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VBAC appointment - feeling really disappointed now and not sure what to do

(37 Posts)
shelley72 Wed 06-Feb-13 15:03:48

I know I still have weeks to decide ultimately, but I have just come back from the vbac clinic and i feel so let down as to how little choice i will have about how to give birth: they do not allow HBAC in this area. you HAVE to go to hospital, you HAVE to be constantly monitored - this means being on the bed in all likelihood as there are only 2 'handsfree' monitors in the hospital - and you HAVE to have a cannula fitted immediately. They will also induce at 41 weeks, if you dont want an ELCS. Our hospital has a vbac success rate of between 70% (at its highest) to 21%. You will of course be sharing your midwife, and there are only 2 rooms with birthpools, IF you are allowed to labour in there (becasuse of the monitoring).

It all sounds so negative. why the bloody hell would someone want to give birth in these conditions? i KNOW that the safety of the baby is paramount (mothers health and happiness secondary) and so i can see why a home birth / birth centre may not be ideal. even though i have the same chance of a 'normal' delivery as i did the first time around (i have had one VB, one ELCS for breech presentation). and iwould have a midwife with me constantly but with only intermittant monitoring.

of course i am going to wait and see how this baby is lying nearer the time and take it from there but i thought that you were supposed to have some kind of choice in all this birthing palava. it seems that there isnt really much choice at all and i dont really know where to go from here. the thought of surgery isnt ideal and scares me somewhat - it may not be as straightforward as last time - but at the same time the thought of being strapped to a bed for x hours ending up with an assisted delivery / EMCS doesnt fill me with delight either.

has anyone had a VBAC? is it really that grim?

Pontouf Fri 15-Feb-13 18:32:00

Sorry just saw that Larry had already posted that - must read to end of thread before posting!

Pontouf Fri 15-Feb-13 18:30:02

By the way I also have issue with the emphasis on certain stats over others. Especially the cord prolapse being underemphasised and the scar rupture in vbac being constantly bandied about! Also the 1:200 risk of uterine rupture does not give any information on the outcomes of those ruptures. It includes tiny scar openings that have little effect on outcome as well as catastrophic ones.

Pontouf Fri 15-Feb-13 18:26:40

Hi Icompletely know about guinea pigs, I'd be really grateful for those links if you wouldn't mind? Thanks very much smile

larrygrylls Fri 15-Feb-13 16:17:19

(as in a home birth VBAC, not as in a VBAC)

larrygrylls Fri 15-Feb-13 16:16:23


When I said "you are welcome to disagree with them", I didn't mean it in the sense that they will welcome it! I meant you listen to them, ask lots of questions and generally nod your head. Then you go off and make a decision and find a professional who will assist you in executing it. If you cannot find ANY professionals to assist you, I suggest that you may want to revisit the decision...

The thing about uterine rupture, though, is that although the risk is overstated, when it does happen the consequences are severe for both mother and baby. The 0.5% represents anything from a small and harmless tear to complete rupture, I looked at a paper that suggested the meaningful risk was closer to 0.05% or 1/2000. However, that 1/2000 is often fatal to the mother as well as the baby and needs emergency (hospital) treatment.

Again, the choice is personal. It is a tiny risk but one I would not be comfortable with someone in my family taking.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 13:04:17

I think the annoyance larry comes from the over-stating of some risks over others, rather than the discussion of risks per se. I think most women understand that birth is not without any risk. But it is not helpful to women who wish to make an informed choice about interventions when some risks are privileged over others. For example, the RCOG states that the risk of cord prolapse is 0.5% (approx. the same as the risk for uterine rupture in women who opt for a vbac) and is 'not common' and yet lots of women are told repeatedly about the risk of uterine rupture and the intervention it requires. Similarly, many women are not told that induction of labour increases the risk of uterine rupture even in a non-scarred uterus. Yet the NHS performs many routine inductions.

I think using the knowldeg of the consultant is great advice, unfortunately I don't think one is 'always welcome to disagree with them'. I have repeatedly been told that my requests are non-negotiable, despite providing evidence for why I want what I want (or don't want what I am suggesting). This is also my third pregnancy and I am much more knowldegeable about pregnancy, labour and birth than I was in the previous pregnancies. It was not made clear to me that I had the right to question, challenge or refuse intervention. Similarly, when Drs made a decision there was very little discussion of risk, and yet when I made a request it was all anyone could talk about. So it is not that I am anti-medicine in any way shape or form, but I do get cross when people are put in circumstances where an informed decision is not made available to them.

larrygrylls Fri 15-Feb-13 10:15:48

There seems to be a lot of anger against the advice given to the OP. Not sure I get it really.

