I hate making decisions...

Well I had my apt with the specialist this morning at Greenlane hospital. It didn't help me make a decision about VBAC vs elective at all. He just told me all the things I already knew, & then told me it's up to me. I am so confused. I hate making decisions at the best of times, & this feels like such a big decision to make. I wish I had a crystal ball so I knew how things will work out if I try for the VBAC. The specialist said that is the problem with professional women, they want to be in control & know everything, & unfortunately labour & birth are not like that. I told him actually I dont' want the c section or the VBAC & asked whether maybe the stork could bring my baby instead. Apparently not which I think just sucks.

Anyway, I have another apt booked for 23 march & if I want the c section he will book it then, but by the sounds of things it will only be performed around my due date.

I was hoping after this apt I would have a better idea of what I want to do but I'm just as confused as before. Maybe I should flip a coin....

Bizzy if I knew the VBAC wasn't going to end in another emergency C section I would go for it, but of course there's no guarantee.

I didn't mind labour, I just didn't like the specialist shouting "crash c-section" & then me being wheeled straight into surgery & an aneasthetist standing next to me ready to knock me out if the epidural top up hadn't worked quickly enough & I could feel the cut. I definitely didn't like not knowing if my baby was going to be ok. It was a very stressful experience, & I'd prefer not to repeat it.

Last C section was down to failure to progress (I never got past 4cm, despite 12 hours of labour & having syntocin) & when they took him out he was posterior, chin flexed & cord round his neck, so he was never coming out the normal way. The specialist said the positioning of the baby isn't something that tends to recur, but he doesn't know why I didn't dilate, so obviously there's no guarantee I'll dilate next time.

Also a 1 in 200 risk of uterine rupture doesn't sound very low risk to me, especially when possible outcomes of uterine rupture inlcude baby dying, being brain damaged, hysterectomy for me or death for me. If the risk was 1 in 2000 or 1 in 20 000 then that would be low risk, but 1 in 200 doesn't sound great to me. I feel like maybe I'd be irresponsible taking a risk with a vbac when my 2 1/2 year old son needs his mother. Imagine something happened to the baby or me-I'd feel a right idiot for not having the elective then wouldn't I? I know it's worse case scenario, but it's still a possible scenario. I'm just scared sh*tless I think.

Argh I hate having to decide. Obviously if I could have a straight forward vbac & have a healthy baby (& be healthy myself) then the recovery would be heaps better than major abdominal surgery (especially as I have a toddler to care for), but it seems the pros of vbac (having the birth experience I'm "meant" to have & being up & about hours after with no surgery to recover from) don't outweight the possible cons (uterine rupture & all it's possible complications) . I feel like the safe option is the c section. And yes, my recovery from the c section was really good, so I'm not afraid of it, but my MW says it's only because I have nothing to compare it with.

Oh I'm so confused...

Edited by Odettenz

you dont have to make the decision immediatley so take the time you need. also i would suggest looking round this section of OB at some old topics - there are lots of interesting stories about VBACS and even a VBA3C...   you might want to look into hypnobirthing also - there is some ladies on here who are doing and have done it - to help if you decide to labour. and hopefully just writing it down on here is helping make things clearer in your head too.

Hi Odette. I haven't had a CS, but I have just been reading about VBAC in "Ina May's Guide to Childbirth" by Ina May Gaskin.  If you can find a copy, I definitely recommend reading it.  With my first pregnancy, I was sh*t scared of labour and birth and my very first question of my MW was "Is it true you can't have an elective C-section on the Coast?" (not realising at the time what a terrible question that was to ask a homebirth MW hahaha).  I was lucky enough to meet a number of lovely women during pregnancy, including this MW and her backup, who slowly changed my whole attitude towards labour and birth. The only book I read during pregnancy was Ina May's.  I ended up believing in myself and trusting my body and having a hassle-free, natural birth in hosptial.  It helped to know that bubs was in the optimal position when I went into labour ... from what I've heard posterior babies sound a lot more painful.

Did your OB explain exactly why the chances of rupture were so high?  I don't know much about it, but isn't it more likely to happen if your placenta is attached to the previous incision site?  Would knowing the reasons behind the odds help to make your decision?

Hi
I can empathise with your decision dilema's, I am struggling with the whole process at the moment - it's driving me nuts too!

I have been doing lots of reading & internet research which has helped with my knowledge base but hasn't really provided a clear predictor for making a decision.

C/sections carry risks too particularly for mum (bleeding, infection etc...) so get some information (if you haven't already) on what is involved.

I think it is a more emotional decision particularly when there isn't a medical reason to go with a c/s. It might be a good idea to think through what happened last time, did you feel cheated or feel like a failure? Will you feel like that if you go for an elective? If the process of how the baby arrives doesn't particularly worry you and you aren't hoping for a large family, then maybe being in control and calm leading up to birth is really important to you.
And that is okay!

Was your first labour induced? Induced labour is more painful, so if you go for vbac, you probably won't be induced. Spontaneous labour is much easier to handle particular in the early stages.

HTH

Reading your post, if I was you I'd go for the elective c-section. If your recovery from the emergency one was good, then surely it can only be as good or better with an elective? I could be wrong, but you seem to be leaning towards wanting the c-section but feel like you should want/have VBAC?

