anyone "refused" to have continual monitoring for their VBAC attempt? Confused and emotional!!

[basilbrush]

My son's birth was pretty scary, I was going for a HB but transferred after 17 hours of proper labour on midwife's advice for slow progress. (was 6 cms) Placenta abrupted on way to hospital in car, was zoomed into emergency theatre and DS, although small at 5lbs as placenta had been failing for some weeks, was OK, thank god.

I have been told that the chance of a repeat abruption is very small but DH and I are going for a hospital birth this time just in case. I am 33 weeks and was scanned last week to check on baby's size and will be again at 36 weeks. At moment, baby is bigger than DS was at same scan which is good sign.

I have read up on VBAC and know that my best chance is to keep mobile, find positions that suit me, etc etc. I want to be in the midwife led unit which is literally down the corridor from the cons led unit in the hospital so if there is a problem, I can be transferred in two seconds.

However, consultant told me last week that because I've had a C section I have to be in the CLU, strapped to foetal monitor throughout my labour, with IV drip in hand and nil by mouth in case I need surgery. I think this will radically reduce my chances of success.

She got grumpy and said that my only option is to sign a legal waiver saying I don't want continual monitoring if I want to be in the MLU and gave me a lecture about how intermittant checks every 15 mins still leave plenty of time for my baby to die...

I am very torn. Should I sign the waiver or should I just accept that my DS did almost die and I should just do what I'm told?

HELP!

who will be reading the print out and how often? bet they aren't reading it continuously! in which case, doppler every 5 minutes gets you more attentive care then a mw (if you are lucky, remember the documentary recently where it is untrained volunteers asked to interpret the machinery!!) popping her head round the door every 15/20 minutes

tbh, it sounds like you are able to do things the way you want to, mlu etc, the consultants might be grumpy about it but are willing for you to go ahead. the waiver is to cover their backs in case of problems, and I can see their point in a way, it stops anyone claiming they were never told of any risks.

I had a vbac, stayed at home for most of labour so no monitoring, refused cfm, had doppler. all informed choice, which I am a big believer in.

Sorry if my opinion made you ButterflyBessie. That wasn't my intention. I possibly didn't explain myself very well. Unnecessary monitoring can only be established as definitively unnecessary after the event. As the majority of babies are born perfectly healthy there is plenty of evidence to support your argument that monitoring is unnecessary. I look at from the point of view of a mother whos ds was not born perfectly healthy and so I was happy to accept what turned out to be unnecessary monitoring in my two subsequent deliveries. As morocco says it is about informed choice. But it is also about accepting the consequences of those decisions too. I would imagine that is why a consultant would want a mum to sign a waiver stating that she was making an informed choice that wasn't in line with his or her opinion. The odds are that the baby will be fine but perhaps the consultant feels the need or the health authority feels the need to protect themselves from lawsuits should things go wrong. People on here might not be the type to sue in these circumstances but there are people out there who would.

Thanks Shouldbeworking, I do get a little and about it all, simply because neither of my sections were necessary and it was just convenient for the medics.

I am well aware that there are times that sections are vital and the same with cfm

I understand your views and realise that I am very lucky that I do have 4 healthy dcs.

I am saddened and "disgusted of Tunbridge (or Tonbridge )Wells" by the state of the maternity services today that the easiest think for those providing care is just to strap labouring mothers to the monitor and pop in and out of the room as and when (happened to me with dc2)

BTW I would not have contemplated litigation if things had not gone according to my plans, as they were that, my plans. Medical malpractice is another kettle of fish..........

shouldbeworking -- the studies that have shown that routine CFM doesn't improve outcomes haven't just focused on the majority of babies that are born perfectly healthy, though. They look across all cases and routine CFM doesn't appear to help ensure that you have a healthy baby. That isn't just my opinion; as I understand it, it's what the weight of all the available current research, carried out by real experts in the area, says. If CFM can be scientifically shown to improve outcomes then I'll be all for it.

So why do hospitals do cfm then? I am genuinely interested in knowing. Do they think it give mums or mws peace of mind? Or do they just have the equipment so think they may as well use it?

I think (thi bit is entirely my opinion, though) that they genuinely think it improves outcomes. After all, it seems like common sense that it should.

