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.

Ok. I'm moderating myself here as my views are very vehement (and funnily enough agreed with by my local SoM). Although one thing I would say is don't allow them to allow you.... They can't STOP you doing anything, you could give birth in a tree in the middle of a field if you like, you 'allow' them - ie you can refuse internal examinations or blood pressure checks if you like and there's bog all they can do.

Before anyone takes me up on that I hasten to add the desire to birth in trees and refuse medical interventions isn't wise imo, but it's to illustrate a point.

So OK, the Cons has advised you don't use the MLU. The final decision on whether the staff there are happy to take you is down to the SoM not the consultant so I'd advise having a chat with her. From one who was once so ardent a VBAC'er but has had a pretty nasty mmc and subsequent induction I can only speak from personal experience - I did try VBAC again but in a consultant led unit - it was my choice and I was happy with that.

If it is a MLU that is right across the corridor from the CLU then I'd consider opting for it.... with SoM support. However if it's quite a trek to get to emergency support then I'd be loath to give it a go. Or I'd look for another hossie nearby with a MLU attached.

You don't have to agree to being stuck on the bed being monitored, a midwife can listen in frequently on a portable doppler and THEN if there are any concerns you can go on the monitor if it's deemed necessary. If you are stuck on your back I'm sure you realise it does increase the chances of a repeat section.

If it comes to it and you do opt for the CLU then there are ways you can make it all less clincal. You can take throws, cushions, pillows and duvets from home, they'll all have a familiar smell, play music you've chosen and you can ask for the lights to be dimmed unless actual examination is needed for instance.

Good luck with whatever you choose. You do have options, just do your research (eg I believe the rupture rate is a little lower than you've been quoted).

The consultant is being bossy because it is his responsibility to ensure the safe delivery of the baby. He has a LOT more experince of this than TiredofYorks

I think you would be MAD to not listen to him.

Let him do his job.

I don't get this "Them and Us" attitude towards medical staff and birthing.

They intervene for a reason and its not just to spoil your experience, it is to ensure that the mother and baby are both safe.

As I said, OnEdge, I have moderated my views as I don't think it's fair to the OP to be ranty.

My views were unfortunately formed by the way I was treated over the birth of DS2.

I think the OP would find disagreement even between consultants. It happens in every field of medicine. Not one consultant knows the absolute set in stone outcome of every single case. There wouldn't be progress to be had if they did.

midnightsun That's very interesting - I had a similar tale - they just don't know specifically what went wrong, he had the cord around his neck but not enough to cause the decelerations and they don't think that was the cause of it all. I had a couple of minor other issues but just nothing concrete - like you, my notes draw a blank. I will be asking for a c-section next time btw.

One of my friends went for a VBAC. She had an elective due to obstetric choleastasis (sp??) so it wasn't even that she had problems during an attempted natural labour or anything when she had her first DC.

She ended up with her baby being delivered by forceps, so an episiotomy and her uterine scar also ruptured so she had to essentially have another c-section to sew her back up again. She took weeks to recover afterwards and couldn't pick her toddler up for nearly 2 months.

She has been told it will need to be a looong time before her body would be able to cope with another pregnancy.

I am pregnant with DC2 after an emcs due to lack of progress and foetal distress. I am very much erring towards an elective section, but if I do attempt a VBAC it will be in our big, impersonal CLU because I would consider that the only safe option for myself and my baby.

I tried for a VBAC after an EMCS first time around. I was on a monitor, but able to move around a fair bit. Good job I was being monitored as the baby's heart rate dropped very suddenly and I was having a crash section literally within minutes. My scar had ruptured and both myself and dc2 were nearly in big trouble.

Thank goodness I was being closely looked after. Yes, the risk of rupture is low, but it happens. Why risk it? With hindsight (of course!) I wish I had opted for an elective CS - it would've been an altogether more civilised birth.

Good luck, whatever you choose.

How about somewhere in the middle. You probably. Won't be able to choose mlu, they just won't let you in. So go to consultant unit.

You don't have to be monitored all the time even if policy says to. How about thirty mins monitored then an hour of mobilisation with intermittent listening in?

Some info

some more info

May help you make decisions. I am also in a position whereby I am planning a VBAC but haven't been met with particularly open arms and enthusiasm from either the consultant (lovely man, very experienced, seen two ruptures in his career, definitely want him to be there and wielding his scalpel if I'm going to be a third!) or the midwife I spoke to on the ward ("Weeeelllll, I have delivered babies for women who've had a previous section before ..." )

I think all you can do is inform yourself.

