VBAC vs Elective C-Section - Totally confused & FED UP(15 Posts)
Apologies in advance, as this is bound to be a long one.
I am feeling so utterly confused and pissed off with it all today and could dearly do with the advice and support of some wise MN-ers.
First birth was 3.5 years ago. Straightforward pregnancy with the exception of late-onset but quite severe SPD. Pushy midwives gave me two sweeps early on (one on my due date and one at 40+5), then super-pushy hospital doctor insisted on me coming in for induction at 41+3 (which turned into 41+5 because of lack of beds!). 4 doses of prostin pessaries and 4 days of me languishing on my back, hooked up for continuous foetal monitoring, had no effect (perhaps unsurprisingly?). Horrible, bullying doctors told me I 'had' to have a c-section at 42+2 and I did (I know now I didn't 'have' to do anything). Straightforward delivery, big and beautifully healthy baby (10 lbs 2 oz) born. My whole experience in London NHS hospital hideous. Very poor ante-natal and post-natal care, some of which was dangerously negligent. Struggled quite badly after the birth, slow recovery in some respects, never got on well with BF-ing, and suffered with full blown PND for a while.
Fast forward to now. I'm 28 weeks pregnant with no.2.
As soon as I found out I was pregnant I did a bit of research into hospitals (couldn't face going back to same one) and VBAC. Chose another big London NHS hospital, but one which I had been led to believe was supportive of VBAC. Had my heart set on VBAC from the start - mainly because of slow recovery after section, and because I felt there was no real reason for me not to attempt it.
At my booking in appoitnemnt I had a long chat with a fantastic, supportive midwife who helped me to 'debrief' my last birth, was supportive of the whole VBAC thing and reassured me that I would be able to stay mobile during this birth in order to give me the best chance of labouring naturally, and that if I went overdue again this time they wouldn't push me into coming in too soon and that it would be 'up to me' to decide, on the basis of all the information available, when would be the right time to go for a section if nothing was happening (as they don't induce with VBACs). I've been feeling pretty positive about the whole thing since then. Of course, this being London and the NHS, I haven't seen the same midwife or doctor twice, but all of those I have seen have seemed pretty supportive of VBAC and I have been trundling along through this pregnancy feeling Ok about it.
Then yesterday. Had an appointment with a doctor at the hospital to discuss the birth (their idea, not mine). I prepapared by doing lots of research into VBAC, and also had some questions for the doctor, who turned out to be a very young looking guy (very nice young man, but slightly off putting, him being a man and so young). Anyway...first of all I was told I would 'have to have continuous foetal monitoring' and that 'if he was honest, there wouldn't be much of a chance for me to be mobile'. I pressed him what 'have to' meant, and he said it was hospital policy and that 'a few women are adamant they won't have it, but they are ignoring the risks in my opinion, and would have to sign waiver forms to say they understand that risk'. OK. Pushed him on the fact that correlation between CFM and better outcomes not established. He pretty much admitted it, but said 'If we didn't do CFM on VBAC-ers, most would be fine and a small percentage would die/their babies would die. An that percentage would be greater than women who hadn't had previous c-sections. So there is a risk'. Right Great start. Made to feel really jumpy at the first hurdle. He also pretty much agreed that without being mobile, I had less of a chance of a successful VBAC, but that weighing up the risks, CFm was the much more sensible option. So...moved on to talking about other stuff that might make the birth more likely to happen straightforwardly. can I use water? 'NO'. What, not even a bath? 'Not once you are hooked up to the CFM, NO.' Great. So what will happen if I go overdue? 'You will need to have a sweep or two from 40 weeks + and we would bring you in for a section at 41 weeks.' I would need to? (When pushed) 'Ok, it would be up to you, but we would strongly reccommend it'. OK. He then went on to say my chances were 'about 50/50' maybe slightly less because I had never laboured at all in my first pregnancy. He then smiled patronisingly at me and said 'Look, it;s worth a shot, eh?'
So - that is the support I am going to get with a VBAC.
I am just so hacked off. On the way home I thought, 'OK, so I could go and get a doula or independent midwife at vast expense, then argue my points again at my 34 week appointment and then have to argue them constantly (probably) during the birth with a load of unsupportive, constantly changing shift staff.' But have I got the fight left in me to do this? To have to fight for a shot at letting my body do what it's supposed to do, and to have to put up with the constant scare mongering and conflicting information manipulated by hospital staff to suit their own agendas? Arghhhhhh. I am just so tired of it already and I haven't had a single contraction.
Started to think maybe I should just go for a section. It would cut out all the mental stress (and distress), although dreading the physical recovery afterwards and feel sad that nobody except me is even vaguely positive about VBAC in reality.
