VBAC questions

[cori]

I am hoping to have a VBAC in approximately 8 weeks time. I just realised I have lots of questions I have forgotten to ask the midwife.

As I have never had a proper labour, I feel like a beginner at this.
Assuming contractions start at home, How do I know when to go to hospital? Usually they want you to go in when they are coming every 5 mins dont they? For VBAC do you go in earlier?

How closely do they monitor you when you get there? I want to have an active labour not be confined to a bed.
How long do they let you labour for before suggesting a caesarean?

Hello Cori

I had a vbac a couple of years ago and I can only pass on my own experiences but here goes.

I went in when I felt I'd rather be at the hospital than at home. Not very precise I know, but it is quite a personal thing I think. I guess my contractions were about 5 mins apart, but can't honestly remember. I just stayed in the bath at home until I thought it would probably get quite difficult to travel if I left it any longer.

Different hospitals have different monitoring protocols none of which you have to adhere to - your labour, your body, your decision. Best to find out beforehand and then plan what you want. I think it's reasonable to expect them to monitor you for a time when you arrive and then if all is well they really should be able to manage with a handheld for a few minutes every now and again. I even got in the birthing pool at one point and would have been monitored with a waterproof handheld if I'd stayed there (I didn't as I didn't like it).

As long as there is no medical risk to you or the baby, you should be able to labour as long as you want to before you opt for a caesarean. I think firstly you should try and believe in your ability to give birth but also in your ability to decide when enough is enough.

These answers may sound a bit trite but it is such a personal thing. I think it's very important to discuss everything in minute detail with your midwife beforehand, so that there are no nasty surprises on the day. Try to decide in advance what you will and will not put up with from the hospital protocols - everything is negotiable. You may get the impression that you are seen as a walking cs scar, but it really needn't be like that. I completely forgot about that issue once I was in labour and had a very normal and quite quick labour and birth.

Try searching the archives on here for vbac - there will be some really helpful threads I'm sure. hth and good luck.

Hi cori,
I had a VBAC in the summer. I read all the VBAC threads on here and most of the links to other info as well. My birth plan was quite detailed about but I felt I had made informed choices.

I was told to go in when I was getting three contractions in every ten minutes. My waters went before the contractions settled down and so I went in then.

I agreed to baseline monitoring and was happy enough to have the monitor on after the initial half an hour as dd's heartrate was quite high. I didn't want it left on if there had been no other reason.

I refused a cannula, though they tried to bully me into this, it was one thing I held out on. If I had actually needed a drip, then I would have agreed.

I was told (by a moronic locum SHO) that I would only be allowed to labour for 5 hours, as my scar wouldn't cope with any more. He told me that they only let first labours go for ten hours. I would have had more confidence in him if he hadn't had to play chinese whispers with his registrar over every single one of my questions. I was also told I could ask for a section at any point.

As soon as I was in active labour, they again tried to get me to have a cannula put in. Even though the monitor was attached, I was still able to move around from sitting on a stool to lying on the bed to standing. I felt it was up to them to ensure that I was able to move and be monitored. So the midwife had to adjust the monitor pads a couple of times. I would just announce that I had to roll over, take a shower, stand up etc and dh and my birth partner would help heave me around.

I felt closely monitored by a machine, not by a person and that the monitoring was a back-covering exercise. If they were so concerned about me being a VBAC, then I would have been checked more frequently.

Once the contractions were really strong it all went much more quickly then I had anticipated - I was expecting a centimeter an hour, but went from 5cm to finishing pushing in just over three - the midwife told me that this is quite common in VBAC, even if you haven't laboured before, your cervix just flips open!

In the end, despite having SPD, I had a straightforward labour and gave birth on all fours. My section first time round was straightforward too, so I am a very lucky woman.

Wow, I think this is my longest post in three years!

HTH

Oh yes, the cannula bullying thing. I had that too - absolute bl**dy nonsense. I did need one in the end, but they put it in with no fuss when they needed to and I didn't even notice.

hi cori,
as franke and nome said before: there are quite a number of vbac threads already, that you could have a look at. just two examples you can find \link{http://www.mumsnet.com/Talk?topicid=1365&threadid=143998&stamp=060214021535\here} and \link{http://www.mumsnet.com/Talk?topicid=1365&threadid=114181&stamp=051128215334\here}. make sure you are well-informed!

i had a succesful vbac in december 2005 at 41wks, after a c-section in december 2003 due to undiagnosed breech. i was told to come in with contractions 3-5 mins apart, for at least an hour, and ended up going in many times before the real labour day with false alarms, starting 2wks before due date.

i came in with at 3cms dilated, contractions every 5 mins (had been every 2-3 at home and in the car), and was continuously monitored for about 3 hrs, but was on long cords, so could be active (sat on birthing ball most of that time).
i was happy to go along with both monitoring and cannula. monitoring they need to do to follow the heart rate of baby esp. during and after contractions. i felt a handheld monitor would only give them a short reading, so they could miss out on my baby getting stressed. the cannula is of course not v.comfy, but in an emergency situation it is good if they have a way in already, as veins will collapse sometimes. also, my veins are notoriously difficult to get into (i have crap veins according to midwife). with me, they 'forgot' to set the cannula, so i ended up having to have one set up when i was fully dilated, and they missed 3x .

i ended up with a spinal and forceps delivery. the spinal was because they thought they would have to do another c-section, as ds2 was very stuck, but fortunately i managed to get him out anyway.... he had the cord around his neck 3x!!

i was told that i would have to dilate 0.5-1cm per hour once in active labour (from 3cms). if slower, it would mean failure to progress and it would probably be another c-section.

make sure you have a good and realistic birthplan, and preferably discuss it with your midwife or consultant at hospital. i had a v.detailed birthplan and think it helped in getting the experience i wanted.

anyway, this post is getting far too long... have a read through the other threads, i found it v.helpful when i was making my decision vbac/c-section, and was preparing for the irth. good luck!

I dont understand why the baby needs continual monitoring because of VBAC. I thought the risk associated with VBAC were more to do with scar rupturing rather than the baby getting stressed.
How do they monitort the scar, and did anyone feel any particular pain around that area in the last weeks of pregnancy or in labour?

Apparently one of the signs of rupture is a massive drop in bp and the baby becoming distressed.

cori, i was told to pay attention to any pain in scar area: if there's any pain in between contractions it's not a good sign. this is why it is probably best if you try to have just gas&air, tens or water (bath etc) as pain relief.
i know that sounds a bit funny coming from someone who actually had a spinal, but in my case they thought they might need to do a section, as baby was v.stuck, heart rate dropped, and i started having bad pains in my scar.
apparently, they can also do ultrasound to determine the thickness of wall of the uterus at the scar, and to determine if the position of placenta is close to the scar (this wouldn't be good). i didn't have this done though, so i couldn't tell you how reliable the prediction of scar rupture from this is.

Cori

Excuse me if I only post briefly... you'll find that I've posted before on lots of VBAC threads. Just wanted to make two points really...

(1) They will probably tell you to go in as soon as they are sure you're in labour 'just in case'.

(2) If you want to avoid being strapped to a monitor throughout your labour, act now. Get your midwife and consultant (if poss!) to write in large letters in your notes that you do not need to be continuously monitored and that they are happy for you to be monitored intermittently with a hand-held device. I really believe that this made the difference between me giving birth naturally and not. Don't wait till you're in labour. If you get a jobsworth midwife, you'll just be told that 'it's the rules' that you have to be monitored continuously... and you really really don't!

Good luck.