VBAC coming up, hospital want continuous monitoring, canula, etc etc.....what do I do?

[WhatFreshHellIsThis]

So up until Friday I wasn't sure I was going to be able to go for a VBAC as the baby was breech (am 34 weeks) but it has obligingly turned over and is currently head butting my bladder. Nice.

However, had meeting with my consultant on Friday and he tells me that the hospital want me to be continuously monitored in labour as 'foetal distress is an early indicator of the CS scar weakening' - I'm not keen on continuous monotoring particularly as it means I can't use the birth pool.

He also says they want me to come in as soon as contractions are strong and regular, rather than doing most of it at home and coming in when they're a few minutes apart.

And they want to put a canula in as soon as I get there, in case they have to rush me to theatre, which isn't a massive deal, but I'm worried about all this messing around making me tense and inhibiting labour.

He said I have a 1 in 220 chance of scar rupture, that sounds high to me, I thought it was slimmer odds than that?

I had a horrid medicalised time with DS, who was induced, didn't work, ARM, Syntocinon, the lot, then emergency CS, and I was really hoping to be able to spend quite a lot of this labour at home.

Any thoughts on this? I like my consultant but he was pretty firm on all this, and I'm feeling a bit railroaded.

bump?

I am in the same position, although I think mine is 1 in 300. After discussing with a couple of midwives (After the consultant said the same thing as yours) we have agreed that I don't have to come in straight away, don't have to have canula or epidural. The midwife does want me continously monitored but says they have very long leads these days so I can still be as mobile as possible.

I emailed the NCT about this and they were really helpful. I shall cut and paste her email to me. I hope it is relevant,

Here it is

Have you found the article "VBAC - On whose terms" on our website (www.caesarean.org.uk) - this covers interventions and restriction that health professionals often try to place on VBAC women. You do not have to accept any interventions, and there should be no need to have this agreed with the consultant, although if the midwives feel that they have to follow what the consultant suggests then it may be easier to see the consultant again and get it clearly written on your notes that you have not agreed to CFM or an epidural.

Is your birth plan something you have written or is this something that they have given you to complete, and who will you have a chance to discuss it with before the birth?

If your birth plan something that they see as a crucial document for managing your care during labour then putting that you don't want CFM or an epidural may be sufficient, to remove hassle about it when you are in labour. However, if you feel that they do not see you birth plan as crucial to caring for you then I would suggest seeing or speaking to the Head of Midwifery or a consultant midwife at Queen Charlottes, express your concerns about these intervention and discuss making sure that the midwifery staff are not going to hassle you into accepting them in labour, and to get something written in your notes. Alternatively you could write to them asking them to confirm that they will be supportive of your decision to have an active VBAC labour with intermittent monitoring; I would always suggest that such letters are copied to the Chief executive of the Trust and to AIMS (www.aims.org.uk), as this seems to focus people's mind on their responsibilities.

Some women do manage to negotiate use of birth centres for VBAC, is the one at Queen Charlottes in the main unit, if so rapid transfer in the case of a problem is not really an issue. Again this is something you may be able to negotiated with the the Head of Midwifery or consultant midwife. Some women have effectively played the "homebirth" card here - stating that if they can't use the birth centre then they will have a homebirth instead, as that is something that they can't refuse you, as they can't force you to come into hospital, but they still have an obligation to provide maternity care for the birth.

There are a couple of egroups (where emails sent to the group are received by all the members of the group, allowing shared discussions, without everyone having to be online at the same time) that may be of help. There is an NCT group for general caesarean discussion, which can be joined at groups.yahoo.com/group/nct-caesarean and an independent group for women who want a natural VBAC or a HBAC (homebirth after caesarean) which can be joined at groups.yahoo.com/group/ukvbachbac/

Will you be seeing him again? If not, could you call his secretary and ask what the best method of contacting him would be?

Maybe highlight that for you, having the baby in hospital already is a compromise, while you understand his concerns, would intermittent monitoring be just as effective so you could still use the birthing pool.

Alternatively, could you find out what the hospital's policy is on VBAC (Southmead and St Michaels and change to the more favorable one?)

Yeah I had this bollocks too and asked to see the head of midwifery and pointed out that continuous monitoring has never been shown to improve outcomes in VBACs and the restriction of movement it causes is liable to decrease your chances of success.

Plus - putting a canula in - well let's be honest, if they are going to take the time to shave your fanny to do an emergency caesarian, don't you think they can take a sec to put a frigging needle in?

