to consider going against consultants advice?

[TiredofYorks]

DS1 (2.4) was born by emergency C section.

I am 36 weeks pg with DC2 and have just been to see the consultant. He said because of previous CS I am high risk and need to be in the consultant unit.

I asked if I definitely can't use the Midwife led unit (it is across the corridor from the consultant unit) and he said no, so I asked if that ruled out a water birth (there is one on the Cons unit) and he said yes as I have to be monitored throughout.

I then asked if I would have to be immobile, he said that there is one mobile monitor but if that is in use then yes I will be immobile and will have to stay on the bed.

I asked exactly what the risk is and he said 0.7%.

I know this is a low risk and I do think I'll cope better if I'm left to it (well I think so anyway) and also I really wanted a waterbirth.

So would I be unreasonable if I considered going against the consultants advice and opting to use the Midwife led unit anyway?

Sorry for the long post.

Think you just have to do what's best and safest for your baby. Good luck!

this prob makes me a bitch but

how would you feel if you go against the advice and something does go wrong?

I'd always do what medical staff advised me to tbh.

There are loads of these threads on the pregnancy board, you might get some more detailed advice there.

YANBU, but...

What exactly was the reason for your emcs the last time? Has the issue arisen during this pregnancy? What mobile monitoring equipment does the MLU have?

I too had a c-section for my first birth (DD - 5) and wanted a natural birth for my second child (DS - now 2)....I was advised that i would have to be closely monitored and i was happy with that, providing i could still try for a natural birth. Anyway, during birth, cord got wrapped round DS neck and he couldn't breath ... lots of drama ensued, so i guess what i'm trying to say is by all means go for the natural birth, but if it was me, I would err on the side of caution.

I think, to me, it would depend on why you needed your previous section also is there any chance you could meet with the head midwife (think she is called the Supervisor of Midwives) to talk her thru what you would like and your concerns. I think my decision would also be influenced by what the midwifes thought (i.e in my hospital there are midwives happy and experienced enough to monitor a VBAC waterbirth)

Sorry, I don't really understand 0.7% risk of what?

I had a similar situation.

I had dc1 in a MLU.
dc2 needed to be born by csection
dc3 - I really wanted a VBAC if possible, and hated the idea of being in a large, impersonal hospital. However, I wasn't allowed to deliver in the MLU as I was 'high risk'.
The irony is that I could have insisted on a home birth (which is your right too).

So - it came down to home birth, or large, Consultant led hospital.

In the end I went for the hospital. The risk of uterine rupture is very small, but once you've had a csection it is a risk and I felt it was only morally right not to take that risk.

On the plus side, I spent as much of early labour as possible in the bath, I kept as mobile as I could, and I avoided interventions like epidural which could have led to a longer stay after the birth. As it was, I came home the same morning.

Overall, it wasn't ideal, because I am a firm believer that unless you actually need medical intervention, a hospital isn't the best place to give birth. However, when you're already in a compromised situation, I felt that was the best option.

Hope that helps

go for a second opinion

Two of my friends advised to have planned sections following difficult first births and emcs, decided to go VBAC. Neither one of them came home with their baby girls. I can't imagine losing a baby but losing one through VBAC when you could have had a section seems very cruel. Maybe their babies wouldn't have made it anyway, but I am sure they must think about that all of the time.

I had an emcs for the first and was told I had to VBAC for the second, that one enede up with a GA and the other two were planned.

Agree go to the superviser of midwives. I had to go to mine to be allowed on the midwife-led home from home unit (not a high risk pregnancy as such, but an existing medical condition).

Talk it through with her - in most places these days a previous C-section alone would not necessarily be automatic-immobile-on-the-bed-for-nine-hours labour. (Ruddy stupid anyway given lying flat on your back doesn't actually help you give birth - honestly, only one mobile monitor, what century are they in?)

Depends entirely on the reasons for the section and whether they are likely to affect you this time. Risk of uterine scar rupturing is considered small I gather and you say the hospital unit is only across the corridor... (It isn't Tommy's, is it?)

TiredofYorks. Does your unit have a consultant midwife? She can support your choices for labour. In my unit VBAC women can have intermittent monitoring and use the birthing pool if they wish. They have a discussion with the consultant midwife who gives them information about VBAC. You have every right to choose where you labour and give birth. If all is well in your pregnancy, there is no reason why you should not be able to use the midwifery unit. If you have no joy with the consultant midwife you can contacvt your local supervsior of midwives. Your community midwife can advise you who that it.

Surely the MLU won't want you anyway?

