What to say to consultant about wanting a VBAC

[Chirpygirl]

I had DD by CS at 41 weeks last year as she was an undiagnosed footling breech.

Next one is due when she is 20 months and I have been told I will be banned from birthing centre (so no pool) and continually monitored once I am in labour, thereby pretty much buggering up my chances of a VBAC.

I know continual monitoring is not necessary but does anyone have any concrete evidence or any idea what I can say when I go to see consultant next Tuesday? I will be on my own with DD as DH can't get time off so won't have backup either!

there have been a few threads about this, will link to them shortly

if you want a water birth,which incidentally is great for VBAC, you could look into hiring an indie midwife and a birth pool for a homebirth

you can refuse CFM...you can have intermittent monitoring.....the worst thing to encourage a good labour is being tethered to a bed, flat on your back

I had CFM, but I laboured at home for the majority of the time, and when i did get to hospital, the midwives turfed me off the bed and made me stand and rock and move with the contractions! the leads were long enough to do that, so i didn't find it impinged on my labour...

CFM does not improve or guarantee an outcome, and IMHO< it encourages more intervention, not less

my recommendations for succesful VBAC are

a doula or some other female support ( mum, sister , best friend)

a good knowledge of how you want to labour

not being immobile for any length of time

will try to link to the other threads

Thanks lulumama, was hoping you would spot this!
Unfortunately I can't afford a doula and don't have any close female friends that live near enough to help. Plus DH is totally against a homebirth so I am going to have to go into hospital but I think I may delay it as long as possible!
What I am really looking for is evidence that CFM encourages interventions as I have heard it does but want something I can show the consultant IYSWIM.

some doulas do offer a sliding scale of fees, and there is a hardship fund that you might be eligible for.....if by any chance you are near me, I would happily doula you !

www.mumsnet.com/Talk?topicid=1365&threadid=327008&stamp=070528140559 this thread could be useful to you !

if you stay at home until your contractions are around 3 minutes apart, you have a good chance of arriving at hospital in established labour and therefore less chance of being sent home, which can be disheartening or being faffed with !

did you labour at all with DD?

Well, the cons will try to say that you are high risk and therefore do not fall into the right category but you could print out:

Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour. Which shows that CFM does not improve outcomes for baby but does increase risk to mother of further intervention (and I can vouch for that!)

Also Electronic fetal monitoring Is not necessary for low risk labours and Birth can be a hazardous journey: electronic fetal monitoring does not help.

I believe that intermittent auscultation using either a Pinard stethoscope or a hand held doppler ultrasound device every fifteen minutes is the ideal with changing to CFM IF it becomes necessary. VBACers should not be treated as a rupture waiting to happen as by doing that it becomes a self fulfulling profecy, because the labour is interefered with and the woman is restricted in labouring according to the way her body naturally wants to.

I can send you a word.doc with loads more VBAC links if you wish, some of which are:

Mary Cronk's thoughts on early detection of scar problems during VBAC

Check out all of www.vbac.org.uk/

Birth plan inspiration

And if by any chance you live near me, Angus in Scotland, then you could have me as a Doula too!

I also had a 'discussion' with cons about using the CMU attached to the hospital. Apparently I would be excluded, having had a CS, despite having had a VBAC since. I mean can anyone tell me what the difference is between labouring in the labour suite and going to theatre, and labouring in the CMU and going to theater, when they are in the same building!!!!!! I will not let this rest!!!!

Thanks, all that is great, DD just woke up so shall be back later!

back again.

Thanks for offers but I am miles from either of you, and 60 miles from teh nearest doula, which sucks!

I didn't really labour with DD, I was admitted when I was 3 cm and operated on 2 days later and I was 4cm, had had mild contractions every 20 mins for all that time but it didn't progress as she had her foot stuck on my cervix....!
What is pissing me off is the labour ward and the birthing centre are next door to each other! so there is no risk to me being in either one, it's just 'policy' ffs!

Am going to have a read through and print some stuff off!

some doulas will travel...worth asking.... if this baby is head down..then pressure will be exerted on the cervix to aid dilation this time

www.rcog.org.uk/resources/public/pdf/green_top45_birthafter.pdf

This fairly new document isn't perfect, but is at least official recognition that vbac is possible and preferable in many cases.

I have been in your position twice, and have booked home births as statistically it's much safer, and the risks posed by constant EFM are eliminated.

The people on yahoo group ukvbac/hbac will be able to give you loads of information health.groups.yahoo.com/group/ukvbachbac/

hth

Lots of great stuff there, thanks guys.

I did ask about a home birth (sod DH!) and the midwife actually said
'Well, I am supposed to be supportive about that but inside I am screaming 'NOOOO', as it would be far too dangerous for you'
stupid bitch.
So not expecting any support from them.

I have insisted on being placed under the only consultant who would try and ECV with DD as the others just seemed far too eager to slice me up for my liking.

