ROT labour position be changed

[karisa282]

hi I’ve had two c sections s
first time I was induced at 39+3 as they said I felt “hot” I was actually just wearing a lot of layers , inductions. Failed and baby became distressed

second time I wanted a VBAC- my labour started naturally with contractions. I visited hospital 12 hours after my contractions started was that a mistake ? It’s about a 30 min drive could the sitting in car have changed baby’s position ..?

but no dilation past 3cm in 36 hours . Apparently there was meconium and they took me in for a section. I was angry as when I entered the labour ward they starved me and didn’t even let me have energy drinks which goes against the Nice Guidelines . I then had an epidural and was sick after some tablets they gave me and I’m running on empty so of course no energy to labour

anyway second baby turns out was in ROT position- was there anyway to fix her position in that case?

It's very difficult to say whether you sitting in a car for 30 mins had changed baby's position- baby could have been like that for a while or just moved. Did your community midwife tell you what position baby was in during your last appointment?

Many women have to travel that distance in a car in labour so don't beat yourself up about that causing the position change as it seems unlikely. You can in theory fix an ROT position but it's not foolproof and harder to do in labour when you're contracting and all your uterine muscles are tight. Spinning babies website details all the exercises you can do to encourage baby to change position but there is no guarantee they will.

Definitely difficult to deal with labour when starved, but the NICE guidelines are to be used for 'low risk' women and staff have to assess each patient individually. Having previously had a section places you out of the low risk category and is often hospital policy that means that you should remain on clear fluids only. That said, you should be offered IV fluids that contain electrolytes to replenish your system. I'm surprised you didn't have these alongside the epidural.

I'm sorry you had a negative experience, but it doesn't sound as though you could have done anything differently- did they offer to send you home after you initially came to hospital at 3cm? Or was there already meconium in your waters?

Hoping you are recovering well and baby is ok.

I was just wondering when labour is not progressing if there are any positions to make baby get into the best position
I was told baby was head down 3 days before when I had the sweep
so to find out was actually ROT during labour is surprising

ROT is a head down position.

Yes ROT is head down, it's not necessarily a position that stops labour progressing normally but can make it slightly harder as it is not the smallest part of the head that is trying to pass through the pelvis first. Often the labour contractions themselves reposition baby but there is no one size fits all answer unfortunately.

Hi, midwife here. Have a look at the spinning babies website for some advice.

Have you had a debrief with a midwife/obstetrician? It sounds like that may be helpful for you to talk through some of your questions/concerns.

Hi I wil check it out
after 32 hours of pains I was 3cm dilated and they decided on a section
but I may have just been in pre labour

as im pregnant currently ( my story is 4 years ago) is it advisable to wait at home when pains start for 36 hours at least as it seems hospital just slows everything

as im pregnant currently ( my story is 4 years ago) is it advisable to wait at home when pains start for 36 hours at least as it seems hospital just slows everything

There isn’t a set time to wait, it depends on how close your contractions are. If many women waited 36 hours they would end up having a baby at home!

What jumps out from this post and your OP is you think you need to wait a set number of hours after labour pains begin. It's not measured in hours because every labour lasts a different length of time and you could end up with a BBA (born before arrival at hospital) which is dangerous especially if there are issues that might necessitate a CS.

You should have had advice (with all 3 pregnancies) about how to time your contractions and when to go to the hospital. It's usually when your contractions are a certain timing (unless you have a complication like polyhydramnios, which I did, which is why I can't remember the contractions timings for when to go into hospital, because my own birth plan from the hospital was to go in as soon as my waters broke which was 17 hours before my daughter was born and that was after I refused to show up to the CS they booked me that I didn't want).

It sounds like you really want a VBA2C and I hope you get it, the best thing you can do is learn as much as you can about labour and delivery so you know when to make the decision to go into hospital, what to do in early labour to get the baby positioned ideally (if possible, it's not always possible to reposition a baby which is why I ended up with a CS with my first). I recommend YouTube channel Sarah Lavonne as she's a qualified labour and delivery nurse in the US and also a doula, and she has really accurate but woman-centred advice: https://www.youtube.com/@sarahlavonne

I totally get how you're feeling BTW, I felt like this after DC1 when I ended up with an unwanted CS that I still think would have been unnecessary if they hadn't been so silly on the induction ward.

