WTF??? Consultant trying to persuade me out of my VBAC as head not engaged at 36 weeks.

[justlookatthatbooty]

Have been happily preparing for my HBAC and haven't had any wobbles whatsoever, just happy to go for it and if it doesn't work out then it doesn't work out.
Keeping it simple is my motto, homebirth being the simplest option I can think of/feel for. So I'm with great and very supportive midwife and doula but they wanted me to talk over risks etc with a hospital consultant, also so that my history (CSec with DS 17 months ago as head didn't engage despite 7cm and 2 days home labour) would all be on record if we needed to transfer during labour. Eventually after 10 hours on the drip I dilated to 10cm but head still only 2 or was it 3/5ths engaged.
Had a 36 week scan yesterday and consult Gynae had an external feel around, pulled a face that DD isn't yet engaged, sent me off for scan with nurse, who thought everything seemed normal and when I came back to his office he said he recommended that I think again and have an elective section. I was totally and utterly gobsmacked and still am. He said that according to circumferance of DD's abdominal area on the scan, she weighs about 2800 (6.1lbs grams now and will gain around 150 grams a week making her a 'big baby' (eh?) by the time she's due. DS was 3800 grams (8.3) when born, which isn't exactly enormous but he made the comment that I seem to grow big babies and that this one will be equally difficult to birth and that a section was the answer. WTF??? I'm a 5'6" and have an athletic build and there is no evidence to suggest that DS was too big to fit through my pelvis. (Don't believe the too big for your pelvis excuse anyway except in very very very rare circumstances where pelvic joints are somehow locked - so much pelvic expansion occurs during birth). I hadn't told him about my HBAC plan as it's kind of illegal (as in totally against midwifery protocol) and I had to search high nad low to find someone to support me here in the Netherlands. Just told him I wanted to be at home for first few cm's and then come in to the birthing centre. I wasn't arrogant but was very clear and confident about my intentions and ability to give birth naturally. I know him to be a pro natural birth consultant, he's famous for being the best of a bunch in a country which is very pro natural birth with a midwifery model in firm place with home births being the norm.

I am so amazed at his recommendation that I am now wondering what on earth there is to this? I thought that 2nd babies often didn't engage til the labour itself? Is it so worrying that she had not engaged yet? I'm 36 weeks exactly. I'm doing everything possible for Optimal Foetal Positioning, acupuncture and cranio sacral and reflexology on a daily basis, but I"m not neurotic about it as I simply believe I can and will birth this baby naturally, even if she is big.
Can anyone shed any light on this? I"m in a really weird space since yesterday, part confused, part outraged, partly knowing I should just stay away from the hospital. I went there to be told what the risks are etc re rupture and so on but the vibe I got is that it's THE HOSPITAL that feels risky, with all that can happen when you step out of the body and into the head and data and interventions and paranoia and hierarchy. Feels wrong wrong wrong. I think I need a teensy bit of reassurance that I'm not crazy to stay at home for the duration of the pregnancy and let things happen in their own natural way and rhythm and if a complication comes up, then we can use the medically available resources from a grounded and non-fear based position.
I"m also now slightly obsessed with her head engaging, but I'm trying not to go crazy bouncing around on the ball or over focusing on it, as staying open and relaxed seems more important.
Any experiences or suggestions or advice very much welcome.

So sad for you do not know about section but this is my second pg and everyone is surprised my baby has engaged.

I do know exactly what made her engage if it helps I sit with my legs crossed all the time (like we did in school) and I was sat like that and felt her engage.

Hope everything works out for you and hopefully someone who knows more will be along shortly.

ds2 didn't engage til labour started, his vbac was very fast and easy although I didn't have a c section for the same reasons as you

what would happen if the same problem occured in this labour? would it just mean going to hospital for a c section after being in labour for a while? or would it mean more complications? if it 'just' means having a c section after giving a vbac a good go, don't see how you lose from trying for a hbac tbh?

had a hbac with my dd - it was fab. wishing you the same

I find your post puzzling, and frankly paranoid. You say "I simply believe I can and will birth this baby naturally, even if she is big" - why do you believe that? You seem to think there is some sort of conspiracy to force yo to have en elective when actually you know best. You seem respectful of this consultant's experience and attitudes so why are you so unwilling to listen to him?

I am no expert, obviously, but I think it is fair to say that an elective CS is preferable and less risky than allowing a mum to go into labour, get into difficulty and then have an emergency CS.

