Re: VBAC Consultants Opinions

June 29, 2000

Sharon

WOW! Sounds like your consultant really encourages VBACs.

Go for it and I hope all is well for the rest of your pregnancy. My DD was a

VBAC and the younger two both quick vaginal births.

SAHM 6, Olivia 2, 1, 15/3/00.

Editor Wallingford and District

June 29, 2000

they will

>offer me scans and checks to guage how the baby is doing and a decision

will

>be made of that basis

: Remember that scans work on a 20% margin of error, so are no more

reliable than other methods of sizing the baby in the late stages of

pregnancy.

June 29, 2000

Wow! Seems like you have a really great consultant. If my hospital had been

even half as encouraging I would probably not have felt the need to go with

an independent midwife.

Go for it!

Helen

(Mum to Emma 8/3/98 and bump due 23/9/00)

June 30, 2000

I was told that I would not be induced it I go past dates but I

>won't absolutely have to have a c section at 42 weeks either, they will

>offer me scans and checks to guage how the baby is doing and a decision

will

>be made of that basis.

The package you've been offered seems prtetty standard to me and it may

well make me the bringer of bad news but continuous EFM seems like a bad

start and the mobile option seems haphazard. While you still have plenty of

time , why not seek out other opinions. As cynic and long time listener to

birth expectations and birth stories - I have yet to hear about a (even so

called) local NHS vbac apart from bfas!

Any decision will be made on *your* basis and always would be (legally) so

they are not being *nice* just optimistic but still expecting you to have

continuous EFM and legally it will be your decision if you agree.

Apparently at the hospital I am using they now have

>a new mobile monitor so although I will have to have continual EFM I can

>remain mobile which I am really pleased about.

No one has to *have* EFM no matter how user friendly, it's up to you. Does

EFM help in VBACs - I'll be most surprised!

There are no real hard and

>fast time limits on the 1st stage of labour although the consultant said he

>would like to see progress of at least 2cm per 4 hours which is better than

>my midwife had said, she reckoned 1cm an hour.

What matters- It is what is best for you(and therefore your baby) not what

is

suiting the hospital/cons/staff. I hate to be the big bad wolf but just be

a little bit cautious in your trusting! There never have been hard and fast

rules until Drs invented them and even so , you do not have to abide by

them.

It must be the most basic rule of pegnancy and yet no one seems to know it

(including me in the past) that you are the same person with the same

rights as a non pregnant person. You can just live your life and dip in and

out of health care as you see fit.

I was also told that if I do

>end up with another section that my partner can come into the theatre with

>me even if I have a general anaesthetic.

That is brilliant , And I know this is probably very important to you but

it's no problem for them to *allow* your partner in to a a Major Operation

but it is a problem to *allow* a normal birth. What do they expect?

Maybe you could think about another opinion, how about an Independent MW?

Fiona

June 30, 2000

Hi Fiona

Well I am quite happy with what has been offered to me at this stage. At

the end of the day surely what is best for the baby is the number one

priority here and I feel that some of the comments you have made make us

lose sight of this fact. If continuous EFM might help show up a sign of a

potential problem then so be it. I would rather have this than put my

childs life at risk for my own selfish needs to have no intervention.

Sharon

Re: VBAC Consultants Opinions

June 30, 2000

Hi

I believe the scans/tests that are being offered would be to check the

integrity of the cord and placenta as they can start to deteriorate if you

go very much past your due date.

Sharon

Re: VBAC Consultants Opinions

> they will

> >offer me scans and checks to guage how the baby is doing and a decision

> will

> >be made of that basis

>

> : Remember that scans work on a 20% margin of error, so are no more

> reliable than other methods of sizing the baby in the late stages of

> pregnancy.

>

> ------------------------------------------------------------------------

> Life's too short to send boring email. Let SuperSig come to the rescue.

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>

June 30, 2000

>Hi Fiona

Well I am quite happy with what has been offered to me at this stage. At

the end of the day surely what is best for the baby is the number one

priority here and I feel that some of the comments you have made make us

lose sight of this fact. If continuous EFM might help show up a sign of a

potential problem then so be it. I would rather have this than put my

childs life at risk for my own selfish needs to have no intervention.

Sharon

I don't know if it's my place to step in here but you sound quite angry,

Sharon! If you are happy then that's fine but have you considered two

points:

1. EFM results are notoriously difficult to interpret, eg the study (no refs

to hand but I'm sure someone could quote them) which gave different readouts

to various consultants and found different people came up with different

interpretations and in fact the same people shown the same readouts at

different times varied too! The use of continuous EFM in otherwise

straightforward births tends to increase the likelihood of intervention -

not to say it won't be useful in your case but the benefits are not clearcut

(as with so much in life).

