How best to prepare for vbac/poss c-section?

[Twiga]

Right, I know this is an often re-hashed subject so apologises in advance. I'm expecting my second baby in June and am hoping for a vbac. Am realistic enough to realise that this may or may not come off but am determined to give it a go. Really just looking for advice on how best to prepare; what kind of thing to put into any birth plans, what might up my chances of managing myself, how can I make a section a more pos experience if it comes to that? etc

Quite nervous about it all already, despite making my feelings clear to mw, they will still want to discuss the whole thing at 34 wks in case I change my mind etc - worried might not get the support I need. Experience last time was rotten; failed induction at 40+12, needed g&a to get through the internals as pessaries made me very sore, failed to progress emergency section at 40+14 - total of 54 hrs in labour. Whatever happens really just want things to be more positive this time round whichever route we end up taking.

If you've read this far, thanks!

My first birth was very similar to yours, so I'll be in the same position as you when I get pregnant again (hopefully soon!)

I am thinking of hiring an IM or a doula next time round, as I think one of the worst things about my first birth was the fact that I never saw the same midwife twice. I felt like I was on a production line. I am hoping that having a familiar experienced person there to support me through the birth will give me the best chance of a successful VBAC.

Lulumama would be a good person to speak to about this, hopefully she will spot this thread soon. Also try searching the archives for VBAC, there have been loads of threads on this subject.

have to go and bath the DCs......

so, in the eantime...this has some good links and stories

definitely second the suggestion of a doula or IM ...

and if you decide on a c.s there is some info i have on that too !

back later..sure there will be lots more responses in the meantime

bumping for you twiga

btw...my first labour was an induction ,failure to progress ..being stuck on a bed, with an epidural, drip and CFM for 6 hours will do that ! LOL

2nd labour was an intervention free vaginal delivery

did lots and lots of reading about birth, Ina May Gaskin, Sheila Kitzinger in particular, trawled the internet for support....

re pessaries....a localised irritation can happen with those....not very nice

do you know much about your last labour . did you go through your notes with anyone afterwards.......?

wanting to be positive whatever happens is good, and i think that if you have a preference it is worth aiming for that !

really important to have confidence in your body and to have support ...

a doula is a good idea. an IM can accompany you to the hospital but not deliver you there, but she can at home

will sort out some links for good websites

Hope this post is not too long and rambling!! I am 40 weeks today and planning for a vbac if possible! I was very wary about how the consultants would approach the matter of vbac but have generally been pleased.

I would definately recommend getting a local doula who has experience with births at your hospital (assuming you plan to go to hospital). Mine has been invaluable in this respect as she has been able to tell me exactly what their routines and protocols are and we have been able to write my birth plan accordingly. For example, my hospital would usually put cannula in your hand and insist on continuous monitoring. I have stated that I don't want either of those things and mentioned it to my consultant too. The consultant has written in my notes that I don't have to have either (in early labour) and my doula has also warned the head of midwifery. You might be quite happy to go ahead with those things, but it helped me to know in advance what I was up against as I knew I wanted as active a labour as possible.

I also have done lots of reading so that I know the likelihood of problems arising and feel very informed.

The staff I have come across at the hospital and the GPs have been more encouraging than I expected so I hope you have a positive experience too!

Rant over!!

Thanks for all the replies, good to hear some pos chat on this. I know what I want but am so scared of it all going belly up and being pushed into things I don't want ie not patic keen to be induced again. I felt very badly informed about what induction entailed and also hadn't really had much chat on sections either.

Lulumama, here's some detail of last time, was induced at term+12, prostin x2, unfavourable cervix and v.tender to examination (needed g&a to cope). Slow progression, artificail rupture of membranes and syntocinon drip. Unco-ordinated contractions, got to 4/5cm dilated and no further. Emergency section under spinal, uncomplicated. Went through the whole range of pain relief, TENS (which I loved), morphine x2, epidural. Was stuck on my back on the bed throughout, but to be fair was so sleep deprived (54 hrs start to finish) and out of it on the morphine that mobalising wasn't an option.

What bothers me the most is the mw who initially started the induction had trouble getting any where near my cervix (high and far back) and have wandered since if I should ever have been induced at that point or if I should have insisted on being left a few more days but monitored. Dd was op and I have bicornate uterus, septated down about a third - couldn't get any sensible chat on how much any of this also contributed to lack of spotanious labour etc.

