Is it possible to have an 'active birth' after first was an emergency c-section?

[Janus]

I've just had my 34 week consultant meeting at my hospital to discuss my labour for 2nd baby. He was very negative, spent first 5 minutes reading off statistics of how many 2nd pregnancies of previous c-section end up with ruptured wounds, how many of those babies then die, how I will need constant monitoring in second labour, how I can absolutely forget about a water birth and won't even be allowed to have a bath as I will have to spend 99% of the labout flat on my back to enable monitoring and I should definitely consider epidural asap (as his wife had epidurals with all 3 of her births????????).
To be honest, it's my idea of a total nightmare. My first labour was extremely active, I dilated to 10cms quite quickly, mostly using the hospital bath, was extremely active, no drugs, etc, and nearly gave birth standing up but my daughter just got stuck and I just couldn't get her out. Her heartbeat then dipped and so we ended up with an emergency c-section. The thought of this labour being almost strapped to a bed has thoroughly depressed me and I honestly don't know how I'm going to cope.
To be honest the care with this whole pregnancy has been crap. I'm 34 weeks and I've had just 3 ante-natal appointments, the hospital very much seems to have the attitude of we will worry about you when you come in during labour, I have no midwife attached to my GP surgery so my hospital is the only point of reference.
To the point (!!!!!!), has anyone else had an emergency c-section and then gone on to have a vaginal birth where they were still in control or active? I understand the need to be monitored but can I insist that I be upright when they do this (thought Mears or Leese could help me here??), even in the bath they do have underwater monitors could they not use this?
Sorry this is so long but I'm so upset and don't know who else to ask as the hospital just seemed to want me out of the doors asap and just kept saying 'let's see how it goes', I want to prepare myself if I can.
Thanks everyone.

[deegward]

Janus

We must be dus within days of each other, and I'm sorry I can't comment on your actual query. All I can say that I have only been to the hosp once for scan, and the rest of the time been at the mw. I think I have seen her three times. It does seem to be " you have done this before so go away" . I Have heard throughmy active birth yoga class, that people have had c sections then had "normal" second birth, also that you can be monitored not lying down. I hope that you get what you want, Its crap enough second time around with ds running around, and thinking "was I this big/uncomfy before"

Take care

[clucks]

Janus

You have opened my favourite topic on mumsnet. You may want to search Sofiaames postings who had VBAC at active birth hospital after her emergency c/section.

I think I am due the same time as you and my consultant, poo-pood the VBAC statistics. I am trying to keep an open mind though and agree to whatever is necessary for a healthy delivery. I will try for a natural delivery simply to avoid further surgery... I have only had 3 ante-natal checks so far but am not unhappy about that because I find them a drag and there's no real evidence that frequent ones make your pregnancy/delivery any different. Good luck..

[bundle]

janus, I've got my 34 wk appt with the midwife - plus an extra dating scan next week with my consultant but I expect I might have to wait until my 38wk appt to ask all about this myself (having an emergency c-section, a bit like you got to 8cm, dd became acidotic & they whipped her out) but I was under the impression that the main restrictions on me this time would be: not going more than 1 week over dates and not being induced - as well as being monitored carefully if I did go spontaneously into labout. my consultant was much more blase about the rupture risk than I was! and from what I remember last time there aren't any underwater monitors

[willum]

After my emergency section last year I had a debrief session with some one from the hospital. I asked her what happens if they try to push me in to things I don't want next time and she said if you just refuse they have to find someway round it. Which I guess is true, because if you refuse to lie down etc. then there is not much they can do to make you! I'm not even pregnant again but I'm already highlighting bits from the Silent Knife to back up my case, also considering giveing birth somewhere other than the hospital.

Good luck.

[witch1]

Janus I have a friend in Germany who has had a VBAC successfully no rupture no epidural no tearing. I also have a friend who has had 4 ceasareans ( not normally recommended coz of scar rupture) She has a distorted pelvis from a riding accident as a child. She would have more but her dh cant face it!

One wonders if you had NOT been in hospital whether you would have had an emergency ceasar.
My third labour was posterior and although I dilated and could be stretched to 10cms coz the baby was not pushing down with crown of head I wasnt getting any contractions. But I was at home so it was totally my decision to keep on trying

I was in labour for hours and hours with very few (but massive when they came) contractions but eventually we got him out by adjusting my position constantly to maintain contact with cervix gentle jumping (really on toddler trampoline!)and keeping moving (up and down stairs) I had both my 2nd and 3rd at home to avoid what I considered unnecessary last minute intervention which instantly involved me getting horizontal with my first. As a novice I just needed a bit more time to get the hang of the pushing and I'm sure I would have managed fine.

