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tell me about your VBAC/attempted VBAC

(39 Posts)
Mandyville Tue 27-Sep-11 20:53:34

I've got an appointment at the VBAC clinic (good innovation) next week and want to get my thoughts/questions in order. First labour was mostly in water and not too bad - but the community midwife has warned me that a water birth probably won't be available for me this time because of the previous c-section. Sooo...

Was your VBAC quite a medical experience? Did you have an epidural? Were you on continuous monitoring? Was it OK?

I hated the monitor first time around and I'm dreading continuous monitoring being recommended this time. I'd love to hear from anyone who had monitoring and found it fine - I don't really want to refuse it if it's recommended...

I don't mind hearing the bad stuff as well as the good - I really just want to be prepared to talk sensibly to a midwife about my pain relief options.

lollystix Tue 27-Sep-11 21:12:04

I had vbac1 out of water - mainly in the waiting room tbh and then it ended up in what can only be described as a cupboard - bit stressful. Asked for wb with vbac2 and consultant ran through risks of no cfm etc but it was a fab experience and delivered him in the pool on g&a. Going for vbac wb again this time too. Got senior mw present throughout too think cos vbac waterbirth classed as high risk (was monitored every 20 mins btw with hand held machine). If u want wb, push for it - you do not need to be strapped to a bed.

MrsHoolie Tue 27-Sep-11 21:15:32

Hello. I attempted a vbac and was told I could have a water birth BUT it is a very pro vbac hospital.
1st baby...2 day labour,only got to 4cm so c section.
2nd baby...24 hours of labour and going nowhere like the first time!but a fabulous experience none the less.
I'm glad I tried.

Mandyville Tue 27-Sep-11 21:35:40

Thanks, guys. I'm nervous about going against medical advice because I pushed to be left alone last time and ended up with an EMCS. Not that I think it could have been avoided (malpresentation) but I think I could have avoided some of the pain, perhaps. And yet, and yet... I still think water is/was a good option for me. Ooh, so tricky.

lollystix Tue 27-Sep-11 22:03:45

The consultant will always say no water and cfm as there is evidence to suggest that cfm most effective was to see that baby not in distress and you can't have cfm in water but there are other ways a mw can ascertain if things are not going well-cfm not the only way.

MerylStrop Tue 27-Sep-11 22:20:56

Hallo

I had DS2 by VBA2C last year at Liverpool Women's Hospital in the Midwife Led Unit. Was really really great.

I was very fortunate that the Consultant Midwife there basically has a mission to support as many women as possible to have as natural a birth as possible.

He agreed that I could labour and give birth at the MLU, where they do not do CFM, and therefore as I would not be having CFM there would be no reason why I couldn't have a water birth if I wished. My (lovely) consultant said the alternative choice was to labour on the Delivery suite, where CFM came more as standard, but went and got a set of monitoring leads and climbed all over the bed demonstrating upright and active birthing positions whilst wearing them. She was happy with my informed decision to go with the MLU.

Epidural is not recommended with VBAC as it can mask the pain that is one of the main signs of scar rupture.

My top tip is to hire a doula if you can possibly manage it. They're very welcome on most hospital wards and can decline all sorts of stuff for you and make sure your wishes are made clear. And some of them can do great massages.

mawbroon Tue 27-Sep-11 22:30:13

I had an ELCS with ds1 because he was breech.

I also have a heart shaped uterus.

DS2 presented head down, and I wanted to try for VBAC.

The consultant said that previous section was a rupture risk, as is mis-shapen uterus. He put my odds at around 70% for successful VBAC. He then said but given that CS rate is 20%, your odds are not that much lower. He wanted CFM, for me to be admitted sooner rather than later when I went into labour and said they would possibly look at a CS sooner into labour if there were probs than they might otherwise.

So, I wrote in my birth plan that I wanted no CFM, no intervention unless totally neccessary, natural 3rd stage, water birth, erm can't remember what else.

