My choices - Repeat CS or Induced VBAC, I don't know what to do.

[DaintreeDream]

Due to my DD's health issues I have been backed into a corner with my birthing choices.

Sure I could go ahead and aim for a no intervention VBAC but I would not put that kind of risk on my baby.

Due to DDs heart problems she will require specialty care immediatly after birth, for this reason my ob would ike to schedule her birth so that he can have the appropriate team ready and waiting for her arrival.

Usually this would mean an induced labour a week or two early. However as I have had a previous CS it isn't that easy. Of course they pefer I just have a repeat CS as it would be easier for everyone involved however they have said that they will support me and help me to have a VBAC it is what I really want.

If I have aim for a VBAC this means I am to be induced. I need to find out all I can about being induced after CS as I was determind I would not need to even face this question I have not educated myself at all as yet.

I DO want to aim for a VBAC so long as I am not putting my DD's life at risk.

My reasons:
* She is going to be in hospital for at least 2 weeks, 1 hour away, I need to drive to see her.
* When she is transferred to the Childrens I want to be transferred with her not be stuck in a bed at the birthing hospital.
* I have a 19 month old DD to care for also.
* There is a chance I may be able to spend an hour with her after her birth, the hospital does not allow babies in recovery, last time it look me a long time to get my feeling back and I spent an hour in recovery, there is my time gone, I will miss out again.
* Even if they do allow baby in recovery, my DD will not be allowed, I would really like her to meet her sister outside of the NICU if at all possible.
* I am allowed to attempt a first breastfeed if she is ok for that first hour or two, if I am in recovery and she is not, we miss out on this breastfeed which I think will prove very important.

I am sure that there are more but my mind is a bit overloaded at the moment.

Please help me with any questions I should ask, things I should consider etc.

I have so much on my mind at the moment with both girls (Matilda has been diagnosed with new medical issues that need to be dealt with before Annabelles birth also) so I am finding it hard to seperate my thoughts.

I just want to cover all bases and do what is right for all of us, DH, I and both of our girls.

Thankyou for any input you may be able to provide.

[rufalina]

Sweet Girl, I was thinking about you yesterday and wondering how you were getting on. And it sounds like you are stuck in a world of medical intervention. So sorry to hear that, and that Matilda is also in need of assistance. Cant be easy on your head, or heart.

I cant really offer a lot of advice, but, personally, I would be trying for the early, gently induced, and supervised labour, knowing that if it fails to progress you can have the c-sect, but gave it a red hot go.

I can understand the reasons behind your thinking and I really believe they are valid. If your OB is keen to support you in a VBAC using induction, then I really think, it is something you should try. From what I have read, the risks with induction for VBAC as about the increased likelihood of scar rupture, due to a fast paced labour, which your body may not be ready for. But I, like you, have not read a lot on this... Hopefully you can get some help here.

Know I am here holding your hand through this. xoxo

[Arimeh]

I've only just caught up with whats going on in your life now honey xxx

I've done a lot of research, as I'm sure you would expect from me.. hehe.. and even my OB wouldn't induce a VBAC. There is just too much risk of rupture honey, you know the risk of rupture for first time mothers who get induced are higher than the risk of rupture for us VBAC's who go into labour naturally?

If it were me, I'd have to weigh up the risks you know? Like, even if you do get induced, there is a high risk that it will end in c-section anyway because bubs wasn't ready to come out - how would you feel if you went through all that and it was still born c-section?

I would have another c-section in your position - and then go for a VBA2C for your third baby

Oh - I nearly forgot, I was driving as soon as I got out of hospital - my OB had no problem with me driving before the six weeks, and neither did my car insurance, so check with both of them, you might be surprised.

Best of luck - you are by far the strongest chick I know.

[rufalina]

Been thinking about this...

Lets just say you go into labour early, spontaneously, there is no notice for a medical team then... so what happens in this scenario? I know how critical it is for you to have them standing by for DD2, but that is one thing I would ask my Ob. Cause even with a 2 week early induction, DD could come prior to that...

And if this warrants a satisfactory response, could you seriously look into alternate labour inducing methods, like acupuncture etc, and get started on them early December, in the hope that you can bring on labour early. Which I know is no guarantee, but is that an option???

Another idea is talking to the hospital about having a private midwife with you in recovery, and does that allow bubs to be with you? Or can you deliver at the hospital where DD will end up so you dont need to transfer?

