I can't decide whether to go for ELCS or VBAC - need advice/experiences please

[pokesandprodsforthelasttime]

I've spent too many sleepless nights worrying about this! I've an appointment with the consultant midwife about a VBAC next week and I really need to be clear about what I want.

DC1 was born by EMCS after a very long latent stage and active labour, she was back to back and brow presentation but this wasn't discovered until the end.

When the brow presentation was diagnosed the obstetrician said I had a prominent sacrum which might be why DC1 had got herself into this position. I have googled this but there doesn't seem to be much info out there, so I don't really understand what it means. Also nothing was written in my notes about it so I'm not even sure if it's relevant.

The consultant I saw a couple of weeks ago said there was no reason I couldn't have a successful VBAC. The hospital are very supportive of VBACs. She said the risks of a CS are higher for me as it will be my 3rd major abdo op (also had surgery for massive ovarian cyst) and may result in adhesions. Which is why I initially agreed to a VBAC.

But I have so many worries:

-I don't have much faith in my ability to give birth naturally

-I'm quite short (5ft 2) and worried this baby will be 9lb going off DC1 weight and family history. I know plenty of short people give birth to big babies naturally, but I'm worried about the shape of my pelvis and the prominent sacrum thing.

-I handled my 1st labour fairly well with regards to pain, but couldn't keep any food or drink down even with anti sickness injections and a drip. I spent a long time in recovery after EMCS as I was so dehydrated.

-I would prefer an ELCS to a EMCS.

• I'm an old fart (38) -6.5 years older and definitely less physically fit than when I had DC1

• I did a VBAC success calculator thingy online which only gave me a success rate of 50%

• I have no urge to give birth naturally just to experience it, or prove I can. My main concern is that DC2 born safely with minimum long term damage to myself.

• I had IVF to conceive this baby (does that make any difference to anything? it's down as a risk factor in my notes)

• I have antenatal anxiety/stress and a history of depression - GP is worried about me developing post natal depression and is keeping an eye on me. I'm worried a traumatic birth may add to my problems!

Sorry for the essay. If you got to the end and have any advice about any of this I'd be very grateful :)

[Boobybeau]

Sorry I don't really have much advice but I think you kinda answered your own question when you said you dont really have an urge to have a natural birth and you just wanthroug and baby to be safe. If you're indifferent about it then I'd go for the safest most predictable option. If you have anxiety issues then being able to control the situation may also help you. Good luck

[Boobybeau]

Sorry I don't really have much advice but I think you kinda answered your own question when you said you dont really have an urge to have a natural birth and you just wanthroug and baby to be safe. If you're indifferent about it then I'd go for the safest most predictable option. If you have anxiety issues then being able to control the situation may also help you. Good luck

[Boobybeau]

Sorry I don't really have much advice but I think you kinda answered your own question when you said you dont really have an urge to have a natural birth and you just wanthroug and baby to be safe. If you're indifferent about it then I'd go for the safest most predictable option. If you have anxiety issues then being able to control the situation may also help you. Good luck

[Boobybeau]

Sorry for the multiple posts, gremlins in the system x

[thegoldenfool]

i went for the elcs after an emcs based on control of the situation and repeat likelyhood and childcare!

i was all geared up to demand a cs and they said yes very easily and I then realised that i wanted a perfect VBAC. However statistically that was unlikely and I had the childcare issue so stuck with the c-section and a bit sad that i didn´t hve a vbac. It was harder afterwards than the first one because of the toddler and I forgot how much it hurt.Also visiting physiotherapist as much tummy muscles haven´t joined and I have a big bump still - this can happen anyway but is more likely after a c-section

it seemed really important then but I have lovely DD2 8 weeks sleeping on me it seems much less important, and in all reality in a couple of years I don´t think I´ll care at all as long as tummy shrinks

[upsydaisy33]

Why don't you print your original post and show it to the mw next week? It strikes me you explain the dilemma very well and maybe better than you might in talking to her without it with you. You sound very sane and thoughtful to me, and she might be able to fill the gaps in your knowledge...

