Help! I don't want all this medical intervention...

[MotherofOne]

Even as I'm writing this I feel quite suprised because this feels so out of character for me... Basically, I like to think I'm intelligent, confident articulate woman, who normally knows her own mind and speaks up for my beliefs. However I am now 26 weeks pregnant, and am finding that my maternity 'care' is making me increasingly frustrated, upset and emotional and I don't know what to do!

My first pregnancy was a catalogue of disasters/traumas & problems: induced at 42 weeks, pethidine which I didn't want but was persuaded to have; suspected CPD (big baby/small pelvis); failed ventouse; emergency caesarian; 'big baby' (10lb 3); scar infection; postnatal depression.
I am desperate to try to avoid a repeat and had discussed with my MW that I'd like to try for a VBAC (Vaginal Birth after Caesarian) this time.
All was going reasonably OK until yesterday when I had to see the Consultant at the hospital as part of the 'special care' programme I'm supposedly on since I had complications last time. Anyway, didn't see the Consultant himself (which pi@**ed me off since he was a distant colleague of a friend of mine which I thought might help) but some junior-looking female registrar who talked at me like I was a 5-year old!
The low down is: I want minimal intervention as I really believe this is partly why I ended up with my last experience:

• would like to try a VBAC
• would like to try a water birth (hospital has a pool)
• I instinctively believe movement /position is VERY important in labour (not least since last time I was virtually strapped to a bed, flat on my back with a monitor on and told not to move as it 'affects the heartbeat trace' (!)

Basically she was incredibly patronising and more or less said:

• I only had a 50% chance of achieving a VBAC - implied 'why bother?'
• I would only be allowed to 'try' for about 4 hours and then they will insist on a C-section
• They will want to do continuous foetal monitoring therefore I will not be 'allowed' a water birth or freedom of movement. And they want me to have all sorts of extra tests - Glucose Tolerance Test to check I'm not developing gestational diabetes (which I can understand and accept as valid) but also extra scans at 36 weeks to try to predict the baby's size (although she admitted herself there can be up to a 30% margin of error) (Why bother? - I thought) I was so choked up with anger and emotion I could barely speak, and in fact as soon as we left the room I burst into tears (poor dh didn't know what to do!) I know why the Med Profession recommends such actions, but I have also read a lot about the risks/benefits of my various options, and I simply fundamentally disagree with their approach. But I'm so emotionally caught up in this since it's me/my baby at stake that I can't engage in a rational argument and debate about it. Anyone else been in the same boat? And what did you do?

MotherofOne

I think you should absolutely stick to your guns. You should insist on what you want and go for it. I had a good labour so can't say I've been in the same situ, BUT I have friends who have been. I know that with my own labour I was very active and moved all the time and it definitely helped, I also used the pool which helped with pain tremendously. A friend of mine had a very similar experience except for the caesarean and has opted this time for having it at home. I know you can't do this. However, why do they want to attach you to a monitor ? Unless the baby is distressed ? Can't you insist on them using a doppler and checking every 1/2 hour instead ?

I honestly believe very strongly that actually the circumstances you are in and how relaxed or not you feel have everything to do with how good / bad the labour is. Obviously complications do arise, however I am sure a lot of these could be avoided. I know my friend felt disempowered and from there it all went down hill. I would insist on using the pool and being mobile and only if they have a very good reason (they know baby is in distress) should they monitor you up.

I simply can't understand with modern technology and scans (especially 4d ones) that they can't work out that the baby's bl--dy head is too big !! Another friend of mine was in labour 42 hours before they bothered to give her an emergency c section - it's disgusting. If they know that you are unable because of the size of the head in proportion to your pelvis, deliver vaginally then they should tell you !

Ignore the registrar and go with what you want - I would. You tell them how it will be. It's so much like a sausage fasctory these days - they want to control everything and turn them around so quick. Do you have a natural birthing centre attached to your hospital - they are great. We have one in Watford and it's the best of both worlds.