I would fight for what you want and if they give you endless stats as to what will hapeen if you DONT do what they want ask for the stats on what might happen the other way. Also very overdue in 3rd pregnancy I was told I would be induced as I was jeopardising the baby old placenta etc. But when we asked what the comparable risk was for induction leading to painful contractions leading to more drugs leading to possible c-section (intervention spiral) they couldnt come up with anything convincing so we went home. So he was v late v heavy and back to front but he still managed fine and on arrival was given a grand tour of the house by his big sisters while I was being stitched. It

when it comes to this you could really get me banging on for ever. However I better go and put my kids to bed as they are rampaging without me...

[mears]

Janus - I am sorry you have met such a negative response from your consultant. I have looked after women who have had a previous C/S in our midwifery unit. Women who want such care discuss it with the senior midwife of the labour ward and our consultants are now happy to 'let' women labour without being strapped to a bed. Continuous electronic fetal monitoring is not the only was to monitor a baby and is definately not the best! It is possible to record how the baby is doing with a doptone which is a hand held monitor used to listen to the heartbeat for 1 minute every 15 minutes. There can be used under water so the baby can be monitored when you are in the pool. You have a right to insist on the type of care you want to receive during labour. Do you not have a contact number for the hospital midwife? Will she not look after you postnatally? Can you find out if one of the other consultants would support your choice - you could then change to them. What about other nearby hospitals. If you do not get anywhere then ask to speak to the Supervisor of Midwives at your hospital. She should be able to help you get the type of care you want. Good luck.

[sleeplessinseattle]

Hi, I had an amazing VBAC with my second baby after an emergency caesarean with my first. I am actually living in america, where the CS rate is even higher than the UK. The pressure to have another caesarean is also huge. But here you get more choice if you're prepared to look for it: I found a great hospital with a low CS rate and a fab team of midwives plus I hired a doula who took me through a huge mental preparation and was a great support (I was crapping myself about a repeat caesarean but didn't want to risk my baby's health by doing anything silly). I'm a journalist and have written about VBAC - the statistics on uterine rupture are actually very reassuring. It sounds to me like nobody has given you any good reason whatsoever to have a repeat CS. Here's the link to the article I wrote about it in the guardian www.guardian.co.uk/health/story/0,3605,523833,00.html.
I would be happy to talk to you more about this. I know how confusing it can feel. There is a lot of literature on VBAC and there are organizations that should be able to help you with info etc. As far as I could work out - and I'm not medically trained - a 'safe' VBAC (ie. with a supportive medical team and no counterindications) is statistically considerably safer than a repeat caesarean. My VBAC was unmedicated, went perfectly smoothly and I never felt worried for a second. Do feel free to email me (from tech I think) and we can talk more.

[SofiaAmes]

Janus, I didn't even bother asking my consultant for permission to have a VBAC. I went directly to the head mid-wife of the active birth floor and she did all the liasing with the consultant for me. I got her number by calling the hospital and asking who was the midwife in charge of the active birth floor. I then called her and explained my situation and she was more than happy to meet with me.

[pupuce]

Janus.... I am soooo upset at reading this !
There are loads of VBAC.... even some women have delivered in water ! I don't even know where to start to be honest... It doesn't help that today I saw a TV programme about awoman giving birth and she was refered to to as "the patient" (please.... is she ill?????) and then the OB admitting that some of the stuff she had done to the mum were probably not necessary! ANd baby not getrting any skin-to-skin for MANY hours. for no medica reason... I was enraged !

Now here is some info for you.... Hope it helps ! At least the numbers quoted are published in recent medical journals !
You could also conmsider a home birth REALLY! or a doula (£250 for most of them)


List risk factors and incidence of uterine rupture.
Incidence:
· 0.05% of all pregnancies (BMJ)
· 0.03 -2% of all VBACs in the USA (JNM)
(BMJ) is the British Medical Journal Feb 2001; Vol 9 No. 2. (JNM) is
the Journal of Nurse-Midwifery Vol. 44, No.1 Jan/Feb 1999.

