VBAC or 2nd Caesarean......

[minimac]

I am currently half way through my second pregnancy and the birth of this baby has me filled with questions (and hugely anxious). My first child was a c-sec (undiagnosed breach at 42 weeks) so i have the choice this time of having a VBAC. Sadly we are no long in ED but i'm still attached to the forum and would value thoughts of those who have also experienced this dilema.

It took me a long time to get over the c-sec pyschologically because it was such a shock to have a breach (perhaps a bit naive to have never considered that I wouldn't have laboured some way or another). This baby is due 3 years later exactly and whilst I have always been adament that I wanted to experience a natural child birth I am now really hesitant. I have been having horrific nightmares/recurring dreams that something goes wrong and happens to the baby because I 'stupidly' chose a natural birth rather than a 2nd c-sec. I can't help but think my 'inner brain' is trying to tell me something. I am bit of a control freak so perhaps i'm trying to 'plan' too much on this birth which is daft i know as it'll come when it comes. I am hugely anxious though of the risks. Yes, i have read up on it and yes, i hear that VBACS are all ok nowadays etc etc but back in the day it was 'once a c-sec, always a c-sec'. Whilst medicine may have moved on, a woman's body is the same the risks are the same. I don't like the idea of 5/6 recovery especially with a child already but the health/wellbeing of my baby goes above and beyond any discomfort i'll feel for a few weeks.

I have heard of many positive VBAC outcomes and it isn't like I'm wanting to hear peoples horror stories but am i mad in consdiering a VBAC and is it just plain safer having another c-section? All maternity wards are full capacity and what happens if I have a junior midwife looking after me who is not experienced enough to notice the signs of my natural labour going wrong because of previous c-sec - the risks are obviously greater this time. I have an appointment with a midwife c-sec referall team that runs in my area but i don't want to be hit with NHS glory chat - i need to hear the realistic side of things.......

Thanks in advance

[Mrs TP]

I went on to having two VBACs after an emergency c-section with number 1. First VBAC was a bit grim with ventouse and cutting but the second was much easier and a great midwife telling me exactly how to push as I never mastered that with the first two births.

My emergency c-section was because the baby got stuck as back to back and presenting face first - she was pretty flat when she came out and we had a horrific few minutes whilst she was worked on but eventually fine. VBAC babies both came out fine and happy and given to me straight away. It is hard work and not particularly pleasant but all fine and dandy and much quicker recovery - I was really shocked in a nice way about the much speedier recovery and being able to think straight about the baby.

Good luck and congrats.

[Mellors]

I think a lot of it depends on the reasons for your first CS and how your pregnancy progresses this time.

I had an EMCS first time round, and when no 2 was due to come only 20 months later I was pretty keen to avoid another one for recovery reasons etc. I spent a lot of time talking to my midwives and the consultants about my options, and the risks, and weighed it up (bearing in mind that medicine has moved on, and CS scars are now much less likely to rupture etc due to the changes in the way they do them).

As my first EMCS was for a random reason (failure to progress - cord wrapped round neck so couldn't descend) rather than something likely to happen again (e.g. baby too big for pelvis) and this second time progressed smoothly I figured I would give it a go but with an open mind.

I went on to have two wonderful VBACS with Nos 2 and 3 , one at home one in hospital, so it is possible. You need to talk it through with your medical staff though - I think if you are so worried about it you need to try and allay your fears first. Also bear in mind that even if you do decide to go for a VBAC it might not happen anyway for reasons out of your control. Thats ok too, there are no prizes for how you do it, just a happy, healthy baby and mum. Good luck :)

[Kes]

Just to give the other side, I had an emergency c section with my first (huge baby, back to back, got stuck trying to do ventouse). I always thought I would want a VBAC next time until I actually got pregnant, I then changed my mind and had an elective c section.

