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Is this normal vbac procedure?(39 Posts)
My consultant basically said if I have a vbac then I will be constantly on fetal monitoring and I won't be allowed to be on a midwifry led unit, I'd be on consult led with no chance of water birth. Also they wouldn't let me labor too long and if I was late then they would go straight to a section and not induce me. Is this normal? I'm thinking I may as well go for a section! My first dd was breech so I have the option for either. I'm 33 weeks now and baby is still breech so I may well end up with one anyway but just wanted to see what others experiences are.
This was the procedure for me too, though I ended up with a second csection.
It isn't a question of "let". This is your body & health professionals can't do anything to it without your consent (unless you're unconscious).
But the fight might be horrible if you want to go against their ADVICE; it is advice not command and control.
As far as I understand, induction for VBAC is known to be too risky. There's a risk of uterine rupture in next labour & they will want information to try to detect that as fast as possible if it happens (hence all the monitoring).
So if it was me I would ask what "wouldn't let me labor too long " means. If they mean after 12 hours.. I'd probably be fed up at that point & not care about CS any more, either. But if "too long" means 2 hours, that's pretty paltry in my mind.
Yeah I understand the risk are much higher for a vbac, I'm really not in to the idea of rupture! I'm seeing the consultant again in 3 weeks so I might just see which way around baby is and decide from there. Although I'm not sure I could handle being strapped up to monitoring for hours upon hours! How restrictive is it exactly? I will definitely ask the 'how long is too long' question at my next appointment.
I think it depends a lot on your NHS trust and your consultant. mine is happy to let me go a bit over dates, will use some but not all induction methods and will let me labour for a "proper" amount of time (whatever that is!!). they do strongly recommend continuous monitoring, as apparently this is the best indicator of potential uterine rupture. I'm happy to go along with that as, personally, I hadn't wanted a water birth.
Ask if they have wireless monitoring - it will make it a lot easier to move around and I think sometimes you can use it in the pool.
Whether you push to be on the MLU, and whether they agree to it, probably depends on the geography of your particular hospital etc. If the MLU was very nearby i.e. on the same floor as the labour ward/operating theatres then I might fight to be allowed to go there. But if being in the MLU would mean an ambulance transfer to the hospital or any delay in treatment/CS in the event of a uterine rupture or foetal distress, then that would be a risk that I wasn't prepared to take.
I was told they would "allow" me to labour for up to 6 hours only.
This was the procedure for me too, but I really wanted to be active. I discussed this with my cosultant, and we agreed 20 mins monitoring per hour. I was going to pregnancy and labour yoga classes, which he liked. As it happened, I had a uterine rupture, lost a lot of blood and DD's heart stopped. Scary to see the monitor flatline, but meant I waS rushed into theatre ASAP.
I should also say that I had continuous monitoring with my first birth (which ended in EMCS) and while it was restrictive, I wasn't pinned to the bed at all.
I had the bands that they put round your bump but I could still move about and get off the bed/get into yoga positions. and don't forget, its not like you have to stay flat on your back even if you are on/near the bed. squatting, kneeling, leaning over the back of the bed, standing and rocking next to the bed are all good things to do. later on, I ended up with the clip that goes on the baby's head because the bands kept coming off
because my bump was so big which was a bit more restrictive, but by that point, I was on the induction drip anyway and so couldn't move around so much because I was tethered to that, and kept getting tangled up in the tubes.
maybe it would be worth finding a pregnancy yoga class and discussing with the teacher about positions/exercises you could use where your mobility might be restricted.
Oh my god, that must have been terrifying for you Bike!
Tbh I've heard some pretty scary stories of vbac's and all the positive ones seem to be from women who've laboured properly before. I don't think my body really laboured properly with dd1 as I was never properly dialated, despite having ridiculous contractions for 20 hours while I waited for an emcs! (They didn't realise dd was breech until after 9 hours of nothing happening..)
It's weird how the recommendations differ depending on which NHS area you're in! Where I am, they will induce, just not using the hormone pessary as this can increase the risk of a uterine rupture more than the hormone drip. They would not want me to labour too long and would probably suggest a c section at that point. I think being consultant led is inevitable, but the extent of monitoring should be negotiable. I had continual monitoring last time, but was mobile throughout within the range of the wires connecting me to the monitor.
I had a vbac 2 1/2 years after having an El/cs for breech baby. The consultant told me lots of things I wasn't "allowed" to do. So I went to the birthing centre at 32 weeks and just rang the buzzer and went in for a chat. It turned out I could use the birthing centre. I signed myself off consultant care and only saw the birthing centre midwives after that. I went 11 days over, had a sweep which started rumbles, then had ds at 14 days over in the birth centre with no pain relief. 5 hour labour, used the pool (another vbac no no according to the consultant), absolutely no monitoring, not even any internal examinations to check how far dilated, enormous baby. So it can be done. You have to go with your convictions, weigh up the perceived risks, and find a sympathetic midwife. Don't go into hospital too early when you go into labour, as the clock does start ticking with a vbac. The birth centre midwives let me pace round the room instead of admitting me, that way I wasn't "checked in" and the timing hadn't seen started. Have you looked into OFP - optimal fetal positioning? It shows you how to watch your posture etc to try to get baby into the best head down position. I did it religiously in my 2nd pregnancy, I was determined I wasn't having another breech baby. Good luck x
Please don't make a decision based on other people's stories on an internet forum. What you have been offered is a safe, standard procedure. The consultant isn't deliberately being restrictive or difficult by advising against certain things, they are trying to manage a significant risk in the safest way possible.
