Anyone out there about to VBAC or who has managed it and has any advice?

[hobnob57]

I'm 34 weeks and would really like a VBAC this time around.

I had an emcs at 40+14 after being induced and DD getting pretty stuck and going into distress. On hindsight, I had a pretty distressing time too since all of my wishes were ignored in the labour ward. Although, at the time, I was naive and trusted their judgements but I feel things may have gone differently if the continual monitoring was eased up a bit and I was allowed to move around and not be on my back on the bed. And the drip turned down (I felt I was on a 'timetable')

I've been trying to read up about VBACs on AIMS and got ever more apprehensive about my chances of having a good go at a low intervention labour. I spoke to my MW who arranged for me to see the head midwife at the hospital at my 36 week appointment instead of the consultant. She's quite up on VBACS apparently. She phoned and told me to come armed with questions and the appointment will last about an hour. My pg brain is struggling to hold anything of value at the moment, so before I go back to AIMS with my pen and paper, is there anything I should be asking that is obvious?

To be honest, rather than questions, I would go along more with an idea of what things I do/don't want and then discuss them (incl how to get them, given that they may involve deviating from hospital policy) with her.

For example, I am 37 weeks and planning a VBAC and things I am quite, erm, vocal about are:

• no CFM without specific indication
• no induction with drugs/ARM
• being able to move about and eat and drink in labour
• being able to go in the pool/bath/shower
• not having a canula

Things that the hospital are at pains to discuss with me are the risks of VBAC and that they will have a lower threshold than normal for transfering me to the high risk side/ performing a cs.

If you are aiming to have minimal intervention, the MW will understand why you want to do so. My aim would be to get her to help relay your preferences to the doctors and to make sure that whichever MWs are on duty whenever you come have been primed to support you.

That's kind of what I had in mind MrsH . DD's labour terrified DH and he is more apprehensive than me about the next one. I need to know there'll be someone there fighting my corner for me (he is more likely to ask them to section me just to get it over with!).

Out of interest, are you requesting no canula for personal preference reasons or to make it a less easy step for them to administer drugs that you don't necessarily want?

Personal preference really.
And I don't buy into the whole "get you prepped in case something goes wrong" thing. I can't help feeling that part of their desire to do that is in case their staff fail to notice that things are going wrong or fail to take appropriate action. To me it is a sort of extension of the inappropriate CFM I had last time (where they left me for an hour at a time and then came in and looked at the print out and left again). I would rather have appropriate care instead of collective arse covering...
Plus I will have an IM with me who says she will insert a canula if things start to look hairy, so that is fine.

I had a vbac. I was very vocal about active labour. They kept me on monitor but it was telemetry so i could move around. Didnt have a canula and was in family room which is fantastic. Not induced and had active labour 8 hours. Ended up with epidural right at end as ds2 was back to back (again) and extremely painful. By the time they examined me I was 10cm.

Felt very proud

That's amazing squiglet, and so good to hear that it CAN work and that appropriate care and intervention levels ARE possible. You must have floated for days

MrsH - having an IM must really put your mind at ease. Like I said, I won't have that luxury and I know that no matter how much I prep DH he will crack to medical opinion so I'm really hinging all hopes on this MW meeting what we'll both attend to set out what should happen.

I spoke to a friend today who ended up with another emcs after her hoped-for VBAC. She was fully dilated and had got to the pushing stage but baby went into distress. Her (mum's) HR went up anytime any consultant came in the room. They said the head wasn't engaged. The MW said it was. Then her temperature went up. She felt it was because of the gown because it was making her bright red and itchy, but this got ignored in favour of investigating other causes. Baby was in distress at that point and led to her emcs.

As we all have done, in hindsight, she feels that things may have turned out differently if the MW was listened to and that she was able to change out of the gown. Who knows really, but I'd rather not have any 'what if's' and be allowed to go with that feels right. I'm so encouraged by your active birth Squiglet.

It's just so difficult, isn't it?
We all have ideas about wanting a hands off approach but when push comes to shove for most of us, if a doctor says we need something, it is bloody hard to say no.
Do you have the option of giving birth on a midwife-led unit? It might be a bit easier to get what you want.

hobnob57 - I had successful VBAC with DS2 and had one of these kinds of chats with head MW at my hosp. at about same stage. Was good - She admitted that they'd mismanaged first labour (apparently you should never let a sun set more than once on a labour - well it set twice on my first as they wouldn't let me in the bloody hospital cos I was't in 'eatablished' labour. It all ended up up with section and lots of blood loss but thankfully a live baby).

Anyway I got her to write on my notes that a) I could come in when I wanted b) I was not to be sent home without being examined by a registrar and c) that they wouldn't let me labour longer than 12 hours if I was getting nowehere without intervention - I was principally terrified of another lonely 50 hour labour at home again.