I am not allowed in our new local MLU because of a couple of what are probably fairly minor issues at the minute. But technically i am 'high-risk'. Sigh.

information about supervisor of midwives

Tbh, I think you need to think very carefully about going against the wishes of a consultant. There will be people on here who say it will be fine, water births, home births are just as safe

However what if something did go wrong... You will probably have to sign some sort of disclaimer anyway. I remember seeing a brilliant drama series staring Trevor Eve as a fertility doctor. A patient BEGGED him to put three eggs back in, it was their third attempt, he warned her that there was a risk of low birth weight, disabilities etc but they wanted to have this final shot. Eventually he went ahead... The babies were born and one was mentally handicapped. The father came and berated the Dr for even giving him the choice...

Interesting dilemina although it was just a drama but having gone through fertility treatment I can quite imagine it happening.

pp - if you are actually advised to have another cs that's slightly different.
My understanding is that the OP has just been advised to deliver in hospital, not to have another cs.

Many women who have a cs have one because of a specific issue related to that pregnancy. eg my dc2 was very prem, but followed a normal first delivery. My dc3 was normal weight and gestation and didn't need to be delivered by cs.In these situations, a VBAC is still statistically safer than a cs. I was offered the choice of having another cs for dc3, which was tempting! But when I looked at the stats, a vbac was statistically slightly safer then another cs which swayed my decision.

Thanks for your replies. To answer some questions.

I was induced at 37+ weeks with DS1 has he had stopped growing and during induction and onset of labour he was distressed, so due to the likelyhood of him being small and not able to maintain his body temperature when he came out they took me straight in for a c section.

I've been monitored closely with this pg and baby is growing within normal range this time so the consultant is happy for me to have a VBAC, but to be monitored continuously.

The 0.7% is apparently the level of risk of my c section scar rupturing during labour.

I am really torn so I will take all your comments on board and most likely re read several times.

I think my concern is that if I am immobile and cannot go with the flow as it were, that I might end up with all sorts of intervention.

Depends on the reason for the first c-section. If they know the reason they can usually can give an accurate risk of the same happening again.

My EMCS was due to failure to progress and foetal distress. I was planning a VBAC but at 41 weeks the consultant (first time I'd seen one all pregnancy) told me that he suspected I'd have the same experience simply because there was nothing in the notes, or my account, to explain why it didn't go to plan.

Uterine rupture risk with a VBAC is so small as to be almost as low as a first time birth, IF you had a straightforward horizontal low bikini cut section. Risk is higher if the VBAC birth is artificially induced.

Good luck with the decisions and delivery.

Is that 0.7 per cent risk of uterine rupture?

It's very low, but I read a story by someone who had a uterine rupture.

Her womb ruptured, the baby fell out into her insides, got tangled in her internal organs and damaged them irreperably - it took them 19 minutes to get the baby out from inside her, in which time the baby suffered fatal oxygen deprivation.

I know I'm going to get flamed for mentioning that and saying I would never VBAC, but this is AIBU so I thought you wanted straight talking.

Sorry....tired brain.....

Ignore me.

I think you need to be very clear that you don't want to be immobilised, and tbh there is no need for that. Your situation sounds similar - my cs was because the baby had stopped growing. I wasn't allowed to labour at all, they went straight for csection.
My dc3 was growing perfectly normally - like you, I was scanned constantly as I was classified as high risk. So there was no reason to take the additional risks associated with csection. I am very glad I went for VBAC, and as I say, although it wasn;t ideal (too many doctors around for my liking, and lots of shift changes and general impersonal atmosphere of a big hospital) it was perfectly successful. You don't need to have interventions. I had gas and air, but refused anything that could have increased the risk of further interventions. I was very clear in my mind that although the hospital was not where I would have chosen to give birth in an ideal world, I was determined to make the experience as natural as possible.
Good luck with your decision.

i dont know your complete history,

but my ds was born by c-section after a failed induction and him becoming distressed.

i fell pregnant with dd when he was only 6mnths old and all the way through they were hhappy with what ever i wished to do, elcs or vbac, aslong as i was in hospital.

As it stands dd had suspected iugr (she didnt and was 100% perfect) and they recomened a section, maybe im soft but ill agree with whatever they told me after many problems with ds, however if theres no other issues in you or the lo, i cant see why consultants being so bossy. try a second opinion.

I was advised to be induced and stay in hospital, consultant said either one of us would 'bleed to death' if I continued with my birth plan. After doing my own research and consulting with my (indpendant) midwife I decided to have a home water birth. All went fantastically. But (BIG BUT) you have to be prepared to accept consequences if things do go wrong. Personally I thought if there were problems,my hospital was only 10 mins drive away so I could go there if I, or my baby, got into trouble.

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