34 weeks pregnant with bipolar 2 and in pain and can't decide between ELCS or VBAC - help!

[Rones]

I'm just over 34 weeks pregnant (although feel as though I could drop any minute I feel so huge!). I'm also in a lot of pain which started about 6-8 weeks ago but has become much worse over the last couple of weeks. I'm sure it's a hiatus hernia (I had a suspected one 11 years ago and suffered with it with my first dd although not this badly). At best it's uncomfortable but at worst it's agony and I feel totally incapacitated. I also have bipolar 2 disorder (off meds since just before falling pregnant) and my mood has really lowered these last couple of weeks, mainly because of the pain I think.

Before all this pain, I was sure that I wanted to try for a VBAC but now I'm not so sure as I'm finding it all so hard. At least with an ELCS I would know (hopefully) the date I'd give birth and could avoid a potentially difficult labour (who knows?). I'm really torn and could do with any advice or experience anyone may have. My first c-section was planned (breech baby) just over 5 years ago and I recovered well physically but there's no medical reason why I couldn't try for a natural birth.....but the closer it gets, the more scared I feel and I'm not sure if I cope given the pain I'm already in (I've been given omeprazole and told to take paracetamol but it's not making much difference so far) and my fragile mental state.

Any comments much appreciated!

Hi there. So sorry to hear you are in so much pain at the moment. Being 34 weeks pregnant is tough enough without added complications.

I can't offer any obstetric advice, I've been lucky enough to have 2 normal deliveries. However I do have a diagnosis of bipolar and my youngest is just 6 weeks old. I too was med free before delivery and my mental health deteriorated in the final weeks due to various stressful things. Unfortunately this has made things very difficult post birth and I've been quite unwell. Please protect yourself in these last weeks and look after your mental health. Bipolar sufferers are at such high risk of problems post birth, it is really important to give yourself the best possible start. You deserve to enjoy those first precious weeks and months and if choosing to have a section helps with this so be it. If your gut instinct tells you a planned section would reduce stress and anxiety, I'd say don't underestimate the importance of this at this time in your life.

Wishing you good luck x

I have had an emergency section then 2VBACS.

A lot depends on your reasons for the section but my advice would always be to try for a VBAC. The recovery is so much better and no two births are the same so this time you might not be so lucky plus you will have 2 children to care for.

With my third baby I was on a time limit for giving birth with everyone prepped for a section. I was minutes away from an emergency section under GA but had him vaginally. We were home for tea. My point being you can be prepared for a section so you know what is happening but it doesn't mean it will go ahead.

I have had PND after every baby and had AND with my third but tbh having the VBAC definitely helped my depression.

Thanks Martha and MissStrawberry, you've both given me lots to think about....Sorry to hear you've been so unwell Martha - I can totally sympathise. I suffered terrible PND and was later diagnosed with Bipolar 2 (having had various episodes in my life since the age of 14). You are so right about looking after myself in these last few weeks. I am trying to minimise stress as much as possible although that isn't always easy with no family around and my dd to look after who can be rather demanding (aren't the all:)). We've also been having work done in the house which still isn't finished! I've now been signed off work though so at least that's one less thing to worry about and there's still another 4 weeks of dd at school. Martha - have you started taking meds again post birth? I have a stash of Sertraline lined up just in case....and a mood stabiliser which apparently makes you put on weight but is OK when breastfeeding (which I will). I'm really hoping that I don't have to go back on them but if needs must....I hope you start to feel better soon. Having a newborn is so difficult when suffering with such a debilitating mental health issue.

I'm still very confused about choosing between ELCS and VBAC but I think I'm going to see how things go with my (suspected) hernia pain and how I feel closer to the time. Keep an open mind really. I have a obstetrician appointment again in a few weeks. At the moment I'm thinking try for VBAC and if nothing happens by 41 weeks maybe (or whatever the consultant says the longest is I go), opt for an ELCS, I really don't fancy being induced.

