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?

Good point Bells. I have a friend who was recently induced because the hospital set her dates 2 weeks before she thought they were. She had a traumatic birth (long labour, ventouse etc)and we agreed that she probably shouldn't have been induced at that stage so will pass on your suggestion for next time! Would do it myself having also had my dates messed around with if DS hadn't been such a wopper.

Marina,

Sorry to hear about your wound rupture. There are a few reasons why that might have happened such as the stitches were not well aligned or that you had an infection which delayed healing. It would not interfere with VBAC because the uterus itself did not rupture and of course everything will be well healed now abdominally. Was your abdominal wound one that is vertical rather than horizontal along the bikini line? Those wounds have a higher incidence of rupture than the bikini line ones.
If you did need another C/S, the surgeon would probably use a different material to close the skin than last time just to make sure that all was secure. I have seen wounds rupture before but it is certainly not a common occurence. Hope that helps.

bells, that is really interesting as I have a 35 day cycle so perhaps dd wasn't really due/ I would never ever let anyone try and induce me again, the whole thing was a b**y nightmare and I have never known pain like it, for which they kept giving me paracetamol!

I'd like to know how many women on the planet actually have this famous 28 day cycle. Every single woman I know has at least a 31 day cycle. Ds was delivered at 39 + 5 absolutely coated in vernix which my midwife said was a sure sign he was some way off "done".
Mears, Pupuce, thanks for the tips. Abdominal incision was horizontal, Mears, and I was told there was no sign of infection in the wound anywhere. I put it down to poor needlework. Second time round I had industrial staples (I am told, I wouldn't look). I WILL look at the book, Pupuce, if I can get past that sinister title...!

I had a CS with DS2 which fortunately healed very well but I was never really sure how they fastened me together again. I assume that they used disolving stitches inside but I appeared to have been glued together on the outside and then had some extremely strong tape stuck over the wound with lots of very stiff packing and tape over the top. Can anyone enlighten me? I was asked what sort of delivery I wanted on the next occasion but opted for a natural delivery anyway, which turned out to be quick and easy.

Marina,

Have you had 2 C/S? If so what was the first done for if you don't mind me asking.

PamT,
The usual way of repairing the skin in our unit is subcuticular dexon which is a running stitch if you like, just under the skin so you don't see anything on the surface. Sometimes though you get some oozing of blood so a pressure dressing is applied. That sound like what you describe. Elastastoplast tape is applies to swabs on top of the dressing to apply pressure and stop any oozing of blood. Does that sound familiar?

Mears, that might have been how they did it. I was under a general anaesthetic so wasn't able to see at the time. Perhaps the gooey gummy bits were from the dressing, they were definitely adhesive of some sort rather than pus, blood or anything working its way out. I have to say that my scar is very neat and like a little smile just below the hair line. In its shrunken size you wonder how a baby ever came out of there!

I have a 26 day cycle, confirmed in the cycle I conceived by doing LH testing, so I KNEW when I ovulated. The hospital's due day was therefore later than it should have been - which I wasn't bothered about, as I didn't want to have to be induced. The hospital even managed to make 40 weeks from a Friday into a Sunday due date (they also didn't take into account the Leap Year). As it was, ds was born on the hosptial's EDD - but a few days "over" according to my calculations.

Hi Mears, sorry for any confusion, just the one C-section. Second due early Jan. My mother was a sixties VBAC mum - I was born first, guess what, persistent transverse lie, my sister three years later by the normal route.

Sorry, the "second time round" refers to how they restitched me after the wound rupture.

Thanks Marina,
Another reason that your wound broke dowmn might be that your tissues reacted to the suture material. I haven't come across any research but will keep my eyes peeled ( what a disgusting saying when you see it in print).

Hi.I had my dd in October 2000 by ceasarian. I went through full labour, and was fully dilated for several hours. However dd became stuck. So I had a c-section. I wasn't worried at all..I had read a lot of information when I was pregnant about labour, and c-sections. My husband, who was at the time my boyfriend, was extremely scared at what would happen to me. He calmed down once he saw our dd, and was the first to hold her.
My scar healed well, I had no problems breastfeeding (told my milk would come in later due to c-section). The surgeon told me that I had as much chance as anyone to have a vbac next time. I just didn't like that I had had a c-section due to the amount of pain that I had to suffer afterwards! My husband and I are going to start trying for baby number two in September. I really want a vb next time, especially as i hated spending all that time in hospital!
One thing that does worry me is my scar during pregnancy and labour. I have read some info about the scar rupturing. My skin is not elastic at all. It just doesn't seem to want to stretch..and I got so many stretch marks first time round that even now they are a cm wide, and cover my whole stomach. I am worried that this will cause problems for me, and that as I get further on in pregnancy my scar will get stretched too much.
any advice?

