Terrified they may 'make' me have VBAC.

[Paula1]

My second child is due 29/12/02, first was born by c-section at 38 weeks due to being breech. I have got an appointment in 2 weeks to talk to the consultant (who is new, so the midwives haven't really got a feeling yet for what she is like about these things). I have decided beyond all doubt that I want a second C-section (I know this won't suit everyone), does anyone have any idea of how likely it is/any good things that I can say to the consultant to ensure that 'I get my own way'?? The things I am scared of are that: I've never been in labour, so my body will treat it as a first, and everything will be really slow, my baby is due just after Christmas, what happens if I go into labour and need an emergency C-section during the Christmas holidays and there are only junior staff there? The thought of an emergency c-section fills me with horror. I also don't think I have got the right attitude of mind to face the hurdle that I believe VBAC would entail. Please don't all condem me, I'm really not 'too posh to push', just don't want to go through all the trying to fail and end up with my worst case scenario (emergency CS). Also, if the Consultant won't agree - what other options do I have, can I change Consultants? (and anyway, would one overrule another?) Go private - and if so where?

I'm sure I read a recent study that proved that if you have had one c-section then it is safer for the baby to have another. I can't find the study reference at the mo but will try to look it up. The safety of elective c-sections is very, very good. The safety of emergencies is less good so I completely understand your viewpoint and having one had one c-section I don't think you will have much trouble persuading your doctors that you should have the birth of your choice. Just make it clear how strongly you feel about this. Good luck

Paula, I believe consultants generally prefer to repeat a c-section, it's the mothers who want to try for a VBAC who have to argue, so try not to get too anxious about it.

They always schedule repeat C-sections early, to avoid the risk of you going into labour and getting complications, my last 2 (I had 4 altogether) were done at 38 weeks and then 37 weeks, so if they go for 37 weeks with you that would be around 8/12. Good luck!

Paula 1,

I can understand how nervous you feel at the thought of an unsuccessful trial of labour but have you thought of the positive side? You may end up with the best case scenario.

I delivered a woman yesterday labouring for the first time after a C/S. Her labour was 7 hours, she did not have an epidural or any stitches. She was absolutely delighted and is going home today.

Let me also reassure you that the hospital will not be staffed by junior medical staff at Christmas. The same level of consultant staff is available every day of the year.

I know that at our hospital a trial of labour would be encouraged because the reason for your last C/S was a breech presentation. We also have women in the midwifery unit using the pool if that is what they want. You must write down all your questions so that you are happy that you have all the information you need from your consultant/midwife.

If at the end of the day you are convinced that you do not want VBAC, then I know that in our area the consultant would agree to your request.

I have 3 friends who had emergency c-sections 1st time round. One went on to have an elective c-section (with a general anaesthetic after 5 attempts at an epidural) with her 2nd child, another had an elective c-section with no problems and the other had a VBAC at home and delivered a 10lb baby with no stitches.

The only one who had problems convincing the doctors of her choice was the VBAC so I doubt you'll have trouble with wanting an elective c-section.

The choice is up to you - read up about it so you know you've made an "informed choice" and can present your argument to your consultant rationally and calmly. She may try to put your mind at rest with regars to your fear of a VBAC but I doubt she'll force you into one!

The study was in the New England Journal of Medicine, and showed the risk of scar rupture was higher with labour than with c-section. However the real risk was not so much with normal labour but with induction, which is dangerous for anyone who has had a previous section and should be avoided. I really don't think you will have a problem getting a section if you want one. From the reports of friends who had them, the only downside is that you are in hospital slightly longer and so away from your first child. But my friend went home just two days after her section, so it really wasn't bad at all.

I had an emergency section with DS2 and it left me very bitter and emotionally scarred. I was desperate not to have another emergency section for no 3 particularly when she was suspected of being breech. I agreed to a trial of labour but asked for an epidural just in case. In the event, DD wasn't breech and labour was so short, less than 2 hours from being told that I wasn't in proper labour (even though my waters had gone and I was having regular contractions) that I had no help whatsoever, no time for an epidural and was delighted, though rather shocked. The recovery is much quicker after a vaginal delivery which means you can go home and get on with life much more easily.

Thanks everyone, I'll try not to worry any more until I've seen the consultant.

mears, I do love reading your reassuring messages. I think midwives are wonderful!

Here, here JanH - I think midwives are fast becoming the 'forgotten' professionals (at least in some parts of the country/big hospitals). Can you believe that at one time they were considered 'evil witches' burned at the stake for practicing their craft???! (Sorry Mears!)

They were often as drunk as skunks as well - better ease off the booze

Paula1 and Aloha - you might want to consider reading "Silent Knife" - it's an EXCELLENT book.
Aloha - in particular you might want to read this book to read what is actually meant by "rupture" of scar... and that VBAC is in reality safer than 2nd c-section !

A word of warning though : this book is pro-VBAC (no secret about that) - it was not writrten to encourage VBAC for those who want a 2nd c-section but for all those women who want one but get told off : once a C always a C ! It is full of very interesting information.
Mears/Leese - have you read it ? Any thoughts ?

I'd really like to read that book. Do you know who wrote it and where I can get it?

