Top tips for VBAC discussion with Consultant

[bluesatinsash]

I have my 32 week scan/follow up meeting with Consultant in a couple of weeks and would be grateful for any points I should raise re: me going for a VBAC.

My DS (3) was an ECS after 36 hour labour and classed as 'failure to progress'. Requested a de-brief the next day and CS due to DS not fully engaging plus his head being at the wrong angle. I went into spontaneous labour and had a very empowering 12 hours when I first got to the labour room (having timed my contractions all day at home) sitting on the ball, going for walks, leaning over bed (I only sat on it when being examined) etc. Felt very natural and strong until it all went tits up at midwife change of shift when I was strapped to fetal monitor up on bed, epidural, drip etc. as not dilating enough... I only got to 6cm after the 36 hours.

So what I'm trying to ask is, how do I request NOT to be monitored continously, up on bed from word go, given a 'trial'? I'm not a martyr and if I need another CS then so beit but would love to give birth naturally, to feel what its like to want to push, see baby come out... Plus the recovery, not being able to pick up DS...

Any tips from successful VBACers welcome

[JemL]

I'm hoping for a VBAC (due Tuesday) and like you only got to 6cm...mine was an induced labour, and slowed right down when I got moved to the labour ward from the midwife led unit as they weren't happy with my progress, strapped to bed on monitor and drip, could no longer cope with the pain, etc, ended up em-cs.

I saw the consultant to discuss plans for a VBAC but to be honest all that she did was agree that I would have one. SHe was not at all interested in discussing a birth plan, particularly the ways in which I wanted my birth to be managed differently from the lost of protocol I had been given by my midwife which they use for VBAC's (nil by mouth, continuous monitoring, not using water, cannula inserted, etc) THis is not to say she wasn't helpful, she referred me instead to a consultant midwife, who agreed that it was reasonable for me to deviate from their standard protocol and, crucially, put it all in writing for me, and added it to my notes. THis means I feel more confident about being assertive if I feel that things are not going as I would like, or if a particular midwife is not supportive (even the consultant midwife said that this might be the case, as some are unhappy with deviating from standard procedure when it comes to VBAC> My main piece of advice would be to get the consultant, if they agree to a birth plan with you, is to put it in writing - it will be much more useful when it comes to labour, and can help avoid lots of disagreement and negotiating, at a time you really don't need it!!

Good luck!!

[bluesatinsash]

Thanls JemL - you must post here afterwards to give me inspiration!!

I think the name of the game is being assertive and not just following their orders . Thanks for tips re: consultant writing things in your notes.

Nil by mouth - WTF ?? That's like they're expecting us to fail...

I must summon up my inner Diva for D-day .

Good Luck to you too!

[bluesatinsash]

bump

[MrsHappy]

I'm hoping for a VBAC too in the next few weeks (my first baby having got stuck).

My consultant seems fairly supportive and my intention is to go to the midwife-led birth centre so as to have as few interventions as possible (they don't do CFM or canulas etc). But if for some reason that does not happen I will be operating a very zen line in passive resistance (which I have learned from my 3 year old!):

Dr: Mrs H, we need you to lie down and wear this monitor

Me (bouncing on ball): no thank you [saintly smile]

Dr: Mrs H, stop eating that food!

Me (stuffing in cereal bar): no thank you [crumbs falling out of mouth].

Since I am seeing the consultant next week I am going to ask her to put in my notes that I want no unnecessary interventions and to put that I am ok to use water for pain relief. I reckon being in a pool might get me out of a lot of faffing.

Good luck with your meeting - I am sure requests such as yours must be becoming really common, so hopefully they'll be expecting it!

[barmybinky]

Tips for seeing the cons IF cons is a waste of space (not all of them are) and IF cons can be bothered to talk about mere matters of the actual birth (as JemL seems to have discovered, some of them don't!):
If they say there is anything that you HAVE to do ask why. If it is 'policy' it is AKA Bullshit. If they have a reason ask for the medical studies they have to support this viewpoint.
ie: CFM has not been shown to provide better outcomes than IFM... perhaps because a MW actually has to LOOK at the labouring woman when they do it intermitently?!

Mainly stay strong and understand right now that any and all decisions are down to you. The medics are there to advise and support NOT dictate (much as some of them like to think differently).

If you want to have a homebirth, you can. If you want to have a waterbirth, you can. The thing is that whilst they cannot force you to do something against your better judgement they are not obliged to allow you to use their stuff ie: birthpool or midwife led unit etc. Though these are more enlightened times than when I had my VBAC the support varies greatly depending on your postcode!

