Vbac need some honest advice

[LadyPug]

I am planning a VBAC and was told by the consultant that as dd got stuck In previous birth, it’s unlikely it will happen again and he supports vbac. However, I will not be allowed to labour in the MLU (one corridor away) and will need to give birth in the delivery ward having continuous fetal monitoring (on machine) and a cannula in hand in case require it. I have done research on this monitor and it results in higher chance of Caesarian, it is only useful for monitoring c section scar and has no benefit to the baby. I believe I should be allowed in MLU down the corridor for a water birth and I’m freaking out as last (induced) experience was horrific and was in a small bright room with a rude midwife, no continuity of care and surrounded by cannulas and machines. I believed as this isn’t an induction I would have more control but it sounds like I’m being put in a similar position eg no water birth, no active labour etc. Can someone please tell me they had a VBAC without being continually wired up to a machine or that they were allowed into the MLU or a water birth? I’m getting very anxious!

I had an EMCS with DD1 for what sounds like a similar situation (stuck due to unusual presentation). I had laboured normally until then. I had a VBAC with DD2. I did have to go on the standard labour ward and I was continuously monitored, but I was encouraged to stay at home as long as possible in early labour so fully dilated quickly after arriving. I don't remember really noticing the monitoring belt. To my surprise, I wanted to stay on the bed anyway and couldn't have walked about of you'd paid me. I had quite a good degree of movement anyway and could get into different positions, on all fours etc.

I almost ended up with ventouse as she didn't want to come out but managed by myself in the end. I had a fairly bad 3rd degree tear and actually ended up in theatre for stitching anyway. Overall, I didn't enjoy the experience but was pleased I did it and would choose the same again. The best bit was being able to hold DD as soon as she was born. Also, despite the tear, the recovery was much quicker than from the c-section. I had previously felt that I had a good, speedy recovery from the EMCS but I was noticeably up and about more quickly after the VBAC.

To add, I would have refused an induction as I felt the risks of a rupture were higher.

Thank you minnie this is good to know. Staying at home as long as possible sounds good (although I don’t understand why if they are so concerned about scar rupture me being at home is better than mlu where I’m so close and would feel happier). So was your machine wireless? Will have to find out if ours are too. Did you have to have a cannula? Thank you for sharing your experience. I won’t be induced so if I go over I’ll have to go for elc- not ideal as terrified of this following emc but better than induction!

Vbac after emcs for undiagnosed breech here. Consultant led but all was fine. Don't really recall monitor, wasn't an issue. No drugs and barely bothered with gas and air. Waters went then baby within 3hours.

Thanks Lurpak so could you be active? Last time I was told not to leave the bed due to drip and I want to know that I would be allowed an active labour because before this point I was walking up and down and managing fine

My experience is almost identical to Minnie's. EMCS due to placental abruption, very unlikely to happen again. Had to be in delivery suite with cannula and constant monitoring but I was allowed plenty of freedom and movement. Ended up in theatre being stitched for a 3rd degree tear anyway but my recovery was really fast and i was much more mobile.

Thank you Duchess did you stay at home for a bit first? Thank you so much for everyone taking the time to respond to me, it’s so good to know I’m not alone - although what I’m really hoping for is someone to have been allowed access to either a pool or a MLU!

I've had two vbacs and my response might be coloured by lack of adequate pain relief in the second.

For the first vbac my waters spontaneously went but I didn't go quickly enough into labour so was boosted by hormone drip. I was allowed to wait at home for the 24hrs to see if labour would kick off before the drip. Got an epidural so had a cannula (I think? Maybe it was just for the hormone drip?) and once being induced was attached to belt to monitor contractions. So stuck in bed - but for pushing I moved around a lot on the bed, lots of different positions etc. I wasn't upset by this though because being out of pain was such a relief (spd and I was having contractions, just not soon enough together)

