery even though I forgot the arnica due to him being early, baby was fine, I would not hesitate to have an elective section next time around and would definitely have one instead of an induction of things did not happen naturally. Would not take the risk of a VBAC with induction, no way.

K

I really struggled with the VBAC option when i became pregnant again for the second time after a traumatic intervention-full labour and emergency c-section first time round. Initially i said no way to VBAC as feared a repeat of the first experience but then decided to get as much information as possible before making a decision - Vaginal Birth After Cesearean by Elizabeth Kaufman and The VBAC Companion by Diana Korte are both books i would recommend - not biased. Once i decided to go for VBAC i prepared for the birth as best i could and booked a fantastic doula (a godsend) and went on a hypno-birthing course (i had gut feeling that things might have been different first time round if i had been in more control and hadn't had so much intervention, hence trying to optimise my chances with my prepartion for no intervention second time). However i was then told by my consultant few weeks before due date that my first labour indicated i was physically unable to give birth due to shape of my pelvis which was a real confidence blow but he couldn't prove it and deep down i didn't believe it but this really added to the pressure of still trying VBAC. Anyway all successful ultimately, although i was mentally ready too had it ended in another emergency c-section.

www.victoriousbirth.com is quite a supportive website to take a look at especially if you have had a difficult previous experience - my story is on it if you are interested :-)

Birth choices are very personal and experiences vary so much. My best advice is arm yourself with information and do what feels right for you.

Fantastic posts. Am really surprised that there is so much positivity about c. sections. It is great that everyone gave such a lot of personal information.

Am due with second baby in March. Had ds 23 months ago (to the day) by emergency section due to lack of progress. Have recently been reading up on the vbac option and it terrifies me. I hate the idea of being monitored very closely as I was immobile for most of my last labour and it drove me crazy and impeded my progress I'm convinced.

I also read and I am not sure if it is true that you can't use a birthing pool for a vbac. Anyone know anything about that?

I too had a really quick recovery after the section and marched off next morning to reclaim my baby from the nursery with midwives pointing and whispering in amazement. But obviously that was not remotely unusual considering your information here.

Think I am with tex on this one and will be interested to see what the response is from the medical staff. Good luck tex and hope it all works out. Thanks for this thread. It is very helpful.

It is possible to labour after a previous C/S without being continiously monitored electronically and to use the birthing pool. You just have to state that is what you want. Medical and midwifery staff do not have the right to prevent you from labouring the way you choose.

I actually looked after a woman last week who wanted to use the pool. She had a labour and felt that was due to being confined in bed and monitored for other reasons first time round. Her care plan stated she wanted to use the pool and have minimal intervention. She actually went on to need another C/S but was delighted with the fact she got to choose the labour she wanted. She had no pain relief in labour which was her choice. She loved the pool. Unfortunately baby did not descend but she was happy that she gave it her best shot.

I have seen many women have successful VBAC. I think though that labour should be spontaneous (however research seems to say induction is OK but that is intervention from the start). I have seen many women chose repeat C/S. The choice has to be the woman's.

Thanks mears.

That's helpful Mears - I was expecting to be dictated to about certain things like monitoring and the pool, if I go down the vbac route, but at least being baby no.2 I know how to be more vocal about what I want and know to do my research before consultant appts and the birth itself. My recovery from a caesarian last time was also very good, certainly not what I had expected. Only issues I have with having one 2nd time around is no lifting (a 3yr old) and no driving for 6wks.

Thanks mears. I was hoping you would find this thread.

I know I've said this before, but I really think that if you want to avoid continuous monitoring, it's a good idea to discuss this with your consultant well before the birth. I asked my consultant to write in my notes that he did not consider continuous monitoring to be necessary in my case (and to sign it!), and this definitely helped. The midwives who looked after me in labour were absolutely fine with this, but the one who admitted me (and a few I talked to at the hospital ante-natal classes) were insistent that 'hospital guidelines' stated that I HAD to be continuously monitored. I was just able to say 'Well, Mr X says that I don't, and he's written it in my notes' (... so nerrr! - I didn't actually say that, obviously, but I thought it!).

My consultant was also happy for me to use the pool, although he felt that I should get out for delivery. I decided not to question that, feeling that, basically, once I was in I could just refuse to get out if I wanted to. Sadly I didn't get to use the pool because there was someone already in it. However, I did most of my first stage in the bath (at home and then for a couple of hours in the hospital) and found it great. I'm sure the pool would have been even better.

Another thing that I forgot to mention before is that my hospital had a 'time limit' on the 2nd stage. I can't remember what it was exactly now, but it was something like an hour for 1st-time births and half-an-hour for subsequent births. I made it very clear on my birth plan that, since I hadn't ever been in labour with my first birth, my VBAC was a first-time birth and please could I be given the full amount of time to push before they started talking about intervention. As it happened, they more than took this to heart, as I was pushing for 2 hours (aaargh... this was, honestly, the only bit that I didn't enjoy!) and no-one suggested intervention. I think that this was because I was making progress - albeit slow!