Best of luck. X

[mrsvilliers]

Pokes I could have written your post! I am going through the exact same dilemma for a number of the same reasons (except failed induction/face presentation). I read your post and immediately thought you should just have a section. I suspect that is what I need to go with too but the thought of another section is currently too awful to contemplate. Fwiw I do think an elcs is much easier to recover from (have a few friends who've gone down that road) there is just always that lingering thought that it might be one of those births that go perfectly and you're home 6 hours later...

[Beamae]

I have been stressing all year about this. I ended up going for the VBAC even though I also didn't have the urge or drive to do it and the odds were against me having never laboured before and being a slightly older fart than you. My VBAC last week was successful with only gas and air, no stitches, no instruments. Given the choice again I'd go for the ELCS. Giving birth naturally was not an experience I needed to have and I don't feel like it has necessarily improved bonding or anything like that. Even though my recovery will be marginally quicker - I was up and about walking with the pushchair within a week of my previous section - I am spending the same amount of time settled in at home getting the breastfeeding established and snoozing. So I don't think I have gained time getting back on my feet really.

[HomeEcoGnomist]

It is 3.5 years ago now, but I had a VBAC after EMCS for face presentation.

I remember being quite adamant that I did not want another CS, given I already had a toddler and couldn't face the practicalities of nursery runs etc with stitches (ie no driving for 6 weeks etc) I also recalled things like lifting/going up and down stairs being v difficult - bad enough with one baby, never mind 2.

I went 9 days over my due date and was facing another CS when I finally went into labour. And so quickly that I barely arrived at hospital before DS2 arrived! So I had a VBAC with no pain relief. I can't say I felt that special about it...just happy that I'd avoided the CS

Not sure if this helps, but it is perfectly possible to do.

I'd say it's almost impossible to not get slightly fixated on this (whatever angle is bothering you) ...so just talk It through as much as you need to

Good luck, whatever happens!

[thehairybabysmum]

I had the exact same dilemma and obsessed about it from 20 wks onwards, I simply could not decide (prior to 20 was I was adamant I would have an elec CS).

In the end I booked a CS just after my due date as I couldn't bear the thought of going overdue as was v fed up. Decided to give it a go for VBAC if it all kicked off before then. Which it did, one week before due date, so I laboured, got to fully dilated, DS was showing signs of distress and when they then burst the waters there was a lot of meconium so then went to emergency CS. This did seem less panicky than first time though.

I had also told my labour midwife that I would rather have another CS than the unknown quantity of an instrument birth (appreciate things can progress beyond there being a choice re this).

So overall I felt like I hadn't actually had to make such a defined choice as I did give VBAC a go if before the 40 week mark IYSWIM. Maybe you could keep your options open in this way...just see how it goes, if VBAC going well then go for it, otherwise see if you can go for CS if labour seeming not so straightforward?

[thehairybabysmum]

This was six years ago!! As is the way I think with these things I have barely thought about it since DS2 arrived, despite also having many sleepless nights at the time!

[thehairybabysmum]

I think the pg hormones defo interfere with what would normally be a logical and rational decision process!

[pokesandprodsforthelasttime]

Thanks for your thoughts everyone.

boobybeau and thegoldenfool - yes I'm totally tempted to go for ELCS just for control over the situation. But equally terrified something will go wrong on the operating table or I'll end up in long term pain from adhesions

Childcare and looking after DC1 afterwards isn't really a problem for me as DC1 is 6 and happy to be left with friends and family at short notice, and can do most things for herself now. School is literally round the corner so I don't need to drive.

