VBAC - the reality?

[BlueberryPancake]

Hi everyone, at this stage I have very little chance of a VBAC (because of low placenta and the baby is transverse) BUT if the placenta is up and baby in good position I'd like to go for a VBAC. The birth of my first child was an emergency C sec with quick recovery.

The hospital already informed me that if I go for a 'trial' of labour I will:

• be on a monitor constantly (to keep an eye on a possible uterine rupture)
• be on a "time limit" of 6 hours - now I don't know how strict they are on that!

Now I don't know how any women can give birth under pressure like that. Is it possible?? Any positive experiences??

Many thanks
BP

I got a private midwife for these reasons. worth every penny, even though what happened in the end was another emergency c/sec

But friends of mine have managed VBAC despite the continuous monitoring. Don't know about the time limits though, what's that all about?

try a different hospital! protocols can vary from place to place

bithchoice gives all the stats relating to all maternity units in the country

our hospital had a time limit of 6 hours on getting to full dilation..and constant monitoring

i stayed at home until i was having contractions every 4 minutes or so, and then once i was in established labour, i got from 3 - 10 cm in 2 hours 45 and pushed for only 30 minutes!

hospital did encourage me to get up and move with the contractions, even though i had CFM, the leads are quite long..

you can ask for intermittent monitoring

also, if everything looks fine, the baby is happy and you are , and you are taking a little longer than 6 hours, you can ask for an extension on the time limit

inform yourself as much as possible about the best way to get a VBAC and let the hospital know you are aware of the risks, but feel an active labour will give the maximum chance of a succesful delivery....

also, strictness can vary from consultant to consultant !

also, look into having a doula if you can,for extra support , as that can radically cut your risk of ending up with another c,s

train and place doulas nationwide

doula uk

Sorry for the hijack Lulu how did it go last night.

Hi BP,

The first thing you have to learn is that ALL these things are YOUR choice. Policies are just that.......... policies. They are not the law and more worryingly, they are not in place for YOUR benefit either!

If you and the baby are well then there is no need to place time constraints on any stage of your labour. A random amount of time passing is not a medical reason to procede to a CS.

Do you think you will receive better care with a MW coming in and actually LOOKING at you every 15-20 mins and listening with a sonic aid to your bump or hooked up to CEFM with a MW coming to check the TRACE (not you) every 15-20 mins? CEFM is not shown to improve the outcome for babies but it is shown to increase the incidence of assisted deliveries and CS, so beware!

I hope your placenta 'moves' out of the way enough and baby turns enough for you to try having your VBAC because it is worth it's 'wait' in gold as far as I'm concerned.

Maria xxx

Yes, as Maria says, waves madly, hi Maria, it is your birth and you don't have to ask permission, they have to ask for yours actually!

I can't believe I went into my VBAC knowing as little as I did but I did and ended up with CFM and forceps! I look at my birth notes, study the trace and I am 1000% sure that without the diamorphine I would have been able to stand up for myself and baby's trace wouldn't have been so poor. I believe I was rushed to theatre as a possible UR, covering their backs, for unecessary forceps because I was too drowsy. I did not sign a consent form, in actual fact. And baby's trace was poor for 10 mins and that was just because of poor connection, I think! Her APGAR scores were 9/1 and 9/5 so I can't beleive that there was a true problem. They relied far too heavily on the CFM, rather than treating me as an individual.

Gosh, have I admitted that out loud?

I know of a great place where you can get more support and info for VBAC but I can't post it here. klaw @ macmail. com and I'll tell you, if you want.

Also the 6 hour time limit is total b@ll@cks! We are not machines that do everythign to a set protocol on a conveyor belt. We are individual human beings with feelings.

Next time, as I keep saying, I'm having a HWBAC with a very good HWBAC friend as my Doula. We can do this, we just need to be afforded the dignity, courtesy and respect to do so.

Should there be any kind of valid medical reason for intervention, then of course we will gratefully accept the benefit of life saving procedures that we are fortunate to have. But do not treat us like a Rupture waiting to happen!

Sorry that was a bit of a rant, wasn't it?

Silent Knife is a good book to read.

Hi BP

I have supported many women having a vbac as a doula. I find that it is about 25 x more difficult for women in hospital and although I have seen many achieve their vaginal birth in hospital it has often been an assisted delivery like doulaklaw's experience. Thats not to say that those types of births are not positive for some women - it just depends what you really want. The most beautiful, relaxed and healing vbac's I have seen have been at home, where midwives are more likely to give holistic support, there is no electronic monitoring and time limits are not as stringent. You really do give yourself the best chance at home.

well. like everyone else has said, in fact it's entirely up to you, not the consultants or the mw, whether you go for the continuous monitoring or not, and as a time limit only starts from when you arrive in hospital, one obvious answer is to stay at home as long as pos. why the consultants don't seem to realise this is what stupid time limits lead many women to do, I just don't know, but there you go.
anyhow, all the best with your vbac, mine was great, no cefm, only in hospital for 1.5 hours before ds2 was born

