What would you do CS or VBAC?

Hi Ladies,

I need to get a bit of what would you do if I was you advice. I have tried to give some background so it's a bit clearer of my situation.

I am currently 30weeks and am hoping to have a VBAC. I am type 2 diabetic and have been on insulin since 5 weeks, I have notoriously high insulin requirements in the third trimester, which while they have been really well controlled the whole time I am noticing my requirements are starting to increase rapidly. For those of you who don't know much about diabetes in pregnancy, this in my situation can mean my placenta could fail quicker than normal, if blood sugars are not controlled during pregnancy then bub could have low blood sugars at birth. These are my main issues.

I am under the care of an OB at the teritiary public hospital. I had a growth scan today as I was measuring 3 weeks ahead in fundal height. While he wasn't at all concerned at the fundal height he is a bit concerned at the results of my growth scan. While bub is looking great, blood flow is great and he has no signs of a big belly to cause shoulder distocia, he is measuring really big. I know the scans are notorious for being inaccurate but to be honest I really don't think this scan was. He is measuring 2 weeks ahead all over. This places him at the 95th percentile and they estimate he is already at 1.8kg and thats only at 30 weeks.

So my OB being the great guy he is has not done the whole you must have a CS thing, he has actually booked me in for a second growth scan at 36 weeks before we make anydecisions on anything. Either way he is saying I will most likely need to be induced at 38 weeks as the insulin requirements are so high and he is very nervous about my placenta aging too quickly. I have no problem with being induced early as I understand the risks for my situation and I will not risk the health of my baby to get my vbac. I would rather a CS any day of the week rather than risk his life. And for me these are very real risks.

The question for you all is would you push to be induced by folley catheter and pitocin at 38 weeks, with the risks of rupture and possibly ending in emergency CS or would you just accept the CS is inevitable. I have a 2 year old at home and I won't be able to drive for weeks but I am just unsure what I should do. I only have a 5'2' frame and a kid the size of a small adult scares the beejeezus out of me along with the chance of a repeat performance of the awful recovery I had last time. I couldn't walk more than a few metres for weeks.

So what would you do?

I didn't have type 2 diabetes but all of my boys have been relatively big. DS1 was 4.5kgs at 40+6. He got his head stuck and couldn't get his head down to open up my cervix. I went in to be induced at 3cms and was still 3 cms 9 hours after they had induced me and bubs still hadn't engaged. I ended up with an emergency c-section. When it came time to plan for ds2's birth I contemplated a VBAC for a while however the idea of having another big baby and having things go the same way was a worry for me. I didn't want another emergency c-section so I decided to have a planned c-section. My fundal height with DS2 was 49cm at 36wks. DS2 was born at 38+5 and he was 4kgs. For me the decision to have the planned c-section was the best decision. It allowed me to plan for my recovery, DH and my parents were able to plan to be around to support me and help in the weeks after. I recovered very well after my second and the same after my 3rd.

Whatever you end up deciding make sure you are happy with your decision and it is the best for you and your baby. And whatever decision you make don't feel bad. I was made to feel guilty for choosing to having a planned C-section but I do not regret having had all three of my boys by c-section. It was best for me and for them.

Personally, I would never agree to be induced for a vbac. The risks are far too high for rupture to me.

I had a failed vbac attempt with DD1 - she was said to be 10 pound 4, with a 40cm belly in her wellbeing scan the day before she was delivered (I went to 42 weeks with her).

I had the choice to be induced with the catheter but we decided it was too risky given that she was sitting way up high, the placenta wasn't doing very well, and neither was the cord, so we made the decision that it would be safer for her to be taken out, rather than risk a vaginal birth with a high risk of cord prolapse because of her position.

When she was born she was 8 pound 11 - and skinny. Very skinny. Super long too. My DH is 6 foot 7, so thats why she had been estimated as being so heavy and big, it was her long legs throwing it off. She (at 6 years now) is still way off the charts in height, actually I don't think she has ever been ON the charts LOL

I was upset for several years about her birth, and wondered if I made the wrong decision, but now - 6 years later and actually been through a rupture scare with my last birth 11 months ago, I know I made the right decision.

The risk of rupture is a small percentage for sure, and I strongly believe in going for a vbac if there are no additional risks added to the situation. I had two successful vbac2s after my failed vbac attempt and there was nothing odd or risky with their births.

