How much did you push the "rules" in your vbac?

[HeadFairy]

I'm probably getting myself all in a tizz even before I've seen my consultant (next week), but I'm getting increasingly fed up of being told in one breath that the risk of uterine rupture is really really minimal with a vbac and then in the other breath that I have to have continuous monitoring.
My preference would actually be for a repeat c-section, however if I am going to go for a vbac, I want to at least have a damn good try at succeeding. So I don't want to be on the monitor for 8 hours, I don't want to have to be induced, I don't want my waters broken, I want to use the pool, I want to move around and climb stairs and bounce on balls and do everything I can to have an active labour.

Obviously it depends on the individual staff on the day, but what do you reckon my chances are of pushing the hospital's standard proceedures WRT vbacs?

Or am I being utterly selfish and should just shut up and strap myself on to that monitor?

I tried for a home birth and paid for an independent midwife when I was trying to VBAC, partly because of the concerns about monitoring. I know not everyone wants a home birth and paying is not an option for everyone.

I did find that the head midwife at the hospital was very supportive, when I was still thinking about the NHS route. I saw her as well as the consultant, and was just much more impressed. Maybe it would be worth trying to track her down? They wanted me to see her because of the home birth plan. The consultant felt this was not a great idea for a VBAC and presumably thought she would back him up. The splendid woman did not.

Thanks, I'm worried that I'm being terribly selfish in insisting that if I'm going to go for a vbac then I should have a fair crack at it, with all the options available to normal vbs... obviously appreciating all the time that it's not 100% straight forward and that my previous section will have an impact.

I'm ok about not having a hvbac... I'm quite happy to go in to the hospital much to the community mw's relief. At my booking in she asked me if I wanted a home birth in that voice that really meant "you don't want a home birth do you?"

I get the impression they'd prefer it for women to just follow their rules and not question them. I do feel happier that a section for me would be the better route, but if they want me to have a vb then allow me to do it properly. Or am I just being bloody minded? I can't decide?

Fridayschild... I'm quite tempted to hire a doula to help encourage me and hopefully to offer me some support in getting the birth I want.

I chose a homebirth for my vbac attempt.

Not because I had any huge desire to birth at home, just because I would be able to have a mobile active labour without time constraints, free use of pool and no constant monitoring. Plus one to one care from a midwife.

Aiming for all those things, whether in hospital or out, are good ways to maximise your chance of success IMHO.

I would also have preferred an elective but the consultant was a bitch not keen. I wrote a very firm birth plan that said if it's not going well, transfer in and straight for CS. No messing about with ARM/epidural etc. Had a repeat CS for failure to progress with my VBAC - but it was still a lot better than the crash CS with first baby. They were reluctant to take me for a CS but I wasn't dilating and said no to their suggestions until they had no choice

It's bad that we are pushed in to having a home vbac in order to just get a proper labour without all the constraints of the hospitals rules. I personally would rather be in hospital, but I do feel that I'll get railroaded in to following their proceedures.

I have a horrible feeling that if I do comply with their rules it'll all go horribly wrong. Instinctively I feel that if I'm going to go for vbac then I should do it properly, not fanny around having waters broken, monitored continuously, and eventually being told that surprise surprise that I have failed to progress and that I'm off for a cs, at which point I will melt down with fury seeing as I wanted one in the first place.

I'm thinking far too ahead of myself aren't I?

I took the monitor off refused to have tne induction drugs when I was fully dilated but contractions had eased and then had a physiological final stage.

They would not let me have a water birth. The mw was very supportive but I think she was also worried for her job

I think a lot depends on why you had a section tbh

Headfairy - if you rally want a cs then push for that instead. You can always change consultant if the one you have is not supportive.

Bronze - I had a section as ds was a footling breech hence my concerns that never having been in labour, not much is going to happen in the 8-12 hours they've "allowed" me to labour for. I'm also 39, with a high BMI (29), I just feel that all those odds mean that if I do go for a vbac then I'm going to have to make extra effort to ensure it works, rather than having a "trial of labour" which is what they keep calling it. To me that's setting yourself up to fail. So alongside letting me labour for longer than 12 hours, I think I need to be able to attempt it properly using everything available to make it work. Otherwise there's not much point in my book.

Chynah, I must admit I'm slightly jumping the gun a bit here as I haven't seen the consultant yet, she may well be happy to put me forward for a cs... however all the midwives have been dead set against it when ever I've suggested that might be a better option for me.

