C or V?

[dillinger]

I have a son who is nearly 2, my labour with him was long - I wanted a homebirth and after 2 days of labour at home I was transferred to hospital, he was back to back and stuck. I then had an epidural and was taken to theatre, ended up with keilands forceps being used, I had an episiotomy and a 3rd degree tear. I remember being stitched for 45 minutes but didnt think anything of it - and I healed well.

Im now almost 6 months pregnant and at my booking in appointment the midwife mentioned that a c section may be discussed with me by my consultant further on in the pregnancy but that there was no reason why I shouldnt be able to have my baby vaginally at home as I wanted.

My second appointment was with a different midwife who wasnt supportive at all and said I should have a c section or end up faecal incontinant. This was a huge shock. I asked if that would mean further c sections with subsequent children etc and she said why would I want to try a vaginal after having a c section?! She wasnt friendly and couldnt get me out of her office soon enough it felt. She was brushing off my comments and questions and made me feel that my even thinking of trying vaginally makes me crap

I was upset and met with the midwife 'manager' from my hospital who said there was no reason why I couldnt have baby at home etc and she would make an appointment to see my consultant sooner.

I saw my consultant who said there was a 10% of another 3rd degree tear, and a slight chance within that 10% of further complications, so basically the odds were looking ok. She also said that there was nothing to suggest that this baby would get stuck (while the midwife said the baby prob would) and that if anything the labour would be longer as my uterus would know what its doing etc so to speak! She also said that now we 'know' that a baby CAN pass through my pelvis so that shouldnt be a worry. She said that I prob wouldnt be offered a c section either due to how well Id healed etc.

I left feeling a bit better but what the other midwife said has stuck with me. Im not enjoying this pregnancy much because Im so worried and I dont know what to do for the best. My partner says that if the consultant was worried about that trauma again then she wouldve said, nevermind agree to support me with a home birth and I guess hes right but it still bothers me. Ive changed midwives so I dont have to worry about her turning up on the big day and causing me stress - Im sure shes a nice person but she didnt offer the support I needed.

I know a lot can change between now and then but I just dont know what to do. I dont personally see that opting/pushing to get a c section and having major surgery is better for me than the slight risk of a tear. If I have to have a c section then fair enough but I dont want to pick that option. I sometimes think that either way I'll feel like Ive made the wrong decision. I dont live near family so would have to look after my 2 year old and a newborn by myself after the 2 weeks paternity leave and that causes concern if Ive just had surgery.

I want to try for vaginally at home but does that make me selfish?

Sorry for the long post but Im all over the place. x

[Niecie]

If the consultant says it is OK forget about the midwife. The consultant knows more about complications than the midwife - they are her responsibility.

You can always have a go with a home birth but keep an open mind so that you are prepared to be taken to hospital if there are any problems.

My second birth was so different from the first and you could have a totally different experience too. As you say you didn't have a C-section so you know you can give birth vaginally.

Good luck and try not to worry. Just find yourself a supportive midwife and do what you feel comfortable with.

[Niecie]

By the way, I thought it was very generous of you to say you are sure that the midwife is a nice person. She sounds like a miserable old bat to me! It is not her job to make you worried, it was her job to reassure you even if she is telling you things you may not want to hear.

[lemonaid]

I think you can get a good idea of that midwife's general prejudices after her "why would anyone want to try a vaginal after having a c-section" comment.

On the whole consultants tend to be more pro c-section than midwives, so if your consultant (and your first midwife, and the midwife manager) is perfectly happy having carefully reviewed your first birth (let's be honest, given her attitude and reluctance to spend any time engaging with you how much attention do you think the midwife spent to thinking deeply about your individual circumstances?) then I think absolutely you should go with the consultant and the supportive midwife and the midwife manager, not the single ranty one.

[dillinger]

Thanks for your message. I guess I should remind myself that its the consultant who is used to the more difficult births and so if she isnt worried then I should try not to stress so much right now.

I know that I had to be informed of complications etc but I agree that they couldve been discussed more tactfully. She even told me Id prob need a colostomy bag.