And what happened was that i was in the birthing pool with occasional monitoring with the hand held doppler for around 3hrs. It was lovely! The midwife was concerned about the heart rate so asked me to get out. She examined me and I was 7cm, then she broke my waters. Things really got moving, and she was very insistent that I lie on the bed, despite my protests, but she did get me to lie on my side. The CFM started at this point. I had been pushing for a while when they said we have to intervene. Tried ventouse, no joy. Used forceps. It was close. They were in eyeing me up for an EMCS, but fortunately it wasn't neccessary.

So, although it wasn't the lovely natural birth that I had hoped for, I felt very good about having avoided another CS. The midwife said that had the heartrate not dropped, I would have delivered in about another 15mins. I did this all on G&A and overall was pleased with the outcome, and ds2 was none the worse for it.

Shortly before my due date, I read Ina May Gaskins Guide to Childbirth. Although there's not much in it about VBAC (mostly statistics IIRC) it gave me the confidence to give it a go.

Good luck!

Mandyville Wed 28-Sep-11 10:19:21

How did you all find the confidence to turn down CFM? The thought of the whole thing is pretty intimidating, to be honest. I went as natural as possible with no. 1 and it didn't do me any good - I just can't see myself turning down the monitoring. And yet the monitoring was absolutely the worst part of my first labour - I was soooo relieved when they agreed to take the monitor off and let me in the pool. (I was told that they needed 20 minutes continuous trace before they would let me in the water - it took more like an hour and half to get it to their satisfaction, and the experience was incredibly painful for me.)

So it sounds like I definitely need to ask them to be clear about their monitoring policy and the reasons for it. And (thanks Meryl) I also need to ask about epidural. I was really hoping to be allowed one (anaethetist availability permitting) but I can see now that might not happen. Sounds daft, but the whole thing almost makes me want to request another c-section - at least that part didn't HURT!

hawthers Wed 28-Sep-11 13:42:38

hello i had an elcs first time around at 31 weeks as had a ropey placenta and DS wasn't doing so hot so i've never had a chance to go into labour. pg this time around seems to be going ok (touching lots of wood and crossing anything available) and if it continues to go ok i want a go at a VBAC.

does anyone know if you have to have cfm if you had an elcs first time around due to complications with the pregnancy early on rather than in labour last time?

seem to have gone uncharacteristically tree hugger about this birth and have even purchased the hypnobirthing cd - oh dear

mercibucket Wed 28-Sep-11 13:49:27

the basic 'rule' is that you don't have to have anything eg cfm but it's always wise to read up on the pros and cons before making a decision either way
for me a big drawback with cfm is that it isn't being monitored continuously, you just get someone taking a quick look at it every now and then. it's useful for future lawsuits of course, but I'd rather have a mw paying proper attention and doing a handheld reading every so often. if you don't want cfm, just say you don't want it (it helps to develop a thousand yard stare grin).

they might or might not let you have a water birth, some places do so they must interpret the risks differently to those that don't - so it's not like you're on your own declining cfm and having a water birth if that's what you decide. they can use waterproof dopplers to check heartbeat etc

doulas are fab for vbacs!

MsTimTam Wed 28-Sep-11 14:12:46

I had a VBAC - prior to going into labour I was dead against having CFM and the 'just in case' canula (sp?) put in. As it turned it, I went two weeks overdue and was in hosp for monitoring when my waters broke and labour started pretty much imediately, after about an hour the contractions were so full on I couldn't stand up (my 'stay mobile' plan out the window!) and I got on the bed and the mw put the monitor on me (I didn't have the energy to argue and breathe through contractions!). Even with the monitor on, I managed to move around loads - on my side and on my knees using back of bed for support, etc and the mw just moved the monitor around.

