Advice on Choices?

[twoboyslater]

Hi, I'm 22weeks with ds2 and absolutely torn between my current options for labour.
I went to 41+3 with ds1, had a good labour; slow labour for about 24hrs before going into hospital at 5cms, progressed really well until 7cm then it all went downhill...due to a number of cock ups from the hospital, and 12 failed attempts at an epidural later, the increasing pain in labour turned out to be because ds was back to back& his head was in the wrong position meaning I couldn't birth naturally, despite reaching 10cms. After telling me all of this, they didn't decide on emcs until ds got distressed. Ds is now 19months and I'm still quite sensitive about birth.
So, because of previous emcs, I now have a number of choices for this labour, and I feel like every time I make my mind up, I end up changing my mind. After meeting with the consultant, my choices are;

1. Elcs
2. VBAC
3. Induced VBAC on due date
4. Trial of labour & then cs if no progression after a time set by myself

At the moment, I am swayed towards VBAC/ induced VBAC, but I just can't get my head around the 'what if I end up having to have another emcs?'.

I don't know anyone who has been in this situation before, none of my friends have children, and so I have no one to talk this through with.
Any suggestions/stories would be appreciated- I have 9 weeks until a decision needs to be made, and I want to make an informed choice.

Thanks x

[MumOfMissy]

I would go for option 4. I wouldnt recommend induction: I was induced at 10 days over. The pessary (propess) worked too much too soon and hyper stimulated my womb and I had to be given an antidote. It was extremely painful being induced, I'd avoid if at all poss. In the end my DD's head wouldn't turn and she was delivered via Ventouse.

I understand your fears about VBAC given your past experience. Could you go to a diff hospital? If not, you have the benefit of experience and could do option 4, and make staff aware on the day of your previous history and write a clear birth plan to stick to. I have no experience of emcs but I know I recovered much quicker than my nct friends who had cs/emcs. As you say, you could make a decision earlier so it doesn't have to be an emergency if it comes to a cs, then you would feel more in control and that you'd given VBAC your best shot. Good luck x

[hiss]

Hi twoboyslater, you poor thing with 12!! attempts at epidural!!! Would you consider or is it possible for you to have an anaesthetic review prior to labour this time to discuss the previous difficulty with epidural and possibly alternative analgesia for labour next time and also is it possible to have a midwife review your labour notes of your last birth. Some insight may make help you make your decision?

[hiss]

Also have you looked at spinningbabies.com? It has advice on how to help baby into optimal position for birth.

[twoboyslater]

MumOfMissy- thanks for your account, that sounds horrid! Due to the f-ups by the hospital last time, there were numerous meetings with the hospital prior to ds2 even being thought of, in which they apologised profusely and admitted a clear number of errors and dreadful aftercare. As a result, I have a strict plan of care in place for this birth, under additional consultant watch and will have additional checks throughout labour. Basically, I'll be watched like a hawk this is why my preference is VBAC or induction, though your account has made me think through the downsides to induction, so thank you for that

Hiss- I had the privilege of meeting the Anaesthetic Consultant at my previous appt. He advised bypass Pethadine and to have epidural fitted as soon as I need it, as it should be easier to fit earlier in labour, rather than when I'm 8.5cm. There are now notes in my green folder, insisting that the most qualified anaesthetist on shift administers the epidural. Which is quite reassuring!

Mind you, with all of this reassurance, I am still absolutely terrified that it will be the same as last time and will end up in surgery. I feel like im in a bit of a catch22 at the moment- the fear of having another unsuccessful labour and being rushed down for an emcs literally makes me feel sick, but I want to avoid a cs unless it's completely unnecessary as I can't be

[twoboyslater]

(son just started mashing at my phone, sent too early )

As I was saying, I want to avoid a cs unless completely necessary as I can't be off my feet with an 18month old and a newborn. DP works nights and catches up sleep in the day, so really can't afford to be recovering when I'm the only one with them 4 nights/majority of 5 days a week....

I feel like I'm running out of time and I don't have enough info behind me to make a properly informed choice right now. Every time I think ive settled on one idea, I end up feeling like I'm not making the right choice, purely down to a case of 'what if?'. Baby needs to come out one way...!

[MumOfMissy]

It's clear you want to avoid a cs if at all possible and your worst fear is emcs. In that case, thinking logically, your best option would be to try for VBAC, with induction if necessary. Remember that what I told you was only my experience of induction, lots of people have successful inductions. Not every hospital uses Propess, they all have their own methods of induction. Rememder also that before emcs they can try forceps or ventouse to help you deliver LO, and the spinning babies site mentioned earlier sounds good too.

Try and stay positive, think of the most positive outcome instead of the worst. Because of your past experience, it sounds like this time you will have the best possible care, so let that be a comfort to you. And even if the 'worst' happens, at least you know what it's like. Is there any particular aspect of an emcs that fills you with dread? If do, is that something you could discuss with consultant to help reassure you or see if it could be done differently?

