"Support for imminent VBACers" thread?

[pendulum]

Hi there,
I am 38 weeks today and planning a VBAC after my el CS for breech.

I haven't spent much time on the ante natal threads because I couldn't keep up with them! But now I am on mat leave and due date is approaching I would love to chat to anyone else hoping for a VBAC in the near future.

Is there anyone else out there, or another thread I can join? (Am just heading to docs to check baby position but will log in again later!)

Thanks
p xx

I've had a meeting with my consultant midwife discussing having a VBAC Waterbirth. She's agreed to send the following letter to the consultant. Suddenly it all seems very real and scary. I am beginning to doubt myself and my convictions.

Am I being crazy wanting a waterbirth?

heres the letter...

I recently met with AQUABABE to discuss her request to have a vaginal birth after caesarean section (VBAC) and to labour and possibly give birth in water in the hospital. She is 31 years old and has no significant medical history.

Her obstetric history is as follows:

2005 Maidstone hospital 42 weeks Induction of labour. Emergency caesarean section for fetal distress at 3cm. Girl () 8lb 5ozs

Mrs AQUABABE is currently 24 weeks pregnant (EDD 5/5/2009) and her pregnancy has progressed well so far. She is aware that Maidstone and Tunbridge Wells NHS Trust recommends VBAC for the vast majority of women and that approximately 70% of women who opt for this achieve a vaginal delivery. She understands that the risk of scar dehiscence and rupture is approximately 1 in 150 and that the risk of the baby dying from this is about 1 in 3-5,000 and the risk of brain damage is about 8 in 10,000. (Figures from ?Birth after previous caesarean birth?, Green Top Guideline 45, Royal College of Obstetricians and Gynaecologists, 2007).

At our meeting we discussed her request to labour and deliver in water. I have explained that, in line with NICE Guidelines and the Joint Position Statement for Water birth from the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives, the Trust does not recommend water birth for women who have had a previous caesarean section, as it is not possible to perform the recommended continuous electronic fetal monitoring. This may theoretically cause up to 15 minutes delay in detecting a fetal heart rate abnormality.

On discussion, Mrs AQUABABE would still like to labour and possibly give birth in water, however she has agreed to have an admission cardiotocograph recording (CTG) and to have further short recordings performed at regular intervals during labour. She would like to have care provided by a midwife only, unless complications arise, such as meconium stained liquor, fetal heart rate abnormalities detected on external auscultation, scar tenderness or delay in labour. In these circumstances she is happy for the midwife to take medical advice and to abandon her plan for a water birth. We also discussed the fact that scar rupture may not always be preceded by these signs and can be therefore be unpredictable.

Mrs AQUABABE has the Trust information leaflet on vaginal birth after caesarean section and also a copy of this letter. I am satisfied that she is aware of the risks involved, but also understand that this may cause some anxieties for the professionals involved in her care. I therefore think it is important that all staff are made aware of her requests before labour occurs and would be grateful if you could help disseminate this information to your medical colleagues.

TIA

I should add that it hasn't gone to my consultant yet and that she views this as a draft, so i can request to change stuff if i want.

all she is basically saying is that you have been made aware of the potential risks of labouring in water... which you know, but seeing them written down is kind of eeeeeeek !!

look, you can start your labour in water, and if you are unable to continue for whatever reason, get out onto dry land..

it is your choice still, even when in labour

and she is ensuring that those caring for you in labour don;t start questioning your requests when you are in labour

Camgirl.. i am not sure what you mean, that the size of your baby actually damamged your uterus? or there had be a larger cut to get him out? not something i am familiar with, and i would say you need to discuss your previous birth notes with a mw perhaps, so you can make the best decision for next time...

Pendulum - good luck - I managed a VBAC 3 months ago with DD2 after emergency C section due to breech for DD1 and it all went fine and midwife v supportive (unlike consultant who was dying to whip me in for a c section!. Was monitored throughout though which was a pain as it meant I was on the bed all the time and couldn't move around.

aquababe I used this MIDRIS study as the basis for discussion of my VBAC waterbirth request, don't know if it helps?

It is scary seeing the risks down in black & white, but remember there are stacks of other things that can go wrong in ANY labour. Sorry that came out wrong I'm not trying to scare you, what I'm trying to do is put things in perspective, if they wrote & told every pregnant woman she had a 1 in 100 risk of cord prolapse that could potentially put baby's life at risk, there would be a queue at the theatre door for c/s's!!

