VBAC can I have some help with a plan?

[nunnie]

I have not done a plan for either of my previous births, but feel as this one is slightly different I may need one.

Have been told that I need to go to hospital regularly to be measured as my first was a SGA baby and they are saying my son was too, but I am not too sure how they can say that for him really, but they are so hey ho. I asked what the possible outcomes are if baby is seen to be too small and she mentioned they will try one induction and only one due to previous section, and gave the impression if it didn't work then they would leave it . Not overally happy for them to induce really expeciall as if it fails they wouldn't be so concerned as to carry out a CS, so seems a bit pointless really. Can I request this doesn't happen?

Also is it normal or possible to request a CS instead of instrumental delivery? And do I include this on my plan?

What else should be included if anything.

I am not to concerned about what happens if I go over due date, as I haven't done with my other 2, but I suppose this one could be different. Do I include my preferences if this happens? What are my options? I really don't want to be induced if I am honest.

Thank you

Hi Nunnie,
Will try to find some links for you.
Can you give a really brief run-down of your other births, were they both inductions for SGA babies? What weights were your first two? Any sign this on is too from scans or funal heights? Have you had one CS or two?
Do you have any particular preferences about mobility, active birth, monitoring or pain relief? What would your ideal birth look like?
Selina

Ohh yes I can.

DD was born at 39+1 quickly and naturally and not induced she weighed 5lb13oz.
DS was born 36+3 would have been quick but he was brow so EMCS he weighed 6lb3oz.

I had a few scans with my first due to small measurements but the scans all came back fine.
Didn't have any growth scans for DS and infact DD's birth weight wasn't mentioned really.
This time I am only 17 weeks so have only had the one scan and all was fine.

I had a retained placenta with DD which took me to theatre, so mobility isn't an issue for me as I don't know what it's like to be mobile straight after birth.

Only used gas and air with DD, and no pain relief with DS due to arriving when pushing. Had spinal with both once in theatre obviously.

I have been given the impression I will be monitored throughout labour due to VBAC but there is the issue of my quick previous quick progression that might make this impossible.

Ideal birth no theatre, only gas and air, wheelchair delivery to ward A no contact with ward B (ward A is straighforward births), have only ever been on ward B and arrived in a bed.
Would also prefer if there are problems that go direct to CS as really don't want to have forcep delivery for the placenta to then retain and have to have that manually removed too, this is mainly due to the manual removal being unpleasant as it is, without being instrumented first if that makes sense.

DD was only a tiny bit on the small side, and for a first baby and a girl, I would not be especially freaked out. DS again on the smaller side of average but still a normal weight.

I went for a HBAC with my second after a crash CS under GA for DD who was also a brow.

My plan basically said - no induction or augmention whatsoever - the risk of rupture with a VBAC is very small but induction increases the risk significantly.

My plan was essentially - I will go into labour when baby is ready and hopefully it will come out ok. If things are not going right I will have a CS. No alternative.

In the event, I had a long latent stage again, but then went into active labour, but then had 'failure to progress' - or slow progress as my HB friendly MW called it!

I was upright, mobile, labouring at home so I was happy I had done all I can to have a normal delivery. I transferred to hopsital and asked for a CS. They will very unwilling, and told me they would give me an epidural and break my waters.

I told them they wouldn't.

As I had been labouring a good while with no progress and I had refused their kind offer, I got my CS. It was lovely to be awake, I had a spinal block. Incidentally the cord bloods showed baby was getting distressed when they got him out, so I was absolutely right to insist on no intervention and straight to section.

My aim was to avoid a crash section at all costs - I didn't care too much whether I had a VB or a CS to be honest, I just didn't want to experience the fear and trauma I had the first time round, so my priorities may be different to yours.

But yes, you can refuse induction. Or anything else.

Many consultants would not entertain the idea of inducing a VBAC at all, and I would not consent to it personally.

Would recommend having a look at the RCOG guidelines

I am a HCP myself and was confident to refuse after doing all my research, I remained bolshy even in labour, but it is hard when they are trying to persuade you.

Do have a good look at your options and decide what is acceptable to you, and ensure your birth partner is aware of your preferences so they can back you up. I would look particularly at whether you want to avoid things like continuous monitoring, epidurals etc as they will reduce your mobility - which can affect your progress and your comfort.