I had a vbac. Different hospitals have slightly different policies. Mine would have allowed induction although I would have refused it due to increased risks. I also laboured for 12 hours - they wouldn't even let me into the hospital until I'd been in labour for about 9 hours, which I was surprised by as I was 6cm dilated by the time I got there and ready to push within an hour. I guess maybe they only count the 6 hours as being in active labour.
I think you probably wouldn't be encouraged to use the midwife-led unit. Some hospitals do have monitors that can be used in pools though, which you could ask about? I had continuous monitoring with the bands and like PP, I wasn't completely restricted and could get into different positions etc.
Does your hospital have a specialist VBAC midwife you could discuss your concerns with?
Don't worry, I'm probably more likely to err on the side of caution than most people... part of me thinks I may as well opt for a section as I'll probably end up with one anyway. Might be a bit pessimistic of me but for some reason I'm just sort of expecting it to go that way.
I'm not one of those who desperately wants to experience natural birth, I just want to do what's best for the baby and me.
X post! Will ask about vbac midwife too, thanks
If you're late you can ask for a balloon in the cervix induction rather than syntocinon. I was allowed to labour for ages (with monitoring) but otherwise what you've described sounds like my experience. Also, if this is going to be your last child id go for another section tbh.
I was told only 6 hours labour - but in practice it was 20+ as they didn't the staff. I wasn't constantly monitored. Don 't think I'd have got a water birth but not sure it was forbidden. I only got an epidural when I asked.
They might have been less happy with a midwife unit distant from the Hospital. And strongly advised against home birth.
I'm not too fussed about being in the consultant led unit, it Is the same hospital, just a different floor so I expect it to be largely the same as the mlu, just with more monitoring.
The thing that bothers me the most is the prospect of going through all the effort to try for natural then ending up with a more stressful section anyway...
That's the reason I didn't go for a VBAC, OP. I had continuous monitoring in my first labour and it was vile, I literally was not allowed to move off my left side and felt like my back was breaking. It wasn't a case of 'well the medical staff can't make you do anything' - that monitoring was very necessary for the sake of my son but it was fucking awful for me. I ended up with a very scary EMCS anyway. So went for an EMCS with my second and it was lovely. Couldn't face all that horrible uncertainty again.
I'm 27 weeks and been told by consultant they really don't want to induce or let me go given my labour with DD which resulted in an EMCS. He said really they wouldn't be happy to let me go over four hours of labour unless things were really progressing.
It's tough because whilst I'd like a VBAC for the recovery I'm too scared that things will go wrong again and I feel it's a case of better the devil you know. I know how tough a section recovery is and hope that this time will be better without the 30 hours of labour before and the infection I developed in labour wiping me out for weeks! You don't sound massively bothered either though?
Hi OP. I am 38 weeks, in a similar situation to you. However, my hospital is very pro vbac and have already agreed to wireless monitoring, a relaxed birth etc. You don't have to be strapped to the bed and they cannot force you to accept all the restrictions (e.g. 6 hours labour - when a normal one is generally much longer). There is some truth in the saying that "it's not you body's failure to progress, but your doctors failure to wait" - so unless signs of fetal distress occur, you could ask to go for longer. I would also read up on the latest research regarding scar rupture as the risks (when properly managed) are low - my vbac midwife quoted 0.5 %.
I opted for a vbac with ds2 3 months ago.
Ds1 was emcs for undiagnosed breech. I was 7cm on arrival at hospital and ready to push by the time i got to theatre aftwr about 9 hours of labour.
Ds2 i asked for a late scan to check position as i didn't want a repeat but otherwise wanted vbac for faster recovery and i did feel fairly confident i could manage with a baby the right way round. I was told i'd need to head into hospital as soon as contracting regularly and would be on continuous monitoring. My hospital don't have wireless monitors unfortunately and i don't think i managed to move much but that was partly me being lazy and partly difficulties with picking up the heart rate which was showing distress. I ended up having to push on my back and then ventouse because of the distress. I went from waters breaking to delivery in less than 5 hours.
Although it all sounds a bit grim on paper i found it a very positive experience compared to ds1 and the recovery was much much easier so it was the right decision for me. I'd have been ok with an emcs if it came to it. Part of me wants to have dc3 just to try and have a straightforward delivery though!
Forgot to mention inductions! I was told they would do a sweep on due date and try to break waters if over (i didn't get that far but think they would have let me go 12 days as usual) but no hormone drips. I guess this is where the limits on length of labour are coming from as they won't want to use a drip to speed things up, but this was mever mentioned to me.
I guess I'm just going to have to stick with my original thought and make my decision when we find out which way around baby is.
Tbh I am quite scared of the idea of childbirth this time round, just because of how wrong it went last time! So that's probably why I'm coming across as not too bothered about the idea of having another CS. Like Anna said, I feel a bit like it might be better the devil you know. But then again I'm fully aware of the things that can go wrong with a section as well!
I think I'm waiting to see which way around the baby is partly because, if it was breech, it'd make the decision for me. I'm indecisive at the best of times and this is probably one of the hardest decisions ever!
As others have said its all dependant on the hospital and perceived risk etc... I was told no induction for vbac but they actually then did induce me at 34 weeks... With a hormone drip which I've heard is a massive no no for vbac but they didn't seem bothered
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