VBAC confusion questions for cons help

[snoozealot]

not one for those looking for positive stories turn away now! I know there are lots of VBAC threads on here but I've done a search and can't really find what i'm looking for - but if you can point me in the right direction please do!this is long.....

I have an aptmt with my consultant on Monday, I assume it's to discuss birth plans (VBAC -i'm only 14/15 weeks now), and I've got a fair idea of what I want to ask but would like some help.

My situation with the 1st birth I had a booked induction at 40+14, and was given prostaglandin gel pessary. Midwife said baby did a big flip not long after I had the gel, and there were some concerns about heart traces for the first 30 mins or so. It seemed to settle so I was told to go for a walk and some lunch for a while. I came back and they said I'd need to have monitoring due to the blips earlier, to press a button when I felt any contractions and to press another one if I had any concerns on the baby's heart beat. So roughly 2 hours after I'd had the gel, I felt the faintest twinge of a contraction, and promptly the heartbeat disappeared totally. I pressed both buttons and within minutes a hoard of ppl were around the bed giving me a quick scan, something about cord round the neck, ceasarian now, sign here, rushed off to theatre, stripped, mask, injections, out. I came round and DD had arrived safe and well thank god. I was in bits, terrified, and in agony, drugged up mess for a good couple of days. Yuk. After they said they had just 15 mins to get her out and also it was a dry birth - my waters had gone - but I'd not noticed this. No-one made much of an issue about it then - could that have made a difference?

That was two years ago. So now I really want to avoid having a CS, but I don't know how I will, as I know induction is not a good idea after cs. My mum was 2 weeks late with both me and my sister, and was induced both times with us. Not with my brother but he was her 3rd and he was big.

I'm also worried about starting labour naturally and freaking that the same thing (fetal distress) will happen again. First time round I'd done a bit of hypnotherapy with a CD,and was hoping to stay at home as long as possible before going to hospital. I couldn't help thinking after if that'd happened DD wouldn't have made it, and it was only as I was in hospital she survived.

Where do I start with this dilema? I really don't want an ELCS, my partners keen on one, but I don't want to be reminded of before and I really don't want the horrible recovery with a newborn and toddler. Plus mad as I may sound I've always wanted to experience bith. I want a natural birth but I just can't see how it could be managed ok or what questions I need to ask.
hope that makes sense TIA

As far as I can gather, you can opt for a natural birth, and if you go over then there are options I believe not sure what they are though sorry.

I am undecided what I want to be honest, and would need to speak to my consultant before I decide.

In my case I have been very stupid and have fallen pregnant far too soon after my EMCS. I labour very quick and my DS decided the would come 4 weeks early (realised after 3.5 hours of pushing he was brow and stuck). My EMCS started off with spinal but it didn't work so I had general. I didn't feel any worse recovery wise than I did with my VB with DD (ended up in theatre as 3rd stage didn't go to plan, after a 2 hour 5 minute labour).
My worry is if I opt for an ELCS I will labour sooner, and not allow any rupture monitoring time.

All you can do is ask what your options are if you do go over as you would like to avoid an ELCS.

wow. sympathies with you! sounds really complex. I hope you get to work out a good option. do you always start early before due date? you never know I suppose, but maybe ELCS is safest? hard one!

My DD was 6 days early 5lb 13oz and DS 4 weeks early and a healthy 6lb 3oz.

I am thinking ELCS might be best for me, but will always keep in the back of my mind that I might get beaten to it. Just hoping it doesn't come in the car as I was pushing withing 5 minutes of arriving with DS and got there as quick as we could. Think that is playing on my mind too, the what if I rupture before I get there, if of course I rupture at all.

Hope you get the answers you need to help you with your decision, and hopefully this little one will come before your due date so the induction question won't be an issue.

Good Luck and congratulations.

Here are the questions I would ask and I would also do my own research as ime the info I have received from Cons has always been their opinion rather than statistical.

What happened to my waters? Did they go and I didn't realise (you may well find it's documented in your birth notes)? Can they just seemingly disappear? If so, how/why? What is the likelihood of it happening again?

What part did the induction drug play in all of this, if any? Could the baby have reacted badly to the chemicals?

Was the cord around the baby's neck? What part could that have played in the heart trace?

It may be possible that I gestate for a bit longer than the average. What checks can be put in place to avoid induction/csection but enable me to gestate longer, but safely? Scans to check amniotic fluid levels and blood flow through the cord?