I got it agreed (eventually) that I could labour in water but would get out at first hint of trouble or for actual delivery (whether they can actually get you out when you are just about to deliver is another issue!! ) Ended up with an el c/s at 40+10 though, long story...

Also worth asking if they have telemetry equipment (wireless CFM), I'm told some types are waterproof so can be used in the birthing pool, allowing the best of both worlds.

I don't think you're crazy wanting a waterbirth at all but can understand that you may think that when you see it written down. I have read many successful birth stories of hwba2+c that have taken place at home.

At least the figures that have been quoted by your Consultant Midwife are correct, at my appointment last week at my hospital I was quoted (by the Clinical Director no less) a uterine rupture rate in excess of 10% and apparently I only have between 20-40% chance of success. I know a vba3c is riskier than a vbac or vba2c but not that much riskier.

Hi all,

I am 31 weeks and trying to decide how to have this baby. All the options seem poor!

They all seem terrifyingly risky and everytime I meet someone new they seem to have a convincing argument for either HBAC, WBAC or even elective CS!

Feeling totally overwhelmed.

Can anyone tell me how they made their birth choices?

xxBB

Shit shit shit, Nevil, just seen this and remembered that I was supposed to some back to this thread ages ago to talk to you about my VBAC with anti-E. I am so so sorry.

Right, here we go. I had anti-E ABs during my third pg, highest level at any time was 1:64, fluctuated between 1:16 and 1:64. I was scanned by the Fetal Medicine guys every 4 weeks (and sometimes more often, depending on the results) to check the cranial artery blood flow. On one occasion, this increased quite dramatically (though still within the limits of normal) so I was scanned weekly until they were convinced that it was an aberration. There was never any suggestion that I should deliver early, though they did not want me to go over 40 weeks. There was no mention of the placenta, just that it would be easier to treat any HDN outside the womb rather than in. I had my final scan 2 weeks before the baby was due, they booked me for induction the day after my due date and sent me off, saying they hoped to see me before then. Oh, and they also said that for Anti-E, there was no correlation between titre levels and the incidence of HDN, so I could have high titres and have no problems.

I tried to discuss my birth with the Fetal Medicine cons, and he was hopeless . However, he admitted this, and sent me off to talk to the consultant MW and obs about it all. Both the MW and the Obs saw no reason why I should not labour in water with the telemetric CFM equipment (though they did point out that the pool/monitor might not be available if someone else was using it). The Obs did want me out of the pool for delivery, but this was because I had post-partum haemorrhage with my VBAC with DD2, rather than anything to do with the scar rupture etc.

In the end, I did not go into spontaneous labour with DD3, so was induced at 40+1. They tried ARM first which did bugger all, then went to syntocinon drip. I had an epidural first though. I dozed through my labour (and DH slept) until the pressure became quite intense. MW checked, 10cm dilated, DD3 born after 29 minutes pushing. I had 2 small stitches, mainly because the scar tissue from the second degree tear with DD2 would not stretch.

DD3 was wonderful for the next 12 hours though with hindsight she was very sleepy and did not feed well. She was taken to SCBU approx 12 hours after birth and placed under triple light theapy, where she remained for the next 4 days. It was not easy - she was fed by NGT, so I had to express milk for her. I also wasn't well-prepared for it as I had thought the HDN would be immediately apparent on birth - it is not, it can develop over time. She came out of SCBU on a Bilibed for 2 days then we spent another day in hospital while they made sure that her bilirubin levels did not bounce back up once she was off the light therapy. Finally, we went home.

I cannot see why you need to deliver at 39 weeks - can I ask what hospital you are at? This post has turned into a complete epic, and I'm not sure if I'm giving you the infor you want/need, so I am going to stop here and you can let me know if there's anything you would like to ask me.

