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?

Thanks flimflam for that yahoo group thing.. I will check it out. Currently dd's position is fine, she's head down and in a good position for a vbac, I don't think she'll turn at this stage now as she's very low down. Sorry you had such a bad experience with your first birth. Maybe that's what's holding me back from leaping head first for a vbac, my cs experience was very positive.

Stripeyknickers, it does seem crazy that women are opting for a home vbac to get away from restrictive protocols in hospital, surely a home vbac has potentially more risks? Or is that all wrong, and a vbac is more likely to succeed if the mother is relaxed in the home environment? I have been told that I can have some time off the monitor (15 mins at a time - huh? WTF?) to get in to the bath (all their rooms have baths in) but I can't use the pool. I think they may have to prise me out with a crane once I'm in the bath and feeling comfortable!

l39 - congrats on your vbac... but I'm a bit at them mixing your heartbeat up with the baby's!

Now, where can I buy myself a wireless monitor?

Headfairy - I have my consultant appointment tomorrow (I am 20 weeks). I had a c-section first time round as ds was also breech. I also have the exact same concerns as you regarding a vbac. I want a natural birth with no interference, failing that I want another c-section. I am petrified that I will fail to give birth labour naturally and end up with an emergency c-section. I know this sounds daft but I tend not to be good at things that most people do without thinking, I failed at breastfeeding and I have dyspraxia which I know is totally irrelevant but it adds to my anxiety as I am used to my body failing me despite my best attempts.

When I had my booking in appointment my midwife brought up the subject of c-section and she said that I would not be offered a further c-section as the first c-section was for breech presentation. As far as they are concerned I am not considered to be any different than a first time mother with the exception of induction, they do not induce women who have previously had c-sections.

When you had your first apopointment with the consultant, how much detail did she actually go into regarding plans for birth? Did she expect you to have a detailed birth plan? I assume from your previous posts that they were not open to your suggestion of a csection.

Headfairy - my first cs was for placenta praevia. I had been in hospital from 27 weeks and dd was born at 36 weeks to ensure that I didn't go into labour naturally, which would have been dangerous for both of us. I'd had a lot of bleeding and [TMI alert] had lost various bits of placenta [yuk emoticon] and dd was small for dates (even for 36 weeks). Altogether I was in hospital for 10 weeks and she was in for another 2.5 weeks... so you can see why I was keen to have a VBAC and get in an out as quickly as possible, 2nd time around! Also, the pp is a non-recurring thing, so once I knew my placenta was in a safe place with dd2 there was no reason not to go for the VBAC.

The monitor they used on me was just the little one like the midwife uses in the doctor's surgery. If they can't use it under water, you just need to poke your belly out a bit for them to get to it... you shouldn't need actually to get out of the water!

Oh also... forgot to say re. time limits... I insisted that my birth with dd2 be treated as a 'first labour' since I had never been in labour with dd1. That bought me a bit more time, but I did need longer than they would normally allow at the pushing stage [more TMI... apparently too much horse-riding had given me a perineum of steel ]. If it looks as if you are making progress - albeit slow - they shouldn't make the 'official' time limit the only criterion. I know this isn't the same everywhere though, and I think I got lucky with (a) my consultant and (b) my midwives on the day. Good luck!

Thanks for that totally.. wow, no wonder you wanted to get that vbac!

That's interesting about the monitor.. do you mean the one the mw uses to listen to the baby's heart beat? I might ask about that when I see the cons....

at your perinium of steel... unless you get a perinium of steel from sitting on your fat arse all day, I think that's probably unlikely to be my case!

I'm hoping a lot of the emphasis on time limits is a case of lost in translation and that actually if it came to it, and things were progressing as expected they wouldn't just wheel me in to theatre because my 8 hours were up, even if I was crowning!

with my 2nd VBAC I refused the continuous monitor (didn't use the fetal monitoring machine at all - they just used doppler and other methods of checking things were ok), I refused the cannula, ermm basically I was a stubborn cow and had a fab birth

My sister did have a VBAC that ended up with a uterine rupture. She was continuously monitored but nobody (MW and doctors) noticed anything was wrong until blood started to pour out of her. Her and her baby both nearly died but 7yrs on they are both absolutely fine - which really is a miracle.

Anyhoo, for my VBAC I refused all artificial hormones to speed up labour. My sister had been given syntocin (I think, might be wrong on the details) to speed up labour. Apparently a lot of consultants would never do this but it actually depends where you give birth as they all have different rules. I also left going into hospital until the last possible minute - I was 7cm when admitted. I ended up with forceps but that was more to do with it being a back to back labour than being a being a VBAC.

Remember, they cannot do anything that you refuse permission for. Make sure your birth partner is well prepped.

Blimey thecrackfox... how horrendous for your sister. Glad everything was ok in the end! So it just goes to show that monitoring doesn't necessarily make for a 100% safe birth. I wonder if in her case they were too complacent thinking that as she was on the monitor they didn't have to watch out too closely for signs?

alwayslookingforanswers - I'm going to have to practice being a stroppy cow in a mirror I think!

