36 week consultant appointment re possible VBAC. Staggered by what I was told. Any advice?

[SpiderWilliam]

I bit of background: DS was born via emcs. I went 2 weeks overdue, was induced, fully dilated, pushed, and the cs was performed after he failed to descend and was showing signs of distress. Having reviewed my delivery notes during this pregnancy it seems that malpresetation was the culprit: brow and the head wedged in the side of my pelvis (sorry, can't remember the medical term).

Today I had an appointment with a consultant who I have not met before to decide how this baby should be delivered. The good news was that the baby's head is down and so there is no reason not to go for a VBAC.

However, I am in shock at some of the things the consultant said to me which contradict all I have read about VBACs. AIBU?

1. I must come into hospital as soon as labour starts.
   
2. I must have CFM throughout. (Actually I was kind of expecting this one)
   
3. I must have an epidural. This is probably thing that got to me the most. Apparently an epidural blocks the pain of contractions but not the pain of a uterine rupture, thus making it easier to detect. This is the opposite of my understanding i.e. that an epidural can add to the risk because because you can't feel it rupture.
   
4. Contractions are v painful so I will need to have an epidural anyway. Didn't I find it painful first time round? Yes I said, but syntocin induced contractions are meant to be worse, so I have no benchmark for a natural labour.
   
5. When I suggested that having an epidural makes you less mobile and so inhibits the benefits of being upright etc he said that active birth is not beneficial for lots of women.
   
6. I said that I would probably refuse an induction if I went overdue and prefer to go straight to elcs. He said that the use of syntocin increases the risk of uterine rupture from 1 in 200 for VBACs to 1 in 50. I said that I was uncomfortable with with that level of risk. He said that it's only statistics and that if I didn't have a uterine rupture then I would be 100% successful. He then said it was similar to catching a plane that has a chance of crashing, but that when it lands safely you have been 100% successful. I pointed out that the chances of a plane crashing aren't 1 in 50.
   
7. Sweeps. The MWs have said to me that the key to me having a successful VBAC is getting me into labour in the first place, so doing several sweeps might be a good idea. I asked when they should be scheduled. He said absolutely not. Sweeps should only be done as the first stage of a proper induction, and as I am refusing induction then it would be dangerous to do a sweep. This is because if the baby's head is too high and the membranes rupture it can lead to a cord prolapse. I said that maybe he should be chatting to his midwives about what they are saying to their patients.
   
8. Then he told me that I had too much knowledge for my own good and that this was making me worry unnecessarily. He promised me that both I and the baby will be fine. What a patronising twunt. I know people whose babies have not been delivered safely and have disabilities as a result. He shouldn't make those sorts of promises. That aside, it's not the risks of cord prolapse etc that are worrying me, more that he seems hell bent on pumping me full of every drug going at the earliest opportunity.
   
   I have agreed to think about induction and I have another appointment booked at 41 weeks to decide next steps.
   
   So, what do I do now? I know that I can refuse interventions. So that's an option, but in the heat of labour I'm not that confident about over-ruling the best advice of the professionals. From something he said I have a suspicion that he is quite new to the hospital and generally the hospital does lots to promote active birth. I am wondering whether he is an aberration? Would it be worth calling my community midwife in the morning and asking if their is a mw on the ward who can talk me through this and see if what he has said is consistent with normal protocols?
   
   Any other thoughts? Many apologies for such a mammoth post. I am somewhat by this as you can no doubt tell.

[bubbahubba]

I think you should change consultants. do you have to have a consultant? why can't you just have midwifery led care?
You don't have faith in him now and it certainly doesnt' sound like you are on the same page at all with regards to everything YOU want for YOUR birth and you can pretty much see what's going to happen during the birth (you have said above).

why don't you make an appointment with the supervisor of midwives and see?

[ohmeohmy]

Sounds like he should go back to med school. 1. You can go in when you choose to. You have total control over when you tell them you are in labour. Leave it as late as you feel comfortable. I was 5cm when I went in

• You can negotiate intermittent monitoring. I had this and stood at side of bed when monitors on till crowning.
  