[Midwifemum]

I would get as much info you can about your baby's medical condition and the likelyhood of labour stressing the baby and resulting in an emergency C/S for 'abnormal CTG'. Is your Dr going along with your VBAC plan as a token response to keep you happy or is he/she 110% committed to doing what is right for you and your baby. Inducing after a previous C/S is fraught with danger but can be done. Ask your Dr if they have ever used a double balloon catheter for VBAC induction. Investigate natural methods of induction. The earlier the induction is planned the less likely you are to have a vaginal birth. I don't envy you and the decisions you have to make but hang in there and stay as positive as you can. Go to the birth rites web page for some good tips on VBAC. Thanks for listening.

[Jas]

Hun, Good luck making your decidion it seems you have a lot on the list for vbac!

Usually options for vbac induction are having your waters broken, foley catheter. I have seen one ob use a drip on very very low after AROM didnt work and he was trying to get the vbac to happen for my client (she was being induced due to chronic medicaly issues she has) maybe just talk to your ob and see what options are available to you and ask if they would consider the drip on low if other options don't work. I am so hoping you can have a positive experience although I understand it it will be a hard one for you.

Have u considered a doula? I really think one would be helpful just to keep an eye out for those little details that will improve the experience that might otherwise be forgotten

[julie_ann_jules]

what a rollercoaster u have been on!
My VBA2C in March was induced. It was a wonderful experience They can induce u but just not the same way they can a nonVBAC mum. The prostaglandin gel is a BIG no no but u can have the drip on a lower dose. Once I was in "established labor' I requested to have the drip stopped and my labor continued to progress excelent!
It is really up to you what u decided! It would be harder recovering from a c/s and trying to get around to the hospital with a baby that needs some extra assistance. Personally I choose induction as I just couldn't do another c/section. Emotionally it was so painful for me to even consider induction! I was so depressed and down on the way to the hospital. Luckily I had an awesome OB who has fantastic stats ( 2/3 succesgulf VBAC with induction and 3/4 succesful VBAC without induction)
Yes induction does increase the risk of rupture but for me it wasn't a high enough risk.... there are still higher risks of other complications happening than a rupture. You would be well monitored and you are in a fantastic place and they would have everything ready if u needed a c/s. BUT the risk IS still there.
It all comes down to you and what is important to you.
It is a hard decision to make!
Jules

[Me+him+bub]

i think if i were in your situation i would go the c section.but this is MY opinion. I was induced 2 weeks ago at 38 weeks and i didnt get past 1cm dialation in 30 hours, it was very very painful and it was all for nothing. ended up having a c section in the end which was awful had to use the forceps to get him out. Although i did get to breastfeed him even though i spent over an hour in recovery due to vomiting and panic attacks. If you choose elective c section make sure you still have a birthplan as it is still a BIRTH! and you are entitled to your requests. I wish you all the best and I myself may be in this position next time due to my health issues during pregnancy.

[BellyBelly]

DD - you've been given some good advice here, I would seek further medical opinions on this, like actually ask for a second opinion, (perhaps even call an independent midwife for advice) as it's too hard to suggest what to do when your baby has some sort of heart problem which we don't know anything about. Surgery adds risk which needs to be factored in also so you need to ask for some figures to weigh up the risk. Side effects of surgery include heart issues also, so he needs to tell you if this is going to be more risk than a vaginal birth.

Me+Him+Bub - I'm not sure what reason you were induced for - hopefully not a serious medical problem for you or the bub! However in the case it wasn't and given your ordeal, I would be advising others to avoid an induction in a first place than choose a c/s From what you have said about dilation and the induction only getting you to only 1cm and making you feel frustrated and/or upset that you worked hard for nothing, sounds like your body and/or baby wasn't ready (again I don't know of any pre-existing medical issues), and this highlights what I always say and write in my articles - not all inductions work and labour inductions (especially in first timers) has a very high epidural & c/s rate as a result.

[Me+him+bub]

kelly - I really really wanted a vaginal birth and to go fullterm but my LFT's (liver function) kept rising during the last few weeks, they tested for Hep, cholestitis, infections in me and the baby and no reason was found as to why and therefore the ob said as we dnt know why this is happening ( i was really sick as well, vomiting and fever) we therefore dont know if it is harmful for bub, and i wouldnt have forgiven myself if i had waited and it was something serious, so i was induced, an hour after bub was born my levels were back to normal! but bub was really jaundiced for a week and had the cord around is neck and this prevented him from engaging during the induction (we didnt know at the time) so in the end it worked out for the best but next time I really want a VBAC as im so depressed over my birth experience and was building myself up over the past 9 months for a wonderful birth and now i feel incomplete and dont want to experience life as a woman and never be able to do the one thing which makes us unique: GIVING BIRTH!

