What's in your VBAC birth plan?

[Homsa]

Hi, I'm due in 3 days' time and still agonising over my birth plan. This is my second baby, the first was an emergency cs. So far, I've written the following:

• will consent to continuous monitoring, but will ask to have monitor taken off every now and then so I can have a shower/bath, walk around etc.
• won't consent to use of oxytocin, as I had that last time to accelerate labour and I think that started the whole chain of interventions. This time, if there is genuine cause for concern, go straight to cs. Otherwise, wait and let labour continue naturally, even if it takes longer than they would like.
• no canula in my arm (which is hospital policy) as I have a bit of a needle phobia.

Would be interested to hear what other people are planning for their VBAC, and also what their hospital's policies are re the above interventions! Thanks!

What are your thoughts regarding induction if required? Some places will use one prostaglandin pessary, others won't use them at all. Would you let them try to break your waters / do a sweep?

Pain relief? Some hospitals won't use an epidural as it might mask the pain of scar rupture. Will yours? TENS? Water birth (will they let you?)

I am going to request that my pulse is monitored closely as this can be the only sign of imminent scar rupture in some cases.

Will you let them perform VE's? How often? Do you want to know if you are progressing? This can lead to the whole 'failure to progress' issue if they are carrying out VE's frequently.

I wouldn't consent to continuous monitoring, as I think then you are more likely to get close attention from the staff (re your pulse etc). Then you are more likely to be able to do the walking etc, with the monitoring in between.

I think I will prepare a birth plan for the c/s this time, as I would like things to be done more my way if I have to have another one. There is good advice on this on the \link{http://www.caesarean.org.uk/\caesarean.org.uk} website

Hope that helps a bit?

Hi Laura, thanks for your input, some very good points there. You've given me something to think about!

My hospital won't use prostaglandins, but would do a sweep, which I would be happy to give a go. Not too happy about having my waters broken - if that doesn't get things moving, then you've backed yourself into a corner, haven't you?

Epidurals and TENS they seem to be ok with, but no water birth for me, sadly... But I will insist on a bath or shower, even though that means taking me off the monitor for a while.

Good point about the VEs. Will have a hard time refusing them, as DH is a scientist and will probably want to plot my progress on a chart! But yes, I agree that having them too often is not a good idea.

I know what you mean about the staff paying more attentions to the readout from the monitor than to the woman in labour - happened to me last time round. The mw was constantly scribbling stuff on the printout and hardly ever spoke to me!

So how are you going to have your pulse measured? With a clip on your finger or something like that? Sounds like a good idea, and probably give you more freedom to move around. Have you discussed this with a mw/consultant?

Hi Homsa - fellow April vbac-er here! I've put -intermittent monitoring (but I expect they will try & talk us out of it)
-Don't want to know how dilated (or not) i am or how long I've been labouring unless medically necessary.
-pain relief: will be using TENs, gas & air, massage, aromatherapy - epidural only if get really desperate (they let vbac-ers at my hospital).
-no time restrictions on 2nd stage (unless medically necessary)

I'd rather have a cs than be induced but haven't put that on. Maybe I should.

Could i put in a plea to hear how your birth experiences go if you don't mind. I may be trying for a VBAC in May so would be very interested in your views with hindsight and indeed just a general idea of how it goes this month. So if you were able to post a VBAC - how it went thread under childbirth afterwards, I'd be most grateful (but I know you'll have other things on your mind :))

PS what are VEs? and crikey, hadn't realised they might not let me have an epidural!

Vaginal examinations. Check with your hospital about the epidural, they all have different policies on this.

Can I just add my 2p worth about VEs? I was dead against them for both my labours (one cs, one vbac). But during my vbac, I eventually requested an epidural, it took a while because the team were engaged elsewhere in the hospital. Anyway, they eventually arrived and managed to sort out the epidural whilst I was having serious contractions. As soon as it was in, my midwife decided to do a VE and I was fully dilated. Aaaarrggh! In hindsight, had I known I was on the last of the first stage contractions, I could probably have managed without the epidural. The point of this ramble is....maybe agree to a VE just before they do the epidural as you may be further along and coping a lot better than you think.

Good point Franke! Makes you wonder, though, about that mw's common sense! She's supposed to do a bit of thinking for you!!

I have a similar story: when I had an epidural last time, it worked really well for a while, then I was in more and more agony, regardless of how much they topped it up. DH suggested they check if the tube was still attached to my back, but no one listened to him. Eventually, when they started preparing me for the cs, someone realised that the epidural tube had indeed become unstuck and all the drugs had been dripping into my pillow instead of my back, probably for hours!

fairyglow, I'll try!!!

Hi tonton, hope it all goes well for you!

