deciding what to do regarding birth

[Beanypip]

im just after a bit of advise and what other people would do in my situation.

currently 29 weeks pregnant with dd2 and due to problems with dd1 ive asked for an elcs. I spoke to the consultant and she asked me to think about a vb with compromises. shes written in my notes that if any of the following happen I will be given an elcs straight away:
no induction so if I reach 41 weeks elcs
if my waters break but no labour after 24 hours then elcs
any dips or problems with the heart trace then elcs
no instrumental delivery unless shes right at the end and they can't do elcs
shes written not for arguments under it so I assume that's for the midwives on the delivery ward?

so there are a lot of points there that seem to end in elcs so im wondering if its worth it or just go straight for an elcs at 39 weeks.

just a bit of background on dd1 as mentioned above. got to 40+11 was induced her heartbeat kept dropping she kept getting in distress epidural didnt work they kept pressing the emergency button and giving me oxygen. in the end i was rushed to theatre for forceps and she was born then. turns out she has brain damage and is delayed in her development. shes 2 next month and cant walk or stand un aided yet.

im obviously very keen to avoid that happening but as no one can tell me how or why it happened we have no idea what to do.

I have driven myself crazy thinking this through and I am still no closer to a decision.

so if you was faced with the above what do you think you would do?

thanks in advance and sorry it's so long!

I am the most pro-vb person around but given what happened with DD1, I think for your own sake I would push harder for an elcs, if I were you I would be driving myself crazy too. Who knows whether DD's problems are because of the birth, but you seem to strongly suspect they are. I'd be interested to hear from midwives but I believe women who are relaxed and calm labour easiest - if you are that tense and stressed out about a vb I wouldn't have thought it would have a great chance of going smoothly and I think you could do without another horrendous experience.

I'm very sorry to hear about DD1 and based on your experience having her, I would ask for an ELCS. I had one with DS (breech) and it was planned (an advantage when you need childcare for DD1), calm and generally a positive experience. The only consideration would be will you have help with DD1 in the first couple of weeks, as you wouldn't be able to lift/carry her. Good luck with whatever you decide.

There is NO QUESTION in my mind as to what i'd do- i would be booking in for a section at week 39.

This exact same thing happened to my friend last summer, also resulting in brain damage, and i'm so worried about it myself that I myself am considering the ELCS.

It's simply not worth the risk. The likelihood of ending up with an EMCS would surely be high, if for no other reason than you'd be so nervous and uptight about the whole delivery

I know the pitfalls to a section, let's not open that can of worms, but there woudl be no decision to be made in my mind in your position, none.

Best of luck with your decision.

Hi beany. I also have a brain damaged dd after birth injury. In my case she was dc3 and vbac2. I had an elcs with dc1 due to suspected macrosomia (too big for me to deliver) vbac1 with dc2 (where they were seconds away from an emcs) but was told no clinical reason for elcs for dc3. That said, as I was high risk, they put me in one of the surgical rooms in case. And I still ended up with a brain-damaged baby. Go figure.

My consultant was sensible, and I have a letter on file stating that for all future pg, I should have elcs. No discussions.

Tell them you want elcs, and you are having no arguments. There is absolutely no way that after birth injury etc, you should have the added stress of labour in an already heightened risk scenario.

That said, if you do decide to vbac, please ensure they stick to continuous foetal monitoring, whatever else is going on. They didn't with me. Discuss the NICE guidelines with them thoroughly. CFM will be essential for your own mental stability.

There are quite a lot of posters on sn that have had subsequent babies post birth injury - maybe post there as well?

On a slightly different note, dd2 (my dc3 with cerebral palsy as a result) now skis black runs and has an iq of 142 - at two we weren't expecting her to walk or talk, and she had a spastic quad dx - I wish you and your dd1 the very best as you wend your way through the birth injury aftermath xxx)

Oh, and at 2, they were still playing the 'we have no idea what happened' line as well. Has dd1 had an MRI? At what point? We had a repeat MRI at 4, and requested a neuro debrief, who categorically stated that the damage was due to hypoxia during the birth process (hence the requirement for CFM).

My own theory is that the cord was constricted by her position during labour, but no one noticed because of the lack of monitoring. Did you have CFM with dd1? If so, it would be reasonably easy for an independent expert to check it out and work out whether the hospital reacted appropriately at the right times. Reading our notes and looking at what minimal FHR monitoring was done, dd2's birth was really badly supported. we are some years into a med neg claim, not because we are expecting to get any money (so unlikely it doesn't even feature) but because at some point, dd2 is going to want to know exactly what caused her disability, and 'I don't know, darling' doesn't quite cut it.

thank you for your replies.
I have been very well looked after with this pregnancy as they are keen to avoid anything happening. the consultants have all looked at dd1s notes and all the results from tests etc I think they expect me to go for elcs but wanted me to consider vb. ive only rhought about it because of practical reasons as I have no family around to look after dd1 but dh will have 2 weeks of at least. and if I have a elcs dd1 can go to nursery that day. im also the only driver and dds nursery is a good walk away but I have a friend around the corner who could help with that.

the reason i cant decide is as noone knows what caused the brain damage we still cant be sure it will happen anyway even if I have an elcs. dd1 has had mri scans and genetic testing (that came back clear) the doctor was very surprised to see brain damage as that kind is usually found in prem babies not term+.

im also over weight with spinal problems so the consultant pointed out a section could still go wrong and be dangerious for me.

What kind? She has PVL?

In which case - yes, odd. Is the brain damage a developmental abnormality? I assumed it was caused by a hypoxic incident during birth.

Dd2 has damage to the basal ganglia - classic birth injury presentation in term babies. She was 9lbs.

shes got white matter damage at the front.

I'm all for VB. But I think in your circumstances nobody should be encouraging to do anything you have any doubts over.
If you have any concerns go for cesarean!

Ah okay. That's not usually caused by birth injury in term infants, then, so I can kind of see why they are asking you to consider vbac.

Same rules apply though - if you can't handle the stress of labour in those circs, request elcs. Are they suggesting labour and vbac is better for you with spinal complications? That's pretty weird, too. And ensure NICE guidelines are followed throughout.

Come and chat on the cp thread, if you haven't already. There are lots of ladies who know their stuff about brain damage. My knowledge is more limited to the birth injury stuff (despite the docs telling me for two years she was a total mystery and they had no idea what caused her brain damage).

Good luck with your decision, and best wishes for dd x