3rd birth after 1 CS, then VBAC. Consultant seems ridiculously strict this time!

[basilbrush]

Hello Ladies -

I am 32 weeks with DC3. DC1 was a "real" emergency section, placental abruption, very scary etc. DC2 was long and hard but totally intervention free VBAC in hospital. I have now moved to a completely different area and will be having this baby in a different hospital. I am frustrated with the consultant here who seems determined that as a "high risk" mother, I need to be in bed, attached to montitor for whole labour and with cannula in my hand, "in case" I need a C section.

With my last VBAC, I had a very enlightened consultant who let me keep mobile and they checked the heartbeat every 15 minutes with a hand-held monitor. This meant that I keep upright, walk about, assume position I chose for birth etc. Even so, I had a pretty long labour at 17 hours with 45 minutes pushing. I am convinced that I would still be there now trying to get DC2 out if they had refused to let me stay mobile.

The hospital here is 1/4 size and they are much more wary of sticking to protocol it seems. The consultant refuses to listen to any of my concerns, the way she goes on you'd think I'd had 4 previous sections, not 1 section plus a normal vaginal birth. I am not that old (33!) and don't have any other complications with the pregnancy so far.

I do want to give birth in the hospital as I do want the reassurance of medical backup IF NEEDED. When I say I don't want the cannula / CFM, consultant reacts like I'm asking to labour in a vat of houmous or freebirth alone in a forest glade. But I really don't think that I more "high risk" than any of the other first time mums who come in to the ward and are allowed in the water tub and on the birth balls and are encouraged to give birth on their hands and knees, not flat on their backs à la 1972.

What I don't want is to be so concerned about transfering to the labour ward that I stick it out at home for as long as humanly possible and then end up having a baby in the shower! I know this might seem like a tempting option but to a certain extent, I am still haunted by DC1's dramatic arrival (after all, he could have died) and I know I would, perversely, feel more relaxed in hospital. AS LONG AS THEY LET ME MOVE AROUND!! :-)

Any thoughts / advice would be gratefully received.

This hospital can tell you what their guidelines are, and what the consultant advises, but you can decide what you do or do not consent to.

You can ask for a meeting with a consultant midwife (if they have one) or a supervisor of midwives and ask for an individualised care plan to be drawn up which includes intermittant monitoring, no canula as routine and being able to move around as you wish.

There is no need to see it as a fight, you simply state your wishes and refuse to agree to anything else - "no thank you" will suffice! There is a really informative and supportive VBAC group on facebook - VBAC Support UK I think it is.

You can also not see the consultant again and stick with midwifery care - you just say no!

I had a planned cs then a long but intervention free vbac, strapped to the bed with a monitor, then another vbac where I was monitored, with the belt thing round my tummy, but the midwife encouraged me to stand and use the birthing ball, lean over the bed, rock etc. it was a good compromise. I am at a different hospital for DC 4 and I hope I can do that again.

I had el c/s then Vbac. Dc3 was born at home....

It is usual to recommend continuous monitoring for a VBAC due to the scar on the uterus and the potential for uterine rupture (and also in your case previous abruption), although the evidence base for this is shaky to say the least. You don't need to do anything other than decline their plan, no-one can make you do have continuous monitoring or a cannula. You don't need a meeting with a consultant midwife or make a big drama, but it may be a good idea to write all your wishes down in advance stating that you are aware of the potential risks but wish to remain mobile and have intermittent auscultation for the midwife who cares for you in labour. However, if you do end up with continuous monitoring for any reason there is no reason for you to be stuck on the bed, you can be up and mobile beside the CTG/on the birthball and some units even have telemetry where you can wander further.

I have exactly the same birth history as you - although my VBAC with DC2 was shorter than yours. I am 39+3 now and the attitude has been "you've had one VBAC do what you like." Apparently the chance of a natural birth is around 90% so why you are being treated as high risk when they know you can push a baby through your fanjo I have no idea.

My advice is to smile and politely decline the CFM etc. if you don't want it.
I saw the Supervisor of midwives at my hospital to ensure I had a birth plan that everyone agreed to because I didn't really want to argue with anyone on the day itself. She was great and we have a plan (water, wireless monitoring) and a back up plan (water, out of pool for trace every 2 hours in case wireless kit bust). If pool is in use I'll be in MLU on ball, freedom of movement etc. I agreed to a cannula for the sake of compromise and it won't restrict mobility.

Agree with the replies! You can decline CFM - it's up to you, not the hosp. You have shown that you can have a VB, so if you do what you did last time - keep mobile, FM very 15 mins - the consultant and more importantly the mws - should be happy with that!

This study suggests that the uterine rupture rate of someone who has had a previous cs is one in 500. As this will include women who have had more than one section, and women who are induced, if you have had one previous section, and you are in spontaneous labour then your risk is probably smaller. So this means that 499 women will be monitored in order to potentially predict one uterine rupture and the fetal heart rate is only one way of diagnosing a uterine rupture, there are several other ways, there is no single symptom that everyone with a uterine rupture will have.

