Argh! VBAC chat with consultant made me angry, any help?

[Chulita]

I just had a consultant appointment and she basically said all the things I didn't want to hear:

CFM
No water labour/birth
Continuous assessment from 4cm onwards
No labouring at home (at all, she stressed this)
No wandering around, only as far as the monitor leads will reach

Canula pre-fitted for when if I fail
Argh! I would like an active birth with as little intervention as possible. The only reason I had an emcs last time was because DD was OP, face presenting, cord round her neck and wedged at an angle. I went into spontaneous labour and fully dilated (it took 6 days to get fully dilated but I got there) Now I'm have a serious VBAC wobble...I'm only 21 wks so I've got time to think but this has really thrown me off.

Help!

Hi there Chulita

I just wanted to encourage you that it is possible to negotiate and that you don't have to go along with what they say.

At my booking appointment I asked for a copy of the protocol for VBAC which basically stated everything that you've said - and I didn't feel that this would help me to achieve a VBAC - I felt that it was setting me up to fail.

I'm now 38 weeks and if things go as planned will deliver in a small midwife unit with no over intrusive interventions and as long as the midwife on shift feels happy I can use the pool. The consultant I saw a few weeks ago had to say that this was all against medical advice (I think you would struggle to get any consultant supportive of deviating from a medical protocol)

So I do feel for you. My suggestions would be to firstly get as well informed as possible so that you can show them that you have done your research (I bought the AIMS book on VBAC and have found it has given me so much confidence to not feel that I need to go along with medical professionals). Is there any way to find a supportive midwife? Don't be afraid to discuss protocol and to ask to do things differently. Also different hospitals/consultants may be more willing to discuss what would work best for you and I've heard of a few on here that will allow VBAC women in a birthing pool etc. I'm sure lots of others will come along with their thoughts but I just wanted to say hi.

Some consultants forget that hospital policy is just that, and that their job is to recommend not dictate . You might find these phrases by Mary Cronk useful for reminding them of those points in a polite but clear manner! What does your MW say?

Ultimately, they cannot force you to have any intervention you do not want. They cannot force you to have a hospital birth if you would rather birth at home. If you feel that the consultant is not open to a reasoned discussion, you could ask to be transferred to someone more sympathetic. If you still don't get anywhere then you might want to do your own research on whether you want to accept any/all/none of their suggested interventions and then let them know your decision in writing.

meant to say it can also be highly illuminating to ask "why" a lot, followed up with what research they're using to support their recommendations... It's (frighteningly) surprising how few of the recommendations in these situations are supported by published, peer-reviewed research. Which begs the question of who's best interest the recommendations are in...

(Cynic? Me?)

The MW said to try and labour at home for as long as possible and that if I really nagged at them they couldn't stop me from getting in the pool if it was free but they don't recommend it.
I'll have a look at the AIMS book, there's no way the consultant would discuss anything - she gave me that pitying look that medical professionals are so good at when I tried to discuss CFM.
I think the wobble mainly comes from them banging the uterine rupture drum which is a scary thought although very rare.
IMO, the sooner I get into hospital, the sooner they clog me up with stuff and the more likely I am to need a csec.

Good luck happy2beme!

Oh dear, esp in relation to no labouring at home, esp as the midwife thought it was ok - and she knew you had a CS - is there anything to your particular circumstances that make labouring at home more problematic?

re: the pool - they have underwater dopplers and the midwife can hold it on you continously, she might just get a sore arm - however I think worth fighting the other things first eg CFM / not being able to move around.

If you did go into spontanous labour last time AND fully dilated, then provided baby in good position it might all be very quick, and the CFM etc might all be irrelevant.

I second the recommendations for AIMS (www.aims.org.uk) and hiring a doula. It sounds to me like they're desperately trying to cover their backs in case of the very remote chance that there could be a problem, ie. this is more about them being worried about being sued than anything else.

