CFM during VBAC

[peanutdream]

Hi

Does anyone have any interesting links/stats/experiences of continuous fetal monitoring during a vbac. I understand it is standard practice so I can't really get out of it, and obviously don't want to risk the health of me or my baby unnecessarily.

I am a big active birth fan and had a long active labour (5 days) before DS1 was born by EMCS due to brow presentation and distress during and after contractions (I was monitored for the last hours but this was obviously needed and I was happy with that. I would like a shot at a VBAC but don't mind if a CS is needed due to unavoidable circumstances. I would like to be active and upright if that is what is comfortable at the time and again, I'd like to be on all fours/squatting, again, if this is what is actually comfortable at the time.

I am worried that CFM will cause a cascade of interventions and am wondering if anyone has had CFM and coped perfectly well. How did you manage it? What can I do to minimise the impact of being monitored constantly. My worry is that this birth might be entirely different if the baby is in a good position and I don't want CFM to ruin the chances of giving birth as naturally as possible.

TIA for any info...

I would simply say that what you need to remember is why CFM might be suggested.

The significant risk (as in low chance of happening but potential catastrophe if it does) is of uterine rupture. This can happen exceptionally quickly and if it does and baby comes out into abdomen it has less than 25 minutes before it dies, and from 10 minutes with no oxygen you are on a sliding scale of neurological injury

I don't mean that to be frightening - it is less risky than a cord prolapse (say) which is equally potentially devastating and nothing to do with VBAC but that is what the medical team will be wanting to guard against. The risk of rupture increases if you have an induction

So the key is monitoring. The VBAC should (in my view) always be treated as a high risk labour - that doesn't mean slapping a CFM on and leaving you strapped to the bed, it means intelligent monitoring so that at the slightest whiff of rupture starting the team can be assembled and baby taken out with no harm

As always it is up to you to decide what you want and how you want it to happen but it is I think really important to remember what you are trying to avoid as much as what you are trying to gain - if that makes sense?

I would be looking for supportive intelligent help from midwives and doctors, a clear sense that all knew what they were doing and when - quite agree with wanting to have attendance by midwife reading and monitoring labour not a CFM peeping away on its own in the corner....good luck!

thanks shreddinghippo

'I would be looking for supportive intelligent help from midwives and doctors, a clear sense that all knew what they were doing and when'

thanks oxeye for your words of warning - i do understand what you are saying. so how do you maximise your chances of getting the maximum help. if the midwife is ineperienced or mega busy what can you do???

not the maximum help as such, but the best help so to speak iyswim?!

Thanks Peanut, I hope you feel I am supportive because I really am

I am afraid I think what you need is to be clear and calm but insistent - so plan 1 is reading what you can before you go to discuss labour etc and plan 2 is either ensuring you are going to have consultant led or consultant midwife led care and plan 3 is making sure your DH or some other strong non in labour person is going to help on the night

For example, I would insist on knowing that my previous notes were present on ward, that I was on the labour ward not an ante natal ward, that from the moment I rang up or went in everyone knew I was VBAC and care had to be taken of me

I would tend to go in early whatever they say and make sure everyone knows what is happening - you don't have to be rude or arsy, just calm and clear ... if that helps?

thanks oxeye, i will be as assertive as possible without being arsy .

i have just read the vbac handbook (could not put it down - read it last night) and i have to say a big thanks to whoever recommended it. it has TOTALLY put my mind at ease regarding the types of things i want to aim for as well as being realistic about what can happen in the worse case scenario.

the birth stories in the book are fantastically positive regardless of what actually happens and it is awesome to read them from the point of view of women having had sections before.

i am going to read the book a number of times i should think as it is restoring my faith that this is not just at 'attempt' at a vaginal birth that is most likely to result in another section, but a totally normal event that many women have gone through. it may or may not result in any of the medical interventions, including a section, but it has really clarified what i can do to maximise my chances of a successful vbac.

many many thanks for the recommendation...

thanks carlyvita great read!

Aw nice one! I love the VBAC handbook too. So pleased you found it useful.

And also, do be aware that if issues/questions do arise that you need to talk through, AIMS are excellent at supporting women in getting the birth they want.

All the very best for yours.

good luck Peanut, glad you are feeling positive!

thanks carlyvita, i'll see what the mws/consultant have to say and give them a call if i need to, thanks oxeye