VBAC info/support

[chuck]

I was looking for the article I read it on the other day and couldn't find it. I really need to start bookmarking things. I'll have another hunt once LO is in bed as I think it also included some other factors that increased likilhood of UR...or decreased risk if you didn't have these factors depending on how you look at it.

cheers me dear!

 

[Celesse]

Here we go,

https://www.ncbi.nlm.nih.gov/pubmed/17877673

RESULTS:

Compared with women who delivered vaginally in their first birth, women who underwent a caesarean delivery were, during their second delivery, at increased risk of uterine rupture (adjusted OR 41.79; 95% CI 29.73-57.00). Induction of labour, high (> or = 4000 g) birthweight, postterm (> or = 42 weeks) births, high (> or = 35 years) maternal age, and short (< or = 164 cm) maternal stature were also associated with increased risk of uterine rupture. Uterine rupture was associated with a substantially increased risk in neonatal mortality (adjusted OR 65.62; 95% CI 32.60-132.08)

So in list form things that can increase UR chance:

• Induction of labour
• high (> or = 4000 g) birthweight
• postterm (> or = 42 weeks) births
• high (> or = 35 years) maternal age
• short (< or = 164 cm) maternal stature

I like to look at it that not having these means I have a lower risk of UR. I'm declining induction, I'm 31, I'm 5'8" (which I don't know in cm but I believe is higher than 164cm). So the only added risk factors I could end up with (according to this study) are post term and high birth weight.

 

[chuck]

Thanks for that Celesse I'll add it to the top posts.

 

[angel2010]

This is such a great thread. The info is really helpful. I have only made it through about half of the links on the first page and so far I am impressed! Thank you for making it!

 

[angel2010]

Celesse, thank you so much for posting your plan. It was very informative for me and may steal bits as well!

 

[Celesse]

Consultant appointment tomorrow! Wonder how many times the word "allowed" gets used?!

 

[chuck]

Smile and nod, thank them for their input then make your own choices.

Don't be discouraged by them. As much as we know our rights it's difficult not to walk away from some appointments feeling angry or upset.

 

[K477uk]

Thanks
Its not the pain I'm scared of....I was handling my labour just fine even with out g&a last time. For me its the fear if something goes wrong and I don't have an epi fitted then I will most probably have to go under ga for a section.

I had an EMSC without an pre-pain relief, and had a spinal. It was less than 30mins from being told I needed it and being cut open... So dont worry about that!

I love this thread! Xx

 

[chuck]

Another link in stories section now.

 

[chuck]

Post dates HBAC story added

 

[xpinkpandax]

Don't know whether I should post this here or not but here goes

What are my chances of a natural delivery? - This is me
2 Emergency C-sections
1st Labour FTP, Dilation 6cm, Head Very High Up, Baby Distressed. 11 hours labour.
2nd Labour Meconium in waters, Dilation 9cm, Cervix Very Good, Wasn't 'allowed' to change position, hooked up to drip & heart monitor, epidural, and again head very high up & baby distressed. 9 hours labour

I'm 4ft 11inches, size 3 feet. (was told this counts towards your pelvic size)

Mother had 4 C-sections was told pelvis is too small in the 80's. She always rants on about how I have to accept I have to have another c-section again if I were to have another baby...grrrr pisses me off.

Really hopeful for another try a vbac again but I don't know what way to go about this, I'll probably ttc in another few years time but would like to know the info first. Thanks x

 

[chuck]

Firstly hun welcome! Your kiddos look very cheeky!

As much as your Mother is saying what she feels is right it doesn't make her right, true cephalic/pelvic disproportion is incredibly rare, it's not often a body will make a baby that really will not fit out - its more a matter of baby being positioned correctly.

FTP..is more like failure to wait - were you given anything to 'speed things along' intervention wise? They can be awful for getting babies into distress!

2nd time around sounds similar to me - no wonder baby didnt move where they needed to if you were stuck on your back and hooked up to uncomfortable monitors that all in all make you worry at every little blip!

The 2 labours you have had although both ended in EMCS were different, just as I'm sure the pregnancies were so there is no reason a 3rd labour would be similar...you have laboured twice and dilated a lot previously so this time you stand a great chance.

You need to take back ownership of your body and labour and do it your way next time.

You stand the same chance of VBAC as achieving a VB as a 1st time mother...probably a little more given that you've laboured twice, your chance of Uterine Rupture is slightly increased from the 0.5% of a VBA1C but it's still tiny.

My advice to you would be to look into getting a birth debrief about your previous labours and births - request this with a senior MW and they'll get your notes and go over it all with you. Understand what happened and why those decisions were made for you 9no they may not have been the best decisions but heck they were made and you need to know why).