Imo, it is completely unreasonable of them to pressure you, being continuously monitored will actually increase your risk of having an unnecessary section. I would suggest seeing a supervisor of midwives to discuss it, she should be supportive of your wishes, if she isn't ask to see another one.

Thank you for all of this!

I am currently torn between the "wait and see" approach and the "proactive (but may be perceived as bolshy)" approach. I don't want to come across as a demanding diva but equally, it would give me great peace of mind to know that a plan had been okayed in advance of D-Day.

Yesterday, I wrote a birth plan (I am so grizzled and cyncial now that I swore I wouldn't bother this time but I was so annoyed by consultant meeting that it felt good to get my thoughts on paper!)

However, I am unsure now what to do:

1. Show consultant birth plan at 36 appt? (She is quite scary sand will most likely tell me dismissively for the 17th time that they only do CFM when you are in "active labour". Which is precisely the problem!!!!)
2. Show "named midwife" (who I haven't even met yet) birth plan at "Birth Planing meeting" at 37 weeks and risk her saying, "I have no authority to OK this, you need to discuss with consultant"
3. Try and talk to Head Midwife to discuss Birth Plan in advance and risk pissing them off, thinking I'm going behind consultant's back etc...?
4. (DH's plan!) When in labour, turn up on ward with birth plan and politely reufse CMF / cannula. He says he will back me up 100%. This sounds great in theory but when you are in pain and vunerable, you are more likely to be talked out of things. I worry they will say, "Well, we ae very busy today and we don't have the staff to monitor with you Doppler so for the safety of baby, we strongly recommend CFM"

Hi. I've had 2 "consultant led" vbacs and although I had appointments with consultants throughout the pregnancy, once it came to labour, it was just me and the midwives.

First vbac I was told to get on the bed, continuously monitored and eventually given hormone. It was long and arduous.

Second vbac I stayed at home as long as possible. Refused to get on the bed, so the midwives set it up so I could stand alongside. A cannula was fitted, but before they could get the monitoring equipment on I started pushing. Dd was born very quickly. It was a lovely labour!

So my advice would be go with number 4. Your consultant's unlikely to have anything to do with your actual labour as it happens. And I found, although I'm usually a very compliant person I change when I'm in labour!! :o

Good luck!

I would seriously try to talk to the Head of Midwives about this - they are often your best advocate in situations like this, I was induced for DD3, after an em c-s under GA for first baby, then a forceps VBAC for DD3 with a PPH (yeah, I'm not very good at this giving birth lark ). The head of Midwives was extremely supportive of getting me moving, and she agreed (before they knew about the need for induction) to me labouring in the pool with telemetric monitor though they did want me to birth on dry land due to previous PPH. I guess the difference was that my consultant sent me to talk to the head of Midwives as he said she was by far the best person to help sort it all out!

In the end, I was induced for reasons of DD3's health, did have the CFM band on but was encouraged by the MW who looked after me to move around (she just readjusted the band when it moved) and had a truly fantastic birth experience, thanks to the midwifery care (community MW, Head of MWs and the particular MW who looked after me when I was in labour).

Best of luck!

Agree with Poledra - seek out the head MW for back up. DS1 = EMCS, DS2 = VBAC, DS3 = VBAC waterbirth, DS4 = VBAC waterbirth

It's your birth so be insistent on what you want.

Well, we ae very busy today and we don't have the staff to monitor with you Doppler so for the safety of baby, we strongly recommend CFM

That would be serious bullshit if they did say it to you! If there aren't enough staff to listen in with a doppler than a) who will be watching the CTG to observe if there are any problems and b) it doesn't sound like a very safe situation if an actively labouring woman can't be checked with a doppler on a regular basis!

Update: took the plunge and spoke to the Supervisor of Midwives on the phone yesterday and she was really great! Said that there was nothing outlandish or unreasonable at all about any of my requests, esp since I have already managed one VBAC. She said that they have plenty of first time VBAC mums ask for the same.

She is going to come round to my house and do my Birth Plan meeting herself in a fortnight's time and then will put details on an insert in my notes so that I don't have to keep repeating myself to different staff on the day.

This is such a relief :) (Watch me now go 2 weeks overdue with all plans scuppered!!)

Why not compromise and have a cannula placed (but no fluids running), and have cfm but not be in bed? The lead for cfm is at least 2m long so no reason why you can't be mobile as well. Seems that your consultant / previous birth was unsafe (intermittent monitoring) rather than the current one being unreasonable! Given the history of abruption and c/s, seems like a lot of risk to be taking when a cannula and mobile cfm shouldn't hinder your labour.

With my second pregnancy and this one too, the doctors have kept a close eye on me. I have had loads of extra scans to check on the baby's growth rate and cord flow and to establish that placenta was OK.

With DD2, my consultant and I only finally agreed on intermittent monitoring after my last scan on my due date (I went into labour the next day). If there had been any hint of a problem, I would have gone straight for an ELCS.

This time round, so far, so good with the scans but I am of course only 33 weeks. I will be scanned again at 36 and 40 weeks and obviously any "birth plans" will be fully dependent on the outcome!