2. A mother who wishes to avoid unnecessary interventions is not usually

being selfish! A completely natural birth with a relaxed and happy mother is

probably the best start for the baby too. Obviously things don't always go

according to plan and sometimes medical intervention is necessary to save

the mother or the baby but there are lots of grey areas in between. And in

these grey areas there is room for negotiation.

Good luck with whatever you decide,

Carr

SAHM to four boys

Sunbury & Shepperton Branch

Trainee ANT & Mem Sec

June 30, 2000

Sharon

I have told myself off for being so heavy handed in my comments but just

wanted to make the empowering point that no one *has to have* anything. You

may decide that cont EFM is the way you want to do it but that is not the

same as saying I *have to have it*. To have a mindset which says " I am

doing this because the Consultant says I have to " may seem like the easy,

responsibility free option but the decision to go along with that, is every

bit as much of a decision as it would be to decline the cont EFM. Hope

YKWIM there- a bit garbled!

I have never had a c - never mind a vbac but from others on the list who

have it seems that often the best chance of it being successful is at a home

birth. It seems to me that a vbac may achieved despite cont EFM but not

because of it.

The question of safety is for me a thread which runs through every aspect of

maternity care and is not something that be pulled out of the scenario and

held up as being more important than any other factor. It is all bound up

together.

Fiona

June 30, 2000

> Well I am quite happy with what has been offered to me at this stage. At

> the end of the day surely what is best for the baby is the number one

> priority here and I feel that some of the comments you have made make us

> lose sight of this fact. If continuous EFM might help show up a sign of a

> potential problem then so be it. I would rather have this than put my

> childs life at risk for my own selfish needs to have no intervention.

I was told I would " have to have continuous EFM " for my vbac and when I

questioned it was simply told I was irresponsible. However, with experienced

midwives who are with you throughout labour then monitoring every 20 mins

with a sonicaid is just as effective and far less restrictive as they can do

this in whatever position you are in (even in a birth pool with a waterproof

sonicaid!). There are also other signs to look out for and a good midwife

would not rely on the EFM trace alone. Many of the practises in hospital are

simply done because that is the routine there regardless of the evidence for

or against. I was totally unhappy with the attitude from my hospital which

is why I now have an independent midwife. I want to avoid *unnecessary*

intervention but in the hospital situation I feel there is a different

agenda to my own so by having an independent midwife I will be able to

totally trust her that if she says transfer / intervention is necessary then

it really is. I believe this is best for both the baby and myself - and I am

happy that I am not putting my baby at risk.

I think Fiona was just suggesting that you consider all options but if you

are happy with the hospital and consultant and feel safer with this type of

care then that is best for you. You have certainly been given a lot more

leeway than I was and I don't think the 'package' you have been told is

standard - it seems a little more enlightened and flexible than others I

have heard of.

Helen

(mum to Emma 8/3/98 and bump due 23/9/00)

June 30, 2000

Helen said:

> I was told I would " have to have continuous EFM " for my vbac and when I

> questioned it was simply told I was irresponsible. However, with

> experienced

> midwives who are with you throughout labour then monitoring every 20 mins

> with a sonicaid is just as effective and far less restrictive as

> they can do

> this in whatever position you are in (even in a birth pool with a

> waterproof

> sonicaid!). There are also other signs to look out for and a good midwife

> would not rely on the EFM trace alone. Many of the practises in

> hospital are

> simply done because that is the routine there regardless of the

> evidence for

> or against.

I agree with this completely, having read a lot around it before my vbac.

The book " Guide to Effective Care in Pregnancy & Childbirth " by Enkin is a

good one to read as it is what the obstetrics guys should read. It is

certainly good to have their own book to quote back at them when they start

to go on about scar rupture and continuous efm. Enkin says that having more

than one section is not a contraindication for a normal birth and these

women should be treated just like anyone else in labour. I had a good

hospital vbac, no continuous monitoring, a longer than expected second stage

and everyone was happy. I also refused more than the 2 scans although my

consultant wanted to scan at 36 weeks as Dan had been big. I knew that

scans are notoriously unreliable for predicting size. He wanted to make a

decision based on this. I said " No thanks " . He looked a bit suprised, then

said " alright then, I'll just feel your tummy instead! " With Dan I had 7

scans, predicting a ginormous baby. He was big, but not over 4kg like they

said he would be. And ultimately, it wasn't his size that meant I had a

section, but his position. I did not put Emma at risk - I read a lot and

wanted to avoid another section for all sorts of reasons, believing that if

possible a vaginal birth would be the least risky option for all of us.