Its very hard isn't it because you feel you need someone to tell you in all honesty what the risks are.
I was very lucky in that my mw manged to let me know what she thought. when she agreed with the hospital policy she would say 'I think so and so is for the best' but when she didnt agree she would say 'well the guidelines state' just because she wasn't allowed to even say to me what she thought was best for me in my individual situation. It was this 'well the guidelines say' that gave me confidence to refuse the drip that I was supposed to have as labour had stopped for over an hour fully dilated. She and I were both right.
The worry is though is knowing what really is for the best when as you just don't want to get it wrong do you.

Well that's exactly how I feel QTPie... I know that attitude does have a big part to play in the successful outcome of a vbac, and instinctively I just feel I'm going to fail. Perhaps I'm just naturally pessimistic or perhaps I'm the best one to decide what's best for me and my baby. I don't know.

Bronze - that's been the hardest thing for me this time, getting someone to give me a straight answer about my individual odds of being successful. I keep getting the line about 80% of vbacs are successful nationally, but that takes no consideration of why the previous cs was carried out, age etc of the mother and so on. I keep getting the same old lines trotted out to me and I just want to yell at them "I can get all that from Mumsnet you fools, just talk to ME about MY circumstances!"

I did go to a Vbac clinic which was a bit like an antenatal class for vbac-ers. The midwife there was equally rubbish. Everyone else had had cs for failure to progress (they'd all had back to back presentations with their previous babies hence their failure to progress) and the mw kept going on about how as they'd laboured before, their bodies would remember what to do, they'd dilate faster than a first timer, and that their labour would in all likelihood be faster. She kept saying "of course all that is different for you" to me but nothing more.

She came out with one silly comment along the lines of "you might be one of those lucky people who have really fast labours" when I asked about what happens after the 12 hours are up. She also wouldn't (couldn't?) answer any of my questions about inductions... my mum and sister both went two weeks over with both their babies and were induced each time, so I have a feeling that I may well go over too, but I'm none the clearer as to how an induction will affect the chances of a successful vbac. From what I've read it's much more likely to be successful if you spontaneously go in to labour. So I'm even more against the idea of a vbac if I go overdue.

Can you tell I'm getting frustrated? I'm starting to feel slightly sorry for the poor consultant who will have to field the million or so questions I'll have for her!

I got very arsey indeed over the rules - vbacs much less common here than in the UK and of course no official MW support in the public system (handy having a dsis who is v experienced MW!).

I spent hours researching for evidence as to why their rules were arbitrary and would not be followed. Yes, my birth plan had footnotes [nerd].

Might have been a better use of my time if I'd done some yoga or something to help my body be more ready for the birth. Then again, maybe not...

Hi HeadFairy I feel very much as you do, except I'd really prefer a vb if possible.

I don't think you are being selfish or unreasonable at all - the idea that you should put yourself through a 'trial' of labour on their terms is infuriating.

When are you due? I'm due mid Jan and starting to get quite scared by the whole idea now.

Skidoodle, I'm due Christmas day, so really not long now.

Phdlife, I actually don't mind the concept of a vb at all... after all that's how babies are born. If you don't want to do it, don't have babies, but I feel that if I'm going to have a vbac then I really don't want it to be so highly medicalised that it'll be horrendous for both dd and I. If that is the case, I'd rather go for the cs.

What was the outcome of your vbac phd?

oops got slightly mixed up there, first two paras were for skidoodle!

Talk to your consultant - I was terrified that I would be forced into VBAC fretted like mad about what to say to him etc but my consultant was great and fully supported my cs request. I feel alot calmer and happoer now I have CS Agreed written in my notes!

I was told they can't induced or accelerate labour for a VBAC (as the contractions are much stronger under drugs and too closed together, they fear a rupture). So they let you try naturally, and if nothing happen it is then straight to CS.
Otherwise, I wouldn't even concider VBAC,a s I dont want a repeat of last time: long labor (pain but OK), acceleration (unbearable pain), emCS

I had a successful VBAC in 2002.

I was not monitored continuously, except for about 15 mins when first admitted (but I think they do this to everyone just to check they are actually in labour). I got my consultant to agree to this very early on (at 20 week check) and to write it in my notes with his signature. I had intermittent monitoring every 15 mins with a hand-held monitor which could also be used under water (see below). Obviously had they detected any signs of foetal distress I'd have agreed to more invasive monitoring, but actually, to quote my MW, dd2 was 'the most laid-back person in the room' throughout.

I discovered that induction vastly increases the risk of uterine rupture so I agreed that I would not be induced, but if necessary would agree to another elective section instead.

I was very clear that I would not agree to an epidural, lest it mask any unusual pain between contractions from the scar, which might be a warning of a possible rupture.