Have to say a part of me felt like I failed last time round and am worried about feeling like that again this time. At the end of the day am glad dd arrived safe and sound - she showed no signs of distress at any point during the labour.

Hi Ja9, hoping to read a great home birth story from you soon! Lol from us all in Twiga household x x x

Sorry if this is long and rambling but am starting to realise just how much the whole thing is bothering me the closer I get to June!

(((twiga at this rate i'm going to be induced in hosp - so no HB ! apt for induction 8:30am on tues. they offered to do it later but i'm so desperate to get bub out - haven't been keeping very well which is hard with ds)))

• sorry for hijack.

Oh ja9, sorry to hear you've not been keeping great - can see why you're desparate to get things going. Really hope it doesn't come to the whole induction thing - not a big fan given my experince - and if it does hope it's all very quick and smooth. Gonna pray extra hard for you guys over the next few days. Must be so frustrating having gone early last time too.

Hello - I had a VBAC 2 years ago and was thoroughly glad I plodded on throughout labour. The birth experience made me feel euphoric and although I don't feel cheated from the CS of my DD, it was amazing to birth as nature intended. However, due to the possibility of a uterine rupture, they were very aware througout my labour and the consultant said he only wanted me to push for an hour and after that it would have to be a CS. However, when it came to it, the midwives gave me an extra 1/2 hour and then the consultant realised I really wanted a normal birth and delivered my DS by ventouse. I had an episiotmony but compared to a cs, that was a breeze!
I found good info on the NCT site and there is a site for VBAC deliveries - i'll try to find it for you.

www.caesarean.org.uk/

good site for the reading list - loads of publications/books discussing all aspects of VBAC and CS births.

The 2 women who run the website and offer advice are really helpful too as I remember emailing one of them to explain something and she wrote back very quickly and explained everything fully.

twiga - who've you spoken to about this so far? have you talked through last labour with a consultant?

Thanks Luciemule, will have a look at the link when I get a moment.

Tassis - spoke to obs in Dumfries and also mws there who seemed to think there was no reason why I shouldn't have a vbac, didn't talk time limits or anything. Mw was not overlly impressed by account of induction etc or by the fact that nobody realised dd was op until just before they decided to section. So far haven't discussed paticularly with anyone here apart from mw here today who seemed to hear what I was saying in terms of my choice but was very much well they'll review you at 34 wks. Didn't seem to think there was any need to discuss with a concultant before the 34 wks - I did ask about seeing someone before that. My fear is that with here being a busy and understaffed unit I'll be pushed into things earlier than otherwise and more intervention likely. Wish I was still in Dumfries for this birth, whole aproach was so much more pos.

Tassis - they did go over my notes with me when I was still in hospital last time - mw not consultant - but things still hard to process at that point and seemed to be saying would need section every time, so not overlly helpful.

I would insist on seeing a consultant asap...say you need time to research your choices etc...

i don't think they can refuse you

(did you get your extra scan? i texted you but think it went to old number)

Tassis, mw put in the referal today for the extra scan - I'm a bit annoyed about it all to be honest. Tried to sort out the referal over a fortnight ago when first registered with practice but she insisted on seeing me even though we'd spoken over the phone. Lucky to see her today as origenally the quickest appt I could get was mid-march and as I'm 24 wks on Sunday was going to be too late. She thinks they should fit me in next week as needed - just waiting for appt to come through now.

Old phone been on but upstairs all day so haven't checked it - still using both until I get round to letting everyone have the new number - one of many jobs needing done!

Don't think there is any chance of you being induced. My hospital certainly won't allow it due to increaded risk of scar rupture so that should be one less thing to worry about! If there are any complications they cut straight to the section (excuse the pun (-

What bothers me the most is the mw who initially started the induction had trouble getting any where near my cervix (high and far back) and have wandered since if I should ever have been induced at that point or if I should have insisted on being left a few more days but monitored. Dd was op and I have bicornate uterus, septated down about a third - couldn't get any sensible chat on how much any of this also contributed to lack of spotanious labour etc.

