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Thread: Weighing up the pros and cons

  1. #1
    Debbie Lee Guest

    Default Weighing up the pros and cons

    Now I thought I was pretty set on wanting a caesar this time around. I'm sure most of you have seen my reasons for wanting an elective caesar.
    However, now that I am pregnant, I can't stop thinking about how I would go trying for a VBAC. I lay awake at night thinking about the pros and cons and it's proving to be a tough decision.
    I do have to read up more on both issues and I am yet to speak to my doctor about my choices (I may not have the option of an elective caesar at the hospital I am going to? I don't know).
    However, this is what I have come up with so far:

    Pros and Cons for having another Caesar



    Pros
    * Reduced risk of unexplained still-birth during labour (has occurred in 3 generations of women in my family on my motherís side).
    * Already know what to expect.
    * I wonít be exhausted after another ďfailedĒ labour if I end up having an emergency Caesar anyway.
    * Schedule Caesar will mean that my support network will be able to travel to help with Gabby etc.
    * Neil can pre-arrange time off work (important because they need to have someone to cover his shift).
    * Iíll be able to write a thorough birth plan so that my Caesar experience is more positive than my last one.

    Con
    * Increased risk with major surgery (eg. Uterine rupture.
    * Will never know if I was able to birth vaginally (get to experience labour again etc.).
    * Longer recovery - Wonít be able to pick Gabby up for at least 6 weeks and wonít be able to do other simple household chores until I have recovered.
    * Elective Caesars are usually booked at 38 weeks so baby may be born before he/she is ready.
    * My abs will be even more shot making it more difficult to work off the massive stomach that Iíve managed to grow.


    Pros and Cons for having a VBAC

    Pros
    * Due to previous Caesar I canít be induced (or at least I can refuse because of the risks of using prostaglandins (sp) after a caesar) so I can go into labour on my own.
    * Baby can decide when itís ready to come into the world.
    * May help to establish breastfeeding/breast milk supply earlier than after a Caesar (took 5 days for my milk to come in with Gab and even then I never had a fabulous supply).

    Con
    * High BP may dictate whether Iíll be allowed to go into labour on my own or whether doctors will insist on a Caesar regardless.
    * Iíll be on ďhigh riskĒ and will need constant monitoring which may hinder my labour anyway. I know I didnít like sitting/laying on the bed last time so Iíd want to move around.
    * If something bad happens Iíll blame myself for not choosing to have a Caesar.
    * Fear of stillbirth or something happening to the baby (cord around neck like with Gabby) means I wonít be able to relax and focus on the labour.

    Is there anything I should add to my list of pros and cons, do you think? After reading through my list, what do you think? I won't be offended by opinions if you want to express them and I'd appreciate some input. I want to make an informed decision either way. At the moment I'm leaning more toward having another caesar because my reasons for wanting a VBAC just seem kind of selfish? If that makes sense.

  2. #2

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    I reckon you should just look into your heart and go with the first instinct.
    Nothing is set in stone now anyway, if you decide to go for the c/s all the way through until the last day, you can change your mind I'm sure. It would just be the preparation factor.
    I think the c/s experience would be far more pleasant for you this time around being planned. All that mucking around last time sorta took the joy out of it so to speak.

    You just have to do what feels right for you, not what you "think" you want, if that makes sense.
    In my situation I'm all g'd up for a natural birth, but I can promise that if I get a repeat of the back labour from last time, there is no bloody way I'm going to make it without the epi - I just know that. Contraction pain, no probs, but the back pain, excrutiating, and I'm not going to be a hero - despite my disappointment.
    But thats just me......

  3. #3

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    Pro VBAC

    VBAC is usually safer for mum and baby.
    VBAC reduces the risks of infection to the mother.
    Labour is good for babies in most cases.
    Not having surgery makes mum's recovery easier.
    VBAC reduces the risks of respiratory problems in babies.
    VBAC involves a shorter hospital stay.
    More than 80% of women will be able to have a vaginal birth after a previous cesarean.
    Breastfeeding is easier after a vaginal birth.
    Usually for a variety of reasons, including faster and more direct access to your baby and less postpartum pain for mum.

