VBAC after section

[emmajordan]

Dear all.

I am pregnant with my third child. I had a section on the last occassion and was wondering what I can say to the medical professionals to persuade me to have a section on this occassion. My pelvic floor is bad, I had a long recovery after my first birth (medicalised, vaginal). My first baby was 34 weeks and my second 36 weeks.

My concerns are,

Rupture of the womb - as I get mild polyhydramnious (excess amniotic fluid) in pregnancy and this in itself will put pressure on the womb.
Going into labour if they won't allow me to have a section and the contractions rupturing the scar.
The VBAC birth experience doing me physical damage to my pelvic floor leaving me incontinent in later life.

I have had a medicalised birth before (with my first child) as she was pre-term. On my back, drip, monitor and I imagine that it is the same with a VBAC -as they will need constant fetal monitoring. They don't have portable monitors at my hospital.

If anyone has any medical information with regard to EDS iii (HMS) and how a VBAC is not good then I would love to hear it so I could come armed to my obs consultant appointment. AS I imagine I won't be seeing much of consultants in this pregnancy !

If anyone has had a good VBAC experience then it would be good to hear - but I am worried that the risks are too high.

thanks in advance

Emma

[Eloise]

I don't have any personal experience or much knowledge in this area.

But my mum had her first child by normal vaginal, I was then born by emergency ceasaren as I was in severe distress and then sliced her from her belly button down to the pubic bone, and then she had my brother by normal vaginal birth 22 months later.

My mum said that my brother, the last one by vaginal, was the easiest of the lot. She managed this with no problems at all, even though she had been sliced with the biggest scar possible that had cut through all the muscles that she has in her stomach. (My mum is HMS - it is where I got it from.)

There is much more danger with sections, and a much longer recovery period (and you will have a baby to look after!). So they only ever consider sections if there is a real clinical need, as it is not an easy option - it is a more risky option.

I understand that you have had a bad experience of a VBAC, and a good experince of a section, but you are probably best to speak to as many people as possible who have experienced both and discuss with your midwife and consultant to get as much information as possible of the risks of both (and the benefits).

I think there are plenty of people on this site that have had good and bad experiences of both - I am sure they will all come along with much better advice from personal experience.

[emmajordan]

My recovery after my medicalised vaginal birth was almost a year through mobility problems and was certainly significantly less with the section. So having had both types of birth I am aware of recovery period for me. I am most worried about danger to the baby with the scar rupturing during labour. As I have had PROM with each birth it suggests to me things are not that strong down there.

[Finarda]

Just a note in addition to the PM, (my uterus had stretched really thin and was about to rupture so they did an emergency c-section for my 2nd. It was stretched around the scar from my 1st c-section and they had difficulty finding enough "normal" tissue to be able to stitch me up).

With my attempted VBAC, my son was continuously monitored but they didn't make me lie down all the time - I could get up and walk around a few feet or sit on a exercise ball, I just couldn't go very far because I was attached to the machine. But the difference between being able to squat and stand vs lying down is big. They also allowed me to do that despite having an epidural which is normally a big no-no, but it was the first step in getting them to believe the epidural wasn't working when I wandered off to the bathroom by myself (after convincing them to unhook the cords from the machine for those few minutes). However, I think it depends on the nursing staff as they didn't allow me to get off the bed with my 1st.

That is the other thing to consider about an elective c-section - did the epidural/spinal work OK for you previously? It might be worth having a consult with an anaesthetist from the hospital in advance just so they're aware in case it doesn't work properly for you.

Fiona

[emmajordan]

The epidural didn't work with 1st but did have consult with anethatist with second as was EDS iii diagnosed at that point and also had problems in past with dentist (the usual it seems). The spinal did work with the c-section but I think that they put in enough to drug a horse. I was pretty terrrified but they checked very throughly so I know that side of things should go fine. Prof Grayham found the typical cigarette burn type scarring on my skin when he diagnosed me but my scar looks OK to me - not that I have seen many others !

[emmajordan]

After all that I decided to go for a VBAC and had found a midwife to do it with but the consultant advised me against. He said that with a collogen deficiency the risk of rupture was unknown therefore it was not worth the risk of the scar rupturing and the baby being brain damaged or worse.

I took his advice and the section is booked at 38 weeks to hopefully stop me going into labour.

[rebeccagraceson]

Good luck.

