Going out of my mind with confusion....

After a visit to hospital today, talking to a midwife, and telling her that I would like another cs, I feel as though she was trying to sway me into a VBAC. She says that it is safer for Mother and Baby, but I have read otherwise on the internet, thru many sites. It appears to me that VBAC is more of a risk to the baby. I am going nuts, and just want what is best for me and baby, and I dont know what is in fact the best thing to do in my situation.
If I can be guaranteed a safe vaginal birth, which wouldnt end in a cs anyway.....I would be likely to at least consider A VBAC, if in fact it is safer for baby.
My other dilema is...How much strain does natural childbirth place on the mothers heart? As this worries me no end, with my problems!
I just need some good advice, and facts! I really am going out of my mind....I really dont know what to do...I wish I had a crystal ball :crying: (Lots of hormones raging today)

Hello Ally,

Can I ask why you had your first cesear? Depending on the reason to why you had a cesear in the first place, VBACs are not dangerous at all, infact they can be very rewarding. The internet tends to hype things up alot and place unwanted worry on to mums. Are you reading that there is a risk of uterine rupture? This is so rare these days. It was more common in days when ceasers were cut vertically rather than horizontally along the pubic line.

Have you thought about the possibility of hiring a Doula for your birth? Doula are wonderful women to have around, especially when you are feeling anxious about your upcoming birth. There are a few Doulas around who have specific experience in VBACs, so maybe you could try having a look for one in Adelaide?

However in the end, you must go with your "mothers" instinct. You need to do what you think is best for you and your baby. You cant let someone else tell you what to do, expecially when it comes to your birth.

If you do have heart troubles, maybe you could talk to an obstetrician and see what he/she recommends?

Anyway I wish you the best of luck. I hope it all works out for the best...

Hey Ally, what sites are you reading?! Heaps of recent evidence and studies say otherwise!!! VBACS are very safe and the rate of rupture is very low. In fact you can also rupture with an induction, and mortality from a study in 2000 showed one death attributed to rupture and one death from the repeat caesarean study - so thats a level playing field. Of course these rates are VERY low. A VBAC mother should be treated as a normal birthing mother and latest study is showing caesars to be more risky not just for bubs, but for mum too, than a normal vaginal birth. I have posted lots of the studies in here, just check out the posts I have made by doing a search. The more caesars you have too, the more your risk of things like hysterectomy, PPH etc which jumps significantly with each one. Not to mention infection risk and yes I have heard stories of baby being nicked with the knife. So these things happen that wouldn't a vaginal birth.

A vaginal birth is much better for baby's adaptation to the world and for those wonderful hormones in both mother and baby to kick off in full flight. Contractions are great for baby's lungs and preparation - even some labour is better than none. If you have a supportive midwife and if it's what you truly want, go for it! There is nothing to fear, so if you want a VBAC, you can do it, safely and with support.

Check out http://www.birthrites.org for more info.

Ally, I'm not going to try and sway you in any direction, as I have been in your exact position myself. I just wanted to say this - don't believe everything you read on the internet. Things can be taken out of context & even though it looks legitamite, it might not be.

Talk to doctors / midwives / doulas / VBAC mums / repeat c/s mums.

Read books & medical journals, they are more likely to be reliable than the internet.

I think whichever way you go, you need to research all of your options before making a decision. And if that decision is a repeat c/s you can go into it empowered knowing that you researched everything and made your decision based on the facts as you see them.

Go luck, it certainly is a tough decision to make :hug:

Maternal Risks of Repeat Caesarean

Another recent article:

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Voluntary C-Sections Result in More Baby Deaths

LARGE STUDY shows significant evidence
Article published in the New York Times
By NICHOLAS BAKALAR
Published: September 5, 2006

A recent study of nearly six million births has found that the risk of death to newborns delivered by voluntary Caesarean section is much higher than previously believed.

Researchers have found that the neonatal mortality rate for Caesarean delivery among low-risk women is 1.77 deaths per 1,000 live births, while the rate for vaginal delivery is 0.62 deaths per 1,000. Their findings were published in this month's issue of Birth: Issues in Perinatal Care.

