What can I do to make a VBAC more likely? Lots of Questions

[kitstwins]

Okay. Not even sure we can have another baby (first pregnancy IVF twins) and the shocker experience the first time round (ghastly emergency caesarean) makes me very wary of throwing myself at the mercy of the medical profession. BUT, we would like another baby.

I'm very, very scared of having a dreadful experience again (ended up with healing issues and a cracking case of PND/PTSD) and whilst I know there are no guarantees with childbirth, etc. I am keen to look into what my options are second time around and weigh up whether it is worth the risk.

My twin pregnancy was complicated due to placenta praevia and recurrant bleeds from 23 weeks onwards (several early labour scares). I spent the last month in hospital on bed rest (a joy I can barely articulate!!!) and the pregnancy ended with an emergency caesarean at 35 weeks after a whopper bleed in the night. The anaethetist botched the epidurals and I ended up with a General Anaesthetic which made me very ill. I had problems with healing and took a long time to bond with my babies, although now all is well.

If, and it's still a big IF, I were to have another baby I'd be very keen to avoid a c-section. I was keen to avoid one with the twins' birth but was told that I had to have one due to the placenta praevia and bleeds, which I got my head around. However, it was a ghastly experience and I struggled with healing and pain for a long time afterwards. So if I could avoid one I would love to.

I know lots of hospitals are pro-vbac but is there anything I can do to make it more likely? I'm thinking along the lines of hiring a doula or a midwife and also issues with an epidural. I've heard that you can't have an epidural during a vbac as it can mask the signs of uterine rupture. Is this true? However, if I avoid an epidural and then have to have an emergency caesarean I'm likely to end up needing a general anaesthetic again as there won't be time to site the epidural, which would mean that ONCE AGAIN I'd miss the birth of my child. This was hugely traumatic for my husband and I so if I can avoid this I would love to. Can I have an epidural sited but not have the pain relief put through? So the signs of uterine rupture aren't masked but the 'hardware' is there in case I need an emergency c-section.

Is there anything else I can do? I'm will go private as, again, I'm too scared to throw myself at the mercy of an overstretched and understaffed NHS and I'm also scared of having to have an emergency c-section at the tail end of someone's night shift - it happened to a girlfriend of mine and she has a wonky, hip-to-hip scar to show for her experience. Call me vain, but it would just be an added insult!

Any help would be greatly appreciated. I suppose a lot rests on this

Kx

[whomovedmychocolate]

Okay, first things first, good luck with getting pregnant with the next one. We were told we couldn't conceive naturally for number one and number two - well I'm 22 weeks pregnant and each and every time I've had sex since I had DD I've conceived (miscarried the first one though).

You need to:

(1) Request a scan to locate the placenta late in pregnancy as well as early - obviously total placenta previa does negate the ability to VBAC.
(2) When you get pregnant appoint an independent midwife who will be willing to be your advocate and make sure you are informed of what to do.
(3) You can have an epidural for VBAC but yes it can mask scar pain, I'm not going to for this baby and am actually planning a home VBAC simply because then I know I will get the undivided attention of two midwives, which frankly isn't going to happen at the hospital, and also because midwives have less stuff to hurt you with than consultants. You can however have a low level epidural put in and only turned up when you need it. Your risk of a rupture is low (the general trotted out figure is 1 in 200 but it depends on what sort of stitching was used, where on your abdomen your scar is etc. etc.) Also bear in mind that uterine ruptures are rarely complete, you may get scar dishenience (it breaks down a bit or stretches) but does not rupture all the way through. Also uterine ruptures are not a ten minute thing - it tends to take hours and hours and if you are being checked properly this should be noted (changes in blood pressure etc. before any serious damage is done).
(4) Knowledge is key, you need to go to the VBAC sites and read up and also attend a VBAC clinic - your hospital probably runs one, to find out what a VBAC would mean for you. Bear in mind though you may get even more royally pissed off when you realise how wrong they did things last time - at least I did. But best informed is best armed.

Good luck!
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[ILikeToMoveItMoveIt]

Hello

Like WMMC, I am going for a home vbac this time to avoid the fiasco that was my last birth. I have appointed an Independant MW as I know I can trust her to make the right decisions for me and my baby when the time comes.

I have (and still am!) reading as much information as I can about VBAC and vb, as for me knowledge is power.

Also, having appointed an Indp. MW straight away I have not seen an NHS mw or Ob, and that it is the way I hope it will remain. As I know they will use scare tactics to make me change my mind, and quite frankly I don't want to hear the (mis-informed) crap they want to spout at me. Can you tell I have issues with them??!!