[BellyBelly]

Sorry to hear hon. Have you ventured into our birth debrief forum? It can help to get your feelings out and have them accepted and validated. No-one is going to tell you, 'so what you have a healthy baby,' because birth is more than the outcome. How it's effected you has a massive impact also and it's okay to feel disappointed and depressed about your birth. In fact it can even be harder for you where there was a problem because you expect people to say exactly that - at least your baby was healthy and that makes you feel guilty and ungrateful for feeling the way you do. Be kind to yourself and there are professional counsellors out there who specialise in birth debriefing. x

[Fleur]

Daintree, I fully understand your reasons for wanting a VBAC, they are good reasons!
Mel has a good point - how will you feel if an induced VBAC ends in another CS? If you think you would be ok with this, that the attempt is enough, then I would say do it...

your medical team has given you the go ahead. They would not do this if there was any risk to your bub (by which I mean above the norm... it seems the other issues don't affect here iykwim?)

My suggestions are pretty much the same as the PPs... try some natural induction stuff if that's given the ok... otherwise maybe see if they can try the foley catheter, or a very low dose synto drip...The only thing my Dr was willing to try was AROM, but I have heard of others being induced for VBAC.

As for questions, I guess the only one I would really want to know is - how does the other health issues with your bub affect a VBAC (it sounds like this is fine) and how do they feel about induction options?

But I think the most important questions are with you - what do you really want. How will you feel if it's not possible.
What would be better - to miss out on your VBAC because you opted for the CS, or to miss it because you tried & it didn't work?

- I should add I probably sound really negative here & i don't mean to! Things would more than likely go beautifully for you! just that when I'm trying to make a decision like this, I look at my worst case options & see what I can best live with, if that makes sense?

hope everything goes well for you either way.

[mummato3]

Julie Ann Jules, do you mind me asking you where you had your baby?

[julie_ann_jules]

I had my baby at warragul hospital with Dr David Simon. I live about 40min drive from there but it was sooooooo worth the drive. Dr Simon is one of the leading dr's with VBAC and is heading some recearch in the safety of VBAC PM me if u would like some extra info.....

[DaintreeDream]

Thankyou so much everyone who took the time to reply to my thread, sorry I haven't replied until now, your help is really appreciated and I have read the posts a few times trying to decide what to do.

Unfortunatly attempting to go into labour before getting induced is not really an option, the reason the want either a CS or to be induced is so that they have the team of professionals on standby for baby to arrive. We wanted to avoid baby coming when she is ready as it could put her at risk.

I had a meeting with my ob today and a follow up ultrasound and things are a little clearer and I am happy with the outcome.

One of my issues was that baby may be able to spend an hour or two with me before being taken to NICU/SCN but they do not allow babies in recovery, I spoke to my ob about this and apparently since I have had DD they have changed alot of their procedures to do what is best for Mum and baby and this is something that has changed. Mums who want to breastfeed are allowed to have baby in for the whole CS procedure and in recovery, this bought tears to my eyes, I am so happy, for me and the many other Mums who have had to be away from their baby because of CS.

I also asked if baby was transferred to the childrens within the first 12-24 hours what does that mean for me, they said they would transfer me also, straight away, but they will try to keep baby at the birth hospital for at least 24 hours.

I also had an ultrasound and they were able to see blood flow through the aorta, originally they thought that it was an interruption which means 100% that baby would require surgery, however as they can see the flow it means that it is intact but we have to wait until she is born to see if it is big enough and has enough flow, if it is it may mean no surgery and she may be able to come home with me when I am discharged, we are quietly happy that there is a possibility of this happening but we aren't getting our hopes up to high, we need to be prepared for the worst.

So... what does this mean for my CS VS VBAC debate?

I have a final ultrasound in 7 weeks, we will look to see how everything is looking, if things are looking not so good then I am going to have a CS, this will happen between 37 and 38 weeks (10th-17th Dec) but if things are looking good then they are happy to allow me to go in to labour naturally and attempt a VBAC , I have decided that I do not want to go down the path of being induced and I am pretty happy with the outcome.

Thankyou again for everyones input and comments, you really all did help and give me alot to think about.

[Lulu]

Oh wow. It's great to hear an update and to hear you sound so positive!

xoxoxoxoxo

[feeb]

Sounds like a fair plan!!

Glad you are so positive and things sound like they are all on track.

[DaintreeDream]

Thanks Lulu and Feeb, I am feeling really positive, I am really happy with the outcome of todays appointments I feel like finally things might be going my way.

Oh and I forgot to add, she is still breech so she may choose her own way out yet!