Everything I did was to try and make a vaginal birth more likely.

Good luck to anyone planning a vbac. You need to be assertive and know what

you want (and don't want, even if you think they're on your side! This may

sound paranoid, but I know from experience! But it is possible. It sounds

like Sharon's consultant is being pretty flexible, as many won't consider a

woman for vbac after more than one section, despite what their own books

say! So, GOOD LUCK!

ina

Mum to 24.10.1996 & Emma 15.11.1998

NCT trainee breastfeeding counsellor

ina.@...

June 30, 2000

>Hi Fiona

>

>Well I am quite happy with what has been offered to me at this stage. At

>the end of the day surely what is best for the baby is the number one

>priority here and I feel that some of the comments you have made make us

>lose sight of this fact. If continuous EFM might help show up a sign of a

>potential problem then so be it. I would rather have this than put my

>childs life at risk for my own selfish needs to have no intervention.

>

I don't think that it is a " what is better for mother vs. what is

better for the baby " 'conflict' - the research evidence (in general,

not sure about VBAC) seems to be that continuous EFM does *not* lead

to any better outcome for babies.

There is nothing selfish about wanting no intervention eg we all know

that you have a better chance of breastfeeding if you have less

intervention and we all know that breastmilk is the best. So wanting

as little intervention as possible *is* about wanting the best

possible health for your baby.

Speaking as someone who discharged herself postnatally with a high BP

because I felt it should be got down, not just monitored somewhere I

was unhappy and subject to a lot of emotional blackmail about being

fair to my baby/husband. Came home, BP dropped to safe level out of

bad environment. Nuff said. Community midwives congratulated me on my

decision. (I would of course have gone back if it had not gone down -

but I was scared stiff of being left on my own with my baby in that

room with a rising BP - which was what was on offer)

However, I do appreciate what an uncomfortable situation it is when

you can't just accept everything health professionals say without a

second thought. Some of the angriest Mums are those who find out that

they've had unnecessary things done to them - and they are often

angriest with those who point it out! At least this is all *before*

the event, when you have choices.

--

Vaudin

jennifer@...

" Discontinue use if irritation occurs "

June 30, 2000

Sharon said........ If continuous EFM might help show up a sign of a

potential problem then so be it. I would rather have this than put my

childs life at risk for my own selfish needs to have no intervention.

---------

I don't believe it is selfish to want no intervention...it's pretty clear

that intervention can lead to a cascade of interventions, maybe ending up

with an unnecessary CS or instrument delivery. All these can make it harder

to recover and also interfere with breastfeeding. But that isn't to say all

intervention is bad, sometimes its a lifesaver. It really is about making

informed choices for your own situation, not being told you *have to have*

something. Childbirth is definitely one area where 'One Size Doesn't Fit

All'.

Good luck with your informed choices!!

Lesley Reader

SAHM to four,

Chair and PNDL trainee, Deeside.

June 30, 2000

Sharon said: I would rather have this than put my childs life at risk for my

own selfish needs to have no intervention.

>

: But you and your feelings count here too Sharon. You have probably

made a number of decisons about your baby already - whether to drink during

pregnancy, whether to eat eggs, blue cheese or liver, whether to sit in a

hot bathtub, whether to use an electric sander (!) etc etc. Once the baby

is born, you will continue to make such decisions based on your own good

judgement and experience. There is no need to loose faith in your ability

to make decisions for yourself and your baby just because you are in labour.

Not using EFM will not put your baby in danger. In fact, given your

history, if you opt not to have it you may well get better one-to-one care

from an experienced midwife, which is just what you need if you want a

successful VBAC. Keep pushing them to help you get what you really want.

June 30, 2000

Fiona

I agree with your comments about VBAC at home probably being a beter option

but what seems to have been lost in this thread is that I have had TWO

previous c sections and therefore at a greater risk plus I am over half an

hour from the nearest hospital if my partner was to be here to take me in.