Beamae why do you wish you'd gone for an ELCS? What was it about your VBAC that you didn't like?

homeeco and hairybaby I was nearly 2 weeks overdue with DD and I hated going so far over. I was so huge and in pain by the end I could barely walk! The consultant said I would have an ELCS at 41 weeks if I went overdue as I don't want to be induced (due to risks of scar rupture). I'm already fed up with this pregnancy and I'm only 24 weeks, I think I'd cry if I went one day over 40 weeks!

hairybaby I'm also scared of instrumental birth and tearing or being cut. Basically I'm scared of everything and there is no 100% safe, easy option

I will print out the above list of my worries to show the consultant midwife but I've heard he's very pro-natural birth and promoting normality and I'm afraid he won't give me a true unbiased view.

Also like to add - I told my GP all my worries about the birth and she thinks I should have an ELCS, however I'm aware GPs aren't experts in childbirth by any stretch. Maybe she's coming more from the mental health point of view?

[thehairybabysmum]

I had a v dismissive experience with a v pro VBAC midwife, I contacted hospital and then saw the obstetrician, it was actually him who suggested booking the 40 wk slot and seeing what happened prior to that once I explained my indecision.

[Bythebeach]

I VBACed twice and although that was right for me I was very on the fence both times versus ELCS. My first VBAC also took longer to recover from than my EmCs due to SPD which had been v mild being made horrendous by birthing a big baby.

I think ElCS is a more (but in no way entirely) predictable option and if you are anxious may well be best?

[Isabeller]

I am in a very similar but not identical situation, I will come back tomorrow when I'm awake :)

[Beamae]

I think there is a lottery on both sides. You could go for the ELCS and have a quick, problem free recovery, but there is always that threat of complications. The same on the VBAC side. Your recovery could take longer than a section and have long term complications.

I found that when attending the VBAC clinic and course that they tended to compare best natural births with worst possible sections which wasn't an even playing field. I ended up committing fully to the VBAC thinking if there was a chance that I could escape unscathed and have a quick recovery, it would be the least selfish route to take because I have 2 year old twins who need their mum back.

But the reality for me was that I had been afraid of childbirth for good reason. My labour was quick but brutal. Despite my hypnobirthing classes and hiring a Doula I really didn't cope very well with it. It was harrowing and I was in shock for days. This is also part of the lottery because there is no predicting how it will be for you.

With hindsight I would have preferred calm and predictable. Planned. I hated the waiting, not knowing when it was going to happen. And I hated the experience itself. I had convinced myself when choosing the VBAC that it would be interesting to have the two experiences to compare, but now I know I didn't need to have a natural birth. I had no desire for one, which other women seem to have, and having one hasn't made me change my mind. Sections are simple, straightforward, and you know what you are signing up for. The risks are anticipated.

I thought that with a problem free natural birth I would be up and about, out the house, playing with the kids after a couple of days. But
6 days later I am still lurking in bed or wedged on the couch, breastfeeding around the clock, so in some ways I might as well have had a section. I'm doing a similar pattern of recovery. But then I do have a lot of help so I am taking advantage of that!

Good luck with your decision. It is a difficult one to make.

[pokesandprodsforthelasttime]

That's a very helpful post Beamae thanks.

I agree with your thoughts re: VBAC vs CS. I like the idea of the calm, predictably of a CS. There are risks but I'm aware of these and I know what I'm signing myself up for. With a planned VBAC I feel like anything could happen - right from a lovely calm natural birth, a birth that on the surface goes well but is traumatic (like yours), instrumental delivery, another EMCS or even a ELCS if I go overdue.

[Isabeller]

I'm 23/40 (DC2, EMCS 20+ years ago) and have enough risk factors to mean I'm being carefully monitored with scans GTT etc but no actual problems developed so far. Risk factors are age, previous abdominal surgery as well as EMCS, borderline hypertension, BMI 32 and probably other things but as I say all is going well so far. I don't feel too well mind you.

I am trying to weigh up both sides of the argument with an open mind and look for evidence about my particular chances of successful VBAC or quick recovery from ELCS.

A family crisis is brewing so I might not be back for a while but I am really interested in how you are looking at the question OP.

