VBAC advice needed

[shellbear]

Had a horrible appointment with the midwife today at the Jenna - it's a world away from The Albany who were incredible last time but of course now closed down. I had planned a homebirth for my 2yr old but ended up being induced and with an emergency c/s at kings. Now due with number two end of May and I would like to try for a VBAC at lewisham birth centre - its new, midwife led and attached to the hospital if anything goes wonky. It feels like a battle already with everyone I meet so far saying I need to be on a ward and constantly monitored. Next week I have an appointment with a senior obstretrician and am trying to be armed with facts instead of emotive arguments. Of course I don't want to put my baby or me at risk of scar rupture but if everything is all normal come the day I'd like to try for a birth not attached to a heart machine for hours and hours unable to move. Any previous experiences or positive facts would really help. Shell.

[sillywoman]

Shellbear - I think Kings do special 'VBAC' workshops, maybe you could get onto one? I know it's not Lewisham (maybe they have them there too?) but the hospitals are interconnected, so if they don't have them at Lewisham I'd have thought you could go to a Kings one? Have no idea who to contact to find out more though - sorry.

My advice is persevere, don't be put off - it may just be that you got a duff midwife today. A good friend of mine had baby number 3 at home after baby number one was a c/s & number 2 was vbac - it's done more often than you might think.

[Smiler]

Not really got any advice, but good luck with it. It may be that they are more I was hoping for a similar birth centre / pool vbac at st helier (I moved out of ed when heavily pregnant) and after dicussion they said it'd be ok if everything went smoothly. but in the event I had to be induced on the ward ( and eventually had a second unplanned c-section) after waters went but nothing else happened for days. Even if you do end up on the ward it needn't mean being strapped to a bed and you can discuss what the options are at each stage, the hospital midwives were eager to help rather than tell us what to do as I feared they might!

I found a book called "blooming birth" v helpful second time around, it had a big section on vbac. Kings gave out vbac factsheets with helpful facts on risks etc.

Hope the appt goes well.

[ClareC]

Sounds like we should swap midwifes ;-)

I had an emergency caesarian and fell pregnant again just over 6 months later. I have no wish for a VBAC, actively want to opt for elective caesarian. I know that just because things went the way they did last time doesnt mean it will happen again, but quite honestly I don't feel at all as though I want to be in that position again, the thought of it makes me feel really tense and stressed.

The only way I would ever even slightly consider VBAC is if I could be guaranteed a hospital room and a pool - not feasible given pool's are always subject to availabilty, they dont let you in one until you are 5cm, the recommendation in this situation is continuous monitoring and then there is the small matter of me being statistically 4 times as likely to have a scar rupture given the second pregnancy was so soon after the first.

My midwife is not only not accepting my choice and trying to convince me to go for a VBAC but she also is encouraging me to do so at home ?!? Ive yet to see an Obsteotrician because she won't book me an appointment until we have " discussed it further" - so far our discussions have involved her trying to convince me against ECS and then not allowing me to put my view across or explain how I feel as "we havent time today can discuss later"! Always seems to be time for her to have her say though and pressure me. I don't think she has even seen my notes from my last birth so has no idea what happened.

I know it's not PC to not want a VBAC but to be perfectly honest, the situation is taking the shine off my pregnancy. Last time I enjoyed my midwife appointments, this time I dont look forward to them and they just upset me and make me feel stressed and not in control at all.

Its a shame because other than this issue my midwife seems to be a good midwife and I like her on a personal level.

Anyway, in a very long winded way, what I am saying is definitely pursue your wishes, there are midwifes out there who will encourage your decision, I am surprised you are experiencing resistance to be honest.

Good luck x

[Moos]

I had a VBAC at King's where they did insist on continuous monitoring, so did most of my labouring on the bed (once one was free: spent 3 hours in established labour on a couch in triage first..).

I wasn't all that pleased but it turns out the continuous monitoring was a very good thing when the baby's heartbeat started to be compromised during the final stage of labour, and an emergency team of doctors and midwives popped up like genies to deliver him quick-smart with the aid of ventouse.

Sorry, completely respect your view and preferences, but thought it worth sharing my experience.

[Mellors]

I had a big fight with Kings last time as I wanted a VBAC in water with intermittent monitoring (which they can do, but try and put you off). They wanted me on the bed, which I am sure is what slowed my labour first time and ended up in all kinds of intervention and ultimately a CS.

They were dead set against it (I got pregnant less than a year after my first CS), and tried everything they could to put me off, to the extent I felt my wishes wouldn't be listened to had I gone in in labour. In the end I hired independent midwives and did my own thing (pool birth, not in hospital, out nice and easy in 6 hours).