FWIW, I know exactly how you feel about wanting to experience a natural birth. My VBAC gave me a lot of closure.

ah thank you so much that's lovely, yes fingers crossed I can just avoid the whole induction scenario altogether. Be ideal if we could somehow mix birth habits I'll have a bit of your early days and you can have some of my late days then we should both be fine. lol. just need a spell for slower labour and you're there!

oops sorry move it x post. I love this site! that really sums up everything I knew I needed to say but couldn't get my finger on it IYKWIM, thank you! glad you had a good vbac x

For what it's worth my waters went with both and I knew they had gone, but mine went in pushing.

Someone may come appear to correct me, but from my experience you would have know if your waters had broken as a gush.
I am not sure what it feels like as a trickle mind you so someone else might be able to advise on that.

Also are you certain that the waters had gone, was it something they mentioned after the section? Also what you had was a crash section I gather, I believe an ELCS isn't as bad as an EMCS and a crash one. If worst comes to the worst. I know it's not what you want, but it shouldn't be as scary as not knowing what is going on and being rushed in, in a panic.

As for managing My DD was 3 when DS was born 4months ago and I will not lie and say it was a piece of urine, but it was manageable and nowhere near as bad as I imagined. The hardest thing for me was not being able to read her a bedtime story for the 2 nights I was in, and the not being able to lift her up to cuddle.

yes I've got my head around the idea that if Ido have CS again it probably won't be anything like as bad, and I found the hospital and staff so excellent I would feel safe and positive about it.

The waters thing is very intriguing! I realised after I got home from hospital and could think a bit better that I might have been gradually leaking for the last 2 or 3 months of pregnancy; when i went for a wee it was like an extra trickle happened, I assumed it was something to do with my bladder being a bit messed up by the weight of the baby. I wore the really light pant liners for the last month. I mentioned it to my midwives several times, even when I had my sweep that I seemed to be having a lot of discharge, they asked me what it was like, I didn't really know how to explain it and I can't really remember how I described it, I guess I was embarrassed. They just said it was totally normal, so I didn't worry. Also i had a lot of fluid retention and swelling from about 5 months on, and it was really painful towards the end in my feet and hands, I think that was like my body was trying to conserve all the fluid it could. The photos of me after birth are shocking my whole face and lips all puffed up!

I'm prepared for a CS if I need one, and think it would be much different second time, but it's good to hear the pain wasn't too bad. I just remember clock watching for when I could take my next dose of painkillers before and I don't really want to be so dosed up for so long if there's a next time! I just remember that whole area feeling so delicate and numb and moving was hard etc., but I have read alot of people on here with good recovery stories so positive thinking!
really well done to you though - wish there was a hug emoticon for how it was with your little girl after

Hello there, also hoping for a VBAC (due in May) so I'd be intrigued to see whether there are any quesitons I havent thought of asking!

I have similar concerns to you. Am pg with DC 4 , DDs 1 & 2 were both overdue and I needed to be induced...my waters have never broken (always had the crochet hook job well into labour!) so have NO idea what that feels like . DD3 3 was ELCS as she was well and truly breech. So with DC 4 I am unsure how things will pan out as I'm determined to have my VBAC!! However, if past history is used as a reference I am unlikely to 'kick off' by myself so gawwwwwwd knows ! I don't think I can wait until it happens naturally either as I'm on Clexane for blood clots

I am very interested to hear more about your theory on your waters...! The extra trickle is ever so familiar! Also the just feeling "damp" sometimes! I hope its just watery discharge (sorry tmi!) but I never had it with my 3 DDs. If you find out thats a possibility I'll be mentioning it to my midwife!! DH has started to call me 'incontinent annie'. Arse!

In fact I feel an invention coming on !!

FWIW my ELCS was such a positive experience in itself, very jovial, although I did demand that my darling Consultant (who also delivered DD) switched from Radio 2 to Heart FM!! hehe.

I really hope all goes well for you! X

I've also been looking into VBAC after a previous crash section - now 30 weeks and not really that much closer to a decision, although baby has been consistently breech throughout so if he doesn't flip round the decision may be out of my hands anyway.

Things I have discussed with the consultant are:

1. How they would rate my chances of achieving a VBAC (they have been prepared to discuss this in quite a lot of detail with reference to my previous labour, and not just quote the general stats).

1. At what point in labour they would want to intervene and do a c-section if things weren't going entirely to plan, and what my labour would need to be like to allow it to continue (they are setting quite strict time limits for me).

