Once a c-section, always a c-section?

[clucks]

I had an awful time with my first delivery as contractions would be intense and then disappeaar completely and come back erratically, this went on for 4 days after what was my waters breaking but midwives mistook for show. Anyway, foetal distress was detected and I had an emergency c-section. The baby was covered in meconium and did not have a very high agpar score. The whole thing was awful, the recovery the worst part of it. I had visions of being an earth mother and delivering naturally etc. etc.

This has left me wondering if I am anatomically unsuited to natural delivery (pregnancy was a sail). Should I try again or plan a c-section or even bother with a 2nd child. I would be grateful for any advice. I feel a bit selfish planning my family around an unwanted abdominal wound. Anyone else with similar experiences?

I couldn't comment on your anatomical suitability, clucks, but it's not surprising that your recovery was so bad after labouring for 4 days and then all the anxiety about the baby on top of the actual section - what a horrible situation - I hope the baby is fine now?

An elective section is different altogether though, recovery normally much faster. Did you get any feedback at the time about what caused the difficulties, or have you spoken to anybody about it since?

You may well be able to have a "trial of labour" for a limited and strictly monitored period, to see if things progress better next time, and it could all go fine. Or your obstetrician might think there is too much risk of the same thing happening again and recommend an elective section.

Anyway for what it's worth I've had 4 sections, the first was semi-emergency (distress detected before labour started but baby OK anyway), and apart from my initial disappointment and feeling of failure for not doing it "properly" I haven't had a problem with any of them.

Poor you clucks. This is a tough decision for you, compounded by the awful time you had last time. To really comment, I'd need to have seen your labour notes fully, to see exactly what happened. How dilated were you when you had your caesarean section? Did you have a hormone drip (syntocinon) to regulate your erratic contractions? What position was the baby in? All of these things can contribute to the path of you labour.
Just because your body behaved in this way first time around, does not mean it would do so again. You could contract really well, and deliver normally - sounds like you suffered with some incoordinate uterine action in your first labour, which can often be resolved with a hormone drip if necessary.
Anatomically, I haven't read anything to suggest it would be better for you to opt for a caesarean section this time. As janh suggested, you could go for a 'trial of labour', whereby you labour yourself, but are closely monitored. Should there be any cause for concern/delay, a caesarean section is considered much earlier, in order to prevent repetition of your last experience. Of course, you may not even want to consider a 'trial of labour', and that decision is yours - noone went through what you did.
There is absolutely no reason not to plan a second child, if that is what you had envisioned - things may well be totally different second time around. If not, as I said, this would be acted upon much more quickly. Trust me, people do understand your concerns, and should you get pregnant again your midwife and obstetrician will want to know about these worries you have - it makes for a much better pregnancy/labour for you. Good luck

Havind one C/S does not commit to having another second time around if the factors present for the first one are not there. Having a second section does though.

In many cases here is no reason why there should not be a trial of labour as described by janh.
You won't know if you don't try

It must depend on the reason for the first c/section. I was born c/section due to foetal distress (70's) and my mum went on to have a 'normal' delivery with my brother no problems at all.

I've done it almost every way possible!

No 1 was in posterior position and delivered under epidural with episiotomy and ventouse at 36 weeks.

No 2 was delivered by emergency c-section at 32 weeks due to me bleeding heavily because of placenta previa (placenta over the cervix). They had to wheel me kicking and screaming into theatre because I was desperate not to be knocked out even though it was medically unavoidable.

No 3 popped out of her own accord with nothing more than a bit of gas and air to help her along. She came along at 38 weeks and had looked breech at my last clinic appointment so I was planning on a c-section under local anaesthetic if necessary but wanted to avoid a general at all costs.

Nothing is guaranteed in this game but if you discuss your wishes with the midwives they will try to follow them if appropriate. Your problems first time round could have been hormonal or due to the position of the baby, not necessarily the shape of your body. Don't let your experience put you off having another baby.