I've had an easy, straightforward, gas only VB and an emergency c-section - so both ends of the spectrum! - and I don't feel that VBs are the end all of giving birth.

Ahh I remember being in this position. I hated the fact no one could guarantee that I wouldn't have to have another emergency c/s. I'd rather have the elective than run the risk of having another emergency one. I know a lot of the ladies on here have their heart set on having a vbac. Where as that really wasn't something I felt strongly about. The ob and my midwife 'encouraged' me to go for the vbac but said ultimately it was my decision. I think I knew in my own mind that I'd go for the elective right from the beginning, but I admit I did think about it a bit after some of the conversations with the different health professionals. The fact that I would be so monitored and restricted in what I could do in labour put me off too.

In the end the decision was taken out of my hands. My liver wasn't happy and Sebastian had to come early. They couldn't/wouldn't induce me so elective c/s it was. After he'd come out the ob leaned over the curtain thingy and said he was brow presentation (reason for DD's C/s) so I'd have ended up with a c/s no matter what I had wanted or tried.

Good luck making your decision but to be honest it kinda sounds like you've already made it.

Hey Odette,
I see you are worried about the risk of rupture because the odds seem higher than you would like... I just wanted to put a couple of things in to help with perspective.

For example, did you know the fact that the risk of rupture is actually HIGHER in a woman having her first baby (first ever labour) than the risk of rupture in a woman having a vbac?
That is a statistical fact, with quite a few large studies done overseas that back this up.

Also IF a rupture does occur, the statistics show that fetal & maternal disability or death are on the very extreme side of rupture. There is a very good (but old & american) book called A Silent Knife that has the statistics & also notes & links to real studies done on VBAC that show it is not often all doom & gloom.


Also I read that you didn't dilate well & Bubs was posterior & malpositioned.
Chances of that happening are quite slim, I think if you talke dto your midwife she would be able to explain to you that dilation is helped along by baby's head so if Bubs is not positioned well then your cervix actually CAN'T dilate properly.

There is something call Optimal Fetal Positioning. Try googling it. Basically if you can get bubs into a good position in the last few weeks before you go into labour then it greatly improves you chances of an easier straight forward labour. I worked with this concept quite a bit when working toward my VBA2Cs and had a brilliant labour & birth for my daughter.

c-section also has just as many complications as a VBAC. Some of the more serious ones can result in emergency hysterectomy or internal organ fusion during healing. Just like VBAC risks these are on the more rare side but certainly are risks to think about.
Also a straightforward c-section is going to take longer to heal from than a straightforward vaginal birth. Even a vaginal birth with minor complications is going to have faster healing time than a straightforward c-section.
Something I really struggled with was having a toddler AND a newborn after a c-section. And I had reasonably straightforward c-sections but my natural birth was a zillion times easier.

Now in saying all this, at the end of the day it IS your choice. You have to feel comfortable with what you want to do. If you have real fears about having a vaginal birth then that can hamper you chance of having a good VBAC experience. And at the end of the day, having a healthy & happy Mum & Baby is the most important thing.
So really as your OB said, it is your choice.... LOL!

Toni added my only other piece of information and that was about rupture... no one discusses with you the risk of uterine rupture unless you have had a c-section... however most women dont know the risk they are at if they have not had a section...

I think febgirl has a point.. what will disappoint you more.. vbac ending in section or not trying at all???

Another option is to book your c-section for a set date AFTER your EDD to give your body time to do it yourself, or set a certain number of hours in labour before making the c-section call... that way you are giving your body the space and time to try and do it without calling in the big guns so to speak... I have also heard some women say they were told they could ask for a c-section at any time duiring labour (if they'd already had one before) if they felt they couldnt cope anymore (obviously there is a point of no return, i.e baby coming down the canal, or X cm's dilated already)

Personally, I had the same thoughts as you... I had a shocker of a birth ending in a crash sectyion, and kept going back and forth between VBAC and elective, I even went to ante-nata classes to see what I could learn about labour this time around... in the end, the only selling point for a VBAC to me was faster recovery, whereas the elective would allay all my labour/delivery fears, and it also meant we could organise care for my son while I was in hospital, it meant I could HAVE a birth plan (post-birth anyways) and do all the things I missed out on with my son like skin-to-skin and attempt first feed within that first hour instead of 'winging it' just in case it ended up being another emergency c-section...

I am one of those people that freaks out at the unknown or imagines worst case scenario and cant think of positive 'what ifs' so for ME, and elective was the better choice mentally... and as it turned out physically as well.... I was officially 3 days shy of EDD and my cervix was tight, and Jae was so high up I could feel them trying to push and pull me around to pull her down enough to get her out... I cried when she came out as she came out bellowing like there was no tomorrow... as opposed to my first who came out not breathing and was whisked off to NICU before I saw/heard a thing.

After all that... I dont feel ripped off, I am thankful that I got to experience a much better delivery 2nd time around, and I even ended the day saying that I wanted to do it all again! (after B I swore I wasnt going to have another kid if THATS how it was going to go!)