Want a VBAC, any tips for being prepared when I meet consultant?

[ThatDamnDog]

I've read some superb VBAC threads on here so I know there are lots of well-informed and erudite women in the vicinity.

First section was 3 years ago, for breech presentation, baby was predicted to be big (turned out 8lb 3oz). It was extremely calm and straightforward with no complications and I had (and still have) every faith in my consultant's surgical abilities. But it was also the single most terrifying experience of my life and I was almost in tears looking through the hospital website tonight when I saw photographs of the same operating theatre.

I'm now nearly 30 weeks, and so far after a wee spell in breech presentation this baby appears to be more co-operative than its elder sibling was. I have a routine consultant appointment in 4 weeks, and although I already told him at my 12wk scan that I wanted a VBAC I assume that this meeting will be the one where we get down to nitty gritty. Last time he just put a sticker listing risks in my notes

I have some transferable medical knowledge (am a vet, perform caesarean sections pretty regularly myself) which my consultant knows.

I would love access to the birthing pool, and feel strongly that I want to be able to move around if I feel like it. I'm certain that I don't want any induction or augmentation, and won't have the option of an epidural in this hospital anyway. It's a small consultant-led unit so I do feel a bit like they'll be hovering at the door wielding scalpels.

Any suggestions about

• what to ask
• what to say
• what's reasonable
• anything else!

I'm not by nature very good at being bolshy with knowledgeable medical types (unless they're inept veterinary referral specialists ) and DP is a "do what the doctor says" type.

You already sound like you are better prepared than I was. I wanted all the same things as you for my VBAC (after CS for breech baby first time) but when I saw the consultant at 38wks he said, 'right well we'll give you a chance to go into labour naturally but owing to the increased risks (to the baby) I'll book you in to be induced on your due date' I was so surprised that I didn't question him further but just agreed to it thinking the Dr knows best.
My midwife seemed shocked by what he'd suggested as her advice had been to let the labour start naturally and progress with the least intervention possible. So then I felt crap for not questioning him and thinking more about what I wanted.

Anyway I took his advice and I went ahead and was induced and it was not a wonderful experience but I did manage the VBAC and was pretty chuffed about that.

5 years later its all faded to a pleasantly distant memory, although it bothered me very much at the time that I been robbed of the two 'natural' unmedical deliveries I'd wanted.

So I would say discuss all the possibilities with your midwife first and don't hold back on asking and qestioning everything he tells you until you are sure you are happy with it.

Re the waterbirth, ask if your hospital has wireless telemetric monitors - these can be used in water. And make sure s/he really knows - my community MW told me about them but when I mentioned them to the Foetal Medicine cons (my baby was at high risk for HDN, that's why I was seeing him), he wasn't sure! Fortunately, he was also aware of his own limitations and suggested we bring in the consultant MW to discuss it, and she knew about them.

I didn't get to use the pool in the end (because of DD3's HDN) but they were all prepared to let me, if everything else had been straightforward.

This was for my second VBAC, BTW.

they might be supportive to your vbac.

Ask about monitoring - you can have mobile monitoring.

I'm fairly sure that unless there is a good medical reason for offering you another section, the NICE guidleines state that VBAC os the preferred option.

I had a VBA2C nearly two years ago and it did take some persuading.

I had hired a doula, and lucky for me she just happened to be on the local maternity services liaison committee and knew all the midwives and consultantds and helped me change hospital so that I could get a consultant more amenable to letting me have a trial of labour.

I would also suggest looking at the Royal College of Obs and Gynaes Green Top Guide

I also have a book written with the NICE guidelines and the green top guide in mind. CAT me and I can send it to you as it was in the pile for the next NCT sale anyway.
there was a long running thread called Support for imminent VBACers; have a look up, there are loads of links on the early pages of that thread. It was a lifeline for me when planning my VBA2C.

I'd recommend-
Getting on this forum-
health.groups.yahoo.com/group/ukvbachbac/
Considering a Doula to support you-
www.doula.org.uk/
It is your right to either accept or refuse any of the routine policies for VBAC.
All the policies do have evidence behind them, but they are 'just in case' of very unlikely events occuring, and ,make it harder and less likely you will have a sucessful VBAC (insertion of a venflon, early admission, constant monitoring etc)
Many women in the UK have now had VBAC's outside of guidelines so most units/midwives/consultants have some experience of discussing and signing off birth plans which are 'out of the normal'.
If your unit is not being supportive I would suggest-
Finding out if they have a consultant midwife and askl to see them to discuss your birth plans
-If no consultant midwife, ask to see a supervisor of midwives (part of their remit is to protect the public and see women that are having trouble getting the care they ant/need)
-if still no joy, contact your areas LSAMO (Local supervisory area midwifery officer)
I would also consider transferring your care to another, more supportive unit or planning a homebirth (sometimes if you tell the consultant you are considering a homebirth, they become more amenable to you using a midwife led unit or pool)
Good luck,
Selina x

Great help folks, thank you all.

It's a bit complex because all my antenatal care is via community midwives from one trust while I am going to deliver in a hospital in another trust. This is simply because for unrelated reasons I went there for DS's birth and so it's not an unknown for me, and it means I have direct access to the same consultant.

But if he becomes less helpful I will hopefully be able to transfer back into this trust before delivery

It does mean I've no contact with midwives who work in that hospital, so I think maybe when I see him next month I need to try and approach a midwife there too. After all, at the moment there's no reason why the consultant should have to have anything to do with my labour, is there?

ThatDamnDog. I would get in touch with the supervisor of midwives there and ask if you can come in and see her.

I got your CAT message and have sent a reply

'Scuse me,LacksDaisies, but did you used to have a different (but similar) user name?

Can't see why they wouldn't beg you to have one tbh. Breech was the reason the first time around and so no reason for you to have a CS at all. I had to fight, and lost, to have a cs second time and ended up having a GACS.

Yes Poledra, tis me . Meant to wave to you last night, but had to post and run as DS2 was whinging!