Hossy as soon a labour starts for VBAC? Why?

Ok, I think my local hospital has a policy that it prefers all VBAC clients to come to hospital as soon as labour begins.

What, if any, benefits are there of this? Is it just a monitoring thing? Surely this mode of practice sees a lower sucess rate for VBAC?

Thanx
Tanya

Yes Tanya for monitoring. As you know the risk of uterine rupture is about 1% . VBAC is seen as high risk and all high risk patients are monitored more closely.

As for the monitoring being to the detriment of VBAC there is strong evidence to support just that.

Probably because they will confine you to bed and want you to be monitored the whole time :rolleyes:
Rish of uterine rupture, distress to baby, blah blah blah makes them so adamant that you need monitoring and an early epidural in case a C/S is needed later on... So easy for them to forget that all these things hinder the progress of labour.

If they say they 'prefer', but it is not mandatory, then I wouldn't go. I would want to labour at home for as long as possible because I would be risk factor extraordinaire once I got there. :rolleyes:

Sorry Tan, hopefuly someone else can help you with better info.

Thanx girls... I am preparing for a possible client who is maybe going to try for a VBAC...

She wants to labour at home but everytime she goes to the mws and the Obs they tell her she needs to come in as soon as labour begins. So frustrating!

Yep a few reasons - they want continuous monitoring - and they also want to know how long the woman has been labouring for. VBAC's often have time limits imposed - If she's been at home they have no reference point for the start of labour and have no clue how long it's been unless the woman chooses to tell them.

There is no evidence that either of these practices improve outcomes for these women or their babies, and they DO increase the level of intervention they experience in their labours - which in turn reduces the chances their vbac will be successful.

Alot of women having a vbac already have that little seed of fear in the back of their minds about rupture - this is particularly true of those who go to hospital or use OB's because they perceive that provides some protection against a rupture, despite knowing that both of these choices decrease their chances of a successful vbac. Unfortunately there are caregivers who aren't above exploiting this fear and it's not hard at all to convince a woman who is already a bit nervous about it to come into hospital at the first twinge because it is "safer" or it's necessary.

Also no one can force her to go in before she's ready. The decision as to when she goes into hospital is ultimately her own and the hospital also knows that. She can either be up front and tell them "Thanks I'm taking what you're recommending into consideration but I'll make my own decision on that when the time comes"....or she can nod and smile and do what she wants to on the day.

I don't think this is worth arguing with them over because on the day ultimately she will follow her gut and go in when she thinks she's ready - whether that be the beginning, middle or the end. And what the hospital have had to say about it beforehand probably won't factor into it much.

Thats the opposite of what my MW told me!

She told me that I will be staying at home as long as possible and just talk to her on the phone and let her know how Im going?

Thanx,
Tobi, it's so frustrating when, as a doula, you are trying to present best evidence practices and the Obs and MWs are telling the woman something completely different!!

I think as lonk as you or your support ppl know the symptoms of rupture I can see no reason to rush off to hossy asap! it's insane! You have a great mw Dan... make the most of it :)

Thanks hun...but it actually worries me.

Because I haven't laboured before... I'm worried as I have no idea what I'm doing or what will be happening. I actually think I would rather be in the hospital JIC and for the support. Although, I certainly don't wanna get there early if they are gunna rush me r push me for a c/s

Have you got a Doula or someone who can support you at home?
Last thing you want is to get to hossy and for things to stop. Just a change of enviroment can cause it. Good luck :)

Yes I have heard that things can stop at Hossy.

No I don't have a doula. But i do have a midwife who will be with me throughout

What if the woman has a 'Bulky Uterus'?? Will that help her staying at home longer?

What exactly is a 'bulky uterus'?? What are the symptoms?

Don't tell me they are using scare tactics??!!
My DD#1's aunty was told she can't birth vag because she has a tilted uterus!! :rolleyes:

Tanya- No symptoms for a bulky uterus. I was told at my last mw appointment that I may have one from having the twins, because I was measuring a few weeks further along that what I am. I was also told I had a tilted uterus. I have no idea as I have never had the chance to inspect it.

Hmmm... sounds like speculative talk to me... I think a real 'bulky uterus' needs u/s for diagnosis. From what I can find is caused by fibroids or endo... Not to say you haven't but sounds a bit weird..

I have a tilted uterus... it was diagnosed (can only be done so very early in pg or not pregnant) via u/s before I was pg with Bonnie.

:)

I laboured for 5 hours at home before we decided (with Kelly on the phone) that it was time to head into the hospital. No-on said anything. However I was told by the hospital to come in as soon as anything happened. By the time I arrived my waters had been broken for 8 hours. Umm maaaah!

Sarah H- Tut Tut. Naughty Naughty. I was doing a bit of research tonight, and found that u dont need to go into hospital straightaway, as long as u are aware of the signs of uterine rupture.

Bridg - what are you describing as a "bulky uterus"???? Subsequent pregnancies almost always present a more roomy uterus - a very usual occurance in multi's.

Simply women are asked to present to hospy because of the 1% or up to 10% risk of uterine rupture with a previous c/s.

If you have fibroids or other issues that is secondary and is not simply a vbac issue.

I think it needs to be said that nothing really precedes a uterine rupture except localised intolerable pain. This can happen. It does happen but it is rare. Midwives thankfully will go thru their whole career and not see a uterine rupture.

It is a consideration, but just like we consider before we cross the highway what our moves will be. We need to do this with vbac.

Again, good support (with you Tanya she has that) and advocacy is necessary. We all know that being strapped to a ctg is not conducive to active birth - an important ingredient for vbac.