Have to say a part of me felt like I failed last time round and am worried about feeling like that again this time. At the end of the day am glad dd arrived safe and sound - she showed no signs of distress at any point during the labour.

there is a school of thought that suggests that a Bishops score of 6 or more is best to get a favourable outcome for induction

so it would be interesting to know what your was ...thing is you were 42 weeks, and most hospitals get really twitchy about letting you go past there....even though some women need to be pregnant for 43 weeks

and if your dates were wrong, then you might not even have been term + 14 ...IFYSWIM

so it might be you weren;t ready

OP in itself can make a labour longer and contractions less effective, but that in itself should not stop labour progressing, but coupled with being immobile it might have had a knock on effect

don;t know if baby;s position was dictated by the shape of your uterus..might be worth looking into that, as important to have all relevant info , IMO!

feelings of having 'failed' in some way after a c.s are common, and normal..as long as the birth is not haunting you , IFYSWIM...

it might be worth seeing the head of midwifery, consultant midwife and or obstetrician, as i am wary of 'once a section, always a section', without evidence to show it is necessary for each particular case.

Twiga, your first birth sound similar to mine. I sympathise. The first midwife who tried to break my waters couln't manage to do it. Shift changed and the next midwife was miffed as she understand why one would have difficult with the simple task of breaking waters. I felt like a bloody fish where they were casting their hook. Oh and it was just the biginning of a very long night.

Anyway, good luck with your VBAC.

Hello,

I am new here. My name is Karen, I have had a VBAC with forceps assist and am currently training to be a Doula.

In answer to your question I have a selection of links you may wish to look at:

Best places to start:
www.caesarean.org.uk/
www.aims.org.uk/
www.caesarean.org.uk/articles/VBACOnWhoseTerms.html
www.radmid.demon.co.uk/vbac.htm

Silent Knife: A book you MUST buy and read:
tinyurl.com/2mbhn5 but not necessarily from that site ;-)

Another great book, Spiritual Midwifery:
tinyurl.com/ozs4u
www.inamay.com/books.php

If you have trouble coming to terms with your previous CS:
www.plus-size-pregnancy.org/CSANDVBAC/csemotionalrecov.htm
www.birthtraumaassociation.org.uk/
www.tabs.org.nz/
tinyurl.com/5gscd "You should be grateful"
www.sheilakitzinger.com/ArticlesBySheila/BadBirthHaunts.htm
A Relevant Book Review: www.birthpsychology.com/healing/breview11.html
and another brief overview: tinyurl.com/p6cto

Mary Cronk's scar monitoring procedures:
www.caesarean.org.uk/articles/VBACScarMonitoring.html

For those attempting a VBA2C:
www.homebirth.org.uk/vba2c.htm
www.plus-size-pregnancy.org/CSANDVBAC/vbac_after_2_cs.htm
www.plus-size-pregnancy.org/CSANDVBAC/VBA2Cstories.htm
And a birth story: www.homebirth.org.uk/bernadette.htm
www.caesarean.org.uk/articles/ElectiveSection.html

And risks of UR with VBA2C or more:
medicalcenter.osu.edu/patientcare/hospitalsandservices/press/?ID=2835&SIDS=17&o=0

4 links about pushing I wish I'd known about:
www.birthinternational.com/diary/archives/000558.html
www.birthpsychology.com/messages/push/push.html
www.midwiferytoday.com/articles/pushing.asp
Birth Without Active Pushing
www.harcourt-international.com/e-books/pdf/465.pdf

OK so it's on Homebirth site but I thinks it's relevant. Overdue:
www.homebirth.org.uk/overdue.htm
Also: www.infochoice.org/ic/ic.nsf/icy/12?OpenDocument

To scan or not to scan:
www.homebirth.org.uk/big.htm#2

Just say NO to induction:
www.kentmidwiferypractice.co.uk/induction.htm
www.radmid.demon.co.uk/induction.htm

The most recent Cochrane Review
Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour:
www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006066/frame.html

When trying to argue your case AGAINST monitoring:
bmj.bmjjournals.com/cgi/content/full/322/7300/1436
tinyurl.com/l4s9r

Birth plan inspiration:
homepages.picknowl.com.au/caressa/common/birthplan.htm

The Third stage:
www.homebirth.org.uk/thirdstage.htm
tinyurl.com/3cv7z9
www.cordclamp.com/

If you need to make a complaint about your Maternity care:
www.aims.org.uk/complaint.htm