I asked to be allowed to use the pool and my consultant agreed that I could use it for pain relief during the first stage of labour. (Again, I got him to sign this in my notes.) He wanted me to get out for 2nd stage and delivery, but I had a secret plan that if I felt that the water was helping I'd just refuse to get out when then time came...! As it happened, I didn't get to use the pool because someone else was in it. I did, however, sit in a lovely deep bath for most of the first stage.

I tried to argue against having a cannula on the grounds that I have enormous veins so getting a needle into me in an emergency shouldn't be a problem. It was explained, though, that if I did lose a lot of blood very suddenly the veins might collapse, so I agreed to the cannula in the end. As it happened it never got put in. By the time they got a doctor to come and do it I was in transition... I took one look at the needle and threw up (!!) and the doctor said she'd come back in a bit... by which time I was pushing and it was all over bar the shouting, so they agreed it wasn't necessary.

I'd really have liked a home birth, but my consultant wasn't keen and nor was DH, so I didn't push my luck on that one.

As it happened dd2 was born about 3.5 hours after I went into hospital and within about 8 hours of my waters breaking (slowly) and having my first contractions, and I was home again within 12 hours.

HTH

At my vbac class mamaloco, I was told if we went to 41 weeks they'd try a sweep first (didn't answer my question as to whether the sweep would only be given if you had a Bishops score suggesting it would be worthwhile - grrr!) then if nothing happened after 48 hours it they would try a Syntocinon drip for four hours to induce labour (no pessaries as they can't be withdrawn if contractions are too strong) and then if the drip doesn't get things going they'd break waters and continue with the syntocinon for a further 4 hours, THEN if nothing has moved sufficiently they'd opt for the section.

So 8 hours of misery followed by a section, how lovely

I went down the home VBAC route as I realised (quite late on in my pregnancy) that I was just dreading being in a hospital environment again after a traumatic previous experience - going very overdue then foetal distress when I'd taken the first induction drug leading to EMCS. I went on to have a very successful home birth - maybe I was lucky, I had a supportive community MW team, a straightforward birth - but I was 41, btw. I did have to be quite assertive with the consultants, did my research, thought hard about it, listened to a hypnobirthing CD to get into a positive frame of mind and decrease the fear.

If (big if) you do want to go for a VBAC, then there's no reason why your labour shouldn't go well, if your CS was for a footling breech - you have no more likelihood of that happening again than anyone else.

However, I think you're right that having continuous monitoring, time limits, etc does make success less likely. The thing to remember is that the hospital guidelines can't be enforced. If you refuse to have a canula and they try to make you, you can sue for assault. I learnt a lot about it from an email group on Yahoo groups, which I would highly recommend - do a search for UKVBACHBAC. There are a lot of very wise and supportive women on there with a lot of knowledge of this area, and some people who are going for VBAC after 3 or 4 CSs (and being successful, at hospital and at home).

Totally, thanks for that, it's nice to hear of a success story. Can I ask why you had your original cs? Unfortunately where I'm having my baby they don't have any of those waterproof monitors. I've already asked, and the mw said no. They do have long leads on the monitors though she said, holding up her hands about a foot apart!!

HeadFairy - they can not monitor you without your consent. It depends how well you think you can cope with the possibility of a "battle" when you walk through the door.

Best thing to be would be to write a very clear birth plan stating that you are aware of the risks but you do not wish for continuous monitoring and do not wish to discuss it any further. As a midwife I know I'd be happy with that. However I also know that I'd have to tell the sister in charge, who would possibly then want to come in and make sure you understand the risks as she wouldn't believe me when I tell her that you do.

The only thing is you can't make them fill the pool for you and allow you in. Where I work you'd never get in the pool.

There was an article in a journal recently about how women are having VBACS at home to get away from restrictive protocols in hospitals. It doesn't make sense does it. They says you're too high risk to have a pool birth at hospital so would prefer you to have one at home. I have however worked in another unit that had waterproof monitoring and VBACS could go in the pool. So they're not all bad.

I had a successful VBAC 6 weeks ago.

According to my community midwife, I could have used a pool in hospital with a wireless monitor, and in fact I gave birth in a room with a(n empty) pool in it - I was too far gone by the time I got there to ask about it, and was hooked up to a normal monitor for the birth.

The worrying thing is that they were quite concerned about the baby's slow heartbeat. After a while they realised what the machine was picking up was my heartbeat, and they put a clip on my baby's head. There were four of them there and they weren't rushing from one patient to another (my husband asked later and they only had four women give birth in that whole day, and I was only in labour there for an hour) yet they couldn't use the equipment well enough to tell my heartbeat from hers - makes the monitoring seem a bit pointless really.