Is this normal procedure re VBACs and elective sections? Confused!

[sallycinamon]

I went to see my mid-wife today (I'm 32 weeks)for a routine appointment. I told her that I'd made my decision and was going for a VBAC. I presumed that I'd be allowed to go over-due and if I still hadn't had the baby by 10-12 days over they would give me a sweep or two and if that failed I would have a c-section. (I appreciate the fact that I can't be induced - scar rupture etc.) This seemed like a reasonable plan - at least I would be giving myself the chance to go into labour naturally. How wrong I am! It transpires that what actually happens is I get a sweep at 39 weeks and if i still haven't had the baby by my due date I will automatically be booked in for a section around that time. This seems ridiculous. Provided me and the baby are fine why can't I be left to go overdue like a first time mum? What's the rush? I am unlikely to have this baby early - my first was 10 days late - so it seems i have to resign myself to an elective c-section.

I thought they were trying to bring the c-section rate down and VBAC rate up. It doesn't seem like it to me.

Sorry to rant on but I just wondered whether this is standard procedure. Perhaps I have been a bit naive.

sallycinamon you don't even have to book an elCs at 41+5.... you can opt for Expectant Management and wait for spontaneous onset of labour. While you're waiting you will get daily or so checks of baby, placenta and you. While all is still well you can continue to wait. If a genuine cause for concern arises then you can make an informed decision. Would this be an option you would consider?

hearing anyone use words like 'allow' when speaking about a mentally competent adult and her own body makes me clench up . a sweep at 39w is a ridiculous idea - will probably be v. uncomfortable and completely unproductive unless you're ready to give birth (in which case it'd be a waste of time as things will start naturally anyway). you can ask the mw for the research evidence that backs up this advice and watch her squirm

Sally, never forget that normal gestaion for a human is 36 - 42 weeks -by the time week 42 is up 97% will have had their babies .An interesting quote i got from somewhere re: induction policy, when aske why he booked inductions at 41 + 5 , an eminent obstetrician said 'well if we wait until 42 weeks, they'll all have delivered' [insert Huh??? emoticon]. BTW is the growth scan because of small for dates? - if your 1st was small and you and OH are on the slim petite side, I'd be asking if that is the reason. Scanning for placenta site is a bit ?? they should know from your anomaly scan and unless it's very low and anterior, there's no need for that.

Yes Klaw, 'Expectant Management' sounds like the way to go.

Jamila, can't believe that Obs's stupid comment! Yes, scan is because I'm small for dates and to check placenta has moved since anomaly scan.

Another question - when is the optimum time for a sweep? I'm thinking about avoiding one completely now as I'm wondering whether it was one of the reasons why my first labour was so long and resulted in an emerg c-section. Could it have artificially got things going when me and dd were just not quite ready? I think I'd prefer not to be fiddled with at all! Can sweeps do more harm than good?

glad you're going for expectant management, very sensible

my personal belief re sweeps (not really backed up with any research though!) is that sweeps can be the nudge your body needs to get things going if you were pretty much ready to go anyway. if you're not there, all a sweep will do at best is cause a bit of discomfort or at worst be downright painful and trigger off some weak and ineffective contractions that tire you out at just the time you need to be resting as much as possible.

I think whenever intervention is used to start labour, the HP's have a clock ticking in their heads.
I was given an unwanted sweep which resulted in my waters breaking and DS getting stuck- my body was no where near ready, I should have been going for a sleep, instead I ended up trying to labour sat in a hosptial bed with monitors strapped to me and no-one letting me eat or sleep - madness. They got impatient as DS was getting distressed and put me on a drip - it was inevitable to me I was going to have a section.
Ok rant over - I can't see why you'd want a sweep- just let things take their course as much as you can.

The way to give yourself the best chance at a VBAC is to do nothing which artificially starts labour and to impose no time limits on the length of labour as long as progress is being made - So no sweeps,no nipple twiddling,pineapple chunks,hot sex,castor oil eye of toad or wing of bat! patience is the key if all is well.

I would like to reiterate the point that the medics cannot 'make' you do anything you don't want to do they can only advise

I have had two VBA2Cs, each of them I went over my dates, my second by 17 days.

It is your body, you are in control.

Good luck, & don't let them spout this complete and utter shite at you

SM, I concede they can refuse to perform a section on you if there is no reason other than aversion to vaginal delivery.

The medics can only advise on monitoring, sections and inductions, until that baby is born it has no rights, the mother holds all the cards and just because the obstetrician doesn't want to perform an emcs in the middle of his golf game or at midnight does not mean that a mother has to agree to an elcs on her due date

{grin]

SM I did exactly the same, and when the scan came back with 6 days earlier than they said, I refused to accept it and just changed it on my notes.

My 2 siblings and I were also all at least 2 weeks late, one was over 3 , he is never on time now either

Starlight -- not necessarily (having to give birth vaginally). Although that's an extreme example...

Thanks for your views on sweeps everyone. My mis-givings about them have been confirmed Just putting together a bit of a birth plan and tend to think along the same lines as you Jamila. I don't want any intervention at all until at least term + 12, then I'm prepared to review the situation. No hot curries or sex for me!!

Sallycinamon - your plan sounds entirely sensible. I personally respond with: 'well that may well be your standard policy, but what we'll be doing is.....' when met with such claptrap from midwives.