I managed with just gas & air, but did end up needing forceps at the very end as dd2s heart rate was dropping and they didn't want to let me push any longer. So the 'just in case' canula I had given into came in handy for the spinal block for the forceps delivery. Even with the forceps it was a miles better experience than my emcs.

All the very best!

Mandyville Wed 28-Sep-11 14:43:09

Ah MrsTimTam! I forgot about the whole 'plan out of the window' part of the labour experience. A good reminder that I'm worrying too much about something I probably can't control anyway!

Has anyone had VBAC with an epidural, by the way?

Zimbah Wed 28-Sep-11 19:57:38

I think, according to the RCOG guidelines IIRC, that epidural results in slightly higher VBAC success rate. I don't know the reasons for that though. The issue around epidural preventing you from feeling a scar rupture seems to be more anecdotal/common sense without any evidence behind it. Having said that, scar rupture is so rare that it's hard to get evidence about it. So you shouldn't have any problems from the hosp about having an epidural if you want one, but you would need to decide whether you want to take that 'risk' or not.

I had VBAC recently, I refused CFM - the consultant gave me a hard time saying he'd seen two ruptures detected by CFM. He wrote on my notes to have CFM. When I went into the hospital my doula just told the midwife my birthplan said no CFM and she went along with it without any fuss, just listened in by hand. She asked to put a cannula in and I said I didn't want one, and she didn't argue. It all went fine. However, the decision to refuse CFM is not something to take lightly - I still don't know whether I made the 'right' choice, obviously it worked out for me but there's always the what if situations. I had the monitor on for a short time in early labour and found it only got a reading if I stayed on my back. There's no way I would have been able to cope with labouring like that without an epidural as it made the contractions much, much worse. So if I'd agreed to CFM my labour would have been very different. Instead I spent most of the time lying across a birthing ball or leaning on the back of the bed, and was able to manage with gas and air.

CocktailQueen Wed 28-Sep-11 20:13:38

Hi - I had a VBAC with ds after a ELCS for breech baby with DD. Found out during the CS that I have a heart shaped uterus so was told that future babies would likely be born by CS too.

Anyway, ds was head down and my waters broke at 38 weeks. Went to hosp for monitoring but labour did not start. After 24 hours was induced.

My VBAC was quite a medical experience - I'd read loads about not having cfm and in the end didn't feel confident enough to insist on it. How crap would I have felt if my CS scar had ruptured or something terrible happened to ds, just because I hadn't wanted cfm??

So my contractions started very strongly but I wasn't dilating and was frankly in a lot of pain. The tens machine was irritating, ds massaging me was irritating, I was tired. So I had pethidine; then an epidural; had cfm overnight, got some sleep and dilated overnight so woke up and was ready to push. But of course I couldn't feel enough to push so had episiotomy and ventouse.

TBH if I had carried on labouring naturally I wouldn't have had cfm I don't think; it was entirely my fault for being a wuss and needing medical intervention. Which did lead to a spiral of intervention. Anyway, I had amy vbac - though it was by no means perfect blush. And I loved it - SO much better than my CS.

Good luck with yours smile You can ask about alternatives to cfm.

369thegoosedrankwine Wed 28-Sep-11 21:03:07

DS1 was EMCS due to undiagnosed breech but I laboured until about 8cm when this was discovered confused.

DS2 was a VBAC. I wasn't particularly adamant about a VBAC but as everything looked good, head down etc, I decided to go for it.

I laboured very quick and was monitored as soon as I got to hospital (I was 3cm on arrival and DS2 was born 3 1/2 hours later).

The monitoring didn't bother me at all. It was just another way of making sure that DS was ok and I liked hearing his heartbeat. I could stand and rock with the gas and air and the monitor on until I could rock no more and that is when the epidural was put in.

The epidural was fantastic but I think I had good timing as it kicked in when I was just about ready to push and it didn't slow anything.

DS turned his head and so wouldn't budge after I pushed for an hour. He was eventually a forceps delivery (ow ow ow).

