Is this normal vbac procedure?

[OhWhatAPalaver]

My consultant basically said if I have a vbac then I will be constantly on fetal monitoring and I won't be allowed to be on a midwifry led unit, I'd be on consult led with no chance of water birth. Also they wouldn't let me labor too long and if I was late then they would go straight to a section and not induce me. Is this normal? I'm thinking I may as well go for a section! My first dd was breech so I have the option for either. I'm 33 weeks now and baby is still breech so I may well end up with one anyway but just wanted to see what others experiences are. :)

[OhWhatAPalaver]

Ooh yes, I don't think we'll be having more than 2 so no problem for another c-section on that front!
I am still no closer to deciding so I'm going to see what position the midwife thinks baby is in at my 34 week appointment on Monday and go from there.

[fruitpastille]

One thing to bear in mind is if you are thinking of future children. I've had 3 sections all straight forward. First elcs for breech, 2nd failed vbac, 3rd elcs for breech. I was going to try vba2c until i found that number three was breech. I've now been strongly advised not to have more babies as at my last one my scar was paper thin and the surgeon said it would almost certainly have ruptured if I had laboured. So the more csections you have, the more possible complications there could be with future pregnancies. Luckily three is enough for me!!

[emsyj]

Hopefully you will have a positive and straightforward second birth BaskingTrout. I am now expecting DC3 and having experienced both extremes I am not sure what awaits me this time around!!

[BaskingTrout]

i think that's probably true emsyj

my emcs was for a baby-related reason (DD turned transverse during labour and got stuck, but wasn't too distressed) and the consultant was happy that because I had laboured to fully dilated and had pushed, that I will be able to do it again this time, hopefully with a baby that co-operates!

[emsyj]

I wonder if the approach is different in some cases because of the causes for the first c-section, as you mentioned in an earlier post OP? I am speculating here, but I laboured quickly to 10cm with DD1 before having a crash section due to severe foetal distress. Because this was a 'baby-related' reason, according to my midwife with DD2 I was not at any greater risk of having a section on my second delivery than any other second-timer. I chose midwife-led care and had a short, comfortable and uneventful home birth with DD2. I felt that I could not cope with continuous monitoring as I have to 'pace' in labour and I know from speaking to the hospital near me that their monitoring systems are physically very restrictive - but again, this varies a huge amount from hospital to hospital.
I think if I had been given the choice between VBAC with CFM or an elective section I probably would have been very very torn but ultimately opted for elcs. Or perhaps a VBAC with an epidural.
Regarding induction, in my area they will use a pessary and/or break waters, but wont use a drip.

[Bambambini]

I was surprised when they induced me with my second birth after an EMCS. I wanted to try for VBAC but like the first, I went over. I actually went in to have an ELCS and was booked as first section of the day on the surgery list. I changed my mind with the poor surgeon being very patient and giving me time to "think about it" and decided to go for natural. They broke my waters to try and start me off hitch didn't work. Then resorted to sintocin which I was surprised about. Baby was eventually delivered in theatre by ventuese after a failed forceps attempt.

So you can be induced for VBAC.

[OhWhatAPalaver]

Sounds like you've got it all sorted in your head mrsmugoo, that's really good :) I'm fairly sure my hospital doesn't have wireless monitoring, which is a pain, but then I'm still not even sure what I actually want to happen anyway... Good luck to you, I wish I was so sure about what I wanted!
The posts on here have sort of opened up more questions than answers but hopefully when I next see my consultant she'll be able to answer all my new questions!

[mrsmugoo]

Hi I'm 35 weeks with my second after ELCS with ds1 for breech.

Pregnant with a DD now and fingers crossed she is currently head down as of yesterday so my VBAC dream is still alive!

I've discussed my options with my hospital. I knew from the outset that as a VBAC I would not meet the criteria for the MLU so I'm happy enough using labour & delivery suite. I can make my room comfortable, push the bed to the wall, use a ball, those wedge cushions, dim the lights etc...

Continuous monitoring has been recommended and whilst I'd probably rather not bother with it, they have wireless monitors so as long as it doesn't stop me moving around then I'm fine with it.

I've been told an induction at term+12 would be recommended and it would be via breaking waters and drop but no pessaries. Sweeps recommended from 38 weeks. I'll play it by ear when I get that far I think. Spontaneous labour would obviously be preferable.

I feel quite in control of my options and know I can go straight to a section if I want to.

[GoldenWorld]

Oh meant to add in spite of all our use of pessaries to induce VBACs (and we've had women who've had 2 prev. c-sections go on to have vaginal births the third time) I've only heard of one woman in recent years there having a uterine rupture but I don't know if she was induced or not. It's really very rare but hospitals are incredibly risk averse these days.

[GoldenWorld]

Yep, it's very different. I'm a midwife and the hospital I work in is quite cautious with inducing VBACs and using the drip (although it does depend on the consultant - some are happier than others). It was a bit of a surprise to me as where I trained we used the pessarys, hormone drips, the lot on VBACs and the doctors were quite happy with it. In fact, they were very keen on pushing VBACs as much as possible, whether it meant they ended up being induced or not. Technically, telemetry (monitoring in water) can be used but it's not widely available but to be honest if your consultant is against induction then it's highly unlikely they'd be okay with you using water. But then again, a different consultant may be on the day you go into labour and have a different opinion. Sorry that's not very helpful but unless it's something you know for sure you'd want I'd probably drop the idea as you'd have a fight on your hands there. Unless you got a sympathetic midwife on board, which why going to a VBAC clinic could be a good idea if your hospital does such a thing.

