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VBAC with cannula and CFM any positive stories please share

(18 Posts)
sugarsnappea Thu 09-Jun-11 15:06:51

Hi, My first labour involved a transfer into hospital (from home birth) followed by crash section for undiagnosed breech. This time around I wanted to have as natural a labour as possible but everyone (and every hospital) I have spoken to (private consultant led care) have insisted that (for insurance reasons) VBAC must have cannula and CFM. All the natural VBAC literature says the less intervention the easier and better the birth. Yes, it's all very well to say that I have rights bla bla but if no one will treat me because they have rights too (to not be sued if anything goes wrong) then I have to cave in and have the b****y cannula and CFM. Will people please share their natural-ish/positive VBAC (with cannula and EFM) stories with me?
Thank you

hollyw Thu 09-Jun-11 16:43:10

I don't know if it helps but I refused a cannula (on my 2nd vbac 3 1/2 years ago). They weren't overly impressed but they didn't refuse.

The thought of having a cannula in my hand freaked me out more than giving birth!

Have you googled cannulas and vbacs and found out the reasons why hospitals want you to have one. I'd do that and then weigh up the risk factors and refuse one if you feel comfortable doing so.

x

Backinthebox Thu 09-Jun-11 17:11:21

There's another thread going about VBAC and CFM that I have put my approach on. I had a very valid reason to not want a cannula in my hand, due to pain caused by a mis-sited cannula when I had my first baby, and some some poor treatment by hospital staff which exacerbated the discomfort it caused. I had an appointment with my consultant, and she said that no one could MAKE me have the cannula inserted, but that they recommended it. I was free to ignore their recommendations though. My reasoning was that their main reasons for inserting a cannula were for 'just in case', and while there may be a few very rare situations that need intravenous drugs or fluids immediately with no prior warning, they were so rare I was willing to take the chance. Other situations which require insertion of a cannula are possible to predict after a steady failure to make progress or a steady deterioration in condition. I pointed out that I would like sufficient care that should a cannula be needed we were able to have a sensible discussion about it and I would make an informed consent. I did not want a cannula in place just in case something happened that no one had noticed happening. My consultant was happy with my stance.

I don't know your background, but have you thought about private midwife care instead of private consultant led care? I appointed a private MW to come into hospital with me, to be my supporter and continuity. She came with me to the hospital for my antenatal visits, and fought my corner well. As it was, my baby was accidently born at home, but she was very valuable in ensuring that I was on the list of the most VBAC-friendly local NHS consultant.

peanutdream Thu 09-Jun-11 17:43:29

I hadn't even thought of the cannula?! I reckon Backinthebox has it spot on - 'I pointed out that I would like sufficient care that should a cannula be needed we were able to have a sensible discussion about it and I would make an informed consent. I did not want a cannula in place just in case something happened that no one had noticed happening.' Well quite!

hollyw Thu 09-Jun-11 19:09:07

Backinthebox that's pretty much my thoughts. Think I might quote you this time around :-)

Junebugjr Fri 10-Jun-11 14:08:52

I had a VBAC with a cannula and CFM. I had previously decided to refuse them, but when I turned up at hospital with a fast and furious labour and high bp, and was advised to have an epidural I ended up with them anyway. Even so I had an intervention free easy labour, and just had a little tear.
Inform yourself with the risks of each, and be prepared for anything to happen in labour.

bambinoblue3 Fri 10-Jun-11 14:32:32

I had a VBAC 6days ago and had a cannula and CFM, to be honest i was dreading both but it wasnt actually that bad. I did need the cannula in the end as i had to put on a drip to speed up contractions so that would of happened even if it wasnt a VBAC and the CFM wasnt too bad as i could still get out of bed and walk around a little bit and bounce on ball and my baby got very distressed so im glad i did have the monitor on otherwise it might not have been noticed.

I did get my VBAC in the end and the cannula and CFM didnt make it any less special and in my opinion it wasnt a big deal for me and they do it for a reason not just to make to make you unhappy.

Good luck with your VBAC.

