HBAC: What are the chances?

[Ruth_Baldock]

Righto. I'm 27 or 28 weeks pregnant (dates are iffy) and I am aiming for a VBAC. We had to go to Kings to visit someone today and I practically had a panic-attack. I really don't want to go into hospital for my second baby, but I feel if I bring it up with my community MWs (was going to change to IM after a few issues, then realised that we were stoney broke and...er...couldn't) that they'll refuse to give me homebirth cover.

There are some things going against me here:

1) I became pregnant 9 months post- first c-section.

2) I've had high BP in this pregnancy; last week it was bad enough that everyone started mumuring about pre-eclampsia.

3) I may be all talk, no trousers. If my MWs said 'NO! NO HOMEBIRTH FOR YOU! BAD RUTH!' I'd be likely to say 'Oh okay then...' rather than stand up for myself. Idiot.

Things going for me:

1) Baby is healthy

2) Other than the BP, I am healthy.

3) My husband makes good tea and sarnies, particuarly for hard-working midwives.

4) Er...

5) Oh yes, I remembered! I have a high pain threshold- lasted 20hours whilst being induced with no pain relief apart from tens towards the end and gas and air. Can't have pethidine or an epidural anyway, so couldn't 'reap' the benefits of being at Kings for them...The pain didn't bother me in the slightest last time...I mean, I was in a lot of pain but it didn't make me overly distressed (the lack of progress did).

However, if it all goes pear shaped like last time, I'm worried I'll end up in a similar mental state PP as I was with my son (not good; PND, awful flashbacks for months, etc).

So do I: Broach the subject of a homebirth with my MWs

or

Suck it up and possibly faint from anxiety when I rock up to the labour ward.

?

[ClareC]

Hi Ruth, I too had an emergency C Section first time round, I also fell pregnant again 6 months later... Eek!

I've opted for an elective C Section this time and am under the care of Leonie Penna. On a positive, Leonie advised me there is no evidence to suggest a higher risk of rupture in a VBAC due to the pregnancy being a short period after the first section.

On a negative, she also said no way to home birth and no way to water..... That said, my midwife was keen on both so it's not unheard of. Btw, the continuous monitoring facility for water is unreliable which may be relevant to your decision.

Good luck with whatever you decide.

[Ruth_Baldock]

I've also been told 'no way' to water and 'yes way' to continous monitoring; which I fully intend to decline, over and over and over again. I don't mind so much about not being able to use the birth pool, but I am damned if I am being tethered down again.

It's actually more risky than I've let on to most for me to opt for a repeat c-section because of the general anaesthesia. I had a reaction last time, and the time I had to gave a GA before that, was quite serious. So, I think my MWs reckon we're all stuck between a rock and a hard place. But the baby has to come out some way!

[ClareC]

Just a thought but have you thought about doing HFH at Tommy's? Def worth thinking about as you would have a non hospitalised environment but with the hospital side there should you need it.

[Ruth_Baldock]

I did ask at my booking appointment, but they won't take VBACs apparantly? I am not sure how realistic this is, but I do know during rush hour, it takes over 35 minutes to get there from our house too- not overly keen on getting a cab up to central london with a baby trying to get out :/ Also difficult for my husband if I had to stay overnight etc, as he'd be going from his parents (who will be living in sydenham by then) to tommys and back.

[ClareC]

That's a shame if that is the case, it's the ideal set up and I've heard Tommy's are very pro VBAC. I was concerned about time to get there too, as it was, it only took 15 mins as it was early hours of morning! No guarantees on that happening but I worked on the basis I could always go to Kings given their open door policy whereas had to be booked at Tommy's to go there. Not much help if they won't allow HFH though :-(

[Ruth_Baldock]

When did it all get so complicated??? I've said it before, I may just ignore everything and give birth in a cuboard, like a cat, with Mellors' experienced farmyard help. Cows/ humans, all the same- right?!?

[Helen GV]

you have nothing to lose by just asking, do you? and you could write down any points you want to make that back up your viewpoint/wishes...

(really sorry but have no relevant experience to draw on, just want to add my support!)

[Fuschia]

Contact Jill demilew consultant midwife at kings and arrAnge to talk it all through

She came to my house

She is really really nice

[Kes]

Certainly worth asking, it may also depend on the reason for the c-section last time and how likely it is to be needed again. St T's home from home is strictly low/no risk sadly but there may be something to be said for being at a different hospital, I can't go in the hospital I had my little one without getting panicked, but managed a wee trip to Kings for the first time without any concerns.