There is really no one correct answer to this but for me the elective was absolutely the right thing. I agonised over it for a long time but in the end these were my reasons:

There is still some evidence that a repeat CS is slightly safer than a VBAC. It's a small difference and I wouldn't criticise anyone for choosing a VBAC in spite of it but for me safety is the issue that trumps everything else.

If I had tried a VBAC I'd have had continuous monitoring (you can refuse but again with safety in mind I wouldn't have), this would mean I wouldn't really be having the natural birth I'd like anyway as it would prevent the use of movement, birth pool etc. Things which I found very helpful for managing pain in my first labour.

Also - the only way to be sure you don't have an emergency c section is to have a planned one and I really didn't want another emergency one.

So for me the elective made sense and as it turned out they found all kinds of scar tissue etc. from the first one which was done in a rush in the middle of the night. As this one was planned they had time to fix me up and although that made the immediate recovery harder I felt better after 6 months than I ever did in the 3 years between babies. I also really liked the sense of control that came with the elective. I was calm throughout and able to ask for eg. the screen to be lowered so I could see the baby born and my arms and gown to be arranged in a way that made it possible to have her skin to skin while still in theatre.

Recovery is a definite down side, it was far far easier after a planned one when I wasn't also recovering from 3 days of labour, but I do still look with envy at anyone out and about a week after having a baby. It wasn't a major issue with my older child though as we prepared her for it and made sure there were plenty of people to help out.

Good luck whatever you choose

K

[londonhypnobirthing]

It sounds like you're faced with a difficult dilemna after your first experience of birth. You know the deal with a c-section having been through it before, so I can understand why that option is appealing, despite the post-op recovery. I can also understand your anxiety that your body might not be "capable" of a VBAC. If you feel like you'd really like to experience a natural birth, then I'd say it's worth exploring your fears and anxieties from your first experience. If you're able to understand and release these then I think you could have a really positive VBAC this time around.

Have you considered hypnobirthing at all? I work with lots of second time mums who've had traumatic first births and want the next experience to be different. To see them release their fear and really gain an understanding of birth and how fear affects labour (and babies) is incredible and I see it in practice all the time. I'd be happy to put you in touch with mums who would be happy to share their experience with you. I see that you've moved out of the area, but if you want to tell me where you are now I'd also be more than happy to put you in touch with an experienced practitioner near you.

AIMS (Association for Improvement in Midwifery Services) is also a great resource for questions and options about birth. It's a team of volunteers and their knowledge is unbiased and second to none. Their number is +44 (0) 300 365 0663 - it would really be worth giving them a call and having a chat about what could be right for you. I really can't recommend them highly enough.

If you do decide to go for a CS, then you can still have input into how you want it to be. This is a great article about "the natural caesarian" http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/

If you'd like to talk more, please don't hesitate to drop me a line. I wish you all the best for a happy and healthy pregnancy and a lovely birth experience, whatever you decide.

Warmest,

Hollie

[alieh]

I had a VBAC after having a ceasarean for breech the first time. I much, much preferred the VBAC experience, but everyone has different perspectives. My first c-section recovery was hideously painful and I hated the hospital stay; my son was very big and also breech so not sure if that made the "removal" more aggressive and therefore more painful? I also had a terrible chest cold and the coughing hurt the scar so much. I also generally don't like hospitals. So my hatred of my c-section might have coloured my plans for the next time more than it would for others who had a smoother recovery (it seems like there are lots of people with very easy c-section recovery).

I would really recommend studying the NICE guidelines on VBAC very closely as it is easy to distracted with loads of different information out there and I found these concise and clear.

My understanding was that for women who had their first c-section because of reasons like breech presentation, their chances of a successful vaginal birth are almost the same as for any first time labour. And that the risks to baby were very marginally higher for VBAC (but I think that is the case for all vaginal births over c-section?) but the risks to mother higher for c-section. I may be wrong here, but that is my memory.

Ultimately you have to try to assess what option makes you feel less anxious, regardless of what anyone else thinks. If no one else were ever going to know which approach you chose, would it change your decision?