Overall, the thing to do is to keep asking questions and if you get told 'no' to something keep asking 'why not'. I didn't want to have a cannula in and asked if I could avoid it, since I have (according to one midwife) 'brilliant veins' (!), but when it was explained to me that if things did go wrong and I lost a lot of blood suddenly even my 'brilliant' veins could collapse, then I agreed to the cannula. I think you need to be clear about how far you're prepared to compromise. For example, I wasn't prepared to compromise on the continuous monitoring. If they'd insisted on that, I'd have preferred to go for an elective section, because I am convinced that I could not have laboured successfully flat on my back and immobile.

Hope this helps. Sorry to have gone on again.

I had an emergency caesarian post failed induction with ds1 and desperately wanted a VBAC with ds2. I jumped up and down and got consultant to agree(reluctantly) to water birth with intermittent monitoring. Unfortunately I just did not go into labour and opted for CS at 17 days overdue. The CS was much better 2nd time around (?due to arnica) Ithink this was right for me. I was definitely against 2nd induction as it increases risk of rupture, it didn't work 1st time and there are some points of view expressing concern about effects of syntocin on baby. I think you just have to follow your own instincts (having done research) and sod everyone else. Good luck.

Well i also had emergency c-section with my first and didnt realise even after discussions with my consultant that a vbac would be a good idea for me, after having my second birth by planned c-section i realised i probably could have had a succesful delivery with ds2 as he was apparently in a great position and wasnt nearly as big as my frist baby ( reasons for emergency c-section with ds1 was he was in a very bad position and wouldnt move or come down and he went into distress - he weighed in at just about 10lb! - which i cant imagine helped - im a very small build) so i was pretty annoyed at myself and my consultant afterwards for giving myself the chance to try at least! i was worried regarding uterine rupture but have done a lot of question asking since ds2's birth and realised the chances of this happening are like you say tex about 1 in 400, BUT it wasnt until recently my sisters dear friend tried for a vbac and unfortunatley she was the 1 in 400 and sadly not only did the worst happen, and she ruptured, but they were not able to get baby out in time and she died a few hours later. This obviously is very rare, but for her the 1 in 400 might as well have been 400 in 400! Its not fair of me to frighten people as all women should feel they have choices! i am expecting my third baby in september probably by another planned c-section, but it does still cross my mind to maybe give vbac a go, im just more aware now that these rare occurences actually do occur!!

Tex111: I am SO happy to see that you have made it to the point of having to make this decision!!!

Never having faced the choice myself, I am surprised to find that I am leaning towards the elective section. You've already recovered from one (with labour beforehand) so you know what to expect already. There is no guarantee that you will have a successful VBAC and things could end with an emergency section anyhow...

Don't allow others to pressure you. If you feel better about an elective section then go for it. The goal is to have a healthy baby in the end and there are no bonus points given for trying to be a hero!

Best wishes for whatever you choose. I can't wait to read your birth announcement.

So the mother and baby died AnotherHelen?

No jabberwocky just the baby!

I am supposed to be heading off to bed but have been glued to this thread and read all the way through. Thank you tex for starting it off, it has really made me think...

I had a fairly straightforward delivery with my dd in Feb 2003.

Twenty-one months later had an emergency caesarean with my ds, as my waters broke but labour didn't start. Fortunately I was scanned before I was induced and it turned out he was breech. I was advised to have a section as it was the safest option. At that point there was very little fluid left and the placenta was starting to calcify. During the operation they discovered I had placenta praevia which had not been picked up previously.

I found the recovery after the section took much longer than after the normal delivery. And I had no contractions second time round at all, so I can't imagine what it must be like to have a long, painful labour and then a section as well.

We are now considering trying for baby number three next year and I had automatically assumed I would chose a VBAC, but reading all the postings now I'm not so sure.

There was one posting from kid saying her sister had a vaginal delivery, followed by caesarean then a VBAC - is there anyone else out there who's had three deliveries with a caesarean as the middle one?

Just wanted to mention Jadhfiow I had a similar situation as yours except they didn't figure out ds was breech until after 33 hours of labour! Let me tell you, recovering from a c-section after that has got to be harder than going in without labour first. Plus, I had a terrible infection from my waters being broken for so long and was on two different IV antibiotics for three days. My feet got huge from all of the fluid!!!

Jadhfiow - there is absolutely no reason why you should not have a VBAC since you have had a previous vaginal delivery and 'proved' yourself. I have looked after a number of women who have had C/S in the middle due to breech presentation then had normal delivery next time round. The issue is more for women who have had C/S first time and then labour. For them labour is an unknown quantity. I think if reason for first C/S is not present then a trial of labour is reasonable.

Jabberwocky - sorry to hear about your experience. I was very lucky. The only reason they scanned me before induction was because one of the midwives at the Birthing Centre I was booked into said she heard the heartbeat high up and wasn't sure of the baby's position. She passed that on to the hospital - I was so grateful to her and rang to thank her after the birth. The midwife the day before was convinced the baby was head down.

