Obstetrician scared dh re vbac

[tonton]

Finally saw obstetrician. I'm 28 weeks and had an em cs last time. She didn't have my notes fromlast time even though I'd given all my details to thwem ages ago.
She was very pro vbac (based my vague meories of last time, being due to fetal distress). But then explained risks of scar rupture 0.03% risk of rupture than 1 in 10 risk of brain damage or death of baby. DH now completely freaked out, saying he doesn't want a brain damaged bsby, would rather it died, and doesn't understand why I don't just opt for a elective cs. I suppose both options sound bad to me so I was just planning to go with the hospital's rec of attempting a vbac. I'll be monitored and able to stasnd but not to move around (they only have monitors with a short lead).

do you meant that there is a 1 in ten risk out of the 0.03% that do rupture? that works out to only be a 0.003% risk to the baby, which is extremely low! There are risks with a section too, it sounds like a safe option to me. I think yo need to reassure him you are being monitored and will have a section at the first sign of trouble.

I had a previous section and like you it was because dd1 was in distress and needed out. I went on to have a successful VBAC, the hospital was pro but would have gone with whatever decision I made.

They will not let you labour for long, to avoid scar rupture, so I had an epiostomy (sp?) to speed things up a bit, all went well.

Glad I had a VBAC as it meant I recovered faster and could look after dd1 easier (picking up etc), but I would not have been disappointed with having another section.

My dh went green at most of my consultations at the thought of What Could Go Wrong so yours is in no way odd!

They definitely need to get your notes though from last time and go through them, very shoddy not to have them at this appointment. Mine were very helpful to the consultant as she then knew all the reasons for the previous section. Demand they find them!

xx

Hiya, I can really understand where you are coming from and don't blame your dh for being freaked out by it! I had an emergency cs the first time and was too scared to try for a VBAC even though the consultant kept turning me down and telling me to go away and think about it. I'm now planning my 3rd cs and the consultant told me this time that even after 2 previous cs's there was still a 75-85% chance that I could have a perfectly safe and normal delivery, which I thought was pretty high - I remember when it used to be that after 2 you had no choice but to have another cs.

I hope that you can both reach a decision that you are both happy with in the end and it all goes well

negotiate a time limit on your trial of labour if you are opting for a vbac, i had one of just 6 hrs and in the end had a crash c/s (much better to have a planned one, get epidural in early! ) I think your consultant was being honest, informed consent is about giving as much info as you need to make decisions...dh's are usually pretty spooked by anything so try reversing the figs eg..99% chance of everything being OK

I think you need to speak to consultant again the stats sound wrong.

I had 1st child by c-section - and almost delivered 2nd child naturally - but they feared my scar was unsafe and I had a second c-section - unless your recolds prove otherwise trying to deliver naturally should offer no higher possibility of problems than any one in labour (other than risk to scar) - unless they can show you a specific reason from your notes.

I am thinking about all this myself ATM, as I had an elective caesarian last time (DD was a transverse lie) and the MW has suggested considering VBAC this time. You might want to think about your own position re the probabilities. My hospital's leaflet on VBAC states that 7 out of 10 VBACs are sucessful - meaning that they don't require an emergency CS. I would regard a 30% chance of having one as rather high (but, then, as a former IVF patient, any probability over about 20% sounds quite possible to me!). The data on risks to the baby are also rather striking. Probabilities of death for the baby are very low for both VBAC and elective caesarian, but they are ten times higher for the former than the latter. Again, that seems too high for me. I am going to research this in more depth and am starting to trawl through the medical research literature on all this. CAT me if you would like me to e-mail you some of the material I'm collecting.

or even successful

Can you try telling him that if you have a CS he will have to take six weeks off work as you won't be able to drive?

find other statistics to show him. 0.03 is MINUTE.
find out what the likelihood of you being paralysed by spinal block etc etc is... a caesarean isn't risk free! when presented with ALL the pros and cons of vbac vs elective caesarean he may well come round!

OM, have emailed you on this, and can dig out some more if you wish.

This is purely anecdotal so give it what weight you will but a doctor acquaintance told me that drs themselves tend to go elective cs after a cs (she did). I agree with others who say you should have a good look at all the stats before making a decision.