My last one was a failed homebirth as well, and the only "risk" that we had was that his position wasn't the most favourable one. That was enough to put a hole in my uterus and I was only a few contractions away from a complete uterine rupture. No one expected or predicted it, so while the risk is small, it still exists.

Its a very hard choice to make, who knows, you might go into labour naturally before 38 weeks anyway! Can you go with the "wait and see" approach and not make any final decisions until closer to the birth?

All the best.

I would always choose VBAC. Always. So long as it's safe at the time.

I can't tell you what to do, but as someone who has faced a VBAC turned emergency cs- I was satisfied that I tried my best.

Ask yourself if you would prefer to try and possibly 'fail' or eliminate the guessing and opt for cs. It's a very personal choice.

Oh and you can birth a big baby. :)

I chose a planned c/section.

I got specialist advice, and I got a risk assessment from the specialist so I could make a carefully weighed up decision - with my husband - as to what risks we were and were not willing to take, for a healthy vaginal delivery. My DH would have supported me if I'd chosen differently, but we agreed almost as soon as we got the risk assessment, as it was pretty clear.

For us, the risks were too high, and my recovery was uncertain.

While I would have preferred a vaginal delivery, for me, a planned c/section in those circumstances was empowering. It had been my decision, I could plan for it, make arrangements for mobility ahead of time, and give myself some time to come to terms with my DS2 not being born vaginally.

For me, it wasn't accepting the inevitable (as it was still quite possible that we could have vaginal, the degree of damage was the uncertain factor) but making the decision which was best for both my boys, and myself too (body, mind and spirit).

Because the risks were just too high, and the consequences if those risks came to bear would have been extraordinary and much longer lasting (possibly permanent).

And in the end - in part because we had time to prepare - my recovery was extremely swift. My Dr was able to sign off on me for driving after 1 week, because I was off pain killers and was shockingly mostly fine. So one week out of action instead of possibly 2-4 weeks (all being well) or possibly years (all not being so well...).

That's what I did, and it was absolutely the right decision for my family.

I was induced at 37.5 for my 2nd child as I had a 41 week still birth with my first. My first was induced after she died.
I had a catheter and I have to say it was more painful than anything. It was unsuccessful and I had an emergency CS.
I have been told any more babies would be by CS.
I had the choice of trying for early induction or opting for a CS and tried for VB.
In hindsight I would choose a calm well planned CS with good skin on skin after, the midwife I knew and trusted being there, time to go gently etc.
I would have avoided the emergency rush to theatre and the panic I felt about the CS. I would avoid the pain of the catheter.
At the time I REALLY wanted a VB as I felt I'd really failed in my first pregnancy by not going into labour in time to save my daughters life.
When my induced VB failed I felt I'd failed again.
Knowing all this I wish I'd opted for the CS.

I agree it's a personal choice but whatever you decide make sure you really understand the % of success with early induction and be ready for things not to go to plan.

Good luck on welcoming your baby into the world.

Thanks you so much for such informative responses ladies, it really helps me feel ok either way with what is a really difficult decision for me.

I am glad I have some time to mull it over and ask the OB anymore questions I may have.

I personally would go for the caesarean in your situation.

You can make a decision and change your mind, also. Good luck for your birth!

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I personally would go for the caesarean in your situation.

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I am heading in that direction with my thinking too. As much as I would love a VBAC I think the risks, potential physical damage and increased chances of another emergency CS are just a bit to high for my liking. I think dealing with SCN and trying to establish breastfeeding will be enough of a challenge as it is.

As much as another CS will suck, at least it shouldn't be as bad a recovery as last time as I won't have the 18 hours of induced labor beforehand and I will be able to plan help at home and care for DS in advance.

DH is too excited at the thought of having a date he will meet his littlest man to be impartial but he is supportive of what ever I feel is best for both bub and myself.

How come he will go to SCN? Is that because of the diabetes?

I would also go for a c section too. I've had an emergency c-sect, a pretty horrible VBAC and have chosen an elective c section for this current pregnancy.