The VBAC was a good experience, but in my experience (and this is only mine) the recovery after my forceps delivery was a lot worse than my EMCS - and nobody told me that.

Junebugjr Thu 29-Sep-11 21:54:43

Had a vbac with dd2.

Had cfm and an epidural, spent the day drinking tea and biscuits gossiping with the midwives. It was a nice relaxing day, after running round after dd1 heavily pregnant. They didn't give me any t0pups after 8cms but I didn't find the pushing bit that bad. Recovery much better than after emcs, which I didn't feel 'right' for 2yrs pp.

Mandyville Fri 30-Sep-11 07:56:39

Thanks so much for these stories - I'm especially glad to hear that a labour with cfm can be totally fine!

Backinthebox Mon 03-Oct-11 22:12:26

I had an appointment at the hospital with a very pro-VBAC consultant and another one with the VBAC MW. They talked through the options with me, and I politely declined CFM and a cannula, unless there were indications that they were needed. They said I could use the pool if I wanted to. Everything was very well planned.

In the end he was born so quickly I never got to the hospital grin. Was much easier than first time round.

tiggersreturn Mon 03-Oct-11 23:02:56

I had cfm first time due to induction because of type 1 diabetes. Ended in EMCS for failure to progress at 8cm. Ds was OP. Second time was the dts. Half of pg had obs telling me I was having an ELCS and had no choice in the matter. Queue the NHS cuts and it suddenly switched to you're having a vbac no choice and if it doesn't start of own accord we'll do ARM to start it. I was really not keen on it as firstly I'd finally got my head round having another cs and secondly it sounded like all the things I wanted to avoid- long painful failure of a labour and having to look after 2 babies on top of that and another awful cs.

My vbac appointment was spent going back and forth over what I really wanted to happen at the birth. Cfm was raised a few times because I felt that it had really restricted movement and made labour a lot more painful first time but I'd also identified some other things which had put me in a state of panic leaving me unable to cope and they were things which were easier to take a stand on as no medical benefit/disadvantage just basic courtesy.

In the end my waters went 4 days after my vbac appointment at 33+4. When I got to hospital and was lying waiting to be examined I felt a contraction which became quite regular so when the ob examined me I was 5-6cm with no pain at all. It turned out she'd got it wrong and I was "only" 4cm which I stuck at for 5 hours before pain suddenly got much worse and about an hour later after the head ob that day had said that if I didn't progress I'd have to have a cs and I was saying "yes please" (her response was "first we need to get your pain relief under control before you make such a decision") I somehow jumped from 4-10 and realised that I'd never got to discussing 2nd stage in my appt because I didn't really believe it would ever happen.

38 minutes or so of pushing dt1 arrived with 2nd degree tear but unassisted. 26 minutes later and much easier dt2 arrived.

Yes it was highly medical but with premature labour of twins, type 1 diabetes and a vbac I didn't really expect anything else.

Yes to an epidural although with heavy protests from me as I was managing fine. They were insistant as there's a high risk with twins that somehting can go very wrong btwn dt1 and 2 and they need to get 2 out fast. After the head ob said she'd write in my notes that it was clinically dangerous to refuse I agreed to it. I only had one dose to check it was working though and was able to stand for a lot of the labour and lean in various positions, even with the monitors going. They were restrictive but much less so than the last time.

Each labour is different and this one was a very different experience from ds1 as it started of its own accord and all I cared about was getting 2 healthy babies as it was much too early in my view. Thankfully I got that and a vbac into the bargain which meant I was able to visit dt2 in scbu the next time on my own feet and not in a wheelchair.

ShowOfHands Mon 03-Oct-11 23:10:31

DD- v long labour, mainly at home in water, blue light transfer 6hrs into an 8hr second stage and subsequent episiotomy, attempted ventouse, attempted manual rotation and emcs. Malpresentation (deep transverse arrest).

