VBA2C again!! Saw registrar yeaterday to discuss birth and I'm being pressured to accept CFM...need some reassurance please

[LackaDAISYcal]

I'm currently 35+2 and had my routing AN appointment at the hopsital clinic so that I could discuss my previous wish for a VBA2C.

I didn't see the consultant, however the registrar that I spoke to seemed very good and helpful and was respecting all my wishes until the subject of CFM came up . I had been previously told at my 12 week appointment that I would have to have CFM but in the meantime I have researched this to the nth degree and can find no reason for the CFM other than to make their job a little easier. However, I presented her with some of the research to demonstrate, and was hoping for a frank and open discussion about it, but it was like the shutters came down. The main bargaining chip from her pov was the fact that I am trying for a VBA2C which she admitted the hospital doesn't see a lot of as most women who have had two sections opt for an elective.

She suggested that I could have a scalp clip attached to the baby rather than the belt which would give me a greater range of mobility (one of my concerns), however, I'm not sure I'm happy about the fact that this will mean possible ARM if they haven;t broken naturally by the time I get to hospital.

she also scared us by saying we needed to get into hospital as soon as possible as if my scar were to rupture at home then it wuld be unlikely that the baby would survive and I was putting my own health at risk. She also talked about risks of stillbirth, although was open to me opting for expectant management after 41 weeks whereas before I was told baby had to be out naturally by 41 weeks or it was under the knife for me.

My doula is keen for me to refuse the CFM and although she isn't pressurising me, I'm feeling a bit torn as to what is the best thing to do.

On one hand, I know these interventions are likely to increase the chances of the need for a repeat section, but on the other hand I don't want to do anything to jeopardise the health of my baby or me as I know I would never be able to forgive myself.

And although i know that there is a school of thought that says it doesn't matter how the baby comes into the world privded mum and baby are healthy and well; I need to at least try for a natural delivery to put to bed the ghosts of my pretty traumatic birth with DS. I feel at the minute that it's their way or the highway and that if these interventions are going to cause me to need a CS anyway, why not just get booked in and avoid all the unneccesary pain .

Thanks for bearing with this....I needed a bit of a vent

Good questions Daisy, [pulls up chair to wait for answer]

My lay person thoughts are that if your uterus is compromised your system will go into shock, faster than the baby who is not suffering immediate damage to his/her own organs.... is that a reasonable simplistic discription, Howdie? I'm probably way off base...

I also wonder about traces that seem flat, could this be normal for some mums?

Absolutely Tex, re the pulse, as the scar starts to rupture then maternal pulse will quicken as a result of the body trying to deal with it's blood loss. I think you already mentioned Mary Cronk's article on this, if not it's here:

www.caesarean.org.uk/articles/VBACScarMonitoring.html

Most scar's that rupture will not do so rapidly and the mother will start to show signs before the baby will. The fetus may show subtle signs that are in response to the mother's, such as a rising baseline of it's heart rate but it will not show true distress until the scar has ruptured to the extent that the blood supply to the uterus and subsequently the placenta is affected.

Daisy, you are correct that the maternal observations can be affected by things such as dehydration and infection. That is why MC talks about knowing what the mother's normal pulse is antenatally. Also, ensuring that the labour is kept as physiological as possible - eating and drinking normally and not being restricted by "nil by mouth - in case we go to theatre" policies.

To answer your point about telemetry - they are not all waterproof, certainly not the ones in the unit local to me.

hi daisy. glad i made you lol. not much of that going on in my life at the mo. thanx for responding. have just spoken to a mum at school who is a prac nurse and she said tens machines are poo! and thinking about it i dont see how my dh can lovingly massage my back while i'm strapped up to one of them and i think i'd prefer his touch (cant believe am saying this coz he usually does my head in) during labour. hmmm, wha to do. i think al just go with the flow and see what happens. thanks again.

hi daisy. glad i made you lol. not much of that going on in my life at the mo. thanx for responding. have just spoken to a mum at school who is a prac nurse and she said tens machines are poo! and thinking about it i dont see how my dh can lovingly massage my back while i'm strapped up to one of them and i think i'd prefer his touch (cant believe am saying this coz he usually does my head in) during labour. hmmm, wha to do. i think al just go with the flow and see what happens. thanks again. oh and whats doula?

I am 34 wks pregnant and told VBAC2 is not an option. I am very scared of a section as I nearly bled to death after my last one. I have had a VBAC1 with no continual monitoring but I was fully dilated when reaching the hospital. My history is not good (2 late losses) and I am on blood thinners and have a cervical stitch in. I keep thinking should I push for a VBAC2 and if my cervix is weak won't that mean less contractions. Anyway sorry to go on and good luck x

jellybeans, I'm sure that there will be someone in your trust who will be sympathetic to your wishes. Obviously though you have a pretty complicated OB history and this is why it should be based on individual requirements. I'm sure one of the lovely doulas on here will be able to help, but you can try speaking to the consultant MW at your hospital; it seems, from my limited experience, that it's better to talk to the frontline rather than the generals in these cases as they are the ones who will be with you when it counts.

