Letter from hospital, why trial of labour isn't supported.

[blackduckies]

I had been planning on having a trial of labour< I was'nt even going as far as talking VBAC just the chance to see if there was any potenial.

My original OB suggested it to me, I just thought I would be straight to CS this time around. I found out in the early 30 weeks that he was leaving and going to the hospital I am currently with, then later found out that he won't have started by my due date, so had to change OB's.
I decided to use who had done my emergency CS last time, the recovery had been good etc.. so the discussion starts with him, he is'nt happy about trial of labour but will let me try knowing i am informed of all the risks, each time I see him we talk more about it. I feel that we are at a point where I am going ahead with caution..then in the mail yesterday arrives a letter from the head of midwifery, short and sweet and definately to the point..basically she says that they have been in discussion and that the Ob, herself and other collegues have discussed my case and the option of trial of labour is too risky..outcomes are very high risk with uterine rupture highly likely and hard to predict..with brain damage to baby or death a likely outcome in that eventuality, and for me loss of uterus etc etc etc, they tell me to "carefully reconsider" (like I really have much of a choice) elective CS, but whatever I decide my OB will assist with the birth.

No contact number just hospital switch, you would think there would be a direct line or something...so now I am left with little choice but to go to elective CS, I can't see much point in even trying..I am left deflated and scared and this is not the way to attempt a trial of labour let alone really thinking VBAC..they are obviously making sure they are covered in the event of worst case scenario, but I think this is way out there.

Guess what though!!! armed with her letter I am going to be asking for home help, because it is EXTREMELY DIFFICULT to look after 3 little ones and a new baby after a CS and get housework done..???and if anything happens on the table DH has a letter from them basically forcing me into doing something I am not happy with ( well I'm sure lawyer might see it that way???) Yesterday I was upset and in tears... today, unable to sleep it has turned into completely pee off!!

What gets me the most is that an OB they have employed would have/even suggeseted to me originally that I could attempt it, so what gives there??? His style must be going to seriously compromised when he starts his new job!!! He comes from a highly reputable hospital known for its high VBAC rates, people are travelling form Melb to deliver there..I went for the OB himself on recommendation , after my previous OB left the area..apparently he had big problems with the hosptial, surprise, surprise!!! He also was no slouch he was picked up as the head of Ob at a large Melb hospital.

Anyway enough of my rant I feel so much better now

[HotI]

Do they write about anything specific to you that would make trial of labour more risky, or are they saying that trial of labour after c section is always risky?

I am really sorry that they are doing this, especially so close to bub arriving (leaving you with little options).

take care

Kate

hugs

[Traveller]

hunny it sounds like they are just covering their own backsides, but will still support your trial of labour. They could have written "elective cs or find another doctor" and they have not so see this as a good thing.

If you have made your mind up about labouring then call up the hospital, tell them you are grateful that they will support you no matter what, but you have decided after careful consideration to go ahead with the trial. That's all they are asking you to do...consider again. That is of course if you are still happy to go ahead with the trial, I don't know your medical situation or why they think your VBAC is so much riskier than the average (which statistically has a 75% chance of success when fully supported). That is something only you can decide.

Good luck hunny, and please don't let them grind you down

xx

[Arimeh]

At the end of the day babe, they can't MAKE you do anything - so stick to your guns if its what you really want.

My midwife said that there is always time to go for the emergency section if it looks like its going to rupture, it doesn't just go BANG rupture - you've lost the baby ya know?

I'd be tempted to give it a try if I were you - you want it yes? Never know what you can achieve unless you get in there and give it a go. Even if you ask for continuous monitoring or something to make you feel more secure - thats an option too. Or keep your mind in tune with your body, my middie said that you will know if you are rupturing because the pain continues after the contraction has finished.

Only you can make the final decision because its your body and your baby. They can advise you of what they think you should be doing - but its still your choice.

[blackduckies]

I really wanted to try, it's jsut they make it so darn hard and wear you down, the last thing needed is this worry hanging over your head when you should be feeling positive. I actually went and seen (her, the director of midwifery today) Indeed it is a precaution, and one needed to be taken in case of the worst scenario, drafted by their legal team, but I just hate the fact that we OB and myself have already talked in length about this and I thought we had an understanding??? But he is backing himself up to the hilt JIC. Just not enough in the way of studies and stats on VBA3C!! (I have laboured each time, I have gotten close, its not that I have jsut decided that i want to VBAC after a heap of CS for the hell of it)
Overdue, emotional and over it all makes me wonder if indeed i am being silly and taking an unessecary risk with this precious baby, when the chances of the CS are high..

