Preparing for a VBAC?

[mitfordsisters]

I don't think there's a current thread for VBACers so starting one. I'm 25 weeks now, and had an appointment with consultant midwife yesterday. Will be giving birth at St Thomases in South London. I think they are going to agree that I can labour without Continuous Foetal Monitoring (CFM) - needs to be okayed by the consultant midwife at the Home-from-Home centre.

I'm feeling really positive about this one - first birth was an induction resulting in emcs - determined to make this one different if I can.

Also using a natal hypnotherapy CD to be as relaxed as possible when the time comes.

Congratulations on your new son, MrsJamin!

congratulations MrsJamin

• although am now feeling the need to make sure everything is ready - am wondering if DH will remember how to fit the car seat etc...

saw consultant this morning after a long wait and an odd antenatal appointment - the midwife felt she should do the check anyway even though i don't intend to deliver there.

Am feeling confused after consultant appointment can I ask everyone's opinions? I live in a rural area so choices are limited.

My options are:
option 1: local birth centre with really experienced supportive MW's - am pretty much guarenteed one to one care if not two to one. However if anything goes wrong it's a 20mile transfer which would probably take about 40 mins. Most likely here to get my requests willingly met - water birth, no CFM etc. Was told this morning that choosing this would be against medical advice... this unit is effectively classed in the same category as a homebirth.

option 2:Consultant unit 20 miles away - might begrudingly pay lip service to my birth plan but might be a battle and could quickly become medicalised but would have back up on hand if emergency arose. C/S was here last time and had no major problems but did find MW's overstretched and lots of changes between staff and approaches. Do not feel that i'd have the high level of support as with option 1.

option 3: Differnet hospital 35 miles away apparently smaller than option 2 and greater chance of personal attention, with capacity to deal with emergencies if they arise. DH wants to visit this unit but i'm not so sure whether it's just confusing the issue. Also too far from home?

What would anyone else do?

Just wanted to say congratulations, MrsJamin! That's great news and just the kind of positive story that makes me think "let's go for it".

Good luck with your decision, Happy2bme. Think I'd be tempted by option 3 but I guess it depends how quick a labour you have. What's your gut reaction to the options you were given?

Congratulations MrsJamin!

Happy2bme - I'd be tempted by option 3 as well but good luck with your decision.

Had consultant app't today which helped in one sense but got me very down as well. First part was good, went through my notes from when dd1 was born - I had remembered things out of sequence so am v. glad to get it all straight in my mind finally. No apparent reason I shouldn't be able to have successful VBAC according to consultant - more good news.

Then we get to what the hospital 'recommends' - come in as soon as you're in labour, CFM, canula in when you arrive 'just in case', and timed first & second stages. All of these things (w exception of canula which just freaks me out as I managed to knock four out of my hand during and after dd1's emcs) seem to put more pressure & stress on mums-to-be and make intervention more likely to my mind? She was reassuring that I'd still be able to be mobile with the CFM but as per l39's post - it's far from infallible, and I think wanted me to be grateful that there was no longer a 'strict' half hour limit on 2nd stage.

Left feeling v down... went for cofee and cake with dh and picked myself up - getting the hynotherapy cd on tonight, going to do loads of work on birthplan and coaching of husband to be my/our advocate during the birth. Game on, am determined to give it my absolute best shot!

In other good news though, my iron levels are ok and am measuring bang on for dates - at this stage last time was on iron tablets and measuring 2 weeks big. And got to hear heart beat which is always lovely.

Sorry for mini-rant, needed to get that off my chest!

Thanks happy seven and bumble, am still weighing up all the options, am going to discuss with my lovely midwife on thurs at the birth centre.

Bumble - I know how you feel re consultant appts - If I go to consultant unit I will challenge the cannula - had one in last time - was uncomfortable and stopped me doing things and then by the time it was needed it had been in too long and had to be changed! I did get a registrar to write in my notes that I wouldn't need one until anelgesia required.....but don't be afraid to challenge their 'normal' with what you feel will be right for you - there seems to be very limited evidence to support hard and fast rules.

omg MrsJamin - congratulations - early and so quick! Hope you are all snuggled up and recovering from the surprise.

happy2bme - I'd be wanting the midwife-led unit, but depends how you feel about it.

bumble, you don't have to agree to any of these things, particularly going in as soon as labour starts. Glad your health is good and baby doing well - don't let the consultant rattle you.

I'm reading Ina May's guide to childbirth - good on the research and so positive about women's natural ability to birth their babies.

