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.

" Epidural is best avoided"

Actually if you read the RCOG guidelines it appears that HAVING an epidural increases the succcess rate of VBACs.

Hi Everyone. I thought I would complete the story for you.

My little boy (DS2) arrived weighing 8lb 11oz on Sunday 7 November a few days early, and, yes I got my VBAC.

This is what I posted on DS1's post natal thread for those of you that are interested (it's a bit long):

Thursday had a sweep at 39 weeks and was 2-3cm and had a bit of show on and off. Saturday walked to fireworks display, got home, more show probably from the walk. Sunday: DH asks for the a lie in . DS and I watch Strictly on replay, I feel one or two twinges, DH gets up at 9, we finally erect the Amby hammock. We go for another walk in glorious Autumn weather. Driving back I feel a few twinges and wonder whether I should be driving or not. At home we have lunch and I start counting contractions and realise they are lasting 40 seconds and I am getting 3 in 10 mins. DH thinks I should call hospital but they aren't painful so I hold off. About 2pm I call hospital and they say to come in but only because I say I haven't felt any fetal movements. Slowly head to the hospital, get sent to the day assessment centre, wait for 30 mins to be seen. Beginning to find contractions too strong to sit through. Get a bed and get on the monitor and my waters go everywhere . MW tells me that she will only check my dilation when I request some pain relief. I decline but wonder what happens to people who don't want pain relief, does everyone have pain relief? At about 6pm mw announces that they are closing the ante natal ward for the night and moving everyone on antenatal to post natal, but because I am not an inpatient I can stay on the day assessment unit overnight with DH. I ask what would need to happen for me to go to delivery suite. She says I would have to be in active labour and she reluctantly offers to examine me to see if I qualify. At 7pm I am examined and she is surprised that I am 5-6cm but "let's call it 5" and yes I can go to the delivery suite. Get to delivery suite just before shift handover so lots of coming and going of registrars, mw's etc who are all v keen to offer pain relief, discuss using syntocin if things don't progress. The mw going off duty puts me on the monitor as "that's part of the deal" (for a VBAC) and strongly encourages me to lie down. I am a bit pissed off as they seem intent on medicalising the whole process at the earliest opportunity. Meanwhile the contractions are still every 2-3 minutes and pretty intense but I am breathing through them and trying to remember all the stuff from the hypno CDs about relaxing the rest of your body etc. The registrar decides to "give me" till 11pm before checking my dilation again and continues to mutter about augmentation. DH and I are a bit as we think that's quite a long time off given how things have moved so far. New much nicer mw comes on shift and I manage to zone out between contractions even feeling a bit sleepy at times. Still lying down on my side as everytime I try to get active we lose the trace. Probably at about 10ish the contractions start to feel different with a downward sensation, they also start to get a whole lot more painful. I am trying really hard to grasp onto the phrase from the hypno CD "power, pressure and warmth" but really I am thinking "fuckity fuck this is excruciating". I tell the mw that I am having downward (pushing) sensations. She says it is a good sign but doesn't seem overly phased or interested. A bit later she does check and I am 10cm. She then gets me to lie back on my side and I am wonder if it is possible to give birth in this position. The contractions continue like this. MW keeps commenting on how this is the most serene labour she has seen in a long time. I am feeling the opposite of serene and find this comment a bit implausible. DH starts getting his hand gripped very very hard indeed. MW says that the heartbeat is decelerating during contractions because I am lying on my side and there is no space... Err yes. I get up on my knees and drape over the head board. I can really feel the head getting close now, and then suddenly the head is out. Cue much amazement and exclamation from the midwife who gets a colleague in just in time. I suspect they weren't gloved up or ready. There is then quite a long gap before a final contraction and out comes my baby. I am told to keep still and all I can see are a pair of feet wriggling between my knees. I have to ask whether it is a girl or a boy. There is a gush of blood as DH cuts the cord. I am eventually allowed to turn over and have a cuddle, and I find myself asking the mw if she is ok .

So at 11am I was out walking, and by 11pm my baby arrived.

Generally it was staggering how normal I felt almost immediately after the birth. Getting up, having a shower, walking to the ward, still having the ability to sit up using my tummy muscles. Such a contrast to last time after the emcs. I have some tearing, but that's not even been especially painful.

Thank-you everyone for your help and encouragement when I started this thread. I felt really empowered to stand up for myself when they were pushing pain relief and making ominous sounds about augmentation.

Congratulations! Great birth story.
I was lurking and wanted to say huge thanks for the thread - as I found it really informative.
Am so glad you had a good birth despite the powers that be!
Tho, have been listening to the same cd that you have been, and will probably have 'power,pressure, and warmth, fuckity fuck' emblazoned in my birth script

Wow - what a great story. Very well done you

Thanks Saucetastic and northernlurker.

The weird thing about the natal hypnotherapy CD is that it really did equip me with the skills to put mind over matter. I feel as though I experienced the same level of pain as first time round when I was induced, but that various snippets from the CD would come to me to help me accept what my body was going through and handle it. It's v hard to explain. I wouldn't say that I was in a hypnotic state in terms of what was going through my mind, but clearly from the reaction the medical staff were giving to me (not thinking that things were very advanced) I was outwardly unusually calm compared to most labouring women.

Very glad to hear that Spider - as really hoping it's all going in on a subconcious level! Wishing you lots of sleep!

Congratulations on your VBAC - it's the best feeling in the world

I was promised by consultant that my baby would be fine at my 41week appt...and she died during labour!
Please think about induction...I wish I had been induced as they would have been able to monitor Tallula from beginning to end of labour. I went into labour at home, had very straightforward, textbook labour, got to hospital, was 8cm, 45 min later delivered my beautiful daughter who was perfect and healthy but she stopped breathing during the birth. I wish I had gone in earlier or been given the c section I begged for at my 41wk appt as I didn't want to go overdue again as I had with my first child and been induced....so wish it had been different.
Best of luck,hope all goes well and that they monitor baby and offer you a scan to ensure all is fine with baby.

So sorry Dimi
I hope you are getting the support you need.

That's tragic Dimi. So sorry for your lost daughter.

Dimi, I'm so, so sorry.