Midwife led unit for VBAC? Can it be done?

[ginger2000]

Hi - I am 34 weeks. Have been on a tour of my maternity unit at the hospital. I know I have been booked into the delivery suite rather than the midwife let unit on the floor below because I am having a VBAC. After visiting, I really want to go to the midwife led unit as it looked so much less medicalised. I have been told by midwives that this doesn't happen because i am not a 'low risk' patient.

My feeling is that surely there is more chance of intervention in a very medical environment? I felt so apprehensive walking into the rooms on the delivery suite with the gas and air attached to the wall, possible fetal monitoring where I will be strapped to the bed etc. It just brought back all the horrors of my first birth back whereas the calm atmosphere of the birthing centre with its birthing pools and sensory room, just felt so much more conducive to a successful VBAC. Am going to discuss with my midwife and consultant when i see them but would like any thoughts from people who may have experience of VBACs in similar circumstances. Can I push (scuse the pun!) for a trial by labour in a midwife led unit?

You could speak to the supervisor of midwives at your hospital - you would probably have to get her permission. I'm 37+3 weeks and attempting vbac too. I also asked about using the midwife led unit but was given a blunt no by everyone as it's not hospital policy.

My hospital will let me use the birthing pool room though as they have telemetry monitoring which is wireless and waterproof (probably the main thing they will be concerned about is monitoring you continuously which won't be available in the mlu, although you can refuse this also if you don't want it). Where I am going they also have one room that is designed like the rooms on the mlu, but it is officially in the delivery unit so I can use that too.

That is the reason why ive decided not to go to the head of midwifery about using the mlu as I'm pretty happy with the compromise. Although if they didn't have those rooms I could use then I would attempt to get them to let me use the mlu.

I have read on a couple of threads about people being successful once they have got permission from the right person, so I would give it a go and see what happens (although I wouldn't assume that it would be an easy task!). Good luck!

Thanks Chathappy - sounds like a good compromise on your part. I did ask whether monitoring could be mobile but the woman who was leading the tour said they didn't do that. I will ask a few more questions of my midwife and maybe contact the lead midwife as you suggest.

Good luck too!

FWIW I don't think how cosy and non-medicalised the surroundings are really matters. I had my first baby in the MLU of our local hospital. I chose it because I didn't want to actually be in a medicalised environmetn. If it was possible to go wrong, it did go wrong. This time (I am 38 weeks) I am going to the other hospital in the area, where there is no MLU. All rooms are very medical looking (even their 'homely' rooms don't look much less like a hospital room.) But what is different so far is the staff attitude.

Because of the circumstances surrounding DD's birth I have had an appointment with a consultant there who was so pro-VBAC that all the points I wanted to ensure I got across were addressed by her to my satisfaction without me even needing to say anything. She told me she was happy for me to labour however I wanted within the abilities of the hospital to provide what I wanted, and she was happy to transfer me over to midwife care rather than consultant care. I had an appointment with the senior midwife last week to discuss my VBAC in the pool and what kind of interventions I was happy with and what I wasn't happy with. The whole attitude is a long way from what I experienced with my MLU birth first time round.

Just wanted to let you know I had a vbac 10 days ago, having not been sure I wanted one (went into labour early). I was completely monitored because of the scar rupturing issue (small risk but can happen I understand).

Frankly as I stayed at home until I was 7cm dilated by the time I got there I was desperate for gas and air and anything else on offer and didn't really notice my surroundings.

Also unlike a cs, the last part of labour was totally out of body experience............. good luck though if you talk to the right people I would have thought someone at the hospital will be able to help you get the labour you would like just wanted to let you know from someone who has had a recent vbac.

different hospitals have different polices, from which you can assume there is no one 'rule' or 'safer' option, despite what you might be told. if your hospital has a blanket ban on vbacs in the mlu, this might be for 'political' reasons such as conflict between the mw and consultant teams or stats in a new mlu being affected by transfers during labour to the consultant led unit.

speaking to the consultant mw or supervisor of mw is a good first step towards seeing what is possible, as is thinking more about how you feel about monitoring/when you want to go in to hospital/waterbirth etc. it might be that they are willing to offer a lot of what you want on the consultant led unit. you could also consider a homebirth - this is your choice rather than something they can 'allow'

for my first vbac I just stayed at home til I was 7 cms, by then I couldn't care less what the surroundings were like, refused the monitoring but agreed to the iv drip thing to keep them happy, ds born an hour later. was a great birth in very medical surroundings which I was pretty oblivious to.

for the next vbac, exactly as you describe, the tour of the hospital was v disturbing and brought back a lot of memories so I went with a hbac instead. was also great.

