VBAC - consultant meeting today - another planned so need advice please

[sazlocks]

Last time had planned a home water birth using hypnobirthing and ended with a c section 4 days after waters broke. All fine but not what we planned !
Now 22 weeks and met with the consultant today. I am pretty low risk - in fact the only risk I have at the mo is my previous c section. I would like to have a water birth but the consultant was concerned as she said that was normally for low risk women, would mean I would be on a MLU ( down the corridor from the CLU) and that they wouldn't be able to perform continous fetal monitoring as I would be in water. I have to meet with a senior midwife to see if they are happy to support me to do this so any advice would be welcome please.
Also I am pretty clear that I would rather have another c section than an instrumental delivery - am I mad and would I be better being open minded about an instrumental delivery ?
I have also said that I would not want to be induced again.
Any advice gratefully recieved so I can be better prepared before I see the consultnat again.
thanks

[Toady]

Of course you do realize the decision is yours to make and not the consultants! If it were me I would plan another home water birth as the risk of a uterine rupture is very low (0.35%). Tbh you are less likely to achieve a VBAC in a hospital unless you can be very firm about what you want. My first vbac attempt was destined to fail as I was flat on my back, continuously monitored, timed to dilate at 1cm an hour etc.

My vbac2 suceeded because I stayed at home as long as possible when labouring and he arrived in hospital before they could get the scalpel out again.

Sorry sound a bit 'direct' in what I am saying, am a bit tired tonight.

Of course what is right for me isn't necessarily right for you but it is YOUR decision how you want to birth whether that be in a pool or up a tree .

Will add you to my watch list and catch up with you tomorrow.

[ReneRusso]

Having experienced both, I completely agree that a c-section would be preferable to an instrumental delivery.
Also, I have a feeling it is generally not good practice to induce/augment if you have had a c-section. They would want labour to progress naturally so as not to put a strain on your scar.
Why would continuous fetal monitoring be necessary? Surely nothing but a nuisance if you are trying to achieve a natural birth. Good luck and stick to your instincts.

[MrsHappy]

You sound pretty clued up to me.

I am 36 weeks and negotiating to go to the MLU for a VBAC in water. My experience of CFM from last time was being stuck (lying down - grrr) on a monitor which was checked about once an hour. On the MLU I will be monitored by an actual person every 15 minutes which actually seems like a higher standard of care to me!
My own view is that I do not want any sort of unnatural augmentation because of the inxcreased risks and my consultant is supportive of this.
Not sure about instrumental delivery - I reckon I would take a simple ventouse or forceps lift out but if it came to trying to turn this one with forceps like last time I would rather have a repeat CS.

My advice would be to talk through your preferences with the consultant midwife and see what she says. It really is your choice where and how you give birth, but obviously it is all better if you have supportive HCPs.

[sazlocks]

Thanks all this is really, really helpful feedback. The next step for me is to have a meeting with the senior midwife and put my questions to her to try and get support from that team to have a water birth.
Toady - thanks as you have helped me with my wobbles by reminding me that it is my choice at the end of the day.
Renerusso - your comments about an instrumental delivery are interesting and what my gut instinct tells me - I think I probably need to find out more as I am completely against the idea at present but I am guessing it might be preferable to having major surgery again !
mrshappy( good name by the way!) good luck with your plan - hope it all goes well and I totally agree with your point about supportive HCPs - although I want to have it my way I am also reluctant to try and proceed with a plan that the midwives would feel uncomfortable with - this is a sweeping statement but my experience of the cnsultant approach is that they tend to be a bit more risk averse and I will get more of a hearing from the midwives.
Any other views welcome

[Toady]

I think that is a good move seeing the senior midwife, after all from what I can gather midwifes are the experts in births, consultants are there for problems.

This is easier writing it down than doing it but my advice would be to tell the senior midwife how you intend to birth and that you require supportive staff who are comfortable and experienced with a water VBAC. You do not need continuos monitoring and you could have this done intermitently (sp?) as and if you require it. It is their duty to provide you with what you want and to make sure their staff are competent to support you.

I ended up seeing the senior midwife when I had my VBAC2 (2005) after the consultant had told me I was going to die and then stabbed my notes with his pen when i crossed out the date he put down for my elective caeserean even though I had repeatedly told him I was not having a caeserean. It really helped and she was lovely and really believed that most of us can birth our babies naturally with the right support but ultimately that we were given the correct information and facts and that we (the mums) made our own decisions.

[sazlocks]

Thanks for your advice - it has helped me clarify what I need to do next.

[Poppet45]

Not sure the medics are there to 'give us what we want' Toady, I reckon most MWs and doctors would say their job was to deliver babies safely and with the least risk of harm to mother and child. And sometimes that directly conflicts with a woman's origial preferences.
And I say that as a natural birth advocate who was lucky enough to just need a pool, some nice reflexology and paracetamol for the first 10 hours, but 19 hours later had to have an em-CS... so could have had a nice spinal all along in hindsight Still I'd do the labour again like a shot, if I could just be sure I'd not need another section.

[Toady]

Well that is what the head of midwifery said to me, that her job is to provide with us correct information, pros and cons etc but then ultimately it is our decision on what we want to do and it is their job to support us.

I can come over a bit abrupt sometimes, so apologies for that but I just think it is really important that we do realise it is our decision on how to birth our babies.