VBAC - Feel deflated after 20 week consultant appointment.

[thedollshouse]

I had my 20 week consultation yesterday, I was booked in with the consultant but it was the Registrar who actually saw me. I had an elective c-section 5 years ago due to breech presentation. I researched the options and went in with a birth plan, I felt that the doctor although pleasant and friendly was very dismissive of my plans and I now feel really anxious about the birth. This is how our conversation went:

Me - Ideally I would like a natural birth this time round and would like a trial of labour - Dr - Yes, agree that a natural birth is preferable you are not a candidate for a repeat section anyway as the previous csection was carried out because the baby was in the breech position you are not considered high risk.

Me - I do not want an epidural under any circumstances. I believe that in order for me to labour effectively it is essential that I feel the contractions, I feel an epidural will increase my risk of tearing and increase risk of requiring a csection. Dr - We can't make you have an epidural if you don't want one but if you have had a previous csection it is standard procedure to offer you an epidural as soon as you go into labour as you are considered high risk for a repeat section (which contradicts his first statement )

Me - I do not want a medicalised birth, if it gets to the stage when ventouse or forceps are likely I would rather have a csection. Dr - Totally out of the question, a delivery by forceps is far safer than a csection we would not consider a csection to avoid a forceps delivery

Me - I understand that I will be continuously monitored. Whilst this isn't a huge issue as I don't want a water birth, I feel it is essential for me to have an active birth and I don't want to be confined to the bed. Dr - The risk of scar rupture is very small 0.5% but still significant enough to justify continuous monitoring you will be able to stand up but the wires to the monitors are not long enough to enable you to move away from the bed.

Me - I don't want to be induced and I don't want to go beyond a week over my due date, I would like to be booked in for a csection if I go a week overdue (Midwife previously told me that it is policy NOT to induce women who have had a previous csection). - Dr - A week is not long enough, we would allow you to go 12 days over then we would induce you, you are not a candidate for a csection

I just feel that I have no chance now. In their opinion I will not be considered for a csection because I am not high risk and yet I will not be allowed to labour naturally because I am high risk.

The trial of labour will last between 8-10 hours. There is no way I have a hope in hell of delivering a baby in that time, especially if I am confined to a bed and hooked up to an epidural, my mother and sisters all had labours that lasted between 24-48 hours. I just don't see the point. I really hope that this baby is also breech and then I can just have a repeat section.

Does anyone have any words of wisdom?

TIA

Sorry for some reason the text hasn't bolded. Hope it makes sense.

Firstly, take a deep breath. You are only 20 weeks so everything is subject to change and certainly not worth spoiling the rest of your pregnancy over.
So, as your first section was for breech, you stand an excellent chance of having a successful VBAC (statistically). However, you are right to be concerned that continuous monitoring will restrict your movements but I have never yet seen a machine with wires so short that they do not allow you to rock on a rocking chair or bounce on a birth ball beside the machine. Whether you subscribe to the view that a CTG is necessary is up to you, you do not have to consent to this. The evidence supporting it's use is debatable.
I am personally nervous of epidurals in VBACs because you will be unable to feel the sensations associated with scar rupture, and the suggestion that you should have one sited early is utter nonsense. Epidurals can be sited within minutes if needed, and in a true emergency a general anaesthetic would be used anyway. This would further reduce your chances of a successful VBAC by making you unable to mobilise etc.
The time limit he mentioned for a 'trial of labour' horrendous phrase, is completely nonsensical, you are perfectly within your rights to reject this bizarre suggestion.
With regard to induction, VBACs can be induced/augmented but with particular care due to the scar on the uterus.
With regard to forceps delivery, I feel much the same as you, I would rather have a section, but his response was the standard one.
Hope that has helped a little, post again if you want any further info. The MIDIRS Informed Choice leaflets are very good on VBACs and really give you the information to make decisions you feel comfortable with.

Oh dear. I think you can ask to see a different doctor if you really feel you did not agree with the first one. Sounds as if he/she was spouting "the rules" at you rather than listening to your wishes.

On the last point, why do you not want to go over one week? Just curious. Most women wanting a VBAC are prepared to go to 42 weeks if they have to.