2nd vbac, waters went first again. Was in maternity triage for hours, I could walk around, eat, whatever. DH sent home middle of the night, I declined going home as i was having more (awful) contractions then I'd had before and I really wanted an epidural as soon as I was allowed. Was sat in a bath in water around 3am crying how much pain I was in. Came out, got back to bed, wasn't able to get back off it but they would've let me walk about if I wanted. Was finally able to get examined after shift change at 8 (was sadly uncontrollably yelling at peak of contractions at that point) baby was somehow examined/monitored? Dunno how as I wasn't permanently strapped to anything. But sudden dash to delivery room as I needed to push him out right then (then spent a scary 30 with him on that resuscitation warm lamp bed thing with an oxygen mask on - he's all good though, busy keeping me up right now!). Didn't get a cannula until after the birth - I have no idea what was in the drip, was too focused on the baby. So despite more freedom, what I really came away from the 2nd, after being grateful he got out okay, was it was hellishly painful and I'd have sold my granny to have a sodding epidural - but again I had spd and part of the pain wasn't the muscles it was feeling my pelvis come apart. YMMV.

I didn't have the wireless monitor, just a standard one, but still allowed for a good degree of movement (not sure about walking around). I had thought they would want me in early for monitoring so was really surprised to be left at home. I had to be quite pushy to be allowed to come in when I did!

You have done research on monitoring? And you believe you are better qualified to interpret this research than the consultant? What you are saying doesn't even make sense. Saying a rupture of your scar doesn't impact on your baby is ludicrous. Uterine rupture, if not caught early enough, can easily kill both you and your baby. If you survive, you still risk losing your uterus. If your baby survives, he/she risks brain damage from oxygen deprivation. I'm not at all certain that you have properly understood what your consultant was trying to tell you if you came to the conclusion that preventing this "has no benefit to the baby". Please think some more and talk again if you need to, with your doctor.

Oh good sycamore you again. You who always comes into my thread to say something damaging and one sided. Are a troll or just someone with an agenda? Once I can understand but you seem to only enter threads to make comments like this and you never ask the correct questions to get to the root of an individual issue. My consultant has told me that continual monitoring is standard in the hospital but that based on my scenario he personally doesn’t think I’m high risk and that he thinks I will labour normally. He also only met me for 15 minutes and I want to be considered on an individual basis, not because I happen to have had a section. There is zero evidence of any advantage that continual fetal monitoring in either high or low risk women. It does not reduce the chance of a baby dying, however it IS associated with a significantly increased risk of c section and instrumental delivery. It also has a false positive rate of around 60 percent which means it can suggest there are problems with baby when there aren’t. I want to know why they have specifically said I need this and it seems it’s because it’s what my hospital “do” which isn’t right. I want a labour where I give myself the best chances and that means where I get
Oxytocin and feel safe (this was seriously affected last time by rude staff, continuous monitoring - last time for induction, bright lights and drugs/cannulas etc). I think I’m right to question things and do my research. By all means provide a balanced view but don’t come onto threads trying to make women feel guilty for making choices that don’t involve consultants unless you have something constructive to say which so far you haven’t. If you can provide a balanced view point and some actual information to inform me I’m all ears but otherwise stop being a weirdo trolling the comment boards to use scare tactics like this. A birth environment where I feel safe and supported is 100 percent best for my baby and I won’t do anything that I deem unsafe but I need an active labour (staff have agreed) and I’m looking at how to achieve this. Since ppl are allowed and encouraged to stay at home so long they obviously don’t seem to be that hot on monitoring as there is no midwife team at all with you then!

One more thing... rupture can happen to anyone, not just vbac and 99.5% of people who have vbac don’t rupture. Also they can see the signs physically and by knowing and understanding the woman not just relying on machines (and this usually results in an immediate emc which is what I had last time).

So rupture is a fairly common complication of VBAC. The absolute risk is quite low as you say but given the average obstetrician probably oversees 000s of births in their career, they will see quite a few. This obviously changes their management outlook.

What I would want to understand in your position, is what is the research on scar rupture? What's the best way to detect it ASAP? Perhaps you're right, and continuous monitoring doesn't add much. I personally don't know, maybe your consultant is haunted by a bad experience that ended maternal/foetal compromise, and that's influencing him/her.

Ultimately you should have the choice to labour how you want, but you need to fully understand the risks/benefits of that choice. Good luck.