[pupuce]

Janus.... I am soooo upset at reading this !
There are loads of VBAC.... even some women have delivered in water ! I don't even know where to start to be honest... It doesn't help that today I saw a TV programme about awoman giving birth and she was refered to to as "the patient" (please.... is she ill?????) and then the OB admitting that some of the stuff she had done to the mum were probably not necessary! ANd baby not getrting any skin-to-skin for MANY hours. for no medica reason... I was enraged !

Now here is some info for you.... Hope it helps ! At least the numbers quoted are published in recent medical journals !
You could also conmsider a home birth REALLY! or a doula (£250 for most of them)


List risk factors and incidence of uterine rupture.
Incidence:
· 0.05% of all pregnancies (BMJ)
· 0.03 -2% of all VBACs in the USA (JNM)
(BMJ) is the British Medical Journal Feb 2001; Vol 9 No. 2. (JNM) is
the Journal of Nurse-Midwifery Vol. 44, No.1 Jan/Feb 1999.

[Crunchie]

I hate to agree with Janus, but this is attitude seems to bethe norm as far as my expperience goes. I had a c-section 1st time around (prem baby, 27 weeks pre-eclampsia), and I really really wanted a VBAC. The 1st consultant dismissed it out of hand, the 2nd specialist also said it would be unlikely. Midwives also said I had to have continuos monitoring, I asked if I could have a 'mobile' system which would at least let me stand up, or move, but this was 'impossible' due to the risks involved!
They would 'allow' me to have a trial of labour if I went into it spontainiously (sp?) but a max of 4 hrs, if I didn't get anywhere, then that would be it!

I felt like every idea I had was blocked everywhere I went. I was so upset, because I had set my heart on the perfect birth, full term baby etc etc, no a medical emergency with me terrified my baby or me would die.

In the end my waters leaked for 24 hrs, I went to hospital, and made my own choice to have a c-section. The baby was not engaged, and was still very high up the birth canal. I am pleased I had a secion 2nd time round as afterwards they said there was meconium in the waters and the baby was not going to have come out easily, I could have tried, but would have ended up having a section anyway.

I know this doesn't help Janus, but strangely enough the emotional distress I had after the 1st time wasn't there. I had made the final choice, and therefore felt I had a modicum of control at the end. It wasn't the choice I wanted, but it was better than an emergency

[kaz33]

I am about 25 weeks, pretty much the same position as Janus first time round. In birthing pool, no drugs and fully dilated and baby wouldn't come out. In my case no distress ( well only mine because of a very long labour....) so given c-section.

The midwifes that I see have said that as I was fully dilated no reason not to try for an natural birth, though they will arrange for me to see the consultant nearer the date. Do not want another c-section as I hated everything about it and not scared of the pain.

However, the thought of lying on my back during labour scares me. I think its the thought of not being in control.

Does anyone have experience of the position at the Chelsea & Westminster hospital as what i want is another water birth if possible.

Thanks
Kaz33

[aloha]

Janus - the hospital can't 'make' you do anything. They have no power to force you into anything, much as they would like to persuade you otherwise. If you won't lie down they can't do anything about it - it would be completely illegal to do so. You can insist on pretty much anything you like, though obviously that will be hard if you feel under pressure and unsupported. Would it be worth hiring a private midwife/doula to give you that support. I think it's worth remembering this and even reminding the hospital that they have no right to bully you. What you want isn't what I'd want but if you want it & it's safe for the baby (seems no evidence that it isn't), go for it!

[ariel]

My own experiance is, ds1(7 years old) was an emergancy section as he was brow presentation, had a long labour but he wouldnt move so had to deliver quickly due to distress(his not mine!!) , dd2 (5yrs old) was a competly normal and very quick delivery(although 8 wks prem) no doctor ever said i needed another section , ds3 was supposed to be a section, that was my desicion due to complications after dd getting a infection from me soon after her birth but i laboured early again at 29 wks and again had a quick delivery , both my normal births were quick and faily easy ,i had no pain relief. No doctor has the right to push you into a serious operation unless its really needed.

[Hebe]

Dear Janus,

I had an emergency c-section first time round but went on to have my second baby 'naturally'. The consultant asked me each time I saw him what I wanted to do and he was happy to go along with my choice. If there had been any problems and he had advised a c-section I would have had one - the health and wellbeing of both the baby and myself was and still is more important than giving birth naturally just for the sake of it. I had a really supportive midwife who was absolutely brilliant during my labour - I don't know how I would have managed without her.

PS I was able to move around as much as I wanted to aswell.