Hee hee! That's what I'm hoping MumNWLondon A good quick one this time would be fab.
I can't see any reason for not labouring at home apart from the uterine rupture risk. We live 30 mins from the hospital but I doubt the consultant looked at where I live!

Also labouring at home - what do they mean by that? Both my labours have started verygradually and for the first 2 hours I wasn't really sure if the contractions were BH or for real!

After 4 hours, esp with Dc2, I knew it was real but wasn't especially uncomfortable. Went to hospital after 7 hours still not painful and still 10 minute gaps between(although was uncomfortable by that point), in all that time had no need even to use tens machine. Do they really want you to be in hospital for these mild contractions?

we are currently 4 years into a legal enquiry where cfm was not present in a vbac against nice guidelines. complications are of course very unlikely, and your labour and birth is likely to be trouble free, but it is worth spending a few minutes trying to see the consultant's point of view lol.

when they don't stick to the guidelines, they get people like me asking them difficult questions about how and why their baby sustained brain damaged during the labour process. and they can't answer, as they don't know.

there was no real reason for my first cs - they told me dd1 was mahoosive (scanning large) and she was only 8'6, so in theory i was good to go.

that said, i'm a huge believer in maternal choice, and i strongly believe women should make their own decisions. this is not an attempt to get you to opt for cfm or even a hospital birth if you feel strongly against - just that i find it a little bit sad that hospital staff are found wanting for putting their side of the coin forward.

i actually find the medicalisation of birth quite scary, but the sad fact is that if there had been more medicalisation of dd2's birth, there is a chance that a cs may have prevented some of the brain damage, and almost certainly the immediate treatment after (v) birth saved her life.

sending you vibes for a happy and healthy outcome, whichever way you choose to labour.

madwomanintheattic - I'm sorry your DD2 ran into difficulties during birth .

For me, you've hit the issue on the head when you say "hospital staff are found wanting for putting their side of the coin forward". I don't think that hospital staff should be villanised for explaining the hospital policies in place with the risks and evidence behind them - but I do think there's a problem when they tell women what they "will" have and what they are "allowed" to do, and when they present a very polarised view that frightens women into doing what they're told. How can women make an informed choice if they're put in a situation when they're treated like naughty school children who are incapable of understanding the issues? How can you develop a trusting relationship with your consultant if you don't feel you can ask questions?

Any birth has risks - and arguably you could reduce the risks of serious outcomes if all women laboured in hospital with CFM, etc. But that leads to a level of medicalisation that I think few women would be happy with (and I don't know that the initial assumption isn't flawed -afteral they're incredibly interventionist in the US, but outcomes don't seem to be that great...)

I think we're probably in agreement on most issues here . I hope you get some answers from your enquiry - and agree wholeheartedly with your last comment

i think we definitely agree

my cs took place in a german hospital where it didn't occur to me to ask if i had any other option. i sometimes wonder whether my subsequent births would have been v different if i had been allowed to labour with dd1 instead of being wheeled to theatre.

but it's a fairly pointless wonder, if i'm honest, which is why i'm so pro women being content with their (informed) choices.

It might be possible to come to a compromise on CFM - after all even in "active" labour its not as if you are walking around lots - IMO the important bit is being able to move position - eg kneeling over beanbag (this could be done on a bed), on all fours etc. Maybe a compromise is x mins of CFM in every hour period for example, plus doppler monitoring inbetween.

I know at one point with my DD midwife held doppler to my stomach for around 20 minutes without taking it off.

Obviously different for VBAC but NICE study showed that CFM did not improve outcomes on all women.