-you have a free choice over what pain relief if any you want. No requirement for an epidural though they may want to put a venflon(Needle in hand in case they needed to go to c-section). However you could argue that if you were an emergency in A&E they would be able to get one in in seconds so not really necessary.
-watch some HypnoBirthing births- in the right frame of mind not necessarily painful. He has no idea what discomfort you are capable of enduring so cannot judge.
-dissing active birth just shows what a total twunt he is
-sweeps are not intended to break the membranes. I had one. waters broke about about 12 hours later. Premature rupture of membranes can lead to prolapse but that is not what a mw is doing with a sweep.

SOunds like this bozo has really knocked your confidence. Decide what you want in your birth plan and try to talk it over in advance. MAke sure your partner knows what you want and can advocate for you.
If docs are presenting the scary stuff ask lots of questions- use acronym BRAIN Benfits/risks/alternatives/instincts (What is your gut telling you)/Nothing (What if wait a while)? If they have a valid argument they will have the evidence to back it up. You don't have to justify your choices. Check out www.vbac.co.uk/ and good luck

[moonstorm]

WOW I am with you!

I was told no chemical induction - it increases the risk of scar rupture.

I am pretty certain an epidural is out - but I need to check at my appointment on Thursday.

I have been offered a sweep on my due date ( at the moment I'm 3/5 engaged) and again a week later (not sure whether to accept or decline due to strepb, though)

I have been told that being upright and active greatly increases my chance of a vbac.

He sounds like a total idiot... Can you get someone else???

I;'m sure someone more knowledgeable will be along soon...

[ohmeohmy]

also talk to AIMS they will have loads of advice www.aims.org.uk/

[SpiderWilliam]

Thanks for your replies. It's so good to get some reassurance. DH is being very supportive although couldn't be there this afternoon. He thought I must have had the consultant on the back foot for him to tell me off for having "too much knowledge"

Bubba It's the first time I have met this consultant. At 20 weeks I had an appointment at a "Birth Options Clinic" with a different consultant who was fine and a v lovely MW. Unfortunately I found the debrief on DS's birth quite distressing and cried all over them, so we didn't cover the stuff about augmentation and pain relief that was discussed today. It's not as though I feel as though I have a long standing relationship with the man I met today. If I go into labour naturally then it is all about luck of the draw on the night as to who is on duty. It's not clear whether the same consultant would be doing the 41 week appointment.

Ohmeohmy I have been using a hypnobirthing CD for months now and reading up (Ina May etc), so quite pro that kind of approach. I had a sweep with DS which had no effect, so know that they aren't meant to break membranes. I think he was saying that there is a risk that a sweep might cause this. Thanks for reminding me of the "BRAINS" acronym. I was trying to think what it was from NCT classes first time round.

Moonstorm hope your appointment on Thursday is more positive than mine.

[CarmenSanDiego]

There's a lot of factually wrong information here.

1. Yes, some doctors suggest this. I personally wouldn't. It starts the clock ticking towards another caesarean. Think about the fact that plenty, plenty of women have home VBACs, staying home for not just labour but the birth too. They're just worried about the tiny rupture risk with this.
   
2. CFM. This is standard but you can refuse if you want. The evidence for it actually spotting a rupture early is contentious. In fact, staff can be so focused on the monitor, they're not watching YOU for early signs.
   
3. Never heard this. Very odd.
   
4. This is silly. This is just saying that all women should have epidurals because the pain is too much to bear. Nonsense.
   
5. Active birth is beneficial for pretty much anyone trying for a natural delivery. It opens the pelvis considerably and helps position the baby.
   
6. Yes. Syntocin raises your risk of a rupture. Best avoided if possible. Some doctors still like to use it (especially the American doctors) but evidence indicates it is significantly risky.
   
7. Actually, here I tend to agree with him. I think sweeps are vastly overdone and they do carry some risks. They should only be done if the benefits clearly outweigh the risks (perhaps to prevent a C-Section in someone very overdue). They can cause long false labours and introduce risks of infection.
   