I wrote to someone 'higher' at the hospital, and the woman I met with wrote to me, she mentioned that she had spoken to the midwife concerned and that the midwife said she was 'sorry I had heard things that way' - so its obv just my fault, a pregnant woman going off on one, my partner was in the room with me and he agrees that she couldve been a bit more supportive, I left the surgery in tears. The woman I met also said how nice the midwife was - but if shes that unsupportive and full of offhand comments when shes 'tired' (which she kept pointing out to me during my appointment) then I dont want her turning up in the early hours!

Im hoping that the next midwife I see will be more supportive, if shes not then I dont know what I'll do.

Thanks again.

[dillinger]

Thankyou also lemonaid for your message. I completely agree with you, its just nice to have it written down and from anothers perspective (I think I will try and bookmark this page!) The rational part of me says the same, but its the times when Im lying awake at night and my mind is racing that I really start to beat myself up about it.

Also the midwife didnt have my previous notes or anything in front of her so wasnt able to take any of that into account - I didnt realise how serious a 3rd degree could be until now due to the fact that I was up and about no problem, so didnt think anything of it.

(Oh and in my first post Ive written that the consultant said this labour would be longer, obv (and hopefully!) I meant shorter!)

[Niecie]

Plenty of people (dare I say most people) have a difficult time first time round (including me, although not as bad as you) but breeze through the second time.

Why do we do this to ourselves? She is one unsupportive voice amongst many who are supportive and yet we always focus on the one unsupportive one. Not just you in your situation but many of us when faced with an array of opinions, we focus on the one that worries us and ignore the many that don't. Remember nobody else agrees with her!

[dillinger]

Yes and Im awful for only focusing on the 'bad' side of things!

Its dawned on me though that when I go into labour I dont know how Im going to keep myself calm and stop telling myself that everythings going to go wrong. I felt so confident until I saw that midwife. If Im in a right panic then I know that things can just spiral out of my control, everything will slow down and I'll be back in that theatre before I know it.

Im very cynical and suspicious and I cant help thinking that a reason why I havent been offered a c section despite one person having the opinion that I should (I know she wasnt nice but even so thats what she thought) is because if things DID go that way again and resulted in further surgery, then perhaps itd be cheaper to try and 'fix' me afterwards, rather than have the initial cost of a c section straight away. I dont know facts or figures so cant say that Ive even based that notion on anything relevant, Im just going round in circles with my head all over the place.

Ive got a week until I meet my new midwife, I just wish women had a bit more support cos I could really do with a proper talk about this with someone you know?

Sorry to bump this x

[smileyhappymummy]

just wanted to say, elective C sections are actually quite cheap - much cheaper than emergency care and certainly loads cheaper than repair surgery, so you can set your mind at rest about that!
I think if you want to try it vaginally at home go for it. there is a slight risk that you will tear again - but if you have a section you KNOW that you'll have abdominal surgery and a wound to worry about.
good luck!

[dillinger]

Thankyou, I'll try and cross that worry off my list!

Maybe theres some cd or something I should look for.

[tori32]

Dillinger I completely feel for you as I have similar dilemas and experience of my first birth except after 2 days trying at home I ended up with a c-section under general anaesthetic. I have decided to try a VBAC.

From talking to my midwife and the NCT helpline I have been informed that lots depends on the following.
1.How far you dilated the first time, if you gave birth vaginally then no problem.

1. If the baby was back to back check the placenta position because if it is anterior (nearest your tummy instead of behind towards the back) then this increases the chance of a back to back position because the baby likes to naturally face the placenta. However, its not a massive problem. Read up on the NCT website about optimum foetal positioning or OFP as its abreviated to. This is where you can do certain excercises pre labour and during labour to get into the correct position head down to crown.
2. If you had a long delay in the first stage (which happened to me) it is unlikely that this will be the case again as your body 'knows' what is required and as with anything becomes more effecient at recognising what is happening. Therefore, subsequent births are usually quicker than the first.

