VBAC advice needed

[kpjigsaw]

I had a VBAC at home 18 months ago thanks to the lanes who were incredibly supportive. But don't give up at kings - when i was deciding whether to go for hospital or home i had my consultant's appointment which was with miss penna who i think is one of the most senior people there, but before she came in another doctor (more junior) was taking my history. When i said i wanted a home birth this doctor told me i couldn't even consider it, i had to be monitored and more or less told me if i had a home birth i would die and my baby would die. Really freaked me out. Then the actual consultant walked in and found out what had been said and pretty much dressed this doctor down in front of me and told her "don't ever say anything like that to a patient of mine again". The consultant then earned my eternal respect by saying to me: "some doctors think their job is to tell you what to do. I don't think that. My job is to tell you what the risks are then you make a decision."

If one of the most senior people in the department says that you have the right to make your own decisions about your birth then the midwives and other doctors below her don't have a leg to stand on. Just keep on insisting until you get what you want.

[nunheadmum]

Just another view - sorry seem to be saying a lot on this one. Don't feel that the C-section the first time was somehow a poorer option and a VBAC will be the perfect option. I fought hard to be allowed to do VBAC and be unmonitored. In the end I had a bad experience (just poor level of service, baby was fine) and in retrospect, wish I'd had another c-section as that experience was far more positive.

Not trying to say not to go for VBAC - but be realistic and prepare yourself for the fact that a natural birth doesn't guarantee a good birth. Were I to do it again, I'd definitely get a private midwife/doula if I could afford it as I'm sure that would have helped so much.

[snowboarder]

Forgetful - so sorry you had such a scary experience and I really hope your little one is ok, but I think your post is unnecessarily alarmist - we have all done our research and aware of the risks of scar rupture. Accusations of 'idiocy' are rude and unhelpful. Indeed there are risks in ANY birth, it's just that the risks with a vbac can be more readily quantified.

The reference to what happens (or not) in the US is not relevant, yet, thank goodness. I watched the Business of Being Born last night - wow - interesting but it certainly exposes the US system as a terrifying example of what scare stories and the over medicalisation of childbirth can create.

[SBryan]

Not sure if any of you have seen it but this might be useful....

http://www.rcog.org.uk/files/rcog-corp/uploaded-files/PIVaginalBirthAfterCaesarean2008.pdf

[snowboarder]

I am finding the AIMS publication on VBAC interesting too...not available for download I don't think which is a shame, but see the publications list here...

[ad2000]

.. don't normally reply to threads, but this one is close to my heart at the moment. Due to have baby number 2, and at 37 + 5 days am plunging myself into the unknown. Finances have meant that hiring someone is out of the question and I am with the Peckham Way midwives. I would advise Shellbear to go and see Teresa Arias at KIngs or similiar - she was amazing and went through my previous hospital notes with me, took her time, really explained fully what my options were, what happened in the previous homebirth to emergency c-section birth of my son four years ago. I am so so so tempted to have an elective - this has been mostly due to hearing stories from friends who tried for VBACs and ended up with an emergency c. I really do not want to labour for 2 days as I did previously and end up in the same position. On the other side, many friends have had an elective and recommended the benefits that come with that. I also took a refresher NCT course and the teacher was amazing in giving me lots of practical advice. She did not judge me at any time for any choice I might make. I beleive you can ask for scans later on to check position of baby, there are upteen exerices you can do to get that good position, and Teresa showed me how to manage labour if you do need to be monitored. Still rather scared and unsure to be honest, but know that I can ask for help if I need it. Got another appointment next week and will talk about sweeps etc if I go to 40 weeks. Sorry for rambling and bad spelling - got the 'pregnant and not sleeping' thing. A very good friend pointed me in the direction of this link - http://www.becomingmother.co.uk/?cat=67 - I found the stories on it honest and refreshing.

Good luck with it all - I shall follow this thread with interest and let you know how I get on when my time comes. Thanks for starting the thread - all the contributions have really helped.

[buggie]

Have no VBAC experience to share, but just wanted to stick up for midwives/dr's wanting to put cannula's (the tap a drip is connected to) in before they are needed/even if they end up not being needed in "higher risk" cases

In an emergency (eg postpartum haemorrhage/shock), not only is there a huge amount of adrenaline pumping/stress/pressure on the healthcare professionals to quickly get access (as we call it), it is most likely that your veins will have collapsed making it v difficult (and in worst case likely a large needle would be bored into your shin bone to allow administration of blood/fluids).

Yes it might sting having it in, and yes it might feel awkward, but, if you were aware of the stress getting access into critically ill people/potential delay to treatment it can cause think it's an insurance policy worth investing in.