Motherofone, how I feel for you... been there done that! I was considered 'high risk' with my second baby because of my bloodpressure but besides this had an absolutely straightforward pregnancy. I'd had a straightforward first pregnancy (although with high blood pressure) and a vaginal delivery and 'natural' birth. However, IMHO my experience of pregnancy the second time was ruined by it being medicalised... I had to have antenatals once a week from the off and if I questioned anything (or asked for anything) I was largely ignored or patronised and I very often felt as if I was being told off! At 42 weeks I had a very normal labour although slow and despite what was written on my notes was frankly bullied because I wasn't prepared to have pain relief and was even threatened with a c-section! As it happened the baby came whilst a room full of staff stood around talking about my need for x, y, and z... and my stubborness! I discharged myself within 24 hours! And before anyone says 'they know what they are doing', I knew my body and saw over 36 weeks the same midwife four times... I did do certain things that I was advised to do when I thought them fair.
Motherofone, I don't have a solution I am afraid but lots of sympathy... make sure your partner knows what you do and do not want for that time when you are beyond arguing. Stick to what you feel comfortable with. If, in the unlikely event, I was having another baby, I would employ an independent midwife, who would be there for me, somone I could trust who would get to know me and be best able to advise me. I lost all faith in the medical profession in my second pregnancy. Sorry I can't give you any advice just tonnes of sympathy. Best wishes, let us know how things go... Winnie x

Motherofone, Tillysmummys post reminded me of something I wanted to say also... initially when in labour I had a midwife who was fine with me being monitored intermitantly and encouraged my being active (I think I walked miles)...it was when the shift change tookk place that the situation changed drastically. Thank goodness I had my husband fighting my corner!

And what Winnie said is exactly what happened to my friend. She was in the birthing pool with a wonderful midwife who worked 2 shifts (!!) but then when she had to go the whole thing changed and her experience turned bad.

MotherofOne

I am assuming you are living in the UK therefore you should be receiving 'woman-centred care'. In my own hospital, women with previous C/S are usually kept out of the midwifery unit because of the supposed requirement for continuous monitoring. However, the ultimate decision of what is required for labour belongs to the woman. In our unit we have had women request to use the pool for pain relief and have had vaginal deliveries. The heartbeat of the baby is heard every 15 minutes with a doptone. We automatically cross-match women who have had previous C/S for blood incase thet do require another C/S but that does not mean that they cannot have an intervention free labour.
I would suggest to your consultant that you wish to have an intervention fre labour but realise that should any difficulties arise you are willing to take medical advise which has been fully discussed with you. At the moment there is nothing wrong with your pregnancy and you wish it to remain treated as normal. I think you sound very sensible and, as a midwife, I think it is important that women with previous C/S attempting vaginal delivery should be mobile as much as possible. Something to remember about hospital deliveries where the woman does not have requests honoured. She can actually have a homebirth and the doctor can not do anything about it. I am not for one minute suggesting you should do that but you do have rights. Write out a detailed birthplan and find yourself some evidence to support your 'demands'. You may find that the attitude may change when you demonstrate you have thought things through. It would be good if you had a more supportive midwife. Does your hospital have a consultant Midwife? If so you might be able to access her. If not you could ask for an appointment with the Supervisor of Midwives at the hospital and she should help you get the care you want.

MotehrofOne, have you seen the thread on maternity nurses - the discussion on birthing doulas sound interesting, if you can afford it. I had an emergency c/s for my dd's birth..and if I was to get pregnant again I'm not sure what kind of birth I'd choose, but I can relate to your frustration at your wishes simply not being taken seriously by people who think they know better.

Bundle you read my mind.... Motherofone : I would consider a birth doula if I were you.
You can talk to one and see what sort of support she can/wants to give you and then decide if you want to proceed.
They cost usually between 250 and 400GBP for a birth (how much do new tyres cost???).
If you want to go down that route you need to find a GOOD doula. Someone who you feel you can connect with.

Motherofone, I didn't have exactly your situation, but a couple of things were similar:

1. Being patronised! Hard one to deal with this. The only things I can suggest are: do some research on VBAC and %age success rates etc and go in armed with these; Take a deep breath every time you feel angry and ask the consultant not to speak to you that way.

2. Being told that I couldn't have a waterbirth/home birth because, in my case, they thought my baby was too small but wouldn't committ to guessing a size at all. I was dying for them to guess since I knew what the official "small baby" size was and felt strongly that mine wasn't. (I was right, he was 7lb 1oz) As a result of this the consultant wanted me in hospital, hooked up to a continual foetal monitor and told me "you can forget about your water birth or home birth". Charming!!!

What happened in my situation was:

1. I found out that continual monitoring is one of the most discredited forms of intervention (think my stats at the time were from AIMS or Sheila Kitzinger?) and said that I didn't want it.

2. I had the full support of the midwives who reminded me that it was my right to give birth at home if I wanted to. I also had the support of my GP, who reminded me that obs/gyn consultants have the highest insurance premiums in the profession and are therefore anti any risk at all.

