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How to prepare for consultant appt to discuss HBAC?

(22 Posts)
ovumahead Thu 07-May-15 21:24:10

I am 21 weeks pregnant with second child. Had an emergency caesearen over 7 years ago with DS, after long labour, slowing of contractions, meconium and decelerating foetal heart rate. I felt bloody awful afterwards - traumatised by the (lack of) care I received during labour and postnatally. This time I am aiming for a home birth, I have booked a doula, and feel determined not to repeat any of the nonsense that happened before. My midwife is very supportive, has read through all my previous notes (got copies of them all) and has said she's confident I can labour and birth at home. I got to 10cm last time, but DS had facial presentation and wasn't moving down.

I'm just wondering if anyone here can offer me any advice in preparing for this conversation with the consultant? What to expect? Anything really!

StarlightMcKenzee Fri 08-May-15 16:57:19

If you're absolutely certain then cancel your appointment with the consultant. Only keep it if there is something you need from him/her. Permission to HB is not one of those things.

ovumahead Fri 08-May-15 17:39:30

Hmm. Good point. My midwife said that because I've had a previous cesarean that they would want to run through all the risks with me (aka scare me!) and make sure I didn't feel pressurised in to it. After this I would then need another meeting with the Supervisor of Midwives to draw up a specific birth plan and again go through the individual risks.... Such a lot of palaver!

breakfastinbread Fri 08-May-15 17:54:46

Pretty poor of your midwife to say the consultant is trying to scare you. IMO the consultant has a duty to inform you of the risks, whether these "scare" you or not is down to your own opinions. Just make sure you go in fully informed, then you KNOW this is the right choice for you.

ovumahead Sun 10-May-15 18:43:40

Thank you! Will do some more research in preparation. I'm just generally anxious about birth having had such a traumatic experience before so will brace myself!

ispyfispi Mon 11-May-15 21:42:53

Came to say the same thing! Definitely speak to the supervised of midwives but don't bother with the consultant. In my experience consultants are against home birth even for the very low risk!

ovumahead Sun 17-May-15 05:59:18

I had to see the consultant anyway as have had a problem with my blood in the past. Anyway, the appointment went surprisingly well! Doc was supportive of vbac and natural birthing. The recommended me to go to the birthing centre, which I said was unlikely to happen unless I had to for medical reasons beyond the minor risk of uterine rupture. Explained a bit about my previous birth experience (horror story) and subsequent anxiety about hospital, impact of anxiety on labour etc... She said she agreed a home birth sounded like the right choice! But they officially would still have to recommend a hospital birth as it's policy. So a great outcome - no arguments, no stress, just a conversation and left feeling good. Phew.

Jackieharris Sun 17-May-15 06:08:09

I've found consultants more home birth friendly than midwives in general.

ovumahead Sun 17-May-15 06:37:15

Interesting! I must be lucky then as I have a super supportive home birth midwife... So different to when I had my son 7 years ago. Wanted a home birth then, but absolutely no support whatsoever. Progress!

StarlightMcKenzee Sun 17-May-15 09:43:12

'But they officially would still have to recommend a hospital birth as it's policy.'

It's great you got a good outcome, but in what world is acceptable to have a policy like this that is clearly not in the best interest of the specific needs of mother or the baby?

I mean are they going to write 'we recommend a hospital birth'. Or are they going to write 'we recommend a hospital birth because it is our policy to do so'?

ovumahead Sun 17-May-15 10:44:25

I know. It's just fear on their part. Crazy but tbh I wouldn't expect anything less from our risk averse NHS!

netguru2 Sun 17-May-15 10:48:06

I wanted a home birth after c section and bad post natal depression after a dreadful hospital stay. I'm so glad I was talked out of it. I would have died. I lost 4 litres of blood and two consultants only just managed to stop bleeding.

The most important thing is healthy baby and healthy you. I got a doula to help care for me after the delivery and made sure that side of things worked.

SueGeneris Sun 17-May-15 11:01:56

Thing is, the risk of rupture is small, but what is at risk is huge. Hence the hospital policy. All midwives, consultants etc want is babies delivered safely with minimal risk to both baby and mother.

I am one of the ones who had a uterine rupture during VBAC. No reason to expect that I would but I did. We were in hospital, late stages of labour (10 cm dilated, pushing). DD was delivered by EMCS within 12 minutes, had a stay in NICU but is now a healthy 5 year old. Had I been at home she would have died and so might I.

