VBAC info/support

[chuck]

I dont have much info on VBAC as breech...there isnt much about to be honest as not many will do it.

Obviously you will have the additional rupture risk on top of any breech risks.

Hmmmm will have to look around for some footling breech stats though.

 

[chuck]

Here is a story I remember seeing a while back..just a lovely footling vaginal birth...graphic pics

https://www.birthingway.com/footling_breech.htm

 

[chuck]

A real quick search yielded this...

Prolapsed Cord

There are three varieties:

* Overt cord prolapse - if the presenting part of the fetus does not fit the pelvis snugly after membrane rupture, there is a risk that the umbilical cord can slip past and present at the cervix or descend into the vagina. This is known as overt cord prolapse. It represents an acute obstetric emergency, as prolapse exposes the cord to intermittent compression compromising the fetal circulation. Depending on its duration and degree of compression, fetal hypoxia, brain damage and even death can occur. Exposure of the umbilical cord to air causes irritation and cooling, resulting in vasospasm of the cord vessels.
* Occult cord prolapse - where the umbilical cord lies alongside the presenting part.
* Funic presentation - where the cord can be felt to prolapse below the presenting part before membranes have ruptured. The cord may slip to one side of the head and disappear as the membranes rupture.

Epidemiology
Incidence

The overall incidence of overt prolapsed cord is between 1 and 6/1,000 deliveries.1
Overt cord prolapse occurs in more than 1% breech deliveries:

* 0.5% cephalic and frank breech presentations.
* 5% complete breech.
* 15% footling breech.

https://www.patient.co.uk/doctor/Prolapsed-Cord.htm

 

[K477uk]

Chuck...

Do you have any info on intermitant monitoring vs. continuous?

I had my consultant appointment and they are very keen on VBAC (as I expected) but she did say that she was recommending continuous monitoring, which I don't particularly want as it means lying down for the whole time, and I would prefer to keep moving around...

Thanks xx

 

[chuck]

I was told that even with CFM you'd still be able to stand up lean over the bed.

Not good if you ask me.

I'm sure somewhere I've read that CFM has not been proved to improve outcome Will have to check though.

However hun, you have the right to tell them you don't want CFM and will willingly have ,monitoring by sonicaid on a regular basis as you want to have true freedom of movement and the the reduced stress levels of not having to worry about every beep click and whistle of the monitor.

One of the best indicators of UR problems is pain between contraction, and the best way to notice whats going on in your body is to be relaxed and free to move and do what feels right -difficult on a monitor right?! LOL

 

[K477uk]

Well that was my thoughts.. and I am quite happy just to say no... CFM last time, and was able to stand, but wasn't able to move as much as I wanted and they did take it off... but I just wanted to go in prepared with some info!

Thanks

 

[chuck]

https://www.nejm.org/doi/full/10.1056/NEJM198609043151004

Universal monitoring was associated with a small but significant increase in the incidence of delivery by cesarean section because of fetal distress, but perinatal outcomes as assessed by intrapartum stillbirths, low Apgar scores, a need for assisted ventilation of the newborn, admission to the intensive care nursery, or neonatal seizures were not significantly different.

We conclude that not all pregnancies, and particularly not those considered at low risk of perinatal complications, need continuous electronic fetal monitoring during labor. (N Engl J Med 1986; 315:615–9.)

 

[chuck]

At the end of the day you shouldn't have to go in with referenced cited studies. The knowledge is more for you.

Look at the links in the first post about UR...thats the reason they want CFM because of that tiny 0.05-0.07% risk [please bear in mind that stat includes all UR - scar stretching, true rupture and all UR in unscarred uterii!]

 

[chuck]

Aha heres the sucker...cochrane review article

https://www2.cochrane.org/reviews/en/ab006066.html

a summary..

“Whilst a continuous CTG gives a written record, it prevents women from moving during labour. This means that women may be unable to change positions or use a bath to help with comfort and control during labour. It also means that some resources tend to be focused on the needs of the CTG rather than the woman in labour.”

“There was no difference in the number of babies who died during or shortly after labour (about 1 in 300).”

“Continuous monitoring was associated with a significant increase in caesarean section and instrumental vaginal births.”

 

[chuck]

and this is a good place for a summary of 20 articles on UR
https://birthwithoutfearblog.com/20...ture-a-look-at-20-peer-reviewed-publications/

 

[K477uk]

You absolute star!! Thank you so much!

That a) puts my mind at rest that I am asking for the right thing, b) means I have something to argue about!!

xx

 

[chuck]

Dont argue with them, listen to them and then say I understand what the recommendations are however I am going to do things this way ....... because it will be best for me I understand ALL of the risks including the additional risks of the interventions you are recommending thank you.

 

[tannembaum]

Gosh, the closer the birth gets the more scared I'm getting about them trying to force me to do something I don't want. I would be much more comfortable with a hbac but oh wouldn't be happy with that.

 

[chuck]

MIne wasnt happy about it, I tried anyway,

Fuck em they arent doing it, you are!

I had very little support from OH in labout he;s effing useless - I'm talking uselss in the way he wouldnt come to theatre for my EMCS despite being given the scrubs and he spent the time we went to hospital with his head between his knees or not in the room.

 

[tannembaum]

I think he'll just be too scared after last time. If he isn't comfortable I'll be worrying about him, so hospital it is.
I'm just so scared they're gonna pressure me. They forced me into an epi last time when I REALLY didn't want it

 

[chuck]

It was the opposite with me I spent so much time in hospital worrying about hubby I didnt sort myself out, if I was at home I could forget about him, he was in his own environment so no worries for me.

At any rate in hospital this time, you've been there before, you will be able to draw strength from having done it before, get it your way.

Someone on here had a wonderful turn of phrae in their birth pkan for wanting a physiological 3rd stage...cant remember what threas but they put in there that any attempt to cut the cord before it had stopped pulsating would be deemed as assault.

Likewise if you are that worried about it put in your birth plan that any intervention performed without expressed consent of you or your partner will be seen as assault and you will seek legal help.

 

[chele]

I'm supposed to be doing my birth plan this week and I have no idea what to put. I never had one with Max, as we knew it was unlikely id have a natural birth (was eventually induced and had EMCS). I just don't know where to start

 

[Drazic<3]

Just poking my head round the door girls. I am very early days, but after a very traumatic cat.2 EMCS I'm thinking about what could happen this time around.

 

[chuck]

Welcome Drazic! Things will be different this time they always are!

Chele - start by sitting down with your birth partner and making a list of what you would like to happen and what you would not like to happen ideally.

Make that your starting point and tinker from there.

Someone else here had made their plan like this...

YES
monitoring via sonicaid
active labour
physiological third stage
delayed cord clamping
daddy to cut cord
water birth

NO
CFM
painkillers
VE's
coached pushing

This way they found it easier to make it short and snappy and cut out the waffle - a birth plan needs to be very simple and quick to read no MW has time to read a long amount of prose.

Also make a list of preferences for 'in case ofs' like in case of EMCS...what would you like to happen.

Chele are you planning a hospital or home VBAC?

 

[angel2010]

Do you have anything on the first page about Bishop scores? I have never heard that term until today.

https://www.mybirthbydesign.com/Bishop's Score.pdf