Oldiemum I didn't know there was a higher death risk with vbac than cs. I will cat you as research is always useful.
Those stats were 0.03% chance of rupture then in event of rupture 1 in 10 chance of damage to baby, so yes, 0.003% which does sound low!
Thanks for all your comments. I know statistically I'll probably be fine with a vbac, but his fear always scares me more! Hence I've hired a doula.
Luckily we live near the shops etc so I can manage well without driving.

I saw a consultant for the same reason yesterday. I was also told about the 0.03% risk of scar rupture, but luckily no mention of the 1 in 10 risk of brain damage or death of baby if rupture does occur.

I think you've really got to look at the likelihood that it won't happen - you've got a 99.97% chance of not having a rupture - very good odds. There is a greter chance of the baby being cut during the c/s, than there is of you having a rupture.

Also, a lot of these 'ruptures' are discovered during a c/s, which might not have been because of a suspected rupture (IYKWIM!), so there is an argument that a lot of these would otherwise have delivered fine, without ever fully rupturing. I hope that makes sense.

If you want to find out more about all the statistics, then this is a great yahoo group:

Anyone who wants to search the literature themselves can do it through the PubMed database
here Just type in VBAC to the search 'for' box. You will be able to look at abstracts of articles, but need an ATHENS username and password to get at many of the articles themselves.

This is a really good article on the risks of uterine rupture - Birthrites.org . If you scroll down there is a section with the risks of various things, eg:

Your risk of dying from a rupture of the uterus is: 0.0095% = 0.95 in 10 000 VBAC deliveries
Your risk of dying during an uncomplicated vaginal delivery is: 0.0049% = 0.49 in 10 000 uncomplicated vaginal deliv.
Your risk of dying during an elective repeat ceasarean section: 0.0184% = 1.8 in 10 000 elective csecs
The risk of your baby dying from a rupture of the uterus is: 0.095% = 9.5 in 10 000 VBAC deliveries
The risk of your baby dying during any type of delivery is: 0.12% = 12 in 10 000 births

There are more in the article. Doesn't have the risk to the baby in a cs though.

Thiose are useful stats. Pity about the one that's missed as you say fruitful. Gosh it's alarming me to see 'death' in black and white, even though I can see the risks are low. Weird that risk of dying from vbac is slightly better than from birth in general. A statistical quirk?

I guess "any vaginal delivery" includes uncomplicated births, vbacs, and women with really horrid but undiagnosed complications. Like those women who had a scar rupture even though they'd never had a cs.

This is useful too -

A Guide to Effective Care in Pregnancy and Childbirth - VBAC chapter

Just reading the birthrites.org article, which is fantastic, and really puts everything in perspective.

One quote jumped out at me: 'From the statistics you can see that any doctor that tells you that a certain way is risk free is lying. The only risk free way to have a baby is to adopt.' So true!

I wanted a VBAC with my third pregnancy especially after doing a lot of research. I had my third son two weeks ago, and was monitored closely throughout although I couldn't really move about much because of that. He had to be delivered by forceps but that was due to his position and there was no problem with my scar. I am feeling much more mobile now (two weeks on) than I was two weeks after my C-section and can lift my toddlers, drive etc. If I get pregnant again I will definitely try for another VBAC!

How were th forceps EllaM? Is it something to be avoided at all costs in your experiece or still better than a cs?

tonton - the forceps were fine. I had an epidural so it wasn't painful, the baby had some marks on his face but they cleared up quickly. Some people recommend cranial osteopathy for forceps babies if they seem unsettled in the early weeks and I wish I had done that for my first who was also born by forceps and difficult to settle, but my third seems really laid-back so I don't think cranial osteopathy is needed. I would definitely prefer forceps or ventouse to a c-section.

Poor men, eh? My dh was also completely freaked out by doctors and is now convinced that pregnancy and childbirth are difficult and dangerous.

I had placenta previa with dd1 and was in hospital from 27 weeks. They kept telling my dh that I couldn't go home (which I kept begging them to allow me to do - we lived approx. 5 mins drive from the hospital) as I could bleed to death (and as a consequence lose our baby too) between our house and the hospital. Probably very sensible... I'm not saying that they were wrong to give us the advice to stay in, but they could have done it more sensitively so as to avoid giving poor dh a phobia!