An ambulance would take even longer. My choice is therefore limited by my

situation and location. I therefore feel that I am being offered the best

of a bad situation. I am happy about the EFM because at the end of the day

there might be no proof that it shows up problems but if there are any

chances it will then surely that is a good side to it? Also being offered

mobile EFM is a much better option than I previously thought I had. I see

your point about intevention but at no point has the consultant said

anything is written in stone he has just advised. Surely we only have to

look at the mortality rate of children in todays society compared to even as

recent times as victorian times to show how doctors do help. Where would

all the pre-term babies be without medical intervention? I do understand

that some doctors insist on more control but as many people on this list

have pointed out my consultant has been extremely helpful. I hope this

hasn't caused a " heated debate " I just find it an intersting topic for

discussion and can be very passionate about certain subjects.

Sharon

Re: VBAC Consultants Opinions

> Sharon

>

> I have told myself off for being so heavy handed in my comments but just

> wanted to make the empowering point that no one *has to have* anything.

You

> may decide that cont EFM is the way you want to do it but that is not the

> same as saying I *have to have it*. To have a mindset which says " I am

> doing this because the Consultant says I have to " may seem like the easy,

> responsibility free option but the decision to go along with that, is

every

> bit as much of a decision as it would be to decline the cont EFM. Hope

> YKWIM there- a bit garbled!

>

> I have never had a c - never mind a vbac but from others on the list who

> have it seems that often the best chance of it being successful is at a

home

> birth. It seems to me that a vbac may achieved despite cont EFM but not

> because of it.

>

> The question of safety is for me a thread which runs through every aspect

of

> maternity care and is not something that be pulled out of the scenario and

> held up as being more important than any other factor. It is all bound up

> together.

>

> Fiona

>

> ------------------------------------------------------------------------

> Get Your FREE Online Credit Report!

> http://click./1/5783/10/_/_/_/962360062/

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>

June 30, 2000

Sharon, I am so sorry. You have only been on this list a week. Please don't

feel as though everyone is getting at you about continual foetal monitoring.

They have your best interests at heart, really.

We have quite a few experiences of VBAC here. And we also have some examples of

how interventions, which seem like a good idea before the birth can lead to

other things which are not. This is why we may seem touchy. We are not all

into 'natural' birth and no pain relief, you know (not trying to offend anyone

here). Our experience as a group is wide. There are quite a few people who

have had elective c-sections as well as home water births.

However your consultant does seem to be very positive. He is probably not going

to be there during your labour unless things go wrong. If you find you don't

want to have CFM when you get there you can always refuse it. It will be

midwives who are looking after you.

What I am trying to say, not very eloquently, is if you feel as if you can't

hack all this info - please don't give up on us. Just call time on the

subject. And please, please, please ask any questions you have. You'll get a

mix of opinions, but an awful lot of accurate, research based info as well.

And now is back on the list - pages and pages of it. Welcome back

!

Sue H.

trying desperately to invoke informed choice here and to not offend anyone.

June 30, 2000

Ahaah our posts crossed. If it's heated, passionate discussion you want ,

you've definitely come to the right place.

Sue H.

wary of people unsubbing from the list because they think we are *all* hippy,

sandal wearing, long haired, beaded, middle aged, middle class harridans (that's

just me!)

Sharon Angell wrote:

> I hope this hasn't caused a " heated debate " I just find it an intersting topic

> for

> discussion and can be very passionate about certain subjects.

>

> Sharon

June 30, 2000

Sue described us as not being all:

hippy - not me

sandal wearing - it's summertime and I've been wearing flip-flops every day

long haired - yep, that's me

beaded - no, not advisable with and 11mo

middle aged - getting there

middle class - suppose so

harridans - I'm sure my sons would say yes to this one

Joyce

============

http://clik.to/ourphotos

June 30, 2000

I have been following this thread with interest - not because I have had or am

likely to have a vbac, but because of an experience on the postnatal ward a

couple of weeks ago. I do voluntary work on our postnatal wards and often chat

to the women on general matters as well as about anything they want to discuss

with regard to their births or postnatal care. I saw two women who had just had

their third babies by c. section, both having had prior sections with their

other two babies. I was amazed at the conflicting advice they had been given

prior to their elective sections (something which I am asking our MSLC rep to

raise at the next meeting). One was given the lowdown on all the disadvantages

to having another section, to the extent that she nearly walked out before her

operation. The only reason she decided to proceed was that her two previous

sections had been emergency ones and thus she had not been awake at the birth of

either of her other two children and she didn't want the same for this one. An

elective section meant that she would definitely be awake.

The second woman had been told that, having had two previous sections, she

" would not be allowed " to have a vaginal birth. Clearly the hospital does not

have a definite policy as such conflicting advice is being given to women.

If anyone has any material or references regarding vbacs, could you let me have

it so that I can ensure our MSLC rep is adequately prepared? Many thanks.

Alison