I think with continual monioring it's too easy for the MW's to leave it all to the machine to pick up any potential problems - I felt much "safer" when I was being monitored 2nd time round (without any the monitor being used) than I did first time round where I was continually monitored, mind I'd been induced as well for that so that didn't help.

It does seem to depend on individual staff so much. I had DC1 at home whilst DC2 was C/S for placenta praevia.

When it came to DC3, 5yrs later my consultant was quite happy for me to VBAC in the 'home from home room' (beanbags, big bath etc.) but was overruled by the consultant midwife who wanted me to be continuously monitored/take prophalactic antibiotics/have venous access established etc.

I did masses of research and said in the end that I couldn't trust that my wishes would be followed in labour. I said I would book a home birth with the community team and fully expected her to back down and 'allow' me to labour in the 'home from home room' but she just washed her hands of me.

Two senior midwives did a home visit to evaluate and explain the risks and I had a wonderful early morning labour with DC3 in the bath at home.

Do your research and go with what YOU feel comfortable with. Don't be bullied.

First of all congrats headfairy - I remember you from the TTC boards (I may have had a different name tho- can't remember)

I'm really at the different 'rules' for VBACs in different parts of the country. Here, once you've had a C-section, you are always offered another one regardless of the reason for the 1st one. Mine was for a failed induction for an overdue baby.

I realised as I approached my 36 week appointment that I was very apprehensive about the medicalised nature of the vbac I wanted and voiced this to my community midwife. She referred me to the consultant midwife at 36 weeks instead of the consultant and I couldn't have been more pleasantly surprised. She went through all the reasons for why they advise vbacs to be monitored, etc. and all the stats behind it and inductions, but totally supported my decisions to stuff it all and go my own way. I wrote about our conversation here. She really calmed me down and I didn't have to fight for anything.

I'm now 40+16, have been in early labour since Thursday night and have had my first round of foetal monitoring, going back for more in the morning. Lovely consultant MW passed me on to consultant obs from last Thursday, so I'm having to do a bit more justifying of my reluctance to set a CS date/induction (yes, they do induce VBACs here) but I suppose I see their point. It is theoretically possible that the pregnancy outlasts the placenta and something will have to be done. A hard decision for me to make as I'm petrified of both, and this stop-start labour business isn't helping.

But I'll let you know how I get on.

Do look at the AIMS website for some stats search for vbac, keep calm, and you may be pleasantly surprised. Different consultants have different views on these things.

Forgot to say, I was booked for sweeps at 40 and 41 weeks.

They couldn't do one at 40 weeks because the head was still free. Got 3 done last week: the original 41 week one, a quickie with my local MW and one from the consultant after monitoring on Thursday. They'll do as many sweeps as you ask for, it seems...

Hi hobnob! Thanks for the congrats... good to hear you were actually listened to and I hope you manage to get your vbac. Thanks for the info and links. I will do some more reading up.. poor consultant is going to face a barrage of sceptical questioning from me, but I'm sure they're used to people coming in all guns firing about "I'm not doing this, I want to do that"!

I hope your labour goes well. I'm pretty much decided that I don't want to be induced and I will request a cs if I go over 41 weeks. I really really really don't want to faff around with drips and crochet hooks. If it happens naturally then it's meant to be.

Velvetbee - at the midwife washing her hands of you! Isn't she there to facilitate the birth you'd like, regardless of whether it deviates from what she'd like you to do?

Just bear in mind that what the consultant has to say to you (hospital policy) does not affect what you can in fact do.

So my consultant had to recommend that I was on the CLU with CFM, canula, time limits, going in early etc. In fact I stayed home until fully dilated (although that was cutting it a bit fine!), stuffed my face all day, had intermittant monitoring after each contraction in the second stage, was in the birth pool on the MLU. In the event the doppler picked up a problem with the baby's heartbeat, I transferred to CLU and had another section, but am glad to have given it a good shot.

For me, the safest option was a normal, unmedicated birth and the best way of getting that was going to be to be active and comfortable. I was prepared, if I didn't get the hospital staff to agree to what I wanted, to go to the CLU but would have refused the monitor, or let them use it a bit and then would have unstrapped myself when I felt like it. Far better not to have to do anything that stressful in labour, but I would have done it and was preparing to say in a very calm fashion "no thank you" to any unhelpful suggestions. I also hired an IM to act as my doula at the hospital, so she would have helped with that too.

It is not selfish at all to not want CFM (it is loathesome). In my case the intermittant monitoring did the job and told us that CFM and doctors were needed.

Re the time limits, I told the doctor and hospital MWs that I understood they didn't want me labouring for days, but I hoped that they would look at all circumstances together (dilation, how I was coping, descent etc) before recommending a course of action. And if all else fails just remember they can't force you to do anything.

Also lots of women don't go into labour until after 41 weeks, so if you do want a VBAC don't book a section too early. I thought my consultant would want to book me in when I met her at 40+1, but she said she would see me at 42+1 and we'd discuss options then, which was great. It really took the pressure off - and we agreed no induction/crochet hooks/faffing.

