Please share your vbac stories

[LittleAndOften]

I'm expecting dc2 in November. I had dc1 three years ago and it was a difficult birth - 24 hours of labour after waters broke, induction with epidural, ending with emcs under general anaesthetic (after 18 failed attempts at a spinal). The ante-natal classes I had been to referred to nothing other than the ideal natural birth, so naively I was woefully unprepared for a c-section, or indeed anything going wrong. I missed the birth altogether due to the GA and it took me a long time to accept my "failure" as I saw it, because my expectations had been so different.

This time I am determined to have a vbac. I feel that the choices I was encouraged/persuaded to make last time led to the emcs outcome and I want to have the chance to be in the birthing centre, try a water birth etc, try with just gas & air - options I never had before.

I am told I will be under a consultant and the mw said I won't be able to go to the birthing centre, I'll have to go on the ward because of my history and age (I'm 40). I will be offered elcs but I strongly want to have the chance to try for my ideal natural birth in a relaxing environment.

Am I being unrealistic? Are there grounds on which I can argue for the birthing centre (hospital wing has beautiful birthing centre on one side and ward on the other)? Or do I need to accept another medicalised birth?

Ask to see the consultant midwife. They can talk through last birth and put plan for this one. They will talk through risks etc of different birth settings and help document if you choose to accept these and birth outside of the hospitals guidelines. Be that birth centre, home or on delivery suite but with clear plan/your accepted limits for example you prefer intermittent monitoring unless an issue is found .

Also find out if they have wireless monitoring if you decide or need to have continuous monitoring so can remain mobile, use pool etc too.

@Honeydukesmum thank you this is so helpful. I have an appointment with the consultant midwife in June, so it really helps to know what to ask. I haven't heard of wireless monitoring, I'll definitely remember that.

It all depends on the reason for you not to be able to give birth. It may be that the problem will occur, causing difficulty again.

Speak to the consultant about the reasons and the likelihood of a repeat performance.

@Hadalifeonce
“Not to be able to give birth” nice. I’m pretty sure she gave birth if a baby came out.

My VBAC followed CS for breech baby. I was 9 days overdue, consultant wanted another ELCS but I had hated the one I had had and had a vaginal delivery with my first. He agreed to a half dose of Prostin if I agreed to an epidural (in case of rupture) and constant monitoring. Prostin and epidural went in at 9.30, waters were broken at midnight and dd a back to back baby was born after three pushes at 5.30am. It was probably my easiest birth and I didn't feel one contraction.

@Hadalifeonce at 4cm I was put on a drip and given an epidural - this slowed labour right down and I stopped progressing (probably because I was flat on my back!). I was so exhausted after 24 hours with very close contractions and constant vomiting from pain (and only paracetamol that I couldn't keep down) that I did whatever they said.

We saw the consultant midwife some weeks later and they had no explanation why I failed to progress. I believe had I had the chance to use just gas and air, once I'd gone up to the labour ward, recover a bit then move around, things would have turned out differently.

@Waterdropsdown yup, it definitely did!

@fleshmarketclose thank you. I'm going to push for what I want. Having the information is key. I was so ignorant last time.

I’d second that it’s definitely worth speaking to a consultant midwife.

In my trust a VBAC on the midwife led unit is an absolute no go due to the monitoring and that is a hospital where they are side by side. I know it took about a minute when I got transferred from the midwife led unit to delivery suite with my first.

It’s hard because you can’t really criticise the hospital for wanting to minimise risk - but equally as I was recently discussing with my midwife that stance perhaps makes more women say they want a home birth which is quite probably even more risky in the context of VBAC.

I would look at what facilities your local hospitals have. Most are willing for you to adjust your delivery suite room as you wish (there are some great videos online of how people have done this to make it much less
clinical), wireless monitoring should also help, but some also have birthing pools so it’s worth seeing what is potentially available.

Not had my second birth so can’t help with that part. Have you looked at hypnobirthing (I did it at home with a book/tracks). I think it was hugely helpful, I had a great labour with my first even though I had to be transferred to DS due to meconium in waters and even though I ended up with an EMCS it helped me through that as well and I’ve gone back over it again this time in the hope it will help again.

Did your waters break at the beginning of labour?

@DinoMamasaurus I'd thought it would be a flat no way but the monitoring options available give me hope.

@ShowOfHands yes, and that's why I was put on Syntocinon, but being in that position again I would want to do gas and air for a couple of hours before induction as I think it would have made the difference. DH is medical he says the same, and we both wish they'd had gas and air in the downstairs wards it would have saved me a whole lot of rolling around in my own vomit! I know they still don't have it, so I'm focusing on the things I can influence.