I feel like I need to clarify as it sounds contradictory in my last post, when I went into hospital for induction I had a scan earlier that day that showed baby was perfectly head down and cephalic (as all scans since 28 weeks had also shown), engaged and ready to come out, and when they left me on the ward for 5 days without getting on with the bloody induction, the baby moved to oblique lie and had to be delivered by CS.

Surely getting baby out in as safe a manner for you and baby is the main thing? You've needed intervention twice, as did I but my 3rd was as natural as you could wish for, textbook. But then I never had birth plans, juat rang the hospital when contractions were sufficiently painful and close together. Good luck.

As PP have said, there is no set time to wait. It is generally to call maternity triage when either your waters break or you are having regular, painful contractions 5 minutes apart (3 in 10 minutes). If you did go to hospital and they classed you as in early labour, you could ask to go home for a bit depending on distance or go for a walk as being upright and mobile does help labour progress.
This is just generic labour advice, your midwife should give you advice in your specific situation with what to look out for and when to attend hospital.

have you had any conversations about planning delivery for this one with your midwife/obstetrician? They’ll be able to give you a sensible idea of the likelihood of a successful vaginal delivery after 2 sections if that’s what you’re interested in. If you decide it’s a sensible option for you then they’ll be able to advise you about when to go in etc.

You could have given baby more time to get into a better position. If the hospital was pushing for you to have a c-section you could have asked for more time if the c-section wasn’t what you wanted. Did you have continuous monitoring and where you able to be mobile during your time in hospital?

Meconium doesn’t necessitate a c-section, it very much depends on the type, colour and consistency.

Each labour is different, waiting at home for 36 hours doesn’t seem like the best idea, unless you want a home birth!

I think home births are great btw, I think they give you the best possible environment for a straightforward brith.

So far as then starving you, you don’t actually have to do anything they say. Withholding something that a labouring woman’s body is telling her she needs really doesn’t seem very helpful.

Do you have the option of a birth centre this time? They might have a kinder approach

Imagine there won’t be too many birth centres attempting V2BACs.

how much more time would you have wanted to keep going after 36hrs contracting at 3cm with a malposition and a uterine scar?

@Greybeardy for as long as she wanted to.

It doesn’t sound like OP was well supported on the labour ward last time.

Nice guidance was updated in 2021 to no longer recommend continuous monitoring or cannulas for VBACs it even suggested that a water birth would also be appropriate for a VBAC. Suddenly a birth centre doesn’t sound so silly.

There is no evidence that maternal or fetal outcomes are worse because the VBAC is after 2 c-sections rather than 1.

Sorry - I meant OP wasn’t well supported last time

@PinkPlantCase it sounds like baby likely became distressed given 36 hours of contractions, presence of meconium and previous c section increasing risk of uterine rupture. Yes OP could have left it as long as she wanted to but if medical advice is to go for a c section then that it's hard to dispute.

I am unable to see the update on NICE guidelines that states VBAC is no longer an indication for continuous monitoring. Certainly in our trust our policy is that continuous monitoring is carried out- women can obviously decline this. Women aiming for VBAC attend a birth choices appointment and if women opt for water births or birth centre births then they are required to sign a 'birthing outside of guidelines' form to acknowledge the discussion taken place.

I am very aware of the effect intervention can have on labour and birth and agree in principal that women should be given as much choice as possible but advising someone on the internet to go against medical advice isn't a great thing to do.

I was having contractions every 2 min while at home but it didn’t progress the labour or dilation

I do wonder what makes some women have quick births in a matter of 3/4 hours
is being on all fours helpful ?
I did use a bounce birth ball in 2nd and third trimester but didn’t know if knees should be higher than hips
i also was very inactive as had spd and existing slipped disc in lower back and fibromyalgia