I'm about to go for VBAC #2 in December!

Good luck with your difficult decision.

[Didine]

Hi there,

I can recognise myself in your post as I had the same dilemma during my second pregnancy. I thought I was strongly for a second C-section but I did not like the idea of leaving Number 1 for a few nights.

I read the book below which helped me to relax about the natural birth.

http://www.amazon.co.uk/Vaginal-Birth-After-Caesarean-Handbook/dp/1905177240

In the end after months of thoughts I decided to go for a natural birth. Then of course, my baby was late and as I did not want to be induced, I planned another C-Section for a Thursday.

Then my baby came on the Sunday before... and at home... It went so fast I did not go to the hospital. The baby was fine and I found myself very lucky to have the Lanes midwifes on my side!

On the recovery side, I thought it would be quicker to recover vs C-section. But saying that among the second time mums I know, recovery for elective C-section was longer as well.

We were 4 out of 7 to have a C-section in my second time mums group; 1 had an elective C-section both times; 1 had a VBAC after a first emergency c-section, I had a HBAC after an elective c-section and 1 had 2 emergency C-section. SO difficult to give a trend!

I could discuss that subject for hours...

All the best with your decision!

[alieh]

Also missed the part from your post that you're not in ED anymore....I think assessing the support you have around you is very important. I was with the Lanes and they were so supportive of my VBAC decision that it gave me lots of confidence. Without this it would have been more difficult I think.

Are your midwives supportive where you are now? If not and you decide you want a VBAC you could look into a doula with VBAC experience?

[MrsC]

Hi Minimac,

I had the exact same feelings that you did and kept changing my mind up until 36 weeks. I would say that you have to go with what you feel most comfortable with, there is no right or wrong answer. For me I did a lot of research and had a good understanding of what went wrong with my first labour, which helped put things into perspective. No 2 pregnancies or labours are the same, even from the same mother! In the end I had a very good VBAC, continuously monitored (I was glad of this) lots of gas and air, and I must say a fabulous midwife who had total faith that I could do it. That said I have friends who opted for an elective c section and we're equally happy with how things went.

Essentially it's a very personal decision, go with your gut instinct, tends to always be the right one. Best of luck!

[etta166]

I don't have any direct VBAC experience, but I would second what alieh said about the support that you will have. A close friend had a 2nd EMCS when she was planning a home VBAC for her second. However, she found the second EMCS much easier to deal with, because of the great midwives that she had for the second birth. It is really reassuring to have a midwife that you know and trust, so if you do go for a VBAC then there is a prefessional there to make sure that it is going smoothly and to help you to make decisions during labour that you'll be happy with.

I feel really lucky to have had my 3 babies delivered in the presence of (if not directly by) a community midwife that I knew and trusted. It seems so different from the experience of others with an midwife that they had not met before. What ever you decide, and there is no right or wrong, I think a VBAC will be easier if you can arrange a midwife or doula that you know and trust.

[minimac]

Thanks everyone for your feedback. I guess i've got a lot of thinking to still do. Whilst I have family closer this time which will help the care at the hospital is totally different. I will just be going in as another patient with no rapport or relationship build up with any of the midwives on duty. I see the same midwife for most check ups but she won't be at the hospital. I guess my real concern is that I won't trust any of them to be doing their job properly - hugely negative mindset i know but having had my first midwife at the Lanes who missed the breach I have lost faith in them. That said, once we saw the consultant and were into the Kings hospital for the c-sec itself it all went smoothly. It will be v difficult to believe i'll get the right care at the time that will give me strength to stand by my VBAC decision if that is what i choose without anyone knowing/understanding my fears - i can't quite imagine if i'm in labour it will be the right time to talk about it! As my husband says, i'm a naturally anxious person so maybe all this worry is just in my nature. I am definitely considering the hypnobirthing route as i think it would be very beneficial for me whether i go VBAC or C-Sec. I guess what my underlying fear behind this is all (aside of not trusting the midwives - and i don't mean that horribly as they are wonderful people and do a fab job but i feel i was at the hands of someones incompetence once already) is that if I go VBAC and things go wrong, will having and Emergency C Sec be more traumatic than going in for an elective C-Sec?!