There is some interesting stuff out there (in Super Crunchers, for example) on Evidence-Based Medicine and how difficult it is to implement because of human factors -- both cultural entrenchment of outdated practices and the fact that there are so many research articles published that even to read all of those relevant to his or her particular specialism would be pretty much a full-time job for a doctor. So making sure that the right studies get to and are acted upon by the right people is a particular challenge.

for my planned VBAC (ended up with an el c/s at 40+10 - long story...) I agreed with the consultant either

1. intermittent monitoring & to go on CFM at the first hint of any trouble

or

1. The telemetry kit (effectively wireless CFM, so you can still be mobile - but my hospital only have one set between 9 delivery rooms...so no guarantee it's available)

this article by Mary Cronk might also help - can't see it posted on this thread yet, so sorry if it had been already.

You only have a 1% risk of rupture & most of those are not serious. It annoys me that everyone assumes a VBAC rupture is a ticking time bomb, but no one ever mentions cord prolapse or placental abruption etc, which can happen to any pregnant woman with a similar frequency to VBAC rupture & are potentially equally serious.

So long as you understand the risks they can't make you do anything, but it has to be personal choice about which way you go & I can understand your caution after last time.

Also forgot to add that my experience of CFM first time round (being induced after waters broke & had high BP too) was that if you are lucky someone comes in to check it (and you almost as an after thought!) every half an hour, which kind of defeats the point of it being continuous really if they only spot a problem 30minutes after it started to happen...

CFM was a disaster for me. I wasn't allowed to move as the thing was too big on me and kept falling down. MW came in at loong intervals just to look at the machine.Hellloo, I'm here!- no response, unless the thing had slipped down again and I was accused of moving. It didn't make me feel safe.
I really want to give birth in one of those big pools- what monitoring do they use then, for VBAC? Sorry, am I hijacking

IMO, they do it because

A) it is there

B) they think that it comforts women and makes them feel safer

C) it saves them from law suits

it does have some benefits , for sure, but the way it is forced onto women with no adequate evidence, is wrong.IMO

"Why do you all seem to think that hospitals want to carry out procedures just to inconvenience you or upset you and that they have no medical reason for wanting to do them."

If nobody ever challenged established medical practice we'd still have 100% episiotomy rates, routine induction at term and routine CEFM for low risk mums (which doubles the risk of c-section without improving outcomes for babies).

There will always be debate among doctors and midwives about what constitutes 'best practice' and women have a right to know the range of opinion on the medical protocols they're subject to.

Have your thought about asking to have a meeting with the Consultant Midwife if there is one, otherwise a Supervisor of Midwives. This would give you the opportunity to look at all the different scenarios and options and discuss the pros and cons of them without the pressure that you are likely to feel in labour. That way you could agree a birth plan in a rational state (as compared to asking for things outside the hospital protocols when you are in labour which is much more difficult). The hospital can't make you do anything and so you have nothing to lose and perhaps quite a lot to gain by taking this route.

BTW this is what I have done and they actually suggested that I might like to give birth in the pool if I wanted to which I hadn't even thought to ask about.

lulumama, monitoring does not save the hospital litigation. It is worse to have ignored a bad trace than to not have done one at all. Sadly this does happen as they are difficult to interpret with accuracy which is why women often end up with unnecessary sections, it is a just in case thing.

Basilbrush, consultants are always trying to frighten women unnecessarily by telling them that if they don't do something their baby will die. Well, in most cases it is a load of rubbish and not based on any research . Definately contact a supervisor of midwives or consultant midwife, hopefully they can go through it with you and help you to make a totally informed decision. Surely it is better for you to come in and have support and intermittent monitoring than to stay at home too long on your own.

So glad to read all this as am dying to have vbac for dc2 (in a year or 2 - babs is only 16 weeks old!)
I was planning a homebirth for dc1 but after 12 hours the (consultant) midwife advised me to go to hospital for cfm as baby's heartrate was erratic and waters were stained with meconium. Ended up having cs after 14 hours of cfm and syntocinon drip. Ds's heartrate was fine all the time I was in the hospital until it dropped to 60 on the operating table. this wasn't noticed until they reconnected the thingy on his head after taking me through to theatre. while i understand why i had to go to hospital as there were signs ds was in distress, in retrospect the cfm didn't achieve anything that a doppler wouldn't have.
At my 6 week check the consultant told me i was fine and then spent the rest of the appointment going on about how i would have to go into hospital next time round for cfm. I said I was disappointed as I'd really hoped for a homebirth because I'd felt so much better able to control the pain at home. The consultant said not to worry, I could have an epidural from the beginning! SO not the point!!!
I'd been really chilled about ds's birth until that point, just happy to have a healthy baby, but at that point i remembered how powerless I had felt and burst into tears! I don't know why the consultant felt the need to go on about my next birth at my 6 week check, I can only think she had read my notes and knew I was in the "awkward squad" (I'd refused induction 10 days late and went into labour naturally at 12 days) and thought she'd better get in there early! It was really surreal!