And relative risks of VBAC :-):
www.gentlebirth.org/archives/vbacrisk.html

Epidural anesthesia risk chart:
www.kimjames.net/Labor%20Side%20Effects.htm

What you need to know about midwives and homebirth:
www.nmc-uk.org/aFrameDisplay.aspx?DocumentID=1446

A web site where you can download 21 leaflets about various aspects of pg, labour and delivery:
www.infochoice.org/ic/ic.nsf/welcome_consumer?openform

Shoulder Dystocia, a very long link to read through with links at the bottom:
www.radmid.demon.co.uk/shoulders.htm

If you suffer from SPD:
www.pelvicpartnership.org.uk/index2.html

What about slow and/or long labour:
www.birthingnaturally.net/birth/progress/alslow.html
www.rcmnormalbirth.org.uk/default.asp?sID=1103622088724

Birth stories!!!:
www.vbac.co.uk/stories/

Runa's Birth (a homebirth), a book to read to, and discuss with, your older child:
tinyurl.com/rzxno
or Hello Baby by Jenni Overend: tinyurl.com/yg28qv

So baby's not in the best position:
www.spinningbabies.com/
www.homebirth.org.uk/ofp.htm
www.gentlebirth.org/archives/position.html

If baby is Breech:
www.radmid.demon.co.uk/Skills.htm
www.breechbabies.com/contents.htm
www.birthinternational.com/articles/andrea13.html
www.mother-care.ca/breech.htm
www.moondragon.org/obgyn/pregnancy/breech.html

If you want to find a Doula:
www.doula.org.uk/

A MUST for everyone, how I'd prefer to have a CS:
www.guardian.co.uk/family/story/0,,1656246,00.html

Having difficulty deciding between VBAC and elCS:
www.childbirthconnection.org/article.asp?ClickedLink=274&ck=10168&area=27

And a way to find out what's local to you!:
www.drfoster.co.uk/localservices/birthGuide.asp

A British Independent Midwife:
www.marycronkmidwiferyservices.co.uk/

If only these American ladies were your MW:
www.sheilakitzinger.com/
www.inamay.com/
www.glorialemay.com/

Pelvises I have known and loved By Gloria Lemay:
tinyurl.com/javu6

A great site from a lady in Glasgow who says everything we believe in:
www.yourbabyyourbody.co.uk/default.html

Another FABULOUS site from Oz:
www.cares-sa.org.au/

All these and more are listed on another forum so I couldn't just redirect you but hopefully I've pasted enough relevant links for you to browse through and do your own research for VBAC.

I say that your best chance of a VBAC is to wait for labour to start spontaneously and refuse augmentation, have a good birth plan (there is a link above) and brief your birth partner well about your wishes.

I hope that helps,

love
Karen xxx
David 06/09/93 emCS, flexed and op
Catriona 02/06/05 VBAC with forceps
Twinkle in my eye, hopefully HBAC

"Just say 'no' to induction"

CRIKEY, that must have taken hours to type in! I am off to print some of those links on continuous monitoring though, am 40+2 and continuous monitoring is my main bug bear with the whole VBAC thing.

I had successful VBAC on Saturday so am full of the joys of VBAC at the moment. I would really recommend having a doula - I think it really helps to have someone who you feel is completely on your side and for me that made a lot of difference to my confidence that I could have a successful VBAC. I was also very worried about continuous monitoring but really avoided the issue by staying at home for as long as possible. Again I wouldn't have been confident to stay at home for as long as I did without a doula. Would agree with others advice to read up as much as possible so that you feel fully informed. Very best of luck for a successful VBAC!!

No, makemineaginandtonic, it's all there in a Word doc and on my 'other' board!

I've been collating all these links so that they are not 'wasted' and can be found to support others. We can't do this alone!

Very many congratulations BirdyArms on your VBAC! Be aware that the elation lasts for ever! However, you are not Superwoman and must remember to rest and give that wonderful body of yours a chance to recover.

Well done, you're a star!!

Wow, thanks for all the links Lulumama and doulaklaw, I've had a read through some of the old threads, they've been interesting so far. Will be great to look through some info. Not sure if a Doula is really an option for us, just on a money front etc but dh as a birth partner is great, he'll fight my corner 100% - he's a surgeon but not obs and gynea hence why I'm asking questions on here - he'll not let them be too pushy unless he thinks there's good reason.

Birdyarms, congrats, glad it all went so well for you - it's encouraging to here pos outcomes!