Sorry to rant on and on. can anybody help me clarify things in my mind? Does anyone else know what I'm going through? I know it's not a huge drama or anything, but to me it is all consuming at the moment.
MrsMattie, I'm in exactly the same place as you are at the minute, and I'd just like to say, that it is a huge drama and you're allowed to feel this way
this thread is great; lots of advice and support, including links to the NICE guidelines and the Royal College of Obs and Gynae green top guide on VBAC. There are also links to some good reading material as well.
At the end of the day, they cannot make you do anything; even the CS at 41 weeks (I have been given the same advice btw). You need to find out whether the consultant in charge of you is pro or anti or ambivalent to VBAC and actually meet with him/her to discuss options. And you are perfectly entitled to change consultant to one who is supportive.
I've also had the CFM chat from my registrar, but I'm arming myself for that argument at my 36 week appointment.
I have gone down the doula route and think it will be £500 well spent for getting the birth that I want, or, if I do end up having a section for whatever reason, that she is there to interpret the medical jargon and help us make the best decision given the circumstances.
I'm not surprised you are stressed.
You wanted a VBAC before - is it only the stress that is making you think a CS might be the way forwards?
If so, I think you should seriously consider hiring a private midwife. I've heard that some will work for a reduced fee on occasion if money is an issue. She will be able to fight these battles for you leaving you free to concentrate on yourself. Having a private midwife might also help you to feel safe labouring at home for longer (therefore staying mobile or in the bath if you want and increasing your chances of a successful VBAC!)
and the risks that are involved are miniscule, but I'm sure he didn't quantify those risks to you.
this sort of bullying tactic is bloody annoying.
I was told of the risk of uterine rupture being greater, but that is something like only 0.5% greater than in a woman who hasn't had a previous CS and that the risk of cord prolapse in a normay pregnancy is greater then the rupture risk, but they don't go on about cord prolapse and deliver babies by section ahead of full term just in case of that do they?
keep this bumped for lulumama, VictorianSqualor, FAQ, DaisySteiner and a host of others who have either had, or are very knowledgeable about VBAC.
Even if you could hire a doula for a few hours to come with you to your next appointment to help argue your case. Marslady and hertsnessex are both in your part of the country
and here's a link to my own recent wobble thread. You might find it helpful as well
MrsMattie, I have had 2VBACs, and am very sorry to hear of your experiences. Almost all the staff at my hospital were supportive of VBAC and also, I was induced for my third birth (for good medical reasons not connected to my previous section). Regarding CFM, there are now telemetric systems which are basically wireless CFM systems so you can maintain your mobility. These can also be used in water, so would it be worth enquiring about this at your hospital? The systems are fairly new but surely a big teaching hospital would have one (mine did, though I did not use it)?
I'm not for a moment suggesting that you ignore what the doctor said, but .... what happens in practice isn't necessarily what you might have been told beforehand.
My vbac 4 years ago I had the weird combination of a really negative community midwife and a really positive consultant. As it turned out the community mw was completely wrong in every single thing she told me about having a vbac. I did NOT have continuous monitoring - I did NOT give birth flat on my back - and I was NOT put under time pressure to deliver. The hospital mws were fantastic and supportive and I can't praise them highly enough. And the consultant who I saw before said I had a fantastic chance of having a vbac - and turned out to be right. Don't let the attitude of one individual put you off.
I found with the community mw the best thing to do was to say "thank you for your advice, I'll think about my decision" with the emphasis on MY. I wish you all the best.
Hi MrsMattie. I was kind of in the opposite situation to you. With my first pregnancy, I was induced due to obstetric cholestasis. After 3 miserable days, DD got stuck after I was fully dilated and I ended up with a CS, narrowly missing being cut for a ventouse which would have failed.
With DS, I knew I had a high chance of getting OC again, which meant a definite section as they would not induce me after a cs. My issue was what happened if I didn't. My experience was that I recovered very quickly from my first section and the only really horrific bit was when it all went wrong at the end of my labour and it took hours to get the section. I really wanted to avoid the situation where a VBAC became an emergency section and so I wanted an elective section.
Like you, the MWs were supportive but when I had my consultant appointment they refused and said they would not approve a cs unless there was a reason and that I would have to try a VBAC. That is the policy in my hospital. Eventually, after 3 appointments and lots of arguing, a supportive registrar found a medical reason and I did get my elective signed off, but I found the whole process really stressful.
I think my point is that the hospital will push its own policy on you and use evidence to back it up, even where there is evidence to the contrary. I read an article on here which said that mothers have to live with the decision and so should be supported in making the decision which they believe is right for them and their child. A doula may well be worth it to have someone to support you and argue your corner.