Why do you associate the hospital with fear and risk?

In answer to your question, actually I do think you are crazy to disregard the opinion of an experienced consultant based only on your own confidence in your own body, and your paranoia about the hospital's agenda.

I went in for a routine mw appt at 40+1 with dc3 and asked her to do a quick sweep but when she did the palpation he wasn't engaged at all so she refused to do the sweep because of the risks of cord prolapse.

7 hours later I went into spontaneous labour and my 10lbs 2oz baby was born after a 2 hour labour (and less than 10 mins 3rd stage).

So for me the lack of engagement meant nothing in terms of my labour.

It is absolutely true that 2nd and subsequent babies don't engage early and often don't stay there even if they do. I don;t think I would accept the situation at 36wks as a good enough reason to ave a elcs, if I was in your position.

I'm also 5ft 6 but slightly pear shaped and I've managed to have an 8lb 8oz baby, and 8lb 4oz baby then a 10lb 2oz baby with no issues. I don't think there's any proper evidence that maternal height has any bearing on your ability to give birth. True pelvic disproportion is very, very rare.

My dsis had to have a ecs with her first birth because she didn't dilate beyond 8cms and her baby became distressed when they tried to up the syntocinon drip. Afterwards the doctor said the baby had been 'stargazing' so was presenting with her forehead, rather than the crown of her head. She couldn't dilate because there wasn't the right sort of pressure on her cervix, which sounds similar to your scenario first time round.

IIYW I would carry on doing as you are doing, keeping an open mind and seeing how things pan out on the day.

Good luck!

Thanks for your helpful imput Slushy and Morocco.

WhoDidThat..... find your response strange.

Can you give me a good reason why I shouldn't believe that I can birth this baby in a healthy and natural way, just like thousands of women birthing naturally all over the world this very minute? Can you shed any light as to why the consultant should suggest a section when there is no clear rationale for doing so. I would consider breech or placenta previa or some other clear and presenting complication as clear rationale, but simply that the head hasn't engaged at this point and that she might turn out to be an 8 lb'er? My attitude towards the doctor was enthusiastically open, I was very happy to meet with him and to listen to what he had to say. My post is about being dumbfounded about the recommendation with what appears to me to be no clear grounds. If I were to respond to his recommendation as he suggests and book a section just incase the birth turns out to be difficult and my big baby can't engage even during the labour process, I would be responding out of fear and not out of good reason and rationale.

Why wouldn't I put my confidence in my own body before someone who who deals in complicated births, someone who doesn't actually get to see a normal birth very often at all?

"I know him to be a pro natural birth consultant, he's famous for being the best of a bunch in a country which is very pro natural birth with a midwifery model in firm place with home births being the norm."

Elective sections are far safer than emergency ones, for mother and baby, so his position is understandable; in a culture where supporting women in birthing at home is the norm I would expect them to only take the position they have with you for good reason. Basically. I'd trust him, given what you've said.

I do, actually, know a few people whose pelvises were too small for their babies. It isn't that uncommon, apparently, and increasingly happening in the West, as women who birth babies too big for their pelvis have daughters via section who grow up to do likewise.

I'm not saying that you aren't well within your rights to want what you do, just that as you yourself say, you're being advised to have an elective section in a culture that supports and works towards midwife led, natural, home births. I would go with what the consultant is saying, if you trust him. I do understand that it's horribly disappointing - my son can't breastfeed, and it still upsets me sometimes - but there's a reason a woman dies in childbirth every minute in the developing world. If your consultant thinks an elective is the safest and best option for you and your baby, then I'd be inclined to trust that, and not a fear of hospitals.

Thanks everyone for your posts. Really helpful I'm getting a really good idea of why I've been enjoying the confidence I do and will continue to do through my "trial of home labour". I think I'll start a new post.

Evolution doesn't happen that quickly, Qally, I really, really doubt there are hordes of women whose pelvises are too small/babies are too big to give birth naturally.

There are however hordes of women who have vaginal births with 8lb or 9lb babies.

Consultant attitude quite odd and would bear further questioning, to try to establish quite what his point is.

"Can you give me a good reason why I shouldn't believe that I can birth this baby in a healthy and natural way" ....... because your consultant says there is a risk of you not being able to, that's why.

"Can you shed any light as to why the consultant should suggest a section when there is no clear rationale for doing so" .... clearly he thought there was clear rationale - shouldn't you have asked him rather than just coming away upset and worried. Presumably he didn't just suggest it for a laugh, but because he felt it was the right course of action.