By way of inspiration my 1st labour was almost identical to yours (going on the outline you gave), stuck at 6cm forever despite 32 hours of full on contractions, knackered mum - cs please. For some reason I had my mind set on 24 hours being a 'long labour' (WHY??!? no idea!)
2nd time, I cancelled my 30 somthing week cons appointment as an unnecesary interruption to my week (remember you don't HAVE to go, it is an invitation!). This time I decided a week would be a long labour (!).... went into labour naturally and pushed my back to back baby out a mere 10 hours later, held her in my arms for skin to skin stright from my body and cried my bloody heart you! If I ever have another I'll be doing it at home. Trust your instincts and trust your body, you can do this. xxx

[mamasunshine]

Hi Bluesatinsash, sorry for such a long post! I agree with everything said so far especially getting anything you want agreed for on paper, either by consultant or head of midwifery. When is your app? The best thing you can do is get as much knowledge about VBAC as you possibly can, I think I researched it for my entire pregnancy (extreme!!) There's loads of websites with lots of stats on including the homebirth website (even if not planning homebirth as it goes into induction, CFM etc), just google. Also books esp. 'Vaginal Birth After Caesarean' by Helen Churchill and Wendy Savage. Very small handbook with all latest research written by obs and gynae Dr. Also found Ina May's book on spiritual midwifery very motivating with lots of great tips for natural birthing (sometimes a little hippy!) but you can take out the bits that you want to. I found knowledge is 'power' esp when infront of consultant. Don't see registrar as they just scare you by not knowing anything about VBAC (in my experience).

My story briefly (will try!): Ds1 born 34 wks ECS due to pre-eclampsia, small baby (birthweight 3lb6), his heart rate dropping so rushed me in. Hated the whole experience, the pain and healing was awful (obvioulsy everyone's different). Baby is SCUBU for 4 and 1/2 wks. The c section saved our lives so I know we're very lucky to have had such good treatment. However, with Ds2 as long as good pregnancy i.e. no P.E.T then was determined to have VBAC.

After researching I decided that a homebirth would be best for me as long as health of baby remained good and we only live 5 mins from hospital incase of emergency. Went to consultant with all the facts and spoke to my midwife, as I was 'fully informed' of risks etc consultant signed my notes agreeing to homebirth VBAC!!! When i got to 39 wks my Bp shot up so was admitted to hospital (gutted). they put me on meds to bring it down, and kept doing bloods, checking urine etc incase pre-eclampsia. The registrars were frankly bullies whilst I was in, I had awful comments made to me along the lines of how could i be so irresponible etc to have homebirth, with next comment being "we will induce by 40 wks if no labour had started"!!! WTF? I tried explaining that there was increased chance of rupture if induction but there was no reasoning. So as soon as consultant was back in on the Mon as no registrar would sign me out, he had a chat with me about homebirth whilst on meds maybe not great? But I was thinking surely as long as its just high Bp but under control due to meds then nothing had changed. So I was 'allowed' to go home for the bith. As soon as i got out I went to try reflexolgy for naturally inducing labour (I was 40+3). Walked out of relexologist and contractions started regularly every 10 mins but not too painful!!!

Had long back labour at home (2 days and nights of contractions), used bath, essential oils, calming music, birth ball, found being on all four's helpful for pain, dh massaged back (back pain was AGONY). I always had 2 midwives and 1 student as it was a homebirth. I did have a canula just taped off in hand just to keep midwife happy which wasn't a prob for me at all. Had time allowed to labour cut by half that of a 'normal' labour due to VBAC, but I didn't progress from 4/5cms for 8 hrs! So they made me start walking up and down the stairs and standing upright during contrations (horrible!!) to try and get gravity to help with opening cervix! It worked eventually after 17 and 1/2 hrs active labour (had time restrictions lengthened a bit, head of midwifery gave permission via phone) I was fully dilated. But by now my contractions had practically stopped and i was exhausted all i wanted to do was sleep. Bearing in mind i was only allowed 2 hrs for pushing! So they let me sleep for 30mins, then woke me and made me walk around a bit then I had to start pushing with very weak contrations no more than 8/10 mins apart. baby was fine throughout labour, got to nearly 2 hrs and a midwife use accupressure on my legs to stimulate contractions, which did the job...somehow i don't know how but I managed to push him out v quiclky in the end as paramedics were walking up the stairs to take me to hospital (midwives had to call them to cover themselves). So pushing stage took me 1 hr 58mins

It was the most amazing experince ever giving birth (even though it wasn't 'ideal'), I would def do it that way again. And getting into you're own bed after with your new baby lying next to you is the best feeling in the world!! Also being able to walk around! Had DS2 6lb13. he's now 14wks and a thriving, relaxed very happy baby! I only have 15months between them and the second pregnancy and birth was definately my therapy to help me heal from my 1st experience, and it worked!