8. Awful.
   

I'd change doctors, hire a doula and even consider a home birth. This guy sounds dangerous.

[Appletrees]

I think you should change consultants. Firstly though, however much support you get here, however much you know in your head that he's wrong, there'll be a part of you that is thinking "what if he's right, what if he's right" and these sorts of subliminal worries are the LAST thing you need.

What a shock, when you are mentally preparing yourself for a VBAC. Be very aware of how his words have affected you and make sure you have all the right facts about the claims he made. I think you need another consultant or senior midwife to say, don't worry that's all bollocks.

You need to be so confident when you go into a vbac and twuntery like this is a confidence knocker.

Everyone else has wonderful words and ideas and they all know more than him, that much is obvious.

[SpiderWilliam]

Carmen Are you a medical professional? You sound in the know . It is interesting what you say about sweeps. I'll take that on board. I am not especially in favour of them myself, as the one I had with DS did nothing, but I thought it was interesting that the MW who leads their pro VBAC clinic is all for them and telling women this, and he is saying the opposite.

Appletrees I hadn't really thought about the effect that his words have had on me except that I came out feeling really angry, but you are right, it's not what I need to hear right now. At least my natal hypnotherapy CD has helped get in a positive frame of mind, and tries to discourage negative thinking.

Definitely planning to call my MW tomorrow and see if there is someone else I can talk to.

[Appletrees]

good luck

if it helps, I had successful posterior vbacs after

1.staying home as long as possible (and going home in the middle of one of them)
2.they took the trace off after five minutes because it was uncomfy, and it didn't go back on
3.no epidural either of the two vbacs
4.they are less painful if you are mobile
5.had an "on all fours" after moving about like mad
6.I was told I could not be induced, under no circs was syntocinon to be given
7.yes had a sweep and gave birth forty mins later
8.without looking into it myself I would have had three caesarians because that's what I was told to do

all the best

[CarmenSanDiego]

Good post from Appletrees.

I'm a doula, Spider and I've trained as an antenatal teacher :)

[CarmenSanDiego]

(and had two VBACs myself - one at home :))

[SpiderWilliam]

Thanks Appletrees.

I think I am going to bed now, so wont post again this evening.

Thanks everyone for your support.

[Haliborange]

Agree completely with Carmen.

For my VBAC attempt I
-stayed at home to 10cm
-no cfm

• no drugs (just pool and 3 pointless puffs on gas and air)
  
• was mobile (of course)
  

Interesting he thinks syntocin would lead to success. How many women do you know who've had syntocin and ended with emcs? Cos I know lots.

I'd call the consultant midwife at the hospital, explain your preference for a natural birth and see what can be done. She may also know a more user-friendly consultant for you to switch to.

[chibi]

Try not to let it get you down

What actually ends up happening is not set in stone

Get a second opinion

I was told many of the same things, and ended up labouring without pain relief and birthing with only a few huffs of gas and air

I think it helps to think it through beforehand and know your mind about it

Having said that Ds was born early, way before I thought I needed to really think about the labour and birth

Good luck

[SpookilyDoodleydoohoohoooooo]

I had a vbac 9 weeks ago this is what my consultant said to me (and I really loved her!)

• not ideal to do induction but there was form if necessary but it would increase emcs
  
• nothing about an epidural, infact I had one although it didn't work, I was constantly monitored so not as mobile as I would have liked but I was at home until 6-7cm
  
• I had sweeps at 37,38 weeks, ds born at 39+1 on the day I was scheduled to go in to discuss options.
  

my consultant v keen for me to have a vbac as she knew I had a toddler at home and would want to get home as soon as possible.

I think what you have been told is from a very very nervous consultant or someone who knows diddly squat! Please please ask to see someone else.

[Backinthebox]

Change consultant asap.