Mrsjasmin - Congratulations!! that must have been quite a surprise!
can I ask you two things? You did the active birthing course: was this useful? I have booked 5 sessions yoga + active birth at the birthing centre and my first session is tomorrow...
my second question (if you dont mind me asking) is how much did you dilate with your first one before having your emcs? I went up to 8cm and im wondering whether this mean i'll have a quicker labour this time around??

Happy2bme and mitfordsister - what is the AIM book on VBAC and where do I get it??

ive got my consultant appt at 38 weeks only...

Hi can I join? I am 39+2 with ds2.

I had an elective cs with ds because he was breech. Turns out I have a bicornuate uterus and he was completely stuck.

This time, the consultant has ok'd a VBAC but said I will need CFM. I have decided to go in and see if they have a wireless monitor (prob not!) and tell them that I only want monitored on and off. I wonder how they will take it. Hmmmmm. The consultant also said that a bicornuate uterus is a rupture risk too, so given the sort of double risk, I am not willing to completely reject the monitoring.

I also have a broken ankle, so I am not going to be able to spend very long on my feet at one time, and will probably have to make do with different positions on the bed.

I feel like a first timer, having never had a single contraction before!!

tostaky, I was told that having fully dilated last time before my crash section I have a really good chance of having a successful VBAC and my understanding is that having dilated once your cervix doesn't have to go through the same rigmarole this time so, yes, you should be faster. It's not guaranteed of course but most second timers are faster and as you got to 8cm I think that counts.

mawbroon, I'm v impressed you're going for it especially with a broken ankle! I hope it goes well and they can reassure you re CFM. Keep us posted!

Will do HappySeven.

I think it's the broken ankle spurring me on for a VBAC tbh. I have been laid up since 3rd Jan with the ankle and had to have surgery on it on 14th Jan, so recovery didn't really start until that point. I feel it would be a shame to volunteer for another elective CS and definitely be laid up for another 6 weeks or so when maybe, just maybe I can have a VBAC and a shorter recovery time (fingers crossed!!).

I am not kidding myself, I know full well, it could end up in another section, but I want to at least try!

None of the obstetric people are at all concerned about the broken ankle. It doesn't really appear to be a factor for them!!

Hi

Am getting to that frustarting stage of being wide awake at night so thought i may as well do something rather than wake up dh!

tostaky - AIMS is the association for imporvements in midwifery services www.aims.org.uk/ if you look on their website under publications you'll find a book on VBAC - I've found it useful in getting a balanced perspective on the issues.

mitford sisters - i'm inclined to agree with you and go for the midwife unit - the alternative hospital in option 3 is just to far away (much greater travelling time than the other hospital and unfamiliar town) - these would probably limit when someone was able to bring ds across to see me if I had to stay in.

I know that there are no hard and fast rules - but my gut feeling is that with good attentive midwife care any problems developing would be picked up at an early enough stage to have a non-emergency transfer - I think most of the cases I've read of crash sections due to scar rupture had a lot of early warning signs that were missed so a lot of me wants to place the value on supportive care from experienced MW's rather than having the back up.

mawbroon you are very brave! but i totally understand you, I hate to be laid up. Good luck, not long to go for you!!
happyseven thanks for that! I hope it is!
happytobme I found it!! will try to get a second hand one. Im so glad for this thread.

What is everyone's hospitals time restriction on the first and second stage of labour? so i can compare with my hospital

If someone is no longer needing their VBAC book , i'm happy to swap... www.mumsnet.com/Talk/mumsnet_swaps/917481-Swap-book-on-VBAC-for-mum-baby-book?rnd=1266921234055

Thanks everyone - defintely good to keep hearing I can say no to some of these things - is a good warning of what I can expect and what I need to do to prepare myself and dh.

Mawbroon - hats off to you! Good luck!

My yoga teacher lent me the AIMS book on VBAC, definitely recommend it.

First stage at my hospital they want to see 'progress' of at least 1cm an hour once in established labour. Second stage used to be strictly half an hour - a friend of mine experienced this with her VBAC - but they have apparently relaxed this now and consultant mentioned women who have had 2 hour 2nd stage with VBAC...

tostaky -
Yes the active birthing course was really useful as it helps you understand what's important to try to avoid the need for interventions. Because if you want to avoid another c-section, it gives you practical advice (e.g. keeping off your back, etc). It also reminded me of the benefits of natural birth so it keeps you focused on what you want and what you don't want.

