VBACing in Water and Monitering

[kitstwins]

God, what a waffly title.

I'm 34 weeks and hoping for a VBAC after a truly awful caeasrean first time around. I'd love to be 'allowed' to labour in water at the hospital because I know this dramatically increases my chances of a successful VBAC but I've been rather sniffly told that this isn't possible for a VBAC patient due to the risk of scar rupture.

However I've read somewhere on Mumsnet that continual fetal monitoring was no more effective than intermittent monitoring with a doppler and I'd love to get my hands on the actual statistics so I can blind my consultant with my research when I see him tomorrow (can't find the relevant thread through searching). Basically, if I can show him that I'm at no greater risk with intermittent fetal monitoring and that this can be performed in a pool using 'telemetry' (sp) monitoring then there's no reason why I can't/shouldn't be allowed in water?

Am I talking total rubbish? Would love some advice and also any other tips for pressing my VBAC case.

Any help much appreciated.

Here's a review of 12 studies (including one high quality study of 13000 women) published in 2006. www2.cochrane.org/reviews/en/ab006066.html

Here are the author's conclusions:

"Continuous cardiotocography during labour is associated with a reduction in neonatal seizures, but no significant differences in cerebral palsy, infant mortality or other standard measures of neonatal well-being. However, continuous cardiotocography was associated with an increase in caesarean sections and instrumental vaginal births. The real challenge is how best to convey this uncertainty to women to enable them to make an informed choice without compromising the normality of labour."

It is your choice re: monitoring, though I know sometimes you can be made to feel as if it isn't. On the other hand you may find your consultant v supportive.

Do come back if you don't feel supported - I will point you in the direction of who to speak to to push this forwards.

Have you read the AIMS 'VBAC' and 'Am i Alowed' booklets?

Have you thought about a doula to support you while you VBAC?

speak to a supervisor of midwives in the hospital you plan to deliver at. And also go armed with the cochrane review in your hand too.

Its your choice and your baby.

If you tell them you are sensible etc, and would get out of the pool if you REALLY had to, then they really have to go with your wishes, howver you have to be strong.

I know at my hospital it would be discouraged, but we telemetry CTG and a midwife is busy preparing a presentation on just your scenario!

Good luck

Squiggly & Alimat thanks. I'm using a doula (again, anything I can do to improve my chances) and I've done a hypnobirthing course also to try and manage my fear of hospitals (don't like them since my caesarean four years ago). I'll read up on Cochrane tonight and also press for an answer on telemetry ctg. I just know I'm going to come up against a brick wall of 'no, that's not advised' and I want to be able to ask them to clarify why not. So this is really helpful, thanks.

Just also discovered that there is a VBAC clinic at my hospital, although no one has seen fit to mention this to me when I've raised the VBAC question at previous appointments. Anyone would think they don't want me to have one!

I've had counselling and sessions with an obstetric consultant at the hospital after a v traumatic labour and emcs with my first child. I couldn't contemplate getting pregnant again until I'd talked to somebody about last time and a hypothetical next time.

The consultant was fabulous. They don't have telemetric ctgs but he was very open to discussion about waterbirths and intermittent monitoring. I went in armed with stats and he knew them all backwards anyway. He was very, very clear on the risks and how much it was my choice but it made me feel a lot better to know there are consultants out there who understand the need for control and flexibility for the labouring woman. Can you ask around to see if there are any likeminded consultants at your hospital?

it might be worth asking if your doula knows what your consultant's view on this is and who the VBAC friendly consultant's are...

The Cochrane review doesn't relate specifically to VBAC though but to birth in general. The risk of VBAC that's different is that there's a (very small) risk of scar rupture. The RCOG guidelines www.rcog.org.uk/files/rcog-corp/GTG4511022011.pdf refer to research that shows "an abnormal CTG is the most consistent finding in uterine rupture and is present in 55-87% of these events".

I am hoping for a VBAC in May and really want to avoid continuous monitoring but I haven't been able to identify the evidence that shows intermittent monitoring, which I would vastly prefer, to be as safe (or almost as safe), although I've seen this stated in other posts here. If anyone can point me in the right direction, or pick holes in the RCOG guidelines, then please do as I want to get some more clarity in my mind before I have my 36 week appt with the consultant (not till April).

Just to add, I'm not trying to pick an arguement here or upset anyone but am genuinely wanting to find out what the research shows, if it's possible, as a fellow VBAC-er :)

Hi

I laboured in water for my VBAC last year. My consultant midwife was very supportive. The hospital policy written by her said that VBACers in water should be listened to with a handheld monitor 1 minute in every 15 which I was very happy to do. I agreed with them from the outset that if it showed any irregularities I would get straight out of the pool. It might be worth asking your consultants why you're not 'allowed' to do this at your hospital. The fact that I was 'allowed' to do it at my hospital (QE2 in Welwyn) would suggest that the research shows it to be safe. I find it very odd that it's down to individual hospital policy rather than at a national level.

I second the recommendation to read the AIMS publication on VBAC you can download it online if you want to read it before tomorrow. Knowledge is power! Good luck with your meeting.

Very useful thread, thank you.

Also hoping for VBAC in May but consultants are urging me to have ELCS. Had a phonecall at home from consultant anaesthetist to discuss my case! Funnily enough, he, the obstetrician AND the midwives all assume I'm having another CS and start conversations with: "so when is your caesarean booked for?" followed by surprise when I reply "never, I want a VBAC"!!

Any info about intermittent monitoring in labour would be wonderful as I can think of nothing I'd hate more than being confined to a bed! I like to be mobile in labour & would love to use the pool! . Will be watching this thread avidly!

Timely post from the midwifethinking.com blog.

Worth a read to get some perspective/support/ideas and then discuss with your midwife?

midwifethinking.com/2011/02/23/vbac-making-a-mountain-out-of-a-molehill/