Incidentally, is it totally mad to attempt a homebirth for vbac and what are the arguments for going to hospital besides to have cfm? Also I will need antibiotics next time for strep b, at what point is it administered and do you need to be on a drip the whole time? Can you have this done at home?

Any answers appreciated!!!

PS Portandlemon thanks for brilliant story, I'm amazed you wrote it the day you gave birth! You should get a prize for most committed mner!!!

rodformyownback - the problem with having a home birth after a cs is that if the worst case scenario happened and your uterus ruptured then without immediate access to an operating theatre the baby would probably die and your life would be in danger too. This is the risk, although it is extrememly unlikely to happen. Much more likely to happen if you are induced, have an epidural etc.

Also not generally considered safe to have intravenous antibiotics for gbs at home due to possible risk of severe allergic reaction. You have time to decide whether you would really benefit from these or not, it would depend on your exact situation. The feeling now is that if the only risk factor for gbs is that you had a pos swab in a prev pregnancy you don't need abx, however this message is taking a while to get through to some dr's. If your baby was actually ill or there are other concerns then it becomes more important. There was a good thread about this recently will try and find it for you.

hopefully this is it

rodfor.....have a look at the link earlier down the page. There is good information on there regarding VBAC and HBAC.

There is also a thread in Health called "support for imminent VBACers". There are lots of links posted on page 2 of that thread. Many women have had a successful HBAC. read up all you can and weigh up all the factors before making your decision.

Leaving at least two years between births is a good idea as the risk of scar rproblems increases slighty if less than this, that is from 0.5% to 1.5%, so although the HCPs will tell you the risk is three times greater, as you can see it's still not significant.

Am in awe that you are thinking of the next one already though!

i had vbac for ds2 and then a hbac for dd1, all went fine
again, it's all about knowing the risks and taking responsibility for your choices, but it's perfectly possible to have hbac if you want, or just to try for hbac and transfer in if nec

basilbrush, I had exactly the same with the consultant I recently saw, despite this being my third baby, 1st was cs, 2nd vbac. She inferred I would have to be on the bed, continually monitored. I was not happy, I had this with my second and am sure this is what led to episiotomy and forceps delivery, painful recovery. So, I just told them I wasn't happy with that and asked if there was something else they could do. They then referred me to the Consultant Midwife who, as it happens, I have just seen today. Wow, what a difference!! She was bloody fantastic, raised many of the points that others have said, ie no statistics to say outcome improved by continuous monitoring, etc. When I first go in I have to be continually monitored for 20 minutes, fine. Then, I can do what I want, go in the pool (yipeeee!!), move around, go for a walk, etc. They have waterproof sonicaid for the pool, a belt which I can wear that has no wires attached but is read by a machine the other side of the room and, I believe, you can also have a clip on the baby's head (not mentioned today) which can monitor progress without you being attached.
I honestly felt so miserable after seeing first consultant but feel fantastic today, can you ask if there is a Consultant Midwife you can see, as I said, mine was fantastic!
good luck

I still don't really get some parts of the opinions expressed on here. I'm not having a go or stirring things. I am genuinely interested in other people's views.
I now see that there are genuine arguments for not being continually monitored...doesn't improve outcome etc. But can someone explain why you would want a home birth after a cs. Surely there must be an increased risk of rupture after a previous section however slight?
I had a truely horrendous midwife when I had my first baby so the birth experience was horrible. But the baby has always been more important to me than the birth experience so I still had my 2nd and 3rd babies in hospital because I was told that was the best route for me. Having said that we had moved by this point so no chance of coming across afore mentioned midwife again.
my ds1 has sn....nothing to do with his delivery....so I suppose this is always going to influence my outlook.
I just remember reading another thread about antenatal testing where a mw was describing a woman who was so adamant that she wouldn't have any intervention her baby actually died. The staff knew the baby was in trouble but the mum still refused. Now I really can't see how a woman's antenatal and birth experience can be more important than her baby's life

But as I said I am not stirring, just interested. So I am very happy to be proven wrong!