K

That said about St T's HFH I've just remembered that one of my friends had her baby on the medical unit but managed to blag herself a room on the HFH to recover in, ended up on the ward as she needed longer than 24 hours but I think there are a lot of things you're told No to that can become a yes if you nag enough!

[buggie]

Am sure I'm about to state the obvious (and something that you're already doing), but I'd suggest a duel approach - as well as looking into and hopefully having an HBAC, preparing/trying to feel more relaxed about the possibility of being in hospital and how to make that as positive as you can - am sure relaxation techniques are v difficult to practice with gorgeous S running around, but this might help.

Especially if you're having a history of high BP, the last thing you need is to be labouring at home, having BP or something else occur meaning you have to go into hospital and the stress that causes lead to more probs for yourself and Baby Baldock.

Know you've had problems with your MW's, but if there is one or someone else you could talk to about the panic attack/discuss what might have triggered it and maybe help to reduce your anxiety (Fuschia makes a v good suggestion above).

Am sure no one is wanting you to have a difficult birth or anything that will be upsetting to you, their wanting the best and safest for you and BB.

I can empathise with hospital anxiety - have supported countless parent's in A&E who don't like hospital, often due to past experience and have often found that giving time to talk through their past experiences and ensuring clear communication has helped them cope better.

Fingers crossed you get the birth you want (and deserve :) ), wishing you the best xx

[minder]

I would agree with buggie.

Also, sorry to be so blunt, but you are making it all so complicated. High Blood Pressure issue makes King's a first choice.

In your post you say you really don't want to go into hospital. Why?

What's IM?

If I ever had a fourth baby, I would prefer to be in hospital, even though I had a bad experience post birth with my third.

[Fuschia]

Having had high bp in my last pg an ending up with a drawn out induction I do tend to agree it's a problem likely to rear it's head again later along

All the more reason for Ruth to talk through her options now with the hospital and identify what steps can be taken to minimise her anxiety if a hospital birth is the outcome

My recent birth and time before and after wasn't exactly smooth but apart from one grumpy midwife and an anaesthetist who didn't listen (or check the epidural wAs actually going to work...!) I can't fault my care and I accept I had complications which required intervention

[Ruth_Baldock]

Hi Minder,

IM = independent midwives.

I never intended to be in hospital for my first baby; he was a planned homebirth, but about 10 days before his due date, my waters broke but labour failed to start, so I had to be induced, which didn't work, and ended in a c-section which I was asleep for (spinal condition prevents me having an epidural). I think the reason for my labour failing to progress was the constant monitoring, and being stationary throughout most of my labour (flat on my back on the bed). I DO NOT want to re-visit that experience, but given I am an VBAC, I feel I have looads of restrictions placed on me, provided I deliver in a hospital environment. Kings were excellent throughout the whole thing, from arriving for my induction, to being wheeled onto the PN ward (predictably hectic and understaffed, no-ones fault, but not great, but everyone helped as much as they could in any case...).

However, much as many people will strongly disagree with my views, I could never imagine myself having any of my children in hospital; no matter how first rate the care was. Whenever I go back to Kings, for whatever reason pregnancy related (scans being the main one), I just cannot stand the thought of going back. I'm not wording this very well, I suppose I have a lot of anziety and fear around it all.

Since Tuesday, my BP has slowly and surely been coming down. It's not within the normal range yet, but it's not far off and I think it's because I calmed down and started to think about my birthing options more and more (was origionally contemplating a HFH, like ClareC and other's stated).

[Belle]

Def true it's good to prepare for either eventuality, though I know how hard that is. Last time even thought I'd told myself a hb might not happen, I was still a bit gutted when it didn't. Will your midwives support you at home at least in the early stages? that might help?

[Saffron]

Ruth, even with monitors or a drip, you should still be able to move around at least some. In fact, I'm always a little surprised when women in labour aren't encouraged to move. I can't remember if you said you had a doula? If you must be monitored, helping you to move around gently is something a doula would be able to do.

I know you mentioned you're not keen on the idea of acupuncture, but have you tried acupressure? No needles involved and it might help your blood pressure.

(Do you want to make a playdate for Cheeky S and Little Saff sometime? Hubbie has Little Saff fulltime for a couple weeks. He's looking for things to do.)

:)

[snowboarder]

Ruth - as you know we went for HBAC. We did have IM (yes lucky and we are still paying for them!!) who supported us, so were privileged in that respect, but I did also face opposition from Kings consultants (one ms penna!) but in the end I decided that I had no other risk factors other than a scar on my uterus. And if I was going to succeed at a natural birth I would have more chance at home being able to move around with intermittent baby hr monitoring BUT constant personal monitoring by 2 experienced midwives who would be with me the whole time and watching everything. When I spoke to the Lanes (previous mw) they said that they WOULD support me in an hbac but would make it clear in my notes that it was not advised. So you may be ok? Worth an ask if you feel you want to try. And, no, we didn't succeed, but it was not because I had a previous C section. And the transfer to Kings was calm, because we were sensible and knew when to call it a day.

