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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.
Yeah they say to come in as soon as labour starts for monitoring
but i went in when cx were 1.30 apart and turned out i was 3cm!
also i didnt want to be stuck on the bed so agreed to 30 mins of monitoring and then intermittent monitoring of 10 mins every 30 mins- well that didnt happen as i was in the shower for most of my second stage- it was more like a 30 second monitor every 30 mins!
so they were happy in the end to just come at me every now and then with a portable monitor just to check bubs h/beat and then leave me alone
mind you they came at me with a scalp electrode and wanted to break my waters- NO thanks! You just gotta make sure that your care provider stands by you!
HTH
odette
Im getting more and more scared each day.
How do I know the signs of uterine rupture?? :(
It's ok Dan... like I always say, I have been scared before each of my births. I know I have no rupture to fear, but I just want to let you know fear is normal... don't let it control you or the birth of your son... you were made for this and you are going to be fantastic. I can only imagine how you are going to feel when you are handed you little boy after finally experiencing what it is like to bring him into the world with you in complete control!!
Ok... signs of rupture
And remember it is VERY rare!!
Flowerchild- I have no idea what a bulky uterus. When I had my last mw appointment, she said I seemed further along that I am, and that I might just have a bulky uterus. The measurements at my 20wk scan were in proportion with a 20wk gestation pregnancy.
Det- I was hooked up to a ctg when I went into labour with the boys. The only time I wasnt strapped to one was when I was either in the Air Ambulance or the normal Ambulance. They hooked me up again when I got to Melbourne, and took it off again to take me to theatre.
Im hoping that if I present some info on vbac at my next mw appointment, they might start to listen to me.
Dan, love to you honey.... :hug:
Fear can be a tool to work with my love. So accept this tool and go to it! Your risk of uterine rupture is smaller than your risk of shoulder dystocia. Try not to focus on what may go wrong but what will go right. If we always think what may be we never do what is!
It sounds like you have a competent midwife - offload some of this fear on to her. Listen to your body. Take some time to just sit and be alone with your body and your baby. Do this - don't just read the words but do it. Our wisdom that comes from within is inate. Listen to it. Trust it.
Your body was built for birthing this baby - you will do it along with the strength and knowledge of all that have gone before you!
Sending you love and strength .... :hug:
I didn't get to hossy till I was 7cm with my VBA2C. My contractions were all over the place and I'd had irritable uterus problems so I was convinced I was not in labour even though It was my due date.....so that old saying "you'll know if it is really labour" was not what I experienced. I was still not having regular contractions when I left for the hospital but their intensity let me know I had to go.
I'll be going straight in this time because my labour was so erratic and relatively quick with Quinn. I'm not going to risk having the baby at home.
I am going to have to agree to a 6 hour labour limit to keep the ob happy, but I got into the caseload prog with 2 prior CS so I am still happy. My MW said that labour is considered to have begun once contractions are regular, and I am 4 cm, so I guess that allows me to be very lateral in my interpretation re when I am in labour. So why a hospital at all, because DH is scared, but my MW is sooo lovely, I am sure it will be ok!! Anyway, it is a woman's perogative to change her mind isn't it, just because I agree to a time limit doesn't mean I can't say no????!!!!! If all vital signs for me a bub are fine why should a time limit matter? THe ob said something about the tissue around the scar becoming oedemetus (spelling??) which increases the likelihood of tearing at the edges of the scar if a CS is done, all the more reason not to easily consent I say!!
GardeningKate, which hospital are you going to?
do all hospitals have that policy? cause i m hopingfor a VBAC
I got none of these instructions :dunno: I went to hospital when the contractions were intense and regular (2cm at the time) and delivered vaginally 2.5hrs later :dance: I had remote CTG monitoring so I could still walk around and an epidural was put in 15 minutes before she was born so it hadn't even kicked in (thankfully!!) Not all facilities have the same criteria for VBAC.
I am going to the Sunshine hospital, I am very happy with them (even the ob was reasonable, he did suggest strongly that I should have a CS, but was happy to concede that the research I had done was valid, that other countries do trial o labour even with multiple prior CS without much ado) I think the time limits and conditions on it are to minimise their potential risk of litigation, research shows that while the risk of uterine rupture hardly changes from one to many CS the risk of hysterectomy does increase, however it is still very low, but I guess that would attract a very large payout, so while in terms of medical outcome the risk is small, in terms of punitive damages it is very high. I am becoming very cynical, but Sunshine have been the most supportive, even to consider letting me have a midwife!! Most hospitals have a no trial of labour policy, but ultimately they can't do a CS without your consent! And public hospitals cannot refuse to treat someone for not consenting to an invasive medical procedure, but it is nice to have a bit of support, rather than be emotionally bullied,
OMG... this all sounds very distressing.