My VBAC experience wasn't too fab to start with-left in the waiting room for 1.5hrs whilst contracting every minute so no foetal monitoring as I had specifically requested as they were too busy. When they did see me I was 8cm and too late for any pain relief but that said it was the most amazing experience of my life and I'm so glad I had the courage to do it. Felt like I'd climbed Everest afterwards and all the right hormones kicked in this time unlike with first. Just keep 'upright, active and mobile' - that's what Lulumama advised - I chanted it all the way through my second birth

Well done Jojo! Although again not ideal. It's good to hear that the MW at least allayed some of your fears before you went into labour. I'm looking forward to being able to look forward to this birth!

hobnob, something else that i drummed into my head is that i'd give it my absolute all but if emcs was needed to keep me and baby safe then i was prepared. With ds1 I ad no idea what to expect. I think having that in my head helped too. Despite having had a vbac if we have another i will not be trying for home birth as ds2 wasnt breathing when he was born and apar was only 2 and needed resuss. V scary. His heart rate was dropping and as i was fully dilated thy were going to use ventouse but i managed to push him out without.

I think having a good relationship with the mw really helped too, she really listened and dp was with me throughout. Albeit snoring on the sofa for some

I've had 2 vbacs, one was a hbac. my advice would be to read up and ask questions so you can decide yourself what interventions you are happy with. remember that they can't actually 'make' you do things - they just phrase it that way - in fact it is all advice which you are free to ignore.

i decided the best way to get my vbac was to labour at home as long as possible and refuse cfm. i turned up at hospital 6cm dilated and ds2 was born about an hour later. i refused cfm but did the last part of the labouring on the bed lying on my left side which I was happy with.

with dd I had a doula for the birth - would also recommend this or briefing your partner thoroughly on what you are happy with

but morocco without the fm we wouldnt have known about ds2's heart rate and they wouldnt have had the whole team on standby. I was really anti lying on my back with monitor strapped to me, but they had a telemetry set so i could be active.

I plan on refusing CFM, but have been told that during the second stage they still listen in using a hand held monitor after every contraction. So it is not as if decelerations would (or rather should) go unnnoticed. Anyway, I'm no expert but what you describe (Squiglet) sounds like something that could happen to anyone (not just someone having a VBAC) - is that right?

that's kind of my point though squiglet - you need to make your own personal decision about what risk you're happy with. I decided I preferred intermittent monitoring with handheld (and know people whose baby sadly died due to staff not actually bothering to read the screen on the cfm machines - not a vbac labour though). laoburing at home til an hour off labour means you don't get to be monitored at all til the end - it's not a risk free decision in itself.

Yes, what happened could happen to anyone. Am just glad i was being monitored. It only happened towards the end too, so i expect they'd monitor then anyway. It was very frightening to experience though so hence we will be opting for hospital the next time.

Thanks for the stories, there's lots to think about. I'm so glad I get to speak to someone about this in advance because last time I asked for lots of things during labour/induction and got summarily ignored (telemetry monitoring, a birth ball, no drip, etc.). I'll be stronger this time!

Oh no, I know nothing!!
I had emerg CS last time and was just casually thinking, I want a VBAC.
You girls seem to know so much about it.
I have NO experience of labour. My waters broke and I bled straight away. As soon as I arrived at hospital I was taken straight into a emerg CS due to blood loss (placenta was covering OS slightly).
I hadn't had as much as a contraction.
I know nothing about drugs or moniters or anything.
We don't get antenatal classes here for 2nd babies so I will get no reminders of how things worse.
I don't even remember what a swiss ball is for FFS!
I have an appointment for a scan and high risk clinic in 2 weeks. Just to check out placenta again as it is anterior and was low-ish.
What should I ask? What advice would you VBAC(ers) give in relation to what to do/what not to do?
Ive been told that if I have another CS I should not have a third child due to risks involved so if they suggest a CS at any point I will panic.
Im scared even the thought of this hanging over me is going to have me too tense during birth.

Sorry - Im nearly 27 weeks.
Also 'how things work' not 'worse'
See, panic typing, Im a wreck!

Good luck, do not be afraid. You are lucky to have a positive midwife. Had two vbacs.

One with all the awfulness I didn't need (monitoring, lying on the back etc) and one without, very mobile, all fours and so on.

What they had in common was no epidural.

My advice would be: stay at home as long as possible, longer than you think you can stand it.

Every time you think a doctor is coming to check you in hospital, go to the loo so that you miss him/her. The midwives are more than capable. Doctors start checking their watches.

Walk around a lot. Get rid of any electronic belt. Find a position and if it doesn't suit the monitoring, the position takes priority.

I am not a midwife or health professional : do run all this past yours! (midwife not doctor!)

I am not a midwife.