Scooby

If i were ME in your situation (i can't really pretend i understand you as fully as you do! ) i'd be thinking about the following:

Does the scoliosis mean future bubs will present OP too? Sometimes labour doesn't start because babies are not descending well and sometimes they do not descend well because they are posterior.

The perineum i honestly wouldn't (as me) be concerned about because as we now know, , mine is also very short and i only had a little nick that i didn't even bother getting stitched. I would however be VERY concerned about being cut, because as i found in the articles we discussed on the other thread, it is considered by many to be inexcuseably bad clinical practice to perform an epi on a woman with a short perineum. So i'd want to have an ob who would NOT cut me. This might be hard to find if the baby is indeed going to be OP and not descend...

How afraid do i feel? How much does vaginal birth (as opposed to un-traumatic birth) matter to me at this point in time? After a very traumatic experience perspectives can change. Women who had a successful and even easy vaginal birth like me cannot HOPE to understand how it feels to have been through what you have, and equally a woman who lost her baby, or a year of her health, will have entirely different views of what to her makes a "good" birth.

The newborn pneumothorax i wouldn't think about - why? It can happen. It can happen after a straight-forward vaginal birth, after a section, after forceps. It's caused by the huge pressures inside the chest during those initial first breathing efforts rupturing the small airsacs of the lungs and allowing the air into the chest cavity. It happens to 1-2% of babies, and nothing much makes any difference. Some babies need no treatment beyond oxygen and time, others need a needle aspiration to re-inflate the lung. It is hugely unlikely to happen to your next bub and nothing you can do or not do will make any difference.

So, if this were my decision to make.... I'd wait and make no decision yet.

I would wait for labour to start and see how things went.

IF bubs was still OP by term despite my best efforts to turn them, i'd wait and if i went overdue enough that i needed an induction i would ONLY allow a Foley's catheter induction (which is reversible and needn't progress to full-blown chemical medical induction). If the Foley induction failed but the placenta was failing (and i'd want to check it WAS and not assume it from the dates) i'd have a section rather than risk the induction.

If progression was slow during labour and baby was OP and not descending well i'd definitely walk and crawl and NOT have an epidural. If it came to me needing an epidural i'd have a section to protect my perineum from the damage made FAR more likely by not being able to push well and possibly needing an instrumental delivery again (which i believe was what was at the root of many of your difficulties post birth).

Basically hun i would plan for and aim for as unmedicated a vaginal birth as possible, avoiding epidural/narcotics/back-laying/coached pushing/ALL intervention and IF and when i was forced to deviate very much from that path, i would have a section.

Lots of good thoughts and love

Bx