VBAC ’rules’

'Rules' may not be the right word but you get what I mean (I hope lol)

I went for my OB appointment at the hospital to discuss my last labour and options for this one. I have been told that after reading over my notes they are happy to let me attempt a VBAC. The OB said there are 3 things that I have to do though which are:
*go to hospital as soon as labour starts or as early as possible (I was wanting to labour at home for as long as poss)
*get a luire(sp?) as soon as we arrive at the hospital (i'm fine with this)
and be constantly monitored wither by the one on my belly or the scalp monitor on bubs. (I was wanting to be able to move around and not be confined to the bed).

Now obviously I will do what has to be done for the safety and health of baby and me but 2 of the big things I wanted to be able to do, I have been told I cant. What is everyone's experiances with this are they leinent or do I just have to get use to the idea of having to do it this way?

He also told me he recommends that I get a epidural cathader as soon as we get there aswell (doesn't have to have epi in it but just the cathader inserted incase it's needed in a hurry) I can see how this makes sense but dont know if it will add to the discomfort of not being able to be active or can ya not feel it when it's in there?
I did all of ds's labour with gas (until on op table when they gave me a spinal) and was wanting to try for that again but sounds like i'm going to have to have quite a bit of intervention/monitoring.

At the end of the day my main priority is the baby and what needs to be done at the time I will do but I was hoping to have a bit more 'freedom' I guess. So any thoughts/experiances would be appreciated as my head is spinning a bit at the mo!

Ok well for a start you don't have to do or not do anything, your body, your baby, your choice. They can suggest, they can give you their ideal of how they would like you to labour but you can say no to it all, you have that right.

I was told pretty much the same three things you were and I told my mw that they could take a running jump. She agreed that it's OTT and advised I stay home as long as possible and I refused to be monitored constantly cos I didn't see the need, I also said no to the epidural, although the OB I saw seemed to think I should just get one the second I turned up, and I wouldn't mind constant monitoring cos you can't move with an epi anyway.
I wanted to go in the water and my mw said that if that was what I wanted then the OB's would just have to deal with me climbing out to check me. I also said no to the IV line being put in ready cos it takes them seconds to do so I don't see the point of getting it put in early when it may never be needed.

So I stayed home for the first 5 hours of my labour, didn't get an epi until I had been in labour for 9 hours, they put the IV in when I had the epi. During the time I was at the hospital I was monitored when I first turned up, which i was happy to do, then I was up walking around, went in the shower, decided I didn't want to go in the birth pool, but mw just monitored me by asking about baby movements and occassionally using a doppler to check his heartbeat. I tried gas for a while and then got the epi, from then on I was monitored constantly.
I saw an OB three times during my whole labour, once when I first turned up and she signed something to say I could have an epi if i wanted, then I met the new one at shift change over, and then saw that lady again when mw called her into to check me out (was having some pains near scar) and we did vontouse then as well as had been pushing for just over 2 hours and was very tired and his shoulder was causing me immense pain.

So the experience I had wasn't anything like they had said, however a lady came in at 27 weeks with triplets and my mw said that everyone was far too busy with that and left me alone far more than they usually would. She had said when I turned up I was suppose to be their "high risk" case of the night cos of being a VBAC. So I guess for me I was lucky to get left alone as things may have been different if the OB's hadn't of been so busy and had been in with me more.

Oh, they are definitely "rules"! But I think they are OTT too.

*go to hospital as soon as labour starts or as early as possible (I was wanting to labour at home for as long as poss)

I was advised to go to hospital asap with my VBAC baby so there could be thorough monitoring. As it turned out, baby was facing the wrong way so my early labour went on for about a day. My LMC met us at the hospital, did a CTG, and sent us out for a long walk. I had another CTG and went home until the middle of that night, when I was ready to be at the hospital. My labour didn't properly establish until a few hours later when I had artificial rupture.

My advice is to do all the early labour stuff at home. Keep your LMC advised, she can even visit you at home and do the doppler on the baby if she wants to check how you're doing. It probably won't be counted as labour until you're at the stage of wanting to be at the hospital anyway.

*get a luire(sp?) as soon as we arrive at the hospital (i'm fine with this)

This is the IV line, I assume? I've had this for all my post-c/s births. I think I'll actually decline next time because I find it a small nuisance. But it's not a big deal. It is kinda helpful for them because they can take blood samples and put in antibiotics (if needed) and everything else. And if they put it in a good place, like the back of your hand, it won't get in your way. They will keep it in until your have urinated without probs post-birth.

*and be constantly monitored wither by the one on my belly or the scalp monitor on bubs. (I was wanting to be able to move around and not be confined to the bed).