Good Luck with it anyway

oh, and meant to say that if you have had one VBAC, then surely another one shouldn't be ruled out entirely?

Thankyou My hospital seem to be OK with VBAC after one section but not after two. I will have another chat with them x

At our local hosp a mw told me last week that as a vbac if you are labouring in water, you will be treated as any other pg woman.

If you labour on dry land you will be monitored continuously.

go figure.

jellybeans, there is a thread called "support thread for imminent VBACers" in childbirth that is still active so should be near the top of the page. There are lots of links to further information inlcuding information that says that the increase in risks after 2 sections from 1 section are minimal. It might help to print some of the stuff off and make an appointment to talk to the consultant midwife. the links are on page 2 of that thread.

that's an interesting take on it liaghen; there's no rhyme or reason to the logic at times!

oh, and meant to say will ask about telemetric monitoring thanks, but as the new hospital are happy to go with intermittent monitoring then hopefully it won't be an issue.

the paperwork is being put in place for the move so hopefully I'll be seeing the consultant midwife early next week...

....if I last that long

Hi daisy,

Glad you got some help from the other hospital. I hope it all turns out for you the way you want it this time

Aw thanks lovely

(although calling you lovely with a halloween name like that seems a bit odd )

Thankyou, am off to find thread

here Jellybean

i saw montiroing as HUGE issue for my VBAC but had telementry so was continuolly monitored but able to move around and it was great, managed to be mobile and managed vbac and thanks to the monitoring also it picked up when ds2 heart rate slowed so personally i wouldnt argue against monitoring for vbac but i would try for telemetry because being strapped to bed is awful

cheers Klaw.....was trying to get DS in bed and couldn't find the thread!

I will see what my appointment with the MW brings, but I'm also keeping an open mind with regard to any potential problems and how they will be managed.

thanks everyone for the advice and comments. I'll keep you all posted, wither here or on the other thread.

oh, and Klaw, while you are here....I keep feeling/hearing the amniotic fluid squelching around; sounds like a creaky gate and feels a bit like the fluid in your knees moving. Never had this with the other two, is this normal? It's definately not stomach noises

have they checked for Polyhydramnios? Have no experience of what you're describing and so can't offer any opinions so would always say that if you are concerned about anythin in anyway always get a professional opinion.

But then we know how risky that can be....

Ask Howdie or Mears or Mintpurple...

Which hospital have you been booked into and which are you changing to? I'm being nosy as I come from Leeds originally and hope to move back there in spring/summer 2010 though I should probably try not to keep thinking about trying for a dc3 as I will be over 40 by that time!

from SJUH to LGI elkiedee

According to my doula LGI are much less interventionist than jimmy's...and they have birthing pools.

I had c-section for fetal distress and failure to progress with my 1st. The 2nd I was scared, but determined to have a VBAC. I went into labor and progressed until 7cm, theny had to break my water, due to the fact it was a VBAC and laboring for a long time increases rupture (I was in labor for 32 hrs). I had no epideral and was laboring fine. I had too much water, and when they broke my water it cause the placenta to sheer from teh uterus. Howver they did not know this, but I had EVERY sign of uterine rupture shortly after the popped my water. They rushed me in for c-sect and epideral did not work, so I was put under general. After recovery I was notified that my uterus was PERFECTLY in tact, but the placenta had sheered. Now I am a total advocate for VBAC, and I wish with all my heart I could of had a vaginal delivery. But being told your uterus may be rupturing, will terrify you. I knew ALL the risks and hearing those words, horrfied me, for my life and the baby. I was lucky and my uterus was not rupturing. However no matter how much I want to have a VBA2C, the risk is WAY too high, and I can't handle another event like that, especially if my uterus had ruptured and something had happened to the baby. I don't like the term elective, there's nothing elective about it, but my next will be a planned c-sect. I did experience other severe life threatening problems, but a c-sect may be the way to go. I do have a secret wish...that the next one, I will go into labor before the c-sect and when I arrive the baby will slide right out...a vaginal delivery without the fear of rupture. A VBAC is NOT for the faint at heart!

same with me 1st failed induction and was planned the next day and 2nd failed to progress in labor, failed spinal and then went under g.a the recovery was horrendous.

i agree not for the faint hearted!but def want to try a vbac2 ive got no problems with positioning or anything as such but have alot of fluid round the baby so they keep telling me but not actually telling me what the problem would be? they scanning me every 4 weeks. im 34 weeks bt i do want to plan section at 39 weeks cause im huge or baby suppossed to be large like previous 2.