VBAC - can I have a mobile labour?

[TrinaLuciusMalfoy]

Hi all
Due DC2 in 2 weeks and my consultant has been very pro-VBAC from the word go (excellent as I thought I'd have to fight for it).

However: there seems to be some indecision on using the pool for some of the labour (I appreciate birthing in it is probably out) and the midwife I spoke to yesterday basically said 'you'll turn up, we'll get you on a monitor in bed and that's where you'll stay' (I'm paraphrasing). I'd been having some last minute heeby-jeebies about dropping the whole idea and going straight for an ELCS anyway and this conversation really didn't help! Add to all this I've been having problems with my hip and my physio has told me that labouring on my back would probably give me substantial problems walking again afterwards.

Can anyone give me a positive VBAC story where they were allowed to refuse continuous monitoring and stay mobile - or even spend a little bit of the labour in the water? Because if it really is 'labour in bed on your back or nothing' then I'll skip it thanks!

(Back story, last labour 70 hours, finally made it to 10cm after about 67hours and epi/induction, DD was LOT (or ROT, notes can't make up their mind) and got stuck, EMCS was the only way she was coming out.)

I had a VBAC...the story is not 100% positive but may be helpful to you...

Yes the hospital/midwives attitude was pretty much as you describe - 'stay on the monitors'. I had monitors where I should have been able to at least get up off the bed, get into different positions, move around the room a bit (wireless, on elastic belt around the bump). But in practice whenever I moved the monitors lost contact and stopped working so the midwife said 'for it too work you have to stay in bed' (...grrr...).

I got up to go to the loo and took the monitors off and felt so much better walking around, so when I came back I didn't put them back on.

What helped me was that I had a doula, who was watching me the whole time - -- and because she was there monitoring me visually (the contractions, my movements, pain levels etc...) I didn't feel like I needed the monitors as you do when the midwives are only periodically checking and they are relying on the machines to do the work for them (even though the machines make labouring harder...). She knew how the labour was going just by monitoring me on an ongoing basis, and I think this also made the midwives relax a bit about the lack of electronic monitoring.

This was 8 years ago, so the equipment may have got better. ...but on the other hand it is not too late to get a doula, it was the best money I ever spent.

By the way my first labour was much like yours - second was much quicker!

Good luck.

Thanks for the answer name but - does anyone have a positive experience where they didn't have to lay out cold hard cash for the privilege? Doula really isn't an option :(

I had a VBAC six weeks ago. I refused continuous monitoring, the midwife held the monitor onto my abdomen for short periods of time - I'm not sure how long as I was only there for an hour before I started pushing. They did want me to have CFM but they can't make you! I gave it a go but found it only got a trace if I sat laying back on the bed which made the contractions unbearable, so I said I would not have it.

You can't force them to let you labour in water as that's up to them (although it's worth a try) but you can refuse interventions etc. I also refused the cannula in my hand. I had it written clearly in my birth plan and my doula acted as my advocate, but if your birth partner can do that for you I'm sure you will be able to manage without a doula. But you could stay at home in the bath for as long as possible then go in.

Clearly there is a (small) risk to refusing CFM and to going in as late as possible but you will have to judge that for yourself. It's very difficult, I was lucky I think in that I didn't have to argue with the midwives for me to stay at home, in fact they didn't want me to come in because my contractions were only 2 in 10 so they thought it was early days - but each contraction was around 2 mins long from early labour and when I got to hospital I was almost 10cm so I didn't have a lot of time in which the midwife coudl pressure me! The first midwife when i got there was pretty insistent on CFM but luckly she had a shift change and then the second midwife was happy to go along with my wishes without arguement.

Hm, interesting points raised. I'm not bothered about the cannula - I suffer from needle phobia and had made arrangements last time that I'd have the cannula put in when they admitted me so that it was being done when I was a bit more with it - didn't want to punch out a midwife who was trying to cannulate when it was URGENT! I'd probably do the same this time for my own peace of mind, they can always take it out again.