[cas1968]

Hi Janus,

I am 41 wks pg with second baby, following emergency c/s last time. My labour last time was pretty much like yours. I can still look back at the day and consider it a happy one, despite the abrupt ending. I laboured at home with a TENS machine and was 6cm dilated when I reached the hospital. I continued to use the TENS machine, plus a little gas & air and reached 10cm easily. Unfortunately, my waters had not broken and the mw decided to break them. Because I was 10 days late, that's when things went wrong and my son was born by emergency c/s.

This time around, I have not received any negative reaction to my request for a natural birth, other than being warned about continuous monitoring by one mw early on. However, this has not been mentioned since and my Consultant is very positive that I wil get the birth I want. I saw him today for my 41 week appointment. I am 3cm dilated, but there are no obvious signs of labour. He is quite happy to let me go until 2nd March (although he does not believe I will) before he will intervene. Even then, he will induce (but only one dosage) before using a second caesarean as a last resort. Although I am obviously aware about uterine rupture, this is more due to my surfing the net than the opinion of the medical staff treating me. I also have a friend who had a natural birth following emergency c/s at the same hospital. She refused the continuous monitoring and was allowed to move around freely, being monitored at 20-30 minute intervals.


I hope to be able to come back and report to you shortly that I achieved the outcome I desired but, in the meantime, I wish you good luck with your delivery. xx

[kaz33]

Great thread. Had a midwife appointment this morning and got to ask questions about VBAC and in particular birthing in water. I was told that continous monitoring was required and though I could be mobile I could not go in the water. When I asked if this was standard practice, she said it was. Though as she said - if I refuse to be monitored there was nothing they could do about it.

She then also said that as I would be monitored continously I should stay at home as long as possible and could get in the bath at home. Now does that make sense to anyone ? Surely if there is more danger then I should be in the hospital being monitored ASAP.

Must admit, this time round after a midwife mess up last time ( not noticing baby was in wrong position, therefore not trying to turn baby and ending up with emergency c-section )I am much more inclined TO ASK LOADS OF QUESTIONS.

Going to do some more research and consider my options.

Thanks for everyones input, otherwise I would just have gone along with what the hospital told me.

[baggie]

Hi Janus
My experience sounds very similar to yours. There was no midwife attached to my GPs and so the hospital was the only monitoring agency. They were horrendous, unprofessional, inconsistent and very impersonal. I too had a very quick initial labour, advancing to 10 cms quickly and then babies head stuck resulting in an emergency c section. However, I went on to have a vaginal delivery second time round and all was well. Just remember you are in control however vulnerable you feel and try and arm yourself with as much support as possible. Best of Luck.

[Janus]

Thank you all so much for your replies, this has honestly helped me so much.
Firstly, I rang the midwives attached to the hospital and explained my situation and the 'advice' given by the consultant. The midwife seemed pretty surprised as his suggestions and agreed that there would not be a need for constant monitoring, just a bit more than a 'normal' birth. She also said I could go off for a bath if I wanted but would not be able to have a water birth as they need to be able to keep an eye on previous scar which wouldn't be so easy in water. I'm fine with this, a bath should be sufficient as it certainly worked wonders last time.
I honestly was at the point of changing hospitals and would never have thought about trying to speak to an actual midwife rather than rely on what the consultant said (thank you Mears!).
Last time was a bit scary, my dd had a severe dip in heartbeat (called a severe fetal bradycardia) ending in me having an emergency c-section but under general anaesthetic as didn't even have time to do the eipidural and so partner not allowed in, left outside for 45 mins wondering what was going on, etc. I think he is more traumatised by the exeperience than I am as I was obviously out of it. I'm finding he's getting much more worried about this second time around than I am. (I've been told there's no reason why it should happen again.) So I suppose in the back of my mind I'm thinking he would probably like me to be monitored very closely too rather than go through anything like it again. However, he now appreciates that this consultant's idea of giving birth so upset me that I think he supports a more active birth too.
To hear all your positive stories has completely encouraged me again and today I'm feeling so much more positive and even looking forward to the birth again! Thank you.