1. Size of baby - this was a factor in my last delivery, so I am being scanned for this.

1. Cord round neck issue - was twice round last time, and they have established on a doppler scan this time that the cord is not, so far, round the baby's neck, and have agreed that this could be checked pre-labour: even though it might not be an issue, because it caused complications for me last time I'm particularly paranoid.

1. What happens if I go overdue? I've been told that at term+10 they would admit me and break my waters (trace and scan first to check presentation, cord etc), monitor closely and if I did not go into labour naturally would do a c-section the next day. They have said no to the induction pessary under any circumstances, and probably no syntocinon but that's not completely ruled out.

1. When I need to make a decision by (essentially 32 weeks to book in c-section for 39 weeks, but I can cancel at any time).

1. Recovery from ELCS vs EMCS - I am assured that recovery is likely to be much better, infection rates lower etc.

I am also, for separate reasons, having scans to check the level of my amniotic fluid every 4 weeks or so - could you ask whether they could do this?

It's a big decision, take your time and write down all of your questions so that you don't miss anything out.

Oh wow Grumpy some excellent questions there...am jotting those down!

Have a look at the post below to set your mind at rest if it does end up as c/s.
www.mumsnet.com/Talk/childbirth/1147951-Update-on-ELCS-that-I-didnt-want-an-many-other-recently-started-threads

Emergency caesarean is horrible and nothing like the experience of a planned caesarean. I guess the question is do you really want a natural delivery because you have a burning desire to have one or do you want one because you want to avoid a caesarean because the last was so awful. (Part of the reason emergency caesareans are so bad is that no only is it done in a rush but it is done when the uterus is contracting - ouch!)

Grumpy's list is brilliant. Also get the doc to give you the comparative risks of VBAC versus repeat caesarean.

Good luck:)

clouiseg I think vbac threads are addictive! Sorry, but you won't make your millions, that panty liner that detects amniotic fluid by changing colour already exists :)

Ooooohhhhh really? HOW can I have had 3 nearly 4 DCs and never knew that! Damn! . Oh well will have to keep thinking up my ground breaking invention! If I could just escape the darned baby-brain that is responsible for ideas flitting out as fast as they arrive!

And you're right...! Mind you sooooo many threads are addictive & I don't have much else to do

hi Just wanted to say a big thanks for all your posts - reckon i've got a pretty definitive list of q's on the go now and feel much more like I know what I want to get out of the meeting rather than a sort of vague scratch the head pregnancy brain feeling about it all!

Clouis I really thought you were on to something there! will be googling these magic liners next! so reassuring that I wasn't the only one with the trickly issue but at your man for the nickname. Lol!

Grumpy that's all so useful and I can really relate to feeling anxious about the cord around neck being a problem again- i wondered if I told the cons how I felt they might just say well you'd best just have CS - great to know at least with you that the extra scans are available, will be able to ask now if they can do this.

Ushy thanks for finally clearing up for me why EMCS seem to be more painful than ELCS - that's going to be another question for me as I'm not sure that couldhave been an issue in my case as I don't think I was contracting properly at that point (unless by the time I came round the pessary was still taking effect and I was contracting properly then), so am worried that this just indicates I'm a complete wuss with zero pain threshold!

Hopefully with some good information I'll be able to work out what my desire for a natural birth is about - if anything last time taught me that it really doesn't matter what you think will happen or plan for - expect the unexpected! so now I'm seeing the ELCS as a not so easy to reject option. Not famed for being decisive so I know this will be tough but all your posts really help so much thanksxxx

ooo ps clousieg if it's not TMI, I also remembered that I tried castor oil and hot bath in the big being overdue phase, a couple of days before my induction, and this really got some cramping in the lower regions going IYSWIM! so maybe my waters went in a woosh then but as I was on the loo (Ididn't look!) it went without me realising - I think i'd have noticed if it happened in the bath. hope the consultant has some answers on my mystery waters...

Bless you snooze...I thought I'd be on ebay and here selling my new invention as well....REALLY love to know where to get them

Very best of luck on getting things sorted. X

And my DH does have a habit of keeping my feet on the ground...including the whale noises he makes whilst I'm trying frantically to hoist myself out of the bath...!!