I say this not to scare you because I understand the appeal of HB following a traumatic first hospital birth (mine was similar) but to say the risk of rupture is a very real risk. I hadn't given it a great deal of thought prior to DD's birth other than to know it was a risk. I didn't think it would happen to me. There are a few of us on here who have gone through it.

MayfairMummy Sun 17-May-15 11:51:49

Starlight, i think they're following the NICE / hospital guidelines. While it's annoying, i can totally understand why they have to do it (having had basically the same thing said to me recently re official recommendation). Too many people these days would, if something went wrong, go straight back to that conversation, with a solicitor at their side... hmm

OP, i had a HB first child, who also had a facial presentation (plus arm over head). I pushed for 5 hours and was exhausted by the end, but was still really glad i had him at home. They did check babies heartbeat etc fairly regularly, which was a bit distracting, but had i been in hospital it would have been an "emCS". Obv very different to your case, but do remember that even if things don't go as smooth as hoped, a HB can still be much more chilled than hospital.

Best of luck!

MayfairMummy Sun 17-May-15 17:10:55

Wow. My post uploaded seriously late .... hmm .. Wrote just after starlight. Sorry if its way out of context now ....

ovumahead Sun 17-May-15 21:29:39

Wow thanks for sharing your stories. Not scary to hear about experiences where ruptures have occurred - tbh I need and want to know about these occasions to understand that the risk is actually real. I would never want to put myself or my baby at unnecessary risk. This is the one thing I've spoken to my midwife about numerous times. She has assured me that if they suspected anything was amiss they'd send me in. I'm 10 mins away from hospital. I can choose to go in any time I like too, so can book and start a home birth then just ask to go in. Home birth team are also risk averse in that they don't want death or injury on their hands hence the monitoring and transfer if necessary.

For those of you that did rupture, did it come completely out of the blue, or if not, what were the warning signs? Apparently it's specific scar pain, but is there anything else?

SueGeneris Sun 17-May-15 23:43:28

It was pretty out of the blue. They had broken my waters and that sent me very quickly to full dilation. I was in a lot of pain, placenta was abrupting at the same time (although I didn't know). I can't remember what order it happened but they asked me to push and I was but the baby wasn't coming down. Then they saw a band forming at the top of my uterus. It has a name I can't remember. I remember calling out 'it hurts on the scar' but also feeling like I was saying this out of instinct. I don't remember the specific pain and I didn't know until I came round from the GA and the surgeon came to see me that it had been a rupture. DD was out of the womb and in my body cavity when they opened me up.

To balance this I should say that two of my friends have had straightforward and uncomplicated vbacs.

Wishing you all the best.

ovumahead Mon 18-May-15 05:45:33

That sounds utterly traumatic, both physically and emotionally. I hope you recovered well. How long had it been since your previous cesarean? I've heard this can make a difference in terms of how likely it is to rupture. Poor you! Why did they break your waters anyway? I thought they weren't supposed to do anything like that if you'd had a previous cesarean...? Because it increases the likelihood of rupture.

orangutanhihio Mon 18-May-15 21:44:10

The nhs has to be risk averse to avoid being sued! People would soon moan if they didn't always recommend the 'safest' option. We're all able to make our own decisions though, I'm glad the op has felt able to do so smile

netguru2 Mon 18-May-15 22:22:13

I didn't have a rupture. I had placental abruption. I am truly not trying to scare you, I know what it is like to want a home birth but I nearly died and it happened in the operating theatre. As I said, thank god they talked me out of a home birth. It would have been nice but not worth it in a million years.

ovumahead Tue 19-May-15 07:28:24

Thanks again for your replies. I've had a few private messages in response to this thread too, which have been incredibly helpful. Although I do wonder why people don't want to be open about their experiences, I totally respect everyone's privacy - there really is nothing more private than birthing a baby imo (hence why I'd prefer a home birth) but I have struggled to find accounts online of when things have not gone well - all I seem to find are the stats for these experiences, and long, wonderful accounts of when things have gone brilliantly!

SueGeneris Tue 19-May-15 12:22:57

My rupture happened 2 years after my first CS.

I think re breaking my waters, they had part gone already and they knew I'd been having regular contractions for 2 days so I think they were concerned about keeping things moving? But I can't remember what stage it all happened.

Dc3 was born by planned CS at 37 weeks 4.9 years after the rupture. But that's it for me!

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