[ClareC]

I've had an emergency CSection (non crash) and an elective - the elective was a much better experience and I had less pain / faster healing afterwards. That said, I thought the emergency one was good - my judgement May gave been rose tinted given the labour running up to it ;)

I was only in for one night with both (technically two with the emergency if you include being in the post op recovery room).

The elective was wonderful!! I had two Lanes midwives plus two hospital midwives for my son, everything was calm and everyone happy and joking. It was a boiling hot sunny day in early May (random) and the theatre was full of sunshine!

I was up and walking and showering within 6 hours and genuinely didn't have any pain or discomfort with the elective.

Good luck, whatever you choose it will be what's right for you x

[nunheadmum]

I had an elective C-section for my first (breach) and a VBAC with my second. Of the two, the c-section was by far the better birth experience. I felt quite let down that this wonderful natural birth was actually not that nice an experience due to the pressures on staff in the NHS and folk who, quite frankly, seemed to be in the wrong job. (Actually, I felt ridiculously angry!)

I think the staff you are in contact with will make or break the experience more than which of the two you go for. If you want to go for VBAC, I'd recommend trying to ensure you know which midwife you'll have or take someone along who you feel will know what to do to get you a good experience. Otherwise you can build it into so much in your head what with the should I / shouldn't I decision, that it's very easy to feel all the more let-down if it doesn't go as it should.

And remember that a healthy baby at the end is more important than how it gets there.

[neilly1973]

Hi

I had a VBAC 9 weeks ago after having a EMCS with my first... I can honestly say that despite episiotomy and connotes it was a SIGNIFICAntLY better experience from both a birth and a recovery point of view. I actually kind of enjoyed it!!! No real pain relief (some G&A on route to the hospital) and I felt amazingly in control... It was a very emotional experience to see my baby come out of me and be able to hold him straight away...

Cannot recommend vBAC enough! I also really commuted to the hypnobirthing this time as I was also quite anxious before (like you, also naturally a bit anxious about things!) - it was really useful - I felt totally in the zone. I did a specialise VBAC hynobirthing cd which I could root out the name of!

Happy to chat if you want, just PM me.

Good luck whatever you decide.

[londonhypnobirthing]

Meant to add that if you follow this link http://homebirthersandhopefuls.com/can-i-still-have-a-homebirth/vbac-vaginal-birth-after-cesearean/ and scroll to the bottom of the article, there are a few very good articles about VBACs and the decision-making process.

[ClareC]

There is no right answer, you need to do what feels right for you! My midwife wanted me to go for a VBAC at home. My concerns lay with the risk of rupture and pain management.

My daughter was back to back which led to a long painful labour without much progress. My daughter became distressed hence the ECS. I was just relieved it was over and wanted her out and healthy so it wasn't a bad experience. I then fell pregnant 6 mths later (unplanned). Having read up on ruptures (lancet and BMJ) I realised they were more common than I had been advised. Having had an extremely painful labour first time round I wasn't sure I would be able to tell the difference between what was normal and what was a rupture. I also was unable to find the stats re increased risk (if any) given the short period between pregnancies.

Although my midwife encouraged a home water birth, the consultant obstetrician recommended VBAC definitely not at home and most definitely not in water - water was the only effective pain relief first time round.

On a balance I decided elective was the safest option. It is a hard decision though.

[PollyannaD]

I had an EMCS with my first and then went onto have a great VBAC experience in hospital and then after that two home water births. The recovery time is so much quicker when you have a natural birth and I couldn't have coped not being able to pick my toddler up for 6 weeks if I'd have had a csection. It is important you feel comfortable with your choice though. I agree with an earlier post who suggested hynobirthing. I've never tried it but do really believe in empowering yourself to help you have a successful birthing experience.