Please keep us posted on how you get on.

hi just thought I'd let you know how i got on. first of all i found the experience of just being at the hospital a lot more stressful than Id anticipated - i hadn't expected anything and found myself all panicky and tearful in the waiting room! how embarressing. i think being there it just brought everything back.
I met with the registrar. She was a no nonsense but nice sort. really we discussed what happened last time and came to the conclusion that there were no answers and no guaruntees in life.
She was very firmly set on me achieving a VBAC. I didn't really come away feeling reassured that I would get the extra monitoring or support I hoped for. I was told they would not scan for cord around the neck as it was so common there was no point, and might be there one day but not the next. It was all too much in one go to get all my answers but not a bad starting point. I've decided to try and talk it over more thoroughly with my midwife and see what she suggests. I've looked into private midwife - can't afford it. I'm now considering buying a doppler to measure the heartbeat myself, and possibly a doula who would support me with a hospital birth as my partner is shaky about being at the birth, also told home birth a no go. I did get answers to quite a few questions. The hospital run a VBAC clinic so I have that to really iron things out. I think I have to be realistic about what level of support a hospital can actually offer. Although my experience of the care I received before was very good, I can't help feeling this was because of the emergency situation and higher care needs I had after. I need to look into what the care is like for a "normal" birth.
still a mystery about the waters - apparently as you go overdue your waters do decrease - but the registrar still didn't offer any other explanation as to why i had none, that i'd need monitoring forthat this time.
I'm building myself up to be more positive and try and rationalise it all a bit more.

Hi snoozealot. I empathise with the panicking by being in hospital thing. I find them very stressful after my bad emcs experience. When I had my hospital VBAC (and I have had one at home since) all I had on my birth plan was 'Motherofsnortpigs is hospital phobic' and it worked like a dream - the care I received was absolutely excellent. Do keep talking about what you went through and what you visualise happening this time.

I'll ask my MW about the 'special' panty liners. When I was offered them last time, I wasn't in the mood for noting down the brand name :)

If you want to pursue the independent midwife thing a bit further, I am paying mine in installments at the mo'. It is going to take me until my DC4 is 2yo before I'll have paid her off though (I am 24 weeks pg now). My IM certainly offers a one-off consultation for about £70 if you needed to talk with someone outside the NHS but very, very knowledgable on all things birth and VBAC related.

Hi snoozelot - I'm in a similar situation, I'm 33 weeks and had an emcs last time (following induction at 40+11) due to DS being tangled in his cord and unable to descend and then getting distressed/heartrate all over the place etc.

I attended VBAC clinic at 28 weeks and was recommended to google the ROCG guidelines (leaflet says www.rcog.org/resources/public/pdfgreen-top45-birthafter.pdf).

They ran through my notes from the first time and advised that the situation is unlikely to repeat itself and so I have a 75/80% chance of achieving VBAC, provided I can go into labour naturally by 41 weeks. As DS was over 4kg there is some doubt over whether they'll induce labour again, in which case it'll be a planned cs at 41 weeks. I assume I'll get called for a growth scan nearer the time... Now all I need to do is make sure I go into labour by 41 weeks, despite a family history of repeat inductions! Have been told to try reflexology. Hope that helps

hi mother of and yelters thanks for your posts. I didn't realise IM's were so flexible with payments so I might look in to that further thanks for the tips. So this is your DC4? are you planning another homebirth with your IM?
Yelters hope it all works out better for you this time. I have VBAC clinic at around 30 weeks too so I guess I'll have a better idea then. Not long for you now! keep us posted would love to know how it goes for you all the bestx

Hi snoozealot. Yes, this is DC4 with my IM. I don't know if all IM's are as flexible as mine - she has just delivered back my terry nappies that were in desperate need of a tumble dry! I am planning on a homebirth, but my SIL is getting married 4 days after my due date and we shall be in Bournemouth for the whole weekend, so I might have the baby there - I'll see how big the bath is :) The pantyliners are called amniosense pads, but I don't know where you can get them. It's probably better to go and see your mw if you think you might be leaking. I hope you get your head round everything.

I planned a homebirth for my VBAC attempt, with NHS midwives.

Strongly recommend joining the Yahoo group ukvbachbac as they are a mine of information and support, there are a couple of people on there who have had VBAC after 4 Csections.

Happy to answer any questions if I can help at all. Above all, remember that you can decline any thing you want. Anything.

So if they say their policy is to do XYZ and you are unhappy with it, you can say no. You are not their staff, you are not bound by their policies.

snoozealot, if it's any reassurance, I had an emcs for failed indution with DC1 and went on to have a successful vbac 9 weeks ago. DC2 was 2 weeks early, spontaneous labour and ROM, whole thing over in 2hrs 11mins, start to finish (and I never once believed the staff when they kept telling me second babies are often very different). Was amazing. I found my appt in the vbac clinic at my hospital completely invaluable - while I remained anxious about what would happen second time round, I was able to let go of a lot of the issues I had from DC1's birth. Good luck.