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

(37 Posts)
shelley72 Wed 06-Feb-13 15:03:48

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?

ICompletelyKnowAboutGuineaPigs Thu 14-Feb-13 21:41:11

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.

Velvetbee Thu 14-Feb-13 23:37:27

I had a home waterbirth after CS for DC3.

DC1 was a VB at home
DC2 was ELCS for placenta praevia.

When I discussed the next birth with the consultant he suggested the 'home from home' rooms on the labour ward as offering a good compromise between home and 'managed' labour but the supervisor of midwives said I had to be in an 'at risk' room, continuously monitored, given prophalactic antibiotics, cannula etc

After lots of research and letters back and forth she still wouldn't give an inch so I had a hissy fit and wrote that I didn't trust that my wishes would be respected in labour and I was going to book a home delivery.
I expected that she would then agree to me using the home from home room but I didn't hear from her again. Two senior midwives came to visit me at home and were fantastically supportive.

DC3 was born in the bath (wouldn't really recommend that) and was the most joyful of my 4 labours.
It is dispiriting to have to fight but don't give up.

I would ask them why you have to be constantly monitored if you have to share a midwife. There is no point in continuous monitoring if they are not present the vast majority of the time to watch it.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 10:04:09

I agree with you goody but I was told that because the monitor provides a printable trace, it allows midwives to come and check what's been going on even when they're not in the room, making it more accurate that intermittent monitoring. My argument was that the evidence shows no benefit of having a continuous trace in the first place.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 10:07:27

Good to hear about your positive experience Velvet. I have been toying with a water birth but it would be a real hassle to get a birth pool in our house (we have really awkward taps that you can't connect a hosepipe to). I love my baths in pregnancy though so was not sure what to do as I think I would find it really relaxing.

larrygrylls Fri 15-Feb-13 10:15:48

There seems to be a lot of anger against the advice given to the OP. Not sure I get it really.

Everyone is right in that you cannot be made to do anything. All intervention is up to you. However, after two C sections, you certainly should make yourself aware of the odds of scar rupture, and the consequences, and make an informed decision. For my wife's VBAC, we had a private midwife. She is super in favour of home births, it is her specialty and what she loves to do. However, she just said she could not recommend it with a VBAC due to meaningful risks to both mother and baby.

Due to the (normal) randomness of the NHS, she ended up only having the constant monitor on for the last 90 minutes of labour as there was "no room" in the delivery suite and we were in a side room. It worked out fine but our midwife insisted on listening after every single contraction. I believe the risks of a total uterine rupture are really small (about 1/2000) but the consequences are fairly catastrophic.

I am really surprised that induction is offered at all because we were told by the obstetrician that that increased the risk of uterine rupture really quite significantly.

I think that any partner can listen to a monitor and, as someone who sat through two deliveries with significant decels, I can tell you I noticed every pause in the foetal heartbeat and that you really cannot miss the sound of a sudden change from 120-160 to 60-80 or lower. It is quite scary. Of course, you do need a midwife to confirm it is the foetal hearbeat or the maternal heartbeat and to reposition the monitor if necessary. Again, as a partner, I had no problem getting someone fairly quickly when I noticed decels (or the monitor slipping). You do get some mobility with a monitor if those around you are helpful and I even believe that bluetooth wireless monitors now exist, but are rare on the NHS.

I think that consultants do use "you must" too much. I think what they are (in general) trying to give is best outcome advice. And, as midwives say, obstetricians don't see many normal births so their experience does tend to be the bad outcomes. So, use the consultants. You are welcome to disagree with them but they are a valuable tool. Ask them the risks of any action or inaction and the probabilities and then make an informed decisions which is right for you. Remember these guys charge £250-450/hour privately so their time is valuable and they have a lot of good information for you if you use them as a resource.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 13:04:17

I think the annoyance larry comes from the over-stating of some risks over others, rather than the discussion of risks per se. I think most women understand that birth is not without any risk. But it is not helpful to women who wish to make an informed choice about interventions when some risks are privileged over others. For example, the RCOG states that the risk of cord prolapse is 0.5% (approx. the same as the risk for uterine rupture in women who opt for a vbac) and is 'not common' and yet lots of women are told repeatedly about the risk of uterine rupture and the intervention it requires. Similarly, many women are not told that induction of labour increases the risk of uterine rupture even in a non-scarred uterus. Yet the NHS performs many routine inductions.

I think using the knowldeg of the consultant is great advice, unfortunately I don't think one is 'always welcome to disagree with them'. I have repeatedly been told that my requests are non-negotiable, despite providing evidence for why I want what I want (or don't want what I am suggesting). This is also my third pregnancy and I am much more knowldegeable about pregnancy, labour and birth than I was in the previous pregnancies. It was not made clear to me that I had the right to question, challenge or refuse intervention. Similarly, when Drs made a decision there was very little discussion of risk, and yet when I made a request it was all anyone could talk about. So it is not that I am anti-medicine in any way shape or form, but I do get cross when people are put in circumstances where an informed decision is not made available to them.

larrygrylls Fri 15-Feb-13 16:16:23

ICompletely,

When I said "you are welcome to disagree with them", I didn't mean it in the sense that they will welcome it! I meant you listen to them, ask lots of questions and generally nod your head. Then you go off and make a decision and find a professional who will assist you in executing it. If you cannot find ANY professionals to assist you, I suggest that you may want to revisit the decision...

The thing about uterine rupture, though, is that although the risk is overstated, when it does happen the consequences are severe for both mother and baby. The 0.5% represents anything from a small and harmless tear to complete rupture, I looked at a paper that suggested the meaningful risk was closer to 0.05% or 1/2000. However, that 1/2000 is often fatal to the mother as well as the baby and needs emergency (hospital) treatment.

Again, the choice is personal. It is a tiny risk but one I would not be comfortable with someone in my family taking.

larrygrylls Fri 15-Feb-13 16:17:19

(as in a home birth VBAC, not as in a VBAC)

Pontouf Fri 15-Feb-13 18:26:40

Hi Icompletely know about guinea pigs, I'd be really grateful for those links if you wouldn't mind? Thanks very much smile

Pontouf Fri 15-Feb-13 18:30:02

By the way I also have issue with the emphasis on certain stats over others. Especially the cord prolapse being underemphasised and the scar rupture in vbac being constantly bandied about! Also the 1:200 risk of uterine rupture does not give any information on the outcomes of those ruptures. It includes tiny scar openings that have little effect on outcome as well as catastrophic ones.

Pontouf Fri 15-Feb-13 18:32:00

Sorry just saw that Larry had already posted that - must read to end of thread before posting!

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