DS- attempted vbac. Waters broke early (same as with dd), ds didn't engage, contracted for 38hrs, ds confirmed in crap position, emcs where they confirmed a problem with my pelvis

I had intermittent monitoring and a canula put in later on. They even let me go home overnight at one point. I had a v pro vbac consultant.

I'm really glad I tried btw.

WantsToBeAMan Tue 04-Oct-11 00:20:40

@mawbroon

Forgive me, I don't mean to have a go at you at all. I am just curious about one thing. Why were you glad to have avoided a cesarian even at the cost of taking a risk? I happen to know that ventouse and forceps pose a much bigger risk to the baby. Why would you be willing to let them try that and not a cesarian?
God forbid if you had needed a cesarian. You would have had to recover for all practical purposes from a vaginal birth and a cesarian. That sounds like a potential disaster.

mawbroon Tue 04-Oct-11 07:52:55

Wantstobeaman - the reason I was glad?

I had a broken ankle at the time and was on crutches. I had already spent several weeks out of action and had orthopaedic surgery at 34weeks pregnant. There would have been no way I could have used crutches with a CS wound, so would probably have been confined to the sofabed with a commode (toilet is upstairs).

Had I ended up with a CS, of course, I would have just had to deal with it. DS1 had taken very badly to me being incapacitated with the broken ankle, so goodness knows how he would have coped with me recovering from a cs on top of all of that.

As it turned out, had it not been for the broken ankle, I would have been up and about, doing the school run etc after a week.

nunnie Tue 04-Oct-11 14:20:17

Hi, I gave birth to my DD 4 weeks ago tomorrow.
This was a VBAC, I was given an epidural due to the fact that I was getting alot of pain in my scar which was preventing me from pushing properly. I was montiored closely, and taken to theatre as they thought I would need another CS, but when we got to theatre she was too far down the canal and was facing sideways so I ended up having forceps, which was on my strongly wish to avoid list, but she was distressed and they wanted her out quickly.

usingapseudonym Tue 04-Oct-11 15:04:55

A Vbac carries far far less risks to both mother and baby than a c section!

I'm hoping to vbac this time - luckily my hospital no longer insists on a cannula (yay) but does want cfm. I really really don't want this but seem to keep reading conflicting information as to whether it is necessary or not. THe hospital does have one with "long leads" apparently and they encourage mobility but I remember how hard it was to get a trace last time and really don't want to end up on my back or everything beind dictated by the machine.

I really want a home birth and there are a lot of hbac advocates, but again Id never forgive myself if I was the 1 in 200 for whom a scar rupture does happen for.

Its a minefield. I'm 32 weeks and still weighing up options...

Mandyville Tue 04-Oct-11 15:17:31

usingapseudonym I just don't think that's right. It depends what risks you're talking about. For example, the risk of uterine rupture is non-existent for a c-section and significant (though still tiny, as you point out) for a VBAC. Also, think about probabilities. For most women, the chances of a successful VBAC are roughly 70:30. So, there's a 30% chance that you'll be exposed to all the risks of an emergency section anyway (and that's before we take into account the increased risk of a section for those in certain groups). Rationally, we should be taking into account the risks of VBAC AND the risks of 30% of an EMCS when we make the decision (compared to the risks of 100% of and ELCS).

Having said all THAT... I just don't think the data is good enough to make these decisions on. For a start, it's all observational (not experimental) data. That means that unobserved or unrecorded differences between the mothers and their babies could be contributing to the outcome. To see what I mean, think about the possible reasons for an EMCS in the first place. The studies find that a previous EMCS for shoulder dystocia increases the chances that a VBAC will fail. Suppose there's some other condition which also increases the chances of failure, but which is not identified or recorded in the data? It's not as daft an idea as you'd think - it's why trials/experimental data is preferred in general.

I make myself crazy with this stuff... I'm just really glad to hear that there are others who aren't confident in refusing CFM.

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