Going for VBAC - What do I need to know and what do I need to put into my Birth plan?

[JennaJayen]

Hi everyone.

I was induced at 41+3 with my DS and after a long labour, getting fully dilated and pushing for hours and hours only to find that my DSs head was stuck against to bottom part of my pelvic bone after 2 unsuccessful vacuum extraction attempts I had to have an emergency c-section at 41+5 (I was then diagnosed with cephalo pelvic disproportion as I'd done trial of labour and my OB measured my pelvis after she got my son out)...

Anyway, it was back labour, and I had an epidural as well (which slipped by 3-4mm the night before DS was born so I went for about 6 hours with sever pain going across half of my body and the - oxytocin/cyntocin? whatever it was called - drip was turned up a little bit too high by accident as well) which I have since read can reduce the distance the pelvis can stretch to by quite a bit, so that may have contributed to the problems.

Anyway, I'm getting off topic.

My main concern is that I am terrified of having to be induced again, and terrified of having to have another c-section - as the birth of my DS was rather traumatic and affected me for a long time afterwards and I missed out on being able to give him his first feed on the breast because I was taccychardic in recovery so the nursery staff just gave him a bottle of formula instead, which I think contributed to making it impossible for him to attach for the first 6 weeks of life (he finally attached at 6wks old right when my supply dried up after a bad bout of mastitis).

So, I'd like to know what I need to know about going for and having a successful VBAC, and what I need to put into my birth plan to make sure that I get WHAT I WANT, as I didn't have birth plan with DS (it wasn't commonly used at the hospy I was at and as the midwives changed shifts regularly it made it almost impossible to make sure that all midwives knew everything that every woman wanted).

The midwives I am seeing through shared care will be talking me through the basics of my birth plan when I get closer to 30wks, and they are very supportive of me having a VBAC, but we haven't had the chance to discuss anything about it yet other than that I want one.

Sorry for this being so long and for going off topic a lot, but any help and advice would be greatly appreciated.

[NaeNae]

I personally would put in what you hope to have happen, BUT you also need to remain flexible. They induce a different way for VBACers any way so I would find out as much as possible about the different types of induction methods the hossy uses for people who are having a VBAC.

I don't think there is much you can plan for aside from getting your knowledge up to speed about your hossy policies and interventions during a VBAC labour. Have written what you HOPE will happen and make sure your care givers and partner knows your wish list through but at the end of the day you may need to be a little flexible.

I was always scared about the Uterine rupture but when it came down to crunch time it was really the furthest thing from my mind.

I always worry a bit about posts like this, not to knock you in any way hun, but if you try to plan for the perfect birth and have all these things set in your mind ... what happens IF things don't go to plan? I would hate for ANYONE who has has a disappointing first experience to put so much pressure on themselves second time around that IF things go pear shaped again you get all disappointed again ... that I think would be far worse.



Nae x

[JennaJayen]

Thanks NaeNae.

I'm not worried about uterine rupture - hasn't actually crossed my mind at all this pregnancy, I may just be in denial but it really isn't an issue for me, at least mentally/emotionally.

I just have a general fear of being cut open and of being put under - it was horrible with the emergency c-section, even though I had the epidural, and even though all the surgical team and the anaesthetist tried to make it into a good experience for me, I was taccychardic the whole time, and when I was told I could hold my DS I didn't have any stength left and could hardly move my arms let alone wrap one around him and hold him.

And I didn't enjoy being induced, even though it was done at my request, before the drip was put in I'd just had the gel and pessary/string thing which had started some contractions but after 12 hours they weren't regular and I had only reached 1cm of dilation so they told me I needed the drip, and when that was put in it was put up too high so I wasn't getting much of a break in between contractions. And then the epidural slipped, and I didn't get any sleep that night and had the midwife on night shift told me "shut up, you've got the epidural, be quiet and let the new mums sleep".
I don't deal well with pain too well either, so that almost put me off having another baby.
I scared of it happening again this time as well, and as I'll be at a different hospital it's all new again and I won't know their proceedures etc until I do the tour around 30wks.

Makes everything a bit difficult when I want to know everything I need to know now while I still have some working brain cells lol

[meow]

Regardless of hospital policies you have a right to decline interventions. Minimising intervantions increases your chances of a vaginal birth, VBAC or not. Unfortunately VBACs often seem to include routine intervantions such as continuous monitoring, which will increase your chance of a c-sect. I'd find out what the hospital usually requires, research those and state what you do not consent to in your birth plan.

Some points from my birth plan that you may find relevent are:

I do NOT consent to vaginal exams.

