VBAC appointment - feeling really disappointed now and not sure what to do

[shelley72]

I know I still have weeks to decide ultimately, but I have just come back from the vbac clinic and i feel so let down as to how little choice i will have about how to give birth: they do not allow HBAC in this area. you HAVE to go to hospital, you HAVE to be constantly monitored - this means being on the bed in all likelihood as there are only 2 'handsfree' monitors in the hospital - and you HAVE to have a cannula fitted immediately. They will also induce at 41 weeks, if you dont want an ELCS. Our hospital has a vbac success rate of between 70% (at its highest) to 21%. You will of course be sharing your midwife, and there are only 2 rooms with birthpools, IF you are allowed to labour in there (becasuse of the monitoring).

It all sounds so negative. why the bloody hell would someone want to give birth in these conditions? i KNOW that the safety of the baby is paramount (mothers health and happiness secondary) and so i can see why a home birth / birth centre may not be ideal. even though i have the same chance of a 'normal' delivery as i did the first time around (i have had one VB, one ELCS for breech presentation). and iwould have a midwife with me constantly but with only intermittant monitoring.

of course i am going to wait and see how this baby is lying nearer the time and take it from there but i thought that you were supposed to have some kind of choice in all this birthing palava. it seems that there isnt really much choice at all and i dont really know where to go from here. the thought of surgery isnt ideal and scares me somewhat - it may not be as straightforward as last time - but at the same time the thought of being strapped to a bed for x hours ending up with an assisted delivery / EMCS doesnt fill me with delight either.

has anyone had a VBAC? is it really that grim?

[trafficwarden]

Gah, just lost a huge post! Contact the Consultant Midwife or Supervisor of Midwives in your hospital. They are usually very supportive and you can reach a compromise together and she can do a lot of negotiating on your behalf. There are loads of people on here who have successfully navigated the system and I'm sure they will be on to add their support and information. Remember, they cannot make you do anything, you do not HAVE to accept their policies. You do need to do thorough research and get support from senior Midwives to make the journey easier and less stressful. Good luck!

[oscarwilde]

Had a vbac (back to back) under the conditions you describe and just using gas and air. Was not induced though and baby was only 6lb 6 which is probably why I wasn't screaming for an epidural. It was fine, I was constantly monitored but was able to labour on my knees over the high part of the bed, bounce on a ball for a bit and did not feel like I was chained down. Monitor did keep slipping off and they didn't seem overly concerned in the early stage so you could probably negotiate using the pool until things heat up? My first was emcs due to failure to progress though and the 2nd was an unplanned vbac (scheduled ELCS but 'twas not to be) with a galloping labour so as with all things, you can writea birth plan but the reality may be a million miles away

[LaVolcan]

If you are mentally competent it's not up to them to 'allow' HBAC, and similarly nor do you 'have' to go to hospital or 'have' to be induced at 41 weeks etc.

I have never been in your situation but I would be worried about anyone who had such blanket policies. I would have a lot more faith in someone who said 'with your health we would advise.....'. Can you go elsewhere?

[VinegarDrinker]

You absolutely wouldn't be sharing a MW. VBAC in established labour (ie once on continuous monitoring) is an indication for 1:1 care everywhere.

The rest sounds standard (better than some places which have never heard of wireless monitoring for a start) and is, as I'm sure you know, due to the 1:200 risk of uterine rupture.

With a previous vaginal birth you have a very string likelihood of having a successful intervention-free VBAC.

[NorthernLurker]

This clinic needs a kick up the arse. It's not up to the clinicians to 'allow' you to do anything. I assume you are a competent adult? Then you choose where you give birth not them. You do not HAVE to have a cannula fitted. You will be offered that intervention but if you decline it there's nothing they can do - and if they attempt to put one in then that would be assault. Same with monitoring. You do not HAVE to take it.

I agree contact the supervisor of midwives and discuss further but be clear - you're not asking where you may give birth. You're letting them know what you will need from them.