[IamSlave]

When you say your consultant is very pro VB I just see £ signs in her eyes. Sorry, not much help!

[dublinmary]

I had this dilemma 4 years ago, also following a long traumatic labour with a back to back baby who was over 9llbs. I was keen on trying a VBAC, but when they told me that I could not move around, and would need to be monitored constantly I felt that the odds of having a second EMCS were higher, and I did not want to have to deal with that. Nor did I want to have to fight with the staff for my right not to be monitored etc. I'm sure I have the right, but I didn't have the energy to be arguing with staff.

We booked an ELCS for the day after my due date, as I was confident the baby would be late (I was 10 days late with DS1.) It was a much easier experience than first time round, and I was so much less exhausted than after the long long labour, which made coping with baby and toddler much easier.

Good luck with whatever you decide. I hope it all goes well.

[pokesandprodsforthelasttime]

Haha I'm not quite as cynical as that Iamslave but yeah I get your point. I think this consultant midwife is genuinely interested in natural birth, and I believe he's helped a lot of women achieve the birth they wanted in difficult circumstances (breech, twins, VBACs etc).

I'm also led to believe that continuous monitoring may not be necessary, as they offer intermittent monitoring if requested. So you can move around and even go in the birth pool.

In fact DC1 was monitored during birth via fetal scalp clips which I requested rather than the belt thing - so that I could still move around a bit and sit on my birth ball.

As I say the hospital are very supportive of VBACs - I would say I'm possibly in one of the best places for this. If the hospital weren't being so goddamn nice and accommodating around the VBAC it would make my decision a lot easier - as the ELCS would be a no brainer!

[Mumoftwoyoungkids]

I had a successful VBAC 4 months ago. I describe it as a "perfect" birth. Technically it wasn't perfect - slight PPH and needed a couple of stitches and it hurt like hell - but it was pretty great and I felt amazing afterwards.

I Got the full skin to skin, check the sex, baby move towards the breast for the first feed works which made me feel very bonded to him. (I'd been worried as we thought I was going to miscarry early on and after that I found it hard to bond while he was in the womb as I was too scared.)

Re:monitoring - I had continuous monitoring and didn't find it particularly restrictive. I spent most of my labour kneeling on the bed holding the back board. Stupid thing kept popping off which was really annoying and occassionally panicked meas I couldn't hear the heartbeat. Poor dh was instructed to hold it on which apparently was really uncomfortable for him! I did have a snigger at that afterwards.

The thing that made me decide is that I am really bad at living with "What Ifs". Had I gone for an ELCS I would have always wondered and it would have driven me mad. But I am on the obsessive side so it is likely to not be a problem for most people.

[pokesandprodsforthelasttime]

Thanks for your post mumoftwoyoungkids. Can I ask what was the reason for your CS the first time?

Also want to add - I got skin to skin and the baby crawling towards the breast thing after DC1's EMCS, so I don't think a natural birth is necessary for that to happen.

[HatticusFinch]

I too had the same dilemma, following a traumatic first birth and a EMCS I was terrified to go through it again.

The hospital were very pro VBAC, to the point where the only way I could have a ELCS was if I went overdue or there was a medical reason (this was three years ago) I don't want to sound negative but I really felt like my concerns where mostly dismissed and the over-riding feeling from concerned was 'It'll be alright this time'

So I attempted a VBAC, and when the time came I felt calm and in control and it went really well to begin with. I was also worried that I'd be stuck on a bed unable to move because of the monitoring, but this proved not to be the case as I was still able to move around quite a bit.

I ended up with a crash section under GA so it wasn't a successfull VBAC. Although if I hadn't had the continual monitoring it could have been a very different outcome for us both. I still wish that I'd fought more for a ELCS or moved hospital to try achieve this.

I really hope Pokesandprods that you manage to come to a decision that's right for you and you are happy with it, all the best!

Gawd that's abit long, sorry for the essay!