Also if the surgeon is taking five minutes to scrub in (as they would) is the anaesthesiologist going to be called away on a knitting expedition which stops her putting a canula in?

Seriously, go see the head of midwifery and tell her exactly what you are willing to accept. If you need to, threaten to birth at home and she'll back down.

Bon chance my dear!

thanks fruitstick and ilovemydog - I'm booked in at St Michael's, same as last time, and I wasn't happy with the way DS' induction was managed, we were made to feel very pressured into every stage (really didn't want ARM, for example, but they kept wheeling in doctors until I agreed).

I might line up all my evidence and arguments and then call the Head of Midwifery, as you suggest, fruitstick, as my consultant is lovely but let's face it, he isn't going to be there on the day!

I'm also worried about being 'actively managed' i.e. talked in a C-section if things aren't progressing very fast. I have no faith in my ability to labour, as DS never started at all (induced 17 days over) and I had a second induction with our last pregnancy, where we terminated at 20 weeks (long story) and it took much longer than they expected and they needed lots of drugs to get it to happen. So given that I don't feel confident about labour, I want to make sure I have enough encouragement, rather than people waiting for things to go wrong, iyswim!

lots of people have trouble labouring under "unnatural conditions"
bascially, your body will fight going into labour as it is sure that its not time yet.

if you go into labour spotaniously your contractions will work better, and your body will work with you not against you/

i had a VBAC with my daughter (ended in forceps due to problems pushing)
i didnt have to have continuos monitering, i DID have to have a canula because i had group b strep.
however i do consider my labour as a success, and it took little over 3 hours to dialate. in my first labour i got stuck at 9.5cm and ended in a emergancy c-section.

it just goes to show that you can trust your body to labour well under the right conditions, i was comfortable in the second hospital (i had moved areas) the first one i was not happy in and was scared.

good luck on your VBAC, you DONT have to do anything you feel may effect your chances of labouring well, they can check the babies heartbeat every 15 mins using a hand held device meaning you can stay in the pool.

That's encouraging Natty! I do want a VBAC but then I get scared and think 'maybe I'll just go for the elective' cause it all seems so much easier

But I know I'd be really disappointed with myself afterwards.

Does anyone have any links to research I can use to back up my conversation? Have found some stuff on AIMS, but anything else gratefully received.

Well I have no vbac experience but what I would say is:

Nobody can make you go into hospital 'early'. Just don't ring them until you feel you want to be there then they can't pressure you.

They cannot put a cannula in without your consent (as long as you're conscious obviously) that would be assault! Your dp needs to be your advocate here and just be firm polite and clear ' we don't want that just now'

Induction/labouring - past history is not a prediction of the future. I've gone into spontaneous labour twice now - after an induction at 14 days over with dd1 where it took quite a bit to coax her out. In particular I don't think your experiences last year predict what will happen this year. That was a desperately sad and painful situation - how your body reacted then in no way implies how it will react this time.

I would suggest lots of sex to get things going though

HTH - take care

I think you need to speak to the consultant again as am not sure a midwife will feel comfortable in over ruling a consultant.

Seems to me that the only real issue that needs 'clarification' is the constant monitoring as 'strong and regular' contractions is a bit subjective

Would it be worth calling Southmead to ask about their policy re: VBAC? It's not too late to change if you wanted. I changed at 39 weeks as Southmead didn't have air conditioning and St Michael's did (remember heat wave of 2006?)

Does your hospital have telemetric monitors? These are wireless and can be used in water too. Don;t rely on your consultant to know this, BTW, the MWs are the ones in the know. I'd strongly advise getting onto the consultant MW to discuss this. I found my way to mine via my community MW, who was fabulously supportive of my vhoices.

You might find some more useful stuff here too.

(have had 2 VBACs BTW).

Good luck!

I think it will be worth reminding the consultant that this is your body and your Baby and what happens ultimately is YOUR decision...they can advice you but they can't make you do anything!

Hello NorthernLurker! Lovely to see you again

This is all very good advice - I think I will talk to my community midwife at my next appointment about policies at St Michael's and Southmead and see if I can get to talk to the relevant Head of Midwifery people. I've read that some places have a time limit on each stage of labour for VBACs, really don't want to be labouring against the clock.

The baby is apparently quite a whopper (got scanned on Friday and its head is over the 95th percentile for dates, as is its abdomen....) - the consultant reckons 9lbs minimum..... It's also low, head down (don't think it's engaged though) so I'm very hopeful of going into labour spontaneously before going over due (we've agreed on no induction, not after two crappy ones) but I'm very worried about 'management' of labour making it all go pear shaped.

