H/VBAC consultant appointment - UPDATED

[SmokyJoe78]

I've been lurking for a while and thought I would say hello and ask a question!


I have an appointment with my consultant next week because I had a c-section previously. This time I would like to have an hbac.

Does anyone know what kind of things the consultant will want to talk about? Will they ask about where I plan to give birth this time? And when I mention homebirth, will I have a fight on my hands?

I just don't know what to expect?

 

[Jenniflower]

I don't know personally what would be talked about but I would imagine after stating that you'll be giving birth at home, (Because it IS a statement, not a question. Remember he has to convince you, NOT the other way around) you'll have the talk about risk of a uterus rupture and how they would prefer you to be in the hospital in case this happens. All you need to do is say you respect what they're saying but you feel you best chance at a natural birth will be at home and so that's where you'll give birth.

There should be no reason to have a "fight" persay so long as the consultant does their job and doesn't use the word "Allowed" grrrr that word. Some times all it takes is sitting there for a few minutes while they go on and on about how they know best, bla bla bla. You just smile and nod and in the end say thank you for your time and then when you're with your midwife next time book your home birth

 

[indigo_fairy]

I'm in the exact same position as you, and didn't have a very positive consultant appointment unfortunately. I didn't think about a homebirth properly until I got home and got angry about what he'd said. So I obviously didn't mention homebirth.

He didn't ask me where I wanted to give birth, he told me I would give birth in the hospital and I was NOT allowed a homebirth for the reason that they would want to monitor me. Uterine rupture etc.. but thats only 0.5%? maybe more if you had your previous baby more recently, but for me it was 4yrs ago.

If you read a few posts back you'll see in a bit more detail of how I felt after it, but the main thing that got me totally shocked was he said that they would only let me labour for 8hours, which I know is never going to be long enough, not to mention the added pressure of being on a clock.

I haven't spoken to my midwife yet, but at my next appointment will just tell her that I'm planning one, its not up for discussion. She won't support it, as it goes against 'hospital policy' etc.. I've thought very carefully about it and feel I will be more relaxed at home, with more chance of a natural birth. I'm not going to see the consultant again so will be cancelling the appointment they made for me at 36weeks because I don't want to hear any negativity about my choice so close to birth as I will be more vulnerable then.

So that I have someone supportive I'm hiring a Doula, then even if I do decide to transfer on the day I will still have her to relay my wishes and hopefully still get my natural birth. I really want to do all I can to avoid a c-section, for me it was one of the most awful experiences I've been through, and has taken this long for the emotional scars to start to heal.

Be prepared to be strong in what you are saying, and really question why all the time to what they are saying.

Good luck and look forward to seeing how you get on!

 

[Jenniflower]

Indigo I love your approach to your birth this time around. I think it's very informative and confident. I think a lot of women will learn loads from you.

 

[SmokyJoe78]

Thanks Jenniflower and indigo

- I hate the whole "allowed" thing and I find it hard not to get emotional about the whole thing and then I can't get my point across

I'm going to try hard to stay calm and just kind of listen but not agree with what they're saying - I've made a list of stats and questions I want to ask so hopefully that will keep me focused. Will let you know how I get on

 

[chuck]

He hun,

I'm hoping to HBAC in May.

Luckily both the MW's I have looking after me are very supportive however when I had my booking appt there was an intake of breath and 'well the consultant will say you're not allowed'.

...yes the consultant looked at my notes which clearly state HOME as place of birth and then he asked which hospital I was going to <facepalm> he also tried the scare tactic I had a UR just last week and they only made it because they were in hospital...blah blah blah.

You choose where you want to birth, you cannot be forced into hospital. Yes it'll be easier with support of the professional who look after you but hey you don't need permission.

make sure you go to the meeting armed with info about HB and why it is for you, let them know you are aware of the risks but also the benefits of HB and having 100% attention of your MW.

IF they try to fight your decision remind them to go and read the NICE guidelines that aref reely available online. It is your choice to make.