How much does your consultant know about EDS? Is he just guessing? Maybe it's worth talking to people who actually know about it if you can?

Are there no information leaflets about HEDS or HMS and childbirth that include information gathered on this stuff? There must be enough women diagnosed with these conditions to gather quite a quantity of information about likely consequences of VBAC vs ElecCB.

And if I had a pound for every woman who had an emergency caesarean after a previous caesarean whose scar was 'about to rupture' lets just say I would be retiring about now. It gets them off the hook for giving you an Em Caesarean and you are thankful they have saved you and your baby and there is no comeback. Win-win situation for them! It is normal for the skin around the uturus scar to stretch and thin out - yes, even to being almost see through - in the next pregnancy.

Becky
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[Finarda]

My OB actually said the same - it's really difficult to know the percentage of women in labour who give birth successfully by vaginal means who also had uteruses which were "about to rupture" but were completely fine and never knew about their uterus state, even in a first birth. It's really only those who ended up with the c-sections who find out. They said it may be a perfectly normal state.

However, in my case, it was in the middle of labour that one of the attendants noticed that my 'bump' wasn't the right shape anymore and they'd only seen that once before, when the uterus actually ruptured, and recognised the shape as meaning that there was something seriously wrong with the uterus (not just a 'normal' thinning out), hence the emergency c-section.

When it came to stitching the uterus, they had to call in another surgeon because every time they put the needle in it just ripped through the tissue (and I got to watch as they showed it to each other....)

Having said that, why I chose a VBAC in the first place was that the statistics between VBACs and repeat c-sections only differed by 1% in the rate of uterine ruptures which I did not feel was significant enough to worry about. So I think you should decide what you feel is right for you and the baby and be comfortable with your decision.
Good luck!

Fiona

[janey]

The uterine rupture rate is 0.3 - 0.7% for women having a VBAC so very low risk. The dehiscence rate is 1% (which is when the scar tissue thins and is only seen at section so very hard to know if normal in labouring women).
I can see no reason why you couldn't labour normally but with very close monitoring (and by that I mean a midwife in the room throughout). If there is any deviation from the norm then a section could be done quickly if not you could birth normally.
I have helped lots of women having VBAC's at home and in hospital but none with known HMS. The only thing I definitely would advise against is an induction of labour as this does increase the rupture rate quite significantly.
Good luck with the rest of your pregnancy and enjoy the birth whichever you decide.
Jane
Midwife and mum

[twinklestars]

Hi i had a succesful vbac in april last year. my first child was born july 05 and was an emergency section due to fetal distress. I had a awful labour. My epidural didn't work. Had to have two fitted then a spinal for the actual section after i argued i didn't want a general. My recovery was awful i got a post operative womb infection and a chest infection i was on anti biotics on and off for 20 weeks after my lo was born as the infection kept reappearing. My wound took ages to heal and is still tender now in places 3 tears later. I had a vbac in april 08 as i was terrified of having a repeat experience. I had a wonderful midwife who was very supportive and also a good consultant and they both fought for me and i got the birth i wanted no problems quite short labour and my baby boy was born with no problems i had a small graze no stiches no epidural just gas and air and my recovery was so quick. I had to fight hard but i got my vbac and it was worth it. i was only diagonesed with hms in october 08 so it wasn't a factor with drs etc. sorry i can't be more help just wanted you to know that it can be done.

Joy

[norfolkandchance]

Hello.

Just thought I'd add my two pennies!

I had an emergency c-section in 2004 which healed horrendously, gave me spine-chilling pain and then got a wound infection on top. (very common to get wound infections these days - the antibiotics needed to combat them now have to be very strong due to resistant bacteria). My scar looks dreadful still.

I went on to have a fabulous home water birth - I declined a repeat cs, declined constant monitoring (which has been proved not to improve neonatal outcome but significantly worsen maternal outcome) and opted instead for community midwifery care and a doula. The birth itself was brilliant but I unfortunately suffered a severe haemorrhage about 3 hours later, which required emergency treatment.

I have yet to be formally diagnosed with hms/whatever they might find but believe that the bleed may have been connected with it!

Anyway, my point is that a vbac is absolutely a possibility and to remember that no two births are the same. You may not have as good a cs experience or as bad a vaginal birth experience the next time.