I'm on No 3 and want a home birth again if possible, and apparently King's have said I just need to go in and "sign the disclaimer forms". My Lanes midwife is highly supportive of it.

I think my feeling is a) I really empathise with you and b) stick to your guns - your baby, your body, your birth. Its hard to battle your way through it when pregnant and v emotional though! Feel free to drop me a PM if you want any more info.

[LeilahB]

I had a VBAC in November and it went really well - was intending to have a HBAC but I think I over-estimated my pain barrier and ended up admitting myself to Kings (where they discovered I was fully dilated and therefore couldn't have the epidural I wanted anyway!) Was with the Brierley who were great - my midwife there said that they have a couple of VBACs a month on average (a number of which are HBACs) so it can't be that unusual. Maybe worth giving them a shout to discuss?

[Ruth_Baldock]

No advice but I am right there with you. My vbac baby is due in July and was concieved 9 months post c-section. I had a pretty depressing mw appointment yesterday and I feel the same as you. I will be damned if I am tetherred to a bed being monitored and have an iv and be unable to use the pool/ move around.

Feel free to pm Me. Vbac misery loves company (actually not misery because I WILL birth my baby the way I want and th NICE guidlines can get stuffed)

[nunheadmum]

I had a real fight with No 2 as I was VBAC but determined NOT to be tethered to a monitor and stuck on a bed. In the end I got my way and managed to only have intermittent monitoring. (Noteably, every time I was monitored, things stopped - so I'm even more anti monitoring now!)

At Kings I spoke with Cathy Walton - can't remember her official title but she's fairly senior in the midwifery department - who was really good and gave me a lot of support. She explained why the monitoring is recommended but also pointed out the reasons why in my own case (and many others) there was limited reasons why it was actually necessary unless I wanted it.

I'd recommend you try and speak to someone more senior within the Lewisham set up who understands the reasoning and isn't just quoting recommended procedure and then be willing to quote them to others lower down the chain - it has good effect. I think the problem is that you will be going against NICE guidelines if you're not constantly monitored - but if you can explain that you understand that and would accept it if clinical reasons indicated that it was necessary, then you may find it's accepted more easily.

Good luck - I hope you get listened to.

[CFM]

I had a VBAC baby last July at King's. I felt really supported throughout the (long) labour process and never pressured to have a section, even when things were slow... Ventouse in the end, but still a victory! I would only recommend that you take your notes from your first labour to your obs appointment - it helps them understand what exactly happened and how best to support you this time. You can request them from the hospital, though it can take a while.

[Ruth_Baldock]

Would second getting hold of your notes- was your first baby through Kings? Contact PALS and they can e-mail you a form to request your notes. It costs about 25 quid, and if you collect them in person it can be a faster process. It took me 10 days to get mine and I lug them around to every MW appointment.

[snowboarder]

Shellbear - I was under the impression that none of the midwife led units will take anyone considered to be 'high risk'. Which is annoying, as those people are actually the ones who would benefit from a more relaxed approach I think! I am 36w and had a c section April 2009 with my first. I found both my nhs midwives and the registrar I met at Kings to be pro VBAC but yes, with lots of provisos re monitoring/length of labour etc. And the registrar in particular full of scare stories re scar rupture, which was nice.

The thing I have slowly realised is whilst you do not HAVE (ie I'm pretty sure they can't force you) to follow their protocol, I reckon it will be pretty hard not to come the time. SO I ditched nhs midwives and have gone with an independent midwife unit who are totally unphased by the vbac issue, supportive of homebirth if that's what you want, and who would accompany you into Kings if necessary and be your 'advocates' and help you make and stand by certain decisions. Obviously this decision has come with a rather large cost, but ultimately the care I am and will get in the post natal period whatever happens is far superior.

Now what is not helping my case is that my naughty baby is currently spinning and twisting around and hangs out transverse and breech. Thanks baby, get your head down! Scan on friday to chat further with the dancing one....wish me luck!

[nunheadmum]

My experience was that once I'd got it written in my notes by the consultant or senior midwife (can't remember which), that it had been discussed with me and I understood the issues and risks etc, it was MUCH less of an issue. Essentialy everyone is just worried about being blamed, if things go wrong - if they follow procedure, it's harder to blame them. But if you show you're taking the blame for not following procedure, they're much more cooperative.

In the end, despite my waters breaking 3 weeks early, I was left on the antenatal ward and pretty much ignored unless I asked for attention. No one really questioned the monitoring issue. And when I was monitored, more to check on progress than due to VBAC, I was allowed to do it standing up (although it is harder to get a good reading as the belt moves more).

Hope it works out for you.