Great thanks, very helpful.
You do have quite a few options.
re the SGA- Babies can just be small, your DD was not Low birth weight (LBW) at term (cut off is less than 5lb 8oz) did you have any high blood pressure of pre-eclampsia? Sounds like she was borderline and may have just been naturally small.
Your DS at 36+3 was unlikely to be growth restricted (my DD was 6lb 7oz at 38+4).
How many weeks are you now?
You can definetely specify no induction and no instrumental delivery (unless baby is then too low to deliver by CS in which case it might be safer to have ventouse or forceps)
With the VBAC the hospital would usually suggest constant monitoring and a cannula sited in case you need a drip.
Monitoring can reduce your ability to move around in labour and make the pain hard to cope with.
I have supported women who chose
1- To have cannula and monitoring but try to stay active by standing up and sitting on ball etc
2 Chose not to have cannula because the procedure was painful and 'just in case' so not neccessary
3 Have monitoring for half an hour then off the monitors for half an hour
4 DEclined constant monitoring and just had intermittent on a MLU
5 Had intermittent monitoring, no cannula and birthed in a poool in hospital
6 Two clients have had homebirths after a previous CS

Example birthplan of R (who had early onset type 2 iabetes and a pevious CS)

Birth Plan (37 ? 40 weeks ? Birth Centre)
Membrane sweeps at 39 weeks if labour not started naturally
Expression of colostrum prior to labour
Use the birth centre and pool
Initial monitoring for 20 minutes
Intermittent mobile monitoring during labour with 20 minute trace if concerns arise
Active and mobile birth ? second stage in water or all fours/leaning forward
Hourly monitoring of glucose levels (by husband and birth partner)
No glucose and insulin infusion unless blood glucose exceeds 8mmol/ml (agreed with Mark Clement-Jones)
Levels of less than 4mmol/ml to be treated with dextrose only
Only request gas and air/ acupressure / TENs for pain relief
No canular
No antibiotics
Avoiding internal exams where possible
Chord to be cut once stopped pulsating
Natural third stage unless haemorrhage or concerns around time taken. Injection at earliest after chord has stopped pulsating.
Skin to skin contact immediately
Opportunity to breast feed for at least the first hour
No cow based products to be given to the child ? in the case of hypoglycaemia colostrum or dextrose to be used (sibling has significant dairy allergy)
Photos during labour and birth

Induced Labour
Would appreciate both husband and birth partner present if required at various points
Expression of colostrum prior to labour
Active mobile labour / encouraged to walk around
Use of clip to monitor baby
Hourly monitoring of glucose levels (by husband and birth partner)
No glucose and insulin infusion unless blood glucose exceeds 8mmol/ml (agreed with Mark Clement-Jones)
Levels of less than 4mmol/ml to be treated with dextrose only
Only request gas and air/ acupressure / TENs for pain relief unless a low dose of pethidine is specifically requested
No canular unless specifically required
No antibiotics
Avoiding internal exams where possible
Chord to be cut once stopped pulsating
Natural third stage unless haemorrhage or concerns around time taken. Injection at earliest after chord has stopped pulsating.
Skin to skin contact immediately
Opportunity to breast feed for at least the first hour
No cow based products to be given to the child ? in the case of hypoglycaemia colostrum or dextrose to be used (sibling has significant dairy allergy)
Photos during labour and birth

C-Section
Expression of colostrum prior to labour
If possible birth partner and husband in theatre and recovery
No antibiotics
No insulin glucose solution if blood glucose between 4 and 8 (as per previous D&C)
Chord to be cut once stopped pulsating
Skin to skin contact immediately
Opportunity to breast feed for at least the first hour
No cow based products to be given to the child ? in the case of hypoglycaemia colostrum or dextrose to be used (sibling has significant dairy allergy)
Photos during labour and birth
Back on feet as soon as possible
Minimal pain relief
Assistance with breast feeding

Links for info

VBAC support group
health.groups.yahoo.com/group/ukvbachbac/

More infwww.mother-care.ca/vbac.htm
www.mother-care.ca/affirmations.htm
www.acegraphics.com.au/articles/painlabour.html
www.acegraphics.com.au/articles/sarah01.html
www.acegraphics.com.au/articles/andrea21.html
www.mother-care.ca/pos_pain.htm
www.mother-care.ca/pos_sym.htm
www.mother-care.ca/pushp.html

www.mother-care.ca/vbac_safety.htm

Also some more info at-

www.homebirth.org.uk/vbachome.htm
www.acegraphics.com.au/articles/wagner03.html
www.midwiferytoday.com/articles/whyhomebirth.asp
vbacfacts.com/hbac/

Fantastic and inspiring videos-

www.onetruemedia.com/otm_site/view_shared?p=2a4e81fbf0f66accb8afce

Try ordering this-
www.natalhypnotherapy.co.uk/1676/30571.html

Hope that gives you some ideas.
Have you considered a doula to support you?
S x

Thank you that's very helpful. I don't want an epidural and have managed previously without the need excluding the manual and the EMCS of course if that makes sense.
I do progress very quickly so continuous monitoring is hopefully not going to be likely if I make it to hospital at all.

