What to ask consultant midwife at VBAC clinic?

[maamalady]

I have an appointment on Tuesday to talk through possible VBAC - any ideas what would be good to ask?

This is DC2, my first was induced at 40+11 and born by EMCS due to her head being too big for a vaginal birth.

So far all I can think of is what proportion of successful VBACs are instrumental - I'd rather have a caesarean than forceps... But I'm quite conflicted about whether to try for a VBAC at all or just request an ELCS.

OP no advice really in afraid-I could have written your post although I don't have VBAC discussion til April. Csection for too large baby at 40+1, also concerned about instrumental delivery. Erring towards section but I'm worried about it being just a better the devil you know thing, but feel guilty about not wanting to try for a VBAC.

Maybe ask whether you get monitored more closely with a VBAC-I think you might and that might sway your decision if you particularly like or dislike presence of midwife in room constantly.

Following

I struggled with deciding but went with VBAC (although breech so have a section planned at minute!). My first was traumatic ventouse, 2nd elcs for breech. My deciding factors that I discussed with consultant and supervisor of midwives :
Do they have wireless monitoring? Although if you make an informed choice, you can have intermittent monitoring, I would feel more confident being fully monitored but not via CFM as I don't want to be confined to one position - I feel this contributed to my traumatic first birth. The answer was yes!
Can I have a water birth? As they have wireless, waterproof telemetry, then yes I can labour and birth in the pool.
Other things that are on my vbac birth plan that I discussed are:
Low threshold to section as I do not want instrumental unless it is a dire emergency.
All decisions to be discussed with consultant rather than just junior docs.
I don't want a cannula sited 'just in case' i need a section.
To have an active birth, eat and drink as I need to, quiet and dark environment.
I then also have a 'gentle section' birth plan for my elcs or if I have a vbac and need a section.

Hope that makes some sense! I basically wanted my VBAC to be as 'normal' as possible to increase my chances of having an intervention free, vaginal birth.

I had an EMCS following failed induction last year. So haven't tried for a VBAC but have been thinking about future pregnancies. Questions I'd have around VBAC would include:

• What are the odds of successful VBAC, both in terms of the hospital's rates and the likelihood of me personally being able to have one? I'd want to know whether the reason I needed a CS last time (failure to progress in my case) was likely to rear its head next time round or whether it was likely to be specific to that pregnancy/labour.

• How would the hospital approach a VBAC labour? For me personally, if I'd be on my back throughout, strapped to monitors and with a cannula in place from the start, I think I'd want an ELCS. Agree with the pp about asking what kind of monitoring would be in place.

• If VBAC failed or wasn't progressing, at what point would they recommend a CS and how quickly would it happen? Likelihood of needing a crash CS?

• I'd also want to discuss how big a family I was planning, if I wasn't confident this would be my last pregnancy, and what the implications were for future pregnancies depending on what I chose.

Good luck!

Thanks all :) I will be making a list of questions this evening! Will report back after the appt...

Appointment went well (though I was booked into the wrong clinic, so ended up seeing a consultant doctor rather than midwife), all questions asked and answered :)

Basically it looks like a VBAC is at the same risk of instrumental as any other vaginal birth - and for me it's not something you can predict as previous birth circumstances can't be reliably predicted to happen again. They would do continuous monitoring, but have wireless so it wouldn't restrict mobility. I would have to be on delivery unit rather than the MLU, but that was what happened last time and was fine so I'm happy with that. Also VBAC women get one-to-one midwife care throughout their labour, which is also very encouraging.

I think what I'm going to do is ask for ELCS on/after due date, but go for VBAC if I go into labour before then. Seems like a reasonable compromise!