    VBAC can help prevent injury to your internal organs, like your bladder, intestines, or even the need for an emergency hysterectomy.
    VBAC is less expensive.


    Ok There were some pro's for VBAC.

    You are right about the trouble dealing with Gab too. After a c section even walking to the letterbox can leave you exhausted.


    Con's, ummmm I don't really have any hun. Of course you have to do what you are comfortable doing. Perhaps a good talk with the OB or midwives at the hospital about your fears might help you. I do remember you stressing out about birth when you were pg with Gab so there is obviously "issues" there.

    I hope you don't mind I emailed you some links for some extra info. Hopefully I didn't overload you If you don't want to read them just delete

  4. #4

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    Con for vbac
    * High BP may dictate whether Iíll be allowed to go into labour on my own or whether doctors will insist on a Caesar regardless.
    * Iíll be on ďhigh riskĒ and will need constant monitoring which may hinder my labour anyway. I know I didnít like sitting/laying on the bed last time so Iíd want to move around.
    * If something bad happens Iíll blame myself for not choosing to have a Caesar.
    * Fear of stillbirth or something happening to the baby (cord around neck like with Gabby) means I wonít be able to relax and focus on the labour.
    just want to point out that even tho you are classed as 'high risk' you have a right to say no to constant monitoring, and not being able to move around when you want. i think there is little gain to 'monitoring' from what ive read (something somewhere lol whatever it was it was something kelly posted so prolly in articles...- ) - it said it was better to use a plain old stethescope....

    cord around the neck - from my understanding all midwifes/doctors/obs are trained to feel for the cord around the neck just before baby is 'born'.

    fear of stillbirth is a tough one. its not a proven fact that you have to worry about stillbirths, just a concern you have. id be surprised if a v a g i n a l birth would increase the risk...have you researched that at all??

    best of luck with your decision.

  5. #5

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    Ok my 10 cents worth
    I think personally if you dont have a great relationship with your care team whether be midwives, prob not as you are high risk due to BP or the obst you will struggle in a natural setting. The unpredicabilty of BP is also a big risk if it is not under control by the time bubs is due. As Fi said you dont need to make any firm decision maybe have some time to nut the problems one by one. Like at an appointment ask your carer what is your thoughts on.........
    They will never put your or your babies life at risk but also think if you do deliever at 38 weeker undeveloped that need SCN do they have the facilities.Its hard to drive and look after a child 90kms away 3 days and I was pooped esp with a toddler. So the scenario of c-sect scar and recover child in scn and away from your family. I know it is better than stillborn.
    Ohh Deb its never right or wrong just what is going to be right for you given the circumstances.
    Bec

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    And dont forget Deb - Its still over 8m away, so there is lots of time. This doesn't have to be a decision you make now. Enjoy the pregnancy for a while without stressing about how its going to come out.

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    Not that I've ever had a c-sec and hence a VBAC, but all the VBAC'ers on this site will tell you (I imagine) that there is no selfish reason for wanting a VBAC!!!

    And if you go for a VBAC, well, I'd still be writing up a thorough birth preference sheet! And it's so early on for you I'm sure you would find a hospital/ob to support you

    Good luck....the great thing about Bellybelly is that you'll get support with whatever choice you make.

  8. #8

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    Whilst this decision is a very personal one, and at the end of the day regardless of what anyone says here its something you need to feel comfortable with. I really do think that the chances of stillbirth are extremely low with a VBAC probably only slightly higher than a regular vag birth. If a vag birth is something you want there are people who are trained to help counsel you about your fears. I think its something you can play by ear as has been said, you can always see an ob about a vbac now, and then later down the track if you decide you want a c/s or that you need one for whatever reason you can. At least that way you are keeping your options open.

    If you want to chat hon I'm always here.

    *hugs*
    Cailin

  9. #9
    Debbie Lee Guest

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    I tried to add this to my first post several times... even tried to post straight after but it wouldn't let me (grr!). This is what I wanted to add:

    ETA: Oh and I have read the frequently posted questions post.... I started this thread to get help for my specific situation, iykwim?