Everyone is right in that you cannot be made to do anything. All intervention is up to you. However, after two C sections, you certainly should make yourself aware of the odds of scar rupture, and the consequences, and make an informed decision. For my wife's VBAC, we had a private midwife. She is super in favour of home births, it is her specialty and what she loves to do. However, she just said she could not recommend it with a VBAC due to meaningful risks to both mother and baby.

Due to the (normal) randomness of the NHS, she ended up only having the constant monitor on for the last 90 minutes of labour as there was "no room" in the delivery suite and we were in a side room. It worked out fine but our midwife insisted on listening after every single contraction. I believe the risks of a total uterine rupture are really small (about 1/2000) but the consequences are fairly catastrophic.

I am really surprised that induction is offered at all because we were told by the obstetrician that that increased the risk of uterine rupture really quite significantly.

I think that any partner can listen to a monitor and, as someone who sat through two deliveries with significant decels, I can tell you I noticed every pause in the foetal heartbeat and that you really cannot miss the sound of a sudden change from 120-160 to 60-80 or lower. It is quite scary. Of course, you do need a midwife to confirm it is the foetal hearbeat or the maternal heartbeat and to reposition the monitor if necessary. Again, as a partner, I had no problem getting someone fairly quickly when I noticed decels (or the monitor slipping). You do get some mobility with a monitor if those around you are helpful and I even believe that bluetooth wireless monitors now exist, but are rare on the NHS.

I think that consultants do use "you must" too much. I think what they are (in general) trying to give is best outcome advice. And, as midwives say, obstetricians don't see many normal births so their experience does tend to be the bad outcomes. So, use the consultants. You are welcome to disagree with them but they are a valuable tool. Ask them the risks of any action or inaction and the probabilities and then make an informed decisions which is right for you. Remember these guys charge £250-450/hour privately so their time is valuable and they have a lot of good information for you if you use them as a resource.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 10:07:27

Good to hear about your positive experience Velvet. I have been toying with a water birth but it would be a real hassle to get a birth pool in our house (we have really awkward taps that you can't connect a hosepipe to). I love my baths in pregnancy though so was not sure what to do as I think I would find it really relaxing.

ICompletelyKnowAboutGuineaPigs Fri 15-Feb-13 10:04:09

I agree with you goody but I was told that because the monitor provides a printable trace, it allows midwives to come and check what's been going on even when they're not in the room, making it more accurate that intermittent monitoring. My argument was that the evidence shows no benefit of having a continuous trace in the first place.

goodygumdrops Fri 15-Feb-13 09:41:02

I would ask them why you have to be constantly monitored if you have to share a midwife. There is no point in continuous monitoring if they are not present the vast majority of the time to watch it.

Velvetbee Thu 14-Feb-13 23:37:27

I had a home waterbirth after CS for DC3.

DC1 was a VB at home
DC2 was ELCS for placenta praevia.

When I discussed the next birth with the consultant he suggested the 'home from home' rooms on the labour ward as offering a good compromise between home and 'managed' labour but the supervisor of midwives said I had to be in an 'at risk' room, continuously monitored, given prophalactic antibiotics, cannula etc

After lots of research and letters back and forth she still wouldn't give an inch so I had a hissy fit and wrote that I didn't trust that my wishes would be respected in labour and I was going to book a home delivery.
I expected that she would then agree to me using the home from home room but I didn't hear from her again. Two senior midwives came to visit me at home and were fantastically supportive.

DC3 was born in the bath (wouldn't really recommend that) and was the most joyful of my 4 labours.
It is dispiriting to have to fight but don't give up.

ICompletelyKnowAboutGuineaPigs Thu 14-Feb-13 21:41:11

Hi Pontouf sorry for the late reply, have not stopped for the past couple of days.

I work at a university with a med school so have access to lots of peer reviewed research. I'll get some links together tomorrow and post them/PM you if you like.

IA stands for intermittent auscultation (intermittent listening basically). Theoretically CEM can be used in an upright position and my consultant assured me that this would be the case...but I've heard that in reality moving can cause the monitor to go a bit funny, resulting in women either refusing monitoring/lying down for the needs of the monitor.

I've had to fight my corner on this too.

Tranquilitybaby Tue 12-Feb-13 22:56:35

Have a read of the AIMS booklet 'AM I Allowed', you do jot have to do anything and if you wanted a home birth, midwives would have to be provided to you x

Pontouf Tue 12-Feb-13 14:10:21

By the way, my hospital also advocate induction but I am planning to refuse consent and ask for an ELCS if I go overdue, as it is contraindicated for VBACs.