Again one person who I believe would find her answers in this book :
Silent Knife, Cesarean prevention and Vaginal Birth after cesarean.
Nancy Wainer Cohen and Lois J. Estner

Like Janz I have a totally regular 26-day cycle (wish it was longer) and my dd's were born two weeks and one week early (exactly) respectively than their hospital-given due dates. Both were fully cooked.

Well, I went to see the Consultant, and explained to her all my reasons for not wanting VBAC, and wanting a repeat elective c section. She told me that it was not the hospitals practice to do c section on demand, and as my reason for c section last time was breech that was not considered as a reason for a second. She then went on to tell me that I only had a 50% chance of success of VBAC, that they wouldn't induce me if I went over - they would do a c section, wouldn't let me labour for long etc... I told her that 50% odds weren't good enough for me, she said that it was for most people. Anyway, she let slip that what they were most worried about was that last year they had the 2nd highest rate of c section in the Country and had to get their figures down. Well pardon me for not caring about their figures in Dr Foster good birth guide! When I told her that I had already decided, and that she would not change my mind she said that the Consultants were having a meeting in a couple of weeks to decide whether to offer the procedure privately in the hospital (which is fine by me). What I can't understand though, is that if my chances are only 50% anyway, what is the big deal about doing an elective rather than emergency section? Anyway, enough rambling - anyone know anything about how to book the Portland - or is there anywhere else in the South East that you can go privately?

Dear Paula1

.... what about looking to hire an independent midwife and discussing all of this with her ?
I have just re-read your original post - I believe for what it's worth - that you would benefit from talking things through with someone knowledgeable and who would have the time to listen to your concerns (that probably won't be a consultant or your community MW)... you sound worried/anxious and fear - what ever delivery mechanism you choose - is not good for you or the baby....
Said my peace

paula1 , reading all your previous posts - it makes me angry that the consultant said no. When I see about the high csection rate at your local hospital - not in East Sussex are you?

I had 2 emergency csectons - not ideal but at least I have two 'live children ' regards MABS

Paula1, I was booked to have my dd at the portland as i had a nightmare labor/c-section at an nhs hospital 1.5 years ago with my ds. However, I went to visit the portland a few weeks ago and was appalled at the state of the place and the idea that it was going to cost me £10,000. I called St.JOhns and Elizabeth which has a wonderful reputation but they were already booked for sept. (might still be available for dec.). I ended up reverting back to the nhs hospital where i was booked (not the one where i had ds).
I am a bit perplexed by your consultant telling you that you only had a 50% chance of success with vbac. I was told that I had a very good chance of vbac. The only danger being chance of rupture at the scar which is about 1 in 500 and is less likely than complication from a c-section. Anyway, good luck.

The vast majority of uterine rupture is begnin. "Rupture implies recent tearing with consequent bleeding from the newly torn tissue. At the time of most repeat cesarean, most obstetricians have seen a hole in the old uterine scar. This opening is called a window. It occurs with some frequency and is considered to be a result of healing. It is not a rupture. (....) In most studies, windows are recorded as ruptures and included in rupture stratitics, even though they are of no serious consequences." (...) We found no reports of maternal death associated with the lower segment incision in all the studies we surveyed; the incidence of fetal death associated with VBAC is agreed to be less than with elective repeat cesarean even by the most reluctant VBAC skeptics." (84 and 85 of Silent knife).

