VBAC after 2 c sections, on a small Thai island with some medical facilities- need the MN experience pool!

[duchesse]

My sister lives on a small island in the South China sea. The island has two hospitals and is relatively well provided for medically. She could very easily arrange a C section there, but she would rather have a VBAC.

No doctor either in her island or in a natural birthing centre in Bangkok that she went to, is willing to do a natural delivery after 2 c-sections.

She needs information and ammunition and other people's experiences of birthing in Thailand, VBAC after 2 sections either in the UK or not, and anything else you might think she needs to know.

Timing is crucial as if she chooses to return to the UK to attempt a VBAC, she has to travel within the next 2 weeks.

I don't have anything on the thailand thing, but I am having my VBA2C and have my consultants support.
Has she seen this???
It is a research paper that shows the difference in rupture risks after two csections does not havea significant increase in risk of rupture. (read 6.2), I don't know if it would help her over there, but I know over here it is a good point to start off with.

Hopefully Camilla and/or Klaw will be along soon (VBAC gurus )

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can she get to singapore?

i just ask because a friend who's there used british doulas for a home birth

The thing is that she is 31 weeks now, so can't fly after the next two weeks. She managed to fly to Bangkok at 9 months pregnant last time, because she wore a floppy coat so they didn't notice. I suspect that Singapore airlines might be rather more on the ball. But do you know of VBAC opportunities in Singapore? Could be interesting...

I just know that because of the v v large British community there are trained british doulas who do home births. In addition there is apparently one particular hospital which for SE Asia is quite into natural birth. But you're right about the flying.

Has she investigated British community in Bangkok which might also have doulas? What's her contacts book like in Thailand? Can she contact any of the British "meeting" centres eg clubs, school, int'l medical clinics which have this sort of information?

Presumably though she'd need somewhere to stay in Singapore and the whole thing could prove rather expensive. Also flights to London get v booked up at this time.. got to go but will check later.

She followed up a lead to a natural birthing centre in Bangkok and went to see one of the top natural birth doctors in Thailand the other day, and he just looked at her notes and said no. He wasn't willing to risk it after 2 sections. the thing is that I have one friend who had a VBA2C and another who had a VBA3C, but they both said that you have to be really bloody minded even in the UK to achieve that. The VBA3C friend had to hire an independent midwife.

In Singapore, most women will go private (unless they could not afford it). There is no equivalent of the NHS, every procedure you have to pay for. Just cheaper in a state hospital than in a private hospital.

The care of pregnant women is very much the US-model, consultant-led, rather than midwife-led. I suspect she will be strongly pressured to have a cs in Singapore, unless she has a personal recommendation of a natural-VBAC friendly obstetrician.

Yes, agree with blue shoes if you go hospital route, esp some hopsitals. Private doula care can be different. But sounds like Singapore is not really a goer? Really think the best bet is to explore what private expat midwives might offer in Thailand?

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Duchesse, it's true that you can have problems here getting a VBA2/3C but if you are determined you are likely to get it, it's down to each individual consultant whether theygive the go ahead or not, and at least in the UK you can change them.

Also, wrt flying, iirc airlines will let you on as long as you have a doctors note saying you are capable of flying.

I can't really help, just want this to be kept bumped

I have had two VBA2Cs and agree that bloodymindedness really helps .

I would love to live on a small Thai island though

I had a vbac after 3 sections but I wouldn't attempt it without a hospital/doctors backup in case something goes wrong. Its extremely unlikely that something might but should it, you have a very small window to do so.
What are the medical facilities like?
Personally I would come to the UK. You have a right to a vbac here and doctors/midwives cant refuse to support you even if they do give you a tough time.

I'm with needmorecoffee, over here she will get her vba2c, and she might have people tutting saying she is putting the baby atrisk and her uterus is going to explode but in reality the rupture risk is still not much higher than 0.5%.

if she can come to the uk, that might be a good idea, if only that there is medical back up. she could have a homebirth in the UK and use AIMS and other organiastions to help.

can she have a private midwife where she is?

there is an awful lot of research about the risks of VBAC and VBA2C. but will it hold any weight over there?

Klaw has a whole raft of useful info she can link to easily.

what reason where her other 2 sections for? if they were for issues that might recur, eg. pre eclampsia, placenta previa then she needs to bear that in mind when making her decision

First one was failure to progress (that old chetstnut), second one was almost elective due to time constraints, coupled with pressure not to VBAC from hospital. I don't think there were any actual problems either time, apart maybe from posterior presentation.

so, in reality, she could probably labour and deliver vaginally...best thing she can do is arm herself with as much research and informtaion as possible...

all i can advise on is the flights part, she will be able to get on a plane if covered up and willing to lie about her dates so if she does decide to come back a bit later, it should be possible. noone even noticed i was pregnant and i was 36 weeks and humungous.
unless she can find a consultant her options where she is sound limited tbh unless she is prepared to find a midwife who can attend at home for example - the expat community might be a source of info on this, there might be uk? trained midwives around somewhere willing to attend for example. a mate of mine had a mw travel up from the other side of the sub saharan country she was living in to attend to her birth, the mw was sponsored to help in small villages in the area. obviously though if she does rupture it is much harder for clinics to get ready for emergency c sections - not like in the uk where the obs are on call in the hopsital al the time etc etc
is she just worried about the birth or has she wanted to vbac for a while, it just seems a bit late in the day to be thinking about it, sorry I don't mean that unsympathetically, just thinking perhaps it is a feeling of being trapped into something she is resenting?

Well, she really wanted a VBAC last time, and obviously didn't want the first c section. She has been trying to engineer the VBAC for a while, but had placed her hopes on the doctor she was last week, only to be sent away with a flea in her ear. So is back to square one.

the doctor she saw not was...

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