feeling pressured in to vbac... just a couple of Q's

[mrsmontano]

Sorry it's long, but bear with me, I'm really worried!

Well I'm 18 and a half weeks and saw a consultant today, to discuss my last birth which was an emergency c-sec, and my current pregnancy and upcoming birth. I came away from the appointment feeling really dictated to and disappointed so I wondered if anyone here could help me at all?

I had so many questions I wanted to ask, I've been so worried about everything that I've actually lost sleep some nights, but I didnt really get the the opportunity to discuss anything, I was just told that there's no reason I shouldn't try for a vbac.
The man wasnt rude or anything, he just had a certain manner that didnt leave any room for discussion. He told me what he needed to say, then dismissed me. I'm kind of cross with myself now because I dont see anyone else til 32 weeks, so I feel like I've missed my chance now, and will have to continue worrying til then.

Anyway, a big concern for me was that I would attempt a vbac and end up with another emergency section. It was very traumatic before, and after a long labour I ended up with a baby who needed blood tranfusions after birth and spent a week in scbu. Nobody would tell me what was happening, at all, I was so frightened. I wont even go in to it all now!
I read that about a third of women who attempt a vbac end up with emergency ones.
Does anyone know the actual figures? I cant seem to find anything now.
The consultant said that 80% have a vaginal birth next time after c-sec. Can that be right? The overall cesarian rate for the hospital is 26% I think so I find what he said hard to believe but I just dont know.

I wanted to ask aswell about how much I dilated last time, what effect it would have on the success of a vbac this time. Because I dont think I ever got past 2 or 3cm in about 18 hours of constant contractions. I thought that wasnt a good sign?

Also I'm worried about why my daughter needed the blood transfusion last time, I remember them saying fetal-maternal tranfusion (ie her blood had been going in to me, she was white as a sheet when born and stopped breathing a few times in the next few hours). I've googled... all I've found is that it's a major cause of still birth. Will it happen again? What if it does and nobody knows untill its too late? should I be monitored in some way toward the end of the preg?

Lastly, if I decided I wanted an elective section this time, can I do that? Or can they say no? I don't even know if I have a choice.

I'm a quiet person so I find it hard to get my point across, especially when someone is obviously trying to get me out of his office after 2 mins... I just want someone to talk to!
I will talk to midwife but I dont see her again till 28 weeks, which seems ages away at the moment.

I can't answer most of your questions but I am fairly sure you have a right to an elective c-sec if you want one. A friend of mine was in a similar position but stuck to her guns - explained why she felt it better and they supported her in her decision.

Can you make another appointment with someone to discuss ? Maybe try and see MW beforehand if she is sympathetic. Write down all your questions so you know you've been through them.

Your birth story sounds very similar to mine (including baby two weeks in SCBU with infection) and I was granted an emergency c-section for dd2 without any problem. Could you discuss the situation with your GP? Or with a midwife? You def need more time to discuss yur situation if only to put your mind at rest for the VBAC.
If you are leaning towards having an elective c-section then say so and get them to talk you through it. phone your midwife or hosp and go and talk to them. i'm sure you can have an elective if you want one.

Sorry have to run a bath!

I just had a successful VBAC, so I'll make no apologies for being positive about them, sorry!

For information though, google "association of radical midwives", I cannot remeber exact web address. There is lots of very good, evidence based information on there, NOT v radical by today's standard (I understand in the 60s they were considered radical for suggestion that not EVERY woman must have an episiotomy ). I found this site v helpful in the decision making what type of delivery I would like to aim for this time round.

What your chances are depends a lot on WHY you had the section the first time round. If the cause for it is not present in this pregnancy ie placenta praevia, then it would be reasonable to attempt VBAC.

Remember, nobody can make you do anything you do not want to! Most consultants will respect the woman's wishes in your situation. You have to of course accept that things not always happen they way we would like. If you felt strongly that you did not get on with you consultant ask to see somebody else; this is done all the time, so do not worry!!

My main reason for opting for VBAC was that I did not fancy going home sore to active DCs and newborn to look after.

