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?

clucks, don't read that b**y book, just take deep breaths and tell your consultant you are scared about the possiblity of an emergency c-section. If I have to have another c-section, I want it to be planned & calm. now eat some chocolate.

Dear Bundle,

Just had some chocolate covered brazils. very nice. what a nice person you are. don't mean to trivialise this issue, but chocolate DOES help.

brilliant, clucks. what's your due date? My consultant says it's reasonable in obstetric terms for me to go for a vbac, but I said if I suddenly felt strongly about it I would tell her and I'm sure she'd listen to me because she knows I'm aware of the risks both ways (and not just too posh to push). although my dd's birth was an emergency it was handled well and I have a very neat scar

bundle,

I have a pretty cool scar too, but the experience was poor as you will have gathered. My due date is 17/4. and am seeing the consultant in January. I will try to come across as calm and reasonable and take along a pack of maltersers if things get nasty.

Seriously though, someone needs to talk through the hormone thing with me. Having strange dreams about medical matters don't help.

where do you live clucks? have you met the consultant before? (had some chocolate milk this afternoon, mmmmm)

Bundle
I know what you are going through. I had an emergency section with dd and was terrified of ot happening again. My consultant told me of the risk of rupture, and that I would HAVE to have an epidural in case an emergency was needed again. I got in quite a tizz about it all and had an elective section.
This was an entirely different experience from the first time. The nurses were brilliant- lots of jokes, choice of music( ds born to Robbie!)lots of memories and being able to cuddle ds immediately- a stonking 9lb1. I recovered much quicker and was home in 3 days. Couldn't bf, but that's another story!!
Based on the facts that you gather, you can make the choice best suited to you. Good luck.

Hi. I found that my recovery took a quite a while, although me scar healed really well. I'm just not very good with pain, and make a mountain out of a molehill. I guess the main reason I would like a vbac is for further pregnancies, and the risk of infection of the scar with two or more c-sections. My first c-section was relaxed, as baby was in no distress, so there was no rush for it to be done quickly. This doesn't make me want to repeat it though! I remember teh doctor who performed the c-section saying that there was no reason why I couldn't have a vbac next time, espcially as I had dilated well, and as I said earlier it was just one of those annoying things that couldn't be helped when dd started coming out ear first. It still makes me worry though. I guess as I progress further in to my pregnancy I'll get more info from my midwife...thanks for all teh advice, it really helps to know there are people out there in teh same position.

Bundle/clucks... it isn't a scary book I promise... it's just a book that explains how women can have VBACs (it's American where they are so easily convinced once a C always a C)...
Clucks what do you mean your hormones were dodgy ?
Mears is the MW not me but I can't see why you can't have a better experience next time !
I make no secret of the fact that I feel we need to believe in our abilities to have a natural birth and it sounds like you did believe this... so you had a bad (very bad) experience the first time. Did you dilate at all ? Did you have (serious) strong contractions at any point ? Once your uterus has done some work once, it is usally much more efficient the second time around.

This part of my post is not meant to offend anyone who has had a ceasarian and didn't want it or is pro-c.... I feel I need to write this for those of you who want to know. I think we all have a right to know.

I have talked to people like Dr Michel Odent (birth guru) and Sheila Kitzinger about cesareans, I have been a doula at 2 c-sections... I feel so strongly that this not the best way for the baby to be born (except if there is a medical emergency of course). There are many things that you can do to help yourself have a positive experience of a vaginal birth... these things are not always discussed or taught because many people don't know - even though there are books and websites and experts out there !
I spend time debriefing bad experiences with some mums... and often we can see how she can avoid such a repeat - there are no guarantees of course... but a c-section is not the way babies were meant to be born, they do not get through their placenta the massive release of oxytocyn and endorphins that the mother would naturally make in labour... these are important hormones - in the wild (and yes we are not animals!) , many species reject their off-spring when they are not born naturally because they haven't produced the hormone to love them... of course we are more evolved, and of course a mother of a cesarean baby will love her baby... but their are long term implications for such "deprivation" of hormones. There are now databases which put together studies of illneses and diseases to see if there is indeed a correlation with the way the person was born (induction, forceps, cesarean,...) this is why more and more people are speaking out against ceasareans... and by the way -at the end of the day... a ceasarean is not safer for the mother than a VBAC. Even your consultant will tell you that.
Sorry - I hope I haven't offended anyone.

Clucks - like pupuce I am a at a bit of a loss about this lack of hormone business. Each pregnancy is totally different from the last. Just because your last labour did not establish well does not mean that will happen a second time. It sounds as though you were in hesitant labour first time which means that you did not go into labour properly. This stage is very difficult and in some ways is more painful that being in established labour because it is so demoralising to be in a lot of pain but not getting anywhere. If the baby had not shown signs of distress you would not have needed a C/S at that time. There does not seem to be anything in your history to indicate that this would happen again.
As a midwife I would encourage any woman who does not have recurrent problems from a previous C/S to have a VBAC. However, if you went 2 weeks past your dates with no sign of labour, then you might have to think seriously about induction because that is a risk with a previous C/S. HOWEVER, I have seen women having a normal delivery being induced after a previous C/S. You will need to be guided by your consultant.
Nothing ventured, nothing gained. Good luck

Message withdrawn

I have to say, I loved my little boy before he was born. And I did feel a huge rush of joy when he arrived safely (by c/s) as well, particularly as we would both have died giving birth vaginally and even a cs was slightly risky (complete placenta praevia). And although a VBAC is no more dangerous than giving birth for the first time, it is slightly more dangerous for the baby than having a second c/s, according to a new Scottish study. It's not a huge risk at all, but statistically it is very slightly safer for the baby to be born by c/s if the previous birth was c/s. I think we should remember that they can be very much the best option - not for everyone - but definitely for some mothers and babies.