Have a look here and don't be discouraged. It may be you decide a hospital birth is your preference - but if you do you do NOT need to jave cannulas, epidurals and all. Bet they want to get an epidural in asap too don't they?

[ThreeForTea]

Hi, i'm due to have a vbac in 4-6 weeks. I would really struggle with the conditions you are describing! What i'm finding is that the 'norm' for that hospital is often presented as the only option, unless the woman is prepared to challenge what she is told. Women I know who have had vbacs in hospital have done so a) while mobile (one case in water) b) without a canulla and c) with a doula present in one case. Stock up on the facts and stats and then go back and see if they'll consider your idea of what you'd like. Good luck!

[HolidayArmadillo]

If you'd done your research and were comfortable with your choices I'd be telling 'them' to cock off with their 'not alloweds'.

[VinegarDrinker]

" Bet they want to get an epidural in asap too don't they?"

God yeah, anaesthetists just LOVE to spend their already-pressured time on unwanted epidurals

[NorthernLurker]

Ok well you go ahead and huff Vinegar but unfortunately epidurals are pushed in women perceived as being 'likely' to ultimately require a c-section. Those attempting vbac and the overweight being prime examples. I agree hard-pressed medical staff shouldn't be spending their time putting them in but I know in my local hospital at least ,the policy is for 'strong consideration' to be given to siting an epidural as soon as possible after the woman arrives. You have to refuse it rather than request it iyswim. A counter-productive policy imo because an epidural will make further intervention more likely.

[Panzee]

I thought epidurals weren't loved in VBACs as its hard to tell if the scar is opening if you have no feeling.

[Askja]

I had a successful VBAC 5 days ago (still quite chuffed ). I didn't have continuous monitoring or canula etc. as I went on the midwife-led unit - I talked to a doctor and the supervisor of midwives early on about risks, policies etc. and they were very supportive, though I did have to fight my corner a little bit with the doctor. I would have been allowed in the pool too if DD2 had given me time (she arrived in 2 hours and I was fully dilated when I got to hospital!). I went a bit overdue (40+5) and there were some mutterings about induction but my midwife would have been happy to let me go 2 weeks over provided I had a chat with a doctor about the risks.

I definitely second having a chat with the supervisor of midwives if you're not happy with the options you've been given - I found it very helpful.

[emsyj]

I have just had a VBAC at home on Tuesday following a crash section for DD's birth 2.5 years ago. I was unsure about the prospect of birthing at home and initially booked in to the hospital, but with the option (as I was attended at home by the midwife in labour) to remain at home if I wished. What area are you in OP? I'm in the north west and used the pilot 'One 2 One' midwife scheme that is operating here. www.onetoonemidwives.org/

I didn't visit the hospital during pregnancy at all (had scans at a local clinic) and my midwife (saw the same one throughout) came to visit me at home for appointments. It has been fantastic to avoid hospital and the dreadful food this time around! I was in for nearly a week with DD1.

The policy of my local hospital (which has both a consultant and midwife led unit) is that a VBAC-er requires continuous foetal monitoring and is not allowed a water birth (which was what I had wanted) without consultant approval. When my One 2 One midwife called ahead to say I was coming to hospital and could they prepare a pool room, they refused that option and said I would have to see a consultant on admission and be on the bed for monitoring. This, added to the fact that it was freezing cold, gale force winds and hailing rocks outside at 2am when I was progressed enough to be ready to transfer was my motivation for staying at home, and I'm very glad I did. I had a quick, comfortable delivery with no tears or stitches. I am confident that this would not have happened if I had transferred to hospital.

[StitchAteMySleep]

They cannot force you to have your baby anywhere, nor can they insert a canula against your will. I refused continuous monitoring and the canula during my vbac attempt, supervisor of midwives talked me through risks and then signed my birth plan so that any midwife on duty did not try to go through the same spiel whilst I was trying to labour.

Get yourself on the UK yahoo vbac group, there are some great ladies on there who know how to fight for the birth you want. Some have had home water births after more than 3 c-sections.