I was lucky not to get an infection, even though my waters had been broken for nearly two days. However, ds did and needed light therapy for jaundice and a week of IV antibiotics.

Breech or not breech has been a recurring theme in my labours. With dd I had a home birth until the point they thought I was fully dilated and they were feeling a bottom and not a head. I was bluelighted to hospital to find out I was 5cm and the baby was head down.

All through my late pregnancy with ds everyone said he was head down. Also at my 20 week scan my placenta was high so it was a real shock to discover it had moved and I had placenta praevia. I have spoken to the hospital about it all and asked if I could have a late scan if there is a number three - the consultant thought I had a very strong case for one. I would certainly feel happier going into labour knowing that the baby and my placenta are in the right places!

Mears - thank you for your words of reassurance.

I had first baby with unnecesary c-section, then had a homebirth vbac....I can recommend some good sites to help you come to your decision based on lots of information...good luck in your choice..
vbac.org.uk
vbac.co.uk
vbac.com
homebirth.org.uk
sheilakitzinger.com
aims.org.uk
birthchoiceuk.com
birthpower.com

I had a rupture of my scar during labour with ds2 and was whisked off pronto for an emergency section. BUT I was given Oxytocin which is apparently not a good idea! If you do opt for VBAC, its important that everything happens in its own time to avoid putting too much pressure on the scar.

tex111, I'm had a c-section followed by trial of labour and then another c-section. Both c-sections were emergency, but the first one was much calmer (for me anyway!). I would recommend as have others that you really think about what you want and what you don't want and why. Do research the facts - 1 in 400 is just wrong! Then talk to your consultant (this should not be difficult what ever you chose, as you will be an "at risk" case either way) make sure you talk through different options and that you are in agreement as to the way ahead (if you are well informed you will find that this is much more satisfactory conversation). I think that setting time limits or talking about what interventions you are OK with is a really good idea. Get support - if you can afford a doula then think seriously about it if you are going to try labour at all.

I think that that G2 article was a bit odd, and possibly more to do with underlying conditions and a premature birth, but not all c-sections go to plan (as with births, although it is obviously more controlled). Second sections can have more complications and you can have continence issues too. Although personally I have found friends with poor vaginal births who have far worse long term outcomes than me - I have a section of my tummy with nerve damage, and it hurts if I sneeze (2nd section 5 years ago) but some of them have feacal incontinence problems.

Second sections are more complicated operations (because of the scarring) so expect it to take longer, and that your recovery time may be affected, although I found second time around much easier because I knew what to expect. It is much harder afterwards second time around as you have a little one at home (although a 3 year old is probably a bit different than the 16mth old that I (foolishly) had!)

I hated being in hospital (although I work in the NHS), and second time around was worse, because dh didn't visit much as he was looking after ds. Aside from not sleeping in a strange bed, noisy surroundings, terrible food, boredom etc. Still I'm glad you enjoyed it! (I should say that both post-natal wards I was in were pulled down within a year!)

Anyway, sorry about the long post. I think that this is a subject still way too close to my heart! Oh and in no way shape or form agree to syntocin. I did (God knows why!) and it was a bad bad idea.

for the record I had an emergancy c with my 1st - too big , got stuck 9lb 10 and i am 5 2
i intend on have another
If there is one tije in your I life which You can stand up and say - I WANT this/trhat then surely it is when you are to give birth
it is you/baby and no one else I beleive that babies only 'suffer' if we 'think' they do
do what you want , what feel right and as long as it is not detremtal to you and yours health well hooey

I've had 3 c-sections, 1st&2nd emergency & 3rd elective.With my 1st babys heartbeat dropped,2nd I wanted a trial of labour, my consultant did try induction but said they don't let you labour as long because of the previous section. My labour didn't progress & after quite a few hours in labour i was happy i'd tried but natural wasn't for me, after my section i was told it was just as well as i'd started rupturing.I recovered quickly after my 2nd but my 3rd was probably the most painful afterwards as i was sterilised as well, it too me a few weeks to recover & having 2 other kids to look after was a nightmare. I think everyone has different experiences with c-sections, at the end of the day it's your decision & if natural childbirth really doesn't bother you & you've got help looking after your other little one,then go with what feels right for you.

Good luck when the time comes.

Hi ladies. Still doing my research and found this site which I thought some of you might find useful. It does lean towards repeat cesarean but I think that balances things out as most sites seem to lean towards VBAC. I've ordered my copy of the book and hope it'll be useful.

C-section Guide

....I think you should absolutely go with your instinct. And I say this as someone who had a horrible emergency c-section first time round, and a great VBAC the second! I found it a totally different, less frightening experience and I was hoping that would be the case. I'm actually a massive fan of the v-bac versus c-section, just because I found the latter such a horrible thing. But I really think, for you, if you're thinking this way, you already kind of know what you've decided. VERY best of luck whatever you decide.