Want another VBAC - but today registrar started talking about ARM/intervention due to baby size ...

[greenlawn]

I'm now 37 weeks and completely confused following an appointment today with a registrar! Can anyone help?

Basically my history is:

• elective cs due to identical twins
• VBAC - went really well, 9 1/2 lb baby born at almost full term, no complications
• now 37 weeks pregnant and hoping for another VBAC.

Had a scan last week at exactly 36 weeks, and concern was noted that this baby was "apparently" approx. 7 lbs 9 oz with head and abdo circumference over the 97th centile. Had a bit of a confidence wobble at that one, then decided so what, scans are notoriously inaccurate, and it made no change to my planned birth.

Today I saw a registrar instead of my usual helpful and supportive consultant, and have come out feeling really depressed. Basically he said there's no doubt the baby is very big (but couldn't give me any further idea than that), and if I hadn't gone into spontaneous labour by 40 weeks they'd want me in hospital, ARM and then CS if nothing happened within 2 hours.

On looking at my notes he's written "ARM and synt. if undelivered at 40 weeks". Baby is fully engaged.

Now I've come home I've completely terrified myself reading up about ARM - and what the hell is "synt" - is that being induced? I thought that wasn't meant to happen if you'd had a previous CS?

I'm really fearful of finding myself in a situation where I'm not in control and end up having a horrible non-labour ending in an emergency CS. This is the last thing I'd want. But do I have any other options? I realise I can say no to things, but I'm just wondering where that leaves me.

Sorry its a long post, just bashing out my fears and frustrations.

oh greenlawn. they're talking out of their arses. they have no idea how big your baby is. and, quite frankly, if you've birthed a 9.5lber then you;'ll be fine lol

I had a similar thing where they tried to refuse me a homebirth because my first was 9lb 1 and my second was "going to be much bigger"
he was bigger, but only 4oz more, and I DID have him at home.

you know that scans are stupidly inaccurate, there was a thread on here the other day (best one was the 6lber who turned out to be 12lb :D)

you do NOT have to be induced if you don't want to. it is unlikely that you would grow a baby you couldn't birth naturally, unless you had something like GD making baby abnormally big.

snyt I imagine is syntocinon. so what they're saying is they'll break your waters and give you drugs to make contractions kick in.

Thank you so much for that, I wish I had my nice consultant to talk to, I honestly feel he wouldn't have even started a conversation along those lines. This baby doesn't feel that big anyway!

I had such a nice VBAC before, and everything happened naturally and smoothly, ARM sounds like my worst nightmare. And the mention of 2 hours - where does that come from?! How am I meant to labour under pressure like that?

Take a deep breath and calm down - you KNOW that lots of what they're saying is rubish!

One thing to remember is that they are YOUR notes, and you're perfectly within your rights to add you're own comments to them or make ammendments.

Also remember that they can't force you to have an ARM. They can't force you to have syntocinon. They can't force you to have a CS at all, let alone after an arbitrary (and very short) cutoff.

Is there any particular reason you got the pants registrar rather than your nice consultant? Can you request an appointment with the consultant explicitly to go through some of the issues raised? Whilst I know and you know that what the registrar says isn't cast in stone, I do believe life would probably be much easier if you had "official permission" (euch! - but you know what I mean!) for a plain, simple VBAC.

agree with Tangle,. talk to your nice consultant and explain your worries.

and you are perfectly entitled to refuse to see this other registrar as well.
makes me so mad, a friend of mine had a similar thing and they tried to make her be induced at 37 weeks. she refused and baby was born fine, and not that big at full term.

there is a lot to be said for mother's instinct. I insisted that ds2 was about the same size as ds1. they vehemently disagreed. guess who was right??? me.

don't let a meeting with one wanker put you off. You've had one successful VBAC, I would imagine that counts for a lot. and even more so because your c-section was for twins rather than some kind of complication for a singleton

I would put in writing to this Registrar that you are not intending to have ARM and synt. as per your notes, which s/he has written in without your agreement.