I really hope that things get better, I know how stressful it is but I did get listened to eventually so hopefully you will too.
Thank you all so much for your replies. I'm feeling tired and tearful at the moment, but will come back when I am in a more rational mood and respond. Thank you, again! xx
I am supporting an imminent WBA2C in an MLU, signed off by cons without batting an eyelid. Gem of a guy!
I'd recoomend contacting your HoM and if she is still unsupportive then contact AIMS.
However, IME, HoM are far more supportive and proactive than cons as they are experts in normal childbirth after all. Cons views are skewed because they deal with the abnormal. Remember you have more than 99% chance of not rupturing, especially if you do not allow them to use induction drugs on you.
Remember too, that you've got similar chances of cord prolapse or of needing a post pregnancy hysterectomy during an elCS, Puts it in perspective?
Back! Sorry for delay. Mulling things over in my mind for the past few days and have had discussions with my DH (and my mum, bless her!)
Thanks to all of you who have posted support, your own experiences, links etc so far. It all helps more than you can know to know that others have been through it / are going through it / can relate!
I had a long conversation with my DH the other night and he is supportive of whatever I decide to do, but after seeing my slow recovery from a section last time, he wants me to be absolutely sure before committing to an elective so early on. He has said he will happily pay for a doula if that's what I feel we need (still undecided about that one...will post more on that later).
Anyway, have decided to broach the whole subject again with my lovely, supportive community midwife at my 31 week appointment, then go in all guns blazing at my 34 week appt with consultant and say I am not having CFM and I want to be able to mobilise and use water and that's that. If they can't accommodate, I'll go elsewhere (where? Argh! Better start looking into that...). Have also started to formulate a bit of a plan to stay at home as long as possible if (hopefully) I go into spontaneous labour - going to get some hypnobirthing CDs to try to help with that.
Have got loads more questions for all you clever, brave VBAC-ers out there but have to take DS to fotie clas now, so back later.
MrsMattie what london hospital are you ? At Kings they seem to be very pro VBAC.
UCH. Thing is , I was told they were really supportive of VBAC, so am dubious of all hospitals now
I hope this isn't too late for you.
YOu need to stand your ground. I had an emergency CS with my first as she got stuck and the anaestetic failed, so i felt them operating. Was given all sorts of narcotics and can't remember much about the birth. Drugs made me shake so much that i ended up with a huge, jagged scar. Then had nightmare in postnatal where they refused to give me painkillers as i was breastfeeding, and ended up with a uterine infection as well.
Hence, absolutely petrified of having a CS again.
When pregnant for 2nd time, as well as changing hospital, I went armed with all the VBAC info and stated that I wanted to have a trial of labour, wanted a waterbirth and not continous monitoring. Consultant was prepared to play along on the trial of labour but not the rest. So I arranged an appointment with the Head Midwife, who handed me heaps of info stating that VBAC was more risky and hospital policy was continous monitoring. Politely said that I understood hospital policy - however, it was my body and my birth and that i would not do anything to endanger either life. She agreed that as long as I had 30 mins continuous monitoring on arrival in delivery suite, I could then have intermittent monitoring / waterbirth if all was well.
However, I made her write it in my notes as the instant response of anyone was that continuous monitoring was the policy.
At the end of the day, after an 8 day labour with little progress, I ended up with another emergency section but really felt that throughout my labour, all the staff had tried their hardest to help me suceed in VBAC - it just wasn't meant to be.
But so completely different to the first time - this time, i was so scared but the anaestatist was great and so reassuring. Took time to ensure that i was happy and the surgeon was wonderful as well. He took away the ugly scar and made a really neat one in its place.
Am now expecting 3rd and know it will be an elective. DH not prepared to go through another 8 day senario and the doctors think that I have damaged pelvis due to spinal injury when younger.
Not in London but had 2nd birth at the Rosie in Cambridge and as i said, they really did their best to make it a positive experience. Was out of hospital after 36 hours and recovered so quickly.
I hope that you make the right decision for you and that you get the support you need whatever you decide.
If you're at UCH is Homerton also a realistic option in terms of distance? I had a VBAC there in May this year and was totally supported by great staff. I did post about my experiences on here at the time, but if you'd like to hear more about specific doctors etc feel free to CAT me. I really recommend them. Homerton also has a pool.
I also recommend an independent midwife, I had one as well (couldn't do home birth in the end, as baby a month premature.) But a doula may very well provide just the support you need. Marslady I believe will work in your area and also likes Homerton!! You could try putting a shout out for her...
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