WWYD? Birth choices

[TheLegendOfBeans]

Hello all

I'm having baby #2 here in the Netherlands in October.

DD was born in the U.K., after a 100 hour labour junior doctors strike added a day! thanks to a failed induction, being rigged up to a monitor for days plus my cervix being clamped shut they couldn't even break my waters.

I had a miscarriage a few months later resulting in an op as my cervix was clamped shut.

Are you seeing a theme here?

Anyway, every pregnancy and birth is different and I thought I wanted a VBAC this time. The doctors would like to deliver at 41w meaning if baby isn't here one week after EDD it's gonna be a CS.

I was initially well up for a VBAC but I'm actually starting to go off the idea after I posted on a recent thread about my fantastic CS recovery first time round and was reading about quite a lot of vaginal birth injuries.

If you were in a position to choose, would you opt for a CS at 40 weeks meaning you know exactly when baby will be here and feel like you're in known territory OR would you give yourself the opportunity to deliver vaginally (no more than a week late) and toss a coin between not being sure of how physically damaged you'd be after?

Point of note worth making: in the Netherlands every new mum is given a maternity nurse to come round for a few hours every day for 7 days after the birth. They will do anything and everything from checking wounds to taking older children for a walk to making you tea. Worth considering in terms of recovery.

Im in a similar boat where i had such a traumatic birth 2 years ago that i have the option of elcs this time and Im not sure which to do. I know that 100% i do not want to be induced. Ive been asking around both on here and friends/family and I think im going to discuss elcs as a proper consideration at my next consultant apt. Because i think half the recovery process is to do with being absolutely shattered from the labour process which people tell me you dont get from elcs. I only have 2 real doubts about it; hiw long i will be in hospital away from dd and (very vain of me) its what the damage to my abs/scarring will be like. I will be interested to see more points if view on this. But i think at the moment i am leaning towards elcs.

I had an emcs with my first pregnancy due to failure to progress and Ds showing signs of distress. Like you my cervix refused to budge despite hours of the hormone drip and near constant contractions.

I would definitely opt for a c-section with any subsequent pregnancy as, due to the failure to progress, I'm pretty sure I would end up with a failed vbac and another emergency section. That, to me, would be the worst possible outcome so I'd rather deal with the section recovery which I could plan for if you know what I mean.

Could you talk to your midwife about the chances of a vbac being successful in your particular circumstances? I think that would really influence my view. Best of luck whatever you decide!

Just to add, as I already have the c-section ledge and scarring from my first birth I think I might as well leave the natural exit alone and not risk damage to that area as well, even if it means the tummy is a bit more of a mess! Probably quite vain of me but it's a factor for me!

Sunshine I may well actually copy and paste your first response in my letter to the gynaecologist as it sums up absolutely perfectly what I'm trying to say.

Fairy just to say that with my previous CS my ledge went away after 9 months and my scar went small (3 fingers wide) and pale within the same time fame.

Luckily the incision was made under the bikini line so my massively dense pubic thatch its covered by, well - pubes, basically x

Go for it. It sounds to me as though you're now pretty decided on the section so best of luck in getting that arranged. I hope you have a great birth experience this time round!

The thing that concerns me the most is the idea of "missing out" on labour.

I also want to go on to have another two children and I hope a CS wouldn't damage my choices to go for that eventually.

But overall, the fear of a traumatic vaginal birth meaning I'd be shit scared to event entertain delivering a third child tips the balance a bit.

Im so glad no1 had a dig at me for that vain comment! Thats good to know thanks both! Good luck legend

The thing that concerns me the most is the idea of "missing out" on labour.

Please don't worry about this.

Firstly, you haven't missed out, you had 100 hours of it. That's at least three labour's worth

Secondly, you'll have incubated a baby for nine months, and your only job is to deliver the baby as safely as possible, it doesn't matter how that delivery happens.

I had an EMCS with DD, I won't be having another child, but if I were to, I would absolutely totally and unquestionably have an ELCS. Even with a toddler.

Of course, different folks/ different strokes. It's your choice, but there is no shame in an ELCS.

Another 2 children? Can anyone advise the suggested max number of csecs? Isn't it 2 or 3?

I feel like I've experienced as much labour as I ever need to and you've got about 85 hours on me!

If someone could guarantee me a reasonably straightforward vaginal birth next time I'd be willing to give it a go but I can't see why my cervix would suddenly play ball next time when it didn't last time. I think the reason for the emcs is really key. If I'd got to 10 cm and Ds has got stuck or something then I reckon I might give it a go but 15 hours of labour (10 on the drip) to get to 0.5cm dilated? Not risking that again!

Hmm, thinking entirely hypothetically here as I've been lucky enough to experience 4 straightforward vaginal births & dh is getting the snip after this dc no matter how s/he arrives. I'd go straight for a section. I don't really know why, possibly knowing what I'm in for op & recovery wise.

I think the official guidance is 3 sections but it does vary case by case. I have one friend who was told if she wanted a 4th it would be a possibility (she didn't) & another who was told a 3rd pregnancy would be risky (again she wasn't planning another anyway).

Honestly...if I'd already had a cs I'd be reluctant to wreak my vagina.

In your shoes, I'd seriously look into the implications of a c-section for your ability to bear as many kids as you want. To me, that's the only thing that would make me hesitate.

I was given pretty much exactly the choice that you described in the bolded part of your OP and I chose an ELCS. I'm very glad to be dealing with the known unknowns of a CS as opposed to the unknown unknowns of a vaginal delivery, so to speak.