Take some time to get a handle on your previous experiences - see a counsellor if you feel the need and let go of the fear I expect you have regarding VBAC - you can do it, your body is perfectly capable of doing it you have been failed by the people supposed to be taking care of you not your body like the FTP label stamped on your notes.

Research - take a look through some of the links, I strongly suggest you take a good look at a lot of the natural birthing resources - whether you want to natural birth or use pain relief does not matter but the science behing labour and birth is the same - natural birthing simply aims to understand birth and how to make it a great experience working with the body rather than cramming it full of drugs or forcing it to follow hospital policy.

Get support - whether this be your birth partner or a friend or people here having someone to talk to is invaluable. I would not have gotten to the point where I was confident enough the HBAC without support of my Hubby as I knew I could do it and trusted myself because of the support I had here.

When it comes to TTC and being pregnant, don't worry! You can change your mind when you are in labour if you choose to, you can VBAC. HBAC, ELCS it is up to YOU and YOU only!!!

You can have scan after scan if you like to see babies size - but remember all the scans are subjective and can be out by 20% so always get them carried out by different people to double check any estimates of size...I wouldnt bother personally. Trust your body.

Sorry I'm rambling

What I mean is you can do it, your body is fab if you allow it to do what it needs to (so avoid being told what to do if it doesn't feel right), you can change your mind any time you want, make the experience yours. If you choose to ELCS it does not make you any less of a woman you have to choose hat is right for you and baby after weighing up the risks and all the inf you can.

 

[xpinkpandax]

Thank-you so much for taking your time to reply to me, you've given me soo much more confidence now. I think I won't bother telling my mum of my plans until I'm prepared because I know she'll discourage me. I had a chat with my partner last night and he said he'll support me 100% if I decide to have a home birth, I'm going to start my research and find out if there are any midwives in my area that support HBA2C.

Yes I was given something both times to 'speed things up', towards the end of my second labour when Madison's heart rate was dropping they said they could try forceps or vacuum when they were bringing me down to theatre but it was me that decided to go ahead with the c-section as I didn't want my baby in anymore distress than she already was. Apparently they told me they got her out at the right time as the meconium was in her chest and if she was inside me any longer it would have reached her lungs.

I'd done some research during my pregnancy and was aiming to labour in any position that I felt comfortable with, like squatting, but when I arrived to the labour ward I was told to get onto the bed so I was just sitting there. I said I was uncomfortable and felt I needed to go on all fours or stand, but no I wasn't allowed it was so frustrating because I thought I was doing the right thing listening to the professionals when I should of in fact listened to my body. Thanks again x

 

[chuck]

No problem, I'm no font of knowledge but I help where I can.

Seems like your first labour was a typical long one so they intervened, every intervention increases the risk of more interventions until baby gets distressed and off to theatre you go. You get labelled FTP so they jump the gun a second time also classing you as high risk before you even go into labour. Kinda sets you up to fail doesn't it?

You can have a great natural birth in a hospital if that's what you want - but given your experiences I agree home would be better. Trying to HBAC was the best thing I ever did.

I'm so glad your partner is behind you, mine wasn't and it was tough.

I just posted a fantastic HBA4C story in the 1st post read it for inspiration!

 

[Celesse]

So my consultant appointment on the 5th basically sucked. A lot. I thought that the consultnant would go through the risks, establish my understanding of those risks, discuss the possible implications of those risks and give me opportunity to disucss why I felt ok with them, and ultimately tell me that although it wasn't recommended that support would be provided as there is a duty of care....... what actually happened was he babbled, belittled and generally didn't make sense for an hour. The implication was that if I had a rupture at home the baby would die but that if I had the baby in hospital it would be fine. ..... or at least thats what I think he meant as he acutally said it in an anaolgy about going home by train or car or something.

I should add that my job involves taking minutes from professional meetings so I am very good at listening and making sense of people from all levels. However the consultant didn't make sense. And was vague. And considered himself right even when wrong. I realised early in the consultation he wasn't listening when I told him I knew my actual due date, which is slightly different to the scan due date, as I didn't have a period between babies and was taking LH test's, so knew the exact point of ovulation and had sex both before and afterwards. He responded that women don't always ovulated on day 14 of thier cycle and can get pregnant from sex a few days befor fertilisations. Yeah, no shit.

He also said that no one will support me. That it will literally be a case of calling up the MAU when in labour and refusing to go in. And that the midwife who attends me will not have delivered a VBAC in 10 years and won't know what she is doing.

