Don't want VBAC, help me be logical?

[ConvincingLiar]

I had an EMCS under GA three years ago due to HELLP syndrome. I hadn't even gone into labour and it was all quite sudden. I feel fine about it. I'm now pregnant again and feel I want another c-section. I can't articulate why, I just do. Any thoughts on where I can read about this and try and come to a proper view?

You should should speak to your midwife. I really don't think you should force yourself either way. I had a natural birth with dd (with the help of a low dose epidural) and I loved every second. This time I may need a c-section due to a low lying placenta. I'm a bit scared to be honest, but if it needs to be done I'll do it. In your position, if you get a choice I'd choose the option most appealing to you. You've already had one traumatic birth experience, go with what you want this time and make no apologies.

Thanks. Am seeing the midwife tomorrow for the first time but I know that she's very bossy/pushy and I suspect would not be thrilled about me effectively saying I want to opt out of her service. I know that it's not her decision, but I don't know whether it is entirely mine.

It's nothing to do with your midwife really anyways. Yes she may ask you what your planning to do but as you had an EMCS last time you will be under consultant care anyways. It will be down to you and the consultant to decide what is for the best. Although I think in your case, you may be advised trying for a VBAC along as there is no complications this time is the safest option for you and baby but even then they can't force you.

Thanks. I'm not very pregnant so at least I've got a long time to burry my head in the sand think about it.

Don't beat yourself up! Why shouldn't you want another c section?

If you want logical the RCOG website has the latest research on risks and benefits of vbac and repeat c section. All women will have different likely success rates and risks but if you've read that before you see your consultant you can go in prepared.
My hospital also did a course on it for a few hours, not sure if they all do.

When I had to make this decision I overdosed on horrible things I found on the internet so may have a skewed view.
I decided that VBAC = small risk to the baby.
ELCS = small risk to me.
I would always take the latter, particularly as so many VBACs end in an emergency CS, which is completely different to an elective.

www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/

I'm on currently 6+2 with my fourth, API had a emergency c section last time due to big baby, fail induction etc.. and this time around I'm definitely asking to have a planned c section apparently you now have the right to choose after a emergency c section previously, good luck huni xx

I had to make the same decision, this is my third I had first one traditionally, second one by csection. I have decided on csection. Better for the lady bits, whatever anyone says.

Agreed flourishingmrs!! Ha ha 😂😂 x

If I had a pushy/bossy midwife, I would be asking to be transferred to another midwife's care to be honest. If you don't feel that you can have an honest, open conversation with her and receive unbiased information and support with your decision, ditch her!

I had an emcs under GA with my first baby and found the recovery very hard. I was worried about the risk that my second birth would end in an emcs and did wonder if elcs would be the better option, but ultimately I just didn't want another section (regardless of any 'logic', it just didn't feel right for me) so I had a very uneventful and straightforward VBAC. I was fully supported in my choice by a very kind and understanding midwife who didn't try to lead me in any particular direction and simply supported what I wanted. You have the right to the same experience - support, information and a birth that feels right for YOU, whatever form that takes. Perhaps a different midwife would enable you to feel more confident in your choice?

OP try not to worry too much about it, I know easier said than done.

I had a CS for maternal request with my first.

Recently pregnant (sadly ended in missed miscarriage at almost 13 weeks) I had my booking appointment and the topic of birth came up.

The midwife was really chilled out about it, she said that it was ultimately my decision how I would give birth. She pretty much said that it would be my choice to have another CS. I could also attend the VBAC clinic if I wanted to explore options.

I then received an appointment to see the consultant at around 22 weeks. Sadly never made it that far, but reassured that this was my experience.

Why should your initial preference for RCS need to be reanalysed to be logical or rational? It's a perfectly fine preference and likely to be the best balance of risks given your previous section. Now, this very rough balancing of risks may not be quite true for you if, eg you want an enormous family and plan several more pregnancies Or some other relevant factor you haven't mentioned, but your preference isn't "wrong". I get irritated by the pervasive assumption that all every woman wants is an unmediated vaginal birth.

I had an emergency c section with my first, and it was my recurring nightmare that it would happen again. I FUCKING hated it I felt like I'd been crippled, I went on to have normal births after, and the relief to get up and have a proper bath than lying there having a bed bath and not being able to change my own sanitary towel was bliss.

Wow thanks for all your replies!

emsyj I'd love to swap to be honest but mainly because she's a pain in the arse who talks for too long (about herself) meaning that her appointments massively overrun. She's completely unrepentant about it saying work have to give you the time off, which is true, but my work load doesn't reduce while she's gassing on about her latest holiday. She's the only midwife attached to my GP practice so I think I'm stuck with her. Annoyingly her clinic day is on my only non working day so I expect to be spending a lot of time in the surgery waiting room trying to amuse a bored toddler. I also recall that she had told one of my friends that had also had HELLP syndrome that I hadn't had it at all, er, it was a consultant who had access to all the test results who diagnosed it, not me and what about patient confidentiality?! I never complained because I think she's just a bit full of herself/shit.