MissStrawberry - I think you're very brave going for VBAC after an emergency section and I see you point about recovery. Although people keep telling me horror stories about tears and other issues taking even longer to heal. I know that ultimately it has to be my choice as childbirth is totally unpredictable. I just worry that I won't cope with the pain!

Thanks for your kind words of encouragement and advice. xx

Thanks Martha and MissStrawberry, you've both given me lots to think about....Sorry to hear you've been so unwell Martha - I can totally sympathise. I suffered terrible PND and was later diagnosed with Bipolar 2 (having had various episodes in my life since the age of 14). You are so right about looking after myself in these last few weeks. I am trying to minimise stress as much as possible although that isn't always easy with no family around and my dd to look after who can be rather demanding (aren't the all:)). We've also been having work done in the house which still isn't finished! I've now been signed off work though so at least that's one less thing to worry about and there's still another 4 weeks of dd at school. Martha - have you started taking meds again post birth? I have a stash of Sertraline lined up just in case....and a mood stabiliser which apparently makes you put on weight but is OK when breastfeeding (which I will). I'm really hoping that I don't have to go back on them but if needs must....I hope you start to feel better soon. Having a newborn is so difficult when suffering with such a debilitating mental health issue.

I'm still very confused about choosing between ELCS and VBAC but I think I'm going to see how things go with my (suspected) hernia pain and how I feel closer to the time. Keep an open mind really. I have a obstetrician appointment again in a few weeks. At the moment I'm thinking try for VBAC and if nothing happens by 41 weeks maybe (or whatever the consultant says the longest is I go), opt for an ELCS, I really don't fancy being induced.

MissStrawberry - I think you're very brave going for VBAC after an emergency section and I see you point about recovery. Although people keep telling me horror stories about tears and other issues taking even longer to heal. I know that ultimately it has to be my choice as childbirth is totally unpredictable. I just worry that I won't cope with the pain!

Thanks for your kind words of encouragement and advice. xx

sorry I posted twice!

When my mental health probs I elected for a section for dc2 (due to horrendous first birth). It was wonderful and was all I could cope with at the time as I could not have handled a labour and another potential failed vaginal birth / vbac. I was not mentally robust enough.

Hope that made sense lol

ps with dc 3 I did try for the VBAC and failed but that time I was ok mentally and would not have been devastated.

My elective section was a doddle compared to the emergency ones tbh.

I don't think I helped there did I

sorry LOL

Difficulty is that no-one has a crystal ball, and so there is no answer as to which will be better for you.

All I can tell you is that I had mental health issues in pg and post-natally as well - my first birth was emcs and second a planned section. Both procedures went well and I recovered quickly etc.

Maybe you could do one of those pro/con lists and see? Or flip a coin - that often tells you what you need to know by the way you react to the result

And remember that once the baby is born, barring major problems (which I am sure won't happen), the method by which you gave birth fades into insignificance!

well said Nard - better than my ramblings

Thanks everyone - all good and valid points! Lots to mull over....

No one can make the decision for you. We can tell you what happened with us but it doesn't mean it will with you. Things weren't 100% great but compared to how they could have panned out I was happy. The best thing to do is get as much information as possible. Things happened with both my VBACs due to having the EMCS but I wasn't told about them so were a shock. Get yourself informed and don't worry if you have to make a snap decision there and then but ask questions of why they want you to do certain things and what that means for afterwards.

Thanks MissStrawberry - I'm actually feeling a lot calmer about things today. I've had a bad time this past week especially which culminated in my crying to my GP (who is amazing). I've just done a birth preparation workshop and do actually a lot more positive about the possibility of trying for a VBAC. I think that speaking to my consultant again in a couple of weeks will really help towards a decision too. I'm going to see how I get on with my suspected hernia pain and take things from there.....You are right, only I can make this rather difficult decision but I'm feeling less panicky about it which is a good start.

That is great.

I remember driving my second child when she was a week old and feeling amazing as I had had a section previously. A consultant had tried to bully me into having a section giving me scary statistics. Irony is it was the next labour that was the troublesome one. She didn't have the statistics for that!!