Does this letter sound reasonable?

[TinselBaublesMistletoe]

I've written a letter to my consultant, which I will hand to her, as I'm not as good expressing myself sometimes as I am on paper. The background, for those that don't know, is Tink was born at 31 weeks, because she was coming fast and feet first I had to have a crash section. They didn't allow themselves enough space to get her out and gave me an inverse T shaped scar. I've been told I can't VBAC - no discussion - and that worries me because I suffered Birth Trauma last time and don't want to go there again.

"I wrote this down because sometimes I?m not as good at expressing myself verbally as I can on paper.

I was told after my last section that it was a good thing I had a general because my back wouldn?t have coped with an epidural. My back isn?t better than it was then; if anything it?s worse. Every time I?ve tried to discuss it with a doctor I get told ?we?ll bring you in a few days before the section and stop your Clexane? but the Clexane isn?t the only concern.

I was reading the RCOG guidelines on caesarean section and it says that the risk of rupture with my type of scar is 19 in 10,000 or 1.9%. It also says that only 74% of attempted VBAC are actually successful.

The way I see it if I have a section I can either risk further damage to my back with an epidural ? I?ve been told that my back is past physio now and needs to be dealt with by a specialist ? or have a general which I really wish to avoid as I think it was a big part of my Birth Trauma last time. Or I VBAC with the possibility that I have another crash section with a general, which would be the same outcome as if I hadn?t tried.

I think that looking at the statistics a VBAC with my scar and the success rate of VBAC that I would like to try for one. I managed both my previous labours without pain relief and my false starts with this one I?ve done without, I am happy to keep pain relief to a minimum so as not to disguise any breakthrough pain and I don?t plan on being a hero, if at anytime I feel something is wrong I will be happy to say."

TinselBaublesMistletoe, I'm an editor at heart and found your letter informative but in need of a bit of reorganization. I'm only offering this edit because you requested input. Feel free to totally disregard this. It will not hurt my feelings one bit. I'm wishing you all the best with this birth!!!

***
This note is for clarity.

It is my intention to go for a VBAC. According to RCOG guidelines regarding VBACs, the risk of uterine rupture with my type of scar is 190 in 10,000 or 1.9%. The guidelines further state 74% of attempted VBACs are acutally successful.

My reason for a VBAC, beyond desiring a vaginal birth, is to avoid further damaging my back with an epidural and to be fully conscience throughout the birth experience.

During my last birth a general anesthesia was used in order to perform an emergency cesarean. This lack of conscienceness for the birth of my second child caused me great distress for which birth trauma counseling was required. Also following that birth it was explained to me that my back would not have coped had an epidural been used therefore if a future cesarean is necessary general anesthesia will be required again.

Weighing my options: a scheduled cesarean with general anesthesia or a VBAC with a 26% chance of a repeat emergency cesarean via general anesthesia, I am confident in my decision. I believe I stand a very good chance of having a successful VBAC. If allowed a VBAC I will keep pain relief to a minimum and be completely open to all required monitoring throughout. If, afterall, an emergency cesarean is necessary, I will comply having felt I did all I could in order to achieve my goal.

I like the surfer's edit TBM But with "conscious" not "concience" twice!

LOL Onward. NICE Catch. Wonder what Freud would think about my goof?

Childbirth without Conscience. There's a guru book plus TV series in that somewhere.

Thanks for that Twilight, you've given me something to think about. I can't believe I missed the conscious /conscience thing! I may not use all of it because I want it to be an informal letter I can give to her to start a conversation. TBD is coming to my next appointment as it's during the Christmas break and we're only 3 weeks from when they will want to deliver (I can't believe I've got so far!) and it's a good time to have the conversation.

Have you actaully seen an anaesthetist formally in this pregnancy....

There aren't many people for whom a regional technique (epidural/spinal) is contraindicated. Epidurals are not associated with worsening back pain (honestly big NZ study, but pregnancy is). However some people who have had previous back surgery etc. can't have one and anticoagulation is a big problem..