I am very grateful for the obvious expertise here. Janh, the trial of labour is something to consider, though I hear you have to have an epidural so there's not time wasted should you need a section afterall. Baby is fine thanks and almost two.

leese, My maximum was 2cm dilated, they got as far as putting in a venflon for a hormone drip and then had this show/meconium discussion between the midwives and the obstetrician. The midwives were convinced I was leaking meconium stained waters, the obs scanned me and said there was plenty of water, go it alone. The baby's position was good, loa last I heard but I understand this can change.

Mears, thanks for the encouragement, I would like another child but I need to get a few things off my chest after last time round, I may pay for a private opinion from a consultant (admittedly I'm uncertain for its value).

I do feel that I'm whingeing a bit but honestly, I think I could handle tears and pain a bit better than the incapacity of recovery and infection etc. etc. also the stress affected my breastfeeding and I feel that I failed on that front too. All in all I just want to do 'better' next time round. Also being in my thirties, time is precious. I do sometimes wonder if this has anything to do with it.

Are 'neurotic, ageing, educated' mums more likely to be rubbish at delivery.

Clucks,

Can you get an appointment with the consultant who you were booked with last time to go over your delivery or have you moved? In my neck of the woods you could do that for free. Sounds as though you need a good de-briefing session. Good luck.

Mears
We have moved to SW19 from Guys, but I never saw the consultant last time round. Apparently it was a particularly bad month for them, merger or something. I did have a Harley street guy (waste of time) as I was having bleeding 3 months post-op but he just wanted me to go to the Portland or whatever its called, I must look very rich.

I will ask for a referral but I'm mildly embarrassed about being demanding of attention and worried about getting labelled a nutter, in the nicest possible sense. This website has taught me more about child issues than any medic/HV. THanks again

Clucks,

You won't be labelled as a nutter. Obstetricians and midwives are here to noy only to assist women giving birth but also to allow them to debrief.

We have had women actually come and discuss delivery with the senior midwife of the labour suite prior to becoming pregnant, because of previous experience. One particular lady had had an emergency C/S last time round and, after discussion with her consultant she came to discuss things with the senior midwife because she wanted to be able to have a low technology labour next time round and to use the pool in our midwifery unit. Although the outcome cannot be guaranteed, this woman felt much more ressured about embarking on a pregnancy knowing that the maternity service would do all it could to assist her to get the experience she wanted. She was also made aware that sometimes things happen in labour you don't expect and she was prepared for that and had a greater understanding of why things happen the way they do sometimes.

For a trial of labour you do have a say, and you don't need to have an epidural if you don't want one. On the one hand it can be easier just to get it topped up for C/S if another one is needed, but on the other hand being mobile can be more advantageous. Hope that is helpful.

Clucks, I can really sympathise. I really wanted the whole natural thing. Yoga antenatal classes, no pain relief, water birth etc etc, and I ended up with an emergency c-section too, and a very long recovery time - months and months. All very disappointing and shocking and painful.

But then I had a 2nd baby with no pain relief, the 'natural' birth I'd wanted (without the water). I have to say it was bloody awful, zillions of stitches and a really long recovery time too! But I was glad that I could give it a go, but then if I had a 3rd I may consider elective caesarian. Who knows?

I definitely
-wouldn't let your first experience determine what you do the 2nd time round, especially not to determine whether there even is a 2nd time. Your experience most likely will be totally different.

-WOULD get an appointment with whoever to get a debrief. I didn't and really wish I had. I didn't even know you could do such things, and it would definitely have helped to have had some answers to all the questions.

Good luck. (Btw, I'm wondering about a 3rd because I still don't feel I did my best! Maybe third time lucky - or do you always end up thinking that next time you'll do it right/better?)

Mears

Thanks, I do feel more normal about my anxieties now and will ask the GP for a referral. It's good to know that other people have benefited from a discussion.