3. I therefore went ahead, agreeing to transfer if there were any problems. There weren't, luckily, and therefore I had a problem free, 7 hour 1st labour at home.

Don't know if this helps, but I do remember being very angry at the time about the patronising attitudes of the consultants I dealt with and their keenness on intervention. I fought back with statistics, good midwives and a dollop of bolshiness.

HTH.

Motherofone, you don't have to put up with being bullied in this way. This is your body and your baby and you should be able to make your choices. You could contact NCT, on 0870 444 8707 (you don't need to belong to NCT to use their services) and find out your options from them. They have plenty of evidence about CFM and so on and would also be able to put you in touch with a VBAC group, who could lend you moral support. Good luck.

Motherofone, are you at the Homerton, this sounds scarily like their reaction to my wanting VBAC (and a home birth, but that's a different story.) I found AIMS very useful also a support group for VBAC, can't find the details now but will post them asap. I'm afraid I haven't read all the other posts so may repeat them, but my experience was that Registrars and SHO's are increasingly anxious about litigation and are schooled to avoid any risk, if you arm yourself with as much info as you can, keep calm, put your case to them firmly but calmly you may 'win'. (I know it's not always helpful to think of it as a battle but you know what I mean). I also found that having a couple of the midwives on my side really helped to sway the consultant.

In the end they agreed to me having a Home birth with a pool even though I had emergency C-section with no.1. In the end though what happened was I had a bleed at 34 weeks which worried them and I ended up in hospital, 'strapped to the bed' with a Ventouse and huge episiotomy and I am convinced that if I had been at home, or at least been far more mobile I could have had a much better labour 2nd time around.
I would also recommend you looking into getting a doula which I had planned to, but which didn't work out unfortunately.
Finally, sorry to be so longwinded, if you can afford it, we looked into a private midwife, and she seemed much more amenable.
That's all for now, I'll dig out that VBAC number!

Motherofone, I had a situation very like yours in some respects. I had my first at 27 weeks by C-section (no choice, as I had pre-eclampsia) and second time around I really wanted a natural labour. What I found was such a variety of opinion. Firstly I was told,'forget the idea of a natural birth at all, you'll have a section'. Then after discussion with other midwives, consultants (I was booked into two hospitals in case I needed to go in early), where one would say, 'Oh you can go all natural' and the other would say, 'hooked up to a permenant monitor'. I felt confused, emotional and worried.

Finally at 37 weeks I saw yet another consultant who always 'allows' VBAC or at least a trial. From the information I gathered I got the following impression

1. The risk of rupture is very very small (less than 1%)
2. They prefer to keep you strapped to a monitor because they 'should' be able to tell if the baby is in distress quickly. However most units have 'mobile' monitors which are straps but no wires. Find out if you can have this.
3. Water births are discouraged because if they need to move quickly, they can't
4. they will only allow a 4 hour 'trial' of labour becaue if you are not progressing at all, and intervention is needed, it usually leads to more intervention.
5. for this reason they don't like to induce as it can be the start of a slippery slope.
6. With your history of a 'big baby' I can understand why they want to do another scan, as you say there is a 30% margin of error, but it gives the best indication that we have.

In the end they cannot force you to do anything, and itsounds like you had a really patronising idiot who didn't take time to discuss the whys and wherefores of your situation.

In my case it was all academic in the end. The last consultant visit at 39 weeks agreed that if things looked 'favourable' they would induce me at 40.5 weeks (due to BP they didn't want to leave it). However on my due date I realised I had been leaking water for 24 hrs so I went in, not in labour. Firstly they decided to induce me, then they decided the baby was too high and they wouldn't, then they decided to send in a third person to do an internal who couldn't even reach the baby, so they sent me to bed! The next day I had a junior Dr (who didn't read the notes) try to give me an internal, and I explained that the baby was not engaged and that my consultant would only induce if things were 'favourable'. He went away and said 'No' the other consulatant wants to induce you. I asled if he'd looked at my notes and was told, 'no the consultant didn't realsie you had had a section before'. By this time I was p*ed off and asked for a definative opinion. 3 hrs later a Senior Registar came in (5th internal) and decided there was no point in inducing me as the baby wasn't engaged and what was the point of hours of labour to end up with a section.

Finally I had a section, and after as they were cleaning up they told me if I had been allowed to go into labour (or induced) I would have to have had a section as there was meconium in the waters and the placenta had broken down!

