VBAC -ers. Were you encouraged to have an epidural in case of intervention ?

[Wheelybug]

Saw consultant today - Am 32 weeks. I was asking about CMF and everyone keeps telling me there is flexibility. However, the doctor I saw today (a registrar) said that I would need to be monitored once I was in established labour as 'I would have an epidural in by then'. When I questioned him on this he said it was because there was more chance of having intervention so they would want an epidural in just in case.

Now, I had a c-sec due to failed induction last time so haven't laboured properly so don't know at this point whether I'll be able to take the pain or not but I am hoping for an epidural free birth.

Also, I remember during my induction asking whether I should have an epidural as it was looking quite obvious I would need a c-sec and asked whether it would save the need for a general anaesthetic and being told they would prefer to do a spinal tap for a c-sec and could do it very quickly.

So, just wondered what people's experiences were.

Thanks !

Wheely - I also had a CS due to IUGR and followed up with a VBAC just 14 months later! I had previously had my first baby as a natural VB, so I suppose the difference is that I knew what the pain would be like, but I would definitely say, go for it, you will feel like a million dollars giving birth without epidural, and like Lulu says, there are very sound medical reasons why it's best to avoid an epidural if you can manage it. You are less likely to need further interventions such as forceps etc.
Go for it!

Thanks VH - very positive thanks !

Booksgalore - I agree with the negativity of having an epidural put in, in case it ended up in c-sec. You are admitting it might not happen, which although might be the case isn't the best frame of mind to start with. I don't know if I put this earlier in the thread but I remember with dd I didn't want an epidural (despite the anaesthetist apparently urging the MW to get me to have one because he didn't have anything else to do ). I questioned the registrar at the time as to whether it made sense to have an epidural in case I had to have a c-sec as I worried that if they had to act quickly, I would have to have a general and she said there was no need, that they could give a spinal/epidural v. quickly if they needed to.

Also, when I eventually decided I wanted an epidural after 72 hours of various forms of induction and being knackered the anaesthetist then said he'd rather NOT give me one as it looked likely I'd need a section and he would therefore rather give a spinal block rather than epidural.

DH talked at length about this last night and I was saying that I would compromise on a cannula if I had to but DH thought this was unnecessary as it doesn't exactly take long to put one in.

Its really useful to hear everyone's experiences and am pleased that it doesn't look the norm. Doctors eh - what do they know .

Sorry booksgalore - didn't answer your qu. I have been told that I will not be induced and probably will only be allowed to go a week over (mainly I think due to previous pre-eclampsia rather than c-sec). That is fine - I really don't want to go through the induction process again and currently think 41 weeks might be enough too (I would then have been pregnant 4 weeks longer than with dd !) so these issues I am fine with. Having said that, I have already said to DH that if I get to 41 weeks and am feeling fine then I will ask to be monitored rather than sectioned (so to speak !).

I had pre ec with ds1 and was induced at 37 weeks but ended up with c section, so similar story
ds2 was vbac, refused cfm as I wanted labour to be given best chance, I also stayed at home for most of the labour. anyhow, I only got to 4 cm with ds1 but ds2 entire labour was 5 1/2 hours, really straightforward, fast, uncomplicated. he was born at 41 wks by UK dates, 40 by french dates.
there are some good websites out there worth researching a lot of issues around cfm, epidurals (which I worried would slow labour down/lead to baby in bad position for pushing).

Personally I would say no to cannula,
no to epidural
no to CFM unless intermittant showed a problem
no to a bed
no to induction, even at 42wks
no to the hospital even!

They can't only 'allow' you to go to 41wks. they can't 'allow' you to do anything, it's all YOUR choice, no matter what slant they try to put on it.

And this is where having a doula can help. A doula is not there just for the birth. A doula can be invaluable in the antenatal period in supporting you to make your own informed decisions, in questioning anything you do not feel emotionally able to deal with and generally be a go-between for you with the HCPs.

you could always start by asking about homebirth

they'll agree to anything after that [gri]

morocco I tried that approach- went down like a lead balloon! sense of humour failure I think...

booksgalore we're due same day? Didn't realise you were vbacing too. No-one has even mentioned a cannula to me...- With DD, I had more pain from the cannula than from the emcs- seriously! The bruising was ridiculous.