[Flisspaps]

I'd go and join the Yahoo! VBAC/HBAC group as well as taking advice from here

[SPBInDisguise]

Good luck op. Agree with the others.
I also don't gree that " i KNOW that the safety of the baby is paramount (mothers health and happiness secondary)" - your health and happiness and the baby's are obviously inter dependent but you matter too. Do not begin to feel that your health can be dismissed because of any perceived 'risks'. Weigh up the evidence and agree to interventions you feel are worth it.

[shelley72]

Thanks for all of the replies. Didn?t sleep that well last night and have spent the day pondering what to do for the best. As a bit of background, we are in the south west and this is DC3. DC1 was VB with 3 deg tear which led to much trauma and after effects (for me), DC2 was ELCS for footling breech and recovery was a doddle in comparison. I had been booked as homebirth with both ? was blue lighted in with DC1 after two hours of pushing came to no avail. I thought that I had got over my obsession with having a homebirth, and I do think that its no longer an option for me but maybe I?m not as over it as I thought! I am not overly keen on hospitals, and have always (rightly or wrongly) been of the opinion that being in hospital slows progress and leads to unnecessary intervention. I know that being stressed wouldn?t help me.

So after reading your thoughts, and having calmed down somewhat since yesterday, I realise that a VBAC probably could be attempted ? I am a healthy weight, pregnancy has been ok so far - no major issues that I am aware of. I am however HIGH risk for three reasons (again I am not sure I agree with this) 1. my age (40), 2. that I have had a CS in the past (3.2 yrs by the time DC3 comes along) and 3. that in my first pregnancy (6 years ago!) I had high BP which came down immediately after delivery and has not been high since, not even in subsequent pregnancies. I would also like this reviewed as I really do not feel high risk at all.

So, do I contact the supervisor of midwives at the hospital now? Or wait? Do I need to go through my CMW first? Is there anywhere I can find evidence/guidance that 1:1 midwife care during VBAC should be provided vinegardrinker? They seem to push VBAC (I suspect to get costs and statistics down) but then don?t seem fully equipped or resourced to help make them successful. The MW yesterday DID say that they don?t automatically put in an epidural as it can take away any pain that gives a clue as to scar rupture. Out of curiosity how long (in an emergency) would it take to insert a cannula ? ie would rather only have one if necessary and not ?just in case? ? an anaesthetist isn?t needed for a cannula?

So if I decided to try for VBAC, but didn?t want a cannula unless necessary and to be tethered to a bed just how would I make them listen? They seemed very closed to allowing anything other than hospital policy, for fear of being sued . This is the only hospital available to us so I do feel stuck ? there is a birth centre (next county) which is 15 miles away, and then you are a further 15 miles from hospital should you need it. They view this centre as on a par with home birth so again not sure that would be an option.

HolidayArmadillo ? well actually I had done my research (I thought) ? had read up on VBAC on RCOG website, checked NICE guidelines, read a bit on the internet about scar rupture, inductions etc. Which is why I was surprised that our hospital has so many ?not alloweds? ? it just didn?t seem to fit somehow?

SPBindisguise ? re: the health/happiness of the mother ? twas her comment not mine! I think that you both need to get through relatively unscathed to get off to a good start. They do seem keen at waving the ?safety of the baby? card. And I know that this worries my DH a lot. Not that he would ever make me choose one way or another, but I know that if I did anything selfish and the baby came to harm I wouldn?t forgive myself.

As I tend to carry breech babies, I think am going to wait until 36wks to make a decision ? it may be taken out of my hands as it were. But would like to start preparing my case in the meantime!

*Askja and EmsyJ ? congratulations to you both

[Panzee]

If they are not doing 1:1 care then I would argue they should let you have intermittent monitoring as it is as useful as popping in every half hour to look at a machine.

[StitchAteMySleep]

You write in your birth notes that you refuse cannula, cfm etc... And get them to sign. Let them know if they do attempt to put in iv cannula without permission from you that you will sue them for assault. AIMS are also very good, worth contacting them for advice.