[Nelle]

Huge hugs. Who is your birth support? Do you need to think about any last minute ring ins to help you give what you want a red hot go?

I guess sit down with your birth support partners and discuss what you really want. If you really want to give this VBAC a shot, or labour for a while to help bub go through the motions as much as possible, then talk with your birth support partners about how this will work, and if/when/who makes the call about otherwise.

It sounds to me like the hospital are just covering their butts from a legal perspective. It's a shame it's thrown you into doubt though - you should let them know the impact of the letter, that it doesn't help with patient confidence! Surely that's something they could have covered earlier in the pregnancy when you had a clearer head.

[blackduckies]

Thats what I did today...she was apologetic that it was last minute but the OB had only just consulted with her, I guess he thought he would change my mind and then CR*PPED his pants when I did'nt.
Yes you need time to re-group and go through it all again and I am all out of time, at this point I am spending most of my time wondering when labour is going to start, I have lost my plug over the last few days and am struggling to get focused on anything else. I am in the unfortunate position that my lovely midwife's DD is expecting as well, it should'nt have been an issue but I am going overdue and she looks like she is going early, so I don't have that final commitment from her either which I understand completely, "the best laid plans, and all of that, I guess its the way of life"

[Nelle]

So what do you think you will do? Will you trial a labour? How many C-Secs have you had before?

(if your OB did expect you to change your mind at the last minute - argh! Why couldn't he have been upfront? Ah well, might be a good experience for him to do a trial of labour or VBAC )

[Traveller]

It may interest you that recent research published in (I think) the British Journal of Medicine found that VBA3C is as safe and successful as VBA1C, roughly a 75% success rate. I will try and find you the link.

ETA here it is http://www.rcog.org.uk/news/bjog-rel...ior-caesareans

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology has found that women with three or more prior caesareans who attempt vaginal birth have similar rates of success and risk for maternal morbidity as those with one prior caesarean, and similar overall morbidity (adding vaginal births and emergency caesareans together) as those delivered by elective repeat caesarean.

Planned vaginal birth after caesarean (VBAC) refers to any woman who has experienced a prior caesarean birth who intends to try for a vaginal birth rather than to deliver by elective repeat caesarean. Although relatively low complication rates, including uterine rupture, have been demonstrated among women with two prior low-transverse caesareans who attempt vaginal birth, there are very limited data available on outcomes among women with more than two prior caesareans. Neither the American College of Obstetricians and Gynaecologists (ACOG) nor the Royal College of Obstetricians and Gynaecologists (RCOG) currently recommend planned VBAC attempt in women with three or more prior caesarean deliveries1.

In this study, the researchers sought to estimate the rate of success and risk of maternal morbidity in women with three or more prior caesareans who attempt VBAC. The study reviewed multi-centre data from 17 tertiary and community delivery centres in the Northeastern United States from 1996 to 2000. A total of 25,005 women who had a least one prior caesarean delivery were included.

The findings indicate that women with three or more prior caesarean deliveries did not experience a difference in morbidity based on whether they attempted VBAC or elected for a repeat caesarean. The 89 women with three or more prior caesareans who attempted VBAC were as likely to be successful as women with one or two prior caesareans, 79.8% compared to 75.5% and 74.6% respectively. In addition, none of them experienced significant maternal morbidity such as uterine rupture, uterine artery laceration, and bladder or bowel injury.

The authors suggest that, given the findings, precluding VBAC for all women with three or more prior caesareans may not be evidence based. Although there is a measurable maternal morbidity associated with delivery for a woman with a history of three or more prior caesareans, it does not differ significantly by mode of delivery. Risks associated with multiple caesareans are several, including surgical morbidity and abnormal placentation in future pregnancies.

Lead author, Dr. Alison Cahill, from the Department of Obstetrics and Gynaecology at Washington University in St. Louis School of Medicine, said “These data suggest that women with three or more prior caesareans who attempt VBAC have similar rates of success and risk for maternal morbidity as those with one or two prior caesareans, and along with other publications, suggest that perhaps it is time to revisit the current recommendations for VBAC attempts for women with more than one prior caesarean”.