No probs Poledra, hope your DC is well recovered.
Thanks for info, I have now got my head around antibodies (I think). The antibody I carry can cause HDN although very rare, more likely to cause mild to moderate jaundice which can be treated with phototherapy. Have decided as titres have stabalized at 1:32 and the fortnightly scans for hydrops have all been normal I will not agree to section at 39 weeks (im currently 38 wks) & wait for spontaneous labour. Now worried that the more I prolong the pregnancy the more chance of increasing the severity of the jaundice, have to really make up my mind how long im willing to wait for spontaneous labour to kick off, my initial plan was to wait till 42 wks but don't know if that's wise IYKWIM, may consider sweep at 40 wks. In the mean time will look into natural induction methods to get this baby moving (none of which seem appealing TBH especially sex!).

Thanks for your info will keep you posted.

Thanks for the responses Nevil and Lulumama.
Nevil, I will look up those links.

Lulumama: what happened is that the consultant made the usual vertical cut, but as my son's shoulders were so broad as he was coming out I also got a small horizontal tear in my womb, which is an additional risk factor for a VBAC as this might tear again.

I think I need to talk to the medics some more.

HELLO THERE KLAW JUST THE PERSON I BEEN LOOKING FOR BASICALLY HAD 2 SECTIONS LAST ONE WAS JUST OVER 4 YEARS AGO AND BABIES NOW THEY TRYING TO GET ME TO HAVE A THIRD WOULD DESPERATLY LOVE TO TALK TO SOMEONE WHO EXPERIENCED VBA2C. NOBODY REALLY SUPPORTING ME FOR NORMAL DELIVERY ANY ADVICE ON HOW TO GET LABOR STARTED PHYSICALLY AND WHICH POSITION TO DELIVER. ALSO HAVING SOME CHNESE MEDS FROM PRACTICING HOMEOPATH FOR SAFE LABOUR AND DELIVERY.

HELP DESPERATE NOT TO HAVE SECTION TOO LONG
RECOVERY AND GOT YOUNGSTERS TO LOOK AFTER.

SORRY ITS SUPPOSSED TO SAY LARGE BABIES

camgirl, i don;t really know enough about how an extra tear on the uterus would affect things, so best speak to the consultant obs and midwife

bumblibee.. i made my birth choice based on the fact that i understood how my last birth had ended up in a c.s . i was induced early and immobile and had an epidural before labour properly established. my baby was also i believe OP and having the waters broken meant eh could not shift easily into a better position. so i educated myself and learnt a lot

and then second time round i made sure my birth partners knew how to support me and i had a normal ,straighforward VB

also, i knew without a doubt if i had a planned c.s i would always wonder, 'what if i had tried a VB' and that would have been a big regret

Hello - have posted this elsewhere but can I jump in here and ask you VBAC experts what you think my chances are this time round - I'm 36 weeks today.

I had an emergency section with DD (now 2). My waters leaked two days before my due date - went into the labour ward that night and my BP had gone through the roof - was induced twice and contractions started v strongly the next morning. Went through four hours of full on labour - had a BP monitor, bump monitor, two drips and a catheter so no chance of being active, and no pain relief. Then the crap monitor kept slipping off my bump so records were showing that the baby's heart rate was going down. A consultant came round and recommended a section due to fetal distress, so I was wheeled into the theatre, where the epidural didn't work so DP was ousted and I had a general. Woke up next to a fully clothed baby an hour or so later.

I'm still not sure if my section was necessary but I'm really worried the same thing might happen again - it was a horrid experience and took ages to recover. I'm wondering if there's anything I could do differently next time that wouldn't in any way put the baby in danger.
Like:
Should I go to the ward the moment my waters break or wait until contractions start?
Can I refuse to be induced if I don't want to be?
Can I refuse to have a catheter if I have high BP again?

Thanks

Oh dear oh dear -I've been very naughty, just been reading back and realised i've not been on here for nearly a year, i'll have to call it Mat Leave Ella is now 1 and has been walking since november, here's me thinking, goody it'll be into the new year before she's walking, so i can get looooaaads done - shes the world's lightest sleeper, so the bags under my eyes are spectacular.Sorry for being neglectful LuLu and klaw, but I've neglected everybody this year. Anyway, where were we?

hellooooooooo jamilla !

need so hospital WVBAC info

ok so had my consultants appointment he's ok for me to go ahead with labouring in the water, so long as alls well when i get to pool, but isn't so keen on the waterbirth aspect as he doesn't see the point, but accepts that no one can force a labouring woman to move.
has given me some exercises to do in order to aattempt to get baby to go into a good postion ahead of labour so its as short as possible, therefore the least amount of pressure on scar.

he was surprisingly anti c section

hi everyone, wanted to join in with a question for lulumama if I may....