I am planning to havea tens and stay at home as long as possible but if I know not to expect CFM then I am going to be a lot calmer. I am a fidget at the best of times and hated it when they were monitoring me for DD!

Right, am off to print out and have some leaurely reading, unless anyone else has anything that might help? (like a big stick for beating off over eager surgeons and midwives with monitoring devices )

oh goodness me, far too dangerous indeed...look, there are risks, but how can you make an informed choice when you are told things like that ??

my personal advice on the consultant thing (and I have lots!!! of experience of talking to consultants who are actually lovely people who want to help - well almost always lol) is not to bother going through surveys and statistics but to go in with a clear idea of what you want, having done your research already, listen to what they have to say with a polite expression on your face and then tell them what is going to happen. repeat as necessary. i think they can tell pretty early on if you're going to be one of those pita patients and give up on you.
also, if you don't actually mention that it;s a vbac when you arrive at hosp, chances are noone will notice, judging by friends recent experiences in busy hosps

If you healed well from your caesarian and this baby is in a good position, a normal size and you go in to spontaneous labour you should have a good chance of a normal birth and your risk of having a ruptured uterus is low. Obstetricians generally quote 0.5% of vbac women will have a ruptured uterus but of course that includes women who are induced, have large babies etc. Go for it and make sure you write a consise but strongly worded birth plan re continuous monitoring. Good luck.

I would start with this phrase: 'my body, my baby, my decision. Cooperate with me or I'll give birth to the baby in the car park deliberately '!

Seriously, they can suggest this and that and it's UP TO YOU. In fact you have a right to home birth if you want and they can either appoint a midwife or pay for an independent one I believe.

It makes me really angry because I want a VBAC next time and I've heard all sorts of reasons why I shouldn't not least 'everyone thinks they want one until they are in labour - why should you put yourself through that agony when you don't have too' (like a c-section is painless).

Good luck to you.

Good points all, I don't want to thrust papers on them out of nowhere but am hoping to be able ot quote stats to back myself up (the 0.5% being a perfect example)

Lulumama, it gets better, the silly bint then spent nearly 20 minutes telling me about the benefits of breastfeeding and how I should consider it, while I fed my 1 year old in front of her!

Am not seeing her again!

You know you don't have to see a consultant if you don't want to - I am declining all but the 20 week scan next time because I don't want to have these conversations.

morocco, that's a lovely idea, but having been told blatant lies by consultants ( one of them being 'you have a 40% chance of uterine rupture if you have a vba2c' ) I have found it better to be armed to the teeth with factual arguements

I know I don't have to see a consultant but I would rather have the consultant notes on my file saying not to CFM.

My lovely midwife has suggested refusing all CFM, then bargaining down to 15 minutes on and 15 off, but this still seems like a hell of a lot with all the fannying about putting it ona n off again....

sounds like a winner, chirpy

whomoved...that is my bugbear too !! like a c.s is somehow easy?

the one day of my life , i would live again, if i could, was the say i laboured and gave birth , vaginally, no intervention, to DD, pain and all , was magical !

thats what i mean though, honestly, it works every time, you just listen to all their crap like it's really interesting/relevant/clever of them, with that kind of irritating smile that says 'in one ear out the other'- my dh has perfected this look btw!) and then just tell them what is going to happen. and get them to write down that they have given you a strict talking to and you are still going to ignore all their lovely advice.
perhaps it depends on your personality? i excel at passive-aggressive so it suits me to the ground. i hate all that arguing over facts esp when i know what i'm going to do anyhow so its all totally pointless
you sound a bit more assertive than me

I asked my obs how many ruptures he had seen, it all went quiet... I smiled sweetly....

Chirpygirl - I sometimes think the midwives HOPE that by the time you are in labour you will be less combative (get a good birth partner, and a big stick with your birth plan stuck on the end). If they try and get round you, poke them in the bum!

Don't negotiate with them - if you don't want something say 'I don't want to do that. I'm not going to give my permission for that'. WTF is wrong with using a pinnard stethoscope anyway, I've not met a decent midwife who can't use one and they are much less intrusive and irritating.

Chirpy, I am active on a rival forum where we have had quite a few HWBACs and even some HBA2Cs including at least one triumphant HWBA2C, tell that mw that she needs to update her skills! And check out that VBAC.org site I gave you, there is a section on HBACs which you can ask DH to have a look at too!

BTW, if DH can't go to appt with you can you ask a friend/relative to go with you for back up and moral support?

Thanks Klaw, but DH is so against a HB that he would stress me out too much. It is because his mum had his little bro at home (unintentionally) and it all went a bit pearshaped as he had a cleft and had to be taken in, and his sis had one and her boy had to be rushed into SCBU as well.

The problem I have is I don't have many close female friends that I would be comfortable with in the room (actually, probably only 2 people I would be happy with), and they both live over 150 miles away, so can't really take them, my mum works full time and also lives 250 miles away so I am stuck with DH, unfortunately!