Come and talk to me about VBAC - what questions should I be asking?

[AliBellandthe40jingles]

I've got a meeting in 10 days with the senior midwife at the hospital to discuss a possible VBAC when I have DC2 at the end of March.
Saw the consultant a fortnight ago and she has agreed to a section already if that is what I decide I want, but was very keen for me to go and talk to this midwife and at least have the discussion about how they would manage my labour etc.

The background is that I was induced at 40+10 with DS, needed a second 'dose' of gel 6 hours after the first to get labour going. I had very irregular and mild contractions for a couple of hours and then my waters went and there was meconium in them so I was told I needed continuous monitoring. The contractions immediately became excruciating and there was no break between them - none at all. Laboured like that for about 6 hours, during which time I had a lovely midwife who encouraged me to move around, use birthing ball etc and despite the pain I was ok and managing well with G&A.
I was examined at shift change and found to be only 2cms. The new midwife was awful - made me get on bed so that she could monitor me, wouldn't put the back of the bed right up because then the belt needed holding rather than staying of it's own accord so I was semi-reclined and there I was made to stay, in agony, with what we were later told was a back-to-back baby.
My contractions really slowed down at this point, and the pain was much worse - I am sure because I was now scared and felt really unhappy with the midwife.
Midwife was so unsympathetic, the G&A bottle was empty and she was faffing around writing notes even though DH and I were begging her to get more - DH ended up going outside the room and shouting at someone else to bring some. I had some pethedine which really sent me woozy.
Eventually they decided that I needed syntocin because the contractions had slowed so much, and I was still only 2-3 cms about 10 hours after my waters went, and because of the meconium they were keen to keep things moving. Had an epidural, which went in fine no dramas but even with the drip things slowed even more.
Dr came in at 7am, by which time it was 15 hours since my waters had broken. Got really angry with the midwife because she hadn't turned up the drip at all, just left it on the lowest dose and I hadn't dilated any further - transpired that she was an agency midwife and claimed she didn't know hospital protocol, where anything was kept etc. She never went and bloody asked anyone though.
So then the Dr stayed for about 2 hours - drip gradually increased but no further dilation and by this time DS was showing signs of distress so at around 10am we agreed to a CS.

Sorry that was so long - but the jist is that I just feel that we were so badly let down by the midwives who should have been caring for me. DH kept trying to ask what was going on, and trying to draw attention to the fact that DS' base heart rate had dropped significantly through the night but was repeatedly brushed aside by said awful midwife and made to feel that he was being daft and making a fuss over nothing.

So what do I need to ask, what should I be saying when I see the midwife, what reassurance can she give me?

Any thoughts?

When I was aiming for a VBAC woith my second child I got the consultant to agree to and sign off in my notes the things that were important to me. You could have any midwife attending once you go into labour, so it's important the consultant or somebody senior (Head of Midwifery, or whatever) has signed off your wishes.

My main wish was to be allowed to labour actively, with no restrictions on movement, including NO continuous fetal monitoring. It took a lot of research and persuasion to get the hospital to agree to it. Some hospitals just flat out refuse the 'no CFM' thing.

There are some great web resources on VBAC. The bits abut VBAC on homebirth.org.uk are useful, even if you are planning on having your baby in hospital.

Sorry I can't tell you how things actually went for me, as I ended up having an emergency section at 37 weeks! Lots of VBAC-ers on MN, though, so hopefully some will be along soon.

Oh, my heart really, really goes out to you.

There's so many things to consider about your previous birth experience, having read your story. And I'm sure that ain't the half of it!

These are my thoughts.

Induction.
Well, the good news is they won't be keen to induce you so readily this time! The gel especially is a no-no because of the lack of control the staff have over stopping it if it upsets baby or you. A drip can be used (controversial, but true), but can of course be declined. I'd read up about what term really means though, as 40+10 is no big concern necisarily, if you look at the studies. If happy to wait for a natural start, you can always agree to pop in a couple of times a week for a check.

Midwives.
Oh how dare there be midwives like this out there. It makes me so mad. A good midwife can keep you moving, distracted, focused, calm etc where as a bad one can undo it all with a badly timed quip or unwillingness to accommodate your needs. Aweful woman. Gah!

Hospital
I don't know what you're thinking here in terms of location, but if you are of the opinion that you laboured better under the care of a certain midwife, you would have more control over this at home. Send away any bad-vibe midwives and request a replacement. They will HAVE to send one and you do not have to settle with what you're given (this is true in hospital too- but it's a lot easier somehow to protect your home than a room that isn't even yours!)

If you do want to be in hospital, this is maybe something you should bring up. It's clearly had a big impact on your memories and completely understandable that you don't want a repeat, in terms of care.

Maybe ask to go through your birth notes with a senior midwife too? You may be pleasantly supprised at the positive impact this can have....

Good luck!!!

Sounds horrendous, and somewhat like my first birth experience (although they turned the drip up so I did actually dilate).

I'll give you some useful links this one I thank pacificdogwood for sharing recently. Note all the things that are considered 'protocol' and if some of them don't appeal, make sure you discuss those, and like pressuredrop says get your wishes signed off by someone senior.

And this one is from the homebirth website, but has lots of useful information about VBAC generally.

In the interest of balance, here is the information published by the Royal College of Obs and Gynae.

fwiw my first was an induction resulting in an emcs at 40+22 (yes twenty-two), and the next 2 came all by themselves pretty much on their due dates +3 and +2 respectively. My first VBAC was in hospital, but carefully engineered by my community midwife to be very non-interventionalist (is that a word?!) and the second one was at home, although I did hire an independent midwife as we had moved house and the community midwife didn't seem to be comfortable with my wishes for a low-tech birth, despite the fact I'd done it once before.........

If you do decide that a homebirth is a good idea, do weigh up the risks and benefits very, very carefully and be prepared to have a bit of a fight on your hands if you want it on the NHS.

I would do the reading, make lots of notes about what you want to ask, and take DH with you. If you get a bit upset talking about your first birth, DH can back you up and say it really was that bad and DEMAND they make it a better experience this time round. You will have so much more confidence this time round to tell a MW you are not getting along with to leave and get a colleague - I didn't even realise this was possible first time round.

Anyway, this is a silly-long post now. I hope you have a good meeting and make the best decision for you and your family. Come back and let us know if you can.

Thanks so much for posting ladies, I will have a look at the links and websites etc now.

Just to clarify, I am absolutely not thinking of having a homebirth - the sheer idea of it terrifies me.

Ever since I had DS I have been saying that I would have an ELCS with any subsequent children, and the relief when my consultant said she would do a section at 39 weeks if that is what I want was so immense that I cried.
But, in the interests of making a properly informed decision I am having this meeting, and if I am going to have the meeting then I want to be prepared for it.

carly - that is useful to break it down like that. Consultant has already said that induction is out of the question (which I am pleased about), so if did opt to try for a VBAC and go overdue then it would be an ELCS at no later than 40+10/11.