Hi Homsa, hope this is still in time, I guess you could be having your baby any time now...
I had a succesful VBAC in December 2005, after my first baby was born by em-cs (breech) in December 2003. I had this in my birthplan:

I would make it clear to them that you are aware of risk of uterine rupture (0.3%), but that this should be picked up on in early stages with continuous monitoring of the baby’s hart beat. Are you absolutely sure about the canula? I wasn't too keen on it myself, as I also have a needle fobia, but thought it would be less stressful to have it put in when I was just in established labour (say 3-4cms) than in a hurry and under pressure if things start going wrong. Mine in the end wasn't put in, until I was fully dilated (as things happened much more quickly for me than they had expected, and we were left alone from 3-10cms). They missed 3x: ouch! I am glad I went with it though, as in the end I did require a drip, because I got a bit dehydrated. Also I had an episiotomy plus spinal. The spinal wasn't necessary in hindsight, but they thought they had to do another cs as ds2 was v.high up and twisted. He also turned out to have the cord around his neck 3x. In the end I managed to push him out myself though, with a bit of forceps help.

You might want to add something about episiotomy. I think loads of VBACers -like me- end up with episiotomy and forceps/ventouse...

Throughout the rest of my labour I only had TENS and gas-and-air. I did ask the mw about MEPTID, which apparently is like pethidine, but with fewer side-effects, but didn't like the sound of that so decided against it (one of my friend was v.happy with it, and recommended). I did fine with the TENS and G&A anyway...

I also put my preference for labour to be as active as possible: walking, use of birthing ball, etc. I prefer to stick to TENS and gas-and-air for pain relief during labour, and to avoid pethidine and epidural.

Re. the monitoring I was monitored with v.long cords, so could sit on birthing ball and didn't mind the "being attached" at all. I was actually already in established labour when I arrived (3cms), but my contractions were v.slow so they left me on the monitor for ages: I think I was on it for 4hrs, but this period was not continuous, as I was shown how to disconnect to go to loo, or walk around. Then I had a period of about 3hrs of no monitoring, and when they wanted to put me back on I was fully dilated. I had one examination when I came in, and one when I said I felt the need to push (mw didn't actually believe me, but i did turn out to be fully dilated... ). I however did have several VE in the weeks leading upto the birth, as ds2 had threatened for 3 weeks to come, but never did. And oh, before I forget: I also had a sweep the day before ds2 was born, which really set of labour. I was 41wks.

Anyway, this is turning into a long post.... I just want to wish you all the luck and strength you need for your upcoming birth! If I come up with any useful additions to this post in the next couple of days, I'll come and add...

Homsa, I think the midwife had got so used to me saying no to everything, she just lost the will to try and venture an opinion, poor woman.

I had an epidural which fell out too (during my labour which ended in a cs) - I just said "er, am I meant to be feeling these contractions? 'cos I can." So they did another one.

I also refused a canula, they got it in okay when they needed to. I would have been p'ed off if they'd put one in at the beginning and then hadn't needed it.

Thanks honneybunny, good to read about your VBAC experience! It's my due date today, but I haven't had the faintest hint of a contraction throughout this pregnancy, so I think it's quite likely I'll go overdue again. I'm booked to see the consultant at 41 weeks, so I think I'll have a sweep then, it might work for me too!

Good to read about the long cords on the belt monitor and that you were able to disconnect it yourself, that doesn't sound too bad really.

Franke, DH is not happy that I'm going to refuse the cannula, but I said I'll let them put one in at the first sign of trouble. I just know from last time (when they put the syntocinon drip in) that I found that thing in my hand terribly distracting and disgusting, and this definitely had an impact on my labour. Also, since the main thing that had kept me from asking for an epidural had been my needle phobia, I then thought, what the hell, the needle is already in there, so I might as well have an epidural too! I'd really like to avoid an epidural this time, though.

I've had 2 vbac - all fine & very quick. dd3 in 1.5 hrs & ds4 in 10 mins. I had to refuse continuous monitoring - but I had a scan before to check thickness of the uterine wall at the cs scar. I was thick enough so was strong. Doc still wanted the monitoring! but I said no & got this written down.

I stayed upright & didn't need pain relief. No episiotomy or any intervention. Had pph both times though. With dd3 had retained placenta & need it taking out under epidural.

Anyhow wishing you all the best - work with your docs on this xxx

I did'nt make a birth plan with dd2, left it to see how i felt when i got to the hospital. With dd1 i made a birth plan saying i wanted no drugs (worse mistake of my life). So with the 2nd i just told the midwifes what i wanted as and when i wanted it and it was great. Good luck and i hope you get the birth you want.