If you got an epidural in early for labour (VBAC) then providing there wasn't crashing fetal distress it could be topped up for any operative delivery.

Maybe asking to see an anaesthetist, if you haven't done so already might help?

I haven't yet, it was briefly mentioned at one point.

As you say the Heparin would be a problem, but they plan on taking me off first, but part the reason they didn't do it before was because they didn't know the extent of the damage to my back - I had three indicators which would have each been a GA on their own Heparin, my back and time. I mentioned it to the physio after Tink was born and she said it would have made things worse. I'm being treated as though I have PGP - which I am affected by - but I am actually suffering from a fall I had just over three years ago. I fell down the garden stairs and landed hard on my back (a line across my dimples) it never got better from the pregnancy at the time, to my pregnancy with Tink and since I've been pregnant this time I've lost a lot of mobility. They don't know exactly what I've done yet and obviously pregnancy isn't the time to look, my GP thinks it's still bruised and my old physio said the muscles have overstretched to the point where they're not connecting me in the middle. I had a pamper day for my sister's hen night and the lady who did my massage said she could feel where I'd hurt it.

I've had an urgent referal back to the obs physio because I can't weight bear on the right side, I describe the pain there as being in sympathy with a Barbie doll. I'm going to ask her what she thinks about the epidural - it's the same physio who said I need to be refered on after my pregnancy because I'm past physio.

With all due respect to Physiostherapists, epidurals and regional anaesthetic techniques are not their area of expertise. The people with that experise are anaesthetists.

It is customary for 'high risk' ladies to see one before hand to chat through issues and to allow anaesthetic staff time to review any old letters, investigations etc. that may be available.

A plan is usually made at such a meeting and all the options discussed - there may be more pain relief options available in your unit than you know about.

As you are obviously very worried about your back I think you should push to speak to someone with the expertise you need.

I'm hoping we can get the discussion going at my next visit, I'll be 35 weeks so getting very close to when it's all to happen (if it goes their way) and the way things are going they can't keep putting it off.

My back does worry me but I do see things going long before then and it not being a concern if they don't let me at least try. I'm not sure whether my mental health or physical health worries me more! I do think that it could affect at least one of them to go for another section whereas with a VBAC I have a chance of neither being affected.

How's it going?

Any news??? Have read this post with interest and would love to know the outcome??!! x

Good luck. Fab letter.

If all fails threaten them with HBAC

Have popped in from Fab Feb 09 thread - TBM had her baby (little girl, Sian) by c-sec on 2 Jan at 3something in the morning, so didnt get to have a go at the VBAC. Doubtless she'll be on here when she's out...

I did have the CS in the end, I was 35+5 and having contractions off the chart when I was 2cm and not doing much else. I hadn't had chance to discuss it and decided that this wasn't the time.

My old physio was right, they tried for a spinal but just touching my back in the right place had me across the room screaming! He tried poking 3 more times and decided he wasn't happy to continue - I'm hoping he was assessing me and not because my reaction was funny

They came round to discuss it next day and said they think there is a fracture there and they're not sure how I've got through over 3 years, two pregnancies and raised a toddler with it!

Congratulations on the birth. How is your recovery going?

I'm doing really well. It feels odd that I'm feeling so good! I've not even had Day Three Blues (although at one point I thought I did, but I think it was a normal reaction to a circumstance) I've not had the throat problems I had last time, but I think that's the ABs they put me on for a ?UTI. I'm very sore though and my mobility isn't as good as it was before, I've had to have a lot of help in the hospital (which I used to cajole the doctor into letting me out regardless of weight) I couldn't sit myself up or lift her out the cot, so every feed needed someone to come in sit me up and give me the baby. I keep reminding myself that things got this bad when I was pregnant and I wasn't selfish getting pregnant

You sound very good. The healing process takes time but I believe you've done an amazing job so far.