VBAC, consultants and continuous monitoring - AGHHHH

[willum]

I had my first appointment with my new consultant today who told me that if I wanted a VBAC I would need to be continuously monitored - suprise suprise! When I told him that I did not want this and my research had shown that it was just as effective to use 15 min obs with a hand held machine he disagreed. He told me go to away and re-read my research (with the insinuation that I had read it incorectly) and to bring back my proof next time.

Has anyone ever won this battle or am I wasting my time trying? If you have won this one how did you do it?

[pie]

No experience, but can I just say how rude that consultant sounds!!

[WideWebWitch]

Willum, yes, I have won the battle of cfm but not in tandem with VBAC I'm afraid! I've just taken the Marjorie Tew book "Safer Childbirth" back to the library but I'm sure the study discrediting cfm is mentioned in detail in there. Perhaps you could try getting that? My library had to order it for me.

I was arguing that having what the consultant considered to be a smallish baby didn't mean I would need cfm (no growth retardation, just what he considered small, midwives didn't agree with him) and also that I didn't need cfm as I wanted a home birth (the consultant's words: "you can forget your home birth, you're going to need cfm with this one, it's very, very small" - great bedside manner that guy). I got my home birth, no cfm and ds was 7lb 1oz so he wasn't even right about him being abnormally small. What do your midwives think? Mine were fantastic and backed me all the way, as did my GP. So I'd suggest:

• Talking to your midwives and asking what they think re VBAC/CFM
  
• Finding the study
  
• Talking to your GP if she/he is sympathetic and you feel you could do with some additional medical support. Mine agreed with me and said she'd support me in my home birth decision which helped my morale if nothing else.
  
  Let us know how you get on. I'm sure lots of others will have good advice and experiences.

[willum]

He was one of those strange people who can say anything and still some how sound nice and caring, instead it sounded like I was the rude one!

[WideWebWitch]

Haven't waded through this lot but lots of studies here You probably need to find the most relevant/recent study and someone to help you interpret the results though(not being insulting, just that I would!)

[pie]

Had a liitle look around and found that, like you say, alot of research points to no reason for continous monitoring with VBAC as the only indicator, unless your previous section was because of fetal distress.

Here is some stuff and interesting enough it says this:

"Medical practitioners are required by law to seek the consent of a patient before any form of treatment or care is administered. Often, particularly when 'routine' procedures are used during labour and birth, consent tends to be assumed rather than sought, leaving the onus on the mother to refuse...Any treatment or care given following a mother's clear refusal or in fact given without the mother's consent, would constitute assault and the health practitioner concerned would be laying themselves open to legal action by the mother."

But whilst research seems to point one way, the Royal College of Obstetricians and Gynaecologists here . But if the risk is as low as 0.03% - 0.07% seems like they are just covering their arses rather than offering any overwhelming proof of necessary continual monitoring.

Also worth noting that their guidelines, which I assume you consultant follows state that:

"Women should have the same level of care and support regardless of the mode of monitoring"

Stick that in his face! Or you could just try putting your foot down as it were.

[pie]

Sorry, after that second link it should say that the Royal College list VBAC as one of the reasons for continual monitoring.

[SueW]

If you go to this site for caesareans and VBACs, you can email Debbie or Gina, both of whom should have up-to-date research that will help.

[mears]

Willum - I am so fed up of consultants and their attitudes to continuou monitoring and VBAC. Is there a midwife consultant at your unit - if so, contact her for help.
The advice you have had so far is spot on. Professionals can recommend continuous monitoring to you, but cannot force you to have it done. As a midwife I passionately believe that the best way to achieve a VBAC is to encourage mobility and as physiological a labour as possible. Women at our unit can use the pool and have a waterbirth as well. The only thing is they have to be vocal and actually request that otherwise they conform to the continuous monitoring route. You could speak to the senior midwife of the delivery suite about it - that is what used to happen at our unit. Now the consultant just writes to the senior midwife to let her know when a woman who is a previous C/S is requesting to use the midwifery unit. If you have no joy, then tell them that you will have a home birth if they don't facilitate your wishes. That should make them become a bit more accommodating Don't give up - it is YOUR BABY.

[willum]

Thanks every one I will print out the links to take with me next time.

Mears - like you said I think moving around is so important. I had continuous monitoring last time and I think that was a large part of the reason I ended up with a section.

The impresion I get is that he realises its my decision to refuse it, but he will do every thing he can to try to get me to accept it, including the big guilt trip. I said I want to use the birth pool and he has said I can but only for pain relief as I will have to get out so the scar can be monitored. In fact thinking about it his reasoning for the continuous monitoring was to monitor the scar - how does the machine monitor your scar?

[SofiaAmes]

willum, please search and find the earlier threads on VBAC. I described mine in detail several times. I must have had the same consultant as you....he was just so rude to me and completely dismissed the research I had done. Luckily I had a wonderful midwife (I was convinced she was Mears for a while as she sounds just like her).
I'd be happy to talk to you on the phone regarding my VBAC if you'd like. Just send me an email through mumsnet.

[willum]

SofiaAmes - I did read them a while ago but can't remember them, so I'll be printing it all out to go over again. Did you find that what the consultant said did not realy matter or did you have to convince the midwife as well? Thanks for your offer of talking it through with me, the idea of things ending up like they did last time scares the hell out of me!

[pupuce]

Mears correct me if I am wrong but the reason for constant monitoring is that if your scar does rupture your baby's heartbeat will change (dramatically).... there are other signs such as your symptoms...

1. pain !
   
2. your pulse!
   
3. the look of you generally.... believe me if you rupture you won't look hot !
   