Hi,
I had my vbac 6 weeks ago, after a crash c secunder ga with my 2nd.
I didn't write a birth plan, but did have documented in my notes that a cs would only be done in an emergency under ga again(I have probs with my back)
I accepted monitoring(but was also able to unplug myself to go to toilet etc, and spent most of my time standing - could walk in the room with partner/midwife trailing behind with monitor.
Als had cannular , but don't mind needles, so not an issue for me. Idid need very speedy intervention with my 2nd and didn't want any delays if needed sec.
I delivered my son with large epi, and ventouse...so niot ideal, but much better than cs recovery for me.
did it all with gas and air, until sutures with a local.

Hope you don't have to wait too much longer...ds was 8 days late, and I hated it! Good luck.

I'm hoping for a VBAC in October - quite a way off I know - so have read this thread with great interest
Laura, I have a question - why would having frequent VEs interfere with progression?

what is the canula for? I thought it was just something stuck in the back of your hand so that needles can be put in very quickly (had it last time for intravenous antibiotics but not to do with birth). Presumably you can't administer the epidural this way or can you?

tonton - out of interest why do you not want to be told how far along you are? Will be watching this thread with interest as i plan to have a vbac next time.

The canula is so they can give you fluids (if you have an epi), take blood or give you any other drugs you may need. I did'nt have one with my first but did with dd2 as i had an epi so they gave me fluids. The epi is still given in your back.

nowanearlyNicemum - the VE's don't interfere with progression in themselves (unless you really don't like having them done / find them extremely painful), but if they are doing them very frequently, they have a very clear idea of what is happening. Great if you're a dilate at 1cm per hour after 3cm type person, but not if you are a get to 3cm and then stay there for hours followed by dilation to 10cm in seconds type of person. Does that make sense? Maybe some are a good idea - on arrival at hospital, maybe four hourly and then if you feel like pushing, but I wouldn't agree to have them much more frequently than that. Otherwise if they feel like you aren't progressing to textbook rules, you are more likely to end up with a c/s. I hope that for this labour I will be left to get on with it for as long as it takes, so long as the baby and I are still in good shape.

thanks for the explanation Laura, I'm with you now.

HOMSA - as this is your 2nd labour (though your 1st vaginal birth) you can dilate form 3 to 10cm in less than 2 hours... most women do.
Good MWs know VE on a "multip" is basically useless. As she examines you and you are 4cm and 10 mins later you want to push... it's happen countless of times on mumsnet (do a poll if you want )... so what did the VE tell you... didley squat!!!
Women request epidurals when they can't cope anymore and the VAST majority do this when they are within 30 mins of delivering (that seems to have been honneybunny 's exerience). A good MW would help you through transition without an epidural and would recognise your contractions and behaviour to mean that you are in transition.
I am a doula, I can't do VE (and wouldn't want to anyway) and I am always predicting the dilation correctly... it's not rocket science - body language tells you a hell of a lot!

And I would aslo decline continuous monitoring as it would (I agree with Laura) force the MW to be more attentive to you!

Laura - there are women who go from 8 to 4cm too... usually from fear.... so what does a VE do then ?
VEs are not that precise either. they're OK for 1st time mum but really multips making the right sounds don't need one. Many MWs agree with that.

Pupuce - thanks for your words of wisdom on the subject- you explained it far better than my efforts! :) I presume I'd be treated as a first time mum though as I only got to 3cm with ds. Frustratingly (having been stuck at 3cm for days) the doctor said 'ooh you've dilated now, typical isn't it' just as I was being taken to theatre for my c/s. Would love to know how far I did actually get - bet that's not in my notes!

I don't know if I regressed dilation wise due to fear, but my contractions did stop the minute I got to hospital. They went from being regular as clockwork and very strong (every three mins lasting nearly two mins) to being almost non-existent. Amazing what power your body has to stop things you don't feel happy about. I knew I didn't want to be in hospital (had planned a hb for ds, but had to go in due to mild PE)

Laura - sounds to me like you are a typical example of what your (unconscious) neocortex brain can do to someone......
I do know some women who once they get an epidural (1st time mum) will gor from 3 to 10 in hours (but they were at 3 cms for days!)... they finally relax... whilst it's easy for me to type this, a lot of it is with the unconscious though.
In labour you need to avoid adrenalin release because it hinders oxytocyn (contraction) and endorphins (natural pain killers) hormones. Hence water is fab as a lot of women relax so much that both oxytocyn and endorphin release are enhanced.
You need to keep adrenalin at bay... it's basically what a doula does.... we make sure the mum feels safe and unthreatened.... if we can maintain this she'll deliver quickly...
It's not rocket science and many medical studies have demonstrated it....

Thanks for all your birth stories, and for your advice about VEs pupuce. I've rewritten my birth plan several times now and I think I'm finally sure what I want!

I believe the subconscious plays a big part in how your labour goes. I'm wondering if it also plays a part in going overdue? I'm now 3 days over my due date, which is not really surprising as DS was 10 days late, but I'm thinking my rather ambivalent feelings - dreading the birth almost as much as I'm looking forward to meeting my baby - aren't helping either!