I would say stick to your guns, you are NOT SELFISH for trying vaginally. There are far more risks of complications from a c section. Infected scars which may need resuturing, not being able to move brilliantly after the birth for at least a few days, urinary tract infections from having been catheterised (and the indignity). Delay in milk production. The operation its self is exactly the same procedure as a hysterectomy before removal of the uterus, hence weakened abdominal muscles for quite some time after.

Good Luck xx

[tori32]

ps if you want to talk to someone phone this number for the NCT birth advice line 0870 444 8707.
Also the optimum foetal positioning advisor on 0870 4239258. Hope these can help you to work through this. They have helped me tremendously and where very informative and supportive. x

[tori32]

As a theatre nurse I can also say that even a severe tear resulting in a rectal prolapse would not result in you having a colostomy bag, merely an operation to repair the damage. The recovery time for which is far shorter than a c-section. I hope this reassures you and that you go ahead with your home birth.

[dillinger]

Thankyou tori for your helpful messages.

1.I managed to dilate to 7cm while at home, and it was after I had stayed at that for 3 hours that the decision to transfer into hospital was taken, ARM of second waters had also been tried so it was the next thing. I did have a long delay - got into hospital at 9am, and got to 10cm around 3.30/4pm, tried pushing but when nothing was happening was taken to theatre and had my son at 6.02pm.

2.At my 20 week scan I asked about the placenta and Im pretty sure I was told that it is at the back. I will read up about OFP also.

Thankyou also for the advice on the surgery and for the helpful phone numbers. xx

[tori32]

Very welcome and good luck x

[Klaw]

Dillinger, I can see no reason why you can't have a fabulous birth!

You got to 7cm at home last time, FAB! You did fit that baby out!

That mw appointment was a disaster, whether she actually said it or you misunderstood her, is irrelevant. The damage has been done.

How do we fix that?

Read Ina May Gaskin's Guide to Childbirth, or Janet Balaskas Active Childbirth (I've not read but hear she's good), Get Hypnobirthing CDs, get the Pink Kit, do what you can to regain faith that you are a woman designed to give birth and has already done so. Educate yourself about normal birth, take charge of this birth, continue to work with the Supervisor of Midwives to get yourself supportive mw and help, antenatally, in regaining your self belief. Contact a Doula for some Birth Preferences sessions.

Many of the Doulas and mw that post on MN will also support you!

[JenT]

Hi there, What an awful experience you have had thus far with your current midwife care.
I would thoroughly recommend trying to find an antenatal Yoga class. For me this helped me focus past the panic of "OMG how is this baby going to get out!" at 6 months you still should have time to get some classes in and I am sure even if you just manage to go to 2-3 you will benefit from the calm confidence it can give you.
The ones I attended were run by www.birthlight.co.uk but I know there are loads of others across the country.
As for the homebirth and VBAC sorry I can't offer practical advice, just do what you feel comfortable with. Good luck!!

[dillinger]

Sorry to bump this but obv things are getting closer... Ive been reading up on things and trying to stay positive but I guess Im going to have these niggles until Ive had the baby.

I changed surgeries and the midwife I saw was ok, seemed a bit patronising but I put that down to me being incredibly over sensitive about all this now. I have to make my 32 week appointment in a couple of weeks so maybe that will be better (fingers crossed). One thing Im not 100% great about is that she said that I might still end up with that midwife attending to my labour Im aware that the chance is slim but its there nonetheless. My friend and dp have said that at least this midwife knows that I'll bloody well say something if she upsets me again so Im hoping if she does turn up she might try and be a bit extra supportive you know?

I had to go to the hosp for my anti d jab the other week and discussed some of my worries with her. She said that it was likely that the 3rd degree tear 'led on' from the episiotomy and so should effectively be in a 'better' place - what Im trying to say that the area where I am weaker (scar tissue etc) would be along the preferred line and therefor hopefully not towards my backside, iyswim. So hopefully if I was to tear again it would probably be along that line and not really too much cause for concern. She also said that the midwives in attendance would keep an eye on where I tore before, and apparently if things were looking like I was going to tear again and there was 'too much' pressure then they can give a slight cut to ease things along. All seems a bit obvious now shes said that but Im glad she did as I can now see that things can be managed.