shouldbeworking, I see your point entirely and, quite honestly, no monitoring whatsoever is downright stupid. I need reassurance because I have had a previous cs that baby is OK. But, I don't want it to be continuous to the point where, last time, I couldn't even get off the bed as the lead didn't stretch that far. It's a proven and logical fact that being upright, with the weight of gravity etc, is much more helpful in childbirth, opens up passageways, etc. When I first go in they will continually monitor me for first 20 minutes or so, if everything is OK they will then just do it intermittently from thereon in, making much more sense. I think a woman needs to get on and do what her body wants to do, move around, squat, etc and I truly couldn't do this with my second birth and think this is what lead to the forceps birth. Actually, it got her out and she was fine, that is the best outcome possible BUT I would like to try and enjoy (?!) birth a bit more this time and so want to be more free.
I agree though, it would be nuts to think I don't need monitoring but this mostly for the MOTHER'S benefit, ie monitoring the scar, not for the baby. As my midwife explained yesterday, if your scar is going to rupture you feel it yourself much sooner than it shows up on the monitoring screens. The extra monitoring is, therefore, questionable, in my opinion. If, however, there was any kind of doubt as to the baby's health then I would, without question, be happy to be monitored and I would guess most other mothers here would feel the same.

hi shouldbeworking
I can see your point.. the case of a mother so adamant about no intervention that her baby died is pretty abhorrent from that description.
I think it is rare to come across any mother, however keen on HB who would actually want to put her baby at risk for the sake of her own 'perfect birth experience' (not to mention I don't think an injured/stillborn baby would come high on the list of components of anyone's perfect birth)
Many people (myself included) have chosen to go for a HB after a CS because, having done a lot of research, they conclude that the extra risks of so-called 'rupture' are, whilst elevated and real, still acceptably tiny. (FYI, the accepted stats are around 0.5% for a 'rupture' in a VBAC, whilst cord prolapse, for example, that can happen in any birth is 0.6%)

Planning a VBAC in hospital often (although, not always) means being pressured heavily to comply with hospital protocols during labour. These include CEFM (as discussed, not proven to improve outcomes, but proven to increase intervention rates and CS rates), and time limits imposed on the different stages of labour (also not proven to reduce incidences of 'rupture'). You may also be offered (although you shouldn't be) augmentation of labour, which is completely contra-indicated with a previous scar, as the ctx induced can be much stronger and longer than your own body produces. (Most cases of rupture in studies have been due to artificial augmentation of labour)

Aside from all this is the fact that many women need privacy, familiarity, and support from trusted people to allow their body to labour effectively and safely. I know some pp like to do this in hospital, as it's where they feel safe. Coming up to my first birth, I was sure I was one of these. After my own 2 horrific hospital birth 'experiences' I am no longer one. As long as all is well (and I will be monitored every few mins or so with a handheld sonicaid by an experienced, independent MW) I feel that my labour will progress better at home, in private, where I can say who is and isn't allowed into my space, and with pp I can rely on to support me to continue through the pain, as long as all is medically well.

I feel this will give me the best chance avoid a repeat CS... which has risks not only for me (last time I had a massive unexplainable haemorrhage requiring big transfusion, and followed by pain relief failure) but also potentially for the baby (breathing difficulties etc)
There's a good link here

That's by no means the whole argument in favour of HB even after CS, but it's the bones of mine.

Thanks for your opinions...trying to keep and open mind here and different points of view are invaluable

Hello again ladies - I have stirred up a real hornet's nest!!

This is obviously a very emotive issue for many of us...

Obviously no-one wants to jeapordise their baby's safety but I think the kernel of the issue here is that CFM doesn't improve your baby's safety but is still being clung to as protocol for legal reasons. I think one day we'll look back on this like we do now at the 1950s when every woman was routinely blacked out with ether when the baby crowned as it was assumed that the modern woman couldn't bear the pain or push her baby out effectively. So you were unconscious, given the cut and baby was pulled out with forceps. Seems crazy half a century later....

However, such musings don't help me much today - this is the way the system is and I need to figure out where I fit in.

The problem is mainly DH who is the most wonderfully supportive man on the planet but was scared s**tless by DS birth. We have been talking about this and while he seems almost prepared to except my arguments for CFM on rupture, he thinks that I should be on it in case of placental abruption which is what happened last time. I have tried saying that a) even the consultant said there was no statistical likehood it would happen again b) we already know this baby is bigger and better nourished in there c)we would know anyway as I would start bleeding all over the sodding place which is why I am going to hospital this time and not trying for a HB

But his line remains - They're the experts, why on earth would they mislead us? I think you are right, I need to speak to a professional with a different viewpoint like the Chief Midwife and maybe he would listen to them.

I honestly think deep down he would prefer me to book an elective as we would know eaxctly what would happen. But I know any labour is better for the baby than none, preparing it to breathe etc...

I think I need to write a proper birth plan to discuss at my next appt on Wed 30th April