Questions to ask regarding VBAC.

[SolitudeSometimesIs]

I'm hoping to go for a VBAC (haemorraged due to placenta previa and had CS with DS) this time and I was wondering if you had any questions you think I should ask policy/restrictions/risk of another CS etc?

I have a few regarding continuous monitoring (they are very keen on it), going over my due date, having a sweep, chances of another CS and what they will do to speed up contractions/progress my labour. My thoughts are all over the place to be honest, I'm dreading labour because of the enormous blood loss from DS when I haemorraged (sp?) and general fear of the unknown. My CS was very straightforward but the recovery would be different this time due to my two and a half year old.

The hospital are very supportive of VBAC's but I'm afraid that the support is only there as long as you are following their timetable. So I want to ask every possible question to get all the information I can.

So, can you please help me compile a list?

Apologies for spelling misakes, I can't figure out how to turn on the spell check on my computer.

It should also say "...questions I should ask regarding policy/restrictions/risk of another CS etc?"

Will they allow you to go on induction drugs? Some hospitals don't like it.

I had a read of their "Guide to VBAC" and it was really sketchy. It said that in some cases they are used, and in others they aren't. I have read that they can cause the scar to seperate and over stimulate the uterus, but I don't know how they decide who's suitable.

I'll ask the Obs to clarify.

Thanks Suzie

Hi solitude I had an attempted vbac this weekend. My hospital were very pro vbac. I would ask about how long they are prepared for you to labour / push before they will want to look at intervention or cs as for this this was shorter than for a non vbac birth because of the (small) risk of scar rupture. I would also ask about their usual preferences for monitoring - do they prefer continuous monitoring and so your movement is restricted or are they comfortable with monitoring at regular intervals. I have heard of wireless and or waterproof monitoring equipment which would mean you could go in the bath or pool but I don't think that is very common. I would also ask about what their thoughts are if you need to be induced

From my experience, I don't think anything was significantly different because I had had a previous cs. Ixwas continually monitored but that was because I was given the drip because contractions slowed down rather than because it was anything to do with vbac. I ended up having a cs because baby's heart beat started dropping at a relatively early stage but I am still hasty with my experience because I didn't experience labour at all with my first baby and this time I did although not up to the point of birth.

I hope your birth goes well, good luck!

Happy not hasty. Oops! [Smile]

solititude, it depends on the hospital. i was given induction drugs for 15 hours with my attempted vbac during which time i was advised (and was happy to) not have an epidural. induction + no epidural stings a little...

i ended up with cs due to failure to progress. same as my first.

Hi Green,

they seem very insistent on continuous monitoring. I would be stuck in a bed all hooked up to a machine - but I have a plan! I'm going to buy a few reels of surgical tape and stick the monitor to my stomach so I can get out of bed. I had continuous monitoring for 12 hours prior to my CS and the bloody straps kept slipping and there was alarms going off. It was so annoying.

There doesn't seem to be any wireless monitors, the consultant laughed when I asked previously.

Do you mind me asking you both what drugs they gave you to induce you and speed up your contractions?

I think I'd quite like an epidural if I can't move around Suzie, I'm not bad with pain but I can't imagine being stuck in bed and in pain. I would be a lunatic after a few hours.

I was able to get on a ball from the bed withthe monitoring. So a few feet. It wasn't nice but I think that's very much because of the mental issues which come with failure to progress. It's very hard to go through contractions every 3 mins for hours on end and be told you're not getting anywhere.

Can't remember...what would my options have been?

I had syntocin (not sure if that is the right spelling?).

I went into spontaneous labour but dd was back to back so at 2cm I had diamorphine which slowed down my contractions which was why I needed the drip. I would have been able to stand while attached to the machinesabut I felt quite drunk after having the pain relief and so wanted to sit on the bed (they changed the settings so it was more in the shape of a very upright arm chair) and once I had the drip on one side and the monitoring on the the other moving off the bed wasn't really an option.

Didn't have an epidural. Whe the contractions started getting too much again I had has and air then I had a spinal for my c s.

These were mine:
These are questions I prepared for my meetings.
VBAC
1.Pain management during VBAC – are my pain mgmt. options more limited due to link between pain in scar area and rupture, or is monitoring a sufficient indicator should I require an epidural?
2.Among women who attempt a trial of labor after prior cesarean delivery, what is the vaginal delivery rate and the factors that influence it?
3.What are the short- and long-term benefits and harms to the mother of attempting a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
4.What are the short- and long-term benefits and harms to the baby of maternal attempt at a VBAC after prior cesarean versus elective repeat cesarean delivery, and what factors influence benefits and harms?
5.What are the non-medical factors that influence the patterns and utilization of VBAC after prior cesarean delivery?
6.Is continuous monitoring mandatory and if it is, or I prefer to have it, are their facilities to be monitored in a birthing pool at this hospital?
7.www.childbirth.org/section/VBAC.html
8.Should I plan for early hospitalisation – ie if waters break or contractions start naturally to allow for monitoring. What is the general practise in this hospital?
ELCS
9.Who will be my surgeon? Can I request the same surgeon as I had before? Are trainee surgeons allowed to carry out ELCS's? Presumably not allowed to carry out EMCS's?
10.What are the risks of repeat caesarians? What would be an optimum number of children to stop at in order to statistically avoid a high risk pregnancy eg: placenta previa, or post op complications eg: hysterectomy
1.My first CS was entirely complication free but what are the key maternal risks I should be aware of with an ELCS and at what rate do the incidences of these types of injuries rise with multiple caesarians. eg bowel injury, ICU admissions, post-operative ventilator use, cystotomy and more?
2.What are the key risks to the infant I should be aware of with an ELCS?
3.Under what circumstances are forceps used during a CS and am I at higher risk of this use as part of an ELCS if the baby has/has not descended?
4.Will my post op recovery period be longer with a second CS? Internally due to repeat surgery or shorter due to fewer drugs, lack of labour etc?
5.Will the incision be in the same spot or will I have two scars?
6.If I go into spontaneous labour, and there is no medical reason not to try for a VBAC, what are the decision criteria for recommending I progress to a CS? My BP or Fetal distress is an obvious one, is there a time period after which Failure to Progress status is conferred and I have a second EMCS? Under these circumstances, do any of your answers above change?
10. My previous birth notes refer to a narrow pelvis repeatedly, but my daughter was also in a back to back position. Do you recommend an ELCS or a VBAC? Is it my choice?
11. If you are recommending an ELCS or I am choosing to have one (assuming I have the choice), when will it take place ? Week and date?
12. Skin to Skin
13. Infection Rates

Thanks for the list of questions oscar. I went for a chat and scan with the obs and my baby is breech! So typical. My vbac hopes aren't completely gone though because I've started excercises to get the baby turned.

I have three weeks before a decision is made by the obs team. I don't want the baby manually turned and I don't want to try a breech birth - the hospital wouldn't be too keen on it either by the sounds of it.

If it helps, I opted for the ELCS and ended up with a VBAC as DD2 came early. I only had what was described as "minor" internal tears (forceps) but I can honestly say that the recovery from the C-section was much faster.

I loved my recovery from my CS. It was a bit sore but nothing compared to the recovery of some of my friends who have had bad tears and infections. I was able to rest quite a bit after I had DS but this time I'll have a two and a half year old "helping".

I also don't want to have to stay in hospital away from DS either. It's a 5 night stay here and I've never been away from him that long.