I would def reccomend a VBAC to anyone as long as thats the best and safest option for mother and baby

[mamasunshine]

Just to add i only had the tiniest tear, no stitch needed!

[bluesatinsash]

Thanks for your insiring stories barmybinky and mamasunshine and MrsHappy - like your path of passive resistance - just keep munching!

You are so right, so many Mum's just follow Consultant/Midwife 'opinion' not hard based facts. Had to wryly barmy about IFM involving midwife having to actually examine you from time to time .

Both your birth stories were fantastic and just show it can be done, even if its not a straight-forward VBAC either...

My appointment is on 28th of this month so I will be sending off for the two books you recommend and going in pleasent but steely eyed . Its my body, my baby - I am woman hear me ROAR!

[countrybump]

Hi there,

I had a VBAC last week, and I'm really shocked by some of the negative stories people have had in terms of support from medical professionals.

My expereince was a really positive one. My DS, now 3, was born by EMCS when I developed pre-eclampsia and his heart rate dropped. He spent 2 weeks in NICU. I was a little traumatised by the CS, and really didn't want another this time, but I also assumed that pre-eclampsia would return and I wouldn't have a choice!

But, I was really closely monitored throughout pregnancy, and all was fine all the way through, so when it came to talking to my consultant about a VBAC he was very supportive. He told me there would be some precautions, like being monitored, having a canula etc etc, but also said that there was a high chance of a successful VBAC, and recommend I attend a special VBAC clinic. I did attend, and it was a one-to-one chat with a midwife about how labour would be managed. At my hospital there are wireless monitors, so there is not need to be 'strapped to the bed', and they can be used in water as well, and you can leave your room and wander around the hospital.

So, come my due date and I go into labour naturally, and feeling confident that things are progressing I head to the hospital. I was only 1cm, so given a room, but told to walk around to keep things going, which I did. I also had a bath when the pain got stronger, and used the birthing ball. When I was examined later I was found to be 6cm, so in established labour and so had a canula put in and the monitor switched on, but I could still move around as I wanted to.

There were some worrying moment - the monitor picked up a few decelerations in the baby's heatbeat, and also her heart started racing, but things were progressing quickly. As I was only using gas and air I could feel where the pain was, and it wasn;t in my scar. After just 5 hours of 'active' labour my DD was born. Although, I did have a nasty tear as I pushed her out very quickly due to the monitors showing her heart slowing (which we think was actually the monitors loosing contact).

Looking back, I knew things were OK when the monitors said they weren't, and I knew things were still OK when I was pushing her out, as I could feel her moving, but I listened to the midwives and got her out quickly.

So, the constant monitoring might not have been a good thing for me BUT I would still have done everything exactly the same. I got my VBAC, albeit with a bad tear, and I have a healthy DD. I'd rather have things this way, with the monitoring and precautions playing their part in my birth story, than have refused monitoring and not picked up on a potential problem IFSWIM.

I really hope it goes well with your consultant and they are as supportive as mine was.

And - the midwife I had with me, who was the same one from the beginning of my labour right through to birth, had every belief that I was capable of having a VBAC, and was very supportive of me. She ensured my labour progressed rapidly by keeping me walking around or upright and she also gave me the faith I needed to not scream for an epidural!

[bluesatinsash]

Thanks for sharing countrybump - what a lovely birth story and wonderful midwife - can you send her up my way? Hope you're healing well and savouring your new DD.

Our health board does have a reputation for being supportive of VBACs but I do think it can so depend which midwife you get on the day which is unfortunate..

Off to Amazon to order my books .

[Toady]

bluesatinsash, Gina and Debbie on www.caesarean.org.uk/ have a lot of great advice and experience with VBAC, they gave me the confidence to have my VBAC2 and now am planning a home birth for my 4th.

If you go to frequently asked questions and then Can I have a VBAC if ....

Oh and my advice would be to refuse constant monitoring, not great when you are trying to labour.

Hope this helps

[bluesatinsash]

Thanks Toady will have a read through . Good Luck with your fourth DC and second VBAC - confidence and assertivness is the key me thinks...