There is nothing wrong with questioning the medical establishment and I'm shocked that people would take people's opinions at face value.

Ok, if I were in your position these are the questions I would be asking myself and/or the Consultants.

If you are continuously monitored by a machine, how often is the output information looked at?

What sort of monitoring does the continuous monitoring machine do? Just the fetal heartbeat? Or your heart rate and blood pressure as well?

In theory I can understand the medical proffessionals reasons for constant monitoring, however in practice I am unsure of its effectivness.

When I researched VBAC, and after having long and indepth discussions about it with my MW, I found there are various warning signs of uterine rupture. From memory:

Mother: scar pain, increased heart rate and blood pressure.
baby: lowered heart rate.

So, during my labour it was agreed that all of the above would be checked (manually) every 15 minutes.

I feel that being checked by a mw every 15 mins and left to labour in any position I wanted to would lead to an easier labour and birth, than if I was left on my back on a bed being checked every hour (if you're lucky). The machine is only ever any good if the output is being monitored.

I hope you know this already, but I would just like to say that it was not your body's fault that you had a csection last time. It was the induction drug that failed, not you.

Hopefully this will give you some food for thought. Good luck

Hi tired, I am in a similar situation to you although approx 8 weeks earlier than you. I too have been told that I will need to be on continuous monitoring (although the age difference between my two is 17 months).

My understanding of the situation from what my midwife/consultant told me is that the age difference is the important factor - she quoted it as being 18 months not 2.5 years.

The other thing my consultant told me that has made me think I will have cm is that if the uterus does rupture then there is a significant risk that the baby could be born with epilepsy.

The problem as you say is the odds of it happening. They are remote and the figure also covers small ruptures where you might not even notice.

My plan ATM (and this is perhaps something that you could discuss with your consultant) is to do a bit of labouring at home and only go into hospital when I am in established labour. Once I am in hospital I will somewhat reluctantly allow them to put me on continuous monitoring.

I had to be continuously monitored during my last labour and I have to say IMO the stress it caused far outweighed the benefit, however, at the moment I am thinking it is not a risk that I really want to take.

Tiredof
Go for a second opinion.
Do you know what, consultants are only experts in the things that go wrong in Labour and delivery.
The midwives are the experts in pregnancy and delivery of ALL sorts.
For that reason alone consult the midwives supervisor and get their take on what goes on only 'across the corridor'.
Personally think that you want a mobile birthing experience to help you give birth and if you do have a problem then midwives spot it and move you all the way across that corridor pretty damn quickly

I tried for a vbac with my ds and at my consultant appt they said it classed as high risk etc etc blah blah....

I had read up on the risks / implications a LOT and was set on what I wanted... one important fact I became aware of is that when immobile in labour (Ie pinned to a bed) it increases the chances of slow progress and interventions being required.... I went to my appointment with this in mind and made the following clear:

I wanted to try for a vbac
I was aware of the risks
I needed to be as mobile as possible! (I brought this up as soon as they mentioned constant monitoring and also put it in my birth plan!)

The consultant was fine - basically said I could use the mobile monitor but wouldn't be able to move far... however on the day / night / week (don't ask!) I found I was far more mobile than I expected - at my hosp they gave your the band things that go around bump - and they stayed on all the time, then they just hooked you up to the monitor every now and then - they didn't keep me on it all the time unless they had a reason to and I was able to pace the room, go to the bathroom, have a shower etc - I was also left to it much more than I expected (also as per my birth plan)

yes - I ended up with another emergency section, but I felt much more in control and felt that I did everything possible to get my natural birth this time

google hypno birthing - helped me no end!

SkiHorseWonAWean I had an elective c-section on the day at 41 weeks with my second pregnancy.

All along my GP, the hospital midwives, everyone had been telling me that a VBAC was the way to go and with negligible risks, fewer risks than a repeat section.

It was only by chance when I was referred for an ultrasound scan to check the baby's position at 41 weeks that I even saw a consultant. He was the head of the women's clinic, 71 years old, and told me that his experience and gut feeling was that I would not have a straightforward labour this time either. He gave me a worse than 50/50 chance and said if I attempted labour there was a really big likelihood that it would result in another c section. Then he had to phone around and pull strings and argue my case pretty hard to get an "unplanned" "elective" c section on the day.

Although I was keen to try VBAC, I was never totally reassured by any of the people who had told me VBAC would be best/fine. In the presence of this 71 year old consultant though who has delivered thousands and thousands of babies and seen everything that can go wrong (and importantly how often it usually goes joyfully right), and him quietly telling me his view, I felt "well who knows if he doesn't", and I agreed to a c section. I was surprised by how relieved I was and instantly happy with the decision. I don't regret it at all.