For me, given my previous experiences, I'm just not willing to risk the physical damage. Plus halfway through the vbac i distinctly remember thinking "natural birth is really overrated"! Also, my baby after the c section was in much better shape than the vacuum delivery vbac. And, I came so close to a second c section last time that I've accepted I'm not a birthing goddess and a planned c section really isn't all that bad!

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How come he will go to SCN? Is that because of the diabetes?

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Yeah it is, at my hospital anything over 40 units of insulin a day and they have to go to scn for monitoring. I am currently on 64 units and will probably end up somewhere around 100 units a day by 38weeks. Unfortunately my body just doesn't cope with the insulin resistance of pregnancy. My blood sugars are extremely well controlled even with such high requirements, so he hopefully won't be there more than 12 hours with any luck.

I had GD with my first child and was on about 120 units per day at the end. What you haven't mentioned and what no one warned me about is that during labour your BSLs can sky rocket which as you know leads to low BSL in baby after the birth, so you will most likely end up with a drip to control your BSL. When I went to use the bath they wouldn't let me in case I passed out from low BSL, then they decided the BSL was getting too high so I had a glucose/insulin drip that the forever mucked around with. I couldn't move because of all my drips and wires, ended up stuck on the bed, epidural etc.

I have had three vaginal births so obviously I can't empathise with the c-section pain/recovery etc but if I were in your situation I would probably plan for c-section at 38 weeks. Induced births often aren't that great, especially when you are limited to the bed with all your tubes and attachments. I look upon VBAC as I do home birth - it is fantastic for low risk pregnancies but not worth the risk if there is another issue with the pregnancy.

On the bright side, DS returned three great BSLs in a row and only about an hour in special care.

Artechim what you have said are all really good valid points. I was stuck on the bed with wires everywhere last time and it was really ordinairy. I think if I could try for a vbac without the wires etc I may consider it further but I am now resolved that I am going to do a planned cesarean and make the most of knowing when and being able to plan help for after DS2 will arrive.

That being said OMG my family will be complete in approx. 53 days!!

I think being induced at 38 weeks is putting yourself at risk for a failed induction, even without all your other variables- I've seen it happen so many times.

Just sending hugs for you. Hope the decision becomes clear and feels right!

I just wanted to come and update how we went with the OB today.....

I expected to get immediate agreeance to my plan of a planned CS today when I saw my OB, I was pleasantly surprised by him wanting to sit and discuss the options further before agreeing to the planned CS. I have though booked in my CS for 39 weeks. We are both happy with this date as it will give my body a chance to birth naturally (he thinks there is a chance this may happen due to bubs size and how I am tracking) without any induction drugs, yet I have an end date and will not be risking having a baby that is just way too big for me to get out.

OB was very clear that he didn't have a preference for me to birth either way so much so that I am still going to have the growth scan at 36 weeks and if I want to cancel the CS based on the results then I still have that option.

Bub will definitley be going to SCN after birth (all going well once I finish in recovery) and I will be back up and about approx 2-3 hours after the birth (spinal block rather than epi) so it will be barely any time at all til I can be with him again. I feel so good about this plan as it gives me the best of both worlds as my body will have some time to birth naturally before we use the sunroof option.

So I guess I better make up a birth plan for both possibilities. I feel like a huge weight has lifted knowing that I won't be induced and I have a solid plan of action with an OB that believes I have the choice in how I birth :)

Sounds great :)

That's really great :hug:

Great plan :) great to even have a plan sometimes.

I think you've made an excellent navigation of the decision process!

Side note: are you planning to express colostrum antenatally for baby to have in SCN? A few friends have done it recently and I am always interested to hear how it goes.

Luna moth yes I am expressing colostrum, I am lucky that I have a great supply of colostrum and already have 45ml. I am hoping to get close to 100ml by the time bub arrives :)

Nice work mumma!!

I just thought I should follow up with what actually ended up happening. I had my beautiful boy at 38+4 by planned cesarean which was such a fantastic experience. I felt fully informed and in control and have recovered 10 times faster than after my 1st birth.

I managed to express 90ml of colostrum which DS2 practically inhaled in scn and we are now successfully breastfeeding.

Thank you to you all for your honest opinions and feedback as it really gave me the confidence to make a difficult decision and feel comfortable with it for the remainder of my pregnancy.

I'm so glad you had an experience which felt (and was) safe, controlled, and informed :)

That's awesome!

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