VBAC appointment - what to expect?

[noseymcposey]

I have a VBAC appointment with a MW at the hospital tomorrow but not sure what to expect.

I'm pregnant with DC2 and had an EMCS first time round. I think I had the CS because after getting to 10cm it emerged that DS's head was at a funny angle and probably wouldn't come out. Will the MW I see have details of what happened last time so I can get a bit of clarity on what went on?

The reason it's not clear is because I was also unwell (picked up an infection from the epidural (I think) and wasn't passing an urine. I assume that was something to due with the infection, but I know the MW's at the time were pretty concerned about the fact I wasn't passing urine so I don't know if it was that. Again, I have a vague feeling I wasn't passing urine because I'd been on the induction drip for quite a while, they were saying something about not wanting to give me any more of that.

As you can tell it's really unclear to me what happened. In some respects maybe it doesn't matter as all labours are different but I feel a bit emotional about how it went first time round (DS is 2.9) and it might be wise to sort that out before trying to do it again.

On a practical level, what sort of q's should I ask? I understand that this time round I have to be monitored and that I can request to be monitored intermittently instead of continuously. Can they refuse that?
Part of the problem with DS's labour is that when my waters went there was meconium so I was immediately put on the monitor and found it very difficult to cope while having to just sit on the bed. Hence a classic case of more and more drugs and then CS and I'd really like to avoid that. If it's going to end in a CS I'd rather just plan that. I got off to a rocky start with DS and felt completely overwhelmed by having a new baby and I think part of that may be because of not being in a shape to look after a newborn after labour/cs?

Would appreciate any help/advice... sorry for such a long OP!

Anyone? :)

Can anyone tell me what is usually covered in a VBAC appointment please ?

Ideally your old notes will be there and that will give youclarity over what and why things didn't really work out last time. Most mums are ok to plan a normal birth this time because the problems are usually circumstancial rather than definitely happening again. I can't really guess what was the cause for the problems last time but hopefully your old notes will make everything much clearer.

Usually you have about 75% chance of normal birth after one previous c/s. You are recommended to have the baby in hospital because of 1:500-5000 (depending on who you ask) risk of rupture of the old scar in next labour. You will be recommended continuos monitoring, but this has become a lot more negoatiable these days, and there should be no reason why you couldn't walk, stand or bounce on a birthing ball even if you are monitored. The labour and birth in itself is expected to go as normal, with just checks to make sure the old scar is not causing problems. Some people may recommend that you have an epidural to make it quicker to have an emcs if you have problems, but on the other hand your labour is often more straightforward if you don't have one so you need to make that personally, really..... On the appt they will advise about warning signs for breaking of the scar which are severe continuos lower abdominal pain, bleeding, fast heart rate and feeling unwell. In labour you will be advised to come in a little earlier to make sure any potential problems are picked up early, if present, but many midwives are happy for you to stay at home until contractions come every five minutes, depending on how you feel. That said mums who are desperate to have a normal birth this time tend to stay at home for as long as possible to avoid unnecessary intervention but that is not a recommendation as such....

You don't always have to decide on the vbac appt whether you are going to go ahead or not, you can ask to come back once you have had a chance to think about it. Because you had a hard time last time it would be really good for them to check your old notes about what actually happened, and if they don"t have them out of the file, perhaps they could re-book you after they have been obtained.

Good luck with your appt, hopefully you get plenty of answers and peace of mind x

These were my questions for my VBAC appointment:
Will I have one to one care - what does this mean? Will someone be with me all the time?
Can I refuse induction
Do I have to have continual monitoring/ is there an advantage over intermittent monitoring for me or the baby
Do I need an IV - I would rather not
Can I have a water birth
Can I opt for a C Section if I got past e.g 41 weeks
Can DH stay the night in the delivery unit
What is the likelihood of having a c section under GA? What circumstances would this happen
What are the rates of 3rd and 2nd degree tears? Is there an increased risk?
Are the risk factors the same for EMCS as ELCS?
Will I get a tour of the delivery unit?
If the baby of predicted to be over a certain size would an ELCS be recommended?
How many wireless monitoring devices do you have? Is there one for each room?
In what circumstances can I use the pool?
What can you do to ensure I have an active labour?
What do you think are the best indicators of uterine rupture?
Will there be time limits on the stages even if no sign of fetal distress? Difference between restrictions on first and second stage of labour
What happens if I refuse forceps or ventouse? What circumstances would these be advised?

