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?
- I must come into hospital as soon as labour starts.
- I must have CFM throughout. (Actually I was kind of expecting this one)
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.