I'd really rather not read the book I'm afraid, i'd just rather they unzipped the same hole thats there already

Not sure this is really relevant but I'd like to get it off my chest. I have been told by several top medical people that a c-section is safer for the baby than a vd but not the mother. I was late with dd and they took two days to try and induce me. I asked for a c-section twice but they refused; in the end after labouring for 14 hrs dd's oxygen levels dipped and she was delivered after an emergency c-section under a g.a. She was in Nicu for 5 days and her kidneys were compromised and her brain scan was abnormal. Fortunatley all these have now resolved themselves but it could have been so much worse, and our time apart meant that we never managed to establish b/f which has really upset me and is obviously not good for dd. I really do feel quite angry about it. Before this happened I was really against c-sections but if and when no.2 comes along I will definitely be opting for an elective c-section.

It's by Nancy Wainer Cohen and Lois J. Estner, full title is
Silent Knife, Cesarean prevention and Vaginal Birth after cesarean.

I think it's an eye opener.... I had heard excellent reviews so chose to read it... some of the info is fascinating as I have said before.

You can probably get it via Amazon and maybe order it via a bookshop (it's a rather well known book).

I can't even quote parts of the book as too many are good ! But while I can understand where Ionesmum and Paula are coming from, I'd argue information is a weapon not a threat !
I am sure I would have had a c-section if I had not received the care from the MW that I received and for that I am forever grateful and will try to give something back by becoming a doula.

Ionesmum,

Should you have another baby I can understand why you would want another C/S. You experience does not sound at all enjoyable.
Something I think is worth highlighting is that your labour sounds as though it was linked to being induced. How many days past your date were you?
I think that many women do not realise they increase their chances of needing an emergency C/S when they are induced. It is frustrating for me as a midwife to see a huge induction list with the majority of them being for no good reason. Sometimes you ask women why they are being induced and they have no idea! We have a particular consultant who induces women just a couple of days past their date. In fact a woman I know is being induced by him next week on her due date with her second child. Her first labour was spontaneous, easy and lasted 3 hours. She wants to be able to plan things but he has not explained to her that the process may be far more painful because she will be getting pushed into labour when her body is not ready. I hope she goes herself before then.
The average pregnancy for Western women actually last nearer 42 weeks and if that was the date calculated we would have more spontaneous labours.
Going into labour yourself is a different experience from being induced. It's a pity you were not able to do that. Certainly most women who have had a previous C/S should be able to attempt a vaginal delivery second time around, but that prospect is much more possible when labour is left to start on it's own.

YES YES YES Mears - Thank you - it had to be said !

mears- I was 10 days' late. I have since read (on the AIMS site) that oxygen deprivation has been linked to the use of oxytocin. The wonderful obstetrician made it clear to us that he got dd out in the nick of time. If I had my time over I would have left it another couple of days and then stamped my feet until I got my c-section.

But my precious little dd is an absolute treasure, so I count my blessings!

Message withdrawn

Mears, Leese, can I ask your advice yet again?
I had an elective for persistent transverse lie last time and on day five my wound ruptured (down to small bowel) when they took out my stitches. I was resutured (luckily I was still in hospital, but only just, dh arrived to pick us up and found the way to my room barred by about 50 staff) but it took me a long time to get over it all mentally and physically. I can't decide which I'm more scared of now - attempting VBAC and having my wound rupture again or having another C-section and having something similar happen anyway. I did not enjoy the c-section experience much even before this happened, although all went fine during the op etc and the staff were great.
I have been told by midwives and the consultant that what happened to me is rare, which I am sure is true, but it might not be rare for ME. I have a medical consult at 20 weeks and although I know the consultant (and his dishy registrar!) by sight, I would not say he is a warmly reassuring sort of guy - just pleasant and with a good reputation. Do you happen to know if there is any research at all on follow-ups for women with wound ruptures? I'd be so grateful for any leads.

Marina - Silent Knife talks extensively about wound rupture. HTH

Paula1, a friend has just had a second C/S (elective) as she had an emergency one (only14m ago!) and was very ill afterwards. This time she has had a brilliant experience, less bruising and a free tummy tuck! If you really want a caesarian try and find out which consultant is most likely to be supportive (tere's always one) and get transferred.

Good luck, personally I'm too much of a wimp and whebn i was induced with DD a caesarian was my worst nightmare.

Mears, what you say about your consultant inducing 2 days after the due date is really scary. My first child was 5 days late then arrived naturally at a perfectly normal weight (7lb 6oz - not too big), then his sister was 6 days late, also perfect and a similar weight. I think that my 'natural' gestation length is probably just a tad longer than the 'accepted' length. It horrifies me to think that someone might have persuaded me to be induced with either of my babies - it would have been totally unnecessary.

I have a very long but regular cycle (around 36 days). Although I always stressed this, first time around my due date seemed to be calculated from my LMP on a 28 day basis. My son was induced 13 days after my due date.

Second time around, I knew the date of conception and at my first appointment with the midwide, told them my LMP was 10 days later than it actually was. Lo and behold, the baby arrived on the due date. I found being induced really unpleasant and was determined to at least ensure that this time, the calculated due date was accurate.

I was allowed to go 3 weeks (21 days) over due provided I agree to have a daily check after 15 days over due... mainly to ensure that the placenta was all right and baby still fine.
Didn't need the 3 weeks though