    Intrauterine hypoxia ó lack of oxygen ó can be both a reason for performing a Caesarean section and a cause of death, but even eliminating those deaths left a neonatal mortality rate for Caesarean deliveries in the cases studied at more than twice that for vaginal births.
    I am wondering if this is what happened to my older brother who died whilst Mum was in labour. No autopsy was performed (at my mother's request) so it is written down that he died of "inoxia" (sp?). Either way, my mother was never given a reason (nor was she allowed to see her baby, her first born... but that's a whole other thread!).

  10. #10

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    Some labour is better than no labour for the baby, so if you give it your bloody best shot but have to have an emergency caesar, there is a benefit, plus it will be baby initiated labour Like Cai said though, you have to want it, not fear it, or it could be a terrible time for you emotionally and physically. Read some good books, get some good support.

    The Thinking Woman's Guide to a Better Birth or Silent Knife. Read the articles on Birthrites and visit CANA. There is also CARES-SA. The way will be clear with good, solid knowledge and confidence behind you.
    Last edited by BellyBelly; December 5th, 2006 at 12:29 PM.
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  11. #11

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    Deb - being with you through some of your last induction I am just going to disagree with Caro's last statement (not to have a go at you Caro, just that I know Deb pretty well).
    The emergency c/s is not something you want as an option. Yes it will always be there as a last resort, but you can't go into this thinkin - well I can always bow out if things get too tough.
    You either have to commit to the VBAC, and do everything to support yourself in this endeavour (from educating Neil to getting the right people around you), or you accept the c/s and be proud of that decision.
    I dont want you to go through all that labour again, and have the c/s, and feel like you missed out.
    Part of your justification for the planned c/s is having more control over how it happens. You were so knackered and things were so hard after Gab's birth, its not something you need to go through unless it absolutely comes to the crunch, specially with a toddler already there.
    So yes - go for the VBAC, or go for the planned c/s, but don't have that thought of "oh the emergency c/s is always there if it comes to that" because it wont help you be committed to the whole fight for you to do the VBAC.
    I'm sure you know what I mean Deb. And Caro - I'm not having a go at you, or what you said, I just wanted to nip any thoughts out of Deb's head asap

  12. #12

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    I guess thats where it all comes down to perception and how you feel about labour and birth. For me I had completely prepared myself emotionally for the fact I could end up with another cesarean during labour. It wasn't something I managed to accept overnight but I came around, and I think in order for me to have a successful VBAC I had to accept that so that it wasn't going to be something I was worried about during labour. No expectation, let my body do what it could and with the support of my friend and husband and the empowerment of the knowledge I had I would do my best thats all I could do. I didn't have it in my mind as a way out but I knew if something went wrong it was ok to have another c/s. Because even that would be empowered due to the decisions I had made about the c/s procedure and recovery should it happen. I got my vbac but if I had gone on to have a c/s I think I would have been just as empowered as the labour was fantastic and I loved every minute of it

    *hugs*
    Cailin

  13. #13
    Debbie Lee Guest

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    Fi - thankyou for your post. You out of everyone here probably knows more about my horrid experience with having Gabby the most - so you know my decision isn't cut and dry.
    I do hope your next labour is a far cry better than what you went through with Jenna. Perhaps all the hard work you went through with her will pay off and you'll have a magnificent labour?

    Caro -
    Can I ask who had the still borns in your family ? which generations ? Mother Grand mother sister aunty ???
    The 3 generations of women in my family that had unexplained still births were my great grandmother, her daughter (my Nanna) and my mother... all on the same side of the family. So my Mum, my mother's Mum and my grandmother's Mum. To me that's a very compelling reason to be cautious. I have been told that medicine has come a long way in the last 28 years since my mother lost my brother. Yes, I'm sure it has. She was also told this since it was 20-odd years since her mother had suffered a still birth. So, yeah... the argument doesn't hold a great deal of water with me, as I am sure you can understand.
    I appreciate the fact that you're pro-vaginal birth and you can see my reason for possibly having an elective caesar as valid. It goes to show that it's a serious matter and one I can't take lightly.