So (excuse the waffle) all I will say is I know how you feel, I didn't want a section no matter what. However I had one, and before I did I was able to make the choice. It was the choice that empowered me and stopped the unhappiness and confusion. I am sorry to say you will have to come to terms with the fact you may need another section, and it is better to understand that now, than be disappointed on the day. However if you are lucky and everything goes OK you won't need to have a section. All I am saying is please prepare yourself emotionally in advance, bacause it is this that will stop you getting depressed and emotional about it afterward.

I didn't get teh birth I wanted, but at least in the end I chose NOT to be induced and had some control over my baby's birth.

Good Luck

Motherofone
I would add my support to trying to find a good birth doula who you feel will be absolutely in your corner on the day. The obvious option is an independent midwife in a birth centre or home birth but these are very expensive so a doula might be a good compromise.
If you are in London I can recommend an excellent doula (but she is quite booked up in advance).
I was lucky to have the support of community midwives (never saw a doctor) who really promoted homebirth and woman's choice. Is there any way you could switch hospitals? The NCT will be very supportive - so do try giving them a call.

Message withdrawn

When I was pregnant with ds they decided that I needed to see the consultant because they considered ds' shoulders were going to be too wide. The first time I also see one of the consultant's little helpers and later learned from my midwife that I could insist on seeing the head honcho which I did the second time. They weren't very happy about it and made me wait an age. When I said I wanted a water birth he said it was my decision at the end of the day but would I forgive myself if something went wrong. It made me very angry at the emotional blackmail but in the end (as it was my first and I considered they knew best) I went to the main Mat Unit which was awful. As it turned out I would have ended up there anyway even if I had insisted on the water birth as I wasn't dilating fast enough for my contractions and ds deciding to 'help'. They do treat you as some second-class citizens whose mind has obviously been addled by being pregnant. I say go with your own instincts as after all its your body. Its not like you're refusing intervention if its absolutely necessary after all. Nobody can say whats going to happen in labour until its happening and surely whichever birthing help you choose will have enough experience to know when to get help if its needed.

Motherofone, I was talking to my sister about your message (she is an SHO) and she was saying that while the consultant's manner was bad, that obs teams get very twitchy about women who have had bad first experience's ending in CS's wanting VBACs. She says it is not because they are control freak gits but that they have to be sure that they spell out very clearly exactly what risks you could be taking, so that they can't be accused of negligence if anything goes wrong.
I myself had a really crappy experience last time which ended in a difficult forceps delivery. I was also offered a late scan as ds had a whoping great head. They did say that there was 15% margin for error either way but that it would be generally reassuring to have it done. I have to say that I was really pleased to have it as it showed a much more average sized head.
Anyhow, I'm not trying to defend your consultants behaviour, and I hope that you are able to find someone who will be supportive of your choice of delivery.

Motherofone. I can only echo everyone else, its your right to try for the birth you want and not to be bullied or patronised. Its no consolation to you I am sure but your posting has been a timely warning for me. With dd I had an emergency CS, failure to progress etc (due to her being large and face up). I suspect this was inevitable, but the run up was horrendous (and I am still sure that the MW turned up the syntocin drip before the requested pain relief arrived as we had asked on the advice of a registrar who did not even bother to come and see me in person, but I digress..
I have been advised by my GP and MW that they will "let me try" a VBAC but will intervene earlier. It had not occurred to me to ask how much earlier or that they might want continual monitoring. I am off to see the consultant next week and will be making some enquiries. It will be interesting to see how their policy compares.
The language is interesting dont you think. they will "let me try" various others will be "allowed.." whose bodies are we talking about here??

Motherofone, You sound well-informed and articulate - go for what you want and trust your own judgment. It will help if you have a birth partner who fully supports you and will fight for you during labour. My Mum disagreed with my wanting a water birth, labouring on all 4s on the floor, using TENS machine, etc, but when we got to the hospital she stuck up for me, always took my side, and raised her voice too. I also had a typed birth plan which we kept on waving around. It said what I would like to happen ideally, and obvious things like, "I want to move around during labour," "Please respect my choices and do not keep on offering me pain relief," and, "Please allow me to make a noise during labour as this will help me." I would highly recommend a water birth to you. Try and go to a workshop beforehand or watch a video about it. I had to stand up every so often so they could do fetal monitoring with a handheld unit. I actually got out at the last minute and had my baby on the floor, but my brilliant midwives put down a mattress for me. Having been very proud of my natural labour, the placenta then was retained, and had to come out in theatre. So, I don't think anyone ever has a perfect labour just the way she wanted. I hope that whatever your labour is like, you don't get patronised and that you have a healthy baby.