[mears]

Glad you feel a bit happier after speaking to the midwife. Can I just add a point about previous C/S scar and being in the pool in comparison to the bath. The only scar that can be observed is the one on the outside of your abdomen. It will not rupture. The scar which may cause concern is the scar on the uterus which the midwife cannot observe in the bath or the pool. There are signs of uterine rupture such as immense pain over the scar ( initially epidurals were not encouraged for 'trial of scar' labours incase the pain was masked - however the pain is felt despite epidural), possible bleeding vaginally, maternal increase in pulse and marked deceleration of the baby's heartbeat. Uterine rupture is more a possible complication of induced birth. In my experience, women with previous C/S who go into labour on their own can go into the pool. If however, you are happy with a bath, and the staff are happy with you in the bath, then that is the way to go.
Some midwives worry that it is more difficult to get a woman out the pool than it is the bath when problems arise. I have found that women very quickly get out the pool when the need arises - it takes no longer than getting out of the bath. Good luck when the time comes.

[pupuce]

Mears - I am SO glad you posted that....
Would you not agree that a pool would actually put less pressure on a uterus???

I have contacted the people who write the waterbirth guidelines for the UK (in Oxford)... to see what they said about VBAC... and they were saying... this is not an issue - so there are no specific guidelines - but they understood why I was asking. They told me that a lot of labour ward actually are uncomfortable with the whole idea but that fundamentally they shouldn't and that a lot of new monitors easily go under water ... and went on to add... but staff either do not know that or choose to ignore that function.... Not sure if you would agree with hat.

My friend MW said that if I came with the mum (who I am a doula for and is going for VBAC) she would allow her in water... I am now crossing my fingers that she'll be on shift !!!!!

Mears- what is your understanding of how much a mother can ask for.... If she said I WANT to go in water... can the hospital refuse it if she has no sign of anything going wrong?

[mears]

Hi Pupuce - mothers have a right to do anything they want. However, if they do not have the support of the mdwife looking after them, the strain would be immense and I am sure labour would not go well. It is worth hospital staff remembering that if women's wishes are not going to be looked upon favourably then they have the right to opt for a home birth - previous C/S or not. For midwives who are uncomfortable with women's choices, there is the support of the Supervisor of Midwives. The supervisor can also be approached by the woman if she is not receiving the care she wants. At the end of the day, the woman cannot be forced to do what the hospital dictates. She should be given all the information she needs to make an informed choice. If she chooses not to follow hospital advice ( which should be evidence based, by the way) that is her right. Too many hospital practices cannot be backed up by sound evidence. Unfortunately the evidence is not available for many things. Not enough women are labouring after C/S without being continuosly monitored. Those that are 'allowed'more freedom are not known about. It is an area that really needs a lot of work done to provide more evidence. Perhaps that is a project I should research for my Masters........

[SofiaAmes]

I seem to remember (fuzzy even though it was only 5 mo. ago) that I was told that I could use the birthing pool while in labor, but the midwife didn't advise actually giving birth in it as it would hinder her from monitoring. As it turned out in my case, the hospital had something wrong with their water pressure and it took so long to fill the birthing pool that I never ended up using it for anything. She also explained to me that the problem with epidurals is that unless they are done just right you can't really walk and statistically the mobility seems to be important in increasing the chances of a VBAC. Also, pupuce, although there may be modern instruments that can monitor in water, I think a lot of the hospitals don't have them. The stuff the used for my VBAC was light years ahead of the monitoring that they did for my first labor which was only 2 years earlier, but at a different hospital.

[pupuce]

In our local hospitral I know they can monitor under water. I have also heard (from Dr Michel Odent) that research has proven that constent monitoring leads to increase intervention versus interminent monitoring....

I was teaching my antenatal yoga class yesterday and the mums were saying that they didn't feel they had many choices whilst in labour... but in fact they often do... but I suspect women misunderstand a question like :
We would like to monitor you - is that OK with you ... for a "We must monitor you - I presume that's fine !"
Unfortunately once in labour most women find that they want to trust the staff and take any suggestion as a "must do"... it's only based on my experience ...
What do you think?

[WideWebWitch]

Pupuce, I remember reading that continuous fetal monitoring is one of the most discredited forms of intervention. I think it was Sheila Kitzinger, but I could be wrong. Isn't it true that babies sometimes sleep during labour and therefore the heartbeat can slow to a sleeping rate, causing unnecessary concern sometimes? Or did I make that up?!! If so, can midwives tell the difference between sleeping and a problem? Just curious really. Janus, no direct experience, other than that I had a consultant who told me I would have to have continuous monitoring too because ds was small for dates (My midwives disagreed and I didn't in the end but won't bore you with the details!). Very different to your situation but it's good to hear your midwives are supportive. Here's hoping you get the birth you want.