Please take some more time to see what your options are and what the risks and benefits of each will offer. I will volunteer to eat my hat if your consultant has ANY idea at all about eds3/hms, let alone the fact that vbac is SAFER than cs. As a previous poster mentioned, the risk difference is very small but they cannot deny that vbac is still safer. An elective cs IS safer than an emergency cs but again, only by a small margin. What do YOU want? You and the baby are the most important ones in this picture after all!

Hope I haven't rambled too badly - it's far too late!

Debbie xx

[rebeccagraceson]

Fiona it sounds like you had the best care - a midwife who could recognise a problem. What I worry about is when people are relying on a monitoring machine which wouldn't be able to see a funny shaped bump!!!

Thanks everyone for contributing to make this thread more balanced Hope the original poster might find it useful.

Becky
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[Finarda]

PS I totally agree about hazards of reliance of machine monitoring. In my case, I had both a midwife and a doula, as well as having the hospital assigned labour nurse plus the OB who was 'officially' in charge. The doula was the one who spotted that my bump looked odd so she got the midwife to look - midwife agreed that this was not normal. However, they talked to the labour nurse who immediately looked at the machine (I agreed to get hooked up only as a compromise to something else they wanted to do). The machine results looked fine so she said "well, the machine says there's not a problem so there cant' be".... Even worse, the OB was pulled in, didn't really pay attention to the doula or midwife and said that if I was worried I could have a c-section, or the alternative was to try pitocin (which is contra-indicated in VBAC). No-one had told me anything at this point because they didn't want to worry me but I could pick up on the anxious looks between the midwife and doula especially as the OB mentioned pitocin - even *I* knew that wasn't a good idea! So the person with the least reliance on technology and the most reliance on body language, and body signs was the one who first detected the problem - ironic.

I'm not trying to put people off having a VBAC - I did a lot of research before hand and decided on a VBAC so I believe that for me at that time it was the right decision. As long as you have an understanding of the pros and cons of both sides, you will make the right decision for you. There is no right answer that works for everyone!

Fiona

[emmajordan]

In response to the poster - what do I want. I did want the VBAC in the sympathetic environment - but more than anything I want a healthy baby. I appreciate the risk of rupture is 1 per cent (mum and midwife) in a normal person - but it is unknown (no studies done) in a hypermobile person. i just couldn't tolerate the risk of a brain damaged baby or dead baby. I guess for me a section is not the end of the world (and definitely better than a medicalised birth) but I had managed to find an amazing VBAC suite with a water pool and monitors that detatched and could go in the water.

There have been studies on anal and uterine prolapse and EDS III and a vaginal birth can also cause long term pelvic floor problems for hypermobile women - that can not be over come by pelvic floor exercises. Certainly the Rosemary Kleer (the recommended physio by Prof G) said that most of her clients go for section because of risk of tissue damage and significant risk of incontinence in late life. I didn't ask her about VBAC because I only saw her in pregnancy number 2 when I was planning a vaginal birth (that did not happen).

I appreciate uterine rupture from birth alone is not a risk with this condition but I am asking about uterine rupture with a scarred uterus (i.e. previous c-section). I did haemorage with the last section and expect to again with this one. I also understand that collogen deficiencies are not always easy to put in a box ( I fracture easily and so does my daughter) not always a straight symptom of EDS iii - hypermobility syndrome.

Either way I am not taking any risks so am going to go for the section - I could never forgive myself if something happened to the baby - so I hope you will all wish me luck and support my decision.

On a more moany note - my pelvis is killing me - and I can't wait to give birth. I am 37 weeks tomorrow (the longest I have ever been pregnant) it looks like an early delivery is not going to happen !

[rebeccagraceson]

Good luck, I hope it goes well.

Have you got the belly belt thing that supports the pelvis? I know mums with SPD get this and tend to find it helpful.

There have been studies on anal and uterine prolapse and EDS III and a vaginal birth can also cause long term pelvic floor problems for hypermobile women - that can not be over come by pelvic floor exercises. Certainly the Rosemary Kleer (the recommended physio by Prof G) said that most of her clients go for section because of risk of tissue damage and significant risk of incontinence in late life

Just in case any first time pregnant mums read this I think it is worth noting that the majority of hypermobile women have had straightforward vaginal births without these side effects, so as not to terrify anybody. Also, most problems with pelvic floor are caused during pregnancy not birth

I hope it all goes well, and you recover well from the surgery, and enjoy your lovely new baby

Becky
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