Now I don't feel any less safe about having the baby at home. He didn't discuss the implications in any depth so there wasn't the oppurtunity to. What I do feel is very unsupported. I feel that once I go into labour I will be very nervous about phoning up the MAU and being lectured and told to come in if the wrong midwife is on duty. I'm nervous that the midwife sent to me will be unsure and over catiuos and transfer me too easily.

Most importantly I feel that these anxieties, whether true or not, will persist in early labour, put me on the defensive and slow labour down considerably. I had a slow labour last time as I was 42 weeks on the day of labour and sent in for a scan in early labour. I'm certain the faff of the scan, and the later faff of the transfer slowed down my labour meaning when I needed to push her out cos she was distressed I wasn't far enough along.

I asked about being allowed on the midwifery led unit / birthing centre and was told no. I asked about being allowed in the bath during labour and got told there are no baths on the labour ward.

So I've been referred to another hospital and have a consultantion tomorrow. I'm going to get my a natural hospital birth plan wrote up. It may not be my plan A for location of birth, but if I can get a positive hospital birth plan agreed to, it may be better than an uncertain home birth plan.

 

[Celesse]

My new Birth Plan: The natural hospital version.

Birth Plan

Location of Birth

This is the Birth Plan of Celesse, written at 22weeks in advance of a consultation at the QE hospital.

This is my second baby. My first baby was born at the RVI, at 42+1 via emergency Caesarean Section. The reason for the C-Section was my daughter had a high heart rate (190bpm just before delivery) and progress during labour was not sufficient to risk labour continuing. I also had a low grade pyrexia (highest recorded was 37.6- I think) during labour that did respond to IV paracetamol. I was 8-9 cm dilated at delivery.

This birth plan is written with the intention of delivering in the Queen Elizabeth Hospital, Gateshead. My initial plans for this pregnancy was a Home Birth, under the Royal Victoria Infirmary, Newcastle upon Tyne. Although my feelings on risk of having a Home Birth following a Caesarean Section have not changed, I feel the lack of support would create anxiety for myself which could be detrimental to progress in labour.

If the weather is sufficiently bad when I go into labour to warrant me delivering in the RVI then this birth plan should also apply.

I would like to remain on the Home Birth list for the time being. I feel it very likely that a hospital birth would be my first choice, but wish to remain open minded about this. I intend to discuss the matter with my Community Midwife at 36 weeks.

Should this consultation prove successful then I would like to attend the QE for all non emergency care, (e.g. if a planned C-Section was necessary)

Due Date

I have not had a period since before my first daughter was conceived in May 2009. I monitored my fertility using, ovulation microscope, LH test strips, and awareness of chances in cervical mucus.
I ovulated on 3 April 2011 (at around 6pm I had left sided lower abdo pain) making the due date for this baby 25 December 2011.
My 12 week scan showed a due date of 22 December 2011.
I will make decisions about my care and the care of the baby based on the scan due date up until 21 December 2011. After this date I will make decisions based on the ovulation due date.

Induction / Augmentation

I will consider a sweep after 41 weeks, however I am undecided about this and will discuss with my Community Midwife at 40 weeks.

I am willing to attend a Consultant appointment on 5 January 2012 (42 weeks by 12 week scan date) to discuss plans for delivery and monitoring.

I will be declining induction for post dates. If the baby has not arrived by 8 January 2012 then I will opt for monitoring. If a problem is identified through monitoring I will discuss this with my consultant in order to make an appropriate decision.

Should a medical reason arise where induction or repeat C-Section is considered appropriate I would prefer to be induced and monitored appropriately.

I do not want any type of augmentation if at all possible due to the increased risk of uterine rupture.

General- following admission in labour

I would like to labour in the birthing pool room, or a room with an en-suite bathroom. If a room with an en-suite is unavailable on admission I would like to transfer to one as soon as possible.

My allocated birth partner is OH (Partner and father to the baby).

I wish to remain upright and mobile during labour. I want to be free to move as I want, how I want, where I want.

Please remain as hands off as possible and listen to my requests and acknowledge that most of the time I probably know what I’m talking about.

I intend to request my notes at some point in the future, so be polite in them!!

Students are welcome to attend me during labour. Since I’m due on Christmas Day I hope none actually have to work though especially if I deliver on my due date.

Internals

I do not want any internal examinations unless a problem is suspected and would prefer my progress to be monitored by observing changes in my behaviour.

Pain Relief

I would like to use more natural forms of pain relief such as aromatherapy, water, TENS.

I would like the option of labouring in the birthing pool. I understand this may not be possible, due to the recommendation of monitoring via CTG.

If I am unable to labour in the birthing pool then I would like to spend some labour in the bath.

I would like the option of using Gas and Air as labour progresses.

I would like to avoid Pethadine, or equivalent.