The percentage of Caesarean births in the United States increased to 29.1 percent in 2004 from 20.7 percent in 1996, according to background information in the report.

Mortality in Caesarean deliveries has consistently been about 1½ times that of vaginal delivery, but it had been assumed that the difference was due to the higher risk profile of mothers who undergo the operation.

This study, according to the authors, is the first to examine the risk of Caesarean delivery among low-risk mothers who have no known medical reason for the operation.

Congenital malformations were the leading cause of neonatal death regardless of the type of delivery. But the risk in first Caesarean deliveries persisted even when deaths from congenital malformation were excluded from the calculation.

Intrauterine hypoxia — lack of oxygen — 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.

"Neonatal deaths are rare for low-risk women — on the order of about one death per 1,000 live births — but even after we adjusted for socioeconomic and medical risk factors, the difference persisted," said Marian F. MacDorman, a statistician with the Centers for Disease Control and Prevention and the lead author of the study.

"This is nothing to get people really alarmed, but it is of concern given that we're seeing a rapid increase in Caesarean births to women with no risks," Dr. MacDorman said.

Part of the reason for the increased mortality may be that labor, unpleasant as it sometimes is for the mother, is beneficial to the baby in releasing hormones that promote healthy lung function. The physical compression of the baby during labor is also useful in removing fluid from the lungs and helping the baby prepare to breathe air.

The researchers suggest that other risks of Caesarean delivery, like possible cuts to the baby during the operation or delayed establishment of breast-feeding, may also contribute to the increased death rate.

The study included 5,762,037 live births and 11,897 infant deaths in the United States from 1998 through 2001, a sample large enough to draw statistically significant conclusions even though neonatal death is a rare event.

There were 311,927 Caesarean deliveries among low-risk women in the analysis.

The authors acknowledge that the study has certain limitations, including concerns about the accuracy of medical information reported on birth certificates.

That data is highly reliable for information like method of delivery and birth weight, but may underreport individual medical risk factors.

It is possible, though unlikely, that the Caesarean birth group was inherently at higher risk, the authors said.

Dr. Michael H. Malloy, a co-author of the article and a professor of pediatrics at the University of Texas Medical Branch at Galveston, said that doctors might want to consider these findings in advising their patients.

"Despite attempts to control for a number of factors that might have accounted for a greater risk in mortality associated with C-sections, we continued to observe enough risk to prompt concern," he said.

"When obstetricians review this information, perhaps it will promote greater discussion within the obstetrical community about the pros and cons of offering C-sections for convenience and promote more research into understanding why this increased risk persists."

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Ally its so hard to find answers. I hope that you can be at peace with whatever decision you choose to make. As all the others have said there is so much information out there. I would just take more time in reading & writing things down like your fears, your reasons, the thoughts on VBAC's. You have always taken a passionate stand for c/s, and that is your choice, if you are doubting yourself now take more time & think it through.

I spent at least 2 months reading books & reading both sides of the arguement before I felt comfortable voicing my decision for a VBAC. I have yet to experience it yet, it is scary but I feel empowered by the knowledge I have and knowing that this choice was mine to make.

*hugs*

Thanks for your replies 

Mumma Bear; Im not sure how to put the thread here, but my story is under “my reasons for elective cs” in this section. (its just way too long!) Most of it being my heart probs, and I do need to speak to my OB about it. I have been told its nothing to worry about (by my GP) but I don’t feel that I could cope with going thru Natural Childbirth, because of it, hence me thinking of CS again.


To be honest, Im not after the sense of achievement/reward. I was quite happy and confident to have another CS, but it seems hard to find someone willing to do it without persuading me into attempting VBAC.
I thought I had done enough research hence deciding on CS which is what I thought was best for me and bubs. But after speaking to the midwives today I now feel like I am just confused as they are wanting me to attempt VBAC!. The Info that I have been given about VBAC vs CS, and what I have read is just making my head spin. I didn’t have this worry with DS…..I wasn’t persuaded either way back then.

Kelly/Sarah; Thanks for your info….I think I’ll just have to continue more reading to set my mind in concrete. Thankfully I have another 7 Months to go!