I am not an expert on childbirth, which is why I went to the hospital and listened to the advice given to me when pregnant. You are clearly very intelligent and well informed, but you are not an expert either. This consultant is an expert.

Edam - my own baby was 8lb 4, and I had a very easy, natural birth - I am therefore fully aware its the norm! But I was told that evolution is happening that fast, in terms of birthweight. Babies at the larger end of the scale are supposedly increasingly common. I was told that, pre-NHS, most people had babies at home and those who really needed CS often died, and as the birth history of your mother is a fair guide to your own, and the single biggest indicator of birth weight is your parents', then it doesn't seem amazing that a woman who has inherited a small pelvis might also have a baby that can't fit through it. (That could all just be hokum designed to reassure me pre-birth, admittedly! Ds was meant to be huge, but my mother had really easy labours so the midwife said it would probably be fine. I'm suspicious, now...)

Agree more discussion with the consultant is a good idea, because obviously you're right - 8lb isn't much over the average. But if he is as pro-natural as described then surely there's a good reason for his recommendation?

I agree that your consultant's attitude seems odd. My HCPs are all of the view that since noone can predict how a pelvis might behave in labour I might as well give a VBAC a shot, although of course they might be influenced by NHS policy there! FWIW, my midwife says that a too-small pelvis is extremely rare. She sees a lot of VBACs.

I do understand the emotional side for you. It's not paranoid at all to view hospital with fear if that is what you experienced last time. This does have to be balanced with an assessment of what the risks are in your case, and only your medical carers can help you with that. Can you get a second opinion from another consultant? What does your midwife make of his comments?

I reckon also it might be worth posting on the "support for imminent VBACers" thread - lots of knowledgeable women over there.

I hope it works out for you.

Well I think if you wish for a VBAC you should absolutely have one. I find the concept of a HBAC rather scary to be honest but will admit to not knowing that much about them.

I do think that an obstetrician isn't advising you for his own pleasure but based on experience and established medical protocols which are designed to minimise risk. Of course I'm not saying so just believe him, you absolutely have the right to have your own birth plan but within it you need to accept the increased level of risk you and your baby will face.

As long as you are sure that you have done this then you should continue with your well supported birth plan and I wish you luck.

it would be interesting to find out what the increased risk of an attempted vbac in case of pelvic disproportion would actually be - that way you could make a genuinely informed decision

(I like Odent's idea of a planned c section happening after natural labour has started - not a vbac but next best if things don't work out as planned maybe?)

Hi everyone who posted..been offline for a few days and just catching up...
Thanks for your posts, really interesting to read through.
A range of attitudes/opinions here and very helpful and interesting first hand stories WhoDidThat I can't quite get my head around your response which seems to be bordering on the angry/agressive at my questions..... You don't have to agree with me and I'm open to debate but please could you leave out the unpleasant tone? Brings bad taste to the thread...

Saw midwives today after a weekend of scratching my head over the meeting with consultant. So we are continuing with the VBAC preparation as baby is in perfect position, head just above pubic bone and in her estimation perfect size. She urged me to spare myself any doubts about a successful natural and easy outcome to a VBAC. She reminded me that Plan D is the CSection and we have plans A, B and C to get through before we even have to consider it. I then came home and read one of her books and remembered why I consider her to be more of an expert in normal birth than the consultant at the hospital.

Found some of the information and questions on the www.Caesarian.org.uk website helpful and interesting...e.g
"So why are mother?s instincts and their inner knowledge ignored and given so little respect? Why does the medical profession take over the birth process again and again, to the proven detriment of mothers and their babies? Perhaps more importantly, why do mothers let them take over?" I do think there are other sides to this and there are scores of women who are due huge respect for in some cases having to fight for their rights to a CSection when they feel that it's the best for them and huge numbers of doctors who do a great job of listening to labouring or pregnant women and helping them to deliver their babies whether naturally or not. That's undoubtedly true.

The outcome of my experience with the consultant has been a very positive one. In a funny way I realise this blip came my way to strengthen my confidence in myself to approach the forthcoming birth experience with enthusiasm and optimism that no matter what kind of birth the baby and I have,from plan A to plan D, I have remained truly grounded in my own instincts and wisdom.

Thanks for sharing....

justlookatthatbooty, good luck. I understood your confusion with the consultant's logic so I am glad you feel happy with your decision now and whatever the final outcome is.