Am 35 + 3 & 'have' to decide next week whether to go for VBAC or trial of labour. DS1 (now 3) was born by EC after failure to progress. There was a bit more to it but hospital has helpfully lost my notes from 3 years ago. One thing I do know that presumably didnt help was baby being OP.

Lulumama - you mentioned earlier that you thought the fact your waters were broken for you contributed to your OP baby not being able to change position? Curious about this as my waters were broken for me. No one seemed to realise DS1 was OP until the very last minute - is this common or was I unlucky? Also do you happen to know if the chances of DC2 being OP are higher because my first baby was, & can a clever midwife tell by feeling that they are OP?

Thanks in advance for any help! This thread is incredibly useful & already have long list of questions for my consultants appt next week!

DSs position was never made clear to me, but i am sure he was not in a good position as he was not coming down much and the first part of my labour was so simialr to DD, who i had next.

having the waters there makes it easier for a baby to turn and move

also there has been some research that i shall try to find that shows there is no benefit to ARM during labour

also, i know that immobility was a huge factor, as was fear, in my labour not going well

i feel very much that if i had been able to move, had not had the epidural, and been encouraged to move, things would have happened , as with DD it took 15 hours to get to 3ccm and then only 3 hours 15 to deliver her

and she was OP and born OP

yes, a MW should absolutely be able to tell you if the baby is OP or not

some do turn in labour.

also if they are OP , it can take hours of contractions for them to turn OA, or they don;t turn at all

my biggest tip is don;t lie on your back in labour

be upright, mobile and active !

thanks very much lulumama. Think I am brave enough to go for VBAC just need to find out my hospital policy on CFM & keeping active. Fingers crossed.

even if you have CFM, which you can make an informed decision to refuse, you should definitely be able to stand, lean on the bed, use a birth ball, and of course you have to be detached from the monitor to go to the loo. whihc you will need to do in labour.

failure to progress is such a big catch all term, and it can mean women who got to 2 cm or 7 cm and then nothing happens. it is a bit crap IMHO and makes women feel they have failed.

it is a shame that your birth notes are lsot, does your Dh remember much?

do you remember much?

so many little things can make a big difference in labour.. simply being off the bed is the biggest thing you can do in terms of helpng yourself, being upright or at least sat on a birth ball with your legs apart is so helpful

totally agree that failure to progress is such a downer of a term. Cant remember much as it all went on for so many days & we were green as grass so mentally noting things like how many cm's dilated never occurred to us. Cursing myself now of course!
I do remember not ever really feeling the need to push but just being told to do so, then some hours later being told the pushing had done bugger all & to give up. I presumed my partial epidural meant I couldnt feel what was going on properly but I could feel contractions & move around, so maybe I just never got to that stage of labour last time.

Can I join you? I'm currently 30 weeks with dc2, had emcs with dd at 27+5 due to footling breech detected near the end of a largely silent 1st stage of labour.

I'm consultant led care all the way as I had a stitch placed in this pg at 12+4 so won't be discharged until the stitch comes out at 36-37 weeks, assuming I get that far. The type of stitch I have is placed low so can be removed fairly easily so having it in place doesn't automatically mean another section.

I have wanted to go for VBAC since the beginning, have seen a very good cons midwife and asked lots of questions of the obstetricians but remain worried that I won't get enough support to go through with it. Pluses are that the hospital I'm booked at offers mobile epidurals and will do a sweep plus one lot of gel if I go overdue (as if). the mere idea of CFM pees me off, if only because I was hooked up for about 4 hours before dd's birth and that didn't seem to tell anyone very much.

The more I think about it, the more I wonder how much of this is about stuff I never debriefed from last time.........any thoughts?

lizzy, i would definitely debrief that birth immediately.. and get yourself a www.doula.org.uk doula to support you

or look at www.nurturingbirth.co.uk for a list of doulas too

one to one emotional support before, during and after labour is such a benefit

superjumper, an epidural and lack of the urge to push /directed pushing can mean difficulties, as can a malpositioned baby.

sounds like with a bit more help , you could go for it, as these things not necessarily likely to recur

i VBACed an OP baby, it is possible