VBAC - how long do they let you try?

[Merlin]

Probably going to attempt VBAC with this one (ds1 breech, no contractions), so a bit scared as to what will happen. Have had a chat with consultant, which was really more her telling me VBAC was the best way and I didn't really feel she had much time to talk me, but am seeing midwife early next week to discuss further. But I'm wondering do they have a time limit in mind and if you don't progress quickly enough do they whip you down for a section? Bearing in mind this is basically a 1st labour, how do they know whether it will be quick or long? Any midwives out there that can help me so I can at least have a more informed chat with mine? TIA.

It's kind of more a question of how well you are progressing rather than the exact number of hours to be honest.
As a doula I supported 2 previous breech have a VBAC last year... both had longish labour (they started, stopped, started again)... both said they would have gone in much earlier in hospital if they had been on their own.... the secret of VBAC is to stay at home as long as you can as you progress better there.

Thanks Pupuce - I see what you are saying, but I'm petrified that I wont cope with the pain, so will want to get in hospital and get all the pain relief going! Although, contradictory to that I worry that being closely monitored (which is what I've been told will happen) means I'm going to be strapped to a bed and not able to move around much which also would be my worst nightmare!! I've only got 7 weeks to go - trying not to panic!!!

I was allowed to go for an 'offical' labour time of 9hrs 45 minutes with my VBAC - but (and not wanting to worry you) I WAS strapped up to the monitor for most of that as I had to be induced.

Would you consider getting a doula?

I'd do as pupuce says, and stay at home as long as you can, for mobility and progress.

I had hoped for a VBAC last time around, after a footling breech section for DS1, and my (independent) midwife was on for a home birth with very little intervention. She was only worried about monitoring when my waters broke without DS2's head engaged. (I didn't get my VBAC, but the section went fine, and he does have a huge head, and was facing the wrong way anyway.)

Which reminds me, do what you can for optimal fetal positioning in the run up to the labour! I should have done more ...

CAT me if you want and I can give you more details of what my clients did.

NQC - scuse my ignorance but what's optimal fetal positioning? Pupuce, thanks for the CAT offer, I am interested in a doula, just not sure exactly what they do.

Essentially, you want the baby head down (duh) with their spine outwards, if you see what I mean? So the arms and legs are towards your spine. This makes labour faster, as the crown of the head will come through first.

If you do a websearch for "optimal fetal positioning" they will talk about positions you can assume to encourage the baby to shift - largely it's a matter of being on hands and knees.

You can find about doulas on Doula UK website and my website for example. Doulas charge between £250 and £500 (trainees should charge expenses only so that can be very cheap).

Basically we are birth partners with experience of supporting women (and their partner) in labour! I am currently on call for a VBAC (and hoping nothing happens tonight as it is very snowy here!!!)

As for OFP - let me find you some links....

Here is more info on OFP

Pupuce - you're a star, thank you for the info, will have a look at those 2 sites.

Merlin
Good luck with your VBAC. I had one 3 years ago with dd2, after an elective section with dd1 for placenta praevia.

It's great that your consultant is supportive. I get the feeling that most problems come from non-supportive consultants, and midwives who are too scared to go against the consultant...! I also had a supportive consultant, and I got him to agree to write in my notes (in big lettes and sign it that I did not need continuous monitoring in labour as long as everything was proceeding normally and could be monitored at 20 minute intervals with a hand-held monitor. Bless him, he even agreed to let me use the birthing pool (for first stage only), although I didn't in the end, as there was someone in it!

At my hospital they had a 'theoretical' time limit of 1 hour for 2nd stage for first-time mums and 30 mins for subsequent pregnancies. I made sure that I made the point on my birth plan that I was essentially a first-timer, and I wanted my full 60 mins before they went rummaging around in there with the forceps . In the event I had a long 2nd stage of about 2 hours, but no-one even suggested any intervention, because I was progressing well.