Id have absolutely loved an independant midwife but unfortunately my finances dont allow, I still tried to find out what was available to me in this area but closest I could find was midwives in bristol, I emailed but she seemed quite pushy and like I said, the couple of grand was too much

Its upsetting but I dont know if I can go through all this again, I wanted more than 2 children ideally but this is so exhausting, Im so bloody stressed about it all the time, theres no continuity of care and Ive no idea whose going to attend my labour. The last midwife I saw said the only way I can make sure that I dont see that other midwife is if I have my baby in hospital. Im alomost tempted but then Im worried about infections and intervention etc.

If I wrote to the Supervisor of Midwives can I request a particular midwife to be present? I met a lovely midwife when I was carrying my son and I know that they cant make any guarantees but maybe at least then theyd know my preference? I could also then request specifically not to see that other one.

Sorry its so long and rambling but I really need some advice again, it was very helpful last time. x

[lulumama]

have you looked at having a doula?

www.doula.org.uk

to support you?

you are not selfish to go for the kind of birth you would like to achieve...

[VictorianSqualor]

dilinger, firstly ARGHHHHHHHHHHHHHHHHHHH, How dare she be so bloody rude!

I'm currently after getting a VBA2C, with complications and althoguh my consultant would love me to have a csection she said to me that it is completely understandable to not want a c-section so I can't see how anyone can think you should go down that route without wanting to.

Achieving at least to try for the birth you want is probably one of the most important things in childbirth, yet not everyone can understand that.

WRT getting which midwife you want I really don't know, I would expect it all depends on who/how many are on call when you go into labour. If the idea of hospital isn't good for you amybe you could go to a birthing centre? Or arrange to be somewhere else when baby is likely to come?

[dillinger]

Thanks for your advice however I feel Ive got good support with respect to the actual labour, its just the midwife thing that is bothering me so Im not sure a doula would be necessary plus Im almost 30 weeks and wouldve preferred longer to build up a relationship, iyswim.

Theres a good birthing centre not far from me, however Im unsure if that would affect how I manage in labour, I was so looking forward to trying to have baby at home and then being left alone with my family you know? I will look into it though and give it serious thought. At least Id know I couldnt be rushed into things.

It looks like the only other way is to write the letter and at least try?

[lulumama]

you can still try for a homebirth if that is what you want. you can transfer in from home, not back from the hospital or unit!

www.aims.org.uk and www.homebirth.org.uk are great sources of support and information

[VictorianSqualor]

If a homebirth is your wish, go for it, you can always consider tranferring to hospital/birthing centre if the midwife that turns up is the one you dont like.

I'd definitely write, just to try, you could also find out the rough pattern of oncall midwives in your area from somewhere I would assume, not particular midwives but how it works, that way you'll know just how likely it is to be that mw.

[Slacker]

You are entitled to refuse care from any particular midwife, there's a letter on the homebirth site for you to send....here

[dillinger]

Thats the website Ive been using! I've written it out and it'll be posted tomorrow!

I know I cant make any definate choices/decisions because you never know until the time do you but thats what works me up I think.

Thanks all for the help, it really is so very much appreciated.

[Mintpurple]

Hi Dillinger,

The 3rd degree tear was almost certainly caused by the Keillands forceps being used as forceps deliveries have a much higher rate of 3rd degree tears, so its very unlikely that you will have a 3rd degree this time.

As for the m/w - You can refuse any midwife and if you write a letter to the supervisor of midwives explaining the reasons why you dont want this particular person with you in labour, then they should just make alternative arrangements for you, by not having her on call for your birth.

Its so important to have no negative influences around you at the time of birth, that if you can organise this sooner rather than later, then you can put it out of your mind. You need positive thoughts and positive energy around you so that you are encouraged and empowered to know that you can do this, and that it will go well.

I think it would still be worth having a doula with you, even a (cheaper) trainee, as she would bring a lot of positive energy to the situation.

Sorry to sound a bit 'lentil-weavery', (and Im really not) but as a midwife I know you can have a great homebirth if you really want it.