   BTW- it is quite common to have uterine scar dehiscence which is a small opening in the scar - no big deal.... if it is bloodless it does not have a negative consequence to the mother or baby.
   
   I supported 2 women who went for VBACs and BOTH were not monitored constantly.... until the first opted for an epidural (and had a second section ;() and the second had syntocynon (at which point they "forced" the monitoring but she was close to giving birth) and did manage a vaginal birth

[aloha]

Willum, you are in control here, remember that. Your consultant is 'your' consultant - you pay his wages - he does what you want. he can't 'make' you do anything at all. He sounds, quite franky, an arrogant, rude sh*t, and he can stick his patronising manner up his... (ooh, too much wine, methinks!). All he can do is advise. He can't impose anything on you, maybe you should remind him of this. Personally, I loved my section and will be very, very forceful in demanding one again if there is a next time, but I'm a great believer in choice, particularly when it's women v arrogant consultants

[kaz33]

I was terribly concerned about continuous monitoring after having had my c-section last time. Luckily I did not have to lie down and the midwife was excellent at getting me moving and trying different positions. At one point she suggested I came off the monitor as the contractions had slowed down but I declined !!!

So maybe it wouldn't be that bad.

[mears]

You are correct pupuce.

[monkey]

Willum - he sounds so awful - I would hate to have to deal with someone like that - no chance of changing?

For what ir's worth, I had a vbac and the whole thing was treated like any 'normal' woman's delivery, ie no suggestion that a previous c-section should nec. be a prob, no suggestion that I shouldn't have a vbac, & certainly no suggestion of vbac. No chance of dh coming with you next ime? I know it sounds feeble, but sometimes men change thier tunes totally when dealing with another man. Sounds like he went into the wrong area of specialism! All the best

[willum]

Monkey Dh was there!

Found out yesterday that the midwife for my area is generaly thought of as a miserable cow. As she's just coming back from sick leave, chances are she will be even more miserable, so does not look like I'll get much help from her.

DS is situs Inversus (back to front inside) and this can mean heart probs, so I was continuously monitored last time and I am convinced that the reason I did not progress well is all the intervention. This baby will need to be checked out for all that at 20 weeks, however there is no reason to sugest that they will have any thing wrong. I think that the consultant is using DS's condition as an excuse to push me his way, so I guess untill then I will just have to bide my time and collect info.

Kaz33 how did the midwife get you moving yet still keep the monitor working?

[pupuce]

The leads of monitors are quite long you can move around the bed... but not in the hall

[pie]

Some hospitals have a little machine that you hold that transmits the FHM back to a base unit, a wireless sort of thing. You can go anywhere you like as long as you stay within broadcast range.

[mears]

Although movement is restricted on a monitor it dos not mean that different postions out of bed cannot be adopted. Where there are indications for continuous monitoring such as induction of labour, women do not need to be kept in bed. I have monitored women standing, sitting on a chair,birthing ball and on bean bags on the floor. It is a compromise that is often not thought of.

[Eva3]

This is very informative. Thanks to everyone. I was told by my consultant that I had to have constant monitoring and have been very disappointed since. I have my TENS machine and birthing ball all prepared but worry that the fetal monitor will not give me much room to use them. Do they stretch so I can at least be standing and leaning over the bed. I have also been told I have to come in early to the hospital as I had a C-section with my first child (extended breech) and have been told that once the contractions are 5 minutes apart, I should be in. The rebel in me wants to stay home as long as I possibly can. I feel the medical establishment is making it very difficult for me to even TRY to have a VB ! Worse, I am now 5 days overdue and have managed to push the consultant to postpone my c-section for this baby by a week. He has tried to sweep my cervix twice but says it is posterior and closed so no chance ! And if it stays that way, they he cannot break my waters and will not induce in any other way. Am starting to feel rather depressed... I have 9 more days to hope that labour will start naturally.

[mears]

eva3 - no-one can make you do anything! It makes me mad when women are told they 'must' do certain things when in labour. If all is well with your pregnancy there is no reason why you cannot be mobile in labour. As a midwife I would probably want to ensure your baby was happy by doing an initial 30 min tracing. If everything was OK, then there is no reason why you can't be mobile and have the baby's heartbeat listened into every 15 mins. It is different if there are concerns about the heart rate. I have looked after a lady (prev C/S) whose baby needed continuosly monitored but we managed to do that while she was on a birthing ball at the side of the bed, or when she was standing. Women who have had previous C/S have had waterbirths as well. It's your body, your decision.

[mears]

This leaflet will give you some more information about monitoring. It certainly says women who have had previous C/S may be advised to have continuous monitoring but not all professionals agree. If there was going to be a problem with your scar in labour, you would be aware of pain and your own pulse rate would increase so it is not the monitoring of the baby that is the only sign of a problem. That is the purpose of continuous monitoring in your case. HTH.

this

[crazynow]

I have the complete opposite with my consultant, I had an emergency c/s with ds1 because the main thing was they kept losing his heart beat. The 1st consultant i saw said i had to have a c/s with this one the 2nd said no i could go for vb.

I want the baby monitored because of what happend with ds1, but nobody seems concerned with it at all! I'm now 36wks and saw my mw on monday and explained how worried i was and she said that when I go into labour just ring the labour ward explain what happened last time and say you would like to just go up to have the baby monitored and if all is ok go home again!!

This just shows the difference between the hospitals and health care.

The baby is now breech (this baby will take after me and be orkward!) so now I have to see what the consultant has to say - there's still time for the baby to turn (well from what I've read anyway), so I'm not going to panic yet.