 

[SmokyJoe78]

I'm back from my appointment and it went ok.

We decided not to mention homebirth and see if she asked us where we were planning to have the baby - she didn't ask! so that avoided that topic

I was worried about being "overdue" (I don't like that word) again (DS was born 18 days past EDD) and she said that they'd like to make a date for a c-section for 10-12 days overdue - but we can make it for 14 days past too. I have to tell my MW to do this - I think I might "forget" as I can think of nothing worse than being on a deadline (didn't help last time one bit).

She also said that they don't induce VBAC women, but if I go in to have CS then they will examine me and break my waters if they can, to see if that starts things off - they can use the hormone drip if need to (but not gel), and will leave someone for 24 hours after waters have broken (I thought to myself - I know the NICE guidelines say different - 96 hrs? - but I'll broach this if I need to, at the time!)

So, apart from the scheduled CS if I go "too overdue" which I will avoid making the appointment for, it was ok and I feel a bit better about the whole thing (She took my bloodpressure which was high - no wonder I was so anxious )

Interestingly, at the end, she said I was very much in the minority and most women want another CS - I was surprised, especially as I was in tears when I explained I really didn't want another CS!

Thanks for all the advice.

 

[indigo_fairy]

Glad you're feeling better now you've had your appointment I never knew they didn't induce VBAC's, I could never see myself agreeing to have a c-section 10-12 or even 14days overdue, unless there was a problem obviously, I hope this baby knows he or she better make an appearance by then!

 

[Bournefree]

There is an increased risk of uterine rupture with being on the induction drip. The contractions from syntometrine in your blood stream are stronger and chemically forced, rather that oxytocin produced in your brain, which is controlled by a complicated feedback system with baby and your body.
Though it has to be remembered, there are other forms of induction; pessaries, gels, cervical sweeps etc that don't increase your risk of uterine rupture.
XxX

 

[SmokyJoe78]

Though it has to be remembered, there are other forms of induction; pessaries, gels, cervical sweeps etc that don't increase your risk of uterine rupture.
XxX

Thanks.
That's interesting - the consultant said that the prostagladin gel does increase the risk of uterine rupture, so they don't use it because then if they have to use the hormone drip, which increases risk of rupture, the risk is increased again (escalating the risk and she said the need for further intervention ). I guess all health boards are different in their policies

 

[Bournefree]

I find that a very odd argument from your consultant!

Prostogladins don&#8217;t by themselves make contractions happen. They act topically on the cervix to ripen the cervix and set off your bodies natural chain of events. So you are producing oxytocin and making the contractions happen - just like in spontaneous labour. So no you wouldn&#8217;t want to introduce a drip ontop of that - it would increase UR.
So what he or she is saying, is that they don&#8217;t want YOU to go into spontaneous labour, because how would they be able to give you the synthetic Oxytocin (syntocinon, which is a mixture of syntometrine and ergometrine), if needed - but if you ARE in labour and your body has taken over the process naturally, there wouldn&#8217;t be an indication to give you the drip in anycase. You just let your body do it!
To me it me it smacks of your consultant wanting control of your body and labour.

Do you see what I mean - it's an illogical, circular arguement?
1 - we don't want to give you a drip as this increases UR
2 - we don't want to help to start off labour naturally, because how would we be able to give you the drip that would increase your risk of UR?
XxX

p.s - ergometrine is extremely fast acting, and in the right doses, can contract the uterus down in less than 45 seconds given by IV - which is why it is very useful in the event of PPH. So it a very strong synthetic hormone - which is why they don't like to give it to VBAC ladies in labour.

 

[chuck]

I had my VBAC clinic appt yesterday with a senior MW and while I didnt learn anything new I think hubby found it good to hear from the horses mouth how a VBAC is safer all around for mum and baby than a CS elective or EM.