It's also an active little monkey, likes to kick me about a bit. Yikes!

Does anyone know what independent midwives cost? Is it prohibitively expensive?

IM's do cost a fair bit of money...and they also like to be involved in your care longer...so...not sure if it is to late...

A Doula might be an option, too...

I have had two vba2cs, (2 vag births after 2 sections0

I did not have a canula for either one and did not have cfm either

I did have cfm for my first vbac attempt , it ended in another section

You don't have to agree to any of it, is there any chance of changing hospital? I did and it made an enormous difference, I found a consultant who supported me and my wishes

i gather that the mother will experience great pain due to rupture before baby does.

go onto the ukvbachbac yahoo chat site for loads of info and support

it can be done and by god it is worth it

BTW I went 17 days overdue on vba2c number 2

you could always have a homebirth if they (the medics) are proving too difficult!! contact your HOM (head of midwifery) and request support from positive midwives, look on the AIMs website

Don't worry Sorry it may be long!!
I know everyone is different but it sounds so similar to my story. Had an awful first birth, son just wasn't going to play ball, failed induction every drug under the sun and 4 days in labour till emergency c-section.

I was adamant right from finding out i was pregnant with no. 2 that this wouldn;t happen again. Was duly booked for an early induction only to turn up for the induction and be told NO due to failed induction last time. I chose to book for a c-section (1 week of waiting) but daughter wasn;t having any of that and made an appearance 2 days before!!

Yes it was a natural birth and ok so they had me in when contractions were 5 minutes apart, but the continual monitoring meant being monitored once an hour for 5 mins - was able to stroll round hospital and do as i pleased. They even let me continue pushing past the normal 30 mins - think final stage took 1 hr 25 mins but all went fine and now have a healthy 3 yr old daughter. The midwives were more helpful than the consultant i saw, and much more relaxed about the situation which put mine and hubby's mind at rest.

All the best with your delivery which ever way it goes [smile}

here info on fees...
I actually have met this midwive and she is lovely...but obviously don't know where you are...but thought it will give you an idea...

You can say no to anything you don't want. However they may still not let you in the pool even if you decline monitoring. Where I work we would still say no (not me personally) as sister would say if you're in the pool and your uterus ruptures it will be hard to get you out the pool, etc. I've also worked at hospitals where we had VBACs in the pool with a waterproof monitor so it depends on the hospital.

In response to the post about the Dr should have time to put a cannula in your hand if you need an emergency LSCS. Yes they should, but its not always about time. Worse case scenario if your uterus ruptures and you lose a lot of blood very quickly then it can be very difficult to find a vein to put a cannula in. Its unlikely but you may need that cannula there not for a LSCS but to get bllod/fluid into very quickly and 5 minutes could make all the difference.

"i gather that the mother will experience great pain due to rupture before baby does.
"

Not always the case.

I looked afetr a VBAC the other week and CTG was terrible. Emergency LSCS, mum was in no pain apart from normal labour pain. When lscs was done uterus was ruptured and baby was in abdominal cavity. Very lucky to be alive.

stripey, good point about the canula......that would be something that defnitely makes sense...as long as they don't connect anything and bind you to an infusion...just let them put it in and close it up with that little "plug thing" which keeps it open.

Thanks StripeyKnickers, useful to get a midwife's view on it - can you just tell me what CTG and LSCS mean?

Have talked to DP about it and worked out that the problem is mainly about me worrying about not being able to labour successfully, and worrying that I'm going to be interfered with and prevented from doing it and set up to fail.

So we're both going to talk to the hospital about exactly what their policy is on VBACs and exactly at what point they want us to come into hospital, and then see how we feel about what they say.

Sorry for the jargon.

lscs - a section (lower segment caesearen section).

CTG - continuous monitoring.

I had a section with my DD and if I ever have another I'm not sure what I'd do about the monitoring. I would definetly have a cannula though and think I would probably not be monitored.

But obviously choosing not to be monitored would be against all medical advice and my own decision and I'm not saying that I advise its Ok for you not to be, etc, blah, blah (cover my arse).

Yes, stripey, that was my experience too. Trying for a VBAC, scar opened. No pain but the labour wasn't progressing and there was meconium in the waters. They told me it was up to me if I wanted to continue to labour but they would recommend another (emergency) C/S. I decided to go for the C/S at this point and baby's head was pressin aainst start of rupture. I would never have known. However, your life, your risk assessment - I had heard the 1 in 300 or 1 in 260 or whatever statistic and thought it unlikely.