[Kes]

Gosh Clare I'm a bit unimpressed at your midwife recommending a home waterbirth VBAC. Supporting a decision you've already made is one thing but that really sounds like putting natural birth idealism above safety.

Anyway, here is a link to a blog post I wrote early last year, just before I found out I was pregnant with number 2 (and after a not too great meeting with an obstetrician - not Kings btw). It contains links to two studies looking at the safety of VBAC v elective repeat C/S. http://www.southwarkbelle.blogspot.co.uk/2012/03/is-planned-repeat-c-section-safer-than.html

Also here are a couple more about how I decided:

http://www.southwarkbelle.blogspot.co.uk/2012/08/decisions-part-1-show-me-stats.html

http://www.southwarkbelle.blogspot.co.uk/2012/10/decisions-part-2-time-to-decide.html

Hope it's ok to post those but I thought they might be relevant to the OP and those interested in studies on the subject.

[ClareC]

Yes, I was not impressed either.

Tbh I really didn't enjoy my antenatal care second time around as I felt I was put under constant pressure to have a VBAC - the suggestion was made in answer to me stating water was the only pain relief and you can't guarantee getting a room with a pool at Kings (or even a room for that matter;)). I was also given totally incorrect stats re risk of rupture, 1 in 4000 rather than 400 - which the consultant later confirmed to actually be more like 1 in 280 but confirmed there were no stats re how a small gap between pregnancies increased thus (or even if it did).

It was a relief seeing the consultant obstetrician and being recommended no water, in hospital and constantly monitored - made the ultimate decision v easy! She had no issue whatsoever with my decision for Elective C Section.

Everyone's different and what's right for one isn't for another. I'm not a risk taker and with all the information I had to hand it was the safest option for me. It's not easy deciding though so I sympathise with the OP

[jollybaby]

I has an emergency c section with my first daughter after a horrid three day induction. I can honestly say that the c section was the best part of the whole experience and so I was sure that I wanted an ELCS with my second.

For me the main reason was to have some degree of control as I found my first birth so terrifying. I'm not sure if I would have felt differently if my first section had been an elective or for breech rather than 'failure to progress'. I must admit I don't have much faith in my body's ability to give birth.

I'm now living in Kent and didn't meet much resistance to my decision. I was meant to attend a birth options clinic to discuss in detail but the earliest appointment they could give me for this was after my due date! The only time I wavered slightly was when the registrar mentioned the risks of surgery increasing if I go on to have a third section due scar tissue and adhesions.

I must admit another factor in my decision was that I know 2 people who have had scar ruptures - though in both cases mother and baby were fine after. Like kes I wouldn't have been happy to not be monitored etc and so it would have ended up being a medicalised birth anyway.

I'm now 3 months post my second section and happy with my decision. I arrived at the hospital at 7.30 and had my daughter by 11. They lowered the drapes so I could see her being delivered. As with my first section I recovered quickly. Was out having lunch on day 4.

Agree with others that it's a very difficult and personal decision. I suppose in part it depends on the circumstances of your first and how you interpret risk.

[minimac]

Thanks Kes for those southwarkbelle links - really interesting reading. Has to be said, the more I research it the more likely a c-sec no2 is in favour. I'm trying to way up if my 'inner womanly desires' to naturally birth can be tucked away for good (we won't be having any more children).

Jollybaby - Am quite taken aback that you know of two ruptures - a v high number I think for something supposedly 'so rare'. That really does make me think a c-sec is the only route. It could really happen. Also the rates ClareC mentions are much higher than we are led to believe. (Also cannot believe your mw recommended a home vbac - madness!) but thankfully you made the right decision for you.

I still can't help but curse the lanes midwife who missed the breach and has left me with her mistake to 'dodge round' and has essentially taken away some of my rights as a woman (choice or not of a vbac, when faced with so many at risk issues is that really a choice......) - which ultimately has such a huge impact now on my life and my family's.

