VBAC or ERCS

[E1066]

Hi All
Second child due in September and I’m having to consider which route to go down for the birth.

I have a 2yo DD - She will be 2.5 when DS2 is born, - she was born through Emergency CS due to failure to dilate. I stayed at 2cm for 18 hours and baby’s heart started to dip.

I’m incredibly anxious this time round in the pregnancy anyway - I’m an only child and nervous about how a second addition to our family is going to change my relationship with DD. Equally, I have friends whom have suffered tragic vaginal births which makes me nervous. I’m also worried it will be a Covid situation and there won’t be enough people on hand if there’s a problem during VBAC.

But, my biggest worry is uterine rupture. On the one hand I want VBAC because the recovery is quicker and I can’t bare the idea of not being able to pick up my daughter etc for 6 weeks. I also don’t want to have to deliver baby earlier than 38 weeks if I can help it which I think is a factor with ERCS. But on the other hand, I feel if I have an ERCS there are less risks to the baby and myself in terms of uterine rupture?

Has anyone faced a similar dilemma? Are there any symptoms you experienced with UR or indeed anything you advise on which route to go down for the second (and final) pregnancy? I’m terrified something will happen to the baby or indeed myself 😬

Apologies for such a long message, but look forward to hearing some advice.

no knowledge about uterine rupture, but with an elective section you will absolutely be able to pick your baby up before 6 weeks, isn’t it nothing heavier than the baby? I had an elective section with my second and could pick her up no problem by day 3 and carefully on day 2! If I have another (unlikely) I would have another elective, it was fine, my recovery was quicker than with a horrific first vaginal birth, I was back to normal by week 2 and driving again at week 3.

I decided to try for a vbac but knew I wasn't allowed a full induction as this gives highest risk of rupture. When I hadn't gone into Labour by myself, I scheduled an elective section.

I'd do it the same way again, although I really wanted a vbac, the elective section recovery was much better than the emergency one.

Watching with interest as I'm in a very similar situation op! I'm strongly hoping to try a vbac but concerned about the same things as you. Also had emcs last time after failure to dilate (due to scar tissue on my cervix). Had a vaginal birth with dc1 though.

@Rockandgrohl I believe she means not being able to pick up her 2yo dd..

Hi @Fipfop

thanks for this, re ERCS how quickly did you recover and in terms of being able to look after your other child, how quickly did you get back to normal so to speak? X

I had a phenomenally positive VBAC 4 weeks ago. The recovery was miles apart from my EMCS (failure to progress after induction) with my daughter two years ago. So so so much better. I was driving my toddler to nursery 3 days in! I didn't plan it this way but ended up giving birth in water in the birth centre - no continuous monitoring or VEs at all and a spontaneous labour. The recommendation is obviously for continuous monitoring and labour ward but I ended up being sent to the birth centre for triage due to full labour ward and the brilliant midwife reassured me that uterine rupture was incredibly rare and that it would be immediately obvious to them if something was going wrong - she made me feel totally confident in my decision not to have continuous monitoring. I'm aware that my experience is on the very positive end of the spectrum but I wish more people had reassured me that a positive VBAC experience was possible!

What’s ERCS? What does the R stand for?

ask your m/w if they run a VBAC clinic. It’s not to push you either way, but you’ll get a full debrief on your EMCS and a discussion of the risks/ benefits of both.

personally if you only got to 2cm I’d think an ELCS the better choice. I think I was told they prefer you to have gone past 5cm before.

@BelleSauvage9 so it's a bit hard to say because I was unwell with an unrelated issue afterwards. By 6 weeks I was looking after both children by myself despite the other issues. I only took pain relief for around a week. I could go on short walks after a couple of weeks.

ERCS = Elective Repeat Caesarean Section

I can only comment on myself, but if I had another baby I would go for a VBAC. Even though I would likely need another induction.

I had an ERCS. When they opened me up my scar was so thin, they said I would of ruptured had I gone into labour. However I had a debrief and they told me with monitoring they are so good at detecting a rupture they step in at the first sign of trouble. Ie. They think even if I had gone into labour they would of got baby out safe. I do also think I was massively unlucky because I had another child after and when they opened me up the scar was absolutely fine.

I'd also ask them about their procedure for monitoring labour, if they've ever seen a rupture, had a near miss etc. I was told the signs were extreme pain at the scar site.

I have given birth vaginally and do prefer that to a CS in terms of recovery. I had a gut feeling to go for an ERCS though.

First child EMCS and second ELCS

My reasons were

I knew what to expect
I could plan
My tummy was already wrecked after my first born in terms of stretch marks and CS, so I didn't want any short or long term injuries to my perineum. Working in gynae and I have seen a lot of long term consequences of vaginal birth.