I'm sort of in a similar position. First was ELCS for breech and 21 weeks with the second. We're planning to stop at 2 children, if a 3rd surprise baby happens we'd be fine but that's it. So CS is not an issue regarding family size.

I've never had labor so it's a complete mystery how it would go for me. Only "data" I have is my mother who had two EMCS including one failed VBAC. I also know for sure I have a narrow pelvis and fibroids. So as I'm getting closer to d-day with this pregnancy I'm thinking, do I want to take the risk of failed VBAC/EMCS? Or a delivery with loads of interventions e.g. episiotomy, forceps? I already have an awful c-section scar (formed a keloid), that plus a torn up vag doesn't seem very appealing

Just as an aside both my OB-GYN and another senior consultant at a London hospital assured me that you can easily have 4-5 c-sections with the way the procedures are done nowadays.

I'm planning an ELCS after previous loss during vaginal delivery and similarly hoping for a large family, so this was a concern.

BeachBaby

I'm very glad to be dealing with the known unknowns of a CS as opposed to the unknown unknowns of a vaginal delivery, so to speak.

EXACTLY this. I'm not scared of labour/too posh to push, I just know that the chances of me being quite frankly scared for the baby if there has to be a true "emergency" section means that I may end up with PTSD or something after the event: I had PND with DD and whilst it was dealt with swiftly the after effects leave their mark.

Bisquick good advice and matches some I've seen. The Dutch docs are very hand off re recommendations but at the same are quite risk averse re future butts post a second CS. Confusing. Also I'm so very sorry to hear about your loss my love xxx

Thanks TheLegendOfBeans - good luck to you hope the delivery goes off well!

I'm about 18 weeks along in the second pregnancy now, trying to just keep fingers crossed and anxiety at bay!

If you have a second section you'll be less likely to have option of vbac (think it's actually contraindicated?) next time and having more than 3 sections (whilst obviously doable) is considerably higher risk (in terms of risk of scar rupture/abnormal placental adherence and contraction of uterus post delivery). Just something to bear in mind if you're planning on 4 children, not trying to scare you, just good to have all the info at hand. xx

I had an emcs for the first baby but then went for a vbac for the 2nd as we wanted at least one more after that. If you definitely only wanted two I would get an elcs but I think a Vbac keeps your options open. But it also depends what consultant thinks of clamped shut cervix. Emcs is the worst of all worlds.

I think worrying about delivery method for future kids is the wrong way around. Failed VBAC leading to EMCS is very stressful and can be dangerous e.g. fetal distress, uterine rupture. Opting for VBAC is no guarantee that A) you won't end up without EMCS anyway and B) you will actually be able to have 2-3 more kids even if you want to.

My cousin has had 2 EMCS (incl a failed VBAC) and in the second case her baby was NICU for a month. In her case an ELCS would have avoided this completely as it was due to the baby's size.

it also depends what consultant thinks of clamped shut cervix.

Answer:

"Every birth is different"

🙄🙄🙄🙄🙄🙄🙄🙄🙄🙄

Which is frustrating as whilst nothing can be predicted there is such a thing as probability!

To answer a PP, the guidance on how many CS's is "safe"; it varies from 3-4 it seems. Again, it's tricky. Plan is to have last baby at 40.

I'm 35.

Ps: four kids is the plan; it may not happen but I don't want to eliminate the option. Hm.

That is infuriating as a response! Whether a vbac is successful or not must surely have some connection with why the c-section was carried out in the first place?! If it was because baby was breach then I can see there being a good argument for a vbac. If your body has previously failed to do what it needs to do to enable a successful birth surely that has an impact on the chance of a successful vbac?!

Are you in a position to get a second opinion Beans? I'd be tempted to get one if possible.

TheLegendofBeans I agree that based on the reason for the first CS they should be able to make an educated guess. That's very annoying.

I'm not in the U.K. at the moment and the country I'm in has a very risk minimizing attitude. They tend to promote c-section over VBAC and protocol during a VBAC is to rather quickly rush to an EMCS if there are even small signs of distress. So in my case even though I'm a good VBAC candidate (first birth bc of breech) I feel the chance of EMCS is high.

As for number of c sections - the fact is that there are women who do end up pregnant with a 4th or 5th child, either due to planning or happy accidents. Risk goes up but I would actually ask for statistics on outcomes for women who have 4 children all c-section. I have a feeling they are exaggerated. I personally know a woman who has 6 children 3 c-sections including a natural VBAC birth of twins.

In both of your previous experiences you were induced - which may mean that your cervix stayed shut as your body simply wasn't ready to go into labour. They usually don't induce VBACs due to increased risk of rupture so who knows what would happen if you went into labour on your own.
I've had one vaginal (ventouse) and two elective cs for breech. Recovery after my second cs was more difficult than first - although recovery after episiotomy was no walk in the park either!
I am currently pregnant with my 4th and don't know what I'll do yet as I don't know what position my baby will be in. Consultants are happy if I want to go for VBAC and I can stay active/go in pool as they have wireless monitoring. I think I'm just going to have a frank discussion with my consultant nearer the time and take their advice as I trust them and they have always been very evidence based/empowering.
My post isn't much help I know! I think it's a very personal choice and you have to weigh up the risks and go with whatever risks you feel most comfortable with. I've learnt from experience that you can't plan these things too much...all mine were supposed to be home births!