I had a VBAC with my second and was 39 and was told all sorts of reasons that it wouldn't go well. I went and found the head midwife at the hospital and she took over my care and delivered my baby. I had a postpartum hemorrhage and almost bled to death but that was unrelated to it being a VBAC, but it was good that I was in the hospital and they whisked me up into theater as soon as I started hemorrhaging although it turned out to be that my uterus wasn't contracting quickly enough and was solved with a shot of something. So it's possible to do and have it well managed.

However, having said all of that, if I had it to do all over again I would have had an elective CS with both my children. It would have saved me months of recovery and pain and PTSD from the labor and trauma. The CS portion of my first delivery (40 hrs of labor followed by an emergency cs) was the easiest part of it and the easiest part to recover from.

Sorry, make that years of recovery from the tears and stitches and PTSD.

OP, I had a home vbac with support from the community midwives and it was fine. First labour went on forever (51 hours from first contraction, 17 hours active labour, got to 9cm on syntocinon but DS's head was stuck so ecs with a spinal block). I had the same feeling of failure that you describe, it took a long time to get over.

Labour with DD 3 years later was a dream in comparison- 4 hours active labour, into the birth pool in the living room for the last bit and DD was born in the water.

That was 11 years ago now and obviously support is very variable depending on where you live, but that was my experience. At that time, research suggested it was very slightly safer to vbac at home - not sure what it says now.

I tried for a VBAC after a 24 hour induced labour and EMCS with my first. I went in much more positive and dabbled with a bit of hypnobirthing (although I'm the most cynical person ever so it wasn't great for me) and that seemed to help me get through the first few hours of labour.

Unfortunately I got to 10cm and had to have a super EMCS as the baby was stuck in an awkward position, which was exactly the reason for my first EMCS!

So I think a lot of it depends on the reason for the section in the first place. I met with a consultant twice during pregnancy and was told a VBAC would be fine because I'd progressed well first time round and the issues were related to the baby's position. However it seems my pelvis shape just pushed babies into awkward positions!

There are some good vbac Facebook groups. I found threatening a home birth opens up more options. Remember you have to consent to everything. I will not be having a cannula during labour and will only have continuous monitoring if it’s wireless.

I found asking for a copy of the hospital vbac procedures useful as I know what they want and can think about what I will consent to.

Have you spoken to maternal mental health services about your feelings of ‘failure’?

I was in a similar situation having dd - had had section under ga with ds and really didn't want to go there again. I tried vbac, but to be honest my attitude was 'I'll give it a go but the moment anything doesn't go exactly to plan I'm having a section'. I did start labour naturally but stalled at 7cm and asked for section at that point. I'm glad I did, as I was at least conscious this time! but I'm also glad I gave it a try, as getting over sections is no fun. So I'd say, give it a go, but don't get hung up on it, expect it not to go perfectly and have your plan B.

My first birth was similar to yours, induction, being ignored as it never works first time apparently so I was upset at the very start thinking that I was just getting pains from the pessary. How the hell would I cope with contractions?!

Eventually given gas and air that made me vomit on every contraction but not in right frame of mind to put the 2 things together! In birthing pool, got out at 2 in the morning and was 7cm. No encouragement at all, thought I was doing really crappy so had pethodine which more or less stopped everything. Went until lunch time the next day, pushing for several hours but she was stuck and getting distressed so had epidural, failed forceps and suction, then emcs. She then went on to have fits due to the trauma on her little head. In hospital 10 days. Felt a complete failure and out of control. Had PND.

2.5 years later had vbac with my son. No pain relief as I needed to feel in control. Used breathing techniques and gave birth vaginally. It really bloody hurt but was such a better experience. Born at 2 in the morning back home by afternoon.
7 years later I had my 3rd vaginally too, again no pain relief apart from a hot water bottle! Had to be constantly monitored for her heart rate and not in the midwife led unit. Found this one more tiring, perhaps due to being older at 38? Did hypnobirthing. Was lots more discouragement this time to have a vbac, they definitely pushed for me to have a section.

3 years later I wonder why I chose to do the second and third births like I did? I think I felt such a failure and so guilty after my first that I just had to. I was offered elcs but turned them down mostly due to the longer recovery in hospital (first experience was horrendous, hideous unsupportive nurses) and wanting to prove I could do it. I can now see that a elcs isn't failing, as long as you're both healthy then that's all that mattered. But on the other hand I think it helped me put my feelings from my first birth behind me.
Good luck in what ever you decide to do.

Have you asked for a tour?

I’m consultant led, and can’t use the midwife led unit, but the delivery suite is set up in a very similar fashion and still has all the mood lighting/birth pool/aromatherapy/etc options alongside the more medical stuff that might be needed.