Thanks Aloysha I’m open to the other side of the argument, could you send me a link to some info on stats that you have as I want to be fully informed. My consultant said it’s actually really rare and he’s only seen it twice personally in a 40 year career so I didn’t realise it was that common. His argument is that it’s hospital policy so we kind of have to do it type thing which isn’t good enough for me. I’ve researched the warning signs (many of which are based on how a woman feels eg pain between contractions etc) but also research tells me a midwife can spot symptoms also. I will continue to do research but would love more info on anything you know

The RCOG guidelines recommend continuous monitoring, but can't see the research to back this up: www.rcog.org.uk/globalassets/documents/guidelines/gtg_45.pdf

Paragraph on CTG: "The presence of any of the features in the list below is suggestive of uterine rupture. Abnormal
cardiotocography (CTG) is the most consistent finding in uterine rupture and is present in
66–76% of these events. However, over half of cases present with a combination of findings
(most often abnormal CTG and abdominal pain).20,23,120 The diagnosis is made at emergency
caesarean delivery or postpartum laparotomy. Most uterine ruptures (more than 90%) occur
during labour (the peak incidence being at 4–5 cm cervical dilatation), with around 18%
occurring in the second stage of labour and 8% being identified post vaginal delivery.23"

The risk is 1 in 200, so it's low. Also sometimes the rupture isn't even identified until after birth, so there are varying degrees of rupture.

But that does mean that in a scenario where every woman has a VBAC, your average consultant might see some form of rupture quite regularly, if there were 500 VBACs per year they would see 2-3 per year. Over a career of 30+ years that's 60-90 cases with varying outcomes.

I've read things from other obstetricians (online etc.) that say they've seen it more than your consultant.

However if he hasn't seen it that much it could mean two things - either he's great at advising when to have a VBAC OR he hasn't supervised many VBACs...

Thank you Alyosha it’s so contradictory isn’t it? Apparently cfm can alert a false positive in 60% of cases eg suggesting something is wrong and c section is required when it isn’t. Also, consultants advise most women to stay home until around 8cm dilated when the stats you’ve linked to clearly state that’s the highest risk time. Also, apparently only 9% of evidence is based on grade A evidence with a large amount based on opinion alone. I think I will take all of this to my consultant for discussion. Believe me, I do want to do what is safe for the baby but at this rate I might as well opt for elc because I’m not giving myself a good chance for a positive vbac. Thank you for sharing the info

And frankly I would want an obstetrician who has seen quite a few scar ruptures managing my care -they would know when to intervene and when to leave you well alone!

Yes that’s true, he’s the lead consultant in my area!

I had to really push to get into the MLU after a EMCS for a breech birth. Even on the obstetric ward, there was never any suggestion that there would be automatic monitoring and cannula. That said, I went into the MLU and after about 6 hours I was demanding an epidural so off I trotted to the consultant led unit

To be honest, lots of people rave on about how wonderful a VBAC is. Mine certainly wasn't some kind of magical empowering, redeeming experience. It was messy, painful and actually took me two weeks to be confident pooing again - recovery from my section (which was fab, to be fair) was more straightforward. If I were to do it again, I wouldnt' agonize so much over it.

Ladypug - quite! I can understand your dilemma. I hope you get the information you need to make an informed choice.

I have to say my assumption was that cfm failures were more prevalent in normal births, I thought that in VBACs they serve a really clear purpose - monitoring the uterus - rather than monitoring the baby IYSWIM. Hopefully your consultant will be able to advise better....

Just on the cannula, I had a lot of trouble picking up DC1 after my EMCS because it was in my hand. For DC2, I asked the anaesthetist if he could put it somewhere else. He put it up in my forearm, halfway between wrist and elbow, in line with the radius bone. It was so much more comfortable and easy to hold, attach, change her.

Sorry I have no VBAC advice - DC2 was transverse with a cord presentation, so all those hopes flew out the window.

Good luck

I has a scar rupture. I could feel it happening during contractions. Not much to add other than that but it's not just a statistic and it is a real concern.

Thanks notajaffacake that’s good to know. I’m under no illusions that a vbac won’t be all magical etc but it’s what I want (and without knowing that my consultant says he advises it because he thinks same issue is unlikely to reoccur). However, I’m very phobic of hospitals, needles, cannulas etc and believe that last time that was the major issue (along with bad staff) as I coped fine alone to 6cm but as soon as they strapped me down to machines and started giving me drugs I stopped progressing entirely. I’m keen to avoid this treatment this time around (otherwise I might as well go straight to c section)

Thanks Aloysha will see what he has to say! Will take this thread with me!