    Trish -
    Perhaps a good talk with the OB or midwives at the hospital about your fears might help you.
    I'll definitely be doing that. I was going to wait until I had spoken to my doctor (who is an ob I think?) about it all on Friday but I couldn't wait, LOL. So I'll update with information from him. As for a VBAC being less expensive... I'm going public so it doesn't matter LOL. But I guess that is a compelling reason if someone was going private. Thanks for the emails too. Always helped to be armed with heaps of info. I know you have BTDT so I appreciate the advise.

    Joh -
    just want to point out that even tho you are classed as 'high risk' you have a right to say no to constant monitoring, and not being able to move around when you want.
    I've heard that too but I'd also be worried if I wasn't monitored so it's a catch 22. Gab had the cord wrapped around her neck so tight that every time I had a contraction, he heart rate plummeted. I was told at the time that "something" was compressing on the cord and, after extensive monitoring, the decision was made to have a caesar. So I worry about not being monitored in case the same thing happened. That being said, I wonder if the cord would have been wrapped around her neck if I hadn't had so much early intervention. I was induced prior to my due date and left for 5 days in agony with "prostin pain". I believe that that last 2 days I was experiencing contractions but I'll never know for sure. I was exhausted. When my waters were broken (more intervention), there was meconium in the liquor - quite a bit actually. Gab was really stressed. So, yeah, perhaps the reason for needing a caesar with her was specific to the situation a the time and it's highly likely that it won't happen again (especially if I can avoid all the intervention).

    Bec - I appreciate your advice given all you've been through. I have no idea about the special care facilities here in Hamilton - something I should ask about. If I do decide on a caesar, I'll be pushing to have the baby close to the due date if possible.

    Chocolatecatty -
    I'm sure you would find a hospital/ob to support you
    Not a great deal of choice here, mate. The only hospital around here is Hamilton Base Hospital. Anything else is at least an hour away. Geelong is 2.5 hours away. When we first moved, I thought that I would ask to have the baby in Geelong (all my family and friends are there) but that was before I heard about the facilities at Hamilton. Apparently I get my own OB (even tho I'm public) that I see every visit... this is different from Geelong (a much larger hospital) where you see a different doctor just about every time. Patients at Hamilton also get their own room regardless whereas most public patients at Geelong have to share.

    Shannon -
    High BP on its own is not a good indication of pre-eclampsia, which is what you would get induced for
    I wish I had known more about this before having Gab. I was literally told that they wanted to induce me "just in case". My BP was high. However there was no protein in my urine and I was not carrying any fluid. I was experiencing headaches but BP meds probably would have sorted them out. Was I on meds with Gab? No. It was talked about a lot and it never happened. I look back now and wish that I had pushed for them. Thanks for the tip re. taking my BP just before I am due to take my meds. I'll remember that.
    A little labour goes a long way. And it's simply not 'failing' to do it that way. And I don't think wanting to try for a vbac is being selfish at all, I think it's a good thing.
    When you put it that way it seems like the right thing to do. I guess the reason why I felt my reasons were selfish is because I want to experience labour again so that I can see if I can do it... however the wellbeing of the baby should be more important... does that make sense? I want to try vaginal birth for my own personal achievements. However, knowing that labour is good for the baby for a multitude of reasons changes all those feelings of selfishness.

    Cailin -
    I really do think that the chances of stillbirth are extremely low with a VBAC probably only slightly higher than a regular vag birth.
    I guess that's true under normal circumstances but it's my family history that kind of ups the anti... iykwim? I just can't get it out of my head. My Mum has always been very open about her experience of losing her first born (and only boy) but there's always been something "missing" and I'm just so scared of it happening again. I'll definitely talk to my Dr. about it. I hope that he really listens. I've only seen him once so I have no idea what his stance is on VBAC or Caesarian sections.... he may be one of those caesar happy doctors... I guess time will tell. I can always change doctors if needs be.

    Thanks so much for your input everyone. It's certainly food for thought!