OTOH, I did manage to persuade dh that it would be safe to try for a VBAC when I had dd2. It was the best thing I could have done. I had no problems and a (relatively) easy birth with no interventions. I really wanted to try for a home VBAC, but dh wasn't having any of it, and I respected that. The hospital was fine, anyway, and I was in and out in less than 12 hours.

I have posted at length about my VBAC on here before. I am a great believer in staying mobile and refusing continuous foetal monitoring unless there are signs of distress (in which case, obviously I'd have agreed to it). I got my consultant to write on my notes that continuous monitoring wasn't essential in my case, and I think that was helpful, as with his signature on it no-one questioned it when I arrived in labour. Otherwise I think I'd have had more of a fight on my hands. I was monitored with a hand-held device every 15 mins and was in the bath for a lot of my first stage. Even during a long 2nd stage, dd2 was pronounced 'the most laid-back person in this room'. I had no problems at all.

I also believe (from what I've read, I mean - not my own idea!) that having an epidural with a VBAC is not a good idea. If you start getting pain in the scar or pain that continues between contractions then you want to be aware of it immediately, which obviously you can't be if your lower half is numb from an epidural. I decided that I'd rather have a cs than an epidural. Ditto with induction. There is lots of evidence that induced births have a vastly higher rate of scar rupture than non-induced births. Hence I decided that if I got to 42 weeks (or, again, if there were any problems) I'd have a cs rather than allow myself to be induced. It seems odd to me that many hospitals gaily go ahead and induce women who've had previous sections and give them epidurals (both of which seem quite risky), and yet they insist on continuous monitoring, which can only reduce the chances of a successful VBAC...

Anyway, by going through my risk-prevention measures (no epidural, no induction) and explaining why I didn't want continuous monitoring (better chance of a successful birth if mobile) to dh in minute detail, I convinced him that it would be OK to try for a VBAC. I know he was nervous when the time came, but it was all absolutely fine.

I hope that there's something reassuring in there....

It's interesting to read all your thoughts on this. Four years ago I had an elective CS but next time around, I wanted to experience giving birth vaginally. I read all the statistics and research governing induction, scar rupture, etc etc and decided to give it a go. On the whole, I found Drs prefer you not to be induced because often you're catapulted into strong labour contractions which might (or might not) prove to be a bit of a strain on the scar. I knew I would have to be induced since DD no.1 was 14 days late. DD2 went to 15 days and in both cases I was absolutely certain of my dates. I knew the prostyn (so?) pessary wouldn't work 2nd time around (it hadn't the first)so I opted for a foley catheter induction which worked brilliantly to open up my cervix so they could break my waters and put me on the syntocin drip. I too kept upright and mobile and 1.5 hrs later gave birth the way I wanted. Contrary to my expectations, labour pain was perfectly managable (probably due to staying upright I suspect). Looking back, it was absolutely the right thing for me to do - though if you are going to opt for a VBAC, you have to be prepared to argue your way through it and take responsibility for the decisions you've made. I made sure I knew all the research and could negotiate my way through any objections - which is hard work especially when you're feeling vulnerable. I also surrounded myself with people who knew what I wanted and would help me achieve it within realistic safety limits - a brilliant midwife and a doula, as ewll as DH (who wasn't actually convinced I could do it but got to 'catch' his baby on its way out). I think for me the important thing was to try and give it a real go. By the way, Tonton, monitoring was fine - you can still stay upright. I was only constantly monitored when they found meconium in the waters - it was a hand held one before that. To be honest, I found the monitoring rather interesting since my baby's heartbeat rose when I had my contraction (it's supposed to)and I liked the reassurance of that. You could ask though about a mobile monitor (?)- some hopsitals have them I think. Good Luck!

I don't think I'll have much choice re monitoring - they don't have the super-mobile ones, just the one that lets you stand up close by. I think the lead is only about a metre. Since we're (dh & I) both a bit nervous now about the vbac I think we'll go along with the continous monitoring. However I will avoid epidural (easy to say now I know!) and being induced. I'll have a doula so hopefully she'll keep me calm and help counter-act the negatives of being monitored. I'd like to try and avoid being told any numbers (how long I've been going, how dilated I am) unless there's a medical reason to tell me, so I can just get on wioth doing my best.
I've never heard of the 'foley catherter induction' will look it up. Trying ton be more informed this time!