In my appointment they just really answered my questions. I think because I had read a lot she didn't really tell me anything. I had an ELCS though. From reading on here it does seem like different hospitals have different rules - even though there is no good reason especially for me not have another CS it seems I could have one if I wanted one. I went into it expecting a bit of a battle but the midwife was actually very good and a lot of the things I was worried about weren't that much of an issue.

Not sure all my questions are relevant but hope they help (I was/am worried about the idea of giving birth in the delivery unit rather than the midwife led unit and if that would mean I would have more intervention in the birth).

Thank you Lavender and AllBoxedUp for your replies - they are both really helpful!

If 75% of people have a succesful VBAC that's pretty good odds, and higher than I would have thought. I think the CS rate overall is around 30% at my hospital.

Are their risk factors for having trouble with your scar? Perhaps that's a question for the MW. Originally I was hoping for a homebirth and I would dearly love to try that again but I'm not sure I've got the guts to do something they don't support.

Your questions are very helpful Allboxed there are a few things there that I hadn't thought of/didn't know about!

Your question about wireless monitoring devices... I didn't know they existed! Would that mean that even if I had continuous monitoring I could move about as much as I wanted?

Is your question about having an IV related to induction? What is the IV for? I think I had one in each hand which made moving impossible! Though maybe that was later on after I'd had the epidural. Definitely had one though at the start so between that and the monitoring I couldn't move away from the bed.

Your last statement basically summarises how I feel! I would be more than happy in the MLU and think I could cope with that. I am pretty worried about the likelihood of achieving a natural delivery in the delivery unit, on dry land and hooked up to a monitor. My labour with DS was long, as they tend to be in my family and I just can't see it happening without being able to move about properly.

Thanks again for your help both of you :) very very useful!

I had an emergency section with my first and hoped for a vbac with my second. I would say definitely ask about wireless monitoring and how many they gave and then put this on your birth plan. also ask what the hospital policy is on the amount if time they will leave you in labour before opting for section. at my hospital it was 24 hours. I managed to convince them to leave me a couple more after that but at 27 hours they were insistent on another section due to risk of rupture. cannot think of anything else to add that other posters havent mentioned. hope it all goes well

Hi - I had an EMCS with DC1 and it was a very unhappy experience so I wanted to have a home VBAC with DC2. The hospital policy was that a previous CS disqualified you from the MLU on the basis of the risk of scar separation. So my only options were home birth or the delivery unit, which I desperately wanted to avoid. If the MLU had been an optioni may have gone for that.

All of the MW I discussed this with (at least 6, including the midwife consultant) were completely supportive and agreed that the risk of scar separation is overstated, as long as you only had one previous CS with no other complications and your incision is the usual bikini line horizontal cut. I did have an appointment with a consultant to discuss options if I went overdue and she advised against it but not too heavily. I also live less than 10 min from the hospital so could get there quickly if there was a problem.

As it was I had a brilliant birth that made up for the horror of the first time round. I'd really encourage you to read all you can about VBAC and your options and remember that they cannot insist you have any medical procedure you don't want,including monitoring (although mobile monitoring units are becoming more common, my hospital has them). The NCT has an excellent evidence based fact sheet that should help you to understand the options. Good luck!

Thanks milkysmum and fairypangolin

I didn't realise they would only 'let' you labour so long.. although that makes sense I guess. Interesting to know.