  14. #14
    Debbie Lee Guest

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    LOL... so many posts while I was typing up my last one!

    Fi -
    I dont want you to go through all that labour again, and have the c/s, and feel like you missed out.
    This is why I will never, ever let them induce me ever again. I'd rather have a c/s than go through that again. So, yeah, basically if I decide on VBAC, that's what I'll be doing - wholeheartedly. I'll have to go into labour on my own without intervention for it to happen. If pre-eclampsia happens as a result of my BP then I guess a caesar will be the go but at least that'll be out of my control (tho aspect of the caesar will be in my control... I won't be letting them bugger me around again).

    Shannon - One good thing about Hamilton Hospital... the birthing suites don't fill up! Hoorah! You're right... my induction was stuffed up because of stupid hospital politics. They didn't have room for me so they slowed the process down. By the time they were ready to give me more gel, I'd had enough and was in agony. I really was stuffed around before and after the birth... but I didn't jump up and down enough... something that'll be different this time around. I wanted to be a perfect patient last time. This time I want to be the biggest PITA known to man!! hahaha

    Caro - totally get what you're saying and it's definitely food for thought. I do need to get the "failure" idea out of my head before it all starts happening.

  15. #15

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    Cai - I'm with you on accepting the inevitable, and doing the very best you can. I just didn't want Deb to think of an emergency c/s as a way out liek you describe.
    Hell - my labour in a few weeks could end in a c/s, and I just have to accept that things happen for a reason, and while I wouldn't be at all happy, it would just be something in life to accept and deal with. But I dont think its healthy to go into something thinking that there is always the way out if its too hard.
    Cause Deb can do this, and I believe she has the strength to get through a VBAC, and whatever she decides to do is the right decision for her.

    Sit and mull it over for a few weeks Deb, and have a chat at your next appt. Thats what I've done this time too, just sat and contemplated stuff, and brought it up at the next appt. I'm now pretty much at peace with all my baggage, but its taken a long time to get there, and I have to say the inevitability of the impending labour is certainly part of the process!!

  16. #16

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    Absolutely Fi I agree 100% and like shannon said you are a good friend

    Deb I completely understand your fears and they are valid to you I think you're doing a great thing by trying to figure out whats the best option for you. I hope you can get some advice from Dr's.

    Have you read any of the suggested VBAC books? Contacted birthrites?

    Goodluck!

    *hugs*
    Cailin

  17. #17
    Debbie Lee Guest

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    Cailin - I've barely scratched the surface with research but this thread has helped a lot. I will be reading more and more and getting heaps of advice as the months go on so that I can make an informed decision.

    My concern with an emergency caesar is that after the 5 days of prostin pain/labour with Gab, I was totally knackered. I spaced right out once she was born and I firmly believe my milk supply was affected because my body was in shock. Of course other things contributed (them taking her away from me because they were short-staffed for one... grrr!) but I'm just so worried that history will repeat itself!

    Either way, I'll be writing out my birth plan (detailed this time!) and taking several copies. My last birth plan never had a set of eyes laid on it. I had it in my labour bag but never got it out. This time I might staple it to my forehead, PMSL.
    Last edited by Debbie Lee; December 5th, 2006 at 07:09 PM.

  18. #18
    Debbie Lee Guest

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    Thanks Theresa. It's great to hear from a second c/s perspective
    Uno what? I didn't find the caesar itself all that bad. Sure, it was bizarre but it was a far cry better than the agony that I'd been in for days! I recovered fairly well in terms of being confident to drive, lift objects etc. Considering all I'd been through up until that point, I thought my recovery would have been slower.
    So I guess I'm not concerned a great deal about recovering - and I do expect that my BFing will be established better regardless of whether I have a VBAC or a Caesar because a) I'll be more insistent on feeding asap b) I won't be as shy about getting the boozie out c) they'd need a BLOODY good reason to take my baby away from me the night.

    Just told a friend that lives here that I'm preggo. She was telling me that they don't even have 1 baby born a day in Hamilton - so it'll be a completely different ball game in regards to how busy the maternity wards get her as compared to Geelong.

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