I may be wrong (but I don't think I am ) Ceasareans are riskier (higher death rate) for the mother than VBACs.

To my intense irritation I can't find the study reference right now, but in VBAC the de. Of course this is from a very low base so the actual figures are small. Also, second births are normally safer/more uncomplicated than first ones, so it only raises the risk of a baby dying to the same as in any first vaginal delivery.

However, in breech deliveries, four times as many babies die in vaginal deliveries as in c/s - and in the world's biggest study into breech births there was no adverse outcome for mothers in having a c/s (ie no increase in death or complications). This is probably due to the fact that elective c/s are very safe - much safer than emergency c/s.

Just making the point that natural isn't always best.

Um, don't know what happened there... I meant to say that the death rates for babies born VBAC is double that of babies born by C/s after c/s - but that the doubling is from a very low base as second births are safer than first. It means you have the same risk of losing your baby as anyone having a first child naturally.

So if and when I get pregnant again, and if I get obstetric cholestatsis again (which necessitates delivery no later than 37 weeks) Is it worth trying for a VBAC, given that last time I was still only 1 cm dilated after 44 hours and the max dose of prostoglandin. I realy would like to experience a natural birth, but don't want to go through another failed induction.

Found the study you referred to Aloha through Google. Interesting response at
\linkwww.parentsplace.com/expert/birthguru/articles/0,10335,243387_440547,00.html\this{}

Sorry - couldn't get link to work.

Prufrock - The answer to you, in my opinion, would be that if you labour spontaneously you could have a trial of labour. If you needed induced due to a recurrent problem , it may well be best to have a repeat C/S.
Your consultant is the person to ask though.

By the way I typed the link correctly but I see it has come out differently despite previewing the message.

www.parentsplace.com/expert/birthguru/articles/0,10335,243387_440547,00.html

It definately works cutting and pasting.

Mears, thanks for that (I knew I wasn't imagining it), though the article was hard to read due to a large ad appearing in the middle of the page (possibly a problem with iMacs only! I couldn't find he original news story at all though. I wondered if they were sure about the definition of trial of labour. Anyway, it does seem as if any increased risk is very small (which I did say), unlike that for breech births. And the comment that first c/s was the problem was of little relevance if the first c/s had already happened for whatever reason.

Aloha ... let's not confuse all...

Everyone will agree (I presume) that in some cases a caesarean is safer... and sometimes there is no choice... what I am arguing is the fear that some women have after having had a C that they won't be able to have a VBAC.... of course they can and they should ... unless of course there is a medical problem. Some women really want a VBAC and get a very cold response from a consultant, others had such a bad first labour experience that whilst they want a VBAC they are worried (understandably)... Clucks is an example of that.
Bloss tried VERY hard to have her VBAC and couldn't but she feels good about her efforts and she should. (Bloss - for what it's worth... and we have discussed it on other threads I remain convinced that you probably have some sort of issue with the way your pelvis is set up... I have a similar problem)
BTW - you will find most MW (at least the ones that I come accross) saying that yes it is said that C is safer for breech BECAUSE the art of delivering breech vaginally is getting lost ! At our maternity unity 1 breech out of 2 is delievered vaginally. It is a C only if the medical team feels it must be a C (for some specific reason not JUST because it's a breech) or if the mother insists.

May I ask the midwives a question?

Is it true that midwives/doctors (and other medics, the category I fall in) have a much higher than average c/s rate?

My GP (nice, understanding male) claims it is due to lower pain threshold and being over-informed, as his wife had to have a c/section (she is consultant paediatrician). He still went on to encourage a VBAC...nice man, bit too honest.

I am interested to know if this is true. If any of you hot on stats know.

clucks, I'm sure I've read that too...a good friend of mine (former anaesthetist) had a breech first time round, so had elective c-section, and there wasn't even a question of VBAC for her second time around
I think she'd seen too many horror stories unfold and decided to go the planned route

Yes, I remember a survey being published a few years ago (can't rememebr where, possibly Lancet or BMJ) - also can't rememebr whether it was based on preferences or on actual c/section rates. I think it could be due to a number of things - excess paranoia (being too aware of things which might happen but almost certainly won't), or more likely, over attention by medics in the hospital (wanting to be extra cautious and unable to keep their mitts off). I'm a medic (not practising clinically, I hasten to add) but never advertise the fact - and had a very straightforward delivery with not a doctor in sight.

I find that very odd Pupuce. From what I understand it is now generally accepted medical protocol to encourage c/s for all breech births because it reduces the risk of death or disability quite dramatically. The Toronto Term study found that breech babies were four times more likely to die if born vaginally than through c/s, while mothers were NO more likely to suffer adverse outcomes by having c/s. The study also concluded that it wasn't due to lack of skill either as this applied also to midwife-led units and birth centres around the world. While obviously if someone wants VBAC and have no particular medical conditions that make it impossible that decision should always be supported and respected - but I'm sure for most women a healthy outcome for their baby is more important than their own emotional experience of birth. Women with placenta praevia aren't encouraged to have a vaginal birth because it is so dangerous, and I thought breech birth was now considered similarly.

I've read something similar - gp's/consultants tend to favour c/section whereas midwives prefer a vaginal delivery. The reasoning behind it was that consultants tend to get involved only when a vaginal delivery goes 'wrong' and so get a rather skewed experience of childbirth, whereas midwives see many more successful natural births which do not require the intervention of a consultant.

Clucks - I think Elliot has made a good point. Doctor patients tend to have more input from the consultant as a courtesy and where you have doctors, you usually have increased intervention. It is less of a problem with midwives because they tend to know what they want. There is the problem of 'knowing too much' for both groups but I am not sure if it has ever been researched.