Also, I am surprised this registrar said they would induce you, as most hospitals have a policy of not inducing any women who have had previous sections. Do you know how far they will take the induction? Some will do sweeps but nothing more, others will do prostin gel, but I haven't heard of any prepared to do the full works with a syntocinon drip. The reason is induction can bring on stronger contractions which increase the risk of uterine rupture.

There are lots of people on here who have had successful VBACs (I'm not one - had an elective section second time around) so I'm sure someone will be along in a minute with good advice.

www.choicesforbirth.org/booklets.php?id=17
Your midwife may have one or you can order them from this website for a few quid.

Just a quick one as have to go out in a minute but I think you need to put your foot down here. If i was you I would write out a birth plan on exactly how you want your labour to be managed, insist on intermitent monitoring, refuse any examinations then they will not be able to tell how far you are progressing and therefore wont be able to 'time you'. Write down that you absolutely refuse a forceps delivery. Send a copy of this to the head of midwifery and consultant (if you choose to) and ask them to sign it off so everybody understands what you want in your labour.

When I had my VBAC2 I stayed at home as long as possible so that I would not be in hospital that long, I delivered him an hour later. My VBAC1 failed because I went into hospital too early and went through the usual cascade of interventions, which eventually ended up in an emergency nightmare section.

Have you looked at this link www.caesarean.org.uk/, loads of useful information there.

I am due in April too and am opting for a home birth this time to avoid all of this 'bulls**t' which as somebody commented on another thread is sad really as I feel I cannot get the birth that I want being in hospital.

Will see you on the April thread so if you need someone to 'moan or stress out' to I will be there.

Toady x

Thanks for your advice everyone. TuttiFrutti the doctor said that it would be prostin gel that would be used for induction.

I felt that he was very pro vbac but feel that if I go along with their suggestions I am setting myself up for failure.

I will have a look at the booklet reikizen suggested and just wait and see. You never know this baby may end up being breech again and the decision will be taken out of my hands.

Toady I will put my foot down when the time comes. If I feel that they are advising things with our best interests at heart I will take them on board but if I feel they are just taking a robotic stance and advising things to follow procedure I will follow my own instincts.

I'm not brave enough to go for a home birth but I can see why they are becoming so popular.

I have had 2 VBACs after an emergency c-section under general anaesthetic with my first baby. I would say that, even with CFM, I was up and about, moving on a ball etc but I did not have any desire to go walkabout in the hospital, which I know some people do. Have you heard of telemetric monitoring? It's a wireless system which means you can move about freely (within your room, don't know exactly how far the range is) while still begin monitored.

I was induced for my second VBAC (as the baby was at high risk for HDN, nowt to do with my obstetric history) with a synto drip . The particular hospital I went to doesn't use the gel with VBACs, as once it's in, it's in, IYSIM, whereas if you turn off a synto drip, the drug is quickly cleared from your system.

I had epidurals for both my VBACs, one when I was at 7cm (with DD2) during a spontaneous labour, and one from the start of the synto drip with DD3 (no spontaneous onset).

I would strongly advice talking to the head of midwifery at your hospital (have just done the same thing on another thread - it's my own personal soapbox) as they are often more clued up on what is and is not possible for your birth. The consultants at my hospital were prepared to go along with the HoM, as they said they tended to see the births where things were going wrong rather than the more straight-forward ones.

Have wittered on, need to get on with my work, I'll be back later if you want to ask anymore.

Dashing out but just to say every time I saw a doctor with my second pregnancy (after em. c-s first time) I usually saw someone different and got told different things each time about what I would be allowed and not allowed.

Try and see if you can actually see the consultant. Having said that, the consultant often gave me different advice.

FInally, I think it is your right to request a c-sec following a previous c-sec for whatever reason.

Oh, I bought the AIMS book(let) on VBAC - have no need if it and dont' want to bin it. If you CAT me your address I'll send it to you if you'd like (all about your rights and advice on how best to achieve VBAC).

Thanks everyone. Wheelybug I will CAT you, let me know how much the postage is and I will send you a cheque, thanks.

