36 week consultant appointment re possible VBAC. Staggered by what I was told. Any advice?

[SpiderWilliam]

I bit of background: DS was born via emcs. I went 2 weeks overdue, was induced, fully dilated, pushed, and the cs was performed after he failed to descend and was showing signs of distress. Having reviewed my delivery notes during this pregnancy it seems that malpresetation was the culprit: brow and the head wedged in the side of my pelvis (sorry, can't remember the medical term).

Today I had an appointment with a consultant who I have not met before to decide how this baby should be delivered. The good news was that the baby's head is down and so there is no reason not to go for a VBAC.

However, I am in shock at some of the things the consultant said to me which contradict all I have read about VBACs. AIBU?

1. I must come into hospital as soon as labour starts.
2. I must have CFM throughout. (Actually I was kind of expecting this one)
3. I must have an epidural. This is probably thing that got to me the most. Apparently an epidural blocks the pain of contractions but not the pain of a uterine rupture, thus making it easier to detect. This is the opposite of my understanding i.e. that an epidural can add to the risk because because you can't feel it rupture.
4. Contractions are v painful so I will need to have an epidural anyway. Didn't I find it painful first time round? Yes I said, but syntocin induced contractions are meant to be worse, so I have no benchmark for a natural labour.
5. When I suggested that having an epidural makes you less mobile and so inhibits the benefits of being upright etc he said that active birth is not beneficial for lots of women.
6. I said that I would probably refuse an induction if I went overdue and prefer to go straight to elcs. He said that the use of syntocin increases the risk of uterine rupture from 1 in 200 for VBACs to 1 in 50. I said that I was uncomfortable with with that level of risk. He said that it's only statistics and that if I didn't have a uterine rupture then I would be 100% successful. He then said it was similar to catching a plane that has a chance of crashing, but that when it lands safely you have been 100% successful. I pointed out that the chances of a plane crashing aren't 1 in 50.
7. Sweeps. The MWs have said to me that the key to me having a successful VBAC is getting me into labour in the first place, so doing several sweeps might be a good idea. I asked when they should be scheduled. He said absolutely not. Sweeps should only be done as the first stage of a proper induction, and as I am refusing induction then it would be dangerous to do a sweep. This is because if the baby's head is too high and the membranes rupture it can lead to a cord prolapse. I said that maybe he should be chatting to his midwives about what they are saying to their patients.
8. Then he told me that I had too much knowledge for my own good and that this was making me worry unnecessarily. He promised me that both I and the baby will be fine. What a patronising twunt. I know people whose babies have not been delivered safely and have disabilities as a result. He shouldn't make those sorts of promises. That aside, it's not the risks of cord prolapse etc that are worrying me, more that he seems hell bent on pumping me full of every drug going at the earliest opportunity.

I have agreed to think about induction and I have another appointment booked at 41 weeks to decide next steps.

So, what do I do now? I know that I can refuse interventions. So that's an option, but in the heat of labour I'm not that confident about over-ruling the best advice of the professionals. From something he said I have a suspicion that he is quite new to the hospital and generally the hospital does lots to promote active birth. I am wondering whether he is an aberration? Would it be worth calling my community midwife in the morning and asking if their is a mw on the ward who can talk me through this and see if what he has said is consistent with normal protocols?

Any other thoughts? Many apologies for such a mammoth post. I am somewhat by this as you can no doubt tell.

I'm sure my chin feels less mushy than my nose

I have printed out those guidelines Libra thanks for the link.

Called MW this morning, waiting for a return call

I had DS also by emergency section but I had dd normally. I was scanned the day before she was born and when she was 5 days overdue as I had only had 2 movements all day. I was back and forth to hospital and then told to go in when I was bleeding. I now think it was my show. I was treated the same as everyone else except for only being given a set amount of time to get her out. Once I was pushing I had the monitor belt on and she was born after 20 minutes of pushing. I was offered an epidural because I was in terrible pain and they said my baby wouldn't be born that day. I think I had her 45 minutes after they said that.