Reading your post I get the impression that you need a lot more information, both about your previous birth experience, reasons, etc, and about the pros and cons of vaginal vs operative delivery. Contact you consultants secretary and ask for a further appointment with him to discuss options before you next routine check and go to this meeting armed with a lot of info!

Best of luck. I hope you get the delivery you wish for.

vbac 1 - back to back labour, looong. i was in a bit of a state and required an extra week in hosp, ds1 ok.
vbac 2 - labour fine, unfortunately problems with dd2 ended up with 5 week SCBU stay etc etc. not now allowed to labour so will always be planned cs if i have any more.

lots and lots of people have fantastic vbac experiences, and some have bad ones. you have to discuss it all properly with your midwife (i think you should also book an appointment to discuss your first birth btw - it is important to understand all the rationale) so that you can make an informed decision. my team were pushy for a second vbac, and i asked a couple of times whether i could elect for a cs, but was told no. i do wonder whether the outcome would have been different if i'd been a little bit stronger in my choices... but we'll never know.
good luck to you, and i hope you get the opportunity to make your own decision, after getting all the information you need to do so.

Yes I thought that todays appointment was to discuss my last birth, and everything would become clearer. But he just kept saying we don't know why anything happens, childbirth is unpredictable... so I didnt get any answers. I was in there littrally 3 mins maybe 5 max. After waiting an hour in the hot waiting room feeling very sick.

I've done hours and hours research on the internet but you have to take a lot of what you find with a pinch of salt because there are alot of contradictory statistics and advice out there. I was leaning towards elective section after all my research, but his '80% have vbac' threw me abit because I didnt think that many even attempted it, let alone were successfull.
And he didnt present elective c-sec as an option so now I wonder if theyd refuse me anyway.

they didn't present it to me either. and i expect that's why his figure is 80% lol.
just make sure you are making your own decision - important to have that discussion about 'last time' whether he wants it or not. otherwise no-one can make an appropriate decision. he may well have prefectly valid reasons for recommending a vbac on this occasion (ie that similar problems are extremely unlikely to occur) but unless he shares them with you, you will remain unsure if vbac is the right option. having had that discussion you might be totally reassured and confident to proceed naturally when the time comes.
i was told only 25% are unable to successfully vbac btw, which isn't far off from his 80%.

I had my booking appointment with my Gp today and discussed my fears about childbirth and the possibility of an elective section. Like you I want to find out what actually happened when dd was born, ask lots of questions then make a decision.

My GP was great and took me through things and let me cry. She said it will be up to the consultant but if I am sure I know what I want I had to tell the consultant everything I had told her.

Do you have a sympathetic GP you could go and see? They are able to refer you back to the consultant and you could perhaps ask for a different one?

you can ask to get your notes from your last pregnancy/birth and talk them through with a consultant midwife who hopefully will have more time to talk to you about your concerns/questions. It sounds like that might be really helpful for you right now.

most hospitals now are supposed to be encouraging vbac rather than repeat c section unless, obv, c section is medically necessary, so consultant might be thinking of his figures. having said that, I would highly recommend vbac and have had 2 myself.

I'm currently 36wks with DC2, having had Emergency CS with DD. During my 20 week appointment it was 'assumed' by the Consultant I'd want a VBAC and I was quoted the 80% figure ! However I had to be quite forecful and explain that as yet I hadn't made a decision on what I wanted. As a result, I was referred to a the head midwife at the hospital to discuss VBAC, and the issues surrounding my DD's birth in more detail.

As you have already seen the consultant, I'd suggest contacting your own midwife a.s.ap. and asking if she can arrange such a meeting, (with someone other than the Consultant if possible)? Someone who can address your concerns sooner rather than later. I found this very helpful. However I will emphasise I did have to be unaturally 'pushy'to get this - so don't be afraid to explain what it is you want.

I am sorry to read that so many of you have had dubious support from your HCP. I now feel doubly lucky that my consultant said to my :"Which way would you like your baby to be delivered?" and then went through some of the issues.

It is your right to make an informed choice, so I suppost you will have to be assertive about needing more info about why your previous delivery went the way it did (my DS2 was on neonatal ITU and to this day I think it is the scariest place on earth).