Christy; I am still passionate about CS as a choice. Esp for those who elect one for personal and med issues. Im not doubting my choice for cs, rather feel I am being “influenced” into doing other wise LOL! I am getting mixed messages, and with this fragile pregnant state of mind…..Its not hard to do! So I guess I am weighing up my options once again ;)
I am looking forward to reading your birth story tho! Wishing you all the best with the birth! 

Gosh, I hope I am making sense. Thanks for listening xxx

Hey Ally, I actually have no idea what it's like to be making your kind of decision, just wanted to jump in and say I hope you can get your hands on some clear, reliable info, and that your drs can answer your questions, so you can feel confident with whichever decision you make.

Do you see a specialist re your heart? Perhaps arrange to see one to have a chat? I know I'd feel more confident getting info from a heart specialist than a GP or my OB. That's just me tho.

I agree - don't believe everything on the net. Often they are worst case scenarios portrayed as everyday occurrance.

Good luck with your research!

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Unfortunately Ally, there are no gurantees in life. You can not be guranteed a 'safe' any kind of birth be it vaginal, c/s, VBAC, induction etc etc etc. EVERY kind of birth carries with it a risk of complication, some obviously more than others.

Whatever option you want - you will find a plethora of information supporting your choice. You could go around in circles trying to find one overall general consesus - because there is not one. For every for, there is an against. For every against, there is a for. You can get drowned in material. Believe me, I think I've read every study on the internet and in print, medical journals, at the library, and probed every medical professiosnals mind I know. In my previous position I had access to heaps of material and at times I would overwhelm even myself with it all.

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Exactly!!! You seem to take thoughts from my mind, but put them into words more clearly than I can!! I am going around in circles at times LOL! I will most likely stick to my gut feeling of CS, and as you say each birth carries risk,even pregnancy in general. I just need to keep a strong positive outlook, and accept whatever comes my way. Thanks xxx (Hope your DH recovers v soon)

Thanks Liz, I havent seen a heart specialist for over 10 yrs....I really do need to speak to my Doc again to get a referral.....as it worries me either way i go really. Its something i should have sorted well b4 falling pregnant again.

Ally - just wanted to pop in and say that maybe the midwife was playing devils advocate and offering you an option you might not have known existed. If that makes sense??
It follows a breast vs bottle conversation a little while ago where some people feel the medical profession may have let someone who chose to bottle feed down, so maybe all this midwife was doing was ensuring that you knew you could have all the options in front of you if need be - and she would support you.

I think at the end of the day you have to be comfortable with what your plan of attack is. There seems to me to be very little point being persuaded that a VBAC is the way you want to go when you might just end up mentally in a worse way.

Soyeah - just wanted to say that exactly how midwives have to do the whole postnatal depression survey, perhaps they need to discuss all the VBAC vs C/S options to tick off on their list.
Just a thought.

Your Right Fi, They wouldnt be doing their job properly if they didnt discuss all options with me. She was very nice, caring and understanding, and not to mention helpful. I cant believe the support and services that are offered in the public system. I went private last time, and had no support.

Thats the problem with the private system, we get pregnant and think we need the best of everything for our baby, so we choose the person we think is most qualified, best Ob, best hospital etc then only see the Ob for 5 mins every month (after waiting an hour or more to see them!), see no midwives during pregnancy who will actually be there at birth and if you want support, you have to get your own. We still have a long way to go in the birth / post-natal industry as far as support goes, but best outcomes don't always come with the most qualified Ob, particularly for a normal physiological birth. Public hospitals have less intervention rates than private and more midwives are involved with care most of the time. Private is all about $$. You pay big bucks, you get more big procedures.

Ally, didn't you also have other reasons then your heart for choosing a c/s? I guess if your heart is ok to cope with a VBAC, what you really need to think about is the other issue from when your were a teenager. You nned to be comfortable with everything before you can move forward.

I hope that you do find someone who will support your choice 100% with out any pressure.