Although she did seem to contradict herself a bit when it came to talking about my last labour and baby being back to back - she banged on about positioning and how it was important and a few things to do to get baby anterior during pregnancy then said well there is no evidence to suggest there's anything you can do to change positioning while in labour - then how I wouldnt be made to lie flat on my back as it's counterproductive and how if I was on a CTG in hospital having my VBAC I would be able to get out of bed.

....yet when I said I wanted freedom of movement after being forced to lie on my back last time she said well theres its all anecdotal evidence about positioning in labour to move baby?

WTF???!!

At any rate she reckons I'm a great candidate and should stand a good chance of getting a VBAC seeing as I got to 9.5cm last time and I'm not overweight, I'm fairly healthy etc.

But this interested me though, I asked about what would happen if I went over due according to EDD after she said well we talk about about induction (I wondered why she even said it?) and I asked what would be offered/what was procedure for a VBAC Mum..

*sweeps at 41 and 42 weeks
*post date monitoring and depending on cervix ARM (I said ok but then wouldn't I be on a deadline for labour to start because of risk of infection - she prattled on about it only be done if your cervix is open enough and labour will start - BS I thought I was 2/3cm for weeks before I went into SL with Dewi).
*Then PG gel and Synto drip - I said but there's then an increased risk of UR and she wrote down the stats for me (which i knew anyway).

Meh so useful to some degree, I now know that they wont expect me to book a section before 42 weeks if I go over - I have that in writing too.

I did like the way she made certain we both knew the risk of UR was less than 1% but the risk of severe complications from CS for me or baby was most definitely OVER 1% (pah hubby that is why we dont all book electives just so we know the date! LOL)

 

[Bournefree]

Hehehe!!! Well done chuck!!! Sounds like she tied herself up a bit, when she realised how well informed you are!! You must be elated!

I'm so happy for you that it has had a really positive effect on you OH - You must been thinking "....but THIS is what I was trying to tell you all along!".. but as you say sometimes they want to hear it from someone else! Pah!
XxX

 

[Bournefree]

Double post - Why does that keep happening?? Sorry!
XxX

 

[chuck]

I still dont think he's happy 100% with my choice to HB he'd rather I was in hospital but he does agree that being at home has it's benefits.

I dont think she was trying to convince me of anything in particular she just seemed a little contradictory at times was all.

She gave me a photocopy of a leaflet I've been handed at least 3 times 'Birth after CS' and she pointed out that it has the references for the stats from RCOG and NICE. She did pause when I said yes I have read the NICE guidelines for intrapartum care and CS.

There is a workshop at QEQM hospital - my back up hospital a kind of one of antenatal thing that we may go to to get to grips with the mat unit just in case. There's a talk about pain relief and a tour of the facilities etc.

 

[SmokyJoe78]

But this interested me though, I asked about what would happen if I went over due according to EDD after she said well we talk about about induction (I wondered why she even said it?) and I asked what would be offered/what was procedure for a VBAC Mum..

*sweeps at 41 and 42 weeks
*post date monitoring and depending on cervix ARM (I said ok but then wouldn't I be on a deadline for labour to start because of risk of infection - she prattled on about it only be done if your cervix is open enough and labour will start - BS I thought I was 2/3cm for weeks before I went into SL with Dewi).
*Then PG gel and Synto drip - I said but there's then an increased risk of UR and she wrote down the stats for me (which i knew anyway).

Meh so useful to some degree, I now know that they wont expect me to book a section before 42 weeks if I go over - I have that in writing too.

I did like the way she made certain we both knew the risk of UR was less than 1% but the risk of severe complications from CS for me or baby was most definitely OVER 1% (pah hubby that is why we dont all book electives just so we know the date! LOL)

Yeah Chuck it's this bit that interests me too, as DS was 18 days past EDD and I found the whole thing extremely stressful, which obviously didn't help!
You were told pretty much the same things as me about being past EDD. I"m just hoping that it doesn't come to that - my EDD was 21st June and is now 30th June, so I'm thinking of that as extra days anyway