I dilated really quickly with DS1, 6cm in 90mins from waters breaking. So I knew that this time round would be probably faster. The pushing stage was the same as a first timer though. If you dilated quickly first time around, it will probably be faster - so you need a quick plan to get to the hospital! Also we needed quick plans for who would look after DS1, which worked really well.

Tostaky - I don't know if you saw my post further down but you are welcome to my copy. I don't need anything in return - I'll just be pleased not to chuck it as that would be a waste!

CAT me your details and I'll post it to you !

Hallo, wondered if I can join your discussions. It is great to hear people's positive stories, as well as useful to hear where things have gone not quite to plan.

I'm 31 weeks with DC3 and to my huge surprise yesterday my consultant said she saw no reason NOT to try for a VBa2C, so long as I was aware of the risks. I had an EmCS with DS for brow (well, chin) presentation, but it was all very untraumatic, had an elective at 40 +2 with DD, which was awful, and not an experience I'm keen to repeat.

So now I am weighing up options.

I don't feel too bothered about the CFM this time (the consultant put some leads on herself and demonstrated some positions), so long as I can stay upright. Not having a canula though, no way jose.

happy2bme, I would investigate option 3 and see how their midwives approach things.

Happy2beme - you ARE me . My options are 1. MLU, 2. Teaching hospital next door to MLU r 3. Smaller hospital further away. We are rural, so it is about 40mins to 1 and 2, and 45-55mins to 3, depending on whether the railway barrier is down.

First birth was supposed to be in the MLU but I ended up having a CS next door. I understand MLU would prefer not to have me back (as I am a VBAC) and frankly, I don't want to go back . I'd rather not end up in a hospital at all, but even worse would be to not end up in a hospital when I need it and be too far away. So I am going for option 3 too, but taking my own independent midwife as a birth companion, along with OH of course! I don't know if the hospital are happy with that, but I'm not going to give them the option I'm all about me this time (and baby of course,) not about keeping the hospital happy.

wheelyBug Thanks!! I dont have the CAT thing though. If you email me i can send you my address chmarceau at gmail.com

Have sent you an email ! Let me know if it doesn't arrive.

Thanks Wheelybug!

HI guys,

Just thought I would add my great VBAC experience. I had an EMCS in 2006 as DS got stuck then had VBAC in April 2009 which was such a brilliant experience. Like all of you I had my concerns about CFM and not being able to move about. I really thought I would be strapped to the bed but I really shouldn't have worried. I was monitored throughout but had a very active labour. I was surprised at how much I could move around. I moved from the bed to bouncing on the birth ball to using the birthing stool, back to the bed on all fours, whatever I wanted to do I was able to do it - there is quite a long lead on these monitors.

My midwife was fantastic and if they lost the trace for a while when I was walking around they weren't overly concerned they just picked it up when I was comfy again. What I would say is don't go into this labour thinking you won't be able to do what you want just go with the flow and tell the staff what you would like to happen, they can give you medical advice on what they think should happen and I'm sure you can come to a compromise and have the birth experience you want.

I was very proud of myself when it was all over and I will never forget the feeling of my babies warm body being delivered onto my tummy - something I missed out on first time round. Good luck everyone!

Thank you woody - reading all these positive experiences is definitely helping to boost my confidence in aiming for a VBAC.

Pandora - good to hear from you - oh the dilema of options...but good on you for being assertive and taking an IM with you - at least you'll have someone to advocate for you.

I've decided to go for the birthing centre - my option 1, it gives me midwives sympathetic to my birth plan - some more so than others and a shot at a water birth, and hopefully i'll get my favorite midwife on duty - she's said she'll do her best to be there - am just praying for no more heavy snowfalls as the whole unit was closed last month due to the weather! Option 2 i now realise would be a good hour to hour and 20 mins each way to a town unfamiliar to anyone looking after ds so my chance of seeing him would be minimal and that i really couldn't cope with!

Woody - thanks so much for sharing your experience. Think that's a really good point about telling your m/w what you want and working together - I'm sure that my 'failure to progress' past 9cm with dd was partly to do with me agreeing to things I wasn't comfortable with.

Mazzy - am with you on the canula, no way jose! Good to hear your consultant showed you positions for staying upright/mobile whilst being monitored, not opposed to being monitored as such just want to be able to stay upright/mobile...

Lovely to read your experience Woody, and for the confidence boost. Of course,everything is negotiable and should go into a VBAC with that in mind.

Happy - good on you! I have also been signed off to have my baby in the midewife-led unit, with intermittent monitoring - providing I don't go overdue. If I do, then presumably I have to negotiate expectant management with the consultant in order to avoid another cs.