Had a hugely positive VBAC after an emergency CS for failure to progress in second stage due to baby in a ridiculous position (still an awkward bugger now!). My VBAC was fast and uneventful. I wanted to experience vaginal birth which was a big driving factor for me choosing that. I remember being told that's the chance of no scar issue is 99.5% and in the rare situation there is issues it would be an immediate CS, The risk of injury to baby in this case was also low with speedy intervention.
Also the risk of me dying with a ERCS was significantly higher than a VBAC. Was conscious of length of hospital stay, risk of infection, impact on BF and oxytocin levels too. I would however have reserved my right to opt out at any signs of trouble; in that I wouldn't have consented to IOL, instrumental delivery or FBS etc. I was a VBAC as long as I laboured spontaneously, progressed well and there were no red flags basically x

I had 5 csections and probably would've tried for a VBAC the second time, but I decided I'd like to avoid the risk of ending up with an emergency section.

Uterine rupture risk is very small.

You absolutely can pick your baby up. Straight away probably. I always did!

(This isn’t a positive experience)
I opted to trial a VBAC for my second baby in May this year, following an emergency c section with my first.

I was a really good candidate for it with no issues during the pregnancy. Had my last VBAC clinic appointment 3 days before my due date and had a sweep to hopefully get things moving as I wanted to avoid any intervention with induction (something that is strongly linked to increased risk of uterine rupture).

Went into spontaneous labour the day after due date, laboured at home (with guidance from triage) until contractions were 3-4 mins apart and then was told to come in.

My labour went great up until around 7cm dilated when I could no longer cope. Couldn’t explain the pain I was feeling to anybody, I had been using gas and air for around 2 hours perfectly fine and thought I was going to be able to do it when it suddenly switched. The only way I can explain it was that I was fine ‘during’ the contention using gas and air, I’d come to the tail end of the contraction when I would feel immense abdominal pain and my response was to scream through it. The midwife kept asking me what I was feeling and if I was having a contraction and I kept shouting back that I didn’t know what was happening. I’d asked originally for an epidural so they decided to start administering that (I’d been waiting for it for about an hour at this point) so was hooked up to the monitor whilst it was being administered in stages. Still screaming at the end of the contractions, they started the epidural when my blood pressure dropped dramatically and DD2 was having severe decelerations. They decided to call in the consultant who wanted to put a probe onto babies head to get a more accurate reading and it was at this point that they decided I was a CAT 1 emergency section. My uterus had completely ruptured and my baby was coming into my abdomen. The consultant said they only just managed to repair my uterus and was going to give me a hysterectomy (at 29). Baby was taken straight from me and into SCBU where he stayed for 5 days. Both of us are well and have recovered fairly quickly aside from the trauma. Looking back I do wish I’d have opted for an elective section. I know it’s rare to rupture but in hindsight it’s a risk I shouldn’t have taken :(

@NBF2023 i really appreciate you sharing your experience, it must have been terrifying. It’s definitely made me think about my choices as I still haven’t decided and baby is due in 4 weeks. Can I ask how the pain felt different from a contraction? Xx

I've had two vaginal births and two elective CS. If I was to have a 5th I would have another CS. I had my 4th in Jan of this year whilst also having a 6 yr old, a 5 year old and and 18 month old at home and managed to recover really well. By about day 5 I could get myself up and around and by day 9/10 I was pretty much back to it without doing anything too strenuous. My biggest piece of advice if you go for another CS is take all of the help you can get, rest as much as possible and keep on top of the pain relief. I was so worried about how my toddler may react but she was excellent and we still managed lots of cuddles and stories in bed.

@E1066 It was honestly the most intense pain I’ve ever felt which came after each contraction (they didn’t seem to ease up and from my research one of the signs is that your contractions slow or stop but that didn’t happen for me!), so the pain would probably about 20-30 seconds after my contraction would finish and was like double the intensity of the peak of a contraction along with the most intense pressure feeling.

My bodies response honestly was to scream and press myself into the bed because nothing could control that pain, they kept thinking I was pushing because I was pressing myself down so hard (which I definitely wasn’t!). Funnily enough I didn’t think at the time that my uterus might have ruptured and it was only after a nearly 2-3 hour surgery and an abdomen drain that the consultant came and told me what had happened and then it all kind of made sense! I’m due to have a debrief about it tomorrow just to go through exactly what happened because it’s such a blur.

The recovery though really was much smoother I think because I already knew what to expect aside from the obvious trauma of what happened!

Pleaseee don’t let this frighten you into anything as it really is just unfortunate if it happens and honestly can’t be pre empted.
Good luck with whatever you decide :) xxx