The main difference (beyond all the good life saving technology) seems to be you get transferred to the ward afterwards, while if you are midwife led you stay in your own room until discharge.

My waters broke first and labour was 31hrs with a lot of intervention and a crash cs after a failed venture and failed manual rotation. I haemorrhaged and we both sustained injuries. I felt a lot of guilt, robbed of the moment of birth which I don't remember and ended up with PTSD.

It took me a lot of time to have a second and like you, I wanted a healing vbac. I wanted to do it "right". Thankfully, I had some birth trauma counselling and debriefing while pregnant because it became clear that I was setting myself up for failure. I'd decided an emcs was the enemy, hospitals were bad, intervention was giving in.

The obstetric consultant who did my debrief was fab. He explained that waters breaking first were often a sign of a poorly positioned baby ie the waters break because they're lying oddly not because you are labour ready. He said in my case, the long labour, uncontrollable pain, back to back contractions etc all hinted at the same thing. The lack of descent and intervention at the end was inevitable. It was all decided long before I made in-labour decisions iyswim.

It was like a lightbulb going on. I'd been so wrong. I kept telling myself that bodies know what to do, nature should have been allowed to do what it needed to do, I gave in to intervention and didn't trst my body. NO. If the human body can take over in a war zone and birth babies, then the fact mine couldn't do it with medical assistance in a first world country meant the total opposite. It couldn't do it full stop. My baby was malpositioned when labour started. I didn't do that. It was just chance and I spun a narrative of agency and failure across it.

I realised that I truly had no choice. I planned for every outcome and positively. I researched calm, positive caesareans. I discussed different options for interventions. I stopped seeing it as a good vs bad scenario and accepted that I couldn't choose the birth I wanted but I could make choices along the path I was given. I forgave myself.

At 37 weeks pregnant, my waters broke out of the blue and I knew I had another malpositioned baby. I gave it a go anyway. Water, hypnobirthing, staying mobile etc but DS didn't descend a millimetre. After 38 hours of labour, I had an emcs. But I laughed, smiled, dh watched the surgery, we had skin to skin and bf immediately. The surgery was calm and joyful. It was a really healing experience.

I can't give birth vaginally. My babies were 7lbs and 6lbs respectively and I had all the medical help the 21st century can offer. I grew and birthed them a bit differently and it wasn't a failure or second best. Truly.

You might have a vbac and put all this anxiety to bed but please go into it knowing that there are myriad physical routes to motherhood and they are not a hierarchy.

show interesting what you say about waters breaking as I have long and hard labours where my three sisters have babies quick and easy (born in the ambulance and on the way into the labour ward, no pain relief, no intervention and no stitches etc) Each baby I have had (outside the ELCS and the VBAC that was induced with prostin) my waters went first and then needed syntocin to start contractions. Where my sisters' contractions start naturally and waters go just before baby is born.

I am a midwife, had an emergency CS at 9cm first time then 3.5yrs later had a VBAC.
I was induced at 39+4 due to acute polyhydramnios, likely late onset diabetes. First baby was 10lb 5oz and this one also looked big. I had process pessary in on the Friday evening, I contracted all night, it fell out at about 8.30am on Saturday and I had my waters broken at about 11am. I had an epidural around 2pm and was 4cm at 3pm. Fully dilated at 9pm but hardly contracting a at all so I requested the hormone drip to get some more contractions going. Started pushing at 11pm, normal birth at 01.07 on Sunday morning. I did unfortunately have a 3B year and lost 2.5L of blood mainly from my tear, he was 10lb at 39+6. I am happy with my decision for a VBAC and considering another for number 3 when ever that happens.

Speak to your consultant midwife at your trust and come up with a plan for your VBAC. There are new NICE guidelines which won’t have been implemented I suspect in majority of units as it’s very new guidelines but it says that VBAC who labour spontaneously with no other risk factors do not recommend continuous monitoring anymore. Our birth centre does take VBACs if they have a plan made for this, but this will be more routine once our local guidelines change.
PM me if you want a more personal chat

Thank you for your stories, so much food for thought. We did sign up for 'counselling' after ds1 but this turned out actually to be a senior midwife going through my notes and telling us their version of events. They weren't interested in my feelings.

DH is dead against a home birth, as a paramedic he's only ever seen home births that go wrong and is dead against it. I wouldn't push him on it. These accounts do give me lots to base questions on though. Glad I asked you all.

That sounds like birth reflections rather than counselling. I found birth reflections helpful but only because I had counselling and because the consultant and midwife apologised for some of my treatment and make plans to change the policies on the ward.

I haven't heard of birth reflections. Counselling was their term for it.