Sorry that was a hijack, but to return to the OP. If you really desperately don't want consultant care then that is your choice and your right and the odds are that you will have a successful intervention-free VBAC under midwife care. But consultants are not all bad and evil so it might not be the tortuous disaster you fear, if it turns out that you do end up in their unit.

Yanbu, I deliberately missed appointments, refused an x ray and discharged myself "at my own risk" from hospital during labour to get my vbac.

FWIW - I had EMCS with DD1 and was told in no uncertain terms by consultant with DD2 that I would have to have continuous monitoring, no chance of MW led unit etc etc

I was depressed about it all but willing to go along with it because I didn't want to live with the guilt if anything had gone wrong and I hadn't taken the official advice.

In the end DD2 popped out at home - delivered by DH - I'd had pains on and off for two weeks but had been told it was branxton hicks by consultant...errr no, it incipient labour and so when DD2 decided to finally emerge there was no time to get to hospital as the whole thing only took and hour.

(First labour was 28 hours of hell, horrible stressful environment at the hospital, insensitive medics, baby in distress, EMCS - the complete opposite)

I would have been completely talked out of a home birth if I'd tried to plan it, but I have to say it was wonderful and I was delighted. Knowing what I know now, I wouldn't have qualms about it.

So whatever their advice (and they're giving it with the best intentions) they can't know what is going to happen. What really matters is if you can feel happy with your decision - there are many risks in any scenario.

What I'm trying to say is - YANBU!!

"The other thing my consultant told me that has made me think I will have cm is that if the uterus does rupture then there is a significant risk that the baby could be born with epilepsy"

Please someone prove me wrong but I'm pretty sure that is complete bollocks.

And sorry yes had problem free v bac 17 months after emcs. And then another a couple of years later.

Libras..... I'd certainly like to see the evidence

From my reading, the monitoring is actually a fairly reliable method of spotting problems, but ILTMIMI makes an excellent point - who is looking at the trace, and how often?

I think finding a way to be monitored and mobile is going to be, for me, the happiest medium. Sadly it depends on whether the mobile monitor is free on the day [madness]

I thought there was research that showed that continual monitoring did not result in safer outcomes for mother or baby? Anyone have a link to this for OP?

Being tethered down by continual monitoring is something I've always refused, since an hour into my first labour when it was switched on. For that hour, the midwife (and Dr when he came into the room every now and then) looked at the monitor rather than at me, the tightness of the straps made me constantly hot and itchy (some kind of skin reaction), and made the contractions worse.
This has meant in all 4 of my labours my midwife has checked my blood pressure very frequently (something about a change in the mothers bp being the first indication of a prob with the baby) and using a handheld device frequently too.

I've taken medical advice not to have a water birth (though stayed in the bath for most of labouring at home, and only gone to hospital when I need g&a). But continual monitoring is abhorrent to me. (Don't have major medical problems though)

My tip if you end up in the consultant led unit; stay at home until you can't bear the worry and pain any longer, get the belt off after five mins entry monitoring and disappear to the toilet every time your dh or midwife tell you the consultant is on the way. They only start clock watching and that is SO stressful it slows you down.

"Women should be advised to have continuous electronic fetal monitoring following the onset of uterine
contractions for the duration of planned VBAC.
An abnormal cardiotocograph (CTG) is the most consistent finding in uterine rupture and is
present in 55?87% of these events.17
Continuous electronic fetal monitoring is generally used among women during planned VBAC and
thus the estimates of risk of both lethal and non-lethal perinatal asphyxia associated with VBAC are
in this context.87 The relative and absolute risks of severe adverse events in the absence of
continuous electronic fetal monitoring are unknown."
From RCOG Green Top Guideline 45, Feb 07.

I went against the advice of a consultant - but completely different situation. I did my research and decided that the risk (which was actually to me, not my baby) was minimal. I felt that being in hospital was the wrong place for me.

In the end, I had my homebirth and the risk did not materialise although I did end up going in for stitches. DS then ended up in special care and pumped full of antibiotics unnecessarily which only compounded my feeling that hospitals tend to over manage things and compensate far too much. This is because consultants see the worse cases - they don't see a labour from start to finish and certainly don't see normal labours.

I would speak to as many professionals as you can - I would speak to independent midwives who deal with homebirth VBACs all the time. You can arrange an introductory meeting with them (usually costs) and cover everything. Then make your decision.

With a ruptured uterus, Minxie, I don't think you actually have ten minutes.