Monkey,

I am glad you haven't been put off a third and I for one would award you lots of brownie points for having done it both ways. we need more heroines like our mothers. My 5'2 mother gave birth at 13 to a 12 pounder and her most vivid memory is the blood splattered white coats standing over her rather than her lovely new daughter. (not me btw, I was 8 pounds)

Monkey,

Definately you would have a better experience second time round on the 'natural' route because you have 'proved yourself'.
Well done. even though it was not what you totaly hoped for. It definately gets more efficient each time you do it - have babies I mean of course

Hi. I know this is quite an old topic, but hoping someone might know something about my problem. I had a c-section with my daughter,in Oct '00, as she was coming ear first. I had had an epidural in place during labour, but found I did not get total pain relief. When they gave the strong top-up for the epidural it did not take well, and I could still feel them when they were pricking me to see if I could feel things, and in the end they had to do a spinal. I am now 6 weeks pregnant, and would like a vaginal birth. I have been told bye several people who have attempted a vbac that they had an epidural in place just in case they needed a c-section quickly. what worries me is that if the epidural doesn't work properly again, like last time, then is it worth having one in place during labour? What would happen if the epidural did not work properly and I needed a c-section?

Well I'm no expert, but I had a c-section 1st time due to undiagnosed breech & had vbac next time. The doctors - & believe me I asked many) said that there was no reason the next baby would be in a funny position as there wasn't anything mishapen about my innards (they didn't quite phrase it like that) & the breech was just one of those things.

Every one of them also said there was no reason why I couldn't & shouldn't have a vbac & there was never a suggestion of an epidural just in case. I'd check there was no reason for the awkward position & if it was just chance. Maybe they could check poistion just before /during labour & if it's in a good position, surely the epidural would be purely whether or not you wanted one, rather than 'just in case' hth & good luck

I'll have to ask like you said about having the epidural. The awkward position was something that happened by chance during labour, as dd was in perfect position until they started monitoring me, and she didn't like it and decided she'd do a full turn (two weeks overdue aswell, so there was a lack of room in there! lol) and that's when she got herself into a funny position. Hopefully a vbac will go well for me

I had a VBAC 6 weeks ago and am thrilled that I pushed for it as vaginal birth is so much better than a c-section imo. I had the birth in the natural birth section of the hospital and had lots of help and encouragement from the head midwife there. The way she explained it to me is that the danger in a vbac is the possibility of rupture at the c-section scar tissue in the uterus during labor. The best way to monitor for this is to do constant monitoring during the labor. However, in order to do constant monitoring you need to stay still. The best way to keep you still is to hook you up to a epidural. However the catch is that all the research indicates that women on epidurals are much more likely to end up having c-sections because they aren't walking around. After researching I decided that the risks involved in a c-section are higher than the risks involved in a scar rupture (even if there is a rupture, it doesn't necessarily mean problems for the mother/baby). I had only gas and air and was only in labor for 5 1/2 hours (vs. 40 hours the first time). I did actually have a haemorrage after the birth but it turned out to be unrelated to the c-section.
In your case aimee'smum, if you did need a c-section, it could be done under a general anaesthetic. Just make sure that the midwives are aware of your epidural problem when you get to the hospital so they can make any preparations necessary.
There is a lot of useful info. on VBAC's at www.parentsplace.com

Aimeesmum, the risk of scar rupture is VERY low in NON induced labours... if you want more info, I can give yu loads !
There are plenty of VBAC around... and loads didn't have an epi !