I'm not sure what to think when people say they are not allowed to do something. or a consultant wont let them undertake their preferred route. Ultimately the doctors are our advisors surely and having obtained their advice WE must chose what we believe to be the best option for us. No-one can 'make' you do anything.

ps - I saw a fb comment from my IM that 2 days ago they were at a birth where a woman delivered her 3rd baby post c section in the pool at home - baby was 10lb 12oz!! Doubt that would have happened at hospital!

[snowboarder]

And just to add - whilst I'm gutted we didn't get our hbac - I know we tried everything and baby really did need help to come out...

[BellendenBear]

Sorry if this sounds negative, but I would agree with those above who have advised you to prepare as much as possible for coping with a hospital birth. I am very much pro-home birth and choice, (currently 41 and a bit weeks and desperately hoping for one myself) but surely safety must be a priority. All the evidence to support home births as a safe option focus on uncomplicated pregnancies; having raised BP is not uncomplicated for you or the baby. I think your BP is the issue rather than being post-caesarian.

[edanna]

I'd second what Saffron said about being able to move with monitoring and drip. During my first labour, at Kings, I had both but was still walking around, kneeling on the floor, leaning on the birthing ball etc for many many hours! Hopefully you'll get lucky and have a speedy second birth - mine was 90 mins and I was in and out of the hospital in no time. Even though the first one was pretty traumatic I felt fine about going back there - same room! - the second time and I even felt that the second more positive experience healed my bad feelings about the first. If I were you I would go for the hospital option but plan as much as you can to make it comfortable. Good luck!

[Ruth_Baldock]

I am intrigued by the whole mobile monitoring thing. With my first, the monitors fell off whenever i moved, and th trace of my son's HR kept getting lost. In the end, the only way to make sure the blooming monitor stayed strapped on the right place was to stay still (ish). I did try to move around, found standing and swaying/ sitting on birth ball the most helpful, but again- lost all fhr. In the post natal ward, I had bruises from how tight it had been strapped to me, which was nothing compared to everything else going on.

I found my venflow incredibly distracting and unless I need an iv of actual fluids of whatever this time, will be decling one for sure.

[simonethebeaver]

I've been told by my midwives - am yet to experience this! - that there are monitors that can even be worn in water at Kings. I'd love to know if anyone's used those. But if that's the case, then mobile monitoring seems entirely possible. Good luck, Ruth.

[ClareC]

simonethebeaver Wrote:

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

> I've been told by my midwives - am yet to

> experience this! - that there are monitors that

> can even be worn in water at Kings. I'd love to

> know if anyone's used those. But if that's the

> case, then mobile monitoring seems entirely

> possible. Good luck, Ruth.

There are...... unreliable though according to Consultant Obs :-(

[Mellors]

I had a sucessful HBAC last time, and am hoping for another one in a couple of weeks. I had to have independent midwives last time though as King's were very anti, and insisted on continual monitoring, no pool etc which I absolutely refused to have as I am sure its what led to my CS 1st time.

This time they have basically said "Do what you like, its at your own risk", so pool at home it is, with the Lanes (fingers crossed).

I think you have to accept that a transfer into hospital at some point may be necessary or desirable though, and prepare yourself if that does happen. Its also pretty tough to stand up to them when they give you the whole "you might die, your baby might die" speech.

I don't think the short period between pregnancies matters (11 months between my first), but not sure about the high BP - may be a reason they want you to be in hospital?

Tommies defo don't do VBAC in the home from home.

And apparently the telemetry (under water monitoring stuff) at King's rarely works. I'd query why they can't just intermittently monitor you with a normal underwater hand held one (I know there is greater risk of scar rupture not being detected super early, but it depends on your view of that as an overall risk).

You need to talk it all through with your midwives.

Also, and I know birth is a big deal and all that, but really its only a few days of your life. Its honestly not worth beating yourself up about if its doesn't go perfectly the way you want it - main thing is that you and the baby are ok.

[Fuschia]

simonethebeaver Wrote:

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

> I've been told by my midwives - am yet to

> experience this! - that there are monitors that

> can even be worn in water at Kings. I'd love to

> know if anyone's used those. But if that's the

> case, then mobile monitoring seems entirely

> possible. Good luck, Ruth.

they only had one , broken, in dec