With DS2 I was given 4 hours from arriving at hospital to have him, again I had the monitor belt on and he was born 15 minutes after the deadline after 7 minutes of pushing. It was a much worse delivery but he is fine and I don't care about anything else.

oh spiderwilliam what a prat! get rid asap! my ds birth was much the same as yours resulting in emcs. im now 37+4 and been advised to do all the natural induction techniques and go for a sweep if I want 1. of course its better to bring on labour naturally. my hospital has a new vbac clinic which i have been lucky enough to attend many appts. its my hospitals policy that from 3cm i have 1 hr ish per cm then 1.5 hrs for pushing so will have baby in 12 hrs def. if there is slow progress they will start to think about section again. they are really for empowering women and say that epidurals can really slow labour. i live 25 mins from hospital and have been asked to come in when im 5 mins apart based on 2nd babies are usually quicker nothing to do with vbac. im hypermobile with mild spd so being forced to stay on my back (like last time) cannot be an option. i know monitoring me and baby is easier for mws if we are on the bed but tough,we need to get this kid out!! my new mw has suggested efm and occassional monitoring for me. i have an appt booked for 3 days before due date to discus wether or not to be induced or go for elcs. i really think that your consultant should never speak to women ever again as he hasnt even got a clue about basics. like others have said some women have successful home vbacs!! please refuse to see him again and maybe even make a complaint he could really be putting many women in horrible labours with his attitudes and so called advice.

spider here is my experience. DS1 was born by EMCS - he turned once I was fully dilated and syntocin and pushing and epidural all failed to get him out.

DS2 was born 3 1/2 years later - I had to be induced in a hurry at 38+4, they broke my waters, put me on a syntocin drip and cranked it full up until my contractions were regular. I had a straightforward vaginal birth.

I am now pregnant again and will be induced at 38 weeks and I am hoping for another VBAC.

The only thing I can think of (sorry if you have mentioned this already but baby brain is crucifying my ability to read properly) is if your EMCS was not that long ago?

Good luck xxx

DS will be 2y 5mths when this baby is due, so as I understand it long enough ago for the scar tissue to be in reasonable condition. The day after he was delivered a mw told me to give it a minimum of 12 months before ttc.

MW not called me back. I'm going to have to chase her . I'm not really someone who likes stirring things up, but all your replies have given me confidence that it's not a case of me being a hormonal loon! Many thanks.

are you sure this person was a consultant and if so I would suggest you refer him to the DoH guidelines and nice guidelines and his own professional body man's an idiot and is giving incorrect advice if this is what he told you.

I had an emergency cs with dc2; had a successful VBAC with dc3 just over two years later.

Very supportive consultant, the only thing he specified/suggested was that chemical induction was to be avoided. I had a sweep to get things going, no pain relief apart from G&A, and a straightforward labour (I had previously delivered dc1 normally, however).

How can he possibly say you have too much knowledge for your own good??! Are you supposed to submit meekly and brainlessly to whatever course of action he decides upon?

I second the NCT for invaluable information on VBAC.

Finally spoke to MW.

The man I saw yesterday isn't my assigned consultant or the consultant at the hospital who specialises in VBACs (no surprises there). The MW said to ignore everything that he told me, and reassured me that I don't "have" to do anything that I'm not happy with. She is also planning to find out who he is and give him an earful.

So I haven't gone as far as making an official complaint (for now), but I do have a normal AN appointment with my midwife next week, so will follow up with her then.

Talking to the mw has put my mind at rest, although I remain concerned me that this guy is spouting this stuff to women who might not know any better.

Great news, Spider. Well done and good luck!

Brilliant news, Spider

SW - you will need monitoring once you are pushing as that is when the scar is at risk of rupturing. Unfortunately having a 2 + year gap is no guarantee. I had my baby 2 years and 4 months after my emergency section and I had no problem with my scar but I did with my next baby who was born just under 2 years after that. Don't want to worry you, just giving you more information. I hope everything goes well.

Blimey he sounds like a twunt SpiderWilliam. Glad you have sorted it out. :)

1. Speak to consultant midwife

2. Find out if the Trust has a VBAC policy

3. try and find out (off the record) of other consultants who's approach is more pro-VBAC

4. switch consultants asap. You've a right to try for a VBAC and some of these things you are being advised by current consultant are not supportive of this ergo he is not supportive of it

5. be bloody bolshy throughout if needed! Speak to PALS if you have no luck at any point

Oh have just had chance to read other posts! Glad it looks like you'll be able to sort it out

Phipps that's fine, thanks for your honesty. I have been reading through the link that Libra posted and the Royal College of Obs & Gyns look at VBACs less than two years since the cs as being significantly more risky. There is clearly always still a risk which is one of the reasons I was so angry with this guy for "promising" me that everything would be fine. Idiot!