Also the idea to speak to an experience midwife is a great one. Ideally maybe with your records, so she can answer further questions.

It is true, because c-section rates in the UK are rising, there is some pressure on hospitals to increase vaginal delivery rates, but that is their problem and should not be yours.

Sorry you're going through this. It sounds like maybe you need a bit more info about what happened the first time to help you make your decision this time round. Have you seen your notes from your first birth? It should be possible to make an appointment at your hospital to go through these notes with someone (eg midwife) who can explain what happened to you - sometimes it's called a "birth afterthoughts" service. It shouldn't matter how long ago you gave birth. My ds was whisked to NICU and getting hold of his notes really helped me as it's very difficult to take in what is going on even if someone will explain it to you!

Strongly agree with suggestions to make an appt to see gp or mw (whichever you think will be more sympathetic) and request another appt to properly discuss your birth options. Maybe after you have been able to go through your notes.

Good luck!

Oh, and when you go to see your notes or for another consultant/mw appt to discuss birth, write down a list of questions and don't let them push you out of the door until you've asked them all! You can even say at the beginning of the appt "I've made this list of q's I'd like you to answer please..."

I am just preparing to see the MW re a VBAC and have been researching on the web etc, and everywhere it seems to suggest to write down your questions, so I have been doing this.
Does your hospital only let u labour for so many hours, despite you and baby being ok ?
Canula inserted, JUST IN CASE ?
Your hospital rate of VBAC's ?
Can I labour at home for some time or do I need to come in to the hospital as soon as I start ? If so, WHY ?
Will the MW encourage me to VBAC once in labour ?

If anyone else has anymore questions I/We could ask, it would be really appreciated.

They should let you have an elective c-section if that is what you want. Maternal preference is one of the factors listed by NICE as deciding between birth methods, as well as the risk of uterine rupture for anyone who's had a c-s before.

I would query that 80% figure - the figures I've seen in the past are nothing like that. I think the vaginal birth rate in the general population is only about 75%, and it's significantly lower for women who've had previous c-sections: about 66% as I remember it.

I asked the same question at a gynelogical check up to the head obstetrician and he told me that while the rate was about 75-80% a lot depended on the reason for the c-sec. If it was for failure to progress (mine was) then it went down to 40% success rate.

However, shortly after a report (I can't remember if it's by NICE or RCOG but hopefully someone can link to it) came out and none of the hospitals near me had rates anywhere near that. I think the highest was UCH at about 29%. The hospital I went to refused to disclose its figures.

Talk to a midwife. Get her to go through the reasons for the previous c-sec. Also get her to explain hospital policies on cfm and intravenous lines. There are certain factors which can influence the success of a vbac and if the hospital actually subscribes to them you will have a greater chance of achieving it and being supported. You may find that she will support you and recommend an elective if that is the best option for you.

However, if they do not and you are set on having another c-sec (and remember that everything in childbirth is unpredictable to a certain extent), then either ask the midwife or consultant to confirm in writing that the success rate is 80%, that based on your medical history you will be amongst that 80% and anything that goes wrong will be due to his refusal to give you an elective. I can guarantee that he will not write any such thing. Also take someone else with to your next appointment. It is very difficult talking about yourself in that way, when pregnant or not and even harder with dismissive consultants.

see page 91

and this is the one where you can find your trust report

www.healthcarecommission.org.uk/healthcareproviders/nationalfindings/surveys/healthcareproviders/sur veysofpatients/maternityse/reviewofmaternityservices2007.cfm

Good point tigger15 - statistics such as "80% success rate" are pretty meaningless. You need a likelihood of success for you, based on your individual obstetric history, to enable you to make your decision.

thank you all so much for taking the time to answer. I'm not sure who to go to next as I get a different midwife every time, so I've no idea if I'd get a sympathetic one if I make an appointment! my GP is okaaaaay... maybe I'll see him about it all.

yes I should make a list of what I want to know.
tigger that was interesting reading, especially my own hospitals report!
It appears the vbac rate is 44% there. I questioned him when he said 80% but he just kept repeating the figure at me, so frustrating!