I had an excellent c-section experience - no pain, easy recovery etc as it was very pre-planned due to medical reasons. I would hate to have an emergency c-section after a long labour - that would be my absolutele nightmare so I can totally sympathise with Paula1. Paula, can you go back to your consultant and really lay it on thick about how much you don't want a VBAC? Tell them you'd rather kill yourself or something (or at least that you are now extremely depressed and stressed, keep crying and can't sleep for worry etc and worry you won't be able to bond with the baby) - that should get them going! I do believe in women being informed, but I also believe in choice, whether that be homebirth, waterbirth, epi or c-section. If the consultant was willing to have your labour, then it would be fine for them to say no, otherwise I think they should listen. Just my personal opinion. If I have another child I'd really prefer another elective c-section as at least I'd know exactly what to expect, but would be concerned about spending too much time away from my ds, and know I could probably be home quicker with a VBAC, which is another consideration.

Marina - have spoken to some of our consultants about breaking down of wounds. None are aware of any research regarding recurrence , probably because it is not a frequent occurence.

Paula1 - sorry you have been unable to be reassured by your consultant. In her defence the rising caesrean section rates are a national concern. Women are at increased risk of 'injury' with unecessary surgery and in your caes there is not a health reason why you should have repeat surgery. I do not agree with the 50% chance of vaginal delivery as that is an average figure taken from all VBAC after C/S. Reassuringly you have been told you would not be induced or allowed to labour for a long period.
You certainly need to have much more information to make an informed decision. Repeat caesareans are not the easier option.

Ionesmum - I have just reread your earlier posting. C/S are not safest option for babies - often elective C/S babies are admitted to the special care baby unit with respiratory problems because they have not had the stimulation of labour or the journey through the birth canal which encourages the drainage of fluid from the lungs.
Women who have elective C/S can have problems with breastmilk supply due to the lack of circulating oxytocin which is necessary for contractions. My friends SIL had an emergency C/S first time round after going into labour at 41 weeks and B/F for over a year. 2nd time round she opted for elective C/S at 38 weeks and had a much smaller baby who started to lose weight at 2 weeks of age and ended up being admitted to hospital. Her milk supply was non existant and despite a lot of help she could not get lactation established and is now bottle feeding.

I truly believe that VBAC should be given a go but women will only believe that if they have confidence in their health professional. That confidence gives women confidence in themselves.

If you cannot believe in yourself or those around you then you should have another C/S. Do all the consultants have the same conviction? Your consultant could refer you to someone at the same hospital who will do what you ask. At my hospital I know the consultant who would do a C/S at the drop of a hat because he is near retiral and is of the 'old school' where the belief was once a C/S, always a C/S.

The other side of the coin is why should a consultant perform unnecessary surgery which carries a risk that they do not agree with. If there were complications then the consultant has to live with the consequence of carrying out a procedure they did not professionally agree with?

Paula

I was planning to go back to the Portland to have my second child - I had my first there in 2000. I'm a bit worried about your comments, what was so bad about it? I must admit that I thought after all the bad press it has had lately, the care would be super good.

Paula1 - all I can do is endorse other people's comments & send you my sympathy - but you must be assertive with your consultant, insist on seeing another one if possible. All the bad press about the number of c-sections seems to mean that it is impossible to get one now - unless you are a celebrity mum! I asked for a c-section but was refused, but ended up having one by emergency anyway - full GA, DH not allowed in etc etc - I did recover very quickly so I am not complaining, but just wish I had been allowed one when I asked. My DS was born with a medical complaint that, had he been born vaginally, we would have both probably died - don't mean to scare you but I think all points of view should be aired.

A friend recently had a VBAC, at her request, but quite honestly now says she wishes she had had another c-section.

Good luck, be strong.

Lindy - when looking at all points it should be stated that you are more likely to die after a caesarean than a vaginal birth. That is one of the main reasons behind the need to reduce the C/S rate.

Tia, it wasn't me that said anything bad about the Portland, I've never been there and was wondering whether to book it, however the £10000 price tag has put me off somewhat! Thanks everyone else for your very helpful comments. There are other consultants at the hospital who have different views about c-section, I know 2 people who are about to have repeat sections for the same reason as me (breech), and they were just booked in with no question, so I may ask to be transferred to that consultant. My Consultant is new at the hospital (St Johns in chelmsford) and she is going to talk to the other consultants and see me again in 4 weeks with a decision, so I should still have time to make other arrangements. Pupuce, I do take on board, and appreciate, your comments about hiring an independent midwife to talk to, but quite honestly, I think I am too 'closed' on the subject now for anyone to get through to me - I don't actually believe in my ability to succeed at VBAC. Thanks everyone for your helpful and supportive comments