Effie I think finding out the hospital's VBAC policy would be useful.

Libra I am about halfway through the document you linked to. Thanks so much. It makes for interesting reading in relation to my experience so far. There are some recommendations that the hospital has done e.g debriefing on the previous section (which is a newly introduced policy). Then there are other things they have failed to cover: the relative risks of ercs vs vbac. It makes me think that some kind of complaint or forceful letter is warranted, if only to flag up that there are gaps in their processes it is all too easy to fall into.

Phipps, poor you. I actually didn't have monitoring for pushing with my third, which was about 3.5 years after the section and about 2.3 yrs after the first vbac.

I suppose, though this is difficult to say, that I can imagine a situation where you feel you must have monitoring, thus you might be less mobile or not in a good pushing position for you, thus labour is more stressful and goes on longer, so rupture is more likely. So it's not that rupture leads to the need for monitoring, but monitoring might make rupture more likely.

I would never begin to assume that this happened to you Phipps, please don't think I'm saying that at all. You know what happened, which sounds really tough for you. I can just see that it would be a possibility in other cases or other situations.

But I am not in a position to give advice, I only relate my own experience and give an opinion. I haven't any references to back it up.

Hi,

I recently had a wonderful home water VBAC I researched for months. You sound both sensible and well informed. The person you saw is a discrace to his profession, as well as being downright incompetent, the information he provided was floored in most cases and completely fabricated in others.

I have bumped up another post in this section for you called

"Please can you give me info for my meeting with the consultant?"

It has lots of the links to reaserch I used when considering my options, and is the proof this bloke is a complete and utter jerk!!!

Stick with your own plans, they are sound ones. The links will reassure you and shut up any other twat consultants you may encounter - but hoping your next one is better x

Mungo Thanks for bumping the other thread, I will have a look.

Sounds like this guy has no idea about the difference between "risk" and "chance". The chances of uterine rupture increase with the use of Syntocin. The "risk" is the chances of something going wrong multiplied by the severity of the consequences if something does go wrong (he has obviously never had to carry out a risk assessment of anything). A 1 in 50 chance of uterine rupture is not something that I personally would be willing to take, given the consequences of it happening. That is why when I was considering VBAC I said if I go overdue I want to go straight to elcs. The consultant was fine with that.

It's not one in fifty though, is it? It's much less than that. Catastrophic uterine rupture is rare.

Doesn't matter how rare if you are that one. I nearly was and it was only because I got him out so quick that we are both okay. DH nearly lost his wife and son. We wanted more children but were strongly advised not too.

Sounds like he doesn't know what he's on about. I had a vbac and was told the facts very simply which helped inform my decision. Induction is to be avoided. Epidural is best avoided. (utter twonk to suggest an epidural masks contraction pain but not possible uterine rupture. A uterine rupture would start to manifest itself by very similarly located pain, the main difference being it would continue between each contraction. An epidural works by blocking the pain receptors- ie it's a total pain block! I had one with my cs. No way would you still feel uterine rupture starting!!)
To suggest that you would need an epidural anyway because the pain is too much- does he not know that many women give birth without one- even for a first vb!

Sounds like he is expecting things to go badly, and assuming that childbirth needs to be highly medicalised. There is absolutely no reason for it. My vbac was as low tech as it's possible to be in hospital, and you shouldn't be scare mongered into thinking otherwise

Spider, I was treated as VBAC following uterine surgery 1.5 years earlier. I wasn't monitored and was told that I absolutely should NOT be chemically induced, as this causes much more intense contractions and increased the risk of rupture.

1 had a sweep with preg 1 and used castor oil with preg 2. Both were safe considering my history. What I think you need is a gentle, woman-centred labour and birth with no consultant in the room UNLESS an emergency presents itself.

Have you seen the UK Midwives yahoo group? You can join and post your question or search for previous discussions. They are a mine of amazing information based on training, experience, and a high level of respect for the birthing woman.