My waters broke at around midnight, I was having painful contractions by about 2.00 a.m. I got to the hospital at about 6.00 a.m. and was fully dilated by 8.00 a.m. I used Tens at home and when I first went in to hospital. I was strapped to a monitor for about 15 mins when I was admitted, but then they took it off and I was monitored with the hand-held thing every 20 mins from then on. Because the pool was being used, I sat in the bath for about an hour until fully dilated. I had a few whiffs of gas and air, but that was all. I did the 2 hour second stage with nothing... but was in a bit of a trance by that time! Did it all kneeling up holding on to the head of the bed, and literally could not move once dd was born. They were all telling me to pick her up, but I could not move any of my muscles...!!!!

I wrote a VERY strongly worded birth plan stating my requests, and especially that I didn't want to be continuously monitored. I did agree to having a cannula put in and having bloods taken on admission, but actually I was much quicker than they thought I'd be in 1st stage, so by the time they got a doctor to come and do the cannula and bloods I was already pushing and they didn't bother! Result! (I hate cannulas - but I do realise that they can be a life-saver)

What has your consultant said about going overdue? I did quite a lot of reading on this and decided that I didn't want to take the chance of being induced, as there seems to be a much higher chance of scar rupture. So I got my consultant to agree that if I got to 42 weeks I'd have another elective section... but that he'd let me go to my full 42 weeks first. Thankfully not needed, dd was born at 37.5 weeks.

Hope this helps. My advice is to talk to the consultant (if you can) about the monitoring thing, and then write the strongest birth plan that you can muster. One midwife (the one who admitted me) did comment (in my hearing) that 'She's got this birth plan and it's VERY DEMANDING' but yah boo sucks to her I say (in a very mature way... ... I was the one in labour, not her! Everyone else was massively supportive and the whole experience was fantastic....

Good luck

Thanks Ellbell for your detailed reply - not sure if that's just put the fear of God into me more!!!! But it's interesting to hear different peoples stories. Having spoken with Pupuce, I'm going to investigate doulas too, cos I think one of the bigger issues for me is that there wont be a midwife constantly in the room with me, plus I wont know them, so a doula would be really reassuring I think. Anyway, will do some research - at the end of the day baby will come out one way or another!!! And when I go for scan in 4 weeks if it's breech the choice will be taken out of my hands anyway!!!

Hi Merlin, I attempted VBAC in Poole with DS, I found they definitely weren't in a hurry to whip me into theatre, in fact I was encouraged to keep going as long as I could. Can't post more now, DS is waking up, but if you want a coffee to have a chat, let me know, Delgirl has my email address or CAT me.

Merlin - I had a VBAC with dd after an emergency c-section with ds during 2nd stage (so I had already done pretty much the whole of my labour which I realise is a different situation to you). Anyway, I was continuously monitored but I had taken my birth ball into hosp with me - refused to be parted from it and dh had to carry it thourhg the halls - and I sat on that facing the bed, close to the monitor so I could put my head down on the bed between contractions. Seemed to work fine and m/ws were supportive of keeping me upright. Another thing I did was to ask the consultant to write on my birth plan that I be allowed an extra hour for the baby to descend the birth canal before "official 2nd stage" time started being recorded as we worked out that this had been the problem with ds whose head had not engaged before labour. In the end I didn't need it was dd was in a good position and came out very quickly, but it made me feel more in control and confident and the consultant's handwriting on my birth plan made the m/ws take good note of my wishes.

A friend of mine in your situation had a vbac last year - all went well and she had a mobile epidural as she had a tiny dose of the induction drugs to get things going after her waters broke. Worked well for her. HTH.

Hi Merlin - I had a VBAC just over a year ago - I had quite a long labour, stayed out of hospital as long as I could but was 4cm when admitted at 2am...wasn't 10cm until 8pm, then was allowed 1 hour pushing, before help in the form of a ventouse...the staff weren't in a hurry to section .
I was continously monitored in hospital which was quite annoying but i spent the first 8 hours sitting on my birthing ball and staying active.
I had a midwife continually in my room (which to be honest I found intensely annoying..I wanted her to go away so I could get on with it) A doula would have been much better as it would have been someone I knew rather than some dippy-type woman who gave me no confidence whatsoever.