I had a VBAC in hospital 2 weeks ago and had a very good experience. I had a doula (thanks Mars ) because, like you I was really worried about the continuous monitoring and time limits and thought that I would find it really helpful to have someone there who was on 'my side' if I was refusing to go along with the hospital policy. In fact neither of these things were an issue as I stayed at home for quite a long time - and having a doula at home with me made me happier to stay there longer than I would otherwise have done. By the time I got to hospital I was 9cm dilated (maybe didn't mean to stay at home quite that long!) so didn't really want to walk around. I was happy kneeling on the bed and holding onto the back of the bed and they could still monitor me like that. The leads moved out of position quite a bit but I figured it was their problem to put them back.

I refused to have a canula in my hand as was pretty sure that I wasn't going to have a CS by the time they wanted to put it in.

I think it's good to do some reading up about VBACs, if you feel well-informed it is easier to stand up for yourself rather than always following the hospital policy. Also discuss everything with your birth partner beforehand so that you know that they will support you in whatever decisions you make.

Best wishes for a successful birth whichever way it comes out!

OK there's something I don't understand... Uterine rupture is a risk, isn't it? So if you have stayed at home for that long, wasn't it worrying you that something could have happened? I know that the risks are small, but you had no medical support at home, and I really am not ready to take that much of a risk! What would a doula have done if you would have shown signs that the uterine scar was not holding?

I am trying to find the right balance between sound medical advice, and the birth I want. I am not prepared to compromise my health and the safety of the baby!

ok, if a uterus ruptures totally it is a catastrophic event, but it is very very rare...the uterus tends not to just rip open...there are signs of dehisence ( scar separation) before things reach catastrophic proportions....

things should signal a rupture might be happening, before it gets to the point of needing a c.s , to get the baby out quickly....

a CFM trace should not be relied on to point to anything going wrong.

mary cronk has done a good article on signs of rupture .

i know it is a risk, but so many things are a risk, whether VBAC or not.

it is weighing up the risks and making an informed choice

i was more worried about getting to hospital too soon and being made to have a c,s than i was about my scar rupturing....

the risk of cord prolapse is equivalent to the risk of rupture i believe, and every woman is potentially at risk of a cord prolapse...

if you feel that it is a risk too far, and you are not comfortable with it, then that is absolutely understandable

for me, the problems i knew i would have after another c.s outweighed the small risk of rupture, that more than likely would not happen.

Mary Cronk's thoughts on detecting scar rupture

\my hospital VBAC was intervention free !

Well BP, the risk is real but TEENY 0.35%, and that figure also includes the dehiscences, light separation of the scar which is not a problem.

scar monitoring This is a great page about Scar monitoring and is SOOOOOOO much more sensible than the protocols we seem to have inplace in the hospitals. Mary Cronk is a very wise and extremely well respected mw.

You will see that a vigilant mw performing intermittant mornitoring with a hand held sonic aid, recording your temp, pulse and demeanour regularly, just being with you and observing is THE best way to catch a UR. NOT being tied to a blooming machine who doesn't know you from adam and who knows when it was last serviced. With no epidural you can be aware of continuous pain in between contractions and avoiding artificial induction which creates unnatural contractions which put too much pressure on the unterus, you have amuch better chance of VBAC, possibly better chance that a first timer has of avoiding CS in the first place.

On a light hearted note here is a link which gives comparative risks, some of which may be made up, but it helps to get into perspective.risk comparison

I tried to research the risk of emergency hysterectomy because of CS, happened to my neighbour recently, and there's not a lot of research out there for that but I did find a figure of 0.7%. You don't get told you're not allowed a CS because of that risk now do you?

Anyway I have a word doc of ALL the links I post on another board, email me and I'll pass it on, you can then do research to make up your own mind. klaw @ macmail. com (no spaces)

Stay strong!

Cross posting Lulumama! waves

not so far.....

shame..... i 'm sure she will ,she was really glad to have a possible doula.....i'll remind her next week if no joy

I had vbac one week ago. Was fully prepared to fight about everything but was pleasantly surprised at how flexible the hospital was. Waters broke and was allowed to go 24 hrs before having to decide what to do next. Ended up going into labour, baby was OP so had epidural for 2 hours, which then wore off for the pushing stage. Had monitor on after epidural but didn't even notice it and was too uncomfortable to be in any other position than on the bed anyway. Took over 2 hours to push the baby out and had to fight the doctor off at the end, but I just told her that it was my decision and that I wanted longer to try and get the baby out myself. Midwives were very supportive because they could see the baby was very nearly born. They didn't argue with the doctor though, I had to do that myself, you could tell they would have to do what she said when it came to the crunch. Stick to your guns and despite the fact you might not feel like it, try to remember the things you have hoped for the birth!

congratulations !

any experience of vbac after 2 previous c/s?

daisyMOO has had HBAC after two......