Good luck with your future choices, there are woman on here who have had vbac's so they may be along later xx

[VictorianPASqualor]

Firstly, no-one can stop you having a VBAC, they can recommend you have a CS because of previous issues etc but in your position I'd say I'm happy to have more regular testing than with a normal pregnancy but that's it, unless baby is compromised there is no reason to have to have a CS.

I had placental abruption with DD and a general anaesthetic/em cs etc at 32 weeks, was told because of this I had to have a CS with DS which I went along with. Am now 38weeks pg with no3 and am looking at a VBA2C, with consultants backing.

My cons was quite worried about me getting to my due date without any issues and as such I have had uterine dopplers to check placental function/blood flow and growth scans fortnightly to check that baby is growing well and not developing IUGR (apparently a issue if you have previous placental problems, I'm not sure if placenta praevia will come under the same risks though).

Now at 38weeks with no further issues she is actually much more supportive than I was expecting and I am looking forward to the day I meet my baby rather than petrified of more surgery.

I do think you need to come to terms with how your previous birth happened to be able to mvoe on happily though. I am now comfortable with the idea that I may have to have a CS if things go tits up, but I consider that to be the same as the risk with any vaginal birth rather than because of my 'history'.

Take a look at some of these links that talk about previous placental issues to get an idea of what risks there are and if/when you do get pg make sure you have the information with you to put forward to your consultant wrt your birth choice.

I would also suggest trying the NHS before you pay out for private care, your money could be much better spent on an IM or a doula, I'm sure lulu will be along to link to the best places to look for them soon if we haven't x-posted

Links to read.

Vbac, on whose terms, basic things to consider when planning a VBAC.
read part 6
help with getting the birth you want

From what I can gather (don't know much about placenta praevia) the issue is whether or not it reoccurs, not that you had it previously so once you have been scanned and know whether or not you have it again you would know more.

HTH

[whomovedmychocolate]

Hey VS - not long now . My consultant is trying to refer me to Prof Redman because I told him I was having a HBAC and he nearly fainted - silly bugger!

Iliketomoveitmoveit - there is a really good book on VBAC coming out at the start of April, I've ordered it from Amazon (read a few of the extracts and it seems really good anyway).

Kitstwins - one thing is clear and that is that you have to be prepared to go armed with knowledge and expect some resistance, doctors train for many years to be allowed to poke you and it's just not tennis if you turn up and say 'yeah thanks but I'd rather squat in the corner and do it myself' (in their opinions anyway). Consultants assess risk and act conservatively to eliminate that risk. You may be best off avoiding them. I can't because I have a scared DH and a heart condition, but you can still find a way through if you know what you are talking about and display that knowledge.

[ILikeToMoveItMoveIt]

WMMC - what's the book called?

[whomovedmychocolate]

handbook www.amazon.co.uk/exec/obidos/ASIN/1904750214?tag=mumsnet&ascsubtag=mnforum-21

Have also ordered this www.amazon.co.uk/exec/obidos/ASIN/1905177062?tag=mumsnet&ascsubtag=mnforum-21 on someone's recommendation too.

[VictorianPASqualor]

Ha, I've actually found prof redman doesnt say much just keeps saying 'hmmm, risks' and that's about it, I was bloody shocked at katherine though she was rubbing my belly and making jokes last week, then went on to tell me I could have a water birth
You know vacaloca is having a HBAC don't you? From the JR?
(btw your date was wrong, didn't you say 37+something? I'm 38wks tomorrow )

[whomovedmychocolate]

LOL I've never bloody met him and apparently I was under him last time! Have heard nothing from them this time at all. Quite happy not to TBH, parking at the Radcliffe is just a bloody joke and when you are on crutches there aren't a lot of options but to drive.

Have cancelled my 28 week consult up here as I'm out of the country at the time (much to the disgust of the receptionist 'what do you mean you don't want to see him, he wants to see you.') So if they don't call me I'm going back to midwifery care. The care aspect seems to be non-existent anyway, the midwives don't know I exist and forgot to book me, the consultants just play referral tennis back and forth like I am some sort of walking uterine timebomb. Oh and to top it off, I could do with some advice from an obstetrician as I have some scar granuloma (probably a hernia) but only my GP can refer me and he doesn't know who to refer me to so is....wait for it....going to send a note to Silver star.

(May as well be Russell Grant for all the sodding good it's doing so far).

[VictorianPASqualor]

He's a funny little man, dp calls him turtle man I have no idea why. He looks like a proper stereotypical professor or that dude from demon headmaster
Now meet him without laughing

[whomovedmychocolate]

I think Mr Impey is quite nice though. He's sort of cute in a well groomed consultant way (though he's stuck a ten inch needle into me and so I'm obviously a tad put off by that!)