[JKSLtd]

Definitely definitely join the VBAC Yahoo group, lots of very useful knowledge to tap into on there.

I had DS1 VB HB (very slow but community MWs were brilliant and didn't rush me/make go into hosp).
DS2 emcs for undiagnosed breech.

DD (DC3) I was told all sorts of things but I had done my work on the Yahoo group & read Silent Knife (hard to get hold of a copy but I bought one and donated it to the group on the basis it got passed around so ask on there).
I was told by one crap MW that I'd have to sign a 'deviation from protocol' form, she was v unconvinced with my HBAC plans. Came up with some random story about needing to take blood form me weekly so they could know my blood type, etc
My good MW sorted me out and took over my care 100%.

I had a fab HBAC (live thread on here somewhere) with DD. Water birth and everything. She came face first and I tore so we ended up going in for repair work but up until that point it was brilliant.

I would definitely aim for HBAC again.

Good luck with your decisions, they have to be yours, but have faith that HBAC can & do happen :)

[photographerlady]

I am really sorry the appointment has stressed you out dear. I hope the advice that these experienced ladies here gives you puts your mind at ease, just wanted to pop on and throw a bit of support your way.

[ICompletelyKnowAboutGuineaPigs]

Your post made me so cross OP - not with you obviously, with the 'advice' you were given. I am also having DC3 after one VB with 3rd degree tear (following routine induction), an ELCS for transverse lie with polyhydramnios and am planning a HBAC for this baby.

I too was told the hospital don't negotiate on CEM but they also don't provide 1:1 midwife care (which I will get at home). There are no differences in outcomes for mothers OR babies for CEM versus IA except interventions are higher with electronic monitoring.

I spoke to various Drs at the hospital and as soon as I mentioned HB they were falling over themselves to make concessions . So if you do want an active/minimal intervention hospital birth you could always try this. Otherwise, if you do want a HB I would get in touch with the Supervisor of Midwives, a local HB support group (if you have one) and some online communities. I follow Homebirthers and Hopefuls on FB and find it great. It's attached to a very informative blog but provides loads of advice/birth stories etc.

In the end I am planning a HB but am also seeing the labour ward manager to discuss my hospital care in case of transfer. This way I feel I have my bases covered and am more likely to get the birth I'd like.

p.s. what evidence base are your hospital using? They INSIST on CEM but push IoL? Of the research evidence I've seen, artificial induction increases the risk of uterine rupture and is contra-indicated. Rant over.

[Pontouf]

Hiya, sorry to slightly hijack but I am planning a VBAC - due in 8 weeks and am quite concerned about the prospect of continuous electronic monitoring. I have never laboured before (DS was ELCS die to breech presentation) but feel instinctively very strongly that I will want to labour in an upright position, probably kneeling and am worried I won't be able to do that with CEM.

Icompletelyknowaboutguineapigs, you say that the only difference in outcome for mothers and babies with CEM versus IA is higher likelihood of intervention. Firstly what does IA stand for? Also where is this stat from? I'd love to be able to produce it when I see my consultant on the 18th - I want to fight my corner and feel concrete info is my best weapon!

[Pontouf]

By the way, my hospital also advocate induction but I am planning to refuse consent and ask for an ELCS if I go overdue, as it is contraindicated for VBACs.

[Tranquilitybaby]

Have a read of the AIMS booklet 'AM I Allowed', you do jot have to do anything and if you wanted a home birth, midwives would have to be provided to you x

[ICompletelyKnowAboutGuineaPigs]

Hi Pontouf sorry for the late reply, have not stopped for the past couple of days.

I work at a university with a med school so have access to lots of peer reviewed research. I'll get some links together tomorrow and post them/PM you if you like.

IA stands for intermittent auscultation (intermittent listening basically). Theoretically CEM can be used in an upright position and my consultant assured me that this would be the case...but I've heard that in reality moving can cause the monitor to go a bit funny, resulting in women either refusing monitoring/lying down for the needs of the monitor.

I've had to fight my corner on this too.