[alieh]

Not sure if this is true, but I heard that Kings had mobile monitoring technology that can be used even in water? Must not be true if none of you experience VBACers have heard of it. Unless it is very new? I have my birth talk on Monday so will ask my midwife then. Interestingly, I am also 36 weeks with #2 after a section for #1 (breech) and there has been no talk of my having to see a consultant to hear about risks, etc. Maybe she will tell me that on Monday?

[Fidgetsmum]

My sister had emergency C-section for first child (face presentation and failure to progress) but her second and third children were both born at home, in a pool, with short labours (she worked hard to relax and prepare her mind and body for labour using hypnobirthing) and the support of an amazing midwife. According to all the research she did (and she did a lot) the risk of rupture is amazingly small, considering the fuss that medical professionals make about it all.

However, as my sister said, you have to be happy that if you, by chance, are in that tiny minority and things do go a bit awry, will you still feel sure you made the best choice to go for VBAC at the time with the information you had to hand? If the answer is yes, then there's your answer - go for it. If you think you may look back with lots of regrets that you hadn't made the right decision, then perhaps you need to consider a CS after all.

Not CS related, but medical opinion related... I recently had my second baby - my first birth was awful with long labour, ventouse, forceps, third degree tear and large loss of blood (and 1yr of recovery) Not surprisingly Kings were VERY keen I should be in hospital again (particularly because of the severe tearing and bleeding history) and made it plain to me on a number of occasions (making me feel like I was a bad mum for even considering anything other than a hospitalised experience). But I did a lot of my own research and got the support of excellent midwives (the Brierley) and had my baby at home, in my bedroom with a short labour, no tear and delivery of a large 9lb 14oz boy (I'm only 5'2"!)

So just because the medical establishment wear white coats (I know.. they don't nowadays, but you get my gist!) and bombard you with their own statistics, it doesn't mean they're necessarily right for you.

Check out homebirth.org - they've a great section on VBACs.

Whatever decision you make, just be sure YOU are happy with your choices. And good luck.

[nunheadmum]

I think I've heard of this a while back -but may just have been a mobile device to listen for the heartbeat, not full monitoring with readouts etc. But techology may have progressed as it was 2+ years ago.

I'd definitely make sure you ask as it's possible that they will simply presume that you'll be constantly monitored on a bed and not offer options unless you ask. I was the same, c-section for breech with no1 and it was agreed that with no other indications of problems (e.g. not c-section due to failure to progress or problems during the actual birth process) there was no reason to presume that there would be problems second time. Hence being aware of what to look out for regarding problems with the scar itself and intermittent monitoring was deemed to be sufficient.

I remember the NCT site had quite a lot of info on VBAC which I found useful - I have copies but may be out of date. But if you're at Kings and come across problems, do speak to Cathy Walton - I found her to be really helpful.

[alieh]

Thanks nunheadmum. I'll ask for more details about the mobile monitoring and update the thread, in case it is useful for anyone else. I feel lucky to have a midwife (Lanes) who is very supportive of VBAC, active birth, etc. so I haven't been thinking too much about the details. But maybe that will change after we meet to discuss in more detail on Monday!

[shellbear]

Thanks everyone for all of your advice and thoughts. Reading all this I definately think that I want to push for being allowed to give birth in the birth centre - although as you say snowboarder - they have a general policy of no VBAC. I did call and talk to a midwife there who said she would support me if the hospital let me try for the birth centre. I have also tried to sign up a bit late on in the day for the Lanes and Oakwood - who I know are far more like Albany. I think this being my second I didn't have the energy to try and sort out anything better than what the Jenna offered and I thought I was strong enough to stand up for what I wanted the birth to be. But actually after that appointment with a patronizing midwife who dismissed my wishes I just crumbled a bit and realised I just need some kindness, understanding and a level approach to the risks involved - and crucially a respect for the decision then made. Fingers crossed.

[ClareC]

Good luck, it's horrible when your wishes are ignored and there are attempts to push you into a birth you don't want! Seems ironic that those that want VBAC are given grief as are those that don't!!! Maybe the policy is to make anti natal care unpleasant so as to put us all off getting pregnant ever again ;-)

Out of interest, when you have had a C Section, when is it usual, ie at what stage of pregnancy, to see the Obsteotrician?

[Smiler]

Don't think kings has the mobile monitoring technology yet, or they didn't last summer anyway. Is shame.

[snowboarder]

I was told by the Lanes mw that they did have a limited supply. But then anecdotaly that they were 'not in operation' (?) currently. I would say don't count on it...!