[devsdev]

For what it's worth, a "natural" birth can be a very traumatic experience too. I had a very difficult time after the birth of my daughter and it took me months to feel emotionally sound enough to even discuss it. If I had an ECS (which I was fighting to avoid), I'd probably have healed better with less lasting damage, but still beaten myself up about not having had a "natural" birth. So if you choose to go the VBAC route (and if you do I truly hope everything goes very well), just remember that it may not be a perfect experience. Be kind to yourself and do what feels right for you and your family.

[Saila]

I too had what I felt was a v traumatic first 'natural' birth.

I opted for elective section second time round and loved it. Would do it again in a flash.

Everything was totally calm and I even go as far as to say I enjoyed it.

I found the recovery a *doddle* relative to my hideous physical and emotional state post natural. I am *never* doing that again.

[reren]

Really recommend hypnobirthing - whatever route you choose it might make a world of difference just not to feel too anxious for the remainder of your pregnancy? It is kind of miraculous how confident it makes you feel - im actually looking forward to the birth now (due next week!)- not something i would have thought possible before.

[AnyaJoeli]

Hello there

Plucking up the courage to ask forum thoughts on a very personal birth matter, I've been looking through old threads which has already been useful. I'm pregnant with my second?5th pregnancy but 2nd "ongoing", and had a bit of a traumatic time with my first, sounds quite common when reading these posts - not sure if that's reassuring or depressing - induction followed by three nights of no sleep and various horrors ending in a category 1 emcs. One of those where you have to see the only plus as the baby being alive and ok (after being resuscitated). I think for a long time I tucked away the trauma of what happened, although it was heaped on by a very colicky and distressed newborn who didn't stop crying for 4 months so I think I really did suffer from post traumatic stress disorder with the whole birth and newborn experience and am shuddering a bit about embarking on it again.

I went on to have a couple of miscarriages, one of which was at 11 weeks but I didn't have an erpc, it was the day before Christmas, just wanted to go home rather than stay in hospital, and was advised about the risks of erpc by the kindly doctor who probably thought i should just be at home for christmas, but it was clearly an unwise decision as I ended up haemorrhaging whilst on holiday in Sri Lanka and ended up in hospital there which was a bit grim?which no doubt added to my general trauma about all things birth related, as I did really think I might die, and the only other time I've felt that in my life was when I had my son.

So now I'm faced with the vbac choice. I'm with the Lanes for this birth, which is more reassuring than the midwife care I had first time round. In my family and friends circle everyone seems to have trauma-free home births which seem, while of course painful and intense, idyllicly wonderful compared to what I've been through, and their recoveries and newborn experiences seem to be without exception 100% better than mine (possibly my mindset is colouring this too). I will have to have a medicalised birth for various reasons from first time round, so an "idyllic home birth" wouldn't be possible for me even if my anxiety levels would allow it. And if that "ideal" birth isn't available to me, my fear of a medicalised birth ending in emcs may simply be too great to tackle a vbac.

I think I probably know what I really want to do deep down?I think my mental health could probably benefit from the "control" of an elcs. Is this a misplaced thought? I'm trying to read up about both sides but it's just making me a bit foggy about it all.At the moment I've agreed with the consultant that I'll go to 40 weeks and then have an elcs if I haven't gone into labour naturally, as there's no way in hell I'm going to be induced again, and I had placental problems that weren't picked up with my first which meant going overdue by 2 weeks nearly cost us his life. But when my midwife suggested having sweeps from 38 weeks my gut reaction was NOOOOOOOOOO so it made me think perhaps I should fess up to wanting an elcs now rather than dithering about it. And then I think, but maybe I could have a trauma free natural birth and recovery would be an emancipation from all the past traumas?.???

I would really love to hear positive stories of elcs, and of vbac? just to confuse me more?!