Merlin

So sorry if I've put the fear of God into you... not at all my intention. My VBAC was definitely the best thing I've ever done!

I think it depends a bit on personal preferences. I like to have all the information at my disposal and fear not knowing what is happening or might happen. I was not worried about being on my own at all... but I know that I am a bit wierd in this. I didn't really care whether I had anyone with me or not - not even dh, tbh (though obviously I wouldn't tell HIM that and I was glad he was there for his sake)... But I do know that I am odd in that.

BTW a friend of mine who is a single mum had a doula and she was fantastic. I'd recommend it.

Good luck, and please don't worry... The key thing is to find a way to plan a birth that you are going to be happy with (and of course it may not go according to plan... but at least you'll be prepared).

Thanks, and sorry again for worrying you

Ellbell - you didn't scare me - i've done that to myself!!!! As you say it's down to personal preference - but i like to hear of other peoples experiences even if it's not what i would do!! Don't worry I'll still sleep tonight

Glad about that Merlin

For me, the key thing was not being strapped to a monitor. Like you, I had absolutely no experience of labour previously so didn't know what to expect, whether it'd be long or short or whatever, but I really felt that - long or short - I'd like to be able to do whatever I was comfortable with and not be limited by the constraints of the monitor. If there was one thing that, for me, allowed me to have a successful VBAC, that was it.

BTW... I am not totally oblivious to safety concerns... Had the midwives been at all worried by anything when they checked the heartbeat I'd have immediately agreed to going on the monitor, but I clearly remember the midwife saying at one stage 'That baby is the most chilled person in this room'... and she still is like that, amazingly enough! I just add this because I do have one 'friend' who more or less accused me of putting my baby's life at risk by not being monitored continuously or preferably just having another section

Good luck.

I wasn't trying for a VBAC (didn't want one at all, my choice, not trying to influence you for a moment) BUT I went into labour before my elective date, and was basically told I wasn't in labour and was left totally alone on the antenatal ward - they sent my dh home and wouldn't allow him to stay, and I was left totally alone, unmonitored, not looked after at all, and in absolute agony from 2am until gone 8am before they put me on a monitor and examined me and agreed that, um, yes I was in labour 3cm dilated and the fact that I only had pain in my back didn't mean it was 'only backache' as I was consistently told. Just posting this to say that the policy of continuous monitoring seems to go out of the window in a real NHS hospital, that I found the midwives very, very uncaring when I was in pain, and if I wanted a VBAC I would strongly recommend you have real support in the form of a birth doula or independent midwife, as being left alone all night in terrible pain was a truly awful experience for me, and the loneliness and lack of compassion from the staff was actually much worse and more traumatic than the pain - which was considerable and unrelieved - they gave me two bloody paracetamol!!! I was extremely upset by this experience - hence my recommendation not to rely on the NHS, but to get someone who knows what they are doing to help you. I was being asked 'are you in labour' and I kept thinking, 'how the f* do I know? I've never been in labour before. But it bloody hurts!"
I don't mean to put you off - but I don't want anyone to go through my experience.

I stayed at home as long as pssible and that really is a good thing to do. I went in at 8am and was 4cm. by 10.15 was ready to push. Pushed for nearly 2.5 hrs which was not impressed about. The midwifves (i had 3 in the room at the time) decided they didn't want to call the doctor because they wanted it to be their birth! Anyway after 3 attempts at a ventouse delivery I pushed him out naturally at 1.13 the following morning. It was a long hard day! I didn't really click with any of the midwives apart from the one I had when I first went in, but because they work in shifts I never saw her again.

Aloha and about your experience. Sounds awful.

Obviously with all these things, it's very much a question of luck... but I do have to stick up for the NHS and say that with both my births (elective section and VBAC) I couldn't have been treated better (apart from the ignorant midwife you dared to call me 'demanding'!)... and the first time I was in there for 10 weeks so I really got to know the place well...

Ooops... 'who dared', not 'you dared'! Must proof read my posts