[Ellena]

Hi shellbear,

Interesting to read all the posts. I had an emergency c-section in Nov 08 at King's, and i'm due to have baby no.2 in July. After a horrible birth experience, I initially thought only about elective c-section. However, I had a brilliant appointment a couple of weeks ago with Teresa Arias, Consultant Midwife at King's at their VBAC clinic on a Friday afternoon. I thought I was going to have a battle on my hands to argue my case for elective c-section again, but she listened amazingly to my story, went through my notes from my previous birth in detail (and photocopied them for me) to help me understand what had gone wrong, and didn't push me in the slightest. However, she talked about VBAC as an option in a really unpressurising way, and i've since decided to try for a VBAC.

However, for me, I feel the best chance of this is to have a midwife I know with me at the birth, in the calmest possible environment. I was lucky enough to be with the Lanes last time, but now out of area. Therefore we've decided to hire an Independent Midwife. It's an expensive option, but I have been so impressed with their wealth of experience in dealing with VBACS and the success rate they have. It also gives the option to try and have the baby at home, but that if we decide to go into hospital, they will come with us as a birth support.

I did phone Lewisham Birth Centre too, but they said to me that I wouldn't be considered as I had the c-section. Maybe you might have a different experience?

Also, I was told too by another midwife that the birth pools at Kings can be used for VBAC (if free of course!), and they do have mobile monitors, but apparently they are broken at the moment! We were also encouraged to argue for what we want if we do go into hospital- you don't have to have the canular (sp?) in your hand (in case of emergency) if you don't want it, you can say you don't want to be on the bed etc. We were also recommended to get all of your wishes written into a birth plan and put into your notes so that it's clear what you want when you get to hospital.

Anyway- just a few thoughts and good luck!

[Forgetful]

My wife had a VBAC and suffered a rupture. I wouldn't recommend a VBAC to anybody. Despite being on a ward at a major hospital with a heart monitor and one on one monitoring by a midwife, our son nearly died. He was not breathing at birth and suffered several seizures, which can be indicative of brain damage. He seems to have come through ok (though we won't know for sure for a while), but I think you'll understand if I say that it was a less than ideal experience. The highly experienced obstretrician who cared for us decided never to do VBAC again. Indeed, it is not done at all in most of the U.S.

To do it without monitoring or outside of a hospital is the height of idiocy. If something goes wrong, you do not have much time. If my wife weren't monitored (or wasn't in a hospital), she and the baby would be dead. It was all a blur to me, but I do remember the panic as the medical team raced to get the baby out, the baby being artificially respirated, the days in the ICU,,,,

Yes, a rupture happens seldom, but it is not worth the risk.

[sillywoman]

Sounds like there were other things at play with your wife & baby though Forgetful. A friend of mine also had attempted VBAC which ended when the scar ruptured. This was at St Thomas's - so also very carefully monitored. She said when it became apparent that this is what was happening (she could feel it, though it wasn't painful she said) there was a very calm transition to an emergency C/S. no panic, all very standard and both she and baby were absolutely fine and at no point did she feel either of them were in any danger.

Hard to know your full story Forgetful and it must have been very frightening, but it does sound like you were very unlucky - and that can happen in any kind of birth.

Just out of curiosity I'd be so interested too know whether that Obstetrician did indeed refuse to do any more VBAC's. I suspect he'd have trouble getting a job with the NHS if he really stuck to his guns!

Edited to add; that I think if you look into it you'll find that the reason VBAC is done far less in the US than here is down to the money driven Insurance base of their health care system. It's for that same reason the C/S rate in Brazil is currently at 80% - 90% in some places. Nothing to do with the safety of the procedure and the better long term & short term health outcomes for women & babies, rather to do with the ship-em-in, get-it-out approach to labour & birth. I'm sorry for your bad experience Forgetful and do sympathise, but It was just that - your experience. I'm just aiming to put it into some perspective before you terrify the wits out of all the family room readers!

[alethea]

I had a vbac at kings last april which I was really keen to have, they were really supportive, I had the mobile wireless monitor which worked okay but did keep slipping off my belly. They don't really monitor you till you are in proper labour. Because it kept slipping off I did end up on the bed and with ventose etc and the monitoring on the babies head.

I did have to have a canular just in case, even though I didn't want one but at the end of the day it probably was for the best.

I think it really depends on why you had the c section in the first place mine was because my son was breech so there was no reason why I couldn't try for a vbac. On the plus side I had a midwife with me the whole time and my own room etc.

It was a bit stressful in the run up to it as my daughter was 8 days late so I had to push to get them to wait before I was booked in for another c-section, I had that many sweeps it was becoming embarassing.

Kings love a vbac though, the midwifes called me to say congratulations as they knew how much I wanted one, it was a long labour and not quite how I imagined in the end but worth it.

Also re the pain relief, I was only on gas and air as my belief was that was all you could have 'they like you to feel the pain'!!! But depending on the time of your last birth they can give you an epidural.

Ax