I had a VBAC 5 weeks ago. I saw a consultant once only at 25 weeks, and we established that I understood she would recommend certain things and she understood I would refuse them unless it was necessary (eg CFM.) The only definite 'rule' that came out of the appointment (both of us being reasonable and flexible) was that I would NOT be induced. We both agreed on that, and she said she would check me at 10 days overdue to make a plan which would be to either monitor me or a CS, depending on what she found if I went over. She then told me I was low risk and passed me over to MW care, making an appointment for me to see the head MW. She was very relaxed about my reasons for not wanting CFM or a cannula, and we discussed the use of the pool too.

As it was I laboured so quickly I had my baby at home (with private MW in attendance) with no pain relief (none needed) but was VERY active.

It is possible, and I would definitely be requesting a different consultant. At my hospital there was a consultant who was very pro-VBAC and one who was very anti-VBAC. NHS patients were just made an appointment with whoever was next available, mainly because many NHS midwives don't know their locla consultants that well. My private MW requested a pro-VBAC NHS consultant for me - you are entitled to request a particular one.

[SpookilyDoodleydoohoohoooooo]

I have to point out I saw my consultant once a month so did manage to build up a relationship and we decided (unless I completely changed my mind!) that unless my pre-eclampsia returned I would always go for a vbac, one thing that I decided on was the sweeps as my consultant and mw were both on holiday during my due week and I wasn't happy to let other people make the decision for me after 40 weeks, so we as a team made the decision to do the sweeps to see if we could encourage a delivery prior to then so that I could achieve a vbac. As it was I had the sweeps and nothing happened immediately, I think ds was destined to come when he did as I don't think he was forced by the sweeps at all.

(I was lucky my MW and consultant knew each other - I was also lucky that my consultant when dd was born 3 years earlier worked at that hospital - odd - and actually was present at the birth of my bf dd)

[BleedyGonzalez]

SpiderWilliam, I've only read your post but I am shocked that such an inept little twit could be allowed to practise actual medicine on real-live human beings.

You should contact the NCT for advice and reassurance. Not sure what sort of person can help you, but you're more than welcome to message me and I can find out for you.

Sorry for briefness of message! Have to dash - nursery drop-off in the morning!

Oh, also refer to the 'homebirthing.org' website - am sure they have a page on VBAC there (for homebirths - but obviously the stuff about labour and birth are much the same).

Oh, and I suggest you write a detailed complaint to him AND his superiors, detailing the true facts about the useless crap he spouted to you.

[BleedyGonzalez]

And if you want a 'gentle' induction, first try castor oil - mix 2 tbsp into scrambled eggs then fry in onions and garlic; eat on toast. No taste of castor oil. Worked for me within a couple of hours. Got the tip from Ina May Gaskin - super birthing heroine! But you MUST check your cervix first with a clean finger - if it's low down and very soft and mushy, then it's ripe and ready for action!

[SpiderWilliam]

Thanks for your further replies.

In addition to changing consultant I think I will contact the local NCT who I remember from when I did classes with DS have quite strong links with our hospital.

There is also an excellent MW who now mostly works independently but still does some work at the hospital. She delivered my friend's baby and she was so good the baby was named after her! She offers reflexology and works as a doula, so if nothing else it might be good to have some reflexology and talk through what is "normal" VBAC procedure at the hospital.

[tellnoone]

Ask a midwife if there is a vbac hospital policy. I know ours has one.

[DomesticG0ddess]

Wow, I can't believe your consultant said all these things! Kind of the opposite to the things the consultant mw I met with said to me. Good luck with changing consultant - definitely the best thing to do. And perhaps hire the mw you mention as your doula.

[Librashavinganotherbiscuit]

Please read this as then you probably will be more informed than the consultant

There is some evidence to show that having an epidural increases (slightly) your chance of a successful VBAC but I haven't actually read the study so don't know how valid it is.

Does your hospital do a VBAC evening where they will take you thru there hospital policies for VBAC and you can ask your questions?

[kitkat2507]

BleedyGonzalez just out of curiosity how do you checck your own cervix? how would you know what you were feeling for?

[BleedyGonzalez]

Kitkat you just stick a clean finger up your fanjo and have a feel. If it's low down and easy to find, AND it feels mushy, like a soft chin rather than like the end of your nose, then most likely it's ripe. If it's not ready even a sweep won't work.