Most units can do foetal monitoring in the water (no need to stand up) - do check !!!
Also I delivered in water - personal choice of course - also circumstances... but there is no danger (besides the usual risks of any labour of course) to actually deliver in water (as a video would show you)... babies' head can stay 2 minutes in the water before you deliver the body... it usually doesn't take that long as baby's body usually comes out very quickly after that.

MotherofOne - have you considered changing hospitals (if there is another nearby).

The birth of my ds was very similar to yours, an emergency section after full dilation then finding CPD (normal baby/small pelvis); although the section was inevitable I am still livid that I spent the previous 17 hours strapped to a bed with continous monitoring (babe was absolutely fine all the way through), I had an epidural that didn't work and forgot that gas and air existed, (my contractions were so close together I wasn't capable of thinking in between them) and so didn't think to ask for it (and it wasn't offered) so after having a day and a night of labour pains which I coped with very well, (first day at home - didn't go into hospital until waters broke) walking the pain away, I was in agony and unable to move or even change position.

However, even as I was being sewn up the doctor doing the sewing was telling me that I could go for a VBAC next time. I was visited by a couple of the midwives on the ward the next day (I had twelve midwives from entering hospital till birth of baby and their attitudes had a lot to do with my treatment), both of them told me to try VBAC next time.

So, although I didn't feel at all in control during my labour I feel happy that the next time my wish for a VBAC will be supported by this particular hospital.

..

Motherofone,I totally respect and support your right to ask for the birth of your choice, but I have to say that I don't know why people feel so strongly against having a c-section. I had overwhelming medical reasons (placenta praevia) for mine so it was planned well ahead. I didn't go into labour induced or otherwise (life-threatening for me and baby!) but had a very calm and peaceful time and a birth that was painfree but very moving and emotional and a straightforward recovery - I breastfed, was walking pretty normally after a couple of days and completely back to normalin about two weeks. I breastfed from the start and managed the baby alone at home after a week. It was a very succesful birth for me, and I think it was because I had lots of time to get used to the idea, and because I didn't have a painful, physically exhausting and stressful labour with intervention and lots of things going wrong. Without those factors, I really feel a c-section can be a great way to give birth. I'd choose one if there is a next time. Mind you, the consultant really wanted me to have a general anaesthetic and I was absolutely determined to have an epidural - no way was I or dh missing the birth of our baby! In the end I had to really lay it on the line about it being my choice and that they had no right to impose any medical treatment on me against my wishes. I was pretty bolshy and it worked, they backed off and I got to see and hold my lovely, bawling, rather cross looking baby from the first moment of life. The consultant was even able to deliver him onto my tummy and I could feed him rightaway. I'm not trying to tell you to do anything different, but all I really cared about was getting my lovely boy safely delivered so it was a surprise in some ways that the birth experience was so wonderful for me. I'm sure a planned, calm c-section is very different from your first experience, should you eventually need one.

My first baby was induced at 42 weeks and ended in distress and forceps which was awful. My second baby was oblique breach and therefore born by ceasarean. When it came to my third pregnancy I was advised that because of my previous obstetric history I would have to have a 'high-tec' labour which meant a drip tap inserted immediately after labour commenced (whether I needed it or not, just in case I needed a general anaesthetic), to be constantly monitored which of course meant staying on the bed and that a birthing pool would out of the question. I tried to argue with the consultant that surely being monitored and staying on the bed would stop me labouring naturally and the baby progressing because I wouldn't be mobile. I tried to negotiate to being monitored less in the hour. However, they argued that a trial of scar would be needed because if the baby went into distress this would show on the monitoring and this might not be obvious by pain felt by myself. To add a touch of hope here however I went into labour naturally at 40 weeks and arrived at hospital an hour after mild contractions started to find out I was 9cms. I had no pain relief, other than gas and air and my baby was born 2.1/2 hours later. The second stage last 25 mins which for me is fantastic. My midwife advised me to labour on my side which I did and this was quite comfortable. She also 'laboured' me for as long as I possibly could without pushing and this allowed for the baby to descend down the birth canal on its own. I have to say with each contraction I could physically feel the baby get nearer and nearer to being born so eventually I only had to push him a small distance. She said this was the problem the first time, that I had pushed far too early when in actual fact my body could have done most of the work for me. It was a very natural birth this time in terms of letting my body do all the work. There was no distress or panic and actually I wasn't monitored as much because my labour was going so quick. Apparently I had passed the critical part and also I didn't have the drip so I felt I had escaped any intervention. Also there was only my midwife plus one other right at the end. Good luck.

Motherofone, here's that vbac support link i mentioned