I'll blow the geelong trumpet again and say what a brilliant system we have down here for a hospital that does somewhere like 2000 births a year. (rough figures from a few years ago - probably much more than that now).
The FBU (that I'm going through) has 5 midwives that rotate, and I definitly have my favourites. The one I saw today is such a bloody legend. She loves Jenna and has a great laugh with Shane, and she and I are very in synch.
She would do anything to support you in your efforts to have whatever natural birth you want, but she was also the midwife that helped deliver Jenna in theatre and was completely competant with all the catheters, drips, forceps etc. She also is brilliant with breastfeeding support.

Sometimes you just dont have to go private - the public system is awesome in some locations. And I know we are lucky. Now I just have to get her roster and ensure I go into labour when she is there ;) What are my bloody chances of that!!!

You sound a bit more relaxed about it Ally - thats good :D

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Now I just have to get her roster and ensure I go into labour when she is there ;) What are my bloody chances of that!!!

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LOL!!That is the one thing I think about with public....I would worry that i didnt get the midwife that I liked! And i do like the idea of seeing the same person each visit.

True Fiona, those issues are so deep seeded, and will most likely never be resolved, certainly not by the time I need to have the next baby anyway.

Kelly: On the topic of Public V Private, I wonder if GP’s get kickbacks/bonuses if you like, from Private OBs for referring a patient on to them? My GP was adamant that I went private, when I mentioned that I was thinking of going public this time.
He implied that going public is second best when it comes to OB and Care. (Which I am strongly doubting)
I think some Private run hospitals are penny pinching when it comes to care, as there seems to be a lack of staff, from what I have experienced and seen.

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True Fiona, those issues are so deep seeded, and will most likely never be resolved, certainly not by the time I need to have the next baby anyway.

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I don't think they could ever be resolved. I am only assuming what happened. But I guess it would just be a matter of being comfortable with a VB. Have a think about if those emotions are going to have an impact & interfer with things. Or if you will be able to step out of that zone for the birth of your child I hope you KWIM, its such a delicate subject & I am only assuming things. But anyway, you will sort out what is best for you & your baby. I guess also it would be a benifit to let the midwife know that its not just physical/medical reasons that you are wanting to have c/s. I am sure you wouldn't have to go into detail but letting them know in the same way you have expressed on here that there is things from your past that may have an impact on a VBAC also.

Thanks Fiona...I know what you mean. I didnt mention it to the midwives or OB last time, as I just felt its too long a story to explain in 10 min, and that they wouldnt completely understand anyway. I also felt it wasnt a good time for me to re live things, as I just wanted to think about my baby. I have been seing a lovely lady who is helping me, but its not a quick fix unfortunately.

I think you will be surprised at how supportive the midwifes & OB would be. I would think its an issue that comes up alot.

Ally - i'm sorry that you are having a tough time dealing with all of this right now. I'm in a similar boat. I think that it is good that you are looking into your options now. My biggest struggle with a high-risk pregnancy is the lack of control we have. For me i'm looking into my VBAC options as well as hypnobirthing. I am persuing this road because i had no choice last time and have battled with losing control of my birthing situation. If you feel that you will be in control by chosing another c/s then go for it. But it also doesn't hurt to investigate all the options that interest you. This is your pregnancy, baby and body so ultimately you need to choose whatever makes you feel the most comfortable. My thoughts and support are with you Ally. Lets hope we have wonderful pregnancies and birthing experiences which ever way they turn out!

Yeah many GP's subscribe to the 'best medical care' mindframe and pass that onto unsuspecting pregnant women, and those who want a homebirth will know too well that they will cop an earful from a GP. Ignore them, you need to choose whats best for you as a model of care and stats just show you are more likely to have less support and more intervention in a private model. Hardly best care and most definitely not what the WHO define as best care. Completely the wrong way around. Some Obs are very supportive, but they don't have the time and the 'normal birth' mindframe unless proven otherwise. Instead, complicated birth unless proven otherwise :D

Another good thing about knowing the hospital midwives is you will develop favourites and not so favourites but this way you know who to look out for and if you dont get on well with someone, you can ask she not be assigned to you. Or if you have a birth e.g. breech you can ask a midwife be assigned to you with experience in this and get to know her. You will be surprised how accomodating they can be at times.