I do NOT consent to artificial rupture of membranes.

I do NOT consent to an episiotomy.

I would like to discuss all interventions in private with my support team before making a decision.

I wish to have a physiological third stage and do NOT consent to the use oxytocics unless life is at stake.

I wish to delay the clamping of the cord until it ceases pulsating and I wish to cut the cord myself.

I do NOT consent to the use of formula. If baby needs feeding my milk is to be expressed, even if unconscious.

Written consent must be obtained from us before ANY procedures are carried out on baby.

My partner and midwife are to accompany me into surgery and recovery.

I wish to have a spinal block, as opposed to a general anaesthetic.

Baby is to placed skin to skin on my chest immediately after birth, while still in theatre, and we are not to be separated unless life is at stake.

I wish to establish breastfeeding while in recovery.

If baby needs to be taken to special care then baby’s father is to remain with baby at all times.

[Yeddi]

The big thing isn't so much what to put into your birth plan specifically but understanding WHY you are putting it into your birth plan in the first place. If you don't know the why, then you wont know when you need to compromise and when you don't - because being a VBAC you will have to FIGHT to not be interfered with. Knowing why is also important when you are finding it hard to stick to your guns about certain things when the labour becomes hard and following the crowd or having certain pain relief you've said no to begins to look appealing. I have my Birth plan for a VBAC in the birth plan examples thread if you want to have a look. There were a few things that in the end didn't happen according to my plan as I chose to do otherwise during the labour i.e. I didn't want an actively managed third stage at all, however after 36 hours I knew my chances of PPH had increased significantly so after comparing the risks vs benefits I allowed the injection after the cord had stopped pulsating (which took about 3 minutes). It was the right call, as I did haemorrhage and was just shy of needing a blood transfusion. I also had a posterior labour, so after 12 hours allowed a vaginal exam so that I could gage what I needed to do next. I went for another 20 hours of one minute contractions every three and a half minutes apart with only water injections and the shower for pain relief, having two more vaginal exams before I reached 4cm (very slow painful labour) but that was my magic number to get an epidural (another thing I wasn't going to do) because I knew that in some cases the epidural helps facilitate posterior birth rather than impede it. Again the right call, because within two hours I was fully dilated and pushing (my hospital had a self-administered epi, so I was able to stop dosing once I'd reached 9cm so I could feel what I was doing when it was time to push). But as you can see, you need to know WHY you put something in your plan, and WHY you would change it.

[Beach Mama]

Totally agree with Yeddi! I would be doing your research, looking at what is important to you when birthing and then writing your plan closer to your birth. There are many fights you may have to have along the way and being ready for those and where you stand are more important.

A few things that I had to deal with along the way (for my vbac attempt!)
They wanted to book me in at 9 days overdue for a c/s.... I pushed and pushed and argued and with monitoring got them to stretch to 14 days. That was the time that both DH and I were comfortable going to. What is your limit? They will push you on this and it's good to know where your limit is and there is no reason you HAVE to book in earlier than 42 weeks if all is looking well. I also told them at one point to go ahead and book the c.s for 9 days overdue but I wouldn't be there. (Was then told my babies life was at risk at which point I said SHOW ME THE STUDY and walked out)

My hospital wanted to use internal monitoring of baby so I could be active. Catch 22 on one hand they were saying, here be active - it's better for VBAC but on the other wanted to screw some metal into my babies head to which I said hell no. I said I didn't want continuous monitoring, that I was happy to have semi- continuous monitoring depending on what I was doing during labour - if I was sitting on a ball - go ahead and monitor but if I wanted to hop in the bath or shower I was going regardless of what they wanted to do. They weren't super happy but I basically said too bad.

I told them that I would not have lots of VE's and I would tell them when I would be having them. My birth with DD was horrible and I had 12+ ve's that I could count , Im sure I missed some and wasn't going through that again. They were supportive and it was a case of we will see what happens on the day.

My hospital don't induce vbac'ers other than AROM but bubs head has to be fully engaged and for me he never was. Check what their policy on induction is, then research induction in vbacs to see what you are comfortable doing as there are increased risks depending on what they do.

Epidurals can hide uterine rupture and can also tie you to the bed, when you will probably want an active labour so consider pain relief carefully.

Ok babbling now - good luck and the main thing is TRUST your body. Know you can do it!!

Read read read. Joyous birth have loads of articles, stories and threads about vbac that were invaluable to me. The i-can site.
The book Silent Knife is a must read, the VBAC companion is great - might be tricky to get, I also read Labour of Love - not vbac based but just awesome.

Ask lots of questions along the way! Good luck!