Aimeesmum - do not worry yourself unnecessaily about an epidural for labour. You may find that you do not need one. There are advantages to being mobile in labour and it is possible to continuously monitor a baby when you are standing.
There is no longer a need to have an epidural 'just in case' you need a C/S again because a spinal anaesthetic can be given if need be. It has a more dense effect than an epidural and has therefore better pain relief.
If you do decide in labour that you need an epidural, the anaesthetist will read your previous notes to see where the problem lay. It is unlikely that you would have the same problem.
Sorry this is a bit garbled but am rushing to get my eldest ds bullied into revising for his exams.

pupuce - you say the risk of scar rupture is v. low in non induced labour - does that mean it is higher in induced?
I had to be induced at 37 weeks due to obstetric cholestasis and ended up with an emergency c-section 44 hours later. If I get the same thing again (90% likely) is it worth trying for an induced VBAC?

Like I'm even thinking about number 2 yet!

I was told that they won't do an induction 2nd time around if you had a c-section 1st time.

prufrock, my consultant told me risk of rupture during labour following 1 c/section is 1 in 200 - and she wouldn't let me go more than 41 weeks or push for long..which is fine by me!

Yes you can get induced if you had a c-section the 1st time around (not ideal but some women who do not want a c-section and are 42 weeks.....) ... and yes it increases the risk of urterine rupture... I'll see if I can fetch some numbers.
A very good book on this is "Silent knife", it is PRO VBAC... so if that's what you want I would definitely recommend reading it !

Here is more info....
Basically the 1 in 200 number Bundle quoted is not a reflection of what I have read many times (but I have heard it !!). Here is 1 study (I can dish out more but not tonight)...

Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000.

Obstet Gynecol 2002 Oct;100(4):749 Related Articles, Links

A 10-year population-based study of uterine rupture(1).
Kieser K, Baskett T.
Department of Obstetrics and Gynaecology, Dalhousie University, Halifax, Nova Scotia, Canada
OBJECTIVE:To review the incidence, associated factors, methods of diagnosis, and maternal and perinatal morbidity and mortality associated with uterine rupture in one Canadian province.METHODS:Using a perinatal database, all cases of uterine rupture in the province of Nova Scotia for the 10-year period 1988-1997 were identified and the maternal and perinatal mortality and morbidity reviewed in detail.RESULTSver the 10 years, there were 114,933 deliveries with 39 cases of uterine rupture: 18 complete and 21 incomplete (dehiscence). Thirty-six women had a previous cesarean delivery: 33 low transverse, two classic, one low vertical. Of the 114,933 deliveries, 11,585 (10%) were in women with a previous cesarean delivery. Uterine rupture in those undergoing a trial for vaginal delivery (4516) was complete rupture in 2.4 per 1000 and dehiscence in 2.4 per 1000. There were no maternal deaths, and maternal morbidity was low in patients with dehiscence. In comparison, 44% of those with complete uterine rupture received blood transfusion (odds ratio 7.60, 95% confidence interval 1.14, 82.14, P =.025). Two perinatal deaths were attributable to complete uterine rupture, one after previous cesarean delivery. Compared with dehiscence, infants born after uterine rupture had significantly lower 5-minute Apgar scores (P

Having started this thread before my current (2nd tentative pregnancy), I am getting a bit scared again.

At my recent booking in appt, new m/wife told me that it sounds like I had non-established labour last time, complicated by foetal distress (so couldn't be induced). If this means hormones were too dodgy for labour to become established and I can't be induced this time (because of previous c/s) then it sounds like I have to have another one.

I hope someone can make sense of the above. What I am wondering is if hormones were dodgy, are they likely to be dodgy again. (hate that word but it describes the whole birth experience, for me).

I would be very grateful for renewed advice, as I am seeing consultant in Jan and want to seem well-informed. Either natural delivery or elective section, is it too much to ask??

By the way, Sofiaames, you are a very cool customer and we are well-proud of you.

What I meant in that penultimate paragraph is that I wish to avoid an emergency section. I would read the silent knife book but am scared it might give me sleepless nights.

Already am scared of everything with this pregnancy. and I was so cool and mellow last time. Of course Mears will agree the more neurotic you get, the more likely you are to have loads of intervention. Just can't help it..