Pontouf Tue 12-Feb-13 14:08:01

Hiya, sorry to slightly hijack but I am planning a VBAC - due in 8 weeks and am quite concerned about the prospect of continuous electronic monitoring. I have never laboured before (DS was ELCS die to breech presentation) but feel instinctively very strongly that I will want to labour in an upright position, probably kneeling and am worried I won't be able to do that with CEM.

Icompletelyknowaboutguineapigs, you say that the only difference in outcome for mothers and babies with CEM versus IA is higher likelihood of intervention. Firstly what does IA stand for? Also where is this stat from? I'd love to be able to produce it when I see my consultant on the 18th - I want to fight my corner and feel concrete info is my best weapon!

ICompletelyKnowAboutGuineaPigs Tue 12-Feb-13 09:54:02

Your post made me so cross OP - not with you obviously, with the 'advice' you were given. I am also having DC3 after one VB with 3rd degree tear (following routine induction), an ELCS for transverse lie with polyhydramnios and am planning a HBAC for this baby.

I too was told the hospital don't negotiate on CEM but they also don't provide 1:1 midwife care (which I will get at home). There are no differences in outcomes for mothers OR babies for CEM versus IA except interventions are higher with electronic monitoring.

I spoke to various Drs at the hospital and as soon as I mentioned HB they were falling over themselves to make concessions grin . So if you do want an active/minimal intervention hospital birth you could always try this. Otherwise, if you do want a HB I would get in touch with the Supervisor of Midwives, a local HB support group (if you have one) and some online communities. I follow Homebirthers and Hopefuls on FB and find it great. It's attached to a very informative blog but provides loads of advice/birth stories etc.

In the end I am planning a HB but am also seeing the labour ward manager to discuss my hospital care in case of transfer. This way I feel I have my bases covered and am more likely to get the birth I'd like.

p.s. what evidence base are your hospital using? They INSIST on CEM but push IoL? Of the research evidence I've seen, artificial induction increases the risk of uterine rupture and is contra-indicated. Rant over.

photographerlady Fri 08-Feb-13 15:14:45

I am really sorry the appointment has stressed you out dear. I hope the advice that these experienced ladies here gives you puts your mind at ease, just wanted to pop on and throw a bit of support your way.

JKSLtd Thu 07-Feb-13 20:36:40

Definitely definitely join the VBAC Yahoo group, lots of very useful knowledge to tap into on there.

I had DS1 VB HB (very slow but community MWs were brilliant and didn't rush me/make go into hosp).
DS2 emcs for undiagnosed breech.

DD (DC3) I was told all sorts of things but I had done my work on the Yahoo group & read Silent Knife (hard to get hold of a copy but I bought one and donated it to the group on the basis it got passed around so ask on there).
I was told by one crap MW that I'd have to sign a 'deviation from protocol' form, she was v unconvinced with my HBAC plans. Came up with some random story about needing to take blood form me weekly so they could know my blood type, etc hmm
My good MW sorted me out and took over my care 100%.

I had a fab HBAC (live thread on here somewhere) with DD. Water birth and everything. She came face first and I tore so we ended up going in for repair work but up until that point it was brilliant.

I would definitely aim for HBAC again.

Good luck with your decisions, they have to be yours, but have faith that HBAC can & do happen smile

StitchAteMySleep Thu 07-Feb-13 18:28:21

You write in your birth notes that you refuse cannula, cfm etc... And get them to sign. Let them know if they do attempt to put in iv cannula without permission from you that you will sue them for assault. AIMS are also very good, worth contacting them for advice.

Panzee Thu 07-Feb-13 17:11:27

If they are not doing 1:1 care then I would argue they should let you have intermittent monitoring as it is as useful as popping in every half hour to look at a machine. wink

shelley72 Thu 07-Feb-13 16:27:50

Thanks for all of the replies. Didn’t sleep that well last night and have spent the day pondering what to do for the best. As a bit of background, we are in the south west and this is DC3. DC1 was VB with 3 deg tear which led to much trauma and after effects (for me), DC2 was ELCS for footling breech and recovery was a doddle in comparison. I had been booked as homebirth with both – was blue lighted in with DC1 after two hours of pushing came to no avail. I thought that I had got over my obsession with having a homebirth, and I do think that its no longer an option for me but maybe I’m not as over it as I thought! I am not overly keen on hospitals, and have always (rightly or wrongly) been of the opinion that being in hospital slows progress and leads to unnecessary intervention. I know that being stressed wouldn’t help me.

