Whether to choose a planned (elective) C-section or a VBAC

I’m already 31 weeks plus six – where has the time gone?! It’s finally time to decide what type of birth I want. I’ve been waiting to see how the pregnancy develops before deciding whether to have an elective C-section or try for a VBAC.

For my twin pregnancy, I was advised by my consultant at 36 weeks to have a planned C-section as I’m small and the babies were both large for twins. After deciding to follow his advice I developed pre-eclampsia (PE) and found out I was suffering with obstetric cholestasis (OC) which put me on the emergency C-section list anyway. To cut a long story short, the delivery went well but as they removed my two huge placentas I lost a lot of blood. I felt like I was going to die. Before making Husband and the babies leave the room, they warned us there was a chance I’d need a hysterectomy to stop the flow of blood. Thankfully they were able to stop the bleeding using a balloon and drugs so didn’t have to resort to that. My body reacted badly to the drugs and I had the worst asthma attack I’d ever had. My veins kept collapsing, so as they tried to get blood back into me it kept failing. Then my body went into shock and I started shaking so violently I was convulsing off the table. I spent the hours after the boys arrived having blood transfusions, being wrapped in heated blankets, on oxygen and feeling very poorly.

With this pregnancy I’ve been going with the flow. Initially my placenta was low and I was told if it stayed that way it would mean a planned C-section. It has now moved so I could choose either a planned section or a VBAC (vaginal birth after caesarean).

I spoke with a registrar about my options at my last consultant appointment. He recommended I consider a planned C-section. He said that although a postpartum haemorrhage (PPH) is more likely to happen again in a subsequent pregnancy, it was less likely during a C-section. He also said that due to my size (I’m 5 foot), and the size of the baby, there may be issues delivering if I went for a VBAC (although this will be confirmed at a growth scan in a couple of weeks), and that one in every four attempts of a VBAC ends in an emergency C-section. With emergency sections, the recovery time is much longer as your body would have gone through labour and a major operation. He agreed to refer me on to the VBAC midwife so that I could discuss my options, although he warned me she would be very ‘pro’ VBAC and to make sure that I made my own decision rather than feeling pressured into it.

A few days later the VBAC midwife called me. She was horrified the registrar had suggested a PPH was less likely to happen with a C-section, and she went on to list many possible problems that could happen during a C-section. She then went through an enormous list of reasons a VBAC was the right solution. At the end of the conversation she briefly glossed over a couple of the possible negatives of a VBAC. I asked her to post me some information, and agreed to do some more research myself rather than meet up with her. I felt she was biased towards a VBAC and decided it would be more useful for me to have all of the information so I could make up my own mind.

I’ve since done lots of research and have found these points. Please note these are my personal interpretation of the medical research documents I’ve read through. There is a lot more to it, but these facts (and speaking to Prima Baby’s expert midwife Nikki Khan who hosted the antenatal spa weekend I attended earlier in the year) helped me form my own decision:

• A PPH is likely to be spotted earlier during a C-section which means medical staff can react immediately.
• If you’re already in surgery when you are having a PPH then you’re with the experts who can deal with it.
• If you try for a VBAC and fail then your uterus has already been under pressure so is less likely to contract naturally and you’re more likely to have a PPH.
• Bleeding can be underestimated by up to 50% after a VBAC, which can delay treatment.

I’m sure there will be lots of medical experts out there who disagree with some of the above points, and I now know that even ‘facts’ aren’t always truly factual and can be based on a small scale study which makes them less reliable.

While I know there are loads of pros and cons with each option, I’ve decided to have a planned C-section. The decision may be forced on me anyway if I develop PE or OC again (I’m in the process of waiting for OC results as we speak after my tummy started itching a few days ago), or if the baby is big, but it’s a good feeling to know that I’ve read up on everything and I’m confident that this is the safest method of birth for me and my baby.

If you’re in a similar position and are debating what to do, this is a very interesting article on the subject.

If you have a decision to make, be sure to make it yourself. Listen to what other people have to say but don’t let them sway you. Read as much medical research information as you possibly can – it doesn’t all make sense but you can usually pick out parts of it. I know that planned sections aren’t for everyone. I’m not doing it for convenience, or because I don’t want to go through a vaginal birth; I’m doing it because I want to be in the best possible hands, in the best possible place if a severe PPH happens again. And for me that is on the operating table where the consultant who rescued my womb during my twin birth is leading the team.