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VBAC - a positive and informative chat with consultant MW today - lots of info for those wanting to give it a go.

(10 Posts)
hobnob57 Tue 13-Oct-09 15:20:56

I just had my 36 week appointment with the consultant midwife at the hospital, and it was a really positive experience. I?m so glad I raised my initial concerns about labour with my community midwife and she initiated this appointment for me. I learned loads as she was really good at explaining reasons for/against things form an evidence-based point of view. I?ll outline the things I learned in this post, in case they are of any use to others hoping for VBACs (or even normal vaginal births).

THINGS I DIDN'T KNOW (SOME RANDOM)
That scar rupture occurs in 2-7 women in 1000 (more than I thought) but that there are different degrees to tearing, and few of these are dangerous to mum & baby.

That the reasons for induction post-term should be explained to you but (as in my case) often aren't so you feel that you are ?called in? for an induction. Basically the risk of stillbirth 37-40 wks is 3 in 1000, and 40-42 weeks is 6 in 1000 so by inducing you before 42 weeks they are cutting the risk by half. Normally such small numbers wouldn't be thought of as particularly risky but given the catastrophic consequences, it?s thought to be worth intervening.

That you can be induced after a cs (if that's what you wish).

That if you were post dates for pg#1 and there has been no change of partner, the overwhelming odds are that you will be post dates again.

That a water birth is possible after a cs, without continuous monitoring. Whilst at my hospital water births are deemed to be very safe, there isn't enough evidence at present from enough water births to advise on any adverse risks (i.e. severe health implications for baby or even death) so they request that you do your homework and decide for yourself what you think. I hadn't considered that it might not be safe.

That at our hospital, no-one has ever gone beyond 44 weeks without going into labour naturally (and that was before dating scans were routine so gestation is under question there).

They have reviewed their advised 'times' for each stage of labour to be more in line with national statistics, so it has gone from 1cm dilation/hour to 0.5 cm. Again, these are only guidelines and so long as there are no contraindicatory signs, then they should be happy to leave you be if you are not progressing at this rate.

That there are currently trials underway into the effectiveness of perineal massage, and early results are suggesting that it does actually help to reduce tearing. 10 mins a day, apparently hmm.

THINGS I DID KNOW, BUT HADN'T THOUGHT ABOUT PROPERLY
That the hospital's usual policy in dealing with VBACs is based on current evidence of risk re. scar rupture, i.e. CFM, being on labour ward rather than the midwife unit, etc. HOWEVER, as individuals we are empowered to do things just as we wish and the team can only advise if there are any risks associated with our decisions (it didn?t feel that way to me last time, but then you tend to trust what a person in uniform is asking telling you).

WHAT THE PLAN IS
We spoke at length about my previous birth, and about what I wanted this time and why. We collectively came to a decision which the consultant MW will type up for me to check, and it will be put in my hospital notes and hand-held notes and a copy sent to my community midwife for all to see so that no-one panics or gets shirty about me not following protocol. The peace of mind knowing that that will be the case is wonderful. So:
IF I GO INTO LABOUR MYSELF
I phone the MW unit and explain I've started labour and that I'd like to come to the MW unit when I?m ready (cue note-checking for why I'm not going to labour ward).
They advise me of when to come in (same as for normal labours, no hurrying in unnecessarily)
I have access to all the nice things like birth balls and the pool
I won't have a canula fitted since lots of women find it a real distraction and my veins looked huge to her, so it's unlikely to be a problem putting one in if necessary.
I have intermittent monitoring using a sonicaid
I can remain upright and active
I can request an epidural if necessary (out of pool and on labour ward with CFM for this, as normal, but also used to check for signs of rupture due to pain relief)
At ANY stage (bar when it's physically too late) I can change my mind and request a CS.
They advise me if they feel there is any cause for concern. Key thing to look for is pain in scar between contractions (obvious, but I hadn't thought about that).

IF I GO OVER DATES
I get a sweep at 40 and 41 weeks
I meet again with consultant midwife at 41 weeks and review my options, but at the moment they stand as:
I can request and induction
I can request a CS
I can request the placental blood flow and amniotic fluid to be scanned twice a week. If all continues to be well, I wait for labour. If there are any concerns, I have a CS.

So there we have it in writing! I can rest a bit easier now and know that I won't have to fight against folk or get forced into things when I go in. I'm not sure that I would have done anyway, but that's definitely what it felt like last time.

I hope this is useful for others to know, who may feel like they are 'up against it'. There should be SOMEONE in the hospital who is willing to listen to you!

hobnob57 Tue 13-Oct-09 15:39:26

Another statistic to add:
CFM is only 50% effective at picking up scar ruptures, so to be effective needs to be used with other indicators such as maternal blood pressure and pulse readings. So by removing CFM from the equation, scar rupture detection rates don't go down by that much.

Pinkjenny Tue 13-Oct-09 15:48:35

hobnob57 - that is really interesting. I have opted for an ELCS this time round, but I am seriously wobbling about recovery now. This has given me some food for thought. smile

stillstanding Tue 13-Oct-09 15:54:17

That is incredibly interesting, hobnob. I am hoping for VBAC this time round which my MW/consultant fully supports but they say I have to have a scan at 36 weeks to work out how big the baby is/how it is lying before they can fully assess the risks. Will keep your post so I have all the info for then! Thank you for going to the trouble of typing it up.

TheBlairSnitchProject Tue 13-Oct-09 16:14:26

I always thought I's love a VBAC but 2 midwives have now advised me independantly that in thier opinions, DS was just too big for me to deliver naturally and that I will run into all the same issues again this time.

As DS was very poorly during labour and immediately after birth, I don't want to risk it with DD so she'll be delivered by ELCS.

Thanks for the info though - it was very interesting.

<<Apologies for the hi-jack - Pinkjenny - I still have that VBAC book. Should I send it back to you? To the original owner? (forgtten who that was blush ) or pass it on again??>>

Pinkjenny Tue 13-Oct-09 16:17:39

Hi BlairSnitch - it's Charley's, perhaps post on the Dec 09 thread and see what she prefers?

TheBlairSnitchProject Tue 13-Oct-09 16:19:14

Good idea. Thanks Pink

mitfordsisters Thu 15-Oct-09 12:50:08

Thanks for sharing this Hobnob - you are a love! This is really useful.

WorkingStudentMummy Thu 15-Oct-09 13:12:15

Thanks Hobnob - really useful into there - went in for a birth discussion meeting yesterday afternoon after really awful experience first time round. No 2 due in January and I just can't get my head around it at all...

Just a couple of questions (yes, I'm new here!) whats VBAC - think i've got the vaginal birth bit and i'm presuming the C is c-section, but would someone confirm?

CFM??

Lastly, can anyone advise me of alternative pain relief? I've heard that a herbologist (with docs backing) can give me a herbal sedative, just to take the edge off anxiety and without affect Bubs at all, but am finding this kind of info quite hard to get me paws on.

Many thanks everyone!

hobnob57 Thu 15-Oct-09 14:29:11

working VBAC is vaginal birth after caesarian.

CFM - continuous foetal monitoring.

Not sure about alternative pain relief - from what I've heard hypnotherapy can be effective for some, others get by using homoepathic kits (but do get a consultation beforehand). I used TENS for a long time last time during my induction and it worked really well for me, but it was limited in how much relief it gave for full oxytocin contractions. A nice distraction though.

Good luck!

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