I can't sit in the bath at home because of the afore-mentioned hip problem - it's excruciating to try now, I can't think how much worse it'll be when my pelvis is trying to dismantle itself! It's why I like the idea of the pool at the hospital, it's big enough that I won't be forced into an uncomfortable pose. Didn't get to use it last time as when they broke my waters they thought they were stained so 'baby must be in distress' - still left me to carry on labouring for another 14 hours, they can't have been that worried

I know the risks of refusing CFM, and I'm not silly enough to refuse it right to the end - I just want to be able to stay mobile as long as I can bear to, and I know CFM will restrict that.

Consultant has said I need to head in when contractions are between 5 and 10 minutes apart. As hospital's 40 minutes away, we're going to err on the 10 minute side - as soon as things start to dip below 10 minutes we'll be on our way, especially as we have to drop DD off at my parents' first!

I think all in all I'm just dreading this all going the same way DD did and wanting it to be more positive with me in a little more control - and I KNOW if I'm just hooked up to a monitor from the second I get into hospital everything's going to stall and it'll be a CS again. Given how long DD took, I can't bank on it being quicker because it's my second - and much as my consultant's happy that I got to 10cm (ie didn't stall at 7 or something), I'm still not convinced that I did - midwife was a TOTAL COW and I still feel in my gut that she lied to hurry things along because she'd already decided that it was going to be a section

Hi TLM. I had a VBAC 9.5 years ago (just so you know this is not a recent experience!) without CFM, following an elective section for placenta praevia.

I refused CFM, with the backing of my consultant, who said that he didn't think it was necessary and (importantly, I think) wrote it in my notes (signed!). This made a big difference, as it was not just 'me against whatever midwife showed up on the day', iyswim. He also agreed that I could labour in the pool, though he wanted me to get out for delivery.

As it happened, I stayed in the bath at home for as long as I could (appreciate this won't work for you), then went into the hospital using Tens. I was monitored for about 10 minutes, but then allowed to move about. The pool, sadly, was already in use, so I opted to get back in the bath and I stayed there till I was in transition. When I was in transition a doctor came to do my cannula, and I took one look at her and threw up , so she went away, intending to come back in a bit, but by then I was pushing and she didn't bother! All the time I was in the bath a midwife would come by every 20-30 minutes to monitor the baby's heartbeat with a handheld monitor that could be used under water (so I didn't have to get out).

I got out of the bath to push and was allowed to adopt whatever position I wanted (though ludicrously they insisted on putting me in a wheelchair to get from the bathroom to one of the delivery rooms, where I'd have much preferred to have walked...). I laboured kneeling up on the bed, holding on to the frame, which was a good position, I think. I could have done maybe with moving a bit more because the baby crowned quite quickly and then got a bit stuck, but I was never made to (or even encouraged to) lie on my back. The midwife just came round the front of me and monitored me with her hand-held monitor on a regular basis.

Obviously I was lucky and didn't get into any difficulties, but it was a pretty easy birth with no pain relief at all. I was very happy with how it all went.

I hope this is useful. My best piece of advice is to try to get your consultant to endorse your refusal of CFM in writing...

All the best...

Thanks Totally! Hopefully then it is just a question of clearing it with the consultant - I think I'm just anxious as I'm not seeing him until next week, and that feels a LONG way away right now!

Now if only I could get TENS to work...

I'm hoping to HBAC.... so definitely won't be having continuous monitoring!!

I've had two vbacs and both were much better than an emcs. DS 2 was my 1st vbac. To be honest right now I can't remember if I was strapped to a machine for continuous monitoring. I left it late going into hospital and was pretty much 10cm when I got there. THere was a bit of a concern about his heart rate dipping at one point so the midwife got me on all fours on the bed.Ended up with a ventouse but totally got the 'high' feeling after he was born.

DD1 was my 2nd vbac. I seem to remember more talk of continuous monitoring and them wanting to put a canula in - not sure if my memory of this birth is just better or if the hospital became more insistent . Anyway, I refused a canula and continuous monitoring - I agreed to intermittent listening in and the odd half hour strapped to the machine.

I was pretty much 10cm on arrival again but didn't progress as quickly as they wanted. Actually got prepped for a c-section (got as far as having a gown on and an anti acid injection)as the consultant who examined me thought there was a lump on the babies head. Everyone left the room to get things sorted, husband told me to push, then had to run and get someone back in the room and I managed to get her out. Turned out she was sort of side on and with a hand on her face .