I didn't think this would help at first, so I didn't mention it. But reading all the other posts, perhaps I should say that the home birth attempt for DC2 turned into another c-section? And although actually it was more serious, as I could tell from the medical staff at the time and the notes afterwards, Dc2 and I were both ok, and in fact it was a better birth experience than DC1. I felt I had given a VBAC every chance I could, but at the end of the day my birth plan had always said 1. baby ok and 2. mummy ok, and the rest to me has been less important.Just knowing what labour is like helps you to deal with it better I think.

I agree with that Fridayschild.

My first labour was very long, augmented and I had an epidural out of sheer exhaustion. I felt as though my card had been marked. CS was because DD was stuck.

The second time my CS was because the baby was having serious decelerations (and it took place under GA because the epidural would not go in). But having laboured all by myself with no pain relief bar TENS made me feel I had given it a good shot and done the right thing by both me and the baby.

Thanks for your experience MrsHappy. It's all really good ammunition for my meeting. I feel that's all I want, if i'm going for a vbac, then I want to do all I can to give it a fair shot.

Hi headfairy, how did it go with the consultant?

Just to let you know that I had my VBAC of sorts on Sunday night after a very odd labour off contractions at night, when horizontal, for 3 nights which eased during the day when I was up and about. My waters broke in the bath on Sunday evening, and the midwive's unit asked that I come in for assessment with a view to induction given my dates (40+16). I was fuming at this, given all the written agreements, but went in anyway with a view to bullying myself into to pool. The contractions I'd been having were really irregular (every 10 mins-half an hour or so) but were speeding up a bit.

We got put on a monitor (but were offered doppler too), and I was standing for 20 mins. The baby was having decelerations, so I was asked to lie down through a contraction to see if it improved. I told the midwife that things were really sore lying down, and then had a monster contraction where baby's heart dropped like a stone and didn't recover. I got the blue lights to labour ward and was basically prepped for a c-section and examined to find that I was 8cm! In theatre, after a spinal, they found I was fully dilated and so they managed to encourage baby Isla out with ventouse and forceps. It was a very calm experience after the initial panic. She had the cord around her neck, but as they said no-one can tell if distress is due to that or scar rupture so better to be safe than sorry.

I'm so grateful to the obsteatrician for trying the forceps because my instinct was to just go for the section again. The recovery is amazingly different, and well worth the wait.

I'm just sorry it wasn't possible for you mrsH in similar circumstances.

Congratulations Hobnob. I had a failed forceps attempt with DC1, so suspect that in my case even if the epidural had gone in forceps might not have done the job. But am so pleased it worked out for you. . And welcome to Isla.

Just catching up after too many days away... congratulations Hobnob!!! Sorry to hear about the scary blue light transfer to theatre, but great to hear all came good in the end!

My discussion with the consultant went as well as can be expected. She was definitely pushing me for vbac, as I thought she might do, and actually she was very helpful, she said the monitoring didn't have to begin until I was about 4-5 cm dilated, and then I could always come off for half an hour or so if all looked good so I could get in to the bath (no pool for me, but warm bath is fine)

She also answered all my questions about induction too... I've decided that I really don't want an induction, I'd rather a repeat cs, so I'm booked in for a cs at 40+6... New YYear's Eve!! If I go in to labour before then then it's fate and I'll do my best to succeed at the vbac, but I won't have to face an induction which was my biggest fear. So either way, dd will be a 2009 baby!

I hope you're doing well with dd!

DS2 was a VBAC. I was aiming for a home water birth. In the end my waters broke on a Sunday, I was checked out and swabbed on the Monday, and on the Thursday my swab came back with group B strep.

They already knew I was going to 'push' the rules - they weren't keen on the HB in the first place.

I had originally said I'd rather have a c/s than be induced, but in the end I was induced. It wasn't great, but it was OK. They wanted to section me after 3 or 4 hours on the drip when I hadn't dilated at all. I kept saying no no no no, and DS2 was eventually born after nearly 48 hours on the drip!

What did I push - staying at home after my membranes ruptured for 4 days (had daily monitoring at home, and once in hosp), being on monitor - I insisted on being upright on birthing ball, eating/drinking (they wanted me nil by mouth), not having pethidine, not having epidural at start of induction, not letting DH leave at any point (going home, not to loo!), number of people in room - had DH, mum and DSis at various points, number of internals.... most things really!

Good luck for your VBAC if you go into labour before the c/s. It can be done your way, but you have to push for it, and have a supportive birth partner.

I had a VBAC recently.

I was told catagorically they would not induce me.

I wanted to move around but actually it was too uncomfy for me and due to DD2's position I gave birth in stirrups. That may sound horrific but I had little pain relief and it was actually a very positive experience with very supportive midwives.

I was also told they would not take any risks and if they were at all worried would have been taken inot surgery. This made me feel a lot better after the initial consultation and I'm glad I managed it.

If previous section was for breech you have more chance of having a successful VBAC from a Student Midwife is up to her ears in research about VBACS!

LOL ella bella,

I did have a breech baby and did have a loevly student who made her partner wait in the car park until I finished!!