MovingAndScared Fri 10-Jun-11 14:34:10

I had a cannula in my hand - no drip or anything in my sucessful VBAC - didn't notice it at all - and if needed an C-section I felt it would speed things up

CFM - continusus monitoring -right - had this as well - I was hoping to use wireless monitoring -but wasn't working - and some hosptials have waterproof monitors -so you could go in water - so I would maybe look into that -

it was a bit of PITA -a bit distracting in the early stages - but in the early stages had it taken off for loo breaks - and the wire was quite long so I could move around a fair bit anyway

And are you in the UK- as I would looking to finding the most VBAC friendly constultant/hospital - personally can't see the need to go private - and certainly in NHS you could refuse CFM especially in a more VBAC friendly place

Tangle Fri 10-Jun-11 14:45:34

Are you in the UK? If so it might be worth contacting AIMS - they're used to advising women who are facing obstinate care providers.

It seems counter intuitive to me for the consultant to be coming from a place where his fear of litigation is greater than his desire to do his job well and help a woman achieve a positive birth with a level of risk acceptable to both parties. (S)He seems to be starting from the position that "if things go wrong I'm going to get sued" - have you offered to sign a disclaimer stating that it was your informed choice not to have a cannula sited as a precaution, which might give them some comfort (not that you should need to, but if it removes the fight...).

re. CFM, try asking for the research that proves CFM reduces risks and improves outcomes. As far as I am aware, if anything the research shows the contrary, and that regular intermittent monitoring by a MW gives statistically better results - you could try saying you'll sue if they force you to have CFM and wind up with a complicated birth due to lack of mobility!

That said, women can and do have positive births with both cannulas and CFM, as has already been illustrated on this thread. Fingers crossed you manage a positive birth, however it happens smile

DaisySteiner Fri 10-Jun-11 15:07:23

I have rather mixed feelings about this issue. I had a VBA2C a number of years ago without a cannula or CFM. It all went fine, as is statistically likely. And of course, it is your right not to have them and still be cared for, although I guess in your case you may need to transfer to NHS care in order to exercise that right.

With hindsight though having since worked in high-risk obstetrics I'm not sure I would make the same choices if I were to have another baby. WRT the cannula: yes, they can be uncomfortable, and it's not nice having them put in but having been with women having them inserted in an emergency situation with a stressed anaesthetist, I would personally prefer to have one inserted under relatively calm conditions. You also need to be aware that they will NOT do a c-section without one in, so if you need one in a hurry there will be a delay while they get the cannula in. And the sort of emergency that requires a v.fast c-section in a VBAC is also the kind of emergency where it may be very difficult to get a cannula in.

WRT to CFM. NICE guidelines do state that routine CFM does not reduce perinatal mortality. However, afaik this is based on studies of women with low-risk pregnancies, not women planning VBACs where there are additional risks. I do not know of any good quality research comparing outcomes with or without CFM for VBACs. However, there is some evidence that the first signs of scar rupture can be detected by continuous monitoring. There was also a piece in the BJM this month postulating that although CFM hasn't been shown to reduce perinatal mortality, it HAS been shown to reduce the incidence of neonatal seizures which can lead to developmental problems. That's not to say that you can definitively conclude that CFM reduces the risk of developmental problems, but the opinion of the authors was that it may do and warrants further research.

As others have said though, having a cannula and CFM may increase your chance of needing a c-section and/or complicating the birth in other ways. It's up to you at the end of the day, you need to weigh up the pros and cons. I'm sorry that this isn't a positive cannula-and-CFM-birth-story, just thought I'd add my two penn'orth.

Hope it all goes well for you and you get good support whatever you decide to do.

sugarsnappea Fri 10-Jun-11 18:19:27

Thank you all so much! I am chatting with an NHS consultant midwife in a few weeks and so may switch over to NHS, though I am reassured by MovingandScared and my husband will appreciate your comments DaisySteiner.

iamabadger Fri 10-Jun-11 18:27:51

Can't comment on the CFM, am not a midwife, but agree with Daisy Steiner re: it being better to have your cannula put in in a calm situation. If someting went wrong, you could potentially be shocked or dehdyrated by that point, or anxious and in pain and unable to keep as still which could make it more difficult for the cannula to be sited. And TBH, the only person that adversely affects is you because it may be more painful and is more likely to extravasate or need multiple attempts. What perticulary bothers you about a cannula? It really is just a thin plastic tube that's actually left in situ. I have had various ops by the way, so that's not just an opinion I hold bacause I see it so routinely at work.