So after reading your thoughts, and having calmed down somewhat since yesterday, I realise that a VBAC probably could be attempted – I am a healthy weight, pregnancy has been ok so far - no major issues that I am aware of. I am however HIGH risk for three reasons (again I am not sure I agree with this) 1. my age (40), 2. that I have had a CS in the past (3.2 yrs by the time DC3 comes along) and 3. that in my first pregnancy (6 years ago!) I had high BP which came down immediately after delivery and has not been high since, not even in subsequent pregnancies. I would also like this reviewed as I really do not feel high risk at all.

So, do I contact the supervisor of midwives at the hospital now? Or wait? Do I need to go through my CMW first? Is there anywhere I can find evidence/guidance that 1:1 midwife care during VBAC should be provided vinegardrinker? They seem to push VBAC (I suspect to get costs and statistics down) but then don’t seem fully equipped or resourced to help make them successful. The MW yesterday DID say that they don’t automatically put in an epidural as it can take away any pain that gives a clue as to scar rupture. Out of curiosity how long (in an emergency) would it take to insert a cannula – ie would rather only have one if necessary and not ‘just in case’ – an anaesthetist isn’t needed for a cannula?

So if I decided to try for VBAC, but didn’t want a cannula unless necessary and to be tethered to a bed just how would I make them listen? They seemed very closed to allowing anything other than hospital policy, for fear of being sued shock. This is the only hospital available to us so I do feel stuck – there is a birth centre (next county) which is 15 miles away, and then you are a further 15 miles from hospital should you need it. They view this centre as on a par with home birth so again not sure that would be an option.

HolidayArmadillo – well actually I had done my research (I thought) – had read up on VBAC on RCOG website, checked NICE guidelines, read a bit on the internet about scar rupture, inductions etc. Which is why I was surprised that our hospital has so many ‘not alloweds’ – it just didn’t seem to fit somehow?

SPBindisguise – re: the health/happiness of the mother – twas her comment not mine! I think that you both need to get through relatively unscathed to get off to a good start. They do seem keen at waving the ‘safety of the baby’ card. And I know that this worries my DH a lot. Not that he would ever make me choose one way or another, but I know that if I did anything selfish and the baby came to harm I wouldn’t forgive myself.

As I tend to carry breech babies, I think am going to wait until 36wks to make a decision – it may be taken out of my hands as it were. But would like to start preparing my case in the meantime!

*Askja and EmsyJ – congratulations to you both smile

SPBInDisguise Thu 07-Feb-13 13:03:23

Good luck op. Agree with the others.
I also don't gree that " i KNOW that the safety of the baby is paramount (mothers health and happiness secondary)" - your health and happiness and the baby's are obviously inter dependent but you matter too. Do not begin to feel that your health can be dismissed because of any perceived 'risks'. Weigh up the evidence and agree to interventions you feel are worth it.

Flisspaps Thu 07-Feb-13 13:02:43

I'd go and join the Yahoo! VBAC/HBAC group as well as taking advice from here smile

StitchAteMySleep Thu 07-Feb-13 13:02:31

They cannot force you to have your baby anywhere, nor can they insert a canula against your will. I refused continuous monitoring and the canula during my vbac attempt, supervisor of midwives talked me through risks and then signed my birth plan so that any midwife on duty did not try to go through the same spiel whilst I was trying to labour.

Get yourself on the UK yahoo vbac group, there are some great ladies on there who know how to fight for the birth you want. Some have had home water births after more than 3 c-sections.

emsyj Thu 07-Feb-13 12:56:44

I have just had a VBAC at home on Tuesday smile following a crash section for DD's birth 2.5 years ago. I was unsure about the prospect of birthing at home and initially booked in to the hospital, but with the option (as I was attended at home by the midwife in labour) to remain at home if I wished. What area are you in OP? I'm in the north west and used the pilot 'One 2 One' midwife scheme that is operating here.

I didn't visit the hospital during pregnancy at all (had scans at a local clinic) and my midwife (saw the same one throughout) came to visit me at home for appointments. It has been fantastic to avoid hospital and the dreadful food this time around! I was in for nearly a week with DD1.

The policy of my local hospital (which has both a consultant and midwife led unit) is that a VBAC-er requires continuous foetal monitoring and is not allowed a water birth (which was what I had wanted) without consultant approval. When my One 2 One midwife called ahead to say I was coming to hospital and could they prepare a pool room, they refused that option and said I would have to see a consultant on admission and be on the bed for monitoring. This, added to the fact that it was freezing cold, gale force winds and hailing rocks outside at 2am when I was progressed enough to be ready to transfer was my motivation for staying at home, and I'm very glad I did. I had a quick, comfortable delivery with no tears or stitches. I am confident that this would not have happened if I had transferred to hospital.

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