In the event of a complicated labour I would opt for an epidural in advance in emergency procedures (eg to avoid crash section, or instrumental with only local)

Monitoring

I am aware of the NICE guidelines that all women experiencing a VBAC labour be offered CTG monitoring and the reasons for this. I am aware of the risks associated with intermittent monitoring versus CTG and do not expect to need to discuss this during labour. Just tell me if the CTG is ok or not and tell me reasons why it is not ok, don’t attempt to engage me in discussions of what is or isn’t recommended. Be assured I have already considered this when not trying to cope with labour pains.

On admission/ when labour is established I will accept a period of monitoring by CTG. During this I would like to be or on a birthing ball next to the bed, or mobilising next to the machine. I may also choose to sit/ recline/ lie on the bed, but don’t expect this to be the case.

If the trace is non-reassuring then I would like CTG monitoring to continue, be reviewed as necessary and appropriate action taken.

If the trace is normal after a period of 30minutes then I will continue to be monitored by CTG, unless I feel it interferes with my mobility or pain relief options (e.g. getting in the bath).

If I decide that the CTG is interfering with my pain relief or mobility I would like to negotiate a pattern of intermittent monitoring and CTG. For example 30minutes on the CTG, 30 minutes off. Please remember the final decision of how I am monitored is my choice and not that of the midwife or doctor in attendance.

Second Stage

I would like to deliver in an upright position in which I feel comfortable. I don’t know what position I would like to be in until the day, but would probably want to be kneeling on the bed with the head raised, leaning on the head of the bed.

I do not want an internal to determine if I’m “ready” to push, unless I have an epidural in-situ.

I do not want any direction in pushing, other than during crowning of the baby. If I have an epidural in-situ then feel free to tell me when I’m having a contraction and need to start pushing. But please don’t go “push push push push push” as it will annoy me a LOT!

Please stay hands off as much as possible.

Delivery of the baby

I want to baby delivered straight onto my chest/into my arms/between my legs onto the bed so I can pick him up depending on position I deliver in.

I wish to delay clamping of the cord until it stops pulsating. I will cut the cord.

If baby requires a little bit of resuscitation I would like it to be done with baby still attached to me if at all possible.

I would like an extended period of skin to skin contact with the baby, preferably with baby still attached by cord. I am hoping to get baby to “breast crawl” and video this (I’m a peer supported!) and plan to breast feed the baby as soon as possible after birth.

I do not want baby to be bathed, or cleaned too much, just pat him down so he is dry and warm.

I would like baby to receive the Vitamin K via IM injection. If the only option is oral then I don’t want it.

Third Stage

I would like a physiological third stage.

I would like the room to be kept as calm as possible to enable me to achieve this.

I would like to see the placenta after it is delivered, but I don’t want to keep it!

If there is a need for me to have a managed third stage please discuss it with me as appropriate.

Postnatal

Ideally I would like to be discharged straight from the labour ward.

Don’t rush me into getting sorted and off the labour ward to the post natal ward. I want to spend time with my new baby without feeling pressured.

If I am admitted to the post natal ward the baby is to remain with me at all times.

Please do not allow any visitors other than my partner and daughter unless speaking to me first.

My baby will be breastfed. Do not suggest giving him a bottle. Do not give him a bottle under ANY circumstances. Should he refuse to latch on then would like to be provided with a breast pump and will express and give colostrums via cup/syringe. I will provide my own in case of this not being recommended by hospital policy. If staff are insistent on giving formula/ bottle I will discharge us both, against medical advice if applicable.

 

[Celesse]

If the above plan is agreed then great. I'd feel very relaxed and positive about going into hospital.

If it isn't agreed, or made a fuss of even when I point out its "upgraded" from a home birth and I am unable to get a natural birth plan, even with a change of location....then I guess its time to start writing some letters. It WILL be a home birth plan if thats the only way I can guarentee a lot of my birth plan

 

[chuck]

What an asshole of an OB Celesse! You are deffo better off with someone else!

Remember that you dont have to see another OB unless you want to or you have complications in the pregnancy.

Birth plans look good - remember the best way to get what you want is to be vocal about it and ensure the people with you know what you want and stick up for you. You can always say no to things!

 

[chuck]

Just added an accidental unassissted HBAC and HWVAB stories in the 1st post.

 

[chuck]

one thing i will say celesse is to ensure the bits there for labour/pushing/3rd stage need to be short snappy and easy for someone to look at and get what you want....if thy bother reading it at all in some cases.

You know what you want and bu writing it down you have consolidated in your mind what those thing are and for your birth partner too, but MW/OB etc are better off having very clear bullet pointed Do's and Don'ts.