All power to those who have VBAC's though - always think of the case in the first series of "One Born Ever Minute" with the lady who had had CS due to failure to progress in her first labour and despite a rather useless hubbie (who was going to use his level 5 management training skills to help her during labour!) managed to have the birth she wanted 2nd time around.

[Forgetful]

Sillywoman, I must disagree. There was nothing else going on. A uterine rupture is a serious emergency situation. Yes, it sometimes may work out with a minimum of stress (as in your example) or sometimes it may not (as in our case). But it does require immediate medical attention. To say "that was your experience" is not really an argument. The point is that it could be your experience, too.

I stand by my belief that, while you may want to try a VBAC, you need to be in a hospital for it. Sorry, snowboarder, for alarmist language but I think that in this case the alarm needs to be sounded. Again, a rupture is a small risk (though greater than people think), but why take the risk of having one in a home birth situation? I think it is irresponsible (again, sorry if I am direct about it).

Here is another take on it.

http://www.birthstories.com/stories/complications-with-babies/uterine-rupture-and-vbac-why-take-the-risk-1358/

NB: as for the obligatory depiction of the U.S. medical system as a heartless capitalist system ("money-based"), let's not forget that the NHS is money-based, too. The difference is that access is simply regulated by the government bureaucrats, who are the paymaster. I've had experiences with both systems as well as with a couple on the Continent. The NHS can be just as heartless - if not more - as the others. Of course, the NHS is state religion in the UK so no use getting into a debate about it. And there is a huge amount of ignorance in this country about the U.S. system, fed by biased reporting.

[Emily]

Don't blame you for not wanting Kings. THe most evil people I have ever encountered in my life were the witches on the wards at Kings.

[littleEDfamily]

As Forgetful is someone with personal experience of a terrifying life threatening VBAC attempt, I think he is well qualified to give his perspective however he feels best captures it. I don't think it's any different to someone who has been lucky enough to have had a successful VBAC posting (as of course they would be entitled to) words of encouragement that may downplay the risks.

I have no particular knowledge of VBAC (but have learnt a lot from this thread) so won't say anything else except I wish anyone considering one and where to attempt it all the best with what must be a tough and at times confusing decision.

[Moos]

I feel I must add that my experience of the staff at King's was wholly different from that described by Emily.

They are professional, supportive and smart.

[ClareC]

I agree with LittleEDfamily, as lovely as it is to hear successful VBAC stories, it would be short sighted to go into it not understanding the risk involved and that ruptures do happen. There is very little information about this available and the stats on likelihood of occurence rather conflicting!

Thankyou Forgetful for sharing your experience.

Does anyone know what the 'procedure' is with anti natal care when your last birth was an emergency C Section? Is it standard local midwife care or should you be referred to an obsteotrician or other ?

[Moos]

ClareC, it's standard ante-natal care.

[ClareC]

Thanks Moos, do you happen to know in what circumstances you should see an obsteotrician / consultant midwife?

[CFM]

You can ask to see an obs or consultant midwife. I saw a very nice consultant midwife at kings who helped me decide and understand risks and benefits etc... I think it was around 28 or 30 weeks.

[Emily]

"They are professional, supportive and smart."

I think you mean 'lazy, cruel and thick'.

[snowboarder]

littleEDfamily Wrote:

-------------------------------------------------------

> As Forgetful is someone with personal experience

> of a terrifying life threatening VBAC attempt, I

> think he is well qualified to give his perspective

> however he feels best captures it.

Yes, of course, when it is about sharing experiences and hopes and information. As we all know birth is very emotive and I think some posts cease to be helpful and within the debate on this thread when they make accusations of 'idiocy' and 'irresponsibility' about peoples carefully considered choices and dreams.

Moving on (mostly!), I suppose it is all about weighing up risk, and it's so difficult to know whether actually one is in a more 'risky' situation at home. I believe a home birth can mean relaxed familiar surroundings, the ability to move round (therefore less risk of slowing down of labour, problems etc), have a pool/bath/shower, and the CONSTANT presence of one, maybe two midwives who will provide constant monitoring of various methods. And from east dulwich amazingly quick transfer to Kings if needed. Hospital can mean traumatic (car park, lifts, on own, blah blah) transfer whilst in pain, waiting around in triage rooms, no beds, no pool, relative immobility due to monitor belts, and midwives who change shifts and due to the all telling monitor, could leave you alone for half an hour or so. Eg poor pethadine lady on one born every minute. I do really hope that I'm not being naive in thinking that actually the speedier, better care IS at home, and it's not an idiotic or irresponsible decision to at least plan for a home birth whilst all seems well. I think the stats re c section scar rupture are a bit misleading as there are varying degrees of rupture, not all of which result in the very worst of outcomes.