[MumOfMissy]

If so

[NAR4]

I think you were incredibly unlucky OP. All four of my babies were back to back and needed inducing. The first three were actually born still facing the wrong way (which I'm told is unusual). Thankfully I didn't have any of the problems you had. I'm just telling you this so you know it isn't always awful if baby is back to back or you need an induction.

[twoboyslater]

NAR4 - have you any tips/advice on dealing with an induced labour? As I said, I want to be as informed as possible before I finalise my decision. Any input (good or bad) would be very appreciated x

[twoboyslater]

Mumofmissy- I went into labor with ds1 SO calm and relaxed...it was always my plan from the beginning to have a natural birth with as little pain relief as possible. I was completely against the idea of cs, it seemed so invasive and unnatural. I didn't feel like I bonded with my son at all, I didn't hold him for the first 1hr 30 of his life as I heamorraged and needed that fixing as paramount. I still feel that cs is not the right way to go about labour unless completely necessary if mom or baby is at risk.
I was just so neglected in labour, then it was all a rush, and I had to stay in for 3 days due to heamorrage requiring additional observations and blood tests...the aftercare was appalling (passed out in shower and asked for help up, midwife said that she 'wasn't employed to lift people', despite my BP being 80/40, to name just one incident) and i was diagnosed with PTSD from the event shortly after.
I literally cannot talk about the birth without becoming extremely worked up, nervy and upset. I have just about come to terms with the fact that everything that happened with ds1's labour was circumstantial due to his positioning but I can't get out of my head the idea that it MAY still happen again.
A large, large reason for not wanting cs is purely because I don't want to stay in hospital and be treated like an animal. I want to be home, with my kids, around people who will treat me with an inch of respect.
The whole thing has really, really, made me terrified of birth, especially cs.

[MumOfMissy]

twoboys did you have counselling after the birth? Sorry u had such a rough time. If u are worried about positioning, can u spk to a midwife or consultant to agree a plan of action if it happens again?

Re your nervousness, have you heard of hypnobirthing? It works wonders for some people. What about trying for a home birth/water birth? Does your hospital have a birthing centre rather than labour ward?

I had to stay in for 5 days after my DD was born, even though I didn't have cs. I lost 1.5 litres of blood from a tear, then discovered my epidural had been done wrong (post dural puncture) and then got a kidney infection. The only thing that made it slightly bearable was I paid for a private room. A few staff were a bit unpleasant but most were lovely. Guess its the luck of the draw, and you got unlucky. I had trouble bonding with my DD, it took me a few days to start to bond. I think I took too many drugs during labour (ie all of them available), and was just in shock quite frankly.

Anyway, back to you. If you can't go to an alternative hospital or have a home birth then try and think positive. Could you hire a doula to support you through the labour? What little things could you do to make yourself more comfortable if you do have to stay in? Could you pay for your own room? Have friends and family visit you in shifts so you are alone as little as possible? Try some relaxation techniques now to prepare your mind.

It is highly unlikely you will have another experience as bad as your first. Try and stay calm and positive.

[MumOfMissy]

PS Reading my last post back I realised it may sound a bit wanky and posh, Doulas and private rooms, but I agree with you that hospitals are generally unpleasant places and just trying to think what could make you feel better / more relaxed! I know these things cost a lot of money but its the one time in your life you need to feel as relaxed and happy as possible so if you need it, and you can afford it, then go for it! #becausewe'reworthitinajenniferanistonstylee

[NAR4]

twoboys It depends how ready your cervix are and if you are dilated at all what they do first.

As a general rule they put gel on your cervix/insert a pessary, to soften it ready for labour to start. My hospital will do this up to 3 times, six hours apart.

Next they break your waters if you have dilated enough but are not in labour.

Last you get given a drip if you are still not in labour.

Some poor soles will still not go into labour (I only know one person this happened to, who was induced at 38 wks). You may be offerred a CS at this point or sometimes they let you go home and try at a later date. This wouldn't be an emergency CS though.

You don't always have to have all of this done. Try looking up your hospital guidelines on induction as I think they all vary slightly.

It can take days for induction to work and get labour started, so buy lots of magazines, as its a very boring waiting.

I found the whole process alright, up until the drip goes up. In my experience this was very painful (last time) but I think it depends how much you need, as only my last labour was extremely painful, when I had to had the drip stay on full for the entire labour. Personally I would still do it again rather than have a CS, but I have never had one before so partly it is a fear of the unknown and also for practical reasons, with five children to look after.

Oh and if you are induced then you are monitored throughout, but it shouldn't mean you have to be bed riden. The midwife will be with you most of the time due to the monitoring.

I contacted PALS before my last birth, due to concerns that I would have repeat problems that I had during my second birth (although at a differrent hospital) the head of midwifes phoned me for a chat and put my mind at rest before I went in for induction.

Just take it one step at a time and ask for painrelief if you feel you need it.

[NAR4]

twoboys try doing some of the exercises on spinning babies web site. I did manage to get this baby to turn, a few times, doing the exercises. Its just a stuborn one and keeps turning back to back again. It has loads of stuff about good birthing positions as well and ways of managing the pain.