I haven't had a CS - but DD was distressed during her birth - (my first labour) - heart rate acceralating - but they knew that because midwife was monitoring with doppler very regularly - probably checking during and after 1 contraction in 5, and at one point just holding it on. I'm not sure what CFM adds? She was born blue and not breathing but was fine after resuciatation by crash team. I had a 2nd degree tear because I was pushing like no tomorrow and she was born in very uncomtrolled way (ie whole body in one go, no crowning). But I guess because good outcome for her I'm happy that they didn't need to do emergency CS.

madwomanintheattic did you have a rupture? If so did you know you'd had one?
I'm not averse to monitoring, I'm just wary of the strap on monitor that does hinder your movement. I had it towards the end with DD and everytime I moved it would slip and get my heartbeat instead. Fair enough they say you can move but in reality they'd prefer you didn't. I paced a lot during the labour and only had CFM once it was clear things weren't going to plan but if I had to have it from the off I think it would hinder things.
I agree that I sound unfair to them for stating their policies but it's the way they say you're not 'allowed' to do certain things. I would never knowingly put my little baby at risk, but equally I don't want to have a controlled, highly monitored labour because I don't feel that there's enough evidence to show that these methods make a huge difference. They are happy to induce which I thought was a problem with VBACs and if at all possible I want to avoid induction.
I suppose really I'm still very scared about giving birth after the battle DD and I had and to basically be told that I'm going to fail but let's give it a go anyway doesn't give me much encouragement!

yes, it is the language that got right on my nerves
saying you are not 'allowed' to do things such as labour at home or refuse cfm is plain dishonest and a misuse of the word. it's only when it comes to things like using the pool that they can say 'no it's not allowed' and even then it's not a national policy but a local hospital decision

yeah I heard all that chat from my consultant too. The irony was that when I went in as contractions came on thick and fast they couldn't have cared less that I was a VBAC and left me to wait in reception for an hour and a half as they were too busy to deal with me. Rcepetionist told me to be quiet as I was disturbing people and then finally brough out some gas and air for me to use in reception. When they looked at me they found I was 8cm so where was the CFM then???

heard the same chat again from the consultant for my impending third birth and I asked for waterbirth this time (OK in edinburgh you're lucky to find an available bed and midwife so i know it's unlikely)and he was dead set against it. I've made an appointment to see the consultant midwife this time as she's apprently alot more supportive of less interventive VBACs. Maybe you should ask to speak with yours?

Chulita - the other thing I'd add is that what happens in reality isn't necessarily the same as the policy line they lay out. The hospital I had DS at has fairly conservative policies, but when it came to my VBAC the midwife who looked after me actually encouraged me to walk around the labour ward, be in the bath etc etc so CFM went out the window, even though I was expecting to have it. It might have just been luck (she normally worked on the birth centre side), but you never know.

no, not a rupture. we still don't know exactly what happened, but it's likely that at some point the cord became compressed, but because of lack of monitoring, it's 'best guess' at what point, really. all we know is she sustained brain damage due to a fairly lengthy hypoxic episode during the birth process. (due to mri results and clinical presentation at birth and subsequently).

what happened with us was actually in no way connected to the cs - but as a vbac, cfm as laid down in nice guidelines would have provided a pretty good clue as to what happened, and may have highlighted the need for earlier intervention. same with any birth really.

like i said, not here to argue for or against, really, just to pop in and say 'ooo, i wish i'd had cfm' lol. 20/20 hindsight and all that. i'm sure the solicitor thinks the same

I don't think they can actually stop you from labouring at home! I am planning a VBAC and have also been told to go in very early on - I've just decided to be disobedient and stay at home until I feel ready to go in. Is that very irresponsible of me do you think? I plan be in the bath for most of that time!

Also I've heard of people spending lots of time in the loo once in hospital to avoid being monitored (the things we do to avoid confrontation with health professionals).

I'm toying with the idea of asking for a water birth - but haven't received any encouragement from my initial enquiries about even being on the low risk ward once in hospital.

Women have been fighting the battle for VBAC for decades now. While we may lose individual battles with our consultants - in the end we will win the war....

There was a study I came across from a hospital in fife that did successful water birhts for VBAC. Sorry I don't have the URL

good luck to you. I am nearly 34 weeks now and really looking forward to the birth!