i am an aussie in the uk, had my first baby here in a nightmare hospital that has the highest rates of MRSA in the country, and a labour ward that is KNOWN for its closing when its full. you then have to drive to another hospital which is DISGUSTING.
so my waters broke and no labour for 2 days. we tried to get it going so i could get into the birthing centre, but by the 48 hour mark i was only 3 cm. they sent me to hospital. i should have GONE HOME!! the first midwife the saw me stood there with a bag of synto and said 'hi, my name is blah blah, were going to give you this to get you going'. my mum nearly ate her alive and asked to see a manager. here in the uk its more scary than aus by the sounds of things, if you say no to them, they say you are refusing thier care and threaten not to care for you at all. BULLIES.
anyways, i ended up an UNECESSARY emergency CS and suffered post traumatic stress. this time, i was petrified about having to give birth in the uk. we were planning to migrate but were waiting for visas (my partner is jamaican)
i chose a different hospital and then i got referred to midwife/specialist team who advocate for VBAC. the consultant told me that even though it was hospital policy to be monitored you didn't have to be tied down and stay in bed. she was the first person i felt was educated and informed and then practised using the up to date evidence and research. she gave me confidence. she also told me that in MOST cases where they THINK the scar is rupturing, they have CSed and found NO SCAR RUPTURE!!!
Mabella, don't be scared. read and find out as much info as you can. if you google 'optimal positions for birthing' you can find heaps of websites that help you with labour, different positions and how they can help you overcome problems such as baby not in right position.... pain.... uneven dialation... so you don't have to be another CS. fear is disempowering
i have started yoga, so get my muslces and body ready. we got our visas and are flying out in april. i will be 33 weeks!!! and have to relocate to a country, that i don't know, even though i am an aussie, i only know the birthing system here. :o
i swing from being 'ok, i can do this!!' to 'OMG, i just want to crawl in a hole and hide'. which is why i have joined bellybelly, to get support and courage from other women.
i am sad that the midwives are this way in aus to. i don't understand how there is such a wealth of knowledge and reserach amongst us everyday women, and the people who are trained in this feild seem to be so uneducated and uninformed!! is it purly political??:protest:
oh, and the UK is more POLICY happy than aus, they have policies on EVERYTHING. but policies are ONLY guidelines, they are there to cover thier backs, they are not supposed to be the only way.
my two year old is being naughty cause i am not giving him any attention.... so i am off.:vbac:
Hi ladies,
I am planning a VBAC for this bub after a non labouring emerg c-section with DS.
I am going to our public hospital (WCH in Adel) with my private OB who delivered DS. The hospt is over an hours drive away (!) and my OB did say I needed to come in as soon as labour started and I am happy with that.
She also wants remote monitoring for 50% of the time, happy with that. I asked her the other day if she had any time limits for VBAC labour and she said as this is my first labour she thought I might take as long as 24 hours! Happy with that too.
Isnt it frustrating that we get such different responses?
Rachel
Rachel- I was leant a book called 'Silent Knife'. Belly Belly actually sell it on here. If u can get a hold of a copy, then read it. It is such a good book. I have photocopied heaps of stuff out of it to take to the OB in a few weeks, and Im hoping they might listen to me.
Bidg, I have heard of Silent Knife but even the name makes me cringe. I am not anti c-section as it saved my DS. I just want to birth naturally this time as hopefully there wort be any probs with this little one.
Is the book positive or does it take the "all OB's are inherently bad and are trying to trick you into a c=section so they can get back to golf" line??
I would love to hear more about it, do you have the "Pink Kit"?
Rachel
Rachel- My c/s saved all three of us too, but that pregnancy and labour was totally different to this one. The book isnt against OB's, it really just tells u the medical facts like there is no reason to go into hospital asap unless there is meconium on the liquor and stuff like that. It also has heaps of VBAC stories in there.
The info I have been given by my Ob:
-Hospital asap as labour starts.
-Time limit for labour.
-Bung/canular in arm as soon as I arrive.
-Epidural when labour progresses.
-Continuous monitoring (possibly ctg).
-Internals every couple of hours.
One of the statements in the book I agreed with is:
"All drugs or medical procedures have risks. Medical intervention should, therefore, never be done unless the risk of intervention is less than the risk of the medical problem itself without intervention."
I also googled the book, and even thougnh it was written in the early 80's, the book is still as relevant today as it was back then.
Ok, so I went to the OB last week. She said they advise u to come in as soon as labour starts, but ultimately its up to me when I come in. They will do monitoring by ctg, but I can still move around and go in the shower and things like that. She also said that they wont put a time limit on laour, like she first told me. She said I could also birth in the position I wanted, unless things went wrong, and I would have to get on my back. I have done heaps and heaps of research, and I told her that. She was quite impressed.
Bridg, thats great about no time limit on your labor, I think the stress of watching the clock would unravel me.
Rommy's Mummy- I was worried about having a time limit too, because I know that it would hault things.