Ask that this registrar is no longer connected to your care.

Send letter and copies, recorded, to this registrar, the Director of Midwifery, Obstetrics and Gynecology and the Supervisor of Midwives. This way everyone knows that you will not be fecked about roll over and play dead.

Sometimes these people need a rocket up their arses to remind them that they are not God.

[normally, i am a nice person but I am so on your behalf].

What an arse that registrar is! Everything everyone else has said is totally right - you cannot be compelled to labour at a time of their choosing and scan measurements are not 100%. So the baby is looking on the big size - that's fine for you - you've laboured and delivered a big baby before. That 2 hours thing is dreadful as well. Did he give you any idea of what risks he felt warrented this rather drastic plan? In your shoes I wuold be inclined to ring the consultants secretary and ask her when you can get in to see him.

Thank you so much for your responses, took myself off to bed last night feeling a bit more confident.

I was down to see the consultant I normally see, and then he apparently got delayed by an emergency and the midwife just wrote on the white board next to the clinic "Registrar Only Today" - so I was immediately defensive anyway.

I'm going to ask my community midwife if I can see consultant before 40 weeks to go through what the registrar said. I know that when I had my vbac the same consultant told me explicitly that if I got to 40 + weeks and no sign of any action then the most he would CONSIDER would be a sweep, and even then only if I was keen. So I can't believe he would agree to ARM or anything aggressive like that. He had also agreed beforehand no need for continuous monitoring, yet I've also found that in my notes for this birth thanks to the registrar! I feel like my whole birth plan has been sabotaged.

I'm very very sensitive about danger to the baby (of course everyone is) because one of the twins was stillborn, so I'm not going to take any risks but I feel taken advantage of by the registrar - like he knew all he had to say was "its in the baby's interests" and I'd fold under pressure

Thank you again for the advice, I feel much more buoyed up now.

I have a report which shows the increased rates of VBAC success for each successive VBAC if you'd like it?
You KNOW that this registrar is talking bollocks and whilst it would be nice to have your consultant's "permission" to do it your way, you do realise that you don't actually need it don't you?
Anyone who has lost a baby is going to be super-cautious I totally understand that. But don't let them mess with your head to the degree that things get blown out of proportion - a big baby doesn't mean that you have to be induced (in fact it angers me that any obstetrician thinks the increased risk of rupture associated with using syntocinon is less of a risk than having a "big" baby naturally, especially after a previous successful VBAC with a "big" baby).

(stalks off, muttering into her coffee cup)

Glad you're feeling better about things anyway

ARM & synt at 40 weeks is, IMO , a good recipe for an emergency c.s. if your baby is fully engaged, i would warrant it will fit nicely out through your pelvis and foofoo..... the head circ is more of an issue than body size, no? you;ve birthed a 9lb 5 baby so why could you not birth one a wee bit bigger?

you need to do as foxytocin as said, and put your wishes in writing.

and you don;t turn up at 40 weeks for an IOL you don;t want or need

if you get lots of grief, contact www.aims.org.uk and get your supervisor of midwives on side.

vbacqueen1, I would be very interested to know about that report, as I always thought that was the case (and certainly in terms of confidence I was feeling super-confident having done it before) - and yet I was actually told by a mw a few weeks ago (not my usual lovely community mw) "of course, you realise you've got less chance of a vbac this time because your uterus has had to stretch an extra time so there is an INCREASED risk of rupture?"

Not being funny, but this is my 4th and my poor old uterus has been stretched back and forth like an elastic band so I can't see why there is any extra risk this time?

Lulumama - my 9 1/2 + baby was born no problems and an intact perineum so I personally think I have plenty of "give" (ahem!) IF I had what I had last time - namely loads of support from lovely consultant and fantastic mws on the day. I was just hoping I wouldn't have to "fight" for it.

Thanks all.
xx