Can't say it was a totally positive experience as I did feel that some of the midwives wanted me up on the bed as it was easier for them and I felt totally violated by the consultant examination - he did kind of explain what he was doing but it was horrific. I burst into tears after a smear test a few months after the birth as it all came flooding back. But I would do it again rather than have a section.

So in summary yes vbacs are absolutely worth it imo, but you may need to be strong/stand your ground to try and get the birth you want. Make sure your partner knows what you want and will stand up for you too.

Emsies have you mentioned to your midwife that you want a hbac yet? Just wondered what reaction you've had. I'm sort of hoping for one too, although I'm worried about our drive as an ambulance wouldn't get up it. Midwife was ok about it (except for concern over the drive) and one consultant has advised against it but didn't kick up a fuss. The other consultant is totally against it - but I've kept quiet earlier on in the pregnancy when I had appointments with her and have managed to avoid her recently!

I've said to mw from the start I wanted a hb - first booking in appointment she was cautiously supportive as I was otherwise low risk and said she'd arrange for me to see the supervisor of midwives.Second appointment she said "well you do need to listen to the consultant as well" and didn't seem as positive.

The trust is very pro VBAC but I dont think the consultants are pro homebirth. I have my consultant appointment on monday... Deep Breath. We're not far from the hospital (10mins) and I'm happy for intermittent monitoring and to transfer if mw isn't happy.

I feel no 1 went so badly because of the typical long induction, being flat on back, continuous monitoring, stream of different staff, nasty examinations, etc etc and then accused of ftp. Then they realised I had and tried forcepts but hte consultant was so rough and gave up! :( There is no way I want to go through that again.

my VBAC experience 6 years ago was this..I was not contiuously montored until near the end..and even then I remember it being on me but still standing up.. the MW did mobile monitoring before that... I gave birth on the bed slightly raised with pillows under my breasts on all fours..monitor still attached..it's possible...I did definitely not want to lay on my back.. and didnt.. it was great.

When discussing having an ELCS or VBAC with a Consultant (not mine) I was told no waterbirth, no homebirth and constant monitoring and also a cannula to be in place.

Am going to see how strict this policy is at my 36 week appointment as I really don't want the lying flat option would prefer to be able to move around.

Our trust is pro-VBAC but like you nunnie, I think officially its no waterbirth, no midwife unit, no homebirth, constant monitoring and canula.

My midwife said that assuming other factors were still ok, simply having had a c section in her opinion wasn't high risk, which seems to be what a lot of IMs say online. Ho hum. Will see how I go on monday! Maybe if I argue for homebirth I might be able to barter down to active birth on midwife unit ;)

They can't force you, they can just recommend but I am like a shrinking violent when it comes to standing my ground, I go in with the intention of being firm grrrrrr, but then I cave. I have this unfounded opinion that if I go against their advice they will treat me like poo during the delivery and I don't want to wind up the people I will have surrounding me at the magical moment when my child is born.
Should really grow some testicles shouldn't I? On another note think I might be with the swelling down there ;)

I had a vbac a couple of years ago - I agreed to cfm - they'd given me a low level of synto to kick start things after my waters had gone, so already had a drip! but was totally mobile for most of my labour - walked about or bounced on the ball, for all but the last hour of my labour when I was knackered and needed a lie down!

Although I ended up with a ventouse too (heartrate dropped v dramatically) it was a great experience. I'd had an elcs first time round, and I'd definitely go for a vbac again if we have a third.

Not quite what you asked for, but hopefully positive none the less!

Hi Trina,

You didn't used to have a name with Hands and or Turtles in it at some point did you? If so we've crossed paths on the LOT threads so I'm wishing you all the best for the big day, really, really hope it goes well. Even if its not you, I know how you feel DS was an LOT one and stuck like a guddun too and his birth was not good, I felt ignored (I was telling the midwife for hours I thought something was wrong and he was stuck - he was just so high up and I had no urge to push whatsover), demeaned (when she cornered me and broke my waters with me begging her not to) and ultimately ended up in the HDU after complications from having to have a section. I'm trying to keep calm while planning this DC's birth in about 19 weeks time but it really isn't easy.
FWIW I haven't seen my consultant yet but I've seen three lots of mws now who say they are happy for water VBACs and no CFM. In terms of outcomes DC is safer with intermittant than continous unless continuous is being continously monitored live - otherwise all it does is show problems after the event. I just have to be admitted to the MLU, they admit this could be tricky because I had a 1300ml PPH after DS (almost certainly due to a section after two plus hours of pointless pushing) so the consultant will want me to go for consultant led care, but I'm hoping I can persuade her to write me a note letting me into the MLU (just over the corridor). If you do want to labour in water, you will have to hold out and refuse to have a cannula btw, as I've been told they wont' do them for water labours. Anyway I really hope it works out for you.