I can live with pushy, as I'm no push over myself. Professionally I am used to analysing evidence and making reasoned decisions so I'm almost embarrassed and a bit surprised that I have a fairly strong gut feeling. sycamore I might be able to come up with a reasoned balance of risks in support of what I want but I can honestly say I don't know much about it. I think it's probably fear of the unknown.

abbeyRoad thanks for the link, I'll try and have a read before I see midwife tonight. FaFoutis if that's the risk then I'd make the same choice as you I think.

emsyj and sonlypuppyfat unlike you I think I was lucky in that although the first couple of days were terrible, I recovered pretty well from the CS. I suppose there's no guarantee that a second would go so smoothly. I don't blame you for not wanting to repeat such an awful experience.

mummyandwife85 and flourishingMrs glad I'm not alone in feeling like this. dontyoulovecalpol no reason at all I suppose, thanks.

turquoiseDress thanks for your reassurance. I'm sorry you lost your pregnancy, thank you for sharing your experience I assume I'll have to be consultant led because of my history so perhaps I leave the real discussions until I see them.

Thank you all, hope I haven't missed anyone out.

Have you thought about Hypnobirthing? If you haven't fully decided on an elcs it might be worth a look. I found the techniques really helpful with both births and plan to use them again with this one.

I listened to a cd a load in my last pregnancy and found it annoying rather than particularly helpful but because I never went into labour I have no idea how helpful it would have been. I've had hypnotherapy in the past and think it was useful as a placebo but not objectively that effective, I always felt completely conscious and a bit silly during it so I don't know whether I have the right brain/personality for it.

Just to add OP it isn't up to your midwife. They can't sign off c sections - this has to be done by a consultant.
You might not get to see a consultant until a bit later on as they'll probably want anomaly scan done first, unless there's a reason to see the consultant earlier.

I had a bit of a fight to get my elcs after emcs but that was my hospitals policy. Once I'd got through many hoops (midwife, vbac course, psychologist, consultant midwife and 3 consultants) it was signed off.
I think most hospitals arent like mine though.

Short version - it's the consultant you need.
Good luck

I had an EMCS for HELLP after a failed induction attempt, luckily just enough platelets for a spinal so I avoided GA. If I get pregnant again I would definitely want an ELCS. Partly I think I'd feel safer giving birth at 37-38 weeks (to reduce the risk of it recurring) so as I couldn't be induced again it would need to be a section. I don't plan a third child so not worried about risks from more than 2 sections. Slightly more irrationally I don't trust my body to go into labour (didn't last time after 5 hours on the drip) and feel that having had a section scar from one birth I might as well get the same bit of me damaged again!

I'd try speaking to your supervisor of midwives to see if there's anyone else you could go to btw, the breach of patient confidentiality is shocking and you should have someone you can relate to happily. As you'll be consultant led you might be able to skip the midwife altogether.

I know what you mean OP, I did a course and felt really stupid doing some of the breathing exercises. I never felt 'hypnotised' but I did listen to the CDs in labour and I do feel that it made a difference. With my second baby, I really noticed the difference when my CD stopped in the midst of everything - that was true confirmation that it was working, as when the CD finished everything just caved in on me and I couldn't focus on anything except getting it started again!

I agree that you should speak to the supervisor of midwives and see if you can get someone else involved in your care. I personally think that having midwife (or consultant) care from an individual who gets to know you and whom you can trust is hugely important.

jessplussomeonenew that's interesting you feel like I do as we're in the same boat (except I wasn't even close enough to labour for them to try induction). Why do you think you'd have a section at 37/38 weeks? The green top guidance AbbeyRoad linked to seems to talk about it being planned for 39 but do you think a history of HELLP would bring it forward or just a reoccurrence?

Perhaps emsyj I just need to listen to Ewan the sheep? I find that more hypnotically relaxing than the proper stuff.

I saw the midwife last night. True to form she was half an hour late and talked at length about her holiday/grandson/life so the appointment overran making me late for dinner which was a bit awkward as I couldn't explain where I'd been. She didn't express any opinion on birth options save to say that the hospital with a birthing centre was out as I'd be consultant led. I feel happy about my ability to manage her/our relationship. My biggest concern was that she would deny/minimise my history but she didn't do that at all. Although her breach of confidentiality is unprofessional I'm honestly not that bothered by it, I was always more annoyed that she seemed to be suggesting I was making it up/over dramatising it.

No professional advice on the 37/38 week thing, but my thinking is that it would be safer because of the risk of HELLP recurring. It was picked up at 38+6 last time, plus there was some growth restriction going on probably from about 36 weeks (was estimated as 50th centile then, but born at 9th) so I'm keen to minimise that. 37 weeks being term seemed reasonably safe. I know that if you get HELLP again it's generally less severe and develops later but would prefer not to take chances.

It sounds like you have plenty of time to consider your options - don't get too stressed just yet

Your MW can only discuss options with you - it is NOT up to her how you end up delivering.
Ask for a consultant appointment, or even for a debrief regarding your last delivery and why/what happened.

An elective CS is an entirely different animal from a rushed emCS or a crash section.
VBAC can be a very lovely experience too, provided it is what you would like.

You need to be fully informed about the risks and benefits of both options, then the final decision ought to be up to yourself.
Do consider that even after the best CS in the world, you will go home with a newborn to look after AND an older child.... (this swung the decision towards VBAC for me).

Thanks PacificDogwod. I was up and about pretty quickly last time although I know there'd be no guarantee I'd have it so easy on a second section. I am well supported though so probably have the luxury of options I might not have as a single mum or someone without family nearby.