“Many have proposed a ‘conservative’ approach to VBAC attempts, which we agree is prudent. But our evidence does not suggest that a conservative approach, which we interpret as one that aims to reduce morbidity - and specifically the risk of uterine rupture - is necessarily achieved by allowing VBAC attempts only in women with one prior caesarean. Given appropriate patient selection, VBAC following two or even three previous caesareans in certain cases may be reasonably safe.”

Prof. Philip Steer, BJOG editor-in-chief, said “Although confidence in the findings of the study is limited by the relatively small sample size of women who have had three previous caesareans, these findings provide additional information for women, and contribute to the available evidence on VBAC success and safety in women with more than one prior caesarean.

“As childbirth does not always ‘follow the plan’, the results may also serve as a useful reference for clinicians when a women with three or more prior caesareans presents in spontaneous labour.”

[blackduckies]

Thanks girls originally i went armed with the info you have given Traveller, and he said it seemed I was well informed etc, but he persoanlly had'nt seen the studies cross his desk as well as advice from my Ob who was leaving on how to approach him about it all..I think he is just really worried that if it goes wrong he is the one in the firing line..also I find it confusing, he does'nt want me to do it..but if I do he wants me to keep going we had a discussion about my previous labour and the fact i was stuck at the same spot for 7 hours, he wanted me to continue until the morning..which I refused it was clear to me that this was'nt going anywhere and 2 hours later when the CS was performed i was still stuck.. He is still of the same opinion that I should continue on, even though my previous history shows that it will be a non event if it does'nt happen smoothly from the start.

Nellatron If i go into labour before Tuesday I am going to try, if not I am going to CS..its time to meet my baby..I am so over the fighting an uphill battle, all I really want is my baby. I will be disappointed, but i feel stressed sick and can't sleep, my baby has a damaged kidney and we have a "syndrome" hanging over our head..I need to know she is fine..and whether i deliver vaginally or by CS really makes no differnce now. I have given in to whatever happens, which has made me feel a lot better.. verus trying to control and plan for every little thing.

[Nelle]

I think I understand. Wishing you well however things work out. xo

[Fleur]

I'm sorry that you have had this thrown at you at the last minute hun
Lots of warm calm hugs for you, I'll be thinking of you and wishing you all the best for your little girls arrival.

[AngelPants]

im sorry to hear the hospital and OB are not being supportive, i hope everything goes well and ur lil girl arrives safe and healthy no matter which way it happens.
Clare

[*Infinity*]

I am so so sorry to hear that the hospital & your OB have put you through all this additional stress at such a vulnerable time. To me, it amounts to bullying of the worst kind and no woman should be subjected to that when she clearly has the best interest of her baby in mind.

I truly hope you're able to start labour naturally, and it sounds like you're at peace with your decision about where to from here, I wish you all the best welcoming your little one.

Good luck xx

[ezymay]

Big hugs Pam I know how much you wanted to try. No matter what happens your little princess will be in your arms soon.

[Hannahbanana]

Good luck with everything.

It sucks that the hospital had done this to you at the very end with only days to go...

I do hope you get to go into labour before the scheduled CS and have the opportunity to give it a go...

I wish you a safe delivery however it happens and hope you are holding your baby sooner rather than later

[Dedicated Doula Gillian]

Just saw your thread sweetie - You really are having a tough time - grrr
You got my number if you feel like brain storming a few ideas sms me
Either way you know you have my support 100%...
You know I'd think it would be just amazing if you could have a VBAC, but follow your gut...and do what you feel you're ok with.
Chin up sweetie soon you'll be holding bab's.

[blackduckies]

Thanks so much for the ongoing support..

I probablly sound confused in some ways which is true, there is a big part on me that wants to buck the system..but on the other hand, without that professional support in place it is hard to feel confident enough in myself to go for it.. My family are supportive which helps, DH is being a real rock, and my mum is great I only wish she could be there with me, but I also want to know the kids are in safe hands, which is half the battle won..don't need to be worried if they are okay on top of labour.

I have lost more plug so the chance is still there and if it feels like it is going smoothly I will go for it.

thanks heaps Pam.