I imagine it's very difficult making a decision when you've never laboured before but waiting till 36 weeks to see if baby turns or not is a good idea so you have some time to think about it.

[OhWhatAPalaver]

See it's really odd how much the advice varies from different consultants/hospitals. It doesn't exactly make making the decision any easier does it?!

[irregularegular]

I'd never laboured at all before as I had an elective c-section

[irregularegular]

I didn't find the monitoring particularly intrusive. I could still move around. I was standing through most of it.

[irregularegular]

I was induced successfully for a VBAC. Drip not pessary due to risk of rupture. There was more monitoring etc but it was fine. Much much better for me than the c-section (also because breech). I know some places won't induce at all, but my consultant was adamant that the induction by drip did not significantly increase the risks.

[Imnotacelebgetmeouttahere]

As others have said its all dependant on the hospital and perceived risk etc... I was told no induction for vbac but they actually then did induce me at 34 weeks... With a hormone drip which I've heard is a massive no no for vbac but they didn't seem bothered

[OhWhatAPalaver]

I guess I'm just going to have to stick with my original thought and make my decision when we find out which way around baby is.
Tbh I am quite scared of the idea of childbirth this time round, just because of how wrong it went last time! So that's probably why I'm coming across as not too bothered about the idea of having another CS. Like Anna said, I feel a bit like it might be better the devil you know. But then again I'm fully aware of the things that can go wrong with a section as well!
I think I'm waiting to see which way around the baby is partly because, if it was breech, it'd make the decision for me. I'm indecisive at the best of times and this is probably one of the hardest decisions ever!

[cudbywestrangers]

Forgot to mention inductions! I was told they would do a sweep on due date and try to break waters if over (i didn't get that far but think they would have let me go 12 days as usual) but no hormone drips. I guess this is where the limits on length of labour are coming from as they won't want to use a drip to speed things up, but this was mever mentioned to me.

[cudbywestrangers]

I opted for a vbac with ds2 3 months ago.

Ds1 was emcs for undiagnosed breech. I was 7cm on arrival at hospital and ready to push by the time i got to theatre aftwr about 9 hours of labour.

Ds2 i asked for a late scan to check position as i didn't want a repeat but otherwise wanted vbac for faster recovery and i did feel fairly confident i could manage with a baby the right way round. I was told i'd need to head into hospital as soon as contracting regularly and would be on continuous monitoring. My hospital don't have wireless monitors unfortunately and i don't think i managed to move much but that was partly me being lazy and partly difficulties with picking up the heart rate which was showing distress. I ended up having to push on my back and then ventouse because of the distress. I went from waters breaking to delivery in less than 5 hours.

Although it all sounds a bit grim on paper i found it a very positive experience compared to ds1 and the recovery was much much easier so it was the right decision for me. I'd have been ok with an emcs if it came to it. Part of me wants to have dc3 just to try and have a straightforward delivery though!

[TheABC]

Hi OP. I am 38 weeks, in a similar situation to you. However, my hospital is very pro vbac and have already agreed to wireless monitoring, a relaxed birth etc. You don't have to be strapped to the bed and they cannot force you to accept all the restrictions (e.g. 6 hours labour - when a normal one is generally much longer). There is some truth in the saying that "it's not you body's failure to progress, but your doctors failure to wait" - so unless signs of fetal distress occur, you could ask to go for longer. I would also read up on the latest research regarding scar rupture as the risks (when properly managed) are low - my vbac midwife quoted 0.5 %.

[AnnaT45]

I'm 27 weeks and been told by consultant they really don't want to induce or let me go given my labour with DD which resulted in an EMCS. He said really they wouldn't be happy to let me go over four hours of labour unless things were really progressing.

It's tough because whilst I'd like a VBAC for the recovery I'm too scared that things will go wrong again and I feel it's a case of better the devil you know. I know how tough a section recovery is and hope that this time will be better without the 30 hours of labour before and the infection I developed in labour wiping me out for weeks! You don't sound massively bothered either though?

[Ihatechoosingnames]

That's the reason I didn't go for a VBAC, OP. I had continuous monitoring in my first labour and it was vile, I literally was not allowed to move off my left side and felt like my back was breaking. It wasn't a case of 'well the medical staff can't make you do anything' - that monitoring was very necessary for the sake of my son but it was fucking awful for me. I ended up with a very scary EMCS anyway. So went for an EMCS with my second and it was lovely. Couldn't face all that horrible uncertainty again.

[OhWhatAPalaver]

I'm not too fussed about being in the consultant led unit, it Is the same hospital, just a different floor so I expect it to be largely the same as the mlu, just with more monitoring.
The thing that bothers me the most is the prospect of going through all the effort to try for natural then ending up with a more stressful section anyway...

[mummytime]

I was told only 6 hours labour - but in practice it was 20+ as they didn't the staff. I wasn't constantly monitored. Don 't think I'd have got a water birth but not sure it was forbidden. I only got an epidural when I asked.
They might have been less happy with a midwife unit distant from the Hospital. And strongly advised against home birth.

[catkirk]

If you're late you can ask for a balloon in the cervix induction rather than syntocinon. I was allowed to labour for ages (with monitoring) but otherwise what you've described sounds like my experience. Also, if this is going to be your last child id go for another section tbh.

[OhWhatAPalaver]

X post! Will ask about vbac midwife too, thanks :)