Hi, have had 2 VBACs, both with epidural. It was never presented to me as 'something you must have'. After all, I had to have my em c-s under general anaesthetic as my epidural had failed during my first birth, so it's no guarantee. The second time, I asked (or rather, begged) for the epi as I was in a lot of pain and didn't think I could do it. Actually, I asked for another section (worried the epi would not work again) and a wonderful obs peruaded me to try the epi first and see how things went. They went to a forceps birth 5 hours later, which was a raging success as far as I am concerned .

Second VBAC was an induction (for HDN) and I had an epi from the get-go, as I was straight into the synto drip and I knew I wouldn't make it. Had the most wonderful calm serene birth with no further interventions - practically breathed DD3 out.

Neither time was I given a cannula until the epi went in. They did take bloods as soon as I went in, but I did also have PPH after DD2's birth.

I am havering, it's late and I should be sleeping. I loved both my VBACs as they alleviated the guilt and distress I had over DD1's birth. Hope yours makes you feel as good

haven't been in the situation you are - i was sucessfully induced, but just wanted to add that the doc i spoke to told me so many stupid things that were just untrue - that i'd have to be continuously monitored if induced for starters - and so i wouldn't pay too much attention to him as long as you have suportive midwifes.
docs rarely see births that haven't become very medicalised and so have a wonky view of whats normal.

LOL Morocco - I had wonderd about trying to push for the MW led unit as I fancy the pool but have decided not to push my luck and just push for what I think is achievable (even my active birth teacher who thinks anything is achievable says my hospital wouldn't let me near the pool).

This thread (and I expect the ensuing discussions with the above active birth teacher) has clarified that I will state in birth plan:

• No canula
• No epidural unless I ask for one
• No continuous monitoring unless any problem presents itself

I am going to see how I go at 41 weeks (except obviously I will have had the baby by then ) and if I feel like waiting and there are no signs of pre-ec I will ask to be monitored for a bit longer. I won't go over 42 weeks though.

My mum has just pointed out that given my circumstances were very specific last time (early induction - v. stressful, teeny baby) there is no real reason why this has any more chance ending in a c-sec than a normal first time delivery providing everything stays as it is (obv slightly higher risk due to possibility of scar rupture but as the hospital keep telling me it is 0.5% and it is 4 years ago that i had the c-sec so presumably makes it less riskier this isn't much of a risk).

I really appreciate everyone's help and advice on this thread !

your mum sounds a wise lady

just to add, they might not even notice you are vbac when you get to hospital (no, I'm not joking!) so always worth asking about the pool

I had a hbac with a pool with dd. was great. so there's always that option if you're not happy later on in pregnancy

BTW, Wheelybug, my hospital had agreed to me labouring the pool for DD3, though they wanted me out of it to deliver (due to PPH with DD2 rather than em c-s). They had a telemetric monitoring system which is wireless and can be used in water.

Course, it all went out the window when I had to be induced, as they were unhappy with anybody who was being induced going into the pool.

Reposting edited snippet from this thread as realised this is probably a better thread for my Q.

With DD (no 1) I had an elective c/s after a breech diagnosis past 39 weeks. I'm now 18 weeks with #2 and have a consultant appointment in a few weeks to discuss birth options: I've expressed a preference for VBAC and there's no reason at the moment that I shouldn't be able to have one. What I'm concerned about is 'trial of scar' and I want to find out what my hospital (RSCH in Guildford)'s policy is on this. I've heard from my M/W that it's 1cm per hour once I'm in hospital, monitor on at all times, hence no pool, and no home from home room. I'm concerned that as I've never had any labour at all, that I won't have the courage to stay at home long enough so that I don't go in too early. If I do that, there's a good chance that I will end up with a section anyway. So I'm thinking of a doula to help me get into the swing at home and stay there as long as poss i.e. give me the best chance of normal delivery once I get into hosp. Any recommendations for a Guildford/Surrey based one...?

Any experiences of VBACs once overdue would be welcome. The hospital's policy is not to induce (don't know if that means they won't 'speed up' with a drip in labour as well) and they will want a c/s if I get to 41 weeks apparently.

Also, anyone here fought for something other than 'policy'...? I'd be interested to hear of your experiences too.