Hi - no, we haven't crossed paths before, have only ever been this name and Trinaluce :)

Interesting what you say about the cannula though: I'd had the cannula put in on admission for phobia reasons but they said I couldn't go in the water because of suspected meconium in the waters. It will be interesting to ask my consultant if a cannula can be used in the pool, see what his answer is...

Like emsies and nunnie Our trust was pro-VBAC but was no waterbirth, no midwife unit, no homebirth, constant monitoring and canula.

I opted for a second CS in the end as i really didn't want to be fighting everyone and being in labour. As it happened i had a great 2nd CS (first was fine too for placenta praevia) and was almost easier in a way as i knew what to expect IYSWIM

Hope all goes well for you Trina and you do manage to get the birth you want. I would def say this will have a MUCH higher chance if you have it in writing in your notes from the consultant. Good luck

I had a VBAC last year and I just wanted to add that CFM isn't always as limiting as you might expect.

I had pre-eclampsia developing so was induced with synto so they were seriously determined to monitor me closely. But the midwife was really lovely and quite literally bent over backwards at times to maintain the monitor manually while I lurched around mooing. I was quite inactive for a while thanks to diamorphine but on the whole it was a really positive experience and DD was born quickly and without problems (except a bit of a tear). So don't despair :)

Does anyone know why there's reluctance to be allowed to vbac in MW led units attached to hospitals?

No idea RITA, here the midwife led unit is about 30 minutes from the hospital so I can understand the reluctance there, but not if it is attached.

That wasn't helpful was it?

Hi nunnie.. This is my first time posting on MN so apologies in advance if I breach etiquette in any way ;-)
I had a VBAC with my DD (DS was an emergency section due to undiagnosed breech). Like you I was told the birth had to be monitored, on a bed etc. etc. I was desperate for a water birth as I'd been in a midwife unit with DS1 before transfer to the hospital and it was a lovely experience.
My consultant and midwife were very negative and toed the party line but a bolshy friend of mine in a similar position got "permission" for a HBAC so I plucked up the courage and escalated to the head midwife. I had a meeting with her and she outlined all the risks but she was very supportive and agreed to take the case forwards to the registrar who agreed that I could go to the midwife unit and I was to be the first VBAC there!
In the end, it all went a bit Pete Tong as my waters broke but labour didn't start, I was kept in and ended up having her in 1.5 hours from first contraction BUT perseverance and getting it officially signed off is key.
As someone else said, they can only advise you so it is definitely worth exploring further and getting past the jobsworths on the front line.
Best of luck!

Hi there.
Just thought I'd add that I had a very positive experience of an active VBAC labour and birth a couple of weeks ago by opting for a home birth. This way of course I had the dedicated care of midwife so continuous monitoring not as important. I was checked regularly and my body's progress was always being observed closely. I felt really safe all through the labour.

The pool was awesome for my back, which was my major problem this time round as baby was back to back. I did request a transfer after I stuck at 8cm for a long time and suspected a section would be performed. Once arrived at the ward I accepted a short stint (20-30mins) on the belt monitors in order for them to get a baseline, but then had to take them off in order to concentrate on birthing my son. During this time staff were holding the ends of monitors to my tummy- much less intrusive than belts!

There is a lot of confusion over the benefits of continuous monitoring and I'd personally rather have a midwife with me all the time than a piece of equipment that limits my ability to manage the pain and give birth effectively.

I personally don't believe that a VBAC can be classed as seriously high risk in and of itself anyhow. Statistically ANY pregnant woman is much more likely to have a prolapsed cord than a VBAC woman a rupture!

Though obviously, each to her own!