My notes say I will have an appointment at 36/40 to discuss my decision, but DS was born the weekend before my 36/40 chat about my retained placenta plan and I didn't have anything in writing as I wasn't ready not that it mattered as it wouldn't have gone to plan anyway.

So this time I want to be prepared if that makes sense.

I really want a VBAC, I just would prefer them not to induce me if they think the baby is small, as you say DD was only just on the small side, and DS was also small, but he was also 4 weeks early which should surely make a difference! And I want as little intervention as possible and no instrument delivery at all. Would prefer to go straight too CS if there is problem.

I have fallen pregnant very close to my EMCS so I do want to reduce my risk of rupture as much as possible and also feel I have some control during this labour as I didn't have any with DS.

Thank you, my blood pressure has always been fine, both my pregnancies were reasonably trouble free.

I am only 17 weeks, so I have plenty of time left.

What does constant monitoring involve sorry?
With my previous I have been attatched to heart trace thingy. With DS after about an hour of arriving until I was taken off to go to theatre, was this because he wasn't moving down maybe?

Yes the constant monitoring is the two belts that are attached to the monitor, they can quite easily lose the trace so they usually encourge women to sit still on the bed, but to help baby come down without needed intervention its better to be upright standing etc
Sounds like you have a very good chance f having a straightfoward vbac without intervention.

I do hope so Selina, that would be lovely. Would quite happily deliver in the car. DH isn't too keen on that idea though.
There will be a huge sigh of relief when all comes out naturally and healthy including the placenta that is my ultimate wish.

Have you considered a doula? Just to take that anxiety off and remember al the things on our birth pla, and suport your husband too.
They can be at home with yu in early labour and help with the transfer to hospital.
They can remember al the bits that usually get forgotten but can make he difference to feeling your labour is positive and your choice.
If you have any questions about it then please o ask.
S x
PS got some vbac stories on my website-
www.magicalbirth.co.uk/6.html
The pic on the front page is a client who i have been with for 2 vbac's, hr second in a midwife led unit, she had him standing up, born in his bag f waters, with no exams or mnitoring and a natural third stage

I have, and someone on here was asking on a forum to see if there was anyone local as I an't find a local one myself.

This was when I was 99% sure I wanted an ELCS though.
Now I am 99% sure I don't and want to try for a VBAC. My DH is very good, but I can't really expect him to remain rational for me so a rational person with some knowledge would be great I think.

DH works away so it would take the pressure off there aswell.
Not sure if anyone was ever located though :(

Will obviously have to discuss it with DH but I am quite certain he would be happy as it makes his job a bit easier.

Whereabuts are you? or PM me if you dont want to put it on here. I think a doula is as much there for the partner, its to support the two of you, I always work as a team with partners so I think even if initally sceptical they tend to be big converts after!

I live near Preston, and hospital will be Sharoe Green Unit in Preston.

~On the DUK website I've found-
doula.org.uk/content/abi-yaffe-doula-profile
doula.org.uk/content/laura-jefferson-doula-profile
These are a bit further away but lots of doulas travel so you could try them-
doula.org.uk/content/abbie-kohanzad-doula-profile
doula.org.uk/content/michelle-every-doula-profile

S x

Thank you, I have emailed the latter one as she is the only one who mentions covering somewhere reasonably close to me so fingers crossed she will cover here too.

You have been really helpful and I really appreciate it.

x

Probably a stupid question but do hospitals frown on Doula's? Will they see it as a way of me saying I don't trust them?

Ohh I have just found someone else very near on that site too, can I email two?

I think most hospitals now are used uo doulas going in and are happy to see women with good support, especially when its busy.
They will definetely not see it as you not trusting them, doulas are not there to give or contradict medical advice, just to make sure you are emotionally and physically supported.
I would e mail as many as you find, doulas like women to feel really comfortable with them and encourage women to meet a few doulas to find the one you 'click' with (different doulas have different training/philosophies/skills like massage etc)
Hope you find one you like!
S