So did you have a HBAC then fairy? Do you mind if I ask what led to the EMCS first time round?

Thanks for your help :)

Hi - sorry yes I had an HBAC! My EMCs was because DS got stuck- it took 48 hrs of labour incl 2 epidurals to get to 10cm dilated but then he was so wodged in they said he wasn't going anywhere. So I agreed to the CS which was in itself quite difficult because they still couldn't get him out easily. I found the recovery very hard as I had a post partum haemorrhage and a lot of internal trauma (no lasting problems though!)

Second time round labour lasted 2 hours and although it was way more intense than the first time, pushing her out was a transcendent experience.

Most hospitals have a policy that you can only go 48 hrs after your waters burst (which is when I agreed to the CS, they had offered before but I declined) because of the risk of infection. Similarly they may have policies as to length of VBAC labour. Of course they can't make you submit to a cS but if you refused they'd probably give you a lot of dire warnings and maybe get you to sign a disclaimer. I think for most women though 48 hrs is enough!

At your VBAC appt they should be a le to explain these policies to you and they should be written down somewhere so you can take it away to read, since it can be hard to take it all in at one time.

That's really love to hear fairy :)

'lovely' that should say! A successful HBAC would be my ideal scenario, so it's good to hear that it can work like that for some people - and certainly food for thought.

In our local hospital they only have wireless monitoring now which is great (though I still have reservations about CFM as it seems unclear whether it's the restriction of traditional monitoring or the monitoring itself that leads to intervention). From reading on the internet it seems some hospitals want you to have a cannula fitted in case you need an EMCS but the midwife said it was fine to say no to this as they can be fitted pretty quickly if the need it.

I think it is harder to cut through scar tissue and that is one of the disadvantages to repeat CS that they might mention.

The patient information leaflet from Hinchingbrooke is quite good. Hope it all goes well.

How did your appointment go?

I started a similar thread recently - I've got an appointment with a consultant next week to discuss my options (had an EMCS for undiagnosed breech) and I'd like to VBAC if possible. This has all been helpful, thanks.

Well that appointment went very well and was so worth having. Turns out that I had a CS last time because my kidneys weren't functioning properly due to an infection and that combined with DS being back to back and quite high up (despite being 10cm dilated) so it was a combination of different factors plus a long time since waters went. It was definitely useful to hear that and I'm surprised I never knew DS was back to back!

Anyway, no wireless monitors and no walking epidurals at my hospital! Amazing considering it's a newly built all singing and dancing hospital with multi-million pound artwork in the lobby ;)

But the good news is that I can choose to try and deliver on the Midwife led unit which the community MW had previously told me was a no-no. The MW I saw today said that if I want intermittent monitoring I just need to sign a disclaimer and the risks are no different having intermittent monitoring in the high risk unit as being in pool in the MLU as I would have intermittent monitoring there anyway and any hint of trouble and I'd be up the corridor to High risk in any case. She was really quite supportive of it although obviously she couldn't suggest it is as it's not the official policy.

So I'm really pleased with that! She said something along the lines of not all the MW's understand the risks to the same degree as those of them that do the VBAC appointment so she hoped I would get a MW who would be wholeheartedly supportive in the MLU. Essentially implied that it wasn't really an additional risk in reality. Yay!

crossposted theborrower! As above it was really very interesting. We were in the appointment for 90 mins so there was lots covered!

It also gets quite interesting in that they aren't keen to give you a lot of induction drugs if you've had a CS which I'm more than happy with as if we're going down that route again I'd rather just cut to the chase and go for the CS!

Although my appointment was with a MW and I then have a consultants appointment at 36 weeks so may be a different emphasis for you as I notice that your appointment is with the consultant.

Thanks OP! Hope everything goes smoothly for you when the time comes.

Glad everything went well. Very jealous you can go to the MLU - it's just not an option at my local hospital. Good luck.