Thanks - really useful experiences. Its strange - i was 8cm dilated with DD when I arrived at the hospital last time but am really aware of what the room was like etc that I was put into and what happened next. Anyway - I thought I was totally into the VBAC after a meeting with the consultant midwife at 20 weeks who reassured me I could labour as i wanted to in the Delivery Suite. I think I just panicked yesterday during the tour because it all felt a bit too 'real'!!

Think I need to get more reassurance that i can be mobile and not be monitored unless absolutely necessary. Its a real shame though, that there is no access to the water birthing facilities as that is what i would really like.

sanfairyann - For me, a homebirth is just a step beyond my comfort zone. Am half hour from the hospital should something go wrong and I know DH is dead against it. Maybe next time if all goes according to plan this time!

Doodlydoo - huge congrats on your recent successful VBAC - glad it went well for you. What (if you don't mind me asking) was the reason for your c/s?

I had a emcs due to the fact I had pre-eclampsia so they induced me at 39+6, laboured for 48 hours whilst being monitored (looking back I didn't move as much as I should have so didn't help myself but c'est la vie!) dd's heartrate dropped significantly (at that point was only 2cm!) and was rushed to theatre (whilst dh was in the loo ).

Seriously considered another cs all through this last pg, but didn't get the op to make the decision (ds born the day was going to the consultant) but am SO glad. My recovery has been amazing, yes I had a 2nd degree tear but frankly it was only a couple of stitches and less than a week later all healed nicely. Experience was incredible and am so glad that it all worked out.

Wanted to let you know though that I went to see the hospital (different from last time round as we have moved) at 37/38 weeks, without my dh. I came home and cried my eyes out - last hospital was all mod cons, light, airy, birthing suites, patient line tv's etc in rooms and 4 bed wards. As opposed to darker rooms, no tv's, 6 beds to a ward. Not being induced meant that I didn't have to spend much time on the delivery suite or antenatal ward, (only on antenatal ward 2 days prior in early labour for a couple of hours!) then on the ward for about 4/5 hours before being discharged.

All the things I thought were important ended up not being so noticeable as I really just wanted to come home to dd! I did have a fairly mobile birth but I did have to be monitored because of the section but would have preferred that to anything more sinister happening. Who knows if I have no 3 it won't be a problem as should be able to do it exactly as I would like to!

Good luck, really really good luck, I hadn't made a decision about the birth before going to hospital and took the same original birth plan I had with dd!
Hope the hospital lets you have the birth you want!

I am in a very similar situation to you, Ginger except that I'm somewhat earlier on! I am 26 weeks, am desperate for a VBAC, waterbirth if possible, but not sure it's going to happen. My ideal would be a homebirth but we are an hour from the hospital so it's not really feasable and mw is pretty negative on that front.

I have an appointment with the Community Matron (a bit like head of community mw I think) on Wednesday, to find out what I can and can't do. My main worry is I get panic attacks and chlaustrophobia so very worried about 'hospital' style birth, also about being pushed into a situation I'm not comfortable with (again!)

Don't mean to hijack but will let you know if she's any use on Wed., although it may only apply to my (not so) local hospital. I think there is a lot of difference between what service you get where. Which makes me very cross!

Hi Unbuffy - you will find the community matron really positive - I did when I saw my equivalent a while ago. She really convinced me to go for a VBAC after looking through my discharge notes from my previous birth. Good luck when you see her and ask lots of questions!

I think the issue I still have is that if they are all so keen for me to have a VBAC and feel there is no real reason why I can't have a 'normal' birth, why can't I do it my way in the midwife led unit? A few more discussions to be had I think!

DoodleyDoo - thanks so much for your experiences, it helps to see how it will work in practise and also to know its not just me that has a tendency to dissolve into tears everytime I think of how its all going to go!!!

Ginger I sooooo agree. I'm not certain how they classify 'risk' - surely there are other, more serious factors than a previous cs to take into account? Particularly as instances of things going horribly wrong seem to be only as common as with a 'normal' first birth - I'm not certain of the stats, mind, but according to the RCOG Green-Top guidelines, chances of successful vbac are 72-76%. I would be very interested to know what the statistics are for sucessful first vaginal birth IYSWIM for comparison. Also the variation between trusts seems so unneccesary, some women get what they need/want, others do not.

I too keep getting very upset thinking about it. I have to make a very detailed list for Wednesday or brain will go into Blank Panic mode. It is very reassuring to know that a) it's not just me and b) it can all go okay.