Well. We shall see. I do really hope to report back with a positive story.

ClareC - I just asked my midwife to make me a consultant appt (at about 22 weeks I think - consequently wished I hadn't bothered as saw registrar type person NOT a consultant and she merely read from her rule book - however your aims are different) - anyway - good luck EVERYONE on their post c section journey.

[sillywoman]

Emily, You clearly had a very bad experience with the midwives at Kings, and I for one am sorry that you've been left with such a strong antipathy and bitterness toward them. However many, many new parents pass through their doors each year. Many of them will be reading this forum, they will be putting the lives of themselves, their loved ones and their babies in the hands of these professionals now or soon, and as many are first time Mums and Dads I think perhaps you might take a moment to reflect on exactly how constructive your comments re the Kings midwives are to those in your wider community. I think you've made it clear that because of your experience you now hate all Midwives with a fervor. As Moos post shows, many other people have had the opposite experience to you and feel just as strongly that most Kings midwives are caring, compassionate, intelligent & professional.

As an aside, in my job I hear many, many birth stories each year - over the last 700 or more I don't recall anyone having quite the antipathy toward the Kings Midwives that you seem to have. In fact in general most couples speak extremely highly of the care they received on the labour ward. So please, if anyone out there is about to have a baby at Kings, rest assured that Emily's experience of care there - whatever it was - is the exception rather than the norm.

[littleEDfamily]

Re: Kings midwives - it is like any profession, you get the good, the bad and the ugly. And I think you get (or appear to get) more of the bad and ugly in places, such as Kings that are very stretched.

Certainly the midwife who delivered my first baby was not a million miles away from Emily's description (I have heard Kings midwives I know casually share similar sentiments about her). But..... I have encountered more who were closer to Moos' description, so if we're playing an averages game, there is hope! As far as new parents are concerned, I think it is helpful to face up to the fact that you may get someone on 'the day' you really don't gel with, and make sure you are prepared to stand up for what you feel is right for you.

[Ann]

Moos, Sillywoman and littledfamily thank you for your posts . Emily's post would have scared the sh*t out of me if I was just about to have a baby. I wish people would remember that sometimes when they post here.

Sorry to say but Emily does seem a little embittered, check out her posts on The Local Schools thread.

This section of the forum remains very friendly, genuine and hugely beneficial to the local community. Well done all of you!

[Emily]

Sure, if you want people to laugh at you when you are in pain, go to Kings.

[Emily]

And yeah, attack the person rather than listen to the message. I wish someone had the guts to warn me what they were like.

[littleEDfamily]

Snowboarder - meant to add, I do understand what you mean about people calling you can idiot for pursuing a course of action you have carefully researched and considered. I know when I was planning a home birth, normally diplomatic people all but called me a crazy hippy. The one that really hurt was my brother in law telling me I was 'putting personal preference over safety'. Ouch.

[new mother]

I stand by my belief that, while you may want to try a VBAC, you need to be in a hospital for it. Sorry, snowboarder, for alarmist language but I think that in this case the alarm needs to be sounded. Again, a rupture is a small risk (though greater than people think), but why take the risk of having one in a home birth situation? I think it is irresponsible (again, sorry if I am direct about it).

(From Forgetful's post above)

Thank Goodness someone is prepared to say the truth. It is crazy to consider increasing the risks associated with giving birth.

Please please ladies, don't be taken in by lovely sounding stories of being at home with a cup of tea. Birth is brutal. We'd all prefer to be at home, of course. No-one wants to be stuck in a smelly hospital surrounded by strangers and scary medical equipment. You are closer to theatre though if anytyhing goes wrong, which it OFTEN does. Please please realise this. Birth is not coughing and having a newborn next to you for most women. You and your unborn baby MUST be near emegerencey care, JUST IN CASE. We all pray it isn't necessary, but it might be, and that possibility, however slight, should make mothers choose hospital.

[Belle]

It can be just as quick getting from round here to theatre NM as it can be in hospital. There are people who can vouch for that on the forum I think. The midwife with you will call ahead to warn you're coming in, and if necessary you'll go in by ambulance.

In the spirit of Ann and SW's posts (though about a different topic), please bear in mind some of the people posting here are very pregnant, close to birth, have made their choice having done their homework, and probably don't need to be berrated for it at this stage. I know it's a balancing act in the Family Room, and I believe in freedom to express different opinions, but since the original post began as a question about how to get VBAC (and actually asked for positive experiences), it was probably never that appropriate to jump in with 'don't'. I'd say the same if someone started a thread about how to get an elective c-section, it would be equally upsetting if people waded in with the rights and wrongs.