Constant monitoring seems to be interpreted differently by different mw's. With my VBAC I wanted an epidural (don't do it!!!) and that requires the constant CTG monitoring as well, so I consented. They didn't suggest the scalp monitor and it would have been totally unnecessary. With the next birth, my mw had me strapped to the machine but standing up next to the bed (I wanted to be in standing position). Birth #4 I don't remember having the CTG at all - maybe at the start. The mw put the doppler on the baby's heartbeat at regular intervals while I laboured. I was off the bed for that one too. Birth #5 I had hospital mw's and they were very keen to keep the CTG on both my contractions and the baby. Just before I went into "established labour" (so I was already having contractions but okay ones) I went for a toilet stop and only got the baby CTG on after that. I wouldn't have let them put the top strap (contractions one) back on unless there was a concern, coz it is particularly uncomfy in labour!

I was happy to labour on the bed with baby #5 but the mw's told me that if I wanted to go in the shower that was okay, because they had a mobile thing they could run around after me with, something like the CTG but I don't know what it was called.

I would NOT have the scalp monitor unless absolutely necessary. If your labour is ticking along nicely, doppler can pick up heart beat and there's no sign of baby distress, there's no reason to have it. All it will do is get in the way of your legs and you'll be distracted, thinking that you'll hurt the baby. Talk to your mw about doppler or CTG monitoring of baby only.

Hope that wasn't too waffly. I've had a few post-c/s births LOL!

You've definitely given me some good questions to ask the OB when I next see her in a few weeks. If I had to have constant monitoring stuck to the bed with an epidural I would probably choose an elective instead.

I had all of those 'rules' mentioned above pushed onto me with DD's birth and know they didn't help at all. I could feel things going downhill when they went bad so would have consented then, but not before if I thought I had a choice

You don't have to do anything you don't want to do.

I chose to have my vba2cs at home so I could avoid all that intervention.... It is for the most part un-necessary. You can be monitored while you move around (have had that twice now!) and the longer you can hold off before going to hospital the more likely you are to avoid a cascade of intervention that you don't want

Oh and I didnt have an epi catheter in....

Interesting thread. I'm off to see 2 MW's this week and both of them outlined what they 'normally' do for a VBAC but they both talked in terms of 'what we like' but seemed very open to me making my own decisions about things. They told me to labour at home for as long as I could, when I'd go into hospital they'd probably put a lure in (absolutely no mention of epi catheter), they'd do lots of monitoring but I could still be in a pool or whatever position I wanted provided bubs seemed happy. One even said that whilst she wouldn't recommend it if I really wanted a home birth she'd try to make it happen. I wonder if that is the difference between a MW VBAC and an Ob VBAC?

gosh you guys are lucky.. they wouldnt put mine in for hours cause 'you are only in the beginning even though i have a history of going fast' so got almost no pain relief..in fact the whole thing was awful:( though got a healthy baby in the end so that's all that matters!! I do sortof wish I'd tried for a VBAC..but they never said I had to follow any of those rules though...

So... the 'rules' you've been told will be hospital protocol, which the hospital use as guidelines to abide by.

Cuppatea is absolutely right - nobody will stop you doing what you want, even walking right out of the hospital.

My experience: I'm studying childbirth education and have been privileged with a more than helpful midwife, and a huge range of info. I fought tooth & nail to get my VBAC and the MW was right there with me.

CCDHB say go to hospital when your contractions are 10 mins apart (bu gger that!), get a lure, be monitored. I chose to be monitored with the wireless monitors, delayed the lure until the last possible moment (at which point the registrar was getting well shirty with my MW hehe!!) and I went into hospital when I was actually scheduled to go in for an 'elective' caesarean.

With daylight my contractions slowed down (as they do, natural response) and my labour progressed to 4cm dilation. It was a total Godsend that I was monitored as the heartrate was totally unreassuring during contractions, then it had some massive dips and long story cut short, if I'd continued to try labour then I could've been delivering a dead baby due to a complication with the umbilical cord insertion that hadn't been picked up in scans.

So I don't mean to alarm anyone, but I'd recommend even having intermittent monitoring just to check the baby's doing fine particularly during contractions, but the hospitals err WELL on the side of caution which is partly why the c/s rate is so incredibly high in NZ.

Anyway that's my experience FWIW - many friends have had VBACs with no complications whatsoever and chosen to have no monitoring: every woman, pregnancy, birth and baby are different so just follow your gut. Womens' intuition is totally underrated, esp by hospital folk!

i had one, antenatal teachers are your bestcbet :)