I had more or less the same from a registrar at my 20 week appointment and came out thinking I would have to have a homebirth. It went:

me: I won't want CFM.
her: you have to be continuously monitored. You'll be able to stand by the bed, but anyway you will be lying down once you have had you epidural.
me: I won't be having an epidural.
her: But you'll need one once you have the syntocin.
me: why would anyone use synto for a VBAC?
her: some of the consultants sometimes do.
me: I won't be having that.

Your registrar is spouting hospital policy (and may be wrong about some of it - e.g the bit about induction) and essentially would be on thin ice if he encouraged you to do something else.

Re the forceps, there are some circumstances where forceps are likely to be safer and easier than a cs, the main one being where the baby has descended quite far and would have to be pushed back up to be delivered by section. But then I guess for most of us a quick forceps lift out isn't quite what we fret about re instrumental delivery.

Speak to the consultant midwife who is much more likely to be on your side, and will hopefully be able to hatch a plan with your consultant whereby you get what you want. And next time you have an appointment with a doctor, insist on seeing the consultant, not a minion (as is your right).

I had a hospital VBAC and a home VBAC.

Your requests sound reasonable. Bear in mind you can always refuse interventions, no matter what your consultant says - but you need to brief your birth team well! (Have you considered a doula?)

I don't trust CFM because it leads to midwives watching the monitor instead of you. Doppler monitoring is still an option (that I chose in both births).

In hospital, they were ok with me refusing once I'd signed the right papers, although they used the CFM periodically which I was ok with.

Epidural is setting you up for problems from the beginning. It would inhibit your ability to push and move. (It also carries it's own risks).

But if it was me, I would look for another consultant. Hes not really listening to you or taking you seriously.

I had a similar conversation with an SHO at 20 weeks when pg with my DD and left totally disheartened.

I spoke to my wonderful community midwife shortly after - she arranged for me to have a meeting with my named Consultant (not any of her juniors). She was fantastic - totally took all of my concerns on board, went to fetch some monitors and leads and helped me play about with them to see what positions would be possible, advised against induction, wholly supportive of having a doula, agreed no time limits. DD showed no signs of budging however and I ended up with an elective at 40+5.

I suppose what I am saying is - go to see the consultant themselves, change consultants if necessary.

And fwiw they cannot perform a forceps delivery unless you consent.

Good luck

thedollshouse no advice but im thinking of you, i went through a similar experience with a consultant, didnt listen when i was asking for an induction, in the end i was right.

Hi
Don't usually post but this is a subject close to my heart. I have just (4 weeks ago) had DS2 by VBAC after, like you, being disheartened by various consultants' policies / advice.
I was determined to have as natural a delivery as possible and did lots of research on web and books etc. and went to consultants appointments fully armed. I ended up changing hospitals after the first seemed totally sceptical of my wishes.The second did their best to persuade me otherwise but agreed that I was well informed and could have intermittent monitoring, active labour, use the pool etc.
However - in the end it didn't quite happen that way as my waters broke on the Sunday night but I didn't go into labour, though had mild irregular contractions, and after 48 hours was induced by syntocin drip due to risk of infection following waters breaking. At no point was an epidural even mentioned aand in fact I gave birth 4 1/2 hours after going on the drip with just gas and air - My theory is that the 2 days of waiting were doing something useful - I was never examined again due to risk of infection but I suspect i must have been at least a little dilated before going on the drip. I had to have CFM but kind of ignored it in the end, was sat on birth ball, walking up and down room, and gave birth on the bed on all fours - the monitor kept falling off but I thought that wasn't my problem really!
DS1 was born by section at 37 weeks due to placenta previa - so this was effectively my first labour.
I was delighted with how things turned out but am convinced that all the research etc really helped me stick to my guns re active labour and not being browbeaten by the doctors policy.
FWIW the midwives were much more pro my point of view and luckily the drs weren't involved in my labour at all.
Anyway I guess my point is that it is possible to have a succesful VBAC following complications / induction. You can always try different consultants / hospitals. and the better informed you are, the more likely to succeed!
Good luck and I hope you get the birth you want.