I would go for a home birth with an IMW but at £3-4k it's just too much money for us.

doula is a v good idea

have you thought about booking a home birth with your trust? cheaper than an IM but you still get the benefits of mw at home, putting your mind at ease

the important thing to bear in mind is this is all about 'choice'. of course, the hospital might prefer you to have monitors but they can't make you. pool they can say no to but not if you're at home of course.

i went to 40 + 8 i think with dd and did agree to a sweep to get things going but it's all your choice - informed choice being the better option of course

I meant to say, Wheelybug, that you should maybe try talking to the consultant mw in your hospital. My community mw encouraged me to get the consultant mw involved, and she was very pro active births for all mothers. I reckon she was instrumental in getting the consultants to agree.

morocco I know that I theoretically have a choice, but my midwife tells me that they will not support/encourage a home birth for a VBAC and that kind of makes me think that it's a bad idea to push them into it. It will only cause stress and bad feeling.

I had a drug-free VBAC after an emergency c-section with my first son. When I was pregnant with DS2 neither my midwife or my Dr suggested I should have/would need an epidural. IMO once you have all the information you should decide whether you have any pain relief.

I was incredibly pleased with myself as I never really went into labour with DS1 so didn't really think I'd be able to do it. I did & it was the most incredible experience of my life. I'd do it again in a heartbeat.

Best of luck & here's wishing you a successful VBAC

manyhatson

a doula sounds just the thing - she should be able to advocate for you on lots of different things, by the sounds of your hospital

you asked about experiences of going against policy. I announced a wish for a homebirth vbac at about 37 weeks, everyone was perfectly pleasant about it, explained the risks and that they don't recommend it,and don't do hbacs in this area, I said I understood and would still like to go ahead, met consultant and he explained various risks, then signed me off for a homebirth. all went swimmingly, midwife team lovely about it. if you give the impression of being an immovable force in a very pleasant way, and show you understand all the risks/benefits, ime the chances of bad feeling etc are very much reduced.

I posted about this on another thread as had exactly same conversation with consultant.

Don't want CFM or epidural but do I really have to discuss with him again (not due to see him but do have a 38 week midwife appointment) or can I just refuse them when I turn up in labour.

Hi- just on this subject- we are starting up a 'Birth Choices After Casaerean' support group in Coventry if anyone lives close by and is interested. I've just had my second child at home, through the NHS (and with a brilliant doula- who not only made the birth a better experience but helped me enjoy my pregnancy rather than worry about stuff). If anyone is local to us and wants to come along it will be the 1st Thursday of every month 7.30pm (ish) at Earlsdon Methodist Church Coffee Lounge, Coventry. First meeting 5th Feb. My email is [email protected] or call me on 07974 209882 (not after 8pm please- early nights at the mo? )

Really would suggest the book 'Am I allowed' by Association for Improvement in Maternity Services. It helped me realise that every intevention (including going to hospital) was my decision and not somebody elses.

Good luck to you all!

Rachel Bridgeman
Chair- NCT Coventry Branch

Hi there Wheelybug, was just looking at this thread as I'm planning an HBAC this June. Just wanted to mention, when I was talking to my consultant, he said he would look into getting some waterproof mobile monitors (he's a very rare example of a pro VBAC consultant!), so the pool would still be an option if you pressed your hospital/birth unit to get those (they might have them already, you never know). I'm still going for the HBAC just because I think home is the best place for me to be, but its good to know whats available if you do have go into hospital.

PS the consultant said there was also absolutely no other difference between VBAC and 'normal' cases, except that they liked to do the continuous monitoring and preferred to site a canula (but weren't too bothered if you didn't want one). So I guess all the stuff about epidurals etc comes from docs with very out of date information.

Good luck!
Claire

Thanks for all the recent replies.

Fruitstick - I think you can just refuse when you get there. I keep being told you should get the consultant to write in your notes that it has been agreed you don't need it but if your ANC is anything like mine - you never get to see the consultant and see a different reg. each time you go in. Also, write a birth plan detailing all this.

Poledra - I see a community MW next week (only the second time due to having to go to the consultant clinic instead) so will have a chat with her because I sometimes think the MWs have a more sensible approach so she might be able to point me in the right direction of who to talk to/hospital 'policy' etc.

Ernestosmum - sounds like a good talk but unforetunately I am in London so won't be able to attend. Have had a look at some of the AIMS stuff and waiting for the VBAC leaflet to come through.

Claire - sounds like your hospital/consultant are pretty switched on. It doesn't sound like a difficult thing to get in this day and age - waterproof monitors. Which hospital is it ?