MovingAndScared Fri 10-Jun-11 19:49:37

oh and what I decided to which really helped was to have an extra birth partner -as well as DH looked into a doula but in the end went for my friend who had had a VBAC and was brilliant - helped us say no to an intervention and suggested a move in position at one point

LiegeAndLief Sat 11-Jun-11 08:01:22

I had a VBAC with a cannula and CFM as I also had pre-eclampsia (first cs was due to severe pre-eclampsia) and I was very worried about things going downhill fast.

My hospital had wireless CFM, which was great and hardly bothered me at all, I was able to spend hours and hours walking up and down the delivery room and go to the toilet without taking it off etc. However I only knew about the wireless machines because a friend had told me - I think they only had one oe two sets so only gave them to women who actively asked for them, which is a shame! The cannula annoyed me for about 10min and then I forgot about it.

The birth was great. Labour relatively easy, dd shot out a bit too fast resulting in second degree tear but still a hundred million times better than my cs. I have no regrets at all about the CFM and cannula. Good luck! Oh, also had waters broken at 3cm because I wasn't progressing very fast, and that was absolutely fine too. Dd born 3 hours later!

LiegeAndLief Sat 11-Jun-11 08:02:39

Meant to say I had no intervention apart from ARM, used TENS and gas and air towards the end. Breathing really helped.

sunflower Sat 11-Jun-11 20:30:34

I've had two VBACs, both with CFM and a cannula - and an epidural. 1st VBAC I would describe as good, 2nd VBAC was marvellous.

I decided not to fight about the cannula. It wouldn't have been my preference, and I had some issues about feeling like I was being set up to fail, but overall I decided it was irritating but not major. I accepted the CFM as I had chosen to have an epidural both times. In my first VBAC they were happy to do intermittent monitoring until the epidural was sited.

My first VBAC ended with a ventouse, episiotomy and stitches (oh and a pretty big baby). I still found it preferable to my CS first time around, even though that wasn't that bad either (EMCS due to failure to progress). My second VBAC was glorious - really fast and calm second stage, no episiotomy or tears. I was on cloud nine. Okay, so neither of my VBACs were the kind of birth I dreamed about first time around (hoped for a home birth, active throughout, minimal or no pain relief) but I was pretty damn happy with them nonetheless!

Islandgirllk Tue 14-Jun-11 20:38:23

Hi, I too had a breech baby number 1. Then a VBAC for baby number 2 last September. I hate needles (couldn't hold or feed my first baby for a day because of that bloody cannula) and so had already discussed with my community mw about the cannula thing and she wrote in my notes that I didn't want one. When I arrived at hospital the duty mw mentioned it and I just said look in my notes I'm not having one.

When I got to hospital I was already 5cm dilated, I had done nearly 20 hours of contractions at home just with yoga as pain relief. They wanted to monitor me but the only comfortable position I could get in was on my hands and knees so my Mum held the monitor to my tummy rather than having it strapped around me.

Baby was born an hour and a half after I arrived at hospital. No problems, a bit of gas and air and a little tear. I feel very very lucky to have a had such a wonderful experience. I loved my labour and I wish you all the very best for yours. Don't be afraid to question professionals and exert your own wishes.

captainbarnacle Tue 14-Jun-11 20:45:17

I had a vbac 3 years ago - I refuse a cannula several times and my position was respected. I allowed the monitoring, but was annoyed when I asked to go to the toilet (ie escape the labour room!) and was brought a cardbox tray to wee in so that they could continue to monitor me!

